Patients with heart failure (HF) need nutritional management such as sodium restriction and healthy eating habits to relieve symptoms and to manage chronic disease. This case study examined 3 patients who had different nutritional problems and responded positively to the nutrition management program. Patient 1 and 2 had high levels of energy intake and were obese. Patient 1 had a habit of irregular binge eating and frequently consumed sweetened snacks and fast foods. He was advised to eat regular 3 meals per day with balanced food choices. He decreased his energy consumption to the recommenced intake and his body mass index had dropped to 22.9 kg/m2 by his second follow-up visit. Patients 2 ate 3 meals regularly but ate a large amount of food. Although he decreased his energy intake to 97% of the recommended intake, he should be advised to increase his protein intake at the 1st follow-up session because he decreased his protein intake less than 90% of the recommended amount. Patient 3 reduced food intake by half due to dyspnea caused by HF before hospitalization, but symptoms improved after discharge and his energy as well as sodium intake increased. In the second follow-up, his nutritional diagnosis was excessive sodium intake and nutritional intervention was performed to reduce sodium intake. This study showed that additional nutritional problems might arise throughout the nutritional intervention process. Therefore, follow-up nutritional counseling should be held to evaluate the compliance with the nutrition management guidelines and to decide whether additional nutrition problems are suggested.
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Gastroesophageal reflux disease (GERD) is closely related to respiratory issues. We reported the case about the nutrition intervention given to a male infant with congenital bronchomalacia, GERD, and recurrent pneumonia. During the first and second pediatric intensive care unit (PICU) stays, his nutrition status and nutrient intake were good. However, during the 18 days of the third PICU admission, his nutrient intake decreased to 75%–80% of his estimated calorie requirement and his Z-score for weight-for-age dropped to −1.4. We conducted nutritional interventions to improve GERD symptoms and nutritional status include avoiding overfeeding by feeding small amounts frequently, using a pre-thickened formula mixed with a high-calorie formula, and feeding through transpyloric tube. As a result, his daily nutrient intakes gradually increased and his Z-score for weight-for-age was normal. In conclusion, it is important to implement individualized intensive nutritional management to ensure adequate nutrition and growth status in infants with lung disease and GERD.
Although parenteral nutrition (PN) is an important treatment for patients who are unable to tolerate enteral nutrition (EN), recent international guidelines recommended that PN should be reserved and initiated only after 7 days in well-nourished patients. This retrospective study was conducted to analyze the effect on clinical outcomes of a PN protocol with PN starting 4 days after admission to the intensive care unit (ICU). Eighty-one patients who were admitted from January to March of 2012 were included in the pre-protocol group, and 74 patients who were admitted from April to June of 2012 were included in the post-protocol group. There were no significant differences between the two groups when the age, gender, and admission Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared. Significantly fewer patients in the post-protocol group were provided PN (58.1% vs. 81.3%, p = 0.002), which was initiated significantly later than in the pre-protocol group (2.7 ± 2.2 days vs. 1.9 ± 2.0 days, p = 0.046). Five patients (6.2%) in the pre-protocol group acquired central line-associated bloodstream infection (CLA-BSI) in the ICU, yet none of the patients in the post-protocol group developed CLA-BSI (p = 0.03). The duration of antibiotic therapy and ICU stay were significantly shorter in the post-protocol group than in the pre-protocol group. By delaying initiation of PN, short-term clinical outcomes including incidence of CLA-BSI, antibiotic use, and ICU stay might be improved. Further research should be conducted to investigate the long-term effects of the decreased nutrient intake resulting from delayed PN.
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As an adjunct to cancer treatment, the use of health functional foods (HFFs) seems to be increasing. However, little is known for the use of HFFs among cancer patients in Korea. The aims of this study were to investigate the exposure rate of HFF use among gastrointestinal (GI) cancer patients and to examine the relationship of socio-demographic and disease-related characteristics with the use of HFFs. A total of 126 patients diagnosed with GI cancer participated in the study. A cross-sectional survey was conducted using a questionnaire. Over a half of all the patients surveyed (n = 67; 53.2%) used HFFs. Patients who were younger, had higher income, or longer duration of disease showed a trend to use HFFs more frequently, even though the tendency was not statistically significant. The most commonly used HFF was vitamin complex (n = 20; 16%), followed by red ginseng (n = 15; 12%), and sweet wormwood (Artemisia annua) (n = 11; 8.8%). About 26% of all responders expressed concerns for using HFFs. The primary concern was 'going against physician's recommendations' (36.8%). About 63% of respondents expressed a desire to consult with their physicians and follow their recommendations. More basic scientific data and educational materials regarding HFFs are required for both health-care professionals and cancer patients. A larger sample and size-controlled groups representing each cancer type will continue to be recruited for participation in this survey.
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This retrospective study was conducted to determine whether increased length of hospital stay (LOS) and mortality are associated with nutritional risk upon hospital admission in gastrointestinal cancer patients, using a computerized screening tool developed by a university hospital. We included adult gastrointestinal cancer patients whose hospital stays ranged from 24 hours to 90 days. The sample included 4,345 patients. The average age of the patients was 60.5 ± 11.4 years and 2,959 (68.1%) were males. The mean of LOS was 8.2 ± 8.2 days and the mortality rate was 3.4% (n = 146). The majority of the patients were at low risk (LG) (n = 3,102 [71.4%]), while 779 patients (17.9%) were at moderate risk (MG), and 464 (10.7%) were at high risk (HG). In comparing the three groups based on nutritional risk, hospital LOS was significantly longer in the HG (11.4 ± 11.4 days) than it was in the LG (7.7 ± 7.9 days) and the MG (7.9 ± 7.9 days) (p < 0.0001). Significant differences were found in the hospital mortality rate, which was the highest in the HG (13.6%) and the lowest in the LG (1.5%) (p < 0.0001). In the multiple logistic regression analysis, moderate-to-severe nutritional risk, increased age, and emergency admission were selected as significant variables for increased LOS and mortality. Further research is needed to evaluate the benefits of nutritional screening and intervention and their effect on outcomes in various disease populations.
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