Purpose: The study was done to develop an evidence-based enteral nutrition (EN) protocol for effective nutritional support for dysphagia in patients with acute stroke, and to evaluate effects of this protocol on clinical outcomes. Methods: A methodological study was used to develop the EN protocol and a quasi-experimental study to verify the effectiveness of the protocol. The preliminary EN protocol was drawn by selecting recommendations from previous well-designed EN guidelines, and then developing additional recommendations based on high-quality evidence. Content validation was assessed by an expert group, and clinical applicability by care providers and patients. The scale-level content validity index of the final EN protocol was 0.99. Assessment was done of differences in percentage of caloric goals achieved and presence of undernutrition, aspiration pneumonia, and gastrointestinal (GI) complications after application of the EN protocol. Results: In the EN protocol group, the percentage of caloric goals achieved ($R^2=.24$, p=.001) and the reduction of GI complications (p=.045) were significantly improved, but the presence of undernutrition (p=.296) and aspiration pneumonia (p=.601) did not differ from the usual care group. Conclusion: Results indicate that the new EN protocol for dysphagia in patients with acute stroke significantly increased their nutritional intake and reduced GI complications.
Purpose: The purpose of this study was to investigate the nutritional support, gastric residual volume, and nutritional status of the intensive care unit (ICU) patients on enteral feeding. Methods: A descriptive longitudinal design was used to collect 5 day data on enteral nutrition of 52 ICU patients in an university hospital. Nutritional support was calculated with actual caloric intake compared to individual caloric requirement. Residual volumes were measured prior to routine feedings, and the serum albumin levels and the total lymphocyte counts were checked to evaluate nutritional status. The data were analyzed using one group repeated measures ANOVA, paired t-test, and Spearman's bivariate correlation analysis. Results: The subjects received their first enteral feeding on the $5.75^{th}$ day of ICU admission. The mean nutritional support rate was 49.1% of the requirement, however prescription rate and support rate were increased as time goes by. Gastric residual volumes were less than 10 cc in 95% cases. A significant negative correlation was found between nutritional support and nutritional status. Conclusion: The nutritional support for ICU patient was low compared to the requirement, and their nutritional status was worse than at the time of ICU admission. Further studies are necessary to develop nursing interventions for improving nutritional support for ICU patients.
Obesity contributes to an increased risk for chronic diseases, including diabetes, cardiovascular diseases, and certain types of cancer. The prevalence of obesity has increased in Korea. We compared the clinical and dietary characteristics of obese adults (n = 30, 17 men and 13 women, mean age 29.9) to those with a normal weight (n = 15, 8 men and 7 women, mean age 26.5). We determined lipid profiles, fasting blood sugar (FBS), blood pressure, and serum free fatty acid (FFA). Dietary intake was estimated using a food frequency questionnaire (FFQ) and a 3-day dietary record. Exercise patterns and average alcohol intake were determined. The average body mass index was 28.3 kg/$m^2$ in the obese and 21.2 kg/$m^2$ in the normal weight groups. The obese group had significantly higher levels of total cholesterol, LDL cholesterol, and triglycerides, lower levels of HDL cholesterol, and higher blood pressures compared to the normal weight group. FBS was not significantly different between the two groups. The obese group had significantly more subjects with metabolic syndrome (26.7%) compared to the normal weight group (0%). Serum FFA levels tended to be higher in the obese (P = 0.087). No significant difference in caloric intake was observed between the two groups. No differences in carbohydrate, protein, or fat intake between two groups were observed from the FFQ. However, results from the 3-day dietary record showed that the percentage of energy from fat was significantly higher in the obese group. The frequency and amount of exercise did not differ between the two groups. Alcohol consumed per drinking episode was significantly higher in the obese group. These results confirm that excessive weight is associated with disturbances in lipid metabolism in these fairly young and otherwise healthy adults. Dietary factors, including higher fat intake and alcohol consumption, seem to be contributing to the obesity of these subjects.
This study was carried out to examine the effects of alcohol on serum lipid levels. Subjects of this study were 50 military officers living in Honsung, Korea, 25 of whom consumed alcohol on a regular basis and 25 of whom did not. All subjects were previously informed of the purpose of the study and the methods of food intake reporting and blood testing. The age distribution range of subjects was 30-49 years. Weight, height, and body mass index(BMI) were not significantly different between the two groups. Blood pressure was compared, and it was found that the drinker group had mean systolic(SBP) and diastolic blood pressures(DBP) 10mmHg higher than the non-drinker group. Nutrient intake levels of the two groups were not significantly different and were adequate with respect to the recommended dietary allowances. It was found that the drinker group ingested more calories, protein, fat and vitamn B1 than the non-drinker group, while the non-drinker group ingested more carbohydrate, calcium, iron, vitamin A, niacin and ascorbic acid. These differences were believed caused by increased caloric intake from alcohol and additional intake of meat served with drinks for the drinking group. Fourteen of the twenty-five drinkers(56%) had drank regularly for five to ten years. Most drinkers drank 2-3 times per week, with alcohol intake less than two bottles(720ml)of distilled liquor(Soju) at a time. Meat was often served with alcohol as reported by 72% of the drinker group, and was believed to contribute to raised intake of calories, protein and fat in this group. Serum lipid levels of both groups were classified as normal, but the components of total cholesterol, triglycerides were significantly higher in drinkers than non-drinkers. The correlation between triglyceride levels and alcohol intake at one sitting was shown to be significantly positive(r=0.57, p<0.01), so it was believed that triglyceride elevation was associated more with heavy drinking than light drinking. We can conclude that if alcohol is consumed with a normal diet, then serum cholesterol, triglyceride and total lipid levels are expected to increase.
This study was conducted to evaluate the food habits and nutrient intake of preschool children by investigating their food and snack consumption. To accomplish this, a food habit questionnaire and dietary intake survey was administered to 148 children between 2 and 6 years of age (average 4.8 years). According to the Kaup index, the underweight, normal, overweight and obesity levels of the subjects were 4.7, 60.1, 26.4, and 8.8%, respectively. In addition, the total energy intake met the EAR ($1433.94{\pm}369.70kcal$), whereas the protein, iron, phosphorus, vitamin B and vitamin C levels exceeded the EAR and the RI. Furthermore, the nutrient intake profile revealed that the mean caloric value of breakfasts consumed by preschool children in Daegu (403 kcal) was significantly (p<0.001) higher than that of preschool children in the Gyeongbuk area (271 kcal). Additionally, preschool children in Daegu ($382.96{\pm}255.79kcal$) usually consumed significantly (p<0.01) less food than those in the Gyeongbuk area ($413.82{\pm}275.43kcal$). The preferred snacks among subjects (in descending order) were milk, bread, fruit, potato or sweet potato and cookies. The mean score of the Food Habit was $3.72{\pm}0.35$ out of 5, although the score of preschool children in Daegu ($3.77{\pm}0.32$) was significantly (p<0.05) higher than that of children in the Gyeongbuk area ($3.65{\pm}0.32$). Taken together, these results indicate that there were significant differences in the Food Habit and nutrient intake level of children in Daegu and the Gyeongbuk area. Therefore, parents and caregivers should be aware of the importance of the nutritional status of preschool children and choose healthy snacks for them.
To examine the eating attitudes, weight concerns, dietary intake, and menstrual function of Korean female elite athletes, 109 subjects in seven sports disciplines (rhythmic gymnastics, synchronized swimming, badminton, volleyball, Taekwondo, field hockey, and soccer) responded to a questionnaire consisted of three parts; eating attitudes and behavior(Eating Attitude Test-26; EAT26), body weight perception (Body Dissatisfaction Index: BDI) and weight control behavior, and menstrual history and status. They also recorded three-day dietary intake. Body weight (43.6$\pm$4.3 kg) and body mass index (16.7$\pm$1.4 kg/$m^2$) in rhythmic gymnasts were lower than those in other athletes (P<0.05). EAT26 scores were not different among sport events (12.3$\pm$6.5 total), however, eating disturbances (EAT26 score$\geq$20) were highly prevalent in aesthetic athletes ($30\%$) than in others ($5\%$). More than half of the athletes perceived themselves overweight and four fifth of the athletes desired to reduce weight about 4.4 kg. The gymnasts consumed the lowest caloric intake (1028:t371) while the volleyball players did the highest (2995$\pm$342 kcal/d) (P<0.05). The BDI score was not different among sport events. Three fourth of the athletes experienced weight control, and the most frequently used weight reduction method was exercise followed by using robber suits, diet, and sauna. About $40\%$ of the subjects reported irregular menstrual cycles, but menstrual dysfunction ($\leq$6 menses/yr) was only $5\%$. Generally, the Korean female elite athletes desired to reduce weight from their current body weight. No differences in eating attitude and body dissatisfaction were noticed among athletic disciplines. However, eating disturbances were highly prevalent in aesthetic athletes who also reported much less energy intake than the recommend daily energy intake. It appeared that weight reduction methods were not properly practiced in these population. Menstrual dysfunction was minimally reported.
To investigate the effects of crude protein and thyroxine on growth performance, nutrient utilizability, carcass composition, the content of total fat and cholesterol in leg muscle, breast muscle and liver, and caloric efficiency in broiler chicks. The experiment involved 3 levels of dietary crude protein (1-3 weeks: 20, 23, 26%; 4-6 weeks: 17, 20, 23%) and 3 levels of thyroxine (0.0, 1.5, 3.0 mg/kg). In the starting period (1-3 weeks), body weight gain of chicks fed diets containing 26% crude protein and 1.5 mg/kg thyroxine was higher than any other groups, and among thyroxine levels, 3.0 mg/kg thyroxine groups were lower. The best feed efficiency was obtained at 26% crude protein with no thyroxine supplemented or 1.5 mg/kg thyroxine supplemented groups. In the finishing period (4-6 weeks) the highest body weight gain was obtained at 23% crude protein with no thyroxine supplemented group. Feed intake of 17% crude protein with 1.5 mg/kg thyroxine supplemented group was higher than those of the other groups. It was found that the utilizability of crude protein in the starting period, showed the best utilizability at 20% crude protein with 1.5 mg/kg thyroxine group. Increasing crude protein level from 17 to 23%, utilizability of crude fat was decreased. The carcass composition was significantly (p<0.05) influenced by crude protein and thyroxine. Increasing thyroxine level from 0.0 to 3.0 mg/kg, crude protein content was increased whereas, crude fat content was decreased. Chicks fed diet containing 1.5 mg/kg thyroxine showed the lowest total fat content in liver tissue. In breast muscle, it was significantly (p<0.05) affected by crude protein and thyroxine. Present data revealed that the cholesterol content was increased for the chicks fed 3.0 mg/kg thyroxine. It the caloric efficiency, chicks fed a diet containing 20% crude protein with no thyroxine supplementation showed the highest caloric efficiency and the lowest efficiency was from 23% crude protein group with 1.5 mg/kg thyroxine. From this study it may be concluded that crude fat content of carcass could be successfully reduced by dietary supplementation of thyroxine, whereas crude protein content was increased.
Cigarette smoking has long been recognized as a major risk factor in the development of coronary heart disease. Several investigators have reported the strong association between smoking and high serum cholesterol, triglyceride concentration, SFA and low HDL cholesterol, PUFA and $\omega$6 concentrations. Therefore, this study was done to investigate the effect of smoking on the serum lipid profile and fatty acid composition of college women. Sixty-one non-smokers and twenty-seven smokers were selected from college women students in the Seoul area. Their lipid intake, serum lipid concentration and fatty acid composition were examined. There were no differences in the general characteristics and anthropometric indices between the smokers and non-smokers. However, alcohol consumption was significantly higher in smokers than non-smokers (p<0.001). The daily caloric intake of smokers and non-smokers were 1875.84 kcal and 1915.53 kacl, respectively. On the other hand, the mean daily intake of lipids and cholesterol were significantly lower in smokers (p<0.05). In smokers, the mean concentrations of serum total cholesterol, LDL-cholesterol and the LDL-C/HDL-C ratio were higher, and the compositions of EPA and DHA were lowe than in non-smokers. There was a negative correlation between the serum triglyceride and PUFA levels in the two groups. Also, serum HDL-C correlated negatively with MUFA in smokers and non-smokers (p<0.01). These results suggest that smoking cause inadequate changes in serum lipid profile and serum fatty acid composition, thereby increasing the tendency for coronary heart disease.
The purpose of this study was to investigate weight control attempts and related factors among 209 middle school female students in Daejeon. Variables examined were body satisfaction, beliefs regarding weight control, body image, nutrition knowledge, nutritional attitudes, dietary behavior and dietary intake. A cross-sectional survey was employed, and data was analyzed using t-test and chi-square teat (at $\alpha$=0.05). The average height, weight, and body fat (%) of subjects were 160.2cm, 52.4kg, and 25.9%, respectively. Those who attempted weight control were 61.7% of the samples, suggesting that weight control was quite popular among adolescents. Students in the weight control attempt group were more satisfied with their body size (p<0.001), and showed more distorted body image than those in the no weight control attempt group (p<0.001). Most of beliefs regarding weight control were also different in the two groups. The attempt group believed more strongly in the advantages of weight control, and believed less strongly in the harmful effects or difficulties associated with weight control. Although there were no differences in nutrition knowledge in the two groups, nutritional attitudes were slightly more favorable in the attempt group (p<0.01). In contrast, eating behaviors, such as those related to caloric intake (p<0.001), body image (p<0.001), and specific situations (p<0.01) were more desirable in the no-attempt group than in the attempt group. In addition, dietary intake of the attempt group was less adequate than that of the no-attempt group for nutrients such as iron (p<0.01), vitamin A, thiamin, riboflavin, and vitamin C(p<0.05). This study suggests that adolescents who attempt control weight have a more distorted body image and inadequate diet and showed more undesirable eating behaviors. Students should be taught and practice desirable methods of weight control. Educational programs should also include strategies for changing beliefs regarding weight control, as well as modifying diets and eating behaviors.
This study was conducted to investigate the effect of the differences in nutrient intakes on the onset of eye disease in the ophthalmic disease group vs. the normal group. The analysis method of this study was performed by adjusting age and gender. The daily caloric intake was 1,672.1±26.4 kcal in the ophthalmic disease group which was significantly lower than the 2,041.5±13.6 kcal intake in the normal group (P=0.006). The intake of proteins (P=0.015) and carbohydrates (P=0.000) was significantly lower in the ophthalmic disease group than in the normal group. The incidence of eye diseases was found to decrease by about 0.79 (95% CI: 0.74~0.83) times as the NAR index of protein was increased, followed by 0.79 (95% CI: 0.64~0.98) times with an increase in niacin consumption. In this study, income, BMI, smoking, alcohol consumption, and quality of life were considered as the confounding variables related to eye disease, along with age and gender, but did not lead to show significant results. It was found that the ophthalmic disease group had an unbalanced nutritional intake compared to the normal group. Therefore, we conclude that nutrition education is necessary to ensurebalanced eating habits for management and prevention of degeneration after the onset of eye diseases.
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