This study evaluated the effects of replacing skipped meals with oral nutritional supplements (ONS) on the nutritional status and functional health of older adults. A total of 29 participants aged ≥ 65 years who regularly skipped at least one meal per day were included in this single-arm study. For 8 weeks, participants consumed two packs of ONS daily (150 mL each, providing 400 kcal and 18 g of protein) as a substitute for skipped meals. Nutritional status, nutrient intake, body composition, and physical function were assessed before and after the intervention. The Nutrition Quotient for the Elderly score significantly increased from 58.97 to 63.62 (p = 0.014). Total nutrient intake, including ONS, significantly improved compared with baseline (p < 0.01). Body weight and body mass index increased significantly from 58.87 to 59.47 kg (p = 0.028) and from 23.9 to 24.18 kg/m2 (p = 0.016), respectively. Calf circumference decreased significantly from 34.1 to 33.39 cm (p = 0.010). Physical function, assessed using the Short Physical Performance Battery, showed significant improvement (p = 0.003). In conclusion, replacing skipped meals with ONS may enhance nutritional status and support functional health in older adults.
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We investigated adolescents’ perceptions of meat alternatives and examined the relationships among their views on various types of these alternatives. A survey was conducted with 372 middle and high school students, focusing on their perceptions of 3 categories of meat alternatives: plant-based meats, edible insects, and cultured meats. The relationships among these perceptions were subsequently analyzed. Overall, 77.4% of respondents were aware of meat alternatives, and 38.7% reported having consumed them. Perception levels differed by category, with plant-based meats receiving the highest scores, followed by cultured meats and edible insects. Notably, perceptions across the different categories of meat alternatives were significantly correlated. These findings suggest that increasing awareness about meat alternatives—particularly through education—may help promote sustainable and healthy eating behaviors among adolescents.
Malnutrition is prevalent among older patients, leading to increased morbidity, prolonged hospitalization, and diminished quality of life. The Comprehensive Geriatric Assessment (CGA) facilitates the evaluation of multifaceted health issues, enabling individualized nutritional interventions. This case report describes nutritional management guided by CGA in a 75-year-old female hospitalized for severe hypernatremia with significant malnutrition and high-risk for refeeding syndrome. Upon admission, CGA identified multiple comorbidities, cognitive impairment, and complete dependence on caregivers for daily activities. Due to persistent refusal of oral intake, enteral nutrition (EN) was cautiously initiated at 25% of the target energy requirement, with close monitoring of electrolyte levels. Despite an initial decrease in phosphorus levels suggestive of refeeding syndrome, gradual advancement of nutritional support successfully stabilized her clinical condition. Following discharge, structured caregiver education was provided to support EN at home; however, suboptimal intake persisted due to gastrointestinal intolerance, resulting in weight loss. Post-discharge follow-ups identified feeding rate-related symptoms, necessitating formula adjustments and caregiver re-education. This case emphasizes the critical role of CGA in early malnutrition detection, individualized nutritional intervention, prevention of refeeding syndrome, and the importance of continuous post-discharge monitoring and caregiver education. Although the findings are limited by the single-case design, proactive CGA-based nutritional interventions remain crucial for optimizing clinical outcomes in older patients hospitalized due to acute medical problems. Further research involving larger samples and prolonged follow-up periods is required to validate the long-term benefits of CGA-based nutritional intervention.
The primary aim of this study was to evaluate the value of predictive equation (PE) standard care compared with indirect calorimetry (IC)-based nutrition therapy. The secondary aim was to compare the results among 3 groups to assess the accuracy of IC and PE. This was a single-center, retrospective study of patients admitted to the neurosurgery (NS) intensive care unit (ICU), from January 2019, to August 2020. Anthropometric, biochemical, clinical, and dietary data were collected from NS ICU admission to discharge. If patients had an IC: PE ratio of 90%–110%, they were classified into the optimal estimation group (OEG); if the ratio was < 90%, they were classified into the underestimation group (UG); and if the ratio was > 110%, they were classified into the overestimation group (OG). There were no significant differences in anthropometric, biochemical, clinical data and nutrition assessment between baseline and discharge from the NS ICU. The OEG showed a larger cumulative caloric deficit rate compared to UG and OG, though this difference was not statistically significant. There was a negative association between calf circumference (CC) and length of stay (LOS). Repeated measures of CC showed a significant difference according to LOS and groups (p < 0.001). Anthropometric, biochemical, clinical, and dietary data of 77 NS patients were analyzed to determine the effectiveness of concordance between IC and PE. The UG and OG showed a significant decrease in CC during hospitalization, but CC in the OEG was maintained or increased from 4 weeks onward.
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Nutrition fact labels (NFLs) are a simple way to help people improve their nutritional intake by making healthier food choices. This study aimed to evaluate NFL use and eating habit changes among quarantined and hospitalized coronavirus disease 2019 (COVID-19) patients during the pandemic. This cross-sectional study used data from the 2019 and 2020 Korean Community Health Surveys (KCHSs). Data were collected from 229,099 subjects in 2019 and 229,269 subjects in 2020. In the 2020 KCHS, data from 1,073 COVID-19 patients were included. NFL use was divided into 4 categories based on a questionnaire: affect, read, aware, and never heard. Among COVID-19 patients, 32.15% reported that they had not heard of NFLs (never heard group) compared to 44.36% of the healthy population (p < 0.001). A total of 35.1% of COVID-19 patients who reported daily life change scores of 20 or less were in the affect group compared to 23.8% of healthy subjects. In the affect group, the proportion of respondents who reported increased consumption of delivered food was 38.7% in the COVID-19 group, which was 17.1% higher than that in the never heard group (Cramér’s V = 0.257; p < 0.001). Respondents with increased consumption of fast food/soda showed a higher ratio of having never heard of NFLs among healthy subjects (28.5%) than among COVID-19 patients (22.5%; p = 0.043). Confirmed COVID-19 infections and more unfavorable daily life changes due to COVID-19 led to increased nutritional information seeking and NFL use.
Following up with recovered coronavirus disease 2019 (COVID-19) patients is necessary. Given the importance of psychological function accompanied by significant effects of food quality, we want to examine the association between food quality score (FQS) and mental disorders among recovered COVID-19 patients. This case-control study was performed on 246 eligible adults. A validated food frequency questionnaire (FFQ) was used to evaluate dietary intake. We using Depression Anxiety Stress Scales, Insomnia Severity Index, Pittsburgh Sleep Quality Index, and 36-Item Short Form Health Survey questionnaires to evaluate the psychological function. Logistic regression analysis was conducted to estimate the odds ratio (OR) and 95% confidence intervals (CIs) for score categories of the FQS index and psychological function in multivariate-adjusted models. Only in case subjects, we found significant associations between adherence to the FQS diet and depression, anxiety, and stress in the crude model (OR, 0.796, 95% CI, 0.661–0.958, p = 0.016; OR, 0.824, 95% CI, 0.707–0.960, p = 0.013; OR, 0.824, 95% CI, 0.709–0.956, p = 0.011, respectively). These associations remained significant in all two adjusted models. However, no significant associations were found between FQS and psychological functions in the control group. Our data suggests that overall food quality intake is associated with depression, anxiety, and stress symptoms during the post-infection period. Also, adequate daily intakes of fruits, legumes, nuts, and whole grains are associated with reduced risks of psychological impairment and sleep disorders which are common among recovered patients.
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Calcium plays a major role in apoptosis, cell proliferation, and various cellular mechanisms. It is also essential for the function of the pancreas. However, the association between calcium intake and pancreatic cancer is not clear. This study aims to clarify the links between calcium intake and pancreatic cancer risk using a systematic review and meta-analysis of observational studies. PubMed, Web of Science, Scopus, and Google Scholar were searched for eligible articles published through 31 August 2023. Case-control and cohort studies reporting the association between dietary and/or supplemental calcium intake and risk of pancreatic cancer using relative risk (RR), hazard ratio (HR), or odds ratio (OR) with 95% confidence interval (CI) were included. Meta-analysis using a random effect model was used to estimate the significance of the association. Eight studies were included. An inverse association between total calcium intake (dietary and supplement) and pancreatic cancer risk (RR, 0.83; 95% CI, 0.72–0.97; I2 = 0%) was observed. However, the association between dietary calcium intake alone and pancreatic cancer risk did not reach a statistically significant level (RR, 0.91; 95% CI, 0.78–1.06; I2 = 48%). Higher total calcium intake may reduce the risk of pancreatic cancer but the difference between sources of calcium (dietary vs. supplementation) requires further investigation. Also, due to the heterogeneity between the articles, the results of this study should be interpreted with caution.
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Nutrition support is an essential aspect of treatment after bariatric surgery (BS). A high-protein diet with an intake of up to 1.5 g/kg of ideal body weight (IBW) per day is recommended to minimize loss of lean body mass after BS. However, protein intake recommendations may need to be adjusted for patients with compromised renal function, necessitating an individualized approach tailored to each patient’s clinical status. This case report aimed to demonstrate nutritional evaluation, education, and counseling for a male patient with chronic kidney disease (CKD) who underwent BS one year after surgery. Following BS, the patient adhered to the standard Seoul National University Hospital BS diet protocol. Considering his postoperative renal function, protein requirement was set at 1.0 g/kg of IBW. A total of 10 individualized nutritional counseling sessions were conducted according to renal function and complications. One year after BS, he successfully lost weight with % excess weight loss of 93%, maintained CKD stage 3, reduced prescription of oral hypoglycemic agent, improved glycated hemoglobin levels, and improved eating habits significantly. Thus, individualized nutrition intervention is important for supporting patients with CKD to reach their goal weight after BS, improve nutritional status, and prevent post-operative complications.
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Meta-analyses have been conducted with conflicting results on this topic. Due to missing several eligible studies in previous meta-analysis by Lam et al., we conducted an extensive systematic review and dose-response meta-analysis of randomized controlled trials in this regard. A comprehensive search was conducted across various databases, including MEDLINE/PubMed, ISI Web of Knowledge, Scopus, and Google Scholar, until November 2023. Based on the analysis of 33 studies comprising 2,047 individuals, it was found that there was a significant increase in body weight for each 1 g/day increase in omega-3 lipids (standardized MD [SMD], 0.52 kg; 95% confidence interval [CI], 0.31, 0.73; I2 = 95%; Grading of Recommendations Assessment, Development and Evaluation [GRADE] = low). Supplementation of omega-3 fatty acids did not yield a statistically significant impact on body mass index (BMI) (SMD, 0.12 kg/m2; 95% CI, −0.02, 0.27; I2 = 79%; GRADE = very low), lean body mass (LBM) (SMD, −0.02 kg; 95% CI, −0.43, 0.39; I2 = 97%; GRADE = very low), fat mass (SMD, 0.45 kg; 95% CI, −0.25, 1.15; I2 = 96%; GRADE = low), and body fat (SMD, 0.30%; 95% CI, −0.90, 1.51; I2 = 96%; GRADE = very low). After excluding 2 studies, the findings were significant for BMI. Regarding the results of the dose-response analysis, body weight increased proportionally by increasing the dose of omega-3 supplementation up to 4 g/day. Omega-3 fatty acid supplementation can improve body weight, but not BMI, LBM, fat mass, or body fat in cancer patients; large-scale randomized trials needed for more reliable results.
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Hemodialysis (HD) patients face a common problem of malnutrition due to poor appetite. This study aims to verify the appetite alteration model for malnutrition in HD patients through quantitative data and the International Classification of Functioning, Disability, and Health (ICF) framework. This study uses the Mixed Method-Grounded Theory (MM-GT) method to explore various factors and processes affecting malnutrition in HD patients, create a suitable treatment model, and validate it systematically by combining qualitative and quantitative data and procedures. The demographics and medical histories of 14 patients were collected. Based on the theory, the research design is based on expansion and confirmation sequence. The usefulness and cut-off points of the creatinine index (CI) guidelines for malnutrition in HD patients were linked to significant categories of GT and the domain of ICF. The retrospective CIs for 3 months revealed patients with 3 different levels of appetite status at nutrition assessment and 2 levels of uremic removal. In the same way, different levels of dry mouth, functional support, self-efficacy, and self-management were analyzed. Poor appetite, degree of dryness, and degree of taste change negatively affected CI, while self-management, uremic removal, functional support, and self-efficacy positively affected CI. This study identified and validated the essential components of appetite alteration in HD patients. These MM-GT methods can guide the selection of outcome measurements and facilitate the perspective of a holistic approach to self-management and intervention.
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Patients with colorectal cancer may experience symptoms such as diarrhea, nausea, and anorexia, during surgery and chemotherapy, which can increase the risk of malnutrition. In addition, dietary habits play a key role in the onset of colorectal cancer; therefore, it is necessary to improve dietary habits to prevent recurrence during treatment after diagnosis. In this study, a clinical nutritionist conducted 4 interviews for patients diagnosed with colorectal cancer and scheduled for colectomy: before surgery, after surgery, 1st chemotherapy, and 2nd chemotherapy, and provided nutrition care for each treatment course to determine its effects on nutrition status and disease prognosis. Significant weight loss but no decrease in muscle mass was observed during treatment. Body fat mass, although not statistically significant, showed a decreasing tendency. The percentage of people who responded ‘yes’ to the below items increased after compared to before receiving nutrition education: ‘I eat meat or eggs more than 5 times a week,’ ‘I eat seafood at least three times a week,’ ‘I eat vegetables at every meal,’ ‘I eat fruits every day,’ and ‘I eat milk or dairy products every day.’ These results indicate that the patients changed their dietary habit from a monotonous eating pattern to a pattern of consuming various food groups after receiving nutrition education. These results suggest that continuous nutrition care by clinical dietitians, according to the patient’s treatment process, can help improve the patient's nutritional status and establish healthy eating habits.
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This study was conducted to analyze the relationship between cancer-related stress and the types of complementary and alternative medicine (CAM) used by subjects diagnosed with colorectal cancer. The number of study subjects was 142, and for data analysis, descriptive statistics, t-test, χ2 test, logistic regression procedures were performed. Of the subjects, 114 were CAM users, who accounted for 79.6%. When it came to using CAM, 82 (72.6%) said they did “to prevent cancer recurrence.” The most popular reason for not using CAM was “to focus on treatment as instructed by the doctor,” with 22 (75.8%) respondents selecting the answer. Of those who used CAM, 79 (55.6%) said they took “dietary supplements,” followed by 65 (45.8%) who picked “vitamins and minerals.” Regarding CAM usage, ginger, aloe, swimming, and walking had the highest satisfaction (4.25 ± 0.71). The cancer-related stress of subjects who use CAM (18.21 ± 15.37) was higher than that of subjects who did not use CAM (10.11 ± 12.08). Logistic regression analysis determined that cancer-related stress were factors significantly associated with CAM use. Patients using CAM had higher cancer-related stress, suggesting that stress on cancer increased CAM interest. Safe and reliable CAM information and standardized recommendations should be provided to cancer survivors. We propose the development of training programs for CAM to improve communication between medical staff and patients and to protect patients.
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Ischemic stroke and Alzheimer’s disease (AD) are representative geriatric diseases with a rapidly increasing prevalence worldwide. Recent studies have reported an association between ischemic stroke neuropathology and AD neuropathology. Ischemic stroke shares some similar characteristics with AD, such as glia activation-induced neuroinflammation, amyloid beta accumulation, and neuronal cell loss, as well as some common risk factors with AD progression. Although there are considerable similarities in neuropathology between ischemic stroke and AD, no studies have ever compared specific genetic changes of brain cortex between ischemic stroke and AD. Therefore, in this study, I compared the cerebral cortex transcriptome profile of 5xFAD mice, an AD mouse model, with those of middle cerebral artery occlusion (MCAO) mice, an ischemic stroke mouse model. The data showed that the expression of many genes with important functional implications in MCAO mouse brain cortex were related to synaptic dysfunction and neuronal cell death in 5xFAD mouse model. In addition, changes in various protein-coding RNAs involved in synaptic plasticity, amyloid beta accumulation, neurogenesis, neuronal differentiation, glial activation, inflammation and neurite outgrowth were observed. The findings could serve as an important basis for further studies to elucidate the pathophysiology of AD in patients with ischemic stroke.
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This study was conducted to analyze the status of medical food selection process in hospitals within Busan and Gyeongnam area. The survey was distributed to 396 hospitals (general, tertiary and long-term care hospitals) and finally 68 surveys were used for analysis. The questionnaire consisted of 9 general items and 10 items related to enteral nutrition (EN). From the survey we found out that general hospitals and tertiary hospitals normally hire clinical dietitian, while long-term care hospitals hire dietitians with no further qualifications (χ2 = 27.918, p < 0.001). A significant relationship was found between hospital size and the priority for choosing medical foods for patients (χ2 = 11.852, p < 0.05). In general and tertiary hospitals, medical foods were provided exactly according to the doctor's prescription, whereas in long-term care hospitals, only half followed the doctor’s direction and half of them provided the products that has been conventionally used. There was also a significant relationship between hospital size and the method for determination of nutrition requirements (χ2 = 20.496, p < 0.001). Finally, the priority of considerations when developing a ‘medical food guidelines’ was shown in the following order; 1) the type of medical food that can be selected according to the disease state, 2) the nutrient content and comparison table for commercial products, and 3) how to manage complications that may occur when supplying medical food for patients. Developing an EN practice guideline for making a sensible selection of medical foods will provide a valuable information for better patient care.
This study aimed to investigate the current state of foodservice management and demands for improvement in long-term care hospitals. The survey was performed in experienced dietitians working at 25 hospitals. General characteristics, status of sanitary management (document management, self-assessment of importance and performance), necessity and ranking of sanitary management items were investigated. Approximately 2.5 dietitians worked in each hospital, but only 7 (28.0%) hospitals employed clinical dietitians. From the questionnaire, the scores of the importance in sanitary management and performance were 4.5 ± 0.7 and 4.3 ± 0.9, respectively, and were significantly different (p = 0.000). Participants also reported “special therapeutic diets management” and “compliance with standards of refrigerating time, food, method management” had the lowest importance and performance, respectively. The result of Importance-Performance Analysis revealed a significant positive correlation between importance and performance (R2 = 0.427). However, items such as “performing hand hygiene” and “compliance with standards of refrigerating time, food, method” and etc. had low importance recognition with low performance. All participants reported “preparing sanitary management standards was necessary” is necessary and “development of sanitary management manual” is the most important. These findings suggest that sanitary management is important in food service management of long-term care hospitals, and improving awareness is required. Developing a hospital foodservice hygiene manual would ensure better safety and quality for patient care and public health.
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