Nutritional Intervention for a Patient with Laparoscopic Sleeve Gastrectomy for Morbid Obesity: a Case Report

Nutritional intervention for individual patients has a wide range of postoperative food adaptability, so an individual evaluation is required. The medical institution intends to examine the contents of nutritional arbitration conducted on patients who underwent gastric surgery, examine the results, identify the nutritional problems that can be seen through the course of the patient's meal process, and share the clinical experience. In this case study, a 46-year-old female patient was diagnosed with morbid obesity, impaired fasting glucose and hypertension. She was 153 cm tall and weighed 88 kg, with a body mass index 37.6 kg/m2 at initial evaluation. The patient maintained normal biochemical data before and after surgery and shows postoperative weight loss, body fat reduction, and abdominal fat reduction. In this case, blood sugar and blood lipid levels improved after weight loss. The repeated nutritional intervention for a sleeve gastrectomy patient, which is performed by clinical dietitians, is as follows. A balanced diet, supplemented with vitamins and minerals, is very important for preventing nutritional complications after obesity surgery. In conclusion, for stomach surgery patients, a multidisciplinary approach and continuous nutritional management, motivation for weight loss, postoperative dietary adaptation, and individual access to patients are most important.

Understanding for Adequate Health Functional Foods for Diabetes Educators / 임상당뇨병

Recently, increasing interest in health care is boosting demand for products such as immuno-enhanced products and vitamins. There is a large selection of health functional foods for use by diabetics. Diabetic patients may learn about health functional foods from people around them, internet, and TV. Therefore, diabetic educators need to impart a good understanding of health functional foods so patients do not use them indiscriminately. It is important for diabetic educators to specifically ask patients about the use of healthy functional foods in their consultations. In addition, diabetic educators should provide knowledge on the efficacy of health functional foods and the desirable information.

Effects of intensive nutrition education on nutritional status and quality of life among postgastrectomy patients

PURPOSE: We examined the effects of 3 months of intensive education (IE) after hospital discharge compared to conventional education (CE) on nutritional status and quality of diet and life among South Korean gastrectomy patients. METHODS: The study was conducted among 53 hospitalized gastrectomy in-patients (IE group, n = 28; CE group, n = 25) at Kyung Hee University Hospital at Gangdong. Baseline data were collected from electronic medical records and additional information was gathered via anthropometric measurements, assessment of nutritional status through a patient-generated, subjective global assessment (PG-SGA), diet assessment, and measures of self-efficacy and satisfaction with meals for 3 months following hospital discharge. RESULTS: Total PG-SGA scores were significantly higher in the CE group than in the IE group at 3-week post-discharge (5.2 in the IE group vs. 10.4 in the CE group, P < 0.001), with higher scores indicating a greater severity of malnutrition. Energy intake over the 3 months increased in both the IE group (from 1,390 to 1,726 kcal/day) and the CE group (from 1,227 to 1,540 kcal/day). At 3-week post-discharge, the IE group had significantly higher daily protein and fat intake (P < 0.05). Self-efficacy improved in each category (P < 0.001), except for 'difficulty eating adequate food'. When assessing satisfaction with meals, there was a difference in the 'satisfaction with the current meal size' (P < 0.001) and 'satisfaction with the menu content' (P < 0.001). CONCLUSION: Nutritional status among gastrectomy patients in the IE group improved. Relative to the CE control, the IE group demonstrated improved self-efficacy and meal satisfaction 3-week post-discharge.

Influence of Shorter Duration of Prophylactic Antibiotic Use on the Incidence of Surgical Site Infection Following Colorectal Cancer Surgery

PURPOSE: This study aimed to identify the risk factors for surgical site infections (SSIs) in patients undergoing colorectal cancer surgery and to determine whether significantly different SSI rates existed between the short prophylactic antibiotic use group (within 24 hours) and the long prophylactic antibiotic use group (beyond 24 hours). METHODS: The medical records of 327 patients who underwent colorectal resection due to colorectal cancer from January 2010 to May 2014 at a single center were retrospectively reviewed, and their characteristics as well as the surgical factors known to be risk factors for SSIs, were identified. RESULTS: Among the 327 patients, 45 patients (13.8%) developed SSIs. The patients were divided into two groups according to the duration of antibiotic use: group S (within 24 hours) and group L (beyond 24 hours). Of the 327 patients, 114 (34.9%) were in group S, and 213 (65.1%) were in group L. Twelve patients (10.5%) in group S developed SSIs while 33 patients (15.5%) in group L developed SSIs (P = 0.242). History of diabetes mellitus and lung disease, long operation time, and perioperative transfusion were independent risk factors for SSIs. CONCLUSION: This study shows that discontinuation of prophylactic antibiotics within 24 hours after colorectal surgery has no significant influence on the incidence of SSIs. This study also showed that history of diabetes mellitus and lung disease, long operation time, and perioperative transfusion were associated with increased SSI rates.

Nutritional Intervention Using Nutrition Care Process in a Malnourished Patient with Chemotherapy Side Effects

In this case study, the process of nutritional diagnosis and intervention conducted at a hospital on a malnourished patient who underwent treatment for a chronic illness (chemotherapy for cancer treatment) was recorded. The patient received his first round of chemotherapy for colorectal cancer, and then a second round after the cancer metastasized to the liver. The patient was malnourished and had experienced weight loss (17% loss in the most recent 3 months) due to side effects of chemotherapy including stomatitis, nausea, and vomiting. Nutritional diagnosis and intervention via the nutrition care process were implemented through two screening rounds, and the quantity of oral intake increased from 28% to 62% of the recommended daily intake. The patient required continuous monitoring and outpatient care after hospital discharge. It is speculated that if a more active patient education and dietary regimen with respect to chemotherapy side effects had been offered after the patient's first chemotherapy cycle, it might have been possible to treat ingestion problems due to stomatitis during the second cycle of chemotherapy and prevent the weight loss. Henceforth, patients receiving chemotherapy should be educated about nutrition management methods and monitored continuously to prevent malnutrition.

Decreased Intermuscular Adipose Tissue due to Caloric Restriction in Obese Korean Women

BACKGROUND: This study investigated the effects of caloric restriction on thigh intermuscular adipose tissue (IMAT) and the associations of IMAT and metabolic risk factors. METHODS: Thirty-three obese Korean women (BMI 27.2+/-2.5 kg/m2; 32.3+/-8.7 years) were tested before and after 12 weeks of 354.7 kcal/day dietary caloric restriction: waist circumference (WC); %fat according to bioimpedence; subcutaneous adipose tissue (SAT); visceral adipose tissue (VAT); IMAT using single-slice CT scans at the levels of L4/L5 and mid-thigh (midpoint between the anterior iliac crest and patella); fasting levels of leptin, glucose, insulin, triglycerides, total-C, LDL-C, HDL-C, and HOMA-IR. Paired t-test and Spearman correlation analysis were performed. RESULTS: WC, %fat, leptin, glucose, total-C, abdominal SAT and VAT, and mid-thigh IMAT decreased (P<0.05), and %change in mid-thigh IMAT correlated with %change in HOMA-IR (P<0.05). CONCLUSION: Caloric restriction decreased the mid-thigh IMAT in obese Korean women, which may be correlated with reduction of metabolic risk.

Moderate diet-induced weight loss is associated with improved insulin sensitivity in middle-aged healthy obese Korean women

BACKGROUND/OBJECTIVE: The goal of the present study was to investigate the effects of moderate caloric restriction on beta-cell function and insulin sensitivity in middle-aged obese Korean women. SUBJECTS/METHODS: Fifty-seven obese pre-menopausal Korean women participated in a 12-week calorie restriction program. Data on total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), and fasting serum levels of glucose, insulin, C-peptide, blood pressure, leptin and anthropometrics were collected. A dietary intake assessment was based on three days of food recording. Additionally, beta-cell function [homeostasis model assessment of beta-cell (HOMA-beta), insulinogenic index (ISI), C-peptide:glucose ratio, and area under curve insulin/glucose (AUCins/glu)] and insulin sensitivity [homeostasis model assessment for insulin resistance (HOMA-IR), Quantitative insulin-sensitivity check index (QUICKI) and Matsuda index (MI)] were recorded. RESULTS: When calories were reduced by an average of 422 kcal/day for 12 weeks, BMI (-2.7%), body fat mass (-10.2%), and waist circumference (-5%) all decreased significantly (P < 0.05). After calorie restriction, weight, body fat percentage, hip circumference, BP, TC, HDL-C, LDL-C, plasma glucose at fasting, insulin at fasting and 120 min, AUCglu and the insulin area under the curve all decreased significantly (all P < 0.05), while insulin sensitivity (HOMA-IR, QUICKI and Matsuda index) measured by OGTT improved significantly (P < 0.01). CONCLUSIONS: Moderate weight loss due to caloric restriction with reduction in insulin resistance improves glucose tolerance and insulin sensitivity in middle-aged obese women and thereby may help prevent the development of type 2 diabetes mellitus.

The association between measurement sites of visceral adipose tissue and cardiovascular risk factors after caloric restriction in obese Korean women

Quantities as well as distributions of adipose tissue (AT) are significantly related to cardiovascular disease (CVD) risk factors and can be altered with caloric restriction. This study investigated which cross-sectional slice location of AT is most strongly correlated with changes in CVD risk factors after caloric restriction in obese Korean women. Thirty-three obese pre-menopausal Korean women (32.4 +/- 8.5 yrs, BMI 27.1 +/- 2.3 kg/m2) participated in a 12 weeks caloric restriction program. Subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were measured using computed tomography (CT) scans at the sites of L2-L3, L3-L4, and L4-L5. Fasting serum levels of glucose, insulin, triglyceride, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), leptin and homeostasis model assessment-insulin resistance (HOMA-IR) were observed. Pearson's partial correlation coefficients were used to assess the relationship between AT measurement sites and changes in CVD risk factors after calorie restriction. When calories were reduced by 350 kcal/day for 12 weeks, body weight (-2.7%), body fat mass (-8.2%), and waist circumference (-5.8%) all decreased (P < 0.05). In addition, following caloric restriction, serum levels of glucose (-4.6%), TC (-6.2%), LDL-C (-5.3%), leptin (-17.6%) and HOMA-IR (-18.2%) decreased significantly (P < 0.05) as well. Changes in VAT at the level of L3-L4 were significantly greater than those at other abdominal sites, and these changes were correlated with changes in TC (P < 0.05), LDL-C (P < 0.001), SBP (P < 0.001) and HOMA-IR (P < 0.01). These results show that VAT at L3-L4 had a stronger correlation with CVD risk factors than with other AT measurement sites after caloric restriction.

Nutrition Assessment of Older Subjects in a Health Care Center by MNA (Mini Nutritional Assessment)

Elderly people comprise an increasing proportion of the population, and nutritional impairments may contribute to health problems among this group. This study was conducted to evaluate the nutritional status by Mini-Nutritional Assessment (MNA) and to identify relationships among anthropometric measurements, biochemical indicators, bone Mineral Density (BMD) and MNA results among older adults (> or =65 yrs, n=98, 66.7+/-2.5 yrs; M=52, F=46, BMI 24.5+/-2.8 kg/m2) at a Health Care Center. A dietitian administered MNA and collected anthropometric measurements (weight, height, waist circumference), biochemical indicators (albumin, hemoglobin, hematocrit, TLC, glucose, lipids) and the BMD (spine, femur, F=46). Subjects were grouped into a normal nutrition group (0~2 risk factors of malnutrition) and a high risk of malnutrition group (>=3 risk factors of malnutrition) based on their risk factor status for malnutrition. The risk factors for malnutrition include age > or =65 years, PIBW <90%, albumin <3.5 g/dl, TLC <1,500%, Hgb <14 g/dl (men), Hgb <10 g/dl (women), loss of appetite and weight loss 1~3 kg/last 3 months. In addition, subjects were grouped into a normal, osteopenia and osteoporosis group by BMD. We found that 12% of the subjects were at risk of malnutrition (MNA score, 21.4+/-2.1) and that 88% were well nourished (27.3+/-1.5) according to the MNA. Full-MNA scores were positively and significantly (p<0.05) associated with BMI, mid-arm circumference (MAC), calf circumference (CC), albumin and hemoglobin, respectively. The full-MNA score of the high risk of malnutrition group (23.0+/-3.8) was lower than that of the normal nutrition group (27.0+/-2.1) (p<0.05). In addition, the Full-MNA score was negatively associated with the risk factor of malnutrition (r=-0.35, p=0.0004). We found that 39.1% of the subjects had osteoporosis, 45.7% had osteopenia and 15.2% were normal according to their BMD. The MNA score of osteoporosis group (24.58+/-3.3) was lower than that of the normal (27.4+/-1.1) and osteopenia group (26.9+/-1.5) (p<0.05). These results suggested that MNA can be useful as a nutritional screening tool of older adults in Health Care Centers.

Effects of Nutrition Counseling on Quality of Diet, Iron Status and Hematic Parameters in College Women Who Have Self-Recognized Anemic Symptoms / 대한지역사회영양학회지

Iron deficiency is the most common nutritional problem that affects people of all ages in both industrialized and developing countries. Especially, college women are the target population for dietary iron deficiency. Recent study showed that the nutritional status of college women was poor because of insufficient food consumption and repeatabled weight reduction. The purpose of this study was to investigate the effects of nutrition counseling on the diet quality, nutritional status of iron and hematic parameters in college women who have self-recognized anemic symptoms. Anthropometric and dietary assessments as well as blood analysis, were carried out before and after the 8 weeks of nutrition counseling. During the experimental period, the 31 subjects were given nutrition education by a clinical dietitian. Nutrition counseling consisted of pathology of anemia, nutrition information for iron deficient anemia, diet information of balanced meals and menu choices for eating out. As a result, the frequencies of consumption of legumen and vegetables significantly increased after nutrition counseling (p < 0.05). Daily intakes of protein, especially animal protein, vitamin E, niacin, heme iron, and zinc significantly increased (p < 0.05). After nutrition counseling, some self-reported clinical symptoms such as 'dizziness', 'fatigue', 'short of breath', 'headache', 'sleeplessness', and 'beating heart' were significantly improved. Serum levels of transferrin (p < 0.01) and total iron binding capacity levels (p < 0.05) significantly increased. It could be concluded that the 8 weeks of nutrition counseling might be effective on quality of diet as well as iron status and it might also improve the some hematic parameters in college women who have self-recognized anemic symptoms.

The Effects of Soy-Based Infant Formula on Growth and Development, and the Isoflavone Concentration of Plasma and Urine in Full-Term Infants

Soy-based formula has been used for centuries in Korea. Soybeans contain phytochemicals with a biochemically active component, isoflavone. Isoflavone is a kind of phytoestrogens, structurally and functionally similar to estrogen. This study was conducted to investigate the effects of soy-based infant formula on growth, development, and isoflavone concentration in the plasma and urine. Thirty-nine healthy infants who were delivered at K university medical center were recruited. Experimental groups were the breast milk group (n = 15, BM) who were fed breast milk, soy-based formula group (n = 10, SBF) who were fed soy-based infant formula, and the casein-based formula group (n = 14, CBF) who were fed casein-based infant formula for 4 months. HPLC analysis was used to measure the concentration of isoflavones. The measurements of infant weight, length, head circumference and chest circumference were all in the normal growth range and were similar among the experimental groups. No significant differences were found in the scores of total mean of infant development test (Development Quotient, DQ) among the experimental groups. The isoflavone content of soy-based formula was significantly higher than. that of breast milk and casein-based formula. Plasma concentration of daidzein and genistein in the infants fed soy-based formula (daidzein : 264.1 ng/ml, genistein : 392.1 ng/ml) was significantly higher (p<.0001) than that in infants fed breast milk (daidzein : 3.4 ng/ml, genistein : 3.8 ng/ml) and casein-based formula (daidzein: 8.1 ng/ml, genistein: 9.3 ng/ml). Also, urinary daidzein and genistein concentrations in infants fed soy-based formula (daidzein: 19.82 microgram/ml, genistein : 17.89 microgram/ml) were significantly higher (p<.001) than those in infants fed breast milk (daidzein: 0.28 microgram/ml, genistein : 0.22 microgram/ml) and casein-based formula (daidzein : 0.45 microgram/ml, genistein : 0.33 microgram/ml).

The Effects of Soy Milk Supplement on Isoflavone Concentration of Breast Milk, Plasma and Urine from Breast Feeding Woman

Soybeans have been a major protein source for many centuries in Korea. Soybeans contain phytochemicals which are isoflavones, biochemically active component. Isoflavone is a kind of phytoestrogen, structurally and functionally similar to estrogen. It has been reported that the breast milk and blood of breast feeding mothers who consume soy products contain isoflavones. This study was conducted to investigate the effects of soy milk supplement on the isoflavones (daidzein, genistein) concentration of breast milk, plasma and urine from breast feeding woman. Seventeen healthy women who delivered at Kyung Hee Medical Center were recruited. For the first 2 weeks after delivery, seventeen women ingested 400 ml (isoflavone 43.2 mg) of soy milk on the given time starting from the day of giving birth. For the next 2 weeks, soy milk ingestion was withdrawn. Dietary intake and anthropometric data were checked and breast milk, blood, and 24 hr urine samples were collected on the day of giving birth, the 14th (the last day of the supplement phase) and 28th (the last day of the withdrawal phase) day, respectively. HPLC analysis was used to measure the concentration of isoflavones. Dietary intakes of the subjects were inadequate for the Korean RDA regardless of soy milk supplementation. Especially, intakes of vit A, calcium, and iron were very low. The Anthropometric data such as LBM, TBW, PIBW, BMI checked on the day of 14th decreased and maintained their levels by the 28th day. Daidzein concentration in breast milk was not affected by soy milk supplementation. However, genistein concentration decreased by the 28th day (14th day: 0.89 +/- 0.10 microgram/ml, 28th day : 0.48 +/- 0.07 microgram/ml) (p<0.05). Plasma daidzein and genistein concentrations were not changed by the 14th day and decreased by the 28th day (14th day: 49.64 +/- 3.30 ng/ml, 26.72 +/- 2.90 ng/ml, 28th day: 38.30 +/- 4.40 ng/ml, 6.51 +/- 0.50 ng/ml, respectively) (p<0.05). Twenty four hour urine concentrations of daidzein and genistein significantly increased by the 14th day and decreased by the 28th day (14th day: 5.80 :t 0.3 mg/d, 4.17 +/- 0.2 mg/d, 28th day: 6.72 +/- 0.4 mg/d, 5.09 +/- 0.5 mg/d, respectively) (p<0.001). The rate of urinary recovery of daidzein was greater than that of genistein. The results of this study indicate that the supplement of dietary soy milk to the lactating women elevates the contents of isoflavone in the breast milk.

A Study on the Food Habits, Nutrient Intake and the Disease Distribution in the Elderly (Aged over 65 Years)(I) / 대한지역사회영양학회지

The purpose of this study was to investigate the food habits, nutrient intake, and disease distribution in the elderly (aged over 65 years). The correlation of diseases with anthropometric measurements and nutrients was investigated. The correlation of blood parameters with anthropometric measurements and nutrient intake was also studied. The results are as follow: 1) Most elderly men (68.6%) and women (81.6%) had more than three diseases. The food habits of the elderly women were worse than those of the men. Their intake of protein, calcium, iron, vitamin A, and vitamin B2 were lower than the RDA for those particular nutrients. 2) The incidence of gastritis (51.2%), fatty liver (46.4%), and hypertension (45.2%) were the highest among elderly men and women. 3) Anemia was negatively correlated with body weight. Hypercholesterolemia was positively correlated with body fat and negatively correlated with intake of calcium, vitamin A, and vitamin B2. Hypertension was negatively correlated with alcohol consumption. 4) Blood total cholesterol concentration was positively correlated with percent ideal body weight (% IBW). Blood hemoglobin level was positively correlated with Body Mass Index (BMI). Systolic and diastolic blood pressure were positively correlated with % IBW and BMI. Blood cholesterol concentration was negatively correlated with the intake of iron, vitamin A, vitamin B2, and cholesterol, and positively correlated with the consumption of alcohol. Blood hemoglobin level was positively correlated with the intake of total calories, carbohydrates, fat, protein, iron, vitamin B2, phosphorus, cholesterol, salt, and alcohol.