• Clinical Nutrition Research
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• v.11 no.1
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• pp.9-19
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• 2022

This study was conducted to analyze the status of medical food selection process in hospitals within Busan and Gyeongnam area. The survey was distributed to 396 hospitals (general, tertiary and long-term care hospitals) and finally 68 surveys were used for analysis. The questionnaire consisted of 9 general items and 10 items related to enteral nutrition (EN). From the survey we found out that general hospitals and tertiary hospitals normally hire clinical dietitian, while long-term care hospitals hire dietitians with no further qualifications (χ² = 27.918, p < 0.001). A significant relationship was found between hospital size and the priority for choosing medical foods for patients (χ² = 11.852, p < 0.05). In general and tertiary hospitals, medical foods were provided exactly according to the doctor's prescription, whereas in long-term care hospitals, only half followed the doctor's direction and half of them provided the products that has been conventionally used. There was also a significant relationship between hospital size and the method for determination of nutrition requirements (χ² = 20.496, p < 0.001). Finally, the priority of considerations when developing a 'medical food guidelines' was shown in the following order; 1) the type of medical food that can be selected according to the disease state, 2) the nutrient content and comparison table for commercial products, and 3) how to manage complications that may occur when supplying medical food for patients. Developing an EN practice guideline for making a sensible selection of medical foods will provide a valuable information for better patient care.

• Clinical Nutrition Research
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• v.11 no.1
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• pp.50-61
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• 2022

Resting metabolic rate (RMR) accounts for most daily energy expenditure. The low carbohydrate diet (LCD) attenuates decreases in RMR. This study aims to investigate the relationship between an LCD and RMR status among overweight and obese women. We enrolled 291 overweight and obese women in this cross-sectional study. Body mass index (BMI), fat mass, fat-free mass, visceral fat, and insulin level were assessed. RMR was measured using indirect calorimetry. LCD score (LCDS) was measured using a validated semi-quantitative food frequency questionnaire. Analysis of variance, independent sample t-test, and Multinomial logistic regression tests were used. Results showed no relationship between LCDS and deviation of normal RMR (DNR) even after adjust for confounders (increased [Inc.] RMR: odds ratio [OR], 0.97; 95% confidence interval [CI], 0.92-1.01; p = 0.20; decreased [Dec.] RMR: OR, 0.97; 95% CI, 0.94-1.00; p = 0.14). Some components of LCDS had no significant association with DNR, such as carbohydrate and Dec. RMR in adjusted model (OR, 1.62; 95% CI, 0.98-1.37; p = 0.08) and monounsaturated fatty acids and Dec. RMR in adjusted model (OR, 0.48; 95% CI, 0.21-1.10, p = 0.08). However, refined grains had a significant association with Inc. RMR in crude model (OR, 0.87; 95% CI, 0.77-0.99, p = 0.04). There is no association between LCDS and RMR status.

• Clinical Nutrition Research
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• v.11 no.3
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• pp.153-158
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• 2022

Critically ill trauma patients generally show good nutritional status upon initial hospitalization. However, they have a high risk of malnutrition due to hyper-metabolism during the acute phase. Hence, suitable nutritional support is essential for the optimal recovery of these patients; therefore, outcomes such as preservation of fat-free mass, maintenance of immune functions, reduction in infectious complications, and prevention of malnutrition can be expected. In this report, we present the experience of a patient subjected to 40 days of nutritional interventions during postoperative intensive care unit (ICU) care. Although the patient was no malnutrition at ICU admission, enteral nutrition (EN) was delayed for > 2 weeks because of several postoperative complications. Subsequently, while receiving parenteral nutrition (PN), the patient displayed persistent hypertriglyceridemia. As a result, his prescription of PN were converted to lipid-free PN. On postoperative day (POD) #19, the patient underwent jejunostomy and started standard EN. A week later, the patient was switched to a high-protein, immune-modulating formula for postoperative wound recovery. Thereafter, PN was stopped, while EN was increased. In addition, because of defecation issues, a fiber-containing formula was administered with previous formula alternately. Despite continuous nutritional intervention, the patient experienced a significant weight loss and muscle mass depletion and was diagnosed with severe malnutrition upon discharge from the ICU. To conclude, this case report highlights the importance of nutrition interventions in critically ill trauma patients with an increased risk of malnutrition, indicating the need to promptly secure an appropriate route of feeding access for active nutritional support of patients in the ICU.

• Clinical Nutrition Research
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• v.11 no.3
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• pp.171-182
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• 2022

As a result of a nutrition transition, chronic diseases, including diabetes, have increased in Iran. Nutrition education is a cost-effective method for modifying diet and controlling diabetes. This study aimed to examine the effect of nutrition education using MyPlate recommendations on glycemic and lipid profiles and inflammatory markers in Iranian adults diagnosed with type 2 diabetes. A 12-week randomized clinical trial was conducted on 44 adults aged 30-50 years from Ahvaz, Iran. The participants were divided into education and control groups. The education participants were taught the MyPlate recommendations. Serum levels of fasting blood sugar (FBS), hemoglobin A1c (HbA1c), lipid profiles, and inflammatory markers, including high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α, and adiponectin, were measured at the baseline and the end of the study. The results showed that serum levels of FBS (p = 0.014) and HbA1c (p < 0.001) decreased significantly in the education group at the end of the study. The serum level of low-density lipoprotein in the education group declined significantly at the end of the study (p = 0.043). Furthermore, the serum level of hs-CRP (p = 0.005) declined significantly while the level of adiponectin (p = 0.035) increased in the education group at the end of the study. The evidence of this study showed that nutrition education using MyPlate recommendations is an effective method for controlling diabetes complications. A longitudinal analysis with a larger sample size is recommended to confirm the evidence of this study.

• Clinical Nutrition Research
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• v.13 no.3
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• pp.176-185
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• 2024

Helicobacter pylori infection is the cause of 90% of non-cardia gastric cancer. Several dietary elements have been identified as possible contributors to H. pylori infection and its advancement through various pathways. Based on the anti-inflammatory and anti-microbial effects of a diet low in omega-6 and high in omega-3 polyunsaturated fatty acids (PUFAs), this study aimed to assess the ratio of dietary omega-6 to omega-3 PUFAs and the risk of developing H. pylori. The present case-control study was conducted on 150 cases with H. pylori infection and 302 controls. The omega-6 to omega-3 ratio was calculated using food intake information sourced from a validated food frequency questionnaire. Physical activity and demographic data were collected through a related questionnaire. The association between the odds of H. pylori infection and the omega-6 to omega-3 ratio was evaluated using logistic regression models. A p value < 0.05 was considered statistically significant. The findings revealed that individuals in the third tertile had significantly higher odds of H. pylori (odds ratio [OR], 2.10; 95% confidence interval [CI], 1.30-3.40) in the crude model. Furthermore, even after adjusting the potential confounders including sex, age, body mass index, physical activity, energy intake, alcohol, and smoking status, this association remained significant (fully adjusted model: OR, 2.00; 95% CI, 1.17-3.34). Our study revealed a higher ratio of omega-6 to omega-3 was related to a higher likelihood of H. pylori infection. Therefore, it is advisable to maintain a balanced intake of PUFAs in the diet.

• Clinical Nutrition Research
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• v.13 no.3
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• pp.201-213
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• 2024

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to test our hypothesis that herbal tea may improve anthropometric parameters, metabolic factors, and hormone levels in women with polycystic ovarian syndrome (PCOS). A literature search was conducted on Information Sciences Institute, Medline (PubMed), Scopus, Embase, and Google Scholar, up to March 2023 without applying language or date restrictions. RCTs that assigned herbal tea vs. placebo on PCOS women and evaluated changes in anthropometric measurements, metabolic indices, or hormonal profiles were included. Six RCTs with 235 PCOS women (119 in the intervention and 116 in the control group) were included. Meta-analysis showed that herbal tea consumption led to significant decreases in weight (weighted mean difference [WMD], -2.02 kg; 95% confidence interval [CI], -3.25, -0.80), body mass index (BMI) (WMD, -0.88 kg/m²; 95% CI, -1.47, -0.28) and fasting blood glucose (FBG) (WMD, -6.47 mg/dL; 95% CI, -8.49, -4.45), compared to the control group. Herbal tea supplementation has also significantly increased follicle-stimulating hormone (FSH) concentration (WMD, 0.56 IU/L; 95% CI, 0.17, 0.95). Meanwhile, the effect of herbal tea on the waist/hip ratio, hip circumference, waist circumference, body fat, fasting insulin, FBG/insulin ratio, luteinizing hormone, total testosterone, and dehydroepiandrosterone sulfate was not significant. Herbal tea might be a potential supplemental therapy to manage weight, BMI, FBG, and FSH in PCOS women. Further large randomized clinical trials are recommended to affirm these findings.

• Clinical Nutrition Research
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• v.13 no.3
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• pp.165-175
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• 2024

This study aimed to assess the relationship between serum levels of vitamin D with anthropometric indices, lipid profile and vascular inflammatory factors, in patients who candidate for coronary artery bypass grafting (CABG). This analytical cross-sectional study was conducted in patients who were candidate for CABG. Demographic information, medical records, anthropometric indicators, blood samples, and physical activity of 150 patients were collected. 146 participants with mean ± standard deviation of age: 61.8 ± 10.0 years and body mass index: 26.9 ± 3.7 kg/m² completed the study. Based on serum levels of vitamin D, patients were divided into 2 groups; groups with sufficient (≥ 30 ng/mL) and insufficient amount of vitamin D (< 30 ng/mL). The 30.14% of the patients had serum vitamin D deficiency. Ejection fraction (EF) % between the 2 groups had significant difference. Unexpectedly the EF% increased 7% in patients with insufficient level of vitamin D (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.11; p = 0.001). Vitamin D status had a significant inverse association with body weight. The odds of vitamin D deficiency significantly increased by 4% with increasing one kg in weight (OR, 1.04; 95% CI, 1-1.08; p = 0.044). There were no significant association between serum vitamin D level and intra cellular adhesion molecule-1, interleukin-17, fasting blood glucose, and lipid profile (p > 0.05). Considering the inverse association observed between serum vitamin D with EF% and body weight, vitamin D may play a role in modulating of these indices.

• Clinical Nutrition Research
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• v.13 no.3
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• pp.186-200
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• 2024

Meta-analyses have been conducted with conflicting results on this topic. Due to missing several eligible studies in previous meta-analysis by Lam et al., we conducted an extensive systematic review and dose-response meta-analysis of randomized controlled trials in this regard. A comprehensive search was conducted across various databases, including MEDLINE/PubMed, ISI Web of Knowledge, Scopus, and Google Scholar, until November 2023. Based on the analysis of 33 studies comprising 2,047 individuals, it was found that there was a significant increase in body weight for each 1 g/day increase in omega-3 lipids (standardized MD [SMD], 0.52 kg; 95% confidence interval [CI], 0.31, 0.73; I² = 95%; Grading of Recommendations Assessment, Development and Evaluation [GRADE] = low). Supplementation of omega-3 fatty acids did not yield a statistically significant impact on body mass index (BMI) (SMD, 0.12 kg/m²; 95% CI, -0.02, 0.27; I² = 79%; GRADE = very low), lean body mass (LBM) (SMD, -0.02 kg; 95% CI, -0.43, 0.39; I² = 97%; GRADE = very low), fat mass (SMD, 0.45 kg; 95% CI, -0.25, 1.15; I² = 96%; GRADE = low), and body fat (SMD, 0.30%; 95% CI, -0.90, 1.51; I² = 96%; GRADE = very low). After excluding 2 studies, the findings were significant for BMI. Regarding the results of the dose-response analysis, body weight increased proportionally by increasing the dose of omega-3 supplementation up to 4 g/day. Omega-3 fatty acid supplementation can improve body weight, but not BMI, LBM, fat mass, or body fat in cancer patients; large-scale randomized trials needed for more reliable results.

• Clinical Nutrition Research
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• v.13 no.3
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• pp.214-225
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• 2024

Polymorphisms in the melanocortin 4 receptor (MC4R) gene with occurrence and progression of chronic diseases such as obesity and cardiovascular disease (CVD) have long been addressed but there is a lack of evidence for complex interrelationships, including direct and indirect effects of these variables. This review specifically focuses on studying the effects of healthy diet interaction and MC4R polymorphisms on the development of CVD. The quantity and quality of carbohydrates and proteins consumed are related to obesity susceptibility and cardiometabolic risk factors. A healthy dietary pattern such as a Mediterranean dietary can modulate the association between MC4R polymorphisms (rs17782313) and the risk of CVDs. Also, the Nordic diet can reduce lipid profiles such as low-density lipoprotein cholesterol (LDL-C) and total cholesterol levels. On the other hand, MC4R interaction with the dietary inflammatory index decreases high-density lipoprotein cholesterol levels and increases LDL-C and triglyceride (TG) levels. Additionally, the DASH diet decreases TG, atherogenic index of plasma, systolic blood pressure, diastolic blood pressure, and serum glucose. The interaction between MC4R genes and diets plays an important role in the development of CVD. Adherence to healthy diets such as the Mediterranean, Nordic, Anti-inflammatory, and Dash diets might be an efficient strategy to prevent CVD. The potential for personalized diets to be developed for the treatment and prevention of CVD and its related comorbidities is expected to expand as this field develops.

• Journal of the Korean Society of Radiology
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• v.8 no.6
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• pp.317-323
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• 2014

This study aims to suggest and test methods using an orally inserted guiding device in order to improve a motion artifact by involuntary oral motor such as removing one's dentures and swallowing saliva clinically structured cervical spine scan and to make the optimal image by minimizing motion artifact. A cervical spine test was conducted with 30 patients who wore dentures among those who had a cervical spinal disease from January 1, 2014 through June 30, 2014. As for testing methods, after removing denture, T1-TSE-Sagittal, T2-TSE-Sagittal, T1-TSE-Axial and T2-TSE-Axial were obtained in a normal position and a supine position; the orally inserted guiding device was inserted in patients' mouth; and then T1-TSE-Axial and T2-TSE-Axial were retested. As a result, in SNR, T1-TSE-Axial before inserting an orally inserted guiding device was $22.33{\pm}8.59$; T1-TSE-Axial after inserting the orally inserted guiding device was $25.21{\pm}7.93$; T2-TSE-Axial before inserting the orally inserted guiding device was $14.49{\pm}5.74$; and T2-TSE-Axial after inserting the orally inserted guiding device was $16.61{\pm}6.72$. In CNR, T1-TSE-Axial was measured at $0.23{\pm}0.01$ while T2-TSE-Axial at $0.21{\pm}0.01$. As a result of the qualitative analysis, T1-TSE-Axial before inserting the orally inserted guiding device was $3.49{\pm}0.11$; T1-TSE-Axial after inserting the orally inserted guiding device was $3.95{\pm}0.14$; T2-TSE-Axial before inserting the orally inserted guiding device was $3.25{\pm}0.18$; and T2-TSE-Axial after inserting the orally inserted guiding device was $3.68{\pm}0.09$. As a result of using an orally inserted guiding device, the resolution and contrast of the images improved as the patients' involuntary artifact decreased because of removing dentures and swallowing saliva, and it was found that the interpretation of the images and identification of the diseases improved.