• 적정기술학회지
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• 제5권2호
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• pp.118-125
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• 2019

제 5차 IPCC보고서(2014)에 의하면, 지구온난화의 원인은 온실가스(GHG)에 기인하며 가장 중요한 화석연료의 연소에서 발생하는 CO₂, NO₂, 메탄 등이다. IPCC는 2099년까지 지구 온도가 3.7℃ 상승하고 해수면은 0.63 m 상승할 것으로 예측하였다. 기후변화는 SDGs의 매우 중요한 한 부분이며, 그중 지구온난화는 잠재적으로 인류 건강에 가장 큰 위협이며 여러 다양한 질병의 원인이다. 만약 현재의 가스 배출과 토지이용의 추세가 계속된다면 미래의 세대는 질병, 부상, 자연재난으로 인한 사망, 감염, 영양부족, 대기오염으로 인한 사망율 등 매우 심각한 상황에 직면하게 될 것이다. 이 글에서는 홍수, 가뭄, 열 스트레스. 대기오염, 물부족, 영양실조, 전염성질환, 매개질환 등 지구기후변화와 이와 관련된 자연재난과 인류 건강의 관계를 조명하여 보았다.

• Clinical Endoscopy
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• 제56권3호
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• pp.340-352
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• 2023

Background/Aims: Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States. Methods: We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared. Results: From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p<0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management. Conclusions: Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.

• Clinical Nutrition Research
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• 제12권3호
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• pp.177-183
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• 2023

Bariatric surgery is the most effective treatment for sustained weight reduction, and it can result in substantial improvements in the severity of type 2 diabetes, metabolic syndrome, nonalcoholic fatty liver disease, and quality of life. However, sleeve gastrectomy, a weight loss surgery that removes two-thirds of the stomach, reduces appetite and nutrient absorption, impairing digestion and the absorption of nutrients like iron, vitamin B₁₂, and protein-bound nutrients. This case study aims to demonstrate that patients undergoing sleeve gastrectomy require long-term and periodic monitoring of biochemical data, weight changes, and caloric and protein intake by a professional nutritionist to prevent malnutrition and nutritional deficiencies. In this case study, a 48-year-old woman was diagnosed with morbid obesity, hypertension, sleep apnea syndrome, and chronic gastritis. At initial evaluation, she was 160 cm tall and weighed 89 kg, with a body mass index of 34.8 kg/m². At 1 postoperative year, she consumed 650 kcal and 25 g of protein per day, the percentage of excess weight loss was 141.1%, and body mass index was 21 kg/m². Compared to preoperative levels, calcium and folic acid levels did not decrease after 1 postoperative year, but hemoglobin, ferritin, and vitamin B₁₂ levels decreased. In conclusion, when patients experience rapid weight loss after sleeve gastrectomy, follow-up should be frequent and long. Dietary education should be conducted according to digestive symptoms, and oral nutritional supplements, including vitamins and minerals.

• Clinical Nutrition Research
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• 제12권2호
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• pp.99-115
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• 2023

Patients with colorectal cancer may experience symptoms such as diarrhea, nausea, and anorexia, during surgery and chemotherapy, which can increase the risk of malnutrition. In addition, dietary habits play a key role in the onset of colorectal cancer; therefore, it is necessary to improve dietary habits to prevent recurrence during treatment after diagnosis. In this study, a clinical nutritionist conducted 4 interviews for patients diagnosed with colorectal cancer and scheduled for colectomy: before surgery, after surgery, 1st chemotherapy, and 2nd chemotherapy, and provided nutrition care for each treatment course to determine its effects on nutrition status and disease prognosis. Significant weight loss but no decrease in muscle mass was observed during treatment. Body fat mass, although not statistically significant, showed a decreasing tendency. The percentage of people who responded 'yes' to the below items increased after compared to before receiving nutrition education: 'I eat meat or eggs more than 5 times a week,' 'I eat seafood at least three times a week,' 'I eat vegetables at every meal,' 'I eat fruits every day,' and 'I eat milk or dairy products every day.' These results indicate that the patients changed their dietary habit from a monotonous eating pattern to a pattern of consuming various food groups after receiving nutrition education. These results suggest that continuous nutrition care by clinical dietitians, according to the patient's treatment process, can help improve the patient's nutritional status and establish healthy eating habits.

• Clinical Nutrition Research
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• 제12권4호
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• pp.293-303
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• 2023

Patients with chronic renal failure, many of which treated with hemodialysis, present a high prevalence of impaired muscle strength which suggest that muscle mass parameters may be used as markers for changes in muscle in these patients. Measurement of handgrip strength (HGS) is a common, simple, and quick measure of muscle function an indicator of overall muscle strength which has been associated with physical activity and several anthropometric traits. Intercellular adhesion molecule-1 (ICAM-1) and insulin-like growth factor-1 (IGF-1) are biochemical markers associated with inflammatory processes which are a common consequence of dialysis. Additionally, hemodialysis patients frequently present signs of malnutrition and depression. This cross-sectional study aimed to evaluate if muscle and biochemical markers could be used to predict the risk of depression in hemodialysis patients. Several anthropometric parameters, nutrient intake, depression state and the serum levels of ICAM-1 and IGF-1 were determined and Pearson's correlation coefficient and/or Spearman's correlation coefficient were used to test the correlation between them. Our results do not show a correlation between HGF, IGF-1 and ICAM-1 with the depression status of the patients, but mid-arm muscle circumference (MAMC) was statistically and positively correlated with depression. Additionally, ICAM-1 levels were negatively correlated with HGS, MAMC, and IGF-1. Overall, the results of the present study suggest that HGS may be used as an indicator of cardiovascular diseases and MAMC may be a good predictor of the level of depression in hemodialysis patients, although further studies are required.

• 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.

• Asian-Australasian Journal of Animal Sciences
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• 제24권6호
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• pp.766-773
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• 2011

The objective of the present study was to examine whether yaks possess any adaptive mechanisms of nitrogen (N) metabolism to survive in the harsh foraging environment of the Qinghai-Tibetan Plateau. A grazing experiment on native alpine meadows was conducted to determine availability of herbage biomass and body weight (BW) change of yaks over the year, followed by two indoor feeding trials to investigate adaptation mechanisms of N metabolism in yaks fed at similar intake level to grazing conditions. Three castrated males of each of three genotypes; yak (Bos grunniens), indigenous cattle (Bos taurus) and their crossbred - cattleyak (Bos taurus male${\times}$Bos grunniens female), were used in the housed trials. Results showed that: i) Monthly herbage biomass production and daily grazing intakes by yaks over the year ranged from 220 to 4,664 kg DM per ha, and 1.90 to 8.50 kg DM, respectively. For about seven months each year, yaks suffer from malnutrition as a result of inadequate pasture conditions; ii) Urinary N excretion and N retention by yaks were significantly affected by feeding level, and yaks had a lower (p<0.05) average daily urinary N excretion (0.39 g/kg $BW^{0.75}$) and a greater (p<0.05) N retention (-0.09 g/kg $BW^{0.75}$) than indigenous cattle (0.47 and -0.16 g/kg $BW^{0.75}$, respectively). Fasting daily urinary N excretion was greater (p<0.05) for indigenous cattle than yaks (353 vs. 248 mg/kg $BW^{0.75}$). Purine derivative N excretion and purine derivative N index (PNI) increased with increasing feeding level, while the value of PNI was greater (p<0.05) for yaks and cattleyak (0.11 and 0.12, respectively) than for indigenous cattle (0.09) during the feeding trials. These results suggest that yaks could rely, in part, on the recycling of N to adapt to the harsh forage environment on the Qinghai-Tibetan Plateau.), were used in the housed trials. Results showed that: i) Monthly herbage biomass production and daily grazing intakes by yaks over the year ranged from 220 to 4,664 kg DM per ha, and 1.90 to 8.50 kg DM, respectively. For about seven months each year, yaks suffer from malnutrition as a result of inadequate pasture conditions; ii) Urinary N excretion and N retention by yaks were significantly affected by feeding level, and yaks had a lower (p<0.05) average daily urinary N excretion (0.39 g/kg $BW^{0.75}$) and a greater (p<0.05) N retention (-0.09 g/kg $BW^{0.75}$) than indigenous cattle (0.47 and -0.16 g/kg $BW^{0.75}$, respectively). Fasting daily urinary N excretion was greater (p<0.05) for indigenous cattle than yaks (353 vs. 248 mg/kg $BW^{0.75}$). Purine derivative N excretion and purine derivative N index (PNI) increased with increasing feeding level, while the value of PNI was greater (p<0.05) for yaks and cattleyak (0.11 and 0.12, respectively) than for indigenous cattle (0.09) during the feeding trials. These results suggest that yaks could rely, in part, on the recycling of N to adapt to the harsh forage environment on the Qinghai-Tibetan Plateau.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제12권1호
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• pp.39-45
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• 2009

목 적: 영양지원팀(nutritional support team, NST)은 영양부족이 위험성이 있는 환자에게 영양을 효율적으로 제공하기 위해 운영된다. 미숙아는 소화, 흡수의 미숙, 비축된 영양의 부족, 요구량의 증가, 다양한 질환에의 이환으로 인하여 영양 불균형의 위험성이 높으며 경구영양이 완전히 진행되기까지는 총정맥영양(total parenteral nutrition, TPN)에 의존하므로 적극적인 영양지원을 필요로 한다. 이에 본 연구에서는 NST 활동이 신생아중환자실에 입원하여 TPN을 투여 받는 미숙아들의 임상경과에 미치는 영향을 검토함으로써 NST의 임상적 의의를 평가하고자 하였다. 방 법: 2003년 7월에서 2006년 7월까지 분당서울대 병원 신생아중환자실에 입원하여 TPN을 시행 받은 미숙아 48명을 대상으로 하여 후향적으로 의무기록을 검토하였다. 대상 환아들을 NST 활동 여부에 따라 각각 NST 설립 이전 시기인 2003년 7월에서 2005년 2월까지 입원한 미숙아군과 NST 활동 시기인 2005년 3월에서 2006년 7월 사이에 입원한 미숙아군으로 나누어 각 군에서의 임상 지표들을 비교분석하여 NST 활동이 미치는 영향을 평가하였다. 통계학적 분석을 위해 Mann-Whitney 검정과 Fisher's exact test를 적용하였고, pvalue 0.05 미만을 통계적으로 유의하다고 판정하였다. 결 과: 대상 환아 48명(남아 27명, 여아 21명)의 재태기간은 평균 $28^{+1}$주(범위: 25주~$32^{+6}$주), 출생체중은 평균 1,008.5${\pm}$242.5 g (범위: 520~1,490 g), 재원기간은 평균 74${\pm}$40일(범위: 26~274일)이었다. 영양사, 약사 또는 NST가 환아의 TPN에 개입하기까지의 기간이 NST 활동 전에는 14.8${\pm}$21.0일 소요되었으나 NST 활동 이후 0.5${\pm}$2.0일로 유의하게 감소하였다(p=0.000). TPN 투여기간은 NST 활동 전의 41.5${\pm}$26.2일에서 NST 활동 후에는 20.5${\pm}$16.6일로 유의하게 감소하였다(p=0.001). TPN을 통해 투여된 칼로리는 NST 활동 전후로 각각 88.1${\pm}$19.0 kcal/kg/day와 98.8${\pm}$8.2 kcal/kg/day로서 유의하게 상승하였고(p=0.016), 단백 투여량은 각각 2.74${\pm}$0.50 g/kg/day와 3.36 g/kg${\pm}$0.34 g/kg/day (p=0.000), 지방 투여량은 각각 2.53${\pm}$0.86 g/kg/day와 3.40 g/kg${\pm}$0.52 g/kg/day로서 두 군 간에 유의한 차이를 보였다(p=0.000). 환아들의 금식기간이 NST 활동 전후 각각 10.5${\pm}$11.3일과 5.9${\pm}$7.3일로서 NST 활동 시작 후 유의하게 감소하였으며(p=0.017), 환자들이 완전 경장영양으로 진행하기까지 소요된 기간도 각각 44.7${\pm}$26.1일과 24.0${\pm}$17.6일로 NST 활동 후 의미 있게 감소하였다 (p=0.001). 항생제 투여기간도 NST 활동 전의 34.8${\pm}$30.8일에서 NST 활동과 더불어 15.6${\pm}$15.2일로 유의하게 감소하였다(p=0.007). 결 론: 신생아중환자실에 입원한 미숙아에게 있어 NST 활동에 의한 적극적인 영양지원은 적절한 영양을 공급하여 영양상태를 개선하는 측면과 더불어 임상적 측면에서도 장점이 있으므로 미숙아의 영양지원에 있어 NST 활동이 갖는 의의가 크다고 하겠다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제4권1호
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• pp.83-91
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• 2001

목 적: 입원 환아의 영양결핍에 대한 통계가 국내에는 미비하여 영양평가의 지표를 삼기가 어렵다. 입원 환아의 영양상태를 평가하여 입원 환아 영양관리의 필요성을 강조하고 향후 영양평가의 기초자료로 삼고자 본 연구를 하였다. 대상 및 방법: 1994년 2월부터 7월까지(200명)와 1999년 2월부터 7월까지(233명) 조선대학교 부속병원 소아과에 입원한 환아를 대상으로 연령에 대한 체중비, 연령에 대한 신장비, 신장에 대한 체중비를 구하여 급성 및 만성 단백질-에너지 영양결핍의 유병률과 질환별 및 연령군에 따른 유병률의 차이 그리고 영양결핍의 질환별 분포를 비교 분석하였다. 영양상태의 평가는 Waterlow 분류기준에 의해 분석하였고, 생화학적 지표로는 혈색소, 혈청알부민, 총 임파구 수를 조사하여 영양결핍과의 관련성을 알아보았다. 결 과: 1) 급성 PEM은 신장에 대한 체중비로 산출하였는데 1994년에는 중증 0.5%, 중등도 7%, 경도 18%로서 입원 환아 200명 중 총 51명이었고, 1999년에는 중증 2.0%, 중등도 3.6%, 경도 20.0%로서 입원환아 223명 중 총 58명으로 나타나 두 연도에서 영양결핍에 대한 높은 빈도의 유병률을 보였다. 만성PEM에서도 1994년에는 중증 5%, 중등도 5.5%, 경도 25.5%로서 총 72명이었고, 1999년에는 중증2.24%, 중등도 4.04%, 경도 22.87%로서 총 62명으로 나타나 두 연도간의 유의한 차이는 없으나 각각 높은 빈도의 PEM을 보이고 있다(p=0.287). 급성과 만성 PEM 양쪽에 해당되는 환아는 1994년에 25명, 1999년에는 20명이어서 두 연도에서 PEM의 유병률은 1994년에 49.0%, 1999년에는 44.8%로 나타났다. 2) 연령군별로 영양결핍의 정도를 볼 때 급성 영양결핍에서는 경도의 PEM이 전반적으로 높게 나타났으며, 심한 만성 PEM의 유병률은 2세 이전의 영아에서 10.8%로서 높게 나타나고 있으나 이들은 통계학적으로 의미가 없었다(p=0.511). 3) 급.만성 PEM의 질환별 분류를 볼 때 1994년에는 급성 혹은 만성 PEM을 보였던 환아 98명 중 호흡기 질환이 43명으로 52%를 차지하여 가장 많았고, 소화기, 일반 내과, 신경계, 순환기 질환 순이었으며, 1999년에는 99명 중 호흡기 질환이 38명, 소화기, 일반내과, 신경계, 내분비, 순환기 질환순 이었다. 4) 각 질환에 대해 급.만성 PEM의 유병률을 볼때 1994년에는 혈액종양, 내분비, 신경계, 호흡기, 순환기, 소화기, 비뇨기계통의 질환 순으로 높았으며, 1999년에는 내분비, 순환기, 소화기, 호흡기, 혈액종양, 신경계, 비뇨기계통의 질환 순이었다. 5) 1999년에 측정한 신체계측에서 PEM을 보인 환아에서 생화학적 기준에 따라 혈청 알부민치, 혈색소 및 총 임파구 수를 분류해 볼 때 혈색소 및 혈청 알부민 수치가 총임파구의 수치보다 낮게 나타났다. 결 론: 입원 환아 단백질-에너지 영양결핍의 빈도는 1994년에 49%, 1999년에는 44.8%로 높게 나타나고 있음을 알 수 있었다. 따라서 질병의 예방과 효과적인 치료 및 환아에게 적합한 영양처방을 결정하기 위해서는 영양관리의 중요성을 인식하고 포괄적인 영양평가와 함께 올바른 식 습관 형성에 대한 지도를 비롯한 적극적인 영양관리가 이루어져야 한다.

• 한국식생활문화학회지
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• 제18권1호
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• pp.56-68
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• 2003

The objects of this study are to find out (1) real situation of the food supply in prison under Imperial Government of Japan more cleary (historical meaning) and (2) which might help in understanding wrong present food consumption patterns in Korea which causes environmental as well as health problems. It is generally known that the length of the Japanese occupation for Korea is 36 years. However, it is concluded in this study that it was longer (70 years ; from 1875 to 1945 from when Japanese Army attacked and occupied Yungjongdo and Kanghwado island to e time when they were defeated on World War II.) Korea was annexed by Japan in 1910 then the Imperial Government of Japan dismissed the Korea Army, controlled the Office of Justice and the management of prison by force. Since then about 50% of all land was fell into Japanese Government ownership and 80% of Korean farmers became as tenant. After this change, Korea farmers were forced to pay extremely high rent (up to 80% of its harvest). Forced immigration, low price procurement of grain by Japanese government up to more than 30%of their production, was practiced. Accordingly, the food situation of Korean farmers became miserable, which may caused more violations of Imperial Japanese Law. Malnutrition, epidemic diseases, mortality rate of infants soared and average life expectancy shortened to 20-30 years old. This was the period of World Economic Crises and Food Crises in Japan. It was said then that if one Japanese comes to Korea then 200 Koreans will starved to death. Meanwhile, Proconsul Bureau of Chosun requested to the Department of Medicine, the Imperial University of Kyungsung to survey food supply situation of Koreans in prison throughout Korea. Objectives of the survey then was not only to find out scientifically whether it is agreeable in maintaining prisoner's health and also find out the possibility to save food during food crisis. Survey was started from 1923 and ended in 1945, and it focussed on prisoners in the Seodaemoon Prison. This report is the outcome of the first survey. They concluded that the food supplied was nutritionally (had) no problem, in compare with those of workers in the factory, students in the dormitory in Japan and with those of prisoners in Taiwan, France and Germany. Amount of grain supplied were different according to their work lord and was divided into 9 different levels. Total grain was consisted of 50% millet, 30% soybean and 20% indica rice(variety). However, there were no difference in the amount of supply of side dishes between work groups. For the highest working group, 3280g of boiled grain per day was supplied to make stomach full but as a side dishes, salty fermented bean paste, fermented fish and salty soups, etc. was supplied. Deficiency of animal protein were observed, however, high intake of soybean may possibly caused animal protein deficiency problem. On the contrary, the intake of water soluble vitamins were insufficient but the level of calcium and iron intake seems to be sufficient, however, imbalance of intake of nutrition may caused low absorbtion rate which might caused malnutrition. High intake of dietary fiber and low intake of cholesterol may possibly prohibited them from so called modem disease but may caused the defect in disease resistancy againist epidemics and other traditional disease. Over intake of salt(20-30g per day) was observed. Surveyors who attended in this survey, mentioned that the amount of food intake may nutritionally be sufficient enough but the quality of food(and possibly, the taste of food) were like that of animal feed. For the officials who received this report might consider that considering the war situation and food crisis, the supply situation of food in the prison may considered to be good enough(because they are not starving). But as a Korean who studied this report, one feel extremely pity about those situation because (situation of) those period were very harsh under the Imperial Law and keeping the Law by Koreans were almost impossible, therefore, about one third adult violated the Law and were put into jail. And they were treated like animals.