A Case Study on the Customized Nutrition Intervention for a Patient with Primary Gastrointestinal Non-Hodgkin Lymphoma Underlying Chronic Kidney Disease

Non-Hodgkin lymphoma comprises 2.1% of the total number of cancers in South Korea. Among those, diffuse large B cell lymphoma (DLBCL) comprises the largest percentage. Nutrition interventions have been highlighted because nutritional status in non-Hodgkin's lymphoma patients has a significant impact on treatment and prognosis, but relevant studies are inadequate. Therefore, the aim of this study was to share the case of a nutrition intervention for a patient with primary gastrointestinal non-Hodgkin lymphoma underlying chronic kidney disease who was comorbid with tumor lysis syndrome, which was a complication of a specific chemotherapy. The subject is a 76-year-old patient who was diagnosed with DLBCL. He had abdominal pain, constipation, and anorexia. After chemotherapy, he experienced the tumor lysis syndrome. The patient's condition was continuously monitored, and various nutrition interventions, such as nutrition counseling and education, provision of therapeutic diet, oral nutritional supplement, change of meal plans, and parenteral nutrition support were attempted. As a result of the nutrition intervention, oral intake was increased from 27% of the energy requirement to 70% and from 23% of the protein requirement to 77%. Despite the various nutrition interventions during the hospitalization, there were no improvements in weight and nutrition-related biochemical parameters or malnutrition. However, it was meaningful in that the patient was managed to prevent worsening and the planned third chemotherapy could be performed. These results can be used as the basis for establishing guidelines for nutritional interventions customized to patients under the same conditions.

A Case Study on the Customized Nutrition Intervention for a Patient with Primary Gastrointestinal Non-Hodgkin Lymphoma Underlying Chronic Kidney Disease

Non-Hodgkin lymphoma comprises 2.1% of the total number of cancers in South Korea. Among those, diffuse large B cell lymphoma (DLBCL) comprises the largest percentage. Nutrition interventions have been highlighted because nutritional status in non-Hodgkin's lymphoma patients has a significant impact on treatment and prognosis, but relevant studies are inadequate. Therefore, the aim of this study was to share the case of a nutrition intervention for a patient with primary gastrointestinal non-Hodgkin lymphoma underlying chronic kidney disease who was comorbid with tumor lysis syndrome, which was a complication of a specific chemotherapy. The subject is a 76-year-old patient who was diagnosed with DLBCL. He had abdominal pain, constipation, and anorexia. After chemotherapy, he experienced the tumor lysis syndrome. The patient's condition was continuously monitored, and various nutrition interventions, such as nutrition counseling and education, provision of therapeutic diet, oral nutritional supplement, change of meal plans, and parenteral nutrition support were attempted. As a result of the nutrition intervention, oral intake was increased from 27% of the energy requirement to 70% and from 23% of the protein requirement to 77%. Despite the various nutrition interventions during the hospitalization, there were no improvements in weight and nutrition-related biochemical parameters or malnutrition. However, it was meaningful in that the patient was managed to prevent worsening and the planned third chemotherapy could be performed. These results can be used as the basis for establishing guidelines for nutritional interventions customized to patients under the same conditions.

Nutrition Intervention through Interdisciplinary Medical Treatment in Hospice Patients: From Admission to Death

The demand for hospice services as well as for ‘well-dying’ of terminal patients is increasing as patient financial burden is decreasing due to National Health Insurance coverage for hospice care. Hospice institutions utilize interdisciplinary teams comprising doctors, nurses, dietitians, and other health staffs to provide comprehensive patient management. This report examined the nutritional status of a hospice patient from admission to death as well as the nutrition management of this patient in the hospice ward through nutrition interventions performed by a dietitian in the interdisciplinary team. The patient in the present case was a 74-year-old man diagnosed with pancreatic head cancer who died after 26 days of hospice care following transfer from the general ward. During hospice care, the dietitian monitored the patient's nutritional status and performed 8 nutrition interventions, but his oral intake decreased as the patient's symptoms worsened. The average energy intake rates were 30% and 17% of required rates for oral and artificial nutrition, respectively. In line with a report suggesting that the main focus of nutrition in palliative care should be on improving the quality of life and reducing worry in patients, rather than aggressive nutritional management, there is a need for nutrition interventions that are personalized to individual patients by monitoring progress and offering continuous counseling from the time of admission. In addition, further studies such as comparative analysis of nutritional management in Korean hospice ward will be needed for better nutrition management for terminally ill patients.

Heme Oxygenase-1 Induction and Anti-inflammatory Actions of Atractylodes macrocephala and Taraxacum herba Extracts Prevented Colitis and Was More Effective than Sulfasalazine in Preventing Relapse

BACKGROUND/AIMS: In inflammatory bowel disease (IBD), repeated bouts of remission and relapse occur in patients and can impose a risk of colitis-associated cancer. We hypothesized that plant extracts of Atractylodes macrocephala (AM) or Taraxacum herba (TH) may be better than sulfasalazine for treating this disease because these extracts can promote additional regeneration. METHODS: Murine intestinal epithelial IEC-6 cells were pretreated with AM or TH before a lipopolysaccharide (LPS)-induced challenge. Acute colitis was induced with 7 days of dextran sulfate sodium (DSS) in male C57BL/6 mice, and extracts of AM and TH were administered for 2 weeks before DSS administration. RESULTS: In vitro studies demonstrated that AM or TH treatment reduced LPS-induced COX-2 and tumor necrosis factor-α mRNA levels but increased heme oxygenase-1 (HO-1). Oral preadministration of AM and TH rescued mice from DSS-induced colitis by inhibiting inflammatory mediators via inactivated extracellular signal regulated kinase and repressed nuclear factor κB and signal transducer and activator of transcription 3, but the effect was weaker for sulfasalazine than that for the extracts. Anti-inflammatory activities occurred via the inhibition of macrophage and T lymphocyte infiltrations. Unlike sulfasalazine, which did not induce HO-1, TH extracts afforded significant HO-1 induction. CONCLUSIONS: Because the AM or TH extracts were far superior in preventing DSS-induced colitis than sulfasalazine, AM or TH extracts can be considered natural agents that can prevent IBD relapse.

Development of a Nutrition Quotient (NQ) equation modeling for children and the evaluation of its construct validity

The objective of this study was to develop and evaluate the construct validity of a Nutrition Quotient (NQ) for children. In a previous report (Kang, et al., 2012), the food behavior checklist for children's NQ, consisting of 19 items, was grouped into a 5-factor structure according to the exploratory factor analysis: balance, diversity, moderation, regularity, and practice. In this study, the construct validity of the NQ was assessed using a confirmatory factor analysis. Elementary school students (n = 1,393) from six large cities completed the NQ test. Indicator tests suggested an adequate model fit (goodness of fit index = 0.9613; adjusted GFI = 0.95; standardized root mean square residual = 0.0464; chi-square test statistics of < 0.001 p-value, 82.1), and item loadings were significant for all subscales (p < 0.05). The standardized path coefficients were used as the weights of the items. The NQ and the 5 factor scores of the student were calculated by the obtained weights of the questionnaire items. Logistic regression was applied to find the significant factors in order to affect a specific nutrient status. The receiver operation characteristic curve analyses were performed in order to find diagnostic cut-off points of the five factors. The food behavior checklist for children's NQ would be a handy and suitable instrument for evaluating dietary behaviors of Korean children.

Myxoma of Sphenoid Sinus

Myxomas are slow growing, locally infiltrative benign tumors derived from the connective tissue, and it is known never metastasize to distant organ. Generally myxomas arises in bone and soft tissue, most frequently in heart. Myxomas of head and neck area are extremely rare, and most of head and neck origined myxomas are odontogenic and generally are located in the mandible and maxilla. Actually sphenoid and ethmoid sinuses involvement is reported in few cases. So we present the case of a 48-year-old woman with myxoma of sphenoid sinus, which was removed by an endonasal approach. A case report of sphenoid myxoma and brief overview of the literature is presented.

Dietary factors related to hypertension risk in Korean adults-data from the Korean national health and nutrition examination survey III

Regional differences between large cities and rural areas are observed in the Korean National Health and Nutrition Examination Survey (KNHANES). This present study was conducted to evaluate the effect of dietary factors on hypertension risk in Korean populations, especially residents of the Chungcheong province which was not in metropolitan area, using KNHANES III. A total of 544 adults aged > or = 19 years were placed into either the normotensive or the hypertensive group. Subject characteristics, BMI, blood pressure, and nutrient intakes were compared between the two groups using a chi-square test and t-test. We estimated odds ratios (ORs) using multiple logistic regression, adjusted for energy intake and selected covariates. There were significant differences in age, education level, alcohol consumption, and BMI between the normotensive and hypertensive groups. We found decreased ORs for the medium versus lowest tertile of calcium intake (multivariate OR = 0.43, 95% CI: 0.21-0.88), for the highest versus lowest tertile of calcium intake (multivariate OR = 0.43, 95% CI: 0.20-0.90) with significant trends in risk (P = 0.040), and for the medium versus lowest tertile of potassium intake (multivariate OR = 0.43, 95% CI: 0.20-0.89). Subjects with the highest sodium/calcium ratio had a 2.10-fold greater risk of hypertension compared to the subject with the lowest, with significant trends in risk (P = 0.002). Adequate calcium and potassium intake should be encouraged and regional differences should be considered in making a healthy plan for hypertension management.

A comparison of food and nutrient intake between instant noodle consumers and non-instant noodle consumers in Korean adults

Instant noodles are widely consumed in Asian countries. The Korean population consumed the largest quantity of instant noodles in the world in 2008. However, few studies have investigated the relationship between instant noodles and nutritional status in Koreans. The objective of this study was to examine the association between instant noodle consumption and food and nutrient intake in Korean adults. We used dietary data of 6,440 subjects aged 20 years and older who participated in the Korean National Health and Nutrition Examination Survey III. The average age of the instant noodle consumers (INC) was 36.2 and that of the non-instant noodle consumers (non-INC) was 44.9; men consumed more instant noodles than women (P < 0.001). With the exception of cereals and grain products, legumes, seaweeds, eggs, and milk and dairy products, INC consumed significantly fewer potatoes and starches, sugars, seeds and nuts, vegetables, mushrooms, fruits, seasonings, beverages, meats, fishes, and oils and fats compared with those in the non-INC group. The INC group showed significantly higher nutrient intake of energy, fat, sodium, thiamine, and riboflavin; however, the INC group showed a significantly lower intake of protein, calcium, phosphorus, iron, potassium, vitamin A, niacin, and vitamin C compared with those in the non-INC group. This study revealed that consuming instant noodles may lead to excessive intake of energy, fats, and sodium but may also cause increased intake of thiamine and riboflavin. Therefore, nutritional education helping adults to choose a balanced meal while consuming instant noodles should be implemented. Additionally, instant noodle manufacturers should consider nutritional aspects when developing new products.

Relationship between dietary sodium, potassium, and calcium, anthropometric indexes, and blood pressure in young and middle aged Korean adults

Epidemiological evidence of the effects of dietary sodium, calcium, and potassium, and anthropometric indexes on blood pressure is still inconsistent. To investigate the relationship between dietary factors or anthropometric indexes and hypertension risk, we examined the association of systolic and diastolic blood pressure (SBP and DBP) with sodium, calcium, and potassium intakes and anthropometric indexes in 19~49-year-olds using data from Korean National Health and Nutrition Examination Survey (KNHANES) III. Total of 2,761 young and middle aged adults (574 aged 19~29 years and 2,187 aged 30~49 years) were selected from KNHANES III. General information, nutritional status, and anthropometric data were compared between two age groups (19~29 years old and 30~49 years old). The relevance of blood pressure and risk factors such as age, sex, body mass index (BMI), weight, waist circumference, and the intakes of sodium, potassium, and calcium was determined by multiple regression analysis. Multiple regression models showed that waist circumference, weight, and BMI were positively associated with SBP and DBP in both age groups. Sodium and potassium intakes were not associated with either SBP or DBP. Among 30~49-year-olds, calcium was inversely associated with both SBP and DBP (P = 0.012 and 0.010, respectively). Our findings suggest that encouraging calcium consumption and weight control may play an important role in the primary prevention and management of hypertension in early adulthood.

Effect of corn gluten and its hydrolysate consumptions on weight reduction in rats fed a high-fat diet

This study examined the effects of corn gluten (CG) and its hydrolysate consumptions on weight reduction in rats fed a high-fat diet. Eight-month-old male Sprague-Dawley rats (n=40) were fed a high-fat diet (40% calorie as fat) for 4 weeks. They were then randomly divided into four groups and fed the isocaloric diets with different protein sources for 8 weeks. The protein sources were casein (control group), intact CG (CG group), CG hydrolysate A (CGHA group, 30% of protein as peptides and 70% as free amino acids) and CG hydrolysate P (CGHP group, 93% of protein as peptides and 7% as free amino acids). Body weight gain, adipose tissue weights, nitrogen balance, absorptions of energy, protein and fat, lipid profiles in plasma, liver and feces and hepatic activities of carnitine palmitoyl transferase (CPT), fatty acid synthase (FAS), malic enzyme (ME) and glucose-6-phosphate dehydrogenase (G6PDH) were assessed. The CGHA diet had the highest amount of BCAAs, especially leucine, and most of them existed as free amino acid forms. The CGHA group showed significant weight reduction and negative nitrogen balance. Protein absorption and apparent protein digestibility in the CGHA group were significantly lower than those in other groups. Adipose tissue weights were the lowest in the CGHA group. Activity of CPT tended to be higher in the CGHA group than in other groups and those of FAS, ME and G6PDH were significantly lower in the CGHA group than in other groups. In conclusion, the CGHA diet which had relatively high amounts of free amino acids and BCAAs, especially leucine, had a weight reduction effect by lowering adipose tissue weight and the activities of FAS, ME and G6PDH in experimental animals, but it seemed to be a negative result induced by lowering protein absorption, increasing urinary nitrogen excretion and protein catabolism.

Effect of Dietary Iron Levels on Lipid Metabolism, Antioxidative and Antithrombogenic Capacities in 16-month-old Rats

This study was conducted to examine the effect of dietary iron levels on lipid metabolism, antioxidative and antithrombogenic capacities in 16-month-old rats. Thirty-two Sprague-Dawley male 16-month-old rats weighing 618 +/- 6 g were raised for 10 days with medium-iron diet (35 ppm in diet) and blocked into 4 groups according to their body weights. One of groups was sacrificed to obtain initial data and the rest 3 groups were raised for 3 months with experimental diets containing different levels of iron (5 ppm, 35 ppm, and 350 ppm). Total lipid, triglyceride and total cholesterol concentrations in plasma and liver, HDL-cholesterol concentration in plasma, fecal total lipid triglyceride and total cholesterol excretions, thiobarbituric acid reactive substances (TBARS) level in plasma LDL + VLDL (low density lipoprotein + very low density lipoprotein) fractions, blood-clotting time and eicosanoids levels in plasma were measured. The results are as follows: Plasma total lipid, triglyceride and total cholesterol concentrations, TBARS level in plasma LDL + VLDL fractions were increased and blood-clotting time tended to be shortened during 3 months of experimental period. Low (5 ppm) iron diet improved lipid metabolism via increasing HDL-cholesterol and fecal cholesterol excretion. High (350 ppm) iron diet decreased plasma total lipid, triglyceride and total cholesterol concentrations as compared to medium (35 ppm) iron diet and lowered body weight and epididymal fat pad weight. On the other hand, TBARS level in plasma LDL + VLDL fractions and blood-clotting time were increased with high iron diet. It is plausible that low iron diet improves lipid metabolism, antioxidative and antithrombogenic capacities in 16-month-old rats.