A Case Report of the Nutrition Support for a Patient with HELLP Syndrome

A 30-year-old female patient, 18 weeks gestational age, with no prior medical history was admitted to hospital complaining severe right upper quadrant pain. The patient was admitted to intensive care unit (ICU) after emergency surgery to treat intraperitoneal hemorrhage caused by rupture of liver hematoma. Despite the absence of high blood pressure, the patient was diagnosed with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome on the basis of abnormal levels of blood aspartate aminotransferase/alanine aminotransferase, lactate dehydrogenase, total bilirubin, direct bilirubin, C-reactive protein (CRP) and platelet along with liver damage and proteinuria. While in ICU, the patient was given total parenteral nutrition (TPN) and enteral nutrition (EN) for –20 days because oral feeding was impractical. In the early stage, TPN supply was not sufficient to meet the elevated nutritional demand induced by disease and surgery. Nevertheless, continuous care of nutrition support team enabled satisfactory EN and, subsequently, oral feeding which led to improvement in patient outcome.

Comparison of total energy expenditure between the farming season and off farming season and accuracy assessment of estimated energy requirement prediction equation of Korean farmers

BACKGROUND/OBJECTIVES: The purposes of this study were to compare total energy expenditure (including PAL and RMR) of Korean farmers between the farming season and off farming season and to assess the accuracy of estimated energy requirement (EER) prediction equation reported in KDRIs. SUBJECTS/METHODS: Subjects were 72 Korean farmers (males 23, females 49) aged 30-64 years. Total energy expenditure was calculated by multiplying measured RMR by PAL. EER was calculated by using the prediction equation suggested in KDRIs 2010. RESULTS: The physical activity level (PAL) was significantly higher (P < 0.05) in the farming season (male 1.77 +/- 0.22, female 1.69 +/- 0.24) than the off farming season (male 1.53 +/- 0.32, female 1.52 +/- 0.19). But resting metabolic rate was significantly higher (P < 0.05) in the off farming season (male 1,890 +/- 233 kcal/day, female 1,446 +/- 140 kcal/day) compared to the farming season (male 1,727 +/- 163 kcal/day, female 1,356 +/- 164 kcal/day). TEE (2,304 +/- 497 kcal/day) of females was significantly higher in the farming season than that (2,183 +/- 389 kcal/day) of the off farming season, but in males, there was no significant difference between two seasons in TEE. On the other hand, EER of male and female (2,825 +/- 354 kcal/day and 2,115 +/- 293 kcal/day) of the farming season was significantly higher (P < 0.05) than those (2,562 +/- 339 kcal/day and 1,994 +/- 224 kcal/day) of the off farming season. CONCLUSIONS: This study indicates that there is a significant difference in PAL and TEE of farmers between farming and off farming seasons. And EER prediction equation proposed by KDRI 2010 underestimated TEE, thus EER prediction equation for farmers should be reviewed.

The Measurements of the Resting Metabolic Rate (RMR) and the Accuracy of RMR Predictive Equations for Korean Farmers / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to measure the resting metabolic rate (RMR) and to assess the accuracy of RMR predictive equations for Korean farmers. METHODS: Subjects were 161 healthy Korean farmers (50 males, 111 females) in Gangwon-area. The RMR was measured by indirect calorimetry for 20 minutes following a 12-hour overnight fasting. Selected predictive equations were Harris-Benedict, Mifflin, Liu, KDRI, Cunningham (1980, 1991), Owen-W, F, FAO/WHO/UNU-W, WH, Schofield-W, WH, Henry-W, WH. The accuracy of the equations was evaluated on the basis of bias, RMSPE, accurate prediction and Bland-Altman plot. Further, new RMR predictive equations for the subjects were developed by multiple regression analysis using the variables highly related to RMR. RESULTS: The mean of the measured RMR was 1703 kcal/day in males and 1343 kcal/day in females. The Cunningham (1980) equation was the closest to measured RMR than others in males and in females (males Bias -0.47%, RMSPE 110 kcal/day, accurate prediction 80%, females Bias 1.4%, RMSPE 63 kcal/day, accurate prediction 81%). Body weight, BMI, circumferences of waist and hip, fat mass and FFM were significantly correlated with measured RMR. Thus, derived prediction equation as follow: males RMR = 447.5 + 17.4.Wt, females RMR = 684.5 - 3.5.Ht + 11.8.Wt + 12.4.FFM. CONCLUSIONS: This study showed that Cunningham (1980) equation was the most accurate to predict RMR of the subjects. Thus, Cunningham (1980) equation could be used to predict RMR of Korean farmers studied in this study. Future studies including larger subjects should be carried out to develop RMR predictive equations for Korean farmers.

Relationships among Serum Adiponectin, Leptin and Vitamin D Concentrations and the Metabolic Syndrome in Farmers / 대한지역사회영양학회지

The purpose of this study was to investigate the relationships among serum adiponectin, leptin and vitamin D concentrations and the metabolic syndrome in Korean farmers. 105 (26 males, 79 females) farmers (39~78 years, mean age 59.4 +/- 9.6 years) in Gangwon - area were included in this study. Anthropometric measurements and biochemical blood analysis of subjects were carried out. The prevalence of obesity, abdominal obesity, hypertension, diabetes, hypertriglyceridemia, hypercholesterolemia and hyper LDL-cholesterolemia, metabolic syndrome were 51.9%, 65.7%, 49.5%, 15.3%, 17.3%, 13.5%, 11.5% and 40.9%, respectively. Serum adiponectin and leptin levels (8.90 microg/ml and 12.6 ng/ml) of females were significantly higher than those (6.49 microg/ml and 4.88 ng/ml) of males. But there was no significant difference in 25(OH)vitamin D concentration between males (15.4 ng/ml) and females (16.9 ng/ml). In the subjects with metabolic syndrome, the adiponectin levels were significantly lower and leptin levels were significantly higher than those of the subjects without metabolic syndrome. Serum adiponectin level had positive correlations with HDL-cholesterol level (r = 0.325, p < 0.001), but showed negative correlations with triglyceride and fasting blood glucose concentrations, body weight and waist/hip circumference ratio (r = -0.202 ~ -0.317, p < 0.05). Serum leptin and 25(OH)vitamin D concentrations were positively correlated with body fat (kg, %) and BMI, waist and hip circumferences (r = 0.244 ~ 0.682, p < 0.001). The results of this study suggested that adiponectin and leptin levels could be credible indices to predict chronic diseases in farmers. However, further research on vitamin D should be carried out considering another factors.

Assessment of Energy Intake and Physical Activity Level for Korean Farmers to Establish Estimated Energy Requirements during the Off-Season for Farmers / 대한지역사회영양학회지

The purpose of this study was to assess the physical activity level of Korean farmers to establish estimated energy requirements during the off-season. Subjects were 90 healthy males (n = 25) and females (n = 65). Body weight, height and body fat and muscles of subjects were measured. The prevalence of obesity among farmers was 56.7% according to the BMI. The farmers spent about 18 hours 7 minutes (75.5%) in sleeping and resting. The farmers spent about 19 hours 56 minutes (83.1%) out of 24 hours (one day) in "sedentary activities" and spent about 3 hours 56 minutes (16.4%) in "light activities". Physical activity level (PAL, activity coefficient) of female farmers was 1.42 which was not significantly higher than that (1.37) of male farmers. Estimated energy requirements (EER) for farmers who were different in age groups and gender were calculated. For example, the EERs for male and female farmers were 2190 kcal/day and 1712 kcal/day, respectively. The daily energy intakes of male and female farmers were 1803 kcal/day and 1610 kcal/day, respectively. The EER of male farmers was 2190 kcal/day which was significantly higher than that (1803 kcal/day) of the recommended daily energy intake of male farmers. The results of this study suggest that estimated EER of farmers should be modified according to seasonal workload and energy balance of farmers should be evaluated to prevent obesity.

Assessment of Physical Activity Level of Korean Farmers to Establish Estimated Energy Requirements during Busy Farming Season / 대한지역사회영양학회지

The purpose of this study was to assess the physical activity level of Korean farmers to establish their estimated energy requirements during busy farming season. 113 farmers (mean age 51.9 +/- 7.2 years, male 42, female 71) who own farmland area above 300 pyung participated in measurement of body weight and height and interviewing of one-day activity diaries. There was no significant difference in age, BMI between male and female. Obesity prevalence according to BMI among male and female farmers was 40.5% and 50.7% respectively. The farmers spent about 7 hours in sleeping and spent about 4 hours 35 minutes working on the farm and spent about 15 hours 30 minutes (64.6% of 24 hours) in "very light activities" and spent about 3 hours 31 minutes (14.7%) in "light activities". Physical activity level (PAL, activity coefficient) of male farmers was 2.63 which was significantly higher than that (2.19) of female farmers (p < 0.05). Estimated energy requirements (EER) for farmers who were different in age and gender were suggested. For example, the estimated energy requirements for male and female farmers were 3058 kcal/day and 2279 kcal/day, respectively. The results of this study suggest that estimated energy requirements (EER) of farmers should be differentiated according to seasonal workload and energy balance of farmers should be evaluated to prevent obesity.