Korean Journal of Community Nutrition

Research Article

[Korean]
Nutritional Status of Intensive Care Unit Patients According to the Referral to the Nutrition Support Team and Compliance with the Recommendations: Yunjin Sohn, Taisun Hyun; Korean J Community Nutr 2022;27(2):121-131. Published online April 30, 2022; DOI: https://doi.org/10.5720/kjcn.2022.27.2.121

Objectives
This study aimed to examine the effectiveness of the intervention of the nutrition support team (NST) on the nutritional status of critically ill patients.
Methods
The medical records of 176 adult patients who were admitted to the intensive care unit and received enteral or parenteral nutrition for more than 7 days were retrospectively analyzed. The patients were classified into the NST and non-NST groups according to whether they were referred to the NST or not. The NST group was further classified into the compliance and non-compliance groups depending on their compliance with the NST recommendations.
Results
The NST referral rate was 56.8%, and the rate of compliance with the NST recommendations was 47.0%. Significantly higher energy and protein were provided to the NST and the compliance groups than to the non-NST and the non-compliance groups. The proportion of patients who reached the target calories after the initiation of enteral nutrition was significantly higher in the NST and the compliance groups than in the non-NST and the non-compliance groups. The serum albumin and hemoglobin levels significantly decreased in every group, but the changes were significantly lower in the compliance group. The nutritional status at discharge from the intensive care unit compared to the status at admission was significantly worse in the NST, non-NST, and non-compliance groups. However, the status was maintained in the compliance group. The length of stay in the intensive care unit was significantly shorter in the compliance group.
Conclusions
Compliance with the NST recommendations was found to provide more calories and protein and prevent the deterioration of the nutritional status of critically ill patients. Therefore, effective communication between medical staff and the NST from the early stages of admission to the intensive care unit is needed to improve referrals to the NST and compliance with the recommendations.

Citations

Citations to this article as recorded by

Impact of Nutritional Status on Pressure Ulcers and Death among Critically Ill Patients
Miyeon Kim, Soyoung Yu, Hye-Ja Park
Journal of Health Informatics and Statistics.2024; 49(4): 305. CrossRef

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Original Articles

[English]
Current Status of Meal Box Service Management for Children from Low-income Families During Summer Vacation: Borham Yoon, Jihyun Yoon, Jae Eun Shim, Sooyoun Kwon; Korean J Community Nutr 2009;14(2):206-215. Published online April 30, 2009

Abstract PDF: The purpose of this study was to investigate the current status of foodservice management in organizations delivering meal boxes for low-income children during summer vacation. A survey was conducted with persons in charge of meal box production and service of these organizations via mail. Out of 114 questionnaires distributed nationwide, 100 were analyzed (87.8% analysis rate). Over half (53%) of the organizations delivered meal boxes consisting of rice and side dishes while the rest delivered side dishes only. About 81% of the organizations received KRW 3,000 per meal from their local governments and the rest received KRW 3,500. Only 28% of organizations had employed a dietitian. Over one-third (38%) of the respondents were unaware of the official nutritional standard of the foodservice program for low-income children during vacation. Most of the organizations (94%) had menu planned in advance. The average percentage of food cost was 84.1%. Over 40% of the organizations did not keep food samples for sanitation test (43%) and did not take any measures for keeping food temperature during delivery (45%). The organizations delivering rice and side dishes were more likely to be located in cities rather than rural areas and received higher reimbursement rate. The organizations receiving reimbursement of KRW 3,500 or hiring a dietitian were more likely to use standardized recipes, keep food samples for sanitation test, or take measures for keeping food temperature during delivery compared to the counterparts. Respondents reported that increasing reimbursement rate was the most necessary for improving the quality of meal box. This study results showed that the meal box delivery service for low-income children was not properly managed during the vacation, with regards to menu planning and food production. It is recommended that reimbursement rate for meal boxes should be adjusted depending on meal box types and local conditions.

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[English]
The Outcome of Nutrition Support of Surgery Patients with Hypermetabolic Severity by Total Parenteral Nutrition and Enteral Nutrition and Biochemical Data: Miyong Rha, Eunmi Kim, Young Y Cho, Jeong Meen Seo, Haymie Choi; Korean J Community Nutr 2006;11(2):289-297. Published online April 30, 2006

Abstract PDF: This study evaluated the nutrition intake and changes in laboratory data of surgery patients with hypermetabolic severity on nutrition support. From January 2002 to September 2002, 66 hospitalized surgery patients who had received enteral nutrition (EN, n=19) and total parenteral nutrition (TPN, n=47) for more than 7 days were prospectively and retrospectively recruited. The laboratory data was examined pre-operatively, and on the post-operative 1, 3, 7 day and at the time of discharge. The characteristics of the patients were examined for the hypermetabolic severity, The hypermetabolic scores were determined by high fever (> 38 degrees C), rapid breathing (> 30 breaths/min), rapid pulse rate (> 100 beats/min), leukocytosis (WBC>12,000/microliter), leukocytopenia (WBC<3,000/microliter), status of infection, inflammatory bowel disease, surgery and trauma. The scores for the hypermetabolic status were divided into three groups (mild 0-10, moderate 11-40, severe>41). According to the results of the study, 38.3% (n=23), 45.4% (n=30) and 19.6% (n=13) were in the mild, moderate, and severe groups, respectively. There was a decrease in the serum albumin level and weight loss according to the hypermetabolic severity. However, the white blood cells (WBC), fasting blood sugar (FBS), c-reactive protein (CRP), total bilirubin, GOT, and GPT increased. The nutritional intake was TPN (32.5 kcal/kg, protein 1.2 g/kg, fat 0.25 g/kg), EN (28.1 kcal/kg, protein 1.0 g/kg, fat 1.01 g/kg). The serum albumin, hemoglobin and cholesterol were higher in the EN group than in the TPN group. But the FBS, total bilirubin, GOT and GPT were higher in the TPN group than the EN group. In conclusion, there was a negative correlation between the changes in the laboratory data and the hypermetabolic severity. There was an increase in the number of metabolic complications in the TPN group.

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[English]
Effects of the APACHE III Score, Hypermetabolic Score on the Nutrition Status and Clinical Outcome of the Patients Administered with Total Parenteral Nutrition and Enteral Nutrition: Miyong Rha, Eunmi Kim, Young Y Cho, Jeong Meen Seo, Haymie Choi; Korean J Community Nutr 2006;11(1):124-132. Published online February 28, 2006

Abstract PDF: The aim of this study is to evaluate the clinical outcome. Between January 1, 2002 to September 30, 2002, we prospectively and retrospectively recruited 111 hospitalized patients who received Enteral Nutrition (ENgroup n = 52) and Total Parenteral Nutrition (TPNgroup n = 59) for more than seven days. The factors of clinical outcomes are costs, incidences of in-fection, lengths of hospital stay, and changes in weight. The characteristics of patients were investigated, which included nutritional status, disease severity (APACHE III score) and hypermetabolic severity (hypermetabolic score). Hypermeta-bolic scores were determined by high fever (>38 degrees C), rapid breathing (>30 breaths/min), rapid pulse rate (>100 beats/min), leukocytosis (WBC > 12000 mm3), leukocytopenia (WBC < 3000 mm3), status of infection, inflammatory bowel disease, surgery and trauma. There was a positive correlation between hypermetabolic score and length of hospital stay (ICU), medical cost, weight loss, antibiotics adjusted by age while APACHE III score did not show correlation to clinical outcome. Medical cost was higher by 18.2% in the TPN group than the EN group. In conclusion, there was a strong negative correlation between the clinical outcome (cost, incidence of infection, hospital stay) and hypermetabolic score. Higher metabolic stress caused more malnutrition and complications. For nutritional management of patients with malnutrition, multiple factors, including nutritional assessment, and evaluation of hypermetabolic severity are needed to provide nutritional support for critically ill patients.

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[English]
Evaluation and Categorization of Commercially Prepared Enteral Nutrition Formulas: Dong yeon Kim, Hee Jae Suh; Korean J Community Nutr 1998;3(5):729-738. Published online November 30, 1998

Abstract PDF: In order to investigate the types of enteral nutrition formulas currently used in hospitals and evaluate and categorize the commercially prepared enteral nutrition formulas formulas available in the domestic market, we asked dietitians working in 6 hospitals in Seoul to complete the questionnaire and obtained compositional characteristics of 12 commercially prepared enteral nutrition formulas. The average proportion of patients receiving the commercially prepared enteral nutrition formulas(60.6%) was greater than that of patients receiving the in-hospital preparations(31.9%). In the group of patients receiving the in-hospital prepared formulas, the enteral feeding was mainly administered orally, whereas, in the group of patients receiving the commercially prepared formulas, tube feeding was the primary route of formula administration. In both groups, however, a greater proportion of patients received the formulas as total replacements of their meals and for the purpose of dietary supplementation. On the basis of major criteria for evaluation of the commercially prepared enteral nutrition formulas, the 6 products out of the 9 nutritionally complete products formulated for the purpose of dietary supplementation were grouped into the same category(standard protein, caloric density of 1kcal/ml, and tube/oral), so they were considered therapeutically comparable. However, the remaining 3 products were different in protein content(high protein) or route of administration(tube only). Of the 3 nutritonally complete products formulated specifically for the purpose of dietary therapy, 2 products were formulated for patients with renal disease, and the one product was formulated for diabetic patients. Therefore, the data in this study showed that the commercially prepared enteral nutriton formulas became an important part of the enteral nutrition for hospitalized patients in Korea, but the domestic market has not yet generated a wide variety of the formulas, not providing many choices for clinicians to manage the diets for their patients. The results of this study would be helpful for clinicians in choosing appropriate products for their patients, for manufactures in developing new products, and for regulatory authorities to establish the regulation for the broad group fo heterogeneous products that are marketed and will be developed as medical foods. In addition, the process of maintaining the categories for evaluation of the commercially prepared enteral nutrition formulas should be dynamic because new products may not reasonably fit any of the existing categories.

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