• 중환자간호학회지
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• 제11권3호
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• pp.108-119
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• 2018

Purpose : This study evaluated the nutritional status and effect of nutritional support team (NST) management in critically ill patients. Methods : From January 2015 to August 2017, the study retrospectively investigated 128 patients aged above 19 years admitted to a medical intensive care unit (MICU). The patients were divided into two groups: NST (n=65) and non-NST (n=63) groups. Nutritional status, classification of bedsore risks, incidence rate of bedsore and clinical outcomes were compared. Results : The study found a higher rate of the use of enteral nutrition in the NST group (${\chi}^2=45.60$, p < .001). The prescription rate of parenteral nutrition (PN) was found to be lower in the NST group (4.6%) compared to the non-NST group (60.3%). There was a higher PN of total delivered/required caloric ratio in the NST, compared to the non-NST, group (${\chi}^2=3.33$, p=.025). There were significant differences for higher albumin levels (t=2.50, p=.014), higher total protein levels (t=2.94, p=.004), and higher proportion of discharge with survival rates (${\chi}^2=18.26$, p < .001) in the NST group. Conclusions : Providing NST management to critically ill patients showed an increase in the nutrition support. Further, to achieve effective clinical outcomes, measures such as nutrition education and continuous monitoring and management for the provision of nutritional support by the systemic administration of a nutritional support team should be considered.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권6호
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• pp.546-554
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• 2021

Purpose: Malnutrition is a significant issue for pediatric patients with cancer. We sought to evaluate the effectiveness and complication rate of percutaneous endoscopic gastrostomy (PEG) placement in pediatric oncology patients. Methods: A retrospective chart review was performed on 49 pediatric oncology patients undergoing PEG placement at Johns Hopkins All Children's Hospital between 2000 and 2016. Demographic and clinical characteristics, complications, absolute neutrophil count at time of PEG placement and at time of complications, length of stay, and mortality were identified. Weight-for-age Z-scores were evaluated at time of- and six months post-PEG placement. Results: The overall mean weight-for-age Z-score improved by 0.73 (p<0.0001) from pre- (-1.11) to post- (-0.38) PEG placement. Improvement in Z-score was seen in patients who were malnourished at time of PEG placement (1.14, p<0.0001), but not in those who were not malnourished (0.32, p=0.197). Site infections were seen in 12 (24%), buried bumper syndrome in five (10%), and tube dislodgement in one (2%) patient. One patient (2%) with fever was treated for possible peritonitis. There were no cases of other major complications, including gastric perforation, gastrocolic fistula, clinically significant bleeding, or PEG-related death documented. Conclusion: Consistent with previous studies, our data suggests a relationship between site complications (superficial wound infection, buried bumper syndrome) and neutropenia. Additionally, PEG placement appears to be an effective modality for improving nutritional status in malnourished pediatric oncology patients. However, larger prospective studies with appropriate controls and adjustment for potential confounders are warranted to confirm these findings.

• Child Health Nursing Research
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• 제20권1호
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• pp.20-29
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• 2014

목적 본 연구는 미숙아를 위한 수유 프로토콜을 개발하고 적용하여 그 효과를 검증하기 위하여 시행되었다. 방법 미숙아 수유 프로토콜의 개발을 위해 전문가 집단을 구성하고, 문헌고찰과 협의를 통해 작성된 프로토콜에 대해 내용타당도 검증과 예비조사를 실시하여 확정하였다. 개발된 프로토콜은 비동등성대조군 전후시차설계로 B시의 P대학교병원에서 태어난 37주 미만의 미숙아 85명에게 적용되었다. 대조군(n=38)에게 2013년 1월부터 4월까지 일반적인 미숙아 수유관리가 시행되었고, 실험군(n=35)에게는 2013년 6월부터 9월까지 본 연구를 통해 개발된 미숙아 수유 프로토콜이 적용되었다. 수집된 자료는 SPSS 18.0 WIN program을 통하여 t-test와 ${\chi}^2$-test로 분석하였다. 결과 실험군은 대조군보다 첫 수유시간(t=2.22, p =.029)과 완전장관영양에 이르는 기간(t=2.28, p =.026)이 통계적으로 유의하게 감소하였다. 그러나 실험군과 대조군의 생후 7일째 체중 감소율(t=-1.23, p =.222)과 합병증 발생률(p >.05)은 통계적으로 유의한 차이가 없었다. 결론 미숙아 수유 프로토콜 적용을 통하여 미숙아들의 첫 수유시간과 완전장관영양에 이르는 기간이 단축되었다.

• 한국식품영양과학회지
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• 제25권5호
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• pp.855-864
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• 1996

신경외과 및 신경과에 입원하여 경관급식 중인 환자에 대하여 영양상태를 평가하고자 식이조사 및 생화학적 혈액분석을 행하였고, 또한 그 중 영양 섭취량이 부족한 성인 경관급식 환자들을 대상으로 경관 유동식의 보충에 따른 영양상태의 개선 효과를 실험하였다. 본 연구의 비위관 경관급식 환자는 전체 83명 (남 49명, 여 34명)으로 96.4%가 의식상태가 저하되어 있었으며, 경관급식 기간이 6주 이상인 환자가 37.3%이었다. 경관급식 투여방법은 모두 Bolus 투여법 이었으며, 튜브의 종류는 16~18Fr.의 Silicon관 및 Polyvinyl chloride 관을 사용하였다. 식이종류는 표준경관 유동식으로는 병원조제용 혼합 유동식과 상업용 유동식을 이용하였고, 설사나 구토 등의 부작용과 낮은 적응도에 의해 표준경관 유동식을 전 유동식, 미음 등과 병행하거나, 전 유동식만으로 처방하기도 하였다. 경관 유동식의 1일 투여 열량은 남자가 평균 1589.1kcal, 여자는 1315.0kcal였고, 열량대 질소의 비율은 139:1로 양호하였다. 1회 투여용량은 평균 353.4ml로, 350m1이상이 37.3% 에 이르렀으며 용량별 열량은 평균 0.77kcal/m1이었다. 생화학적 조사결과 전체 환자 중 36.1~75.9%가 각 검사치에서 영양결핍 상태이었으며, 특히 혈청 iron은72.3%, hemoglobin은 73.5%, hematocrite치는 75.9%가 결핍상태를 보였다. 열량 및 단백질 섭취량과 생화학적 검사치와는 양( + )의 상관관계를 나타내었다. 연령은 혈청 albumin 및 혈청 transferrin과 음(-)의 상관관계가 있었으며, 경관급식 기간은 total potein, 혈청 albumin, hemoglobin, hematocrite, 총 임파구수 등과 양( + )의 상관관계를 보였다. 또한, 경관급식 기간이 길어질수록 열량 및 단백질 섭취량은 유의적으로 증가하였다. (p<0.05). 7. 경관 유동식 보충투여군과 대조군에 대한 0주와 6주의 생화학적 변화상태 비교에서 total protein, 혈청 iron, 총 임파구수가 대조군에 비해 실험군에서 유의적인 증가를 보였으며 (p<0.05), 영양보충 투여군은 혈청 transferrin, 혈청 iron, 총 임파구수가 기간이 경과에 따라 유의적으로 증가하였다(p<0.05). 이상의 결과로 볼 때, 경관급식 환자들에 대해 경관급식기간을 고려하고, 식이처방 및 유동식의 종류에 적합한 튜브를 선택해야하며, 적절한 투여용량을 결정하는 등 투여방법과 투여경로에 대한 보다 많은 연구가 필요하다고 본다. 특히 경관급식 초기단계에는 질병으로 인한 체내 신진대사의 증가나 육체적, 정신적 스트레스, 또는 구토나 설사 등의 부적응 등으로 적절한 영양섭취가 어려운 상태이므로 영양판정을 통하여 영양소 요구량을 계획하여 유동식을 보급함으로서 부작용은 줄이며 적절한 영양을 공급하여 영양 결핍에 대처하여야 한다.

• Nutritional Sciences
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• 제3권2호
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• pp.57-65
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• 2000

Partial enteral nutrition (PEN) supplemented with insulin-like growth factor-I (IGF-I) to neonatal piglets receiving parenteral nutrition increases lactase-phlorizin hydrolase (LPH) activity, but not LPH mRNA. The goal of the current study was to investigate the mechanism by which IGF-I up-regulates LPH activity. We hypothesized that IGF-I regulates LPH synthesis post-transcriptionally. Methods: Newborn piglets (n=15) received 100% parenteral nutrition (TPN), 80% parenteral nutrition + 20% PEN (PEN), or PEN + IGF-I (1.0mg/kg/d). On day 7, two stable isotopes of leucine, [$^2 H_3$]-leucine and [$^{13}C_1$]-L-leucine were intravenously administered to measure mucosal protein and brush LPH (BB LPH) synthesis. Results: Weight gain, nutrient intake and jejunal weight and length were similar among the treatment groups. PEN increased mucosal weight, villus width and cross-sectional area, LPH activity, mRNA expression and the abundance of proLPHh compared to 100% TPN (p<0.05). IGF-I further increased mucosal weight, LPH activity and LPH activity per unit BB LPH ~2-fold over PEN alone (p<0.05), but did not affect LPH mRNA or the abundance of proLPHh or mature LPH. Isotopic enrichment of [$^2 H_3$]-leucine and [$^{13}C_1$]-L-leucine in plasma, mucosal protein and LPH precursors, and the fractional and absolute synthesis rates of mucosal protein and LPH were similar among the treatment groups. Total mucosal protein synthesis was increased 60% (p<0.05) and LPH synthesis tended (p=0.14) to be greater in the IGF-I treated animals compared to the other two groups. Conclusions: The primary mechanism by which IGF-I up-regulates LPH may be post-translational, either via reducing LPH turnover, or by specifically altering LPH activity.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제21권4호
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• pp.321-328
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• 2018

Purpose: Feeding children is a problem in pediatric intensive care units (PICU) and it is difficult to know the correct amount. The purpose of this study is to evaluate if prealbumin or retinol binding proteins (RBP) are effective relative to daily enteral nutrition, without being affected by severity of diseases or infections and can be used to follow up nutritional amount. Methods: This is a prospective observational study that includes 81 patients admitted to PICU in Akdeniz University with estimated duration >72 hours, age between 1 month and 8 years. Daily calorie and protein intake were calculated and prealbumin, RBP and C-reactive protein (CRP) levels were measured on the first, third, fifth and seventh mornings. Results: We find moderate correlation between daily calorie intake and prealbumin levels (r=0.432, p<0.001), RBP levels and daily protein intake (r=0.330, p<0.001). When we investigated the relationship between changes of prealbumin, RBP, CRP, calorie and protein intake during intensive care stay, we found that increase of Prealbumin and RBP levels are explained by decrease of CRP levels (r=-0.546 and -0.645, p<0.001) and not with increase of nourishment. Conclusion: Even adjusted for PRISM3, age and CRP, prealbumin and RBP are correlated with last 24 hours' diet. However, it is not convenient to use as a follow up biomarker because increase of their levels is related with decrease of CRP levels.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제19권1호
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• pp.44-53
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• 2016

Purpose: Parenteral nutrition (PN) not only provides nutritional support but also plays a crucial role in the treatment of children with intestinal failure. The aim of this study was to evaluate the clinical significance and clinical outcomes of long-term PN. Methods: Retrospective cohort study was conducted using the medical records of patients treated at Seoul National University Children's Hospital. This study included 19 patients who received PN for over six months. Most patients received home PN. Results: The indications for PN included short bowel syndrome, chronic intestinal pseudo-obstruction, and intractable diarrhea of infancy. The median age of PN initiation was 1.3 years, and the median treatment duration was 2.9 years. Two patients were weaned from PN; 14 continued to receive PN with enteral feedings; and 3 patients died. The overall survival rates at 2 and 5 years were 93.3% and 84.0%, respectively. The incidence of catheter-related bloodstream infections was 2.7/1,000 catheter-days and was associated with younger age at PN initiation and lower initial height Z-score. Six patients developed catheter-related central vein thrombosis, with an incidence of 0.25/1,000 catheter-days. Eleven patients experienced PN-associated liver disease (PNALD), and one patient underwent multi-visceral transplant. The patients with PNALD exhibited lower final heights and body weight Z-scores. All patients experienced micronutrient deficiencies transiently while receiving PN. Conclusion: PN is an important and safe treatment for pediatric intestinal failure. PNALD was linked to final anthropometric poor outcomes. Micronutrient deficiencies were common. Anthropometric measurements and micronutrient levels must be monitored for successful PN completion.

• Clinical Nutrition Research
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• 제12권4호
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• pp.304-319
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• 2023

Previous studies have suggested that omega-3 polyunsaturated fatty acids, predominantly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have several health benefits. However, their effect on changes in skeletal muscle mass and strength has not been established, owing to differences in study designs. This systematic review aimed to investigate the recent evidence regarding the role of dietary EPA and DHA in muscle mass changes and their association with muscle strength. Databases including PubMed and Google Scholar were searched for randomized controlled trials and single-arm interventions that investigated the effects of omega-3 fatty acids on skeletal muscle mass, strength, and body composition in adults aged 18 years and older. A total of 18,521 studies were retrieved from the databases and manual searches; 21 studies were quality assessed, and the findings were summarized. Studies were categorized into 3 main categories according to the type of omega-3 fatty acid supplementation: pure compounds such as oil tablets, formulated forms with protein, leucine, and vitamin D, and ingredients added to enteral nutrition support products. Overall, the majority of the study results appeared to indicate that omega-3 fatty acids are beneficial for muscle health. However, meta-analysis was not conducted because of the heterogeneity of the study participants, evaluation method of muscle indices, and intervention periods among the studies. High-quality studies are required to validate our conclusions. However, this systematic review of the effects of EPA and DHA on skeletal muscle and body composition provides evidence that can be applied in both clinical and industrial settings.

• 대한영양사협회학술지
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• 제1권1호
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• pp.21-30
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• 1995

Critically ill patients admitted in ICU and NCU were studied with respect to their nutritional status and support to them at initial period, and the effect of nutritional support after 3 weeks. The nutritional support was supplied to these patients with the enteral and parenteral nutrition. The results of biochemical test and status of nutritional support on 52(29 males, 23 females) critically ill patients were based on medical records and the anthropometry was measured on 28 patients. The subjects were in mild malnutrition. Their initial calorie intakes were 85% of BEE, 57% of total energy requirements and 49% of protein requirement were provided. Two groups, one group of serum albumin level more than 3.5g/dl and the other group of serum albumin level less than 3.5g/dl, were significant different in total calorie and protein intakes. After 3 weeks, inappropriate nutritional support in the group of normal nutrition results in significant decreasing of serum albumin level but, there were no changes in the group of malnutrition. Nutritional support is one of the mainstays in the management of these critically ill patients and is aimed at preventing malnutrition. Therefore, timely nutritional support is heavily required in cases of critically ill patients whether their initial nutritional status is normal or not.

• 성인간호학회지
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• 제20권1호
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• pp.44-54
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• 2008

Purpose: The purpose of the study were to examine the nutritional status of severe brain injury adult patients in critical period, and to compare the nutritional states before and after tube feeding. Methods: Data from 19 patients admitted to the SICU in a university hospital due to severe brain injury were analyzed. Nutritional states were measured by anthropometric and blood biochemical indicators. Results: MAC and MAMC were significantly decreased only at 7 days after admission compared with those on the day of admission. TSF was significantly decreased from 7 days to 14 days after admission. Fat rate was significantly decreased from 3 days to 14 days after admission. Hb was significantly decreased only at 3 days after admission. Albumin was significantly decreased from 3 days to 14 days after admission. However, lymphocyte was significantly increased at 14 days after admission. TSF and Albumin became significantly worse even after initiating tube feeding. Conclusions: Nutritional status of severe brain injury patients in SICU became worse after admission whichever indicators were adopted to evaluate nutritional status, anthropometric or blood biochemical indicators, and became worse even after initiating tube feeding.