• Nutrition Research and Practice
• /
• v.3 no.3
• /
• pp.247-252
• /
• 2009

The present study was to investigate the nutritional status and factors related to malnutrition in end-stage renal disease (ESRD) patients requiring hemodialysis (HD) in South Korea. Subjects were ESRD outpatients from general hospitals or HD centers in Seoul referred to the dialysis clinic for maintenance HD care. A total of 110 patients (46 men and 64 women; mean ages $58.6{\pm}1.0y$) were eligible for this study. The family history of chronic renal failure (CRF) was considered positive if a patient reported having either a first-degree or second-degree relative with CRF. Malnutrition was defined as a triceps skinfold thickness or mid-ann muscle circumference below the fifth percentile for age and sex and forty-seven of the 110 patients were malnourished. Almost all (94%) patients had anemia (hemoglobin: <13 g/dL for men and <12 g/dL for women). Energy intake was below the recommended intake levels of energy [30-35 kcal/kg ideal body weight (IBW)] and protein (1.2 g/kg IBW) in 60% of patients. The duration of HD was longer in malnourished HD patients (P=0.0095). Malnutrition was more prevalent in women (P=0.0014), those who never smoked (P=0.0007), nondiabetic patients (P=0.0113), and patients with bone diseases (P=0.0427), adequate HD (spKt/$V{\geq}1.2$) (P=0.0178), and those with a family history of CRF (P=0.0255). Multiple logistic regression was used to examine the relationship between malnutrition and potential risk factors. After adjusting for age, sex, and other putative risk factors for malnutrition, the OR for malnutrition was greater in HD patients with a family history of CRF (OR, 3.290; 95% CI, $1.003{sim}10.793$). Active nutrition monitoring is needed to improve the nutritional status of HD patients. A family history of CRF may be an independent risk factor for malnutrition in Korean HD patients. A follow-up study is needed to investigate whether there is a causal relationship between a family history of CRF and malnutrition in Korean ESRD patients.

• Journal of Nutrition and Health
• /
• v.33 no.5
• /
• pp.540-547
• /
• 2000

The present study was conducted to document North Korea's long standing food shortage situation and to evaluate the devastating effects of its recent food crisis on the already poor health and nutritional state of the people in North Korea. We analyzed the mail survey data on food consumption patterns and anthropometry of 109 North Korean defectors, male, aged 20 years and older, who resettled in the South during the period of 1988-1999. The result of our survey data indicated that during 1988-1993 when North Korea's food supply was not yet emerged as a serious problem, food and nutrient intake of North Korean defectors was estimated to be significantly lower that the recommended intake levels for maintenance. Energy and protein intake of subjects who defected further with the recent food crisis. For subjects who defected after 1994, the total and animal food intakes were reduced to 67% and 25%, respectively, of the amounts consumed by those who defected in the period of 1988-1993, and their energy and protein intake was decreased by 27% and 30% to the level of 1,181kcal and 40g. Regardless of the time of defection, the mean height and body weight of defectors was significantly lower than that of South Korean reference men. The prevalence of infectious diseases and malnutrition signs was higher among defectors who resettled in the South after 1994 compared to those who resettled during 1988-1993.

• Journal of Nutrition and Health
• /
• v.39 no.7
• /
• pp.617-623
• /
• 2006

The mortality and morbidity rate of hemodialysis patients (HD) remain high. Among many factors, protein and calorie malnutrition has been shown to be a major risk factor for increased mortality in the HD patients population. Malnutrition can be caused by insufficient amino acid intake, nutrient losses in dialysate, oxidant stress and muscle catabolism. In this study, we evaluated the association of markers of nutritional status and essential amino acids intake in HD patients. We investigated nutritional status of 41 HD patients (mean age: $64.2\;{\pm}\;11.5\;y$, men: 24, women: 27) by measuring anthropometric, biochemical parameters and food intakes by using 24 hr recall methods. Subject's total energy intake and total protein intake were $1,648.0\;{\pm}\;397.31\;kcal/day,\;79.2\;{\pm}\;27.2\;g/day$:, respectively. The animal protein intake was $42.7\;{\pm}\;22.1\;g/day$, essential amino acids intake was $23.4\;{\pm}\;9.92\;g/day$, and the ratio of essential amino acids to total protein intake was $29.6\;{\pm}\;5.42%$. There were significantly positive correlation between muscle mass and lean body mass with serum creatinine level (r=0.435, p<0.01; r=0.435, p<0,01). There were also significant positive correlation in muscle mass and lean body mass with pre hemodialysis blood urea nitrogen (preHD BUN) (r=0.329, p<0.05; r=0.329, p<0.05). There were no significant correlation in total energy intake and total protein intake per kg ideal body weight (IBW) to muscle mass and lean body mass. However, there were significantly positive correlation between the ratio of essential amino acids and muscle mass and lean body mass (r=0.368, p<0.05; r=0.405, p<0.01). And serum hematocrit concentration was positively correlated with the ratio of essential amino acids (r=0.032, p<0.05). The results of this study indicate that strong associations exist in essential amino acid intakes with malnutrition than total protein intakes in HD patient. In conclusion, specialized nutrition education should be necessary to efficiently improve the quality of protein intakes.

• Journal of Nutrition and Health
• /
• v.51 no.4
• /
• pp.307-315
• /
• 2018

Purpose: This study evaluated the effects of personalized nutrition intervention for increasing hospital meal intake by elderly patients with malnutrition. Methods: The subjects were 30 elderly patients with malnutrition who visited a general hospital located in Daegu. An individual nutrition intervention such as change of meal types or special meal service was given to the patients according to nutrition diagnosis related to inadequate intake of hospital meals. Nutritional intake status of the subjects was assessed by analyzing energy intake, protein intake, index of nutritional quality (INQ), nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR). Results: The causes of inadequate intake in the subjects were poor appetite or preference problems (46.7%), symptom-related problems (30.0%) and mastication problems (23.3%). The INQ of protein in the subjects was significantly increased from $0.81{\pm}0.17$ to $1.41{\pm}0.25$ after the nutrition intervention (p < 0.05). The NAR of protein (before $0.50{\pm}0.21$, after $0.58{\pm}0.17$), iron (before $0.72{\pm}0.30$, after $0.84{\pm}0.29$) and vitamin $B_2$ (before $0.31{\pm}0.16$, after $0.37{\pm}0.14$) was also increased after the nutrition intervention (p < 0.05). The MAR of five nutrients, protein, calcium, iron, vitamin A and vitamin $B_2$, was significantly increased by the nutrition intervention (p < 0.05). Conclusion: Personalized nutrition intervention according to nutrition diagnosis related to inadequate intake of hospital meals may improve the intake amount of elderly patients with malnutrition.

• Advances in Traditional Medicine
• /
• v.10 no.3
• /
• pp.191-199
• /
• 2010

Acanthopanax Koreanum stem (AK) has been used in Korea as a tonic and sedative as well as a drug with ginseng like activities. The purpose of our present study was to investigate the effects of AK extract (AKE) and Eleutheroside E, major component of AKE on an exacerbated immune function through utilization of protein-energy malnutrition (PEM) diet by using forced swimming test (FST). The immobility time were significantly decreased in the AKE or Eleutheroside E-administrated group compared with the control group on the FST (P < 0.05). The level of blood parameters were not changed significantly. PEM-induced weight loss of mice was reduced by oral administration of 500 mg/kg AKE. AKE oral administration improved the nutritional status such as the food efficiency ratio and the adrenal gland weight. AKE treatment significantly increased the production of interferon (IFN)-$\gamma$ compared with unstimulated splenocytes but not interleukin (IL)-4. Eleutheroside E also significantly increased the IFN-$\gamma$ production but not IL-2 and IL-4 in T cell line, MOLT-4 cells. These results suggest that AKE and Eleutheroside E may influence to immune-enhancing through increasing the physical endurance capacity and immune cell activation.

• Journal of Nutrition and Health
• /
• v.46 no.6
• /
• pp.521-530
• /
• 2013

Protein-energy malnutrition, PEM, and increased hs-CRP level are considered to be associated with increased risk of cardiovascular disease (CVD) in hemodialysis (HD) patients. This is commonly referred to as the vicious circle of malnutrition-inflammation-atherosclerosis cardiovascular disease (MIA syndrome) in chronic kidney disease (CKD). Low protein intake can decrease the serum level of albumin and increase inflammational markers; further, both low serum albumin and high hs-CRP are independent risk factors for all-cause mortality in HD patients. The aim of this study is comparing the serum levels of albumin and hs-CRP in HD patients according to the protein intake levels. The total number of subjects was 60 hemodialysis patients; they were grouped by dietary protein intake: low protein intake group (LPI, protein intake < 1.0 g/kg IBW, 11 men and 19 women) and adequate protein intake group (API, protein intake ${\geq}$ 1.0g/kg IBW, 12 men and 18 women). Blood biochemical parameters, nutrient intake, and dietary behaviors were compared between the LPI and API groups. The LPI group showed a significantly lower serum level of albumin and higher serum level of hs-CRP than the API group (p < 0.05). The LPI group showed a significantly lower intake of most nutrients than the API group (p < 0.05). Index of Nutritional Quality of most nutrients of the LPI and API groups were lower than 1.0. Dietary protein intake was positively correlated with the serum level of albumin (r = 0.306, p < 0.05) and negatively correlated with the serum level of hs-CRP (r = -0.435, p < 0.01). The serum level of hs-CRP was negatively correlated with that of albumin (r = -0.393, p < 0.01). According to these result, serum albumin and hs-CRP in HD patients were influenced by the protein intake levels. To prevent MIA syndrome, it is necessary to improve nutritional status, especially in protein and energy.

• Journal of Community Nutrition
• /
• v.2 no.1
• /
• pp.12-26
• /
• 2000

In Japan, a new nursing insurance system was enforced in April 2000, where premiums were paid according to the level of necessary care. Our project, Nutrition Care and Management(NCM) for the elderly was started in 1995, funded by the Ministry of Health and Welfare of Japan. The NCM project was to provide appropriate nutrition care for the elderly and to see that it effectively functions as part of the health care services. There were 4 stages to the project : the first stage was to find out the PEM status among the elderly patients in hospital and home-care settings in Japan. The 2nd stage was to develop and evaluate nutritional assessment methods, anthropometry, resting energy expenditure measuring methods using of portable indirect calorimeter, and the convenient protein energy intake assessment methods, etc. for the elderly patients with PEM risk. The 3rd stage was to examine the effectiveness of the nutrition care plan induced of protein energy supplement and team care in improving nutrition among the elderly patients. The last stage was to develop the NCM set for the elderly patient based on the past three years of scientific evidence. it is expected that the NCM system for the elderly will provide adequate nutritional care management, improve the elderly care environment and create effective resource management.

• Clinical and Experimental Pediatrics
• /
• v.61 no.8
• /
• pp.231-238
• /
• 2018

Purpose: Wasting and underweight are the 2 main indicators of children's undernutrition. We aimed to estimate the prevalence of undernutrition at the national level in Iran. Methods: We performed a search for original articles published in international and Iranian databases including MEDLINE, Web of Science, Google Scholar, Scopus, CINHAL (Cumulative Index to Nursing and Allied Health Literature), Scientific Information Database, Irandoc, Iranmedex, and Magiran during January 1989-August 2017. Seven keywords, in English and Persian, including malnutrition, protein energy malnutrition, growth disorders, underweight wasting, weight loss, children below 5 years old, and children, were used to search the databases. Results: Finally, 17 articles were included in the meta-analysis, based on which the prevalence of underweight and wasting in Iranian children were estimated to be 11% and 5%, respectively. The prevalence rates of underweight among children in the central, western, southern, and northern parts of Iran and at the national level were 24%, 5%, 20%, 17%, and 6%, respectively. The prevalence rates of wasting in the central, western, southern, and northern parts of Iran and at the national level were 9%, 4%, 11%, 5%, and 4%, respectively. Conclusion: Although the prevalence of underweight and wasting in Iran was low, some parts of the country showed high prevalence. The main reason behind this difference in the prevalence of malnutrition may be due to the level of development in different regions.

• Korean Journal of Community Nutrition
• /
• v.26 no.4
• /
• pp.280-295
• /
• 2021

Objectives: This study aimed to examine the characteristics of patients according to their nutritional status as assessed by five nutritional screening tools: Patient-Generated Subjective Global Assessment (PG-SGA), NUTRISCORE, Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) and to compare the agreement, sensitivity, and specificity of these tools. Methods: A total of 952 gastric cancer patients who underwent gastrectomy and chemotherapy from January 2009 to December 2012 at the Samsung Medical Center were included. We categorized patients into malnourished and normal according to the five nutritional screening tools 1 month after surgery and compared their characteristics. We also calculated the Spearman partial correlation, Cohen's Kappa coefficient, the area under the curve (AUC), sensitivity, and specificity of each pair of screening tools. Results: We observed 86.24% malnutrition based on the PG-SGA and 85.82% based on the NUTRISCORE among gastric cancer patients in our study. When we applied NRI or CONUT, however, the malnutrition levels were less than 30%. Patients with malnutrition as assessed by the PG-SGA, NUTRISCORE, or NRI had lower intakes of energy and protein compared to normal patients. When NRI, PNI, or CONUT were used to identify malnutrition, lower levels of albumin, hemoglobin, total lymphocyte count, total cholesterol, and longer postoperative hospital stays were observed among patients with malnutrition compared to those without malnutrition. We found relatively high agreement between PG-SGA and NUTRISCORE; sensitivity was 90.86% and AUC was 0.78. When we compared NRI and PNI, sensitivity was 99.64% and AUC was 0.97. AUC ranged from 0.50 to 0.67 for comparisons between CONUT and each of the other nutritional screening tools. Conclusions: Our study suggests that PG-SGA and NRI have a relatively high agreement with the NUTRISCORE and PNI, respectively. Further cohort studies are needed to examine whether the nutritional status assessed by PG-SGA, NUTRISCORE, NRI, PNI, and CONUT predicts the gastric cancer prognosis.

• Korean Journal of Community Nutrition
• /
• v.27 no.3
• /
• pp.205-222
• /
• 2022

Objectives: This study examined the characteristics of patients according to nutritional status assessed by five nutritional screening tools: Patient-Generated Subjective Global Assessment (PG-SGA), NUTRISCORE, Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) and to compare the agreement, sensitivity, and specificity of these tools. Methods: A total of 952 gastric cancer patients who underwent gastrectomy and chemotherapy from January 2009 to December 2012 were included. The patients were categorized into malnutrition and normal status according to five nutritional screening tools one month after surgery. The Spearman partial correlation, Cohen's Kappa coefficient, the area under the curve (AUC), sensitivity, and specificity of each two screening tools were calculated. Results: Malnutrition was observed in 86.24% of patients based on the PG-SGA and 85.82% based on the NUTRISCORE. When NRI or CONUT were applied, the proportions of malnutrition were < 30%. Patients with malnutrition had lower intakes of energy and protein than normal patients when assessed using the PG-SGA, NUTRISCORE, or NRI. Lower levels of albumin, hemoglobin, total lymphocyte count, and total cholesterol and longer postoperative hospital stays were observed among patients with malnutrition compared to normal patients when NRI, PNI, or CONUT were applied. Relatively high agreement for NUTRISCORE relative to PG-SGA was found; the sensitivity was 90.86%, and the AUC was 0.78. When NRI, PNI, and CONUT were compared, the sensitivities were 23.72% for PNI relative to NRI, 44.53% for CONUT relative to NRI, and 90.91% for CONUT relative to PNI. The AUCs were 0.95 for NRI relative to PNI and 0.91 for CONUT relative to PNI. Conclusions: NUTRISCORE had a high sensitivity compared to PG-SGA, and CONUT had a high sensitivity compared to PNI. NRI had a high specificity compared to PNI. This relatively high sensitivity and specificity resulted in 77.00% agreement between PNI and CONUT and 77.94% agreement between NRI and PNI. Further cohort studies will be needed to determine if the nutritional status assessed by PG-SGA, NUTRISCORE, NRI, PNI, and CONUT predicts the gastric cancer prognosis.