• 제목/요약/키워드: Clinical nutrition management

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Nutritional management of breastfeeding infants for the prevention of common nutrient deficiencies and excesses

  • Moon, Jin-Soo
    • Clinical and Experimental Pediatrics
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    • 제54권7호
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    • pp.282-286
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    • 2011
  • Breastfeeding is the best source of nutrition for every infant, and exclusive breastfeeding for 6 months is usually optimal in the common clinical situation. However, inappropriate complementary feeding could lead to a nutrient-deficient status, such as iron deficiency anemia, vitamin D deficiency, and growth faltering. The recent epidemic outbreak of obesity in Korean children emphasizes the need for us to control children's daily sedentary life style and their intakes of high caloric foods in order to prevent obesity. Recent assessment of breastfeeding in Korea has shown that the rate is between 63% and 89%; thus, up-to-dated evidence-based nutritional management of breastfeeding infants to prevent common nutrient deficiencies or excesses should be taught to all clinicians and health care providers.

Nutritional education for management of osteodystrophy (NEMO) trial: Design and patient characteristics, Lebanon

  • Karavetian, Mirey;Abboud, Saade;Elzein, Hafez;Haydar, Sarah;de Vries, Nanne
    • Nutrition Research and Practice
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    • 제8권1호
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    • pp.103-111
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    • 2014
  • This study aims to determine the effect of a trained dedicated dietitian on clinical outcomes among Lebanese hemodialysis (HD) patients: and thus demonstrate a viable developing country model. This paper describes the study protocol and baseline data. The study was a multicenter randomized controlled trial with parallel-group design involving 12 HD units: assigned to cluster A (n = 6) or B (n = 6). A total of 570 patients met the inclusion criteria. Patients in cluster A were randomly assigned as per dialysis shift to the following: Dedicated Dietitian (DD) (n = 133) and Existing Practice (EP) (n = 138) protocols. Cluster B patients (n = 299) received Trained Hospital Dietitian (THD) protocol. Dietitians of the DD and THD groups were trained by the research team on Kidney Disease Outcomes Quality Initiative nutrition guidelines. DD protocol included: individualized nutrition education for 2 hours/month/HD patient for 6 months focusing on renal osteodystrophy and using the Trans-theoretical theory for behavioral change. EP protocol included nutrition education given to patients by hospital dietitians who were blinded to the study. The THD protocol included nutrition education to patients given by hospital dietitian as per the training received but within hospital responsibilities, with no set educational protocol or tools. Baseline data revealed that 40% of patients were hyperphosphatemics (> 5.5 mg/dl) with low dietary adherence and knowledge of dietary P restriction in addition to inadequate daily protein intake ($58.86%{\pm}33.87%$ of needs) yet adequate dietary P intake ($795.52{\pm}366.94$ mg/day). Quality of life (QOL) ranged from 48-75% of full health. Baseline differences between the 3 groups revealed significant differences in serum P, malnutrition status, adherence to diet and P chelators and in 2 factors of the QOL: physical and social functioning. The data show room for improvement in the nutritional status of the patients. The NEMO trial may be able to demonstrate a better nutritional management of HD patients.

병원 영양부서의 지식경영 도입을 위한 영양사의 지식기반 환경에 대한 인식 분석 (Analysis of Knowledge-based Environments for Knowledge Management in Hospital Dietetic Departments)

  • 이은정;홍완수;조선경;손춘영
    • 한국생활과학회지
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    • 제19권4호
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    • pp.719-732
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    • 2010
  • This study assessed knowledge-based environments for knowledge management in hospital dietetic departments. This study categorized the current knowledge management environment into routine habits, capability, culture and system. A questionnaire was conducted on dieticians in general hospitals with 400 beds in Seoul and Gyeong-in areas. Excluding responses with significant missing data, 160 usable questionnaires were analyzed by SPSS package programs for the study. The result of the study is summarized as follows. The average number of licensed beds in the hospitals was 717.5 and the average number of meals provided daily was 1,626.3. 53.2% of dieticians were aged between 26 and 35. Of the maximum score of 5 points, habits scored $3.65{\pm}.44$ points, capability scored $3.38{\pm}.44$ points, culture scored $3.21{\pm}.46$ points and system scored $2.77{\pm}.74$ points. Hospitals with a high ratio of occupied beds also had significantly higher points in capability, culture and system. The older the group the higher points it scored in habits and culture. The married group scored higher points in habits while the higher educated group scored higher points in habits and capability. The dietitians in charge of clinical nutrition scored higher points in habit, capability and culture while the higher salaried group scored higher points in habit, culture and capability. Therefore this study would provide useful information for the introduction of knowledge management in hospital dietetic departments.

양평지역 노인의 식품보장 및 식품다양성에 미치는 요인에 관한 질적연구 (Qualitative Study on the Related Factors of the Food Security and Food Variety in Yangpyeong-gun Elderly)

  • 조우균;이재영;박희정
    • 한국식생활문화학회지
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    • 제38권5호
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    • pp.304-313
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    • 2023
  • This study was a qualitative investigation into the food security and food variety among the rural elderly. For the qualitative data collection, nineteen elderly people who lived in Yangpyeong-gun were interviewed individually. Food security and variety was evaluated based on accessibility and affordability. The participants seemed to have difficulty preparing their own meals and eating with their families or others. The frequency of vegetable intake was found to be high, as vegetables were available through cultivation. However, in terms of diversity, the intake of meat and milk, which are sources of protein and calcium, was found to be significantly low. This has to do with very poor physical accessibility. A lack of nutrition education was identified as the biggest reason for not following dietary therapy despite having a pre-existing disease condition. Therefore, for the elderly in Yangpyeong-gun, it is suggested that a basic nutrition policy for food supply that can increase their actual intake is more essential than education on cooking and nutrients. Moreover, periodic nutrition education or a regular counseling system for dietary therapy through local public health centers may help improve the health of the elderly.

체계적 문헌 고찰을 통한 인지기능 개선에 도움을 주는 식사 관리에 대한 연구 (Criteria for diet pattern and meal management to improve cognitive function: A systematic review)

  • 박영숙;이현정;최귀정;허림;남예림;김윤하;김민지;신원선
    • 한국식품과학회지
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    • 제52권5호
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    • pp.450-458
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    • 2020
  • 본 논문에서는 인지기능과 식사중재 프로그램의 관련 효과를 확인하고자 체계적 고찰을 시행하였다. 2019년 데이터베이스 검색, 선별을 통해 총 21편의 연구를 비뚤림 평가하였다. 고혈압 예방 식사인 대시 식단(Dietary Approaches to Stop Hypertension, DASH diet) 1편, 지중해 식단(Med diet) 8편, 마인드 식단(Mediterranean-DASH Intervention for Neurodegenerative Delay, MIND diet) 2편이었다(Table 1). 그리고 그 외의 식이중재는 10편이였다(Table 2). 인지 기능 개선을 위해 대표되는 식단 대시 식단(DASH diet), 지중해 식단(Med diet), 마인드 식단(MIND diet) 비교해 본 결과 공통적으로 야채류, 너트류를 권장하고 붉은 육류는 제한한다. 전세계적으로 각 나라마다 고령자의 인지 개선을 위한 연구가 실행되고 있으며 중재 식사관리는 지중해 식단과 비슷한 식단으로 구성되어 있으며 연구 결과 식이교육, 식이중재 시 인지 개선 효과가 있었다. 이 연구를 통해 식이패턴과 식사의 질을 높이는 것이 중요하고 인지기능 개선에 높은 효과를 보인다는 것을 확인할 수 있었고 치매의 치료법은 아직 개발되지 않았으므로 치매의 진행을 예방하고 발병을 지연시키기 위해 식단 구성시 정제되지 않은 통곡물, 야채, 과일, 베리류, 생선, 올리브유, 너트류, 콩류 섭취를 권장한다. 이 고찰을 통해 인지기능 개선을 위해 단일 영양소, 단일 식품의 섭취의 한계를 확인하였고 한국 고령자에게 맞는 맞춤형 식사교육을 통한 식사관리 중재 프로그램이 필요하다는 것을 확인하였다. 그리고, 이 연구의 결과를 바탕으로 한국형 식사관리 중재 프로그램의 기초를 마련하고자 한다.

소아기에 발병하는 염증성장질환(IBD)은 성인 IBD와 다른 질환인가? - 조기발병 소아 IBD의 역학적, 임상적, 유전학적 특성 및 치료 시 고려 사항- (Pediatric Inflammatory Bowel Disease (IBD): Phenotypic, Genetic and Therapeutic Differences between Early-Onset and Adult-Onset IBD)

  • 서정기
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • 제14권1호
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    • pp.1-25
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    • 2011
  • Inflammatory bowel disease (IBD) develops during childhood or adolescence in approximately 25% of patients with IBD. Recent studies on pediatric IBD have revealed that early-onset IBD has distinct phenotype differences compared to adult onset IBD. Pediatric early-onset IBD differs in many aspects including disease type, location of the lesions, disease behavior, gender preponderance and genetically attributable risks. This review examines the currently published data on the clinical, epidemiological and genetic differences between early-onset and adult-onset IBD. And finally, therapeutic considerations in the management of pediatric-onset IBD are also discussed.

20 kGy 감마선으로 조사된 겨우살이 냉수 추출물의 90일 반복투여 독성평가 (90-day Repeated-dose Oral Toxicity Study of 20 kGy Irradiated Cold Water Extract Powder of Mistletoe)

  • 김진경;전영은;윤성복;이주운;강일준
    • 한국식품영양과학회지
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    • 제40권5호
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    • pp.704-711
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    • 2011
  • 연구에서는 임상에서 암 치료의 보조제로 사용하고 있는 겨우살이의 독성성분의 구조적인 변화를 유도하여 겨우살이의 기능성을 향상시키는 하나의 방법으로, 감마선을 조사한 겨우살이 냉수 추출물의 안전성을 검토하고자 ICR계 열의 암수 마우스에 시험물질을 0, 20, 100 및 500 mg/kg/day의 용량으로 90일간 반복 경구투여한 후, 사망률, 일반증상, 체중변화, 혈액 및 혈액생화학적 변화, 부검소견, 조직학적인 변화를 관찰하였다. 시험기간 중 암수 모든 군에서 시험물질 투여에 기인한 일반적인 증상변화는 관찰되지 않았고, 시험물질의 반복 투여로 인한 사망례 역시 관찰되지 않았다. 시험물질의 투여에 기인한 유의적인 체중감소 또한 나타나지 않았으며, 상기 이외의 육안적인 부검소견에서도 시험물질 투여에 기인한 어떠한 이상소견도 발견되지 않았다. 혈액학적 분석 결과 일부 시험물질 투여군에서 총 백혈구 수와 림프구, 중성구, 단핵구, 헤모글로빈, 혈중 적혈구 비율, 평균 헤모글로빈의 함량, 평균헤모글로빈 농도, 적혈구 크기 분포폭, 혈소판의 수치가 유의적인 변화를 보였으나, 정상범위 내에서의 변화로 감마선조사에 의해 야기된 독성이라고 판단하기는 어렵다. 또한 혈청 중의 alanine aminotransferase, aspartate aminotransferase, 중성지방, 콜레스테롤 수치가 대조군과 비교할 때에 통계학적으로 유의성 있는 변화를 나타냈으나 정상 생리 범위 내에서의 변화로 시험물질에 의한 독성이라 판단하기는 어렵다. 간장과 신장의 조직학적인 관찰에서 시험물질 투여에 의한 변화는 관찰되지 않았다. 이상의 독성 시험 결과, 20 kGy 감마선 조사 겨우살이 냉수 추출물을 3개월간 ICR 마우스에 섭취시 킨 경우, 시험한 최고 농도인 $500{\mu}g$/kg/day에서는 독성이 없는 것으로 판명되었다.

입원 환자용 초기 영양검색도구의 타당도 검증 (Validation of initial nutrition screening tool for hospitalized patients)

  • 김혜숙;이선희;김혜숙;권오란
    • Journal of Nutrition and Health
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    • 제52권4호
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    • pp.332-341
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    • 2019
  • 본 연구는 입원환자의 초기영양평가를 위해 개발된 영양검색도구의 타당성을 평가하고자 입원 후 24시간이내 동일한대상자에게 PG-SGA와 개별면담을 시행 후 그 결과를 비교 평가하였다. CKUNRS와 PG-SGAS 두 그룹 모두 나이는 고위험군이 평균 연령보다 높았고, BMI, 혈청 알부민과 헤모글로빈은 영양불량이 심할수록 유의적으로 낮게 나타났다. CKUNRS와 PG-SGA를 비교 분석한 영양 평가결과 전체 686명 중 영양불량 위험 환자는 각각 107명(15.6%)과 380명 (44.6%)으로 조사되었다. 민감도와 특이도는 각각 98.7% (96.8 ~ 99.5)와 33.3% (28.1 ~ 39.0)로 나타났으며, 두 도구 간 유사성 kappa 지수는 0.34로 CKUNRS는 PG-SGA를 기준으로 어느 정도 타당한 검색도구로 검증되었다. 결론적으로, CKUNRS를 PG-SGA와 같은 공인된 영양검색도구와 비교한 결과 민감도와 유사성 면에서는 어느 정도 타당한 수준의 영양검색도구인 것으로 판정되었으나, 특이도가 높지 않은 부분에 대해서는 추가적인 고려가 필요할 것으로 보인다. 초기입원 영양평가로 효과적인 영양검색도구를 위하여 재원기간, 합병증 유무, 사망률, 환자의 질병 예후와 관련된 유용성은 검증되지 않아 이에 관련하여 추가적 연구가 필요하다고 사료된다. 그리고 보다 정확한 영양불량 환자의 검색을 위해서는 간호사의 입원환자 초기 평가 및 재평가 부분에서 누락 가능성이 있는 체중변화, 소화기계장애, 식욕상태, 저작곤란, 연하곤란 등의 정확한 기록을 할 수 있도록 간호사정 기록자의 지속적인 교육이 필요할 것으로 보이며, 효과적인 초기 영양관리를 위해서는 향후 CKUNRS의 영양검색 기준에 대한 수정보완이 필요하다고 사료된다.

우리나라 60세 미만 성인 1인가구의 식사 규칙도와 대사증후군 유병률과의 관계: 국민건강영양조사 제7기(2016~2018) 자료를 중심으로 (Relationship between Meal Regularity and the Metabolic Syndrome among Korean Single-Person Household Adults under 60 Years of Age: Based on the Seventh Korea National Health and Nutrition Examination Survey (2016~2018))

  • 송지영;최미옥;김오연
    • 대한영양사협회학술지
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    • 제27권1호
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    • pp.1-14
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    • 2021
  • This study aimed to investigate the relationship between meal regularity (i.e. breakfast intake and meal-times), and the risk of metabolic syndrome (MetS) among generally healthy Korean single-person household adults (≤60 years, n=594) based on the Seventh Korean National Health Examination and Nutrition Survey (KNHANES) (2016~2018). Among men (n=325), the breakfast intake frequency was not significantly associated with the pervalence of MetS. However, men consuming a regular meal at least once a day showed a lower prevalence of MetS compared to those whose meals were irregular. These patterns remained after adjusting for age, smoking and drinking habits, individual income, education level, exercise, and total calorie intake. An association between meal regularity and MetS risk was observed in post-menopausal women (n=84), but not in pre-menopausal women (n=185). More specifically post-menopausal women with irregular breakfast eating habits or eating no breakfast at all showed a significantly higher risk of MetS than those eating breakfast regularly after the adjustment. The analysis revealed an odds ratio (OR) of 8.46, confidence intervals (CIs): 1.149~62.199, P<0.05 in irregular breakfast eaters, and an OR of 13.377, CIs: 1.665~107.511, P<0.05, in those who ate no breakfast. Furthermore, post-menopausal women who had irregular meals daily showed a higher risk of MetS than those consuming one or more regular meals/day after the adjustment (OR: 16.888, CIs: 1.258~226.655, P<0.05). In conclusion, the results from this study may be used for formulating optimal dietary guidelines for the prevention and the management of MetS in adults in single-person households.

Clinician Experience with Using Hypoallergenic Formulas to Treat Infants with Suspected Cow's Milk Protein Allergy: A Secondary Analysis of a Prospective Survey Cohort

  • Jesse Beacker;Jerry M. Brown;Jared Florio;Jessica V. Baran;Luke Lamos;Lea Oliveros;Jon A. Vanderhoof;Panida Sriaroon;Michael J. Wilsey
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • 제26권5호
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    • pp.277-283
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    • 2023
  • Purpose: Cow's milk protein allergy (CMPA) is a common condition in infants, but little is known about healthcare providers' clinical experience treating infants with CMPA. To address this gap, we analyzed prospectively collected data from healthcare providers (HCPs) who treated infants under six months old with suspected CMPA using hypoallergenic formulas. The study focused on a commercial extensively hydrolyzed formula containing Lactobacillus rhamnosus GG (ATCC53103) (eHF-LGG) or a commercial amino acid formula (AAF). Methods: In this secondary analysis of prospectively collected survey data, 52 HCPs treated 329 infants under six months old with suspected CMPA using hypoallergenic formulas. A series of two de-identified surveys per patient were collected by HCPs to assess short-term symptom relief in the patients and HCP's satisfaction with the management strategies. The initial survey was completed at the initiation of treatment of CMPA, and the second survey was completed at a follow-up visit. Results: The majority of HCPs (87%) in the study were general pediatricians, and most saw 2 to 10 CMPA patients weekly. Results showed that clinicians reported satisfaction with treatment in 95% of patients in the EHF cohort and 97% of patients in the AAF cohort and achieved expected clinical results in 93% and 97% of patients using eHF and AAF, respectively. Furthermore, few patients were switched from the hypoallergenic formula once initiated. Conclusion: The study provides new insights into HCP perspectives on treating infants with CMPA and supports using hypoallergenic formulas to manage this condition. However, additional prospective controlled studies are needed to confirm these initial findings.