Effects of the Enhanced Recovery After Surgery (ERAS) Program for Colorectal Cancer Patients Undergoing Laparoscopic Surgery.

This study sought to investigate the effects of the enhanced recovery after surgery (ERAS) program on postoperative recovery and nutritional status in patients with colorectal cancer undergoing laparoscopic surgery. A total of 37 patients were included: 19 in the experimental group and 18 in the control group. The experimental group was supplemented with carbohydrate drinks before and after surgery, and the control group was maintained with fasting and water intake in the traditional method. Both care management and nutrition education were implemented for both groups. Patients were evaluated for physical condition, clinical indicators, blood tests, pain, length of stay, nutritional status, and nutrient intake. Use of the ERAS program for the experimental group resulted in shorter length of stay (p = 0.006), less pain (p < 0.001), and a lower rate of malnutrition (p = 0.014) compared with controls. In conclusion, carbohydrate drinks provide great advantages by reducing discomfort, such as pain or thirst, during fasting in patients after colon cancer surgery, helping patients to eat comfortably and actively, minimizing insulin resistance, maintaining nitrogen balance, and reducing infection and anastomosis leakage. For use of ERAS as a standardized program, repeated and expanded research is needed, and a Korean-style ERAS should be prepared by using this approach for various diseases.

Myostatin/Appendicular Skeletal Muscle Mass (ASM) Ratio, Not Myostatin, Is Associated with Low Handgrip Strength in Community-Dwelling Older Women.

BACKGROUND/AIMS: Elevated levels of serum myostatin have been proposed as a biomarker for sarcopenia. Recent studies have shown that elevated level of serum myostatin was associated with physical fitness and performance. This study aimed to examine the significance of myostatin in the association between muscle mass and physical performance in the elderly. METHODS: This cross-sectional study is based on the Korean Frailty and Aging Cohort study involving 1053 people aged 70 years or over. Anthropometric, physical performance, and laboratory data were collected. RESULTS: The mean age of the participants was 75.8 years, and 50.7% of them were female. Serum myostatin levels in men (3.7 ± 1.2 vs. 3.2 ± 1.1 ng/mL, p < 0.001) were higher compared with that in women. Serum myostatin level was associated with appendicular skeletal muscle mass (ASM) index and eGFR by cystatin C. Serum myostatin/ASM ratio was associated with handgrip strength in women. CONCLUSION: Higher serum myostatin levels were related with higher muscle mass and better physical performances in the elderly. Serum myostatin/ASM ratio may be a predictor for physical performance rather than myostatin.

Association between Health Indicators and Health-Related Quality of Life according to Physical Activity of Older Women.

The purpose of this study was to compare sociodemographic factors, health factors and nutritional status according to the physical activity of older women, and to analyze the factors affecting their quality of life. The subjects of this study were 5661 older women aged 60 or older who participated in the Korean National Health and Nutrition Survey (KNHANES) from 2008 to 2013. The socioeconomic factors, subjective health status and disease status, lifestyle and dietary quality, and life quality were compared among two groups (active group and inactive group). The inactive group had significantly higher rates of obesity and unemployment, comorbidities, numbers without spouses, experiencing stress, poor subjective health status, depression or suicidal thoughts, and also higher rates of skipping meals. The life quality index and dietary quality was also significantly lower in the inactive group, and subjects experienced significantly higher pain or discomfort and problems in mobility and the usual activities. The results of multivariate analysis after adjusting for age in groups engaging in physical activities showed the life quality index to increase in accordance with the diet quality, economic income, and education level. It was confirmed that life quality was significantly low if the participant showed a poor subjective health evaluation, obese with many diseases, spouseless, and experienced high levels of stress. Considering the rapid aging and high life expectancy of women, regular physical activity is very important for maintaining health and improving the life quality of older women, and it is believed that comprehensive attention and management of lifestyle and diet quality are necessary.

Association between Inflammatory Biomarkers and Nutritional Status in Fatty Liver.

The prevalence and progression of non-alcoholic fatty liver disease (NAFLD) is mediated via several factors correlating with hepatic necroinflammation (adipokines/cytokines). This study was performed to analyze the level of inflammatory markers according to the presence of NAFLD and to identify related nutritional factors. A total of 80 adults were classified into 2 groups (healthy and NAFLD), and their body composition, blood tests, and eating habits were evaluated. In addition, inflammatory markers (adiponectin, high-sensitivity C-reactive protein [CRP], and tumor necrosis factor-alpha [TNF-α]), nutrient intake status, and dietary quality were compared. The quality of diet was assessed according to the nutrient adequacy ratio and the mean adequacy ratio (MAR). The NAFLD group had a higher body mass index (p < 0.001) than the healthy group and also carried significantly higher CRP levels (p < 0.001) but lower adiponectin (p = 0.001). TNF-α levels increased significantly with fatty liver grade (p = 0.023). The NAFLD group showed significantly higher intake of energy, carbohydrates, iron, sodium, vitamin A and saturated fatty acids, but significantly lower intake of zinc and vitamin E than the healthy group. The MAR values were slightly higher in the NAFLD group but without any significant difference. The levels of adiponectin and vitamin E showed a significant inverse correlation (p < 0.05). Nutritional management of NAFLD patients is important, and the intake of antioxidant and anti-inflammatory nutrients such as zinc and vitamin E should be emphasized.

Nutritional and Clinical Factors Affecting Weight and Fat-Free Mass Loss after Gastrectomy in Patients with Gastric Cancer.

After a gastrectomy, the nutritional status of patients with gastric cancer has great effect on the treatment outcome and patients' quality of life. We investigated the changes in body composition and nutrient intake after gastrectomy in 288 gastric cancer patients. A multiple linear regression analysis was used for each time period to verify the effects of nutritional and clinical factors on weight and fat-free mass loss rates. Gastric cancer patients who underwent a gastrectomy continued to experience weight and fat-free mass loss until three months after surgery and became stagnant at six months. The marginal mean of calorie intake per weight was 24.5, 26.8, and 29.4 kcal at one, three, and six months. The protein intake per kg lean mass was 1.14, 1.14, and 1.16 g at one, three, and six months, respectively. One month after surgery, the rate of weight loss increased significantly in females who received chemotherapy (p < 0.001). At one to three months postoperative, females who had undergone chemotherapy tended to significantly lose weight (p = 0.016). Females with a history of chemotherapy also showed a reduction in fat-free mass for one to three months (p = 0.036). Calorie intake was a significant factor in preventing fat-free mass weight loss at one month after surgery. Chemotherapy was an independent factor affecting the weight and fat-free mass loss rate up to six months after gastrectomy. Careful monitoring of weight and muscle mass changes following active nutritional intervention for sufficient nutrition support could be helpful for patients after gastrectomy.

Establishment of Adequate Nutrient Intake Criteria to Achieve Target Weight Loss in Patients Undergoing Bariatric Surgery.

Although bariatric surgery is the best treatment modality for morbidly obese patients, a 10-30% rate of weight recidivism has been reported in various specialized centers. We examined changes in energy and macronutrients after bariatric surgery and performed analysis to establish appropriate nutritional guidelines for reaching the target percentage of weight loss after surgery. A total of 189 subjects who underwent bariatric surgery were classified into success and failure groups depending on whether or not they reached 50% loss of excess weight at 12 months after bariatric surgery. Physical examinations and dietary surveys were completed before and 1, 6, and 12 months after surgery. Using receiver operating characteristic (ROC) analysis, the optimal cutoff points for nutrient intakes for determining success after bariatric surgery were computed based on maximal Youden's index. At 6 and 12 months after surgery, the success group had significantly lower carbohydrate and fat intakes than the failure group. The cutoff calorie intake for success in weight loss was <835.0, <1132.5, and <1523.0 kcal/day at 1, 6, and 12 months post operation, respectively. With regard to protein, the cutoff intakes were >44.5, >41.5, and >86.5 g/day at 1, 6, and 12 months post operation, respectively. At 12 months, the cutoff ratio for energy obtained from carbohydrates, protein, and fat was <49.0, >24.5, and <28.0%, respectively. Our findings confirm that the level of diet control and nutrition restriction affect the achievement of target weight loss, emphasizing that long-term weight loss is related to compliance with nutrient recommendations.

Annual Prevalence, Health Expenditures, and Co-Morbidities Trend of Iron Deficiency Anemia in Korea: National Health Insurance Service Data from 2002 to 2013.

Despite improvements in nutritional status, iron deficiency anemia (IDA) remains a debilitating nutritional problem worldwide. We estimate annual IDA prevalence rates by sex and age and the trends therein in Korea. We also calculate the health expenditures of IDA and its co-morbidities by analyzing claims data in the National Health Information Database from 2002 to 2013. All analyses were performed based on diagnosis codes of IDA (D50, D50.0, D50.8, and D50.9) regardless of whether IDA was the principal or a coexisting disease. Trends in IDA prevalence rates were evaluated by calculating annual percent changes (APCs) in prevalence. The health expenditures of IDA were calculated based on the direct medical costs (outpatient and hospitalization costs, pharmaceutical costs) and direct non-medical costs (travel costs). The overall IDA prevalence in both sexes increased approximately 2.3-fold from 2002 to 2013; the APC was +7.6%. In females, the prevalence of IDA was highest in aged 30-39 and 40-49 years. The APC was highest in those aged <10 years (+18.2%), followed by those aged ≥80 (+14.7%) and 70-79 (+9.8%) years. In males, the prevalence rates were highest in aged <10 years, followed by those aged ≥60 years. The APC was highest in those aged <10 years (+19.1%), followed by those aged ≥80 years (+10.5%). The total health expenditures increased 2.8-fold during 12 years. Diseases of the respiratory or gastrointestinal tract were the most prevalent co-morbidities in both males and females. The annual prevalence of IDA continues to rise in association with adverse health expenditures and co-morbidities in spite of improvements in nutritional status. Most importantly, infants and young children, the elderly, and females aged 30-49 years are at highest risk of IDA. A national, prospective, and well-organized effort to improve iron status and to manage IDA is required.

The Association between Diabetes Education and Glucose Control in Diabetic Patients: Using the 2008 and 2013 Korea National Health and Nutrition Examination Survey.

This study was conducted to investigate the status of diabetes education in Korean diabetics and to analyze the association between blood sugar control and diabetes education. A total of 1,904 diabetic patients was classified into two groups (well-controlled group and uncontrolled group) using the 2008-2013 Korean National Health and Nutrition Survey data, and various variables were compared. Of the 1,904 patients, 15.9% had received diabetes education. The uncontrolled group had a low economic level, a high rate of drinking and obesity, and a low rate of moderate exercise. And the rate of drug treatment in the uncontrolled group was high, and the rate of education and nutrition education, and the total number of educations for diabetes were significantly lower than those in the control group. Factors affecting blood glucose control were analyzed drinking (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.06-1.7), moderate exercise (OR, 0.45; 95% CI, 0.34-0.6), overweight and obesity (OR, 1.44; 95% CI, 1.17-1.78), duration of diagnosis (OR, 1.07; 95% CI, 1.05-1.08), treatment method (OR, 2.0; 95% CI, 1.45-2.77), nutritional education (OR, 0.62; 95% CI, 0.46-0.85), and education institution (OR, 0.71; 95% CI, 0.54-0.93). The results of this study support that education on lifestyle management, such as a balanced diet, regular exercise, and normal weight maintenance, is essential for blood glucose control, and patients with long-term treatment need cyclic and continuous education.

Factors Affecting Smoking Cessation Success of Heavy Smokers Registered in the Intensive Care Smoking Cessation Camp (Data from the National Tobacco Control Center).

OBJECTIVES: The purpose of this study was to investigate the factors involved in the success of smoking cessation in heavy smokers enrolled in an intensive care smoking cessation camp program. METHODS: Heavy smokers enrolled in the program were classified into a success (n = 69) or failure (n = 29) group, according to whether they maintained smoking cessation for 6 months after the end of the program. Demographics, smoking behaviors, and smoking cessation-related characteristics were analyzed. RESULTS: Statistically significantly more participants in the success group had a spouse (98.6%; p = 0.008) compared with participants in the failure group (82.8%). However, multivariate logistic regression analysis indicated that having a spouse was not an independent factor in smoking cessation (p = 0.349). A significant difference in the frequency of counseling between the success and failure groups was observed (p = 0.001), with 72.5% of those who received counseling on 3-5 occasions for 6 months after the end of program successfully quit smoking, indicating that those who received more counseling had a higher likelihood of smoking cessation success. This was confirmed as an independent factor by multivariate logistic regression (p < 0.005). Furthermore, a graduate school level of education or higher, indicated a statistically greater success rate compared to those that were less well educated (p = 0.043). This was also observed as a significant independent factor using multivariate logistic regression (p = 0.046). CONCLUSION: Education level, marital status, and the number of counseling sessions were significant factors contributing to smoking cessation success.

Relationship between Bone Density, Eating Habit, and Nutritional Intake in College Students.

BACKGROUND: The importance of bone health is emphasized throughout the life cycle. Young adults have problems with bone health due to irregular lifestyle and unbalanced diet, but studies related to them are insufficient. The purpose of this study was to measure the bone mineral density (BMD) of college students and to analyze the differences in BMD according to lifestyle. METHODS: BMD was measured by bone ultrasound in 161 male and female college students. The questionnaire was surveyed about lifestyle, eating habits, and nutrient intake status. RESULTS: Osteopenia was 8.8% in male and 10.8% in female. The body fat percentage of female was significantly higher than male. Male college students, smoking, fast food consumption, and overeating rate were significantly higher than female. Nutrient intake was not significantly different between male and female students. But energy and vitamin A and C levels were inadequate, and protein and sodium intake was excessive compared with the recommended nutrient intake for Koreans. BMD was significantly lowest in male who often intake fast food than male who did not intake at all or intake sometimes. Female who often intake fast food had significantly lower BMD than female who did not eat at all. CONCLUSIONS: College students have different BMDs according to lifestyle. There was a difference in BMD according to smoking and fast food consumption.

Prevalence of Malnutrition in Hospitalized Patients: a Multicenter Cross-sectional Study.

BACKGROUND: Malnutrition is associated with many adverse clinical outcomes. The present study aimed to identify the prevalence of malnutrition in hospitalized patients in Korea, evaluate the association between malnutrition and clinical outcomes, and ascertain the risk factors of malnutrition. METHODS: A multicenter cross-sectional study was performed with 300 patients recruited from among the patients admitted in 25 hospitals on January 6, 2014. Nutritional status was assessed by using the Subjective Global Assessment (SGA). Demographic characteristics and underlying diseases were compared according to nutritional status. Logistic regression analysis was performed to identify the risk factors of malnutrition. Clinical outcomes such as rate of admission in intensive care units, length of hospital stay, and survival rate were evaluated. RESULTS: The prevalence of malnutrition in the hospitalized patients was 22.0%. Old age (≥ 70 years), admission for medical treatment or diagnostic work-up, and underlying pulmonary or oncological disease were associated with malnutrition. Old age and admission for medical treatment or diagnostic work-up were identified to be risk factors of malnutrition in the multivariate analysis. Patients with malnutrition had longer hospital stay (SGA A = 7.63 ± 6.03 days, B = 9.02 ± 9.96 days, and C = 12.18 ± 7.24 days, P = 0.018) and lower 90-day survival rate (SGA A = 97.9%, B = 90.7%, and C = 58.3%, P < 0.001). CONCLUSION: Malnutrition was common in hospitalized patients, and resulted in longer hospitalization and associated lower survival rate. The rate of malnutrition tended to be higher when the patient was older than 70 years old or hospitalized for medical treatment or diagnostic work-up compared to elective surgery.

Serum Vitamin D Level Related to Coffee Consumption in Korean Young Adults Using the 5th Korea National Health and Nutrition Examination Survey.

BACKGROUND: Even young adults are highly interested in their osteological health, yet their calcium intake does not match the level of such interest. Increase in bone loss is known to be associated with higher intake of caffeine and coffee consumption among the young Korean is rising steadily. This study was conducted to reveal the relationship between coffee consumption and serum vitamin D level in Korean young adults. METHODS: This study analyzed potential difference in lifestyle and concentration of vitamin D in blood in relation to coffee intake frequency of 2,523 subjects on the basis of data from the 5th Korea National Health and Nutrition Examination Survey. RESULTS: According to the analysis, groups of males, with high income, frequent social activity followed by alcohol consumption and smoking, and high rate of dining out showed a high frequency of coffee consumption. Vitamin D concentration among the groups was 16.2±5.3 mL and 80.3% of them were considered to be vitamin D-deficient. All the groups appeared to have deficiencies compared to males who did not consume caffeine at all. CONCLUSIONS: The practice of having an adequate amount of coffee is needed, and more efforts should be done to improve vitamin D intake among young adults.

Association between Nutrient Intake and Metabolic Syndrome in Patients with Colorectal Cancer.

The purpose of this study was to investigate the difference of nutritional status according to metabolic syndrome in colorectal cancer patients. The subjects were divided into 2 groups (metabolic syndrome group and normal group) according to the presence or absence of metabolic syndrome in 143 patients diagnosed with colorectal cancer, and their lifestyle and nutritional status were analyzed. Recall method was used for the dietary survey, and metabolic syndrome was defined as the presence of 3 or more of waist circumference, fasting blood glucose, triglyceride, high-density lipoprotein (HDL)-cholesterol, and blood pressure. This study showed that the metabolic syndrome group had a low age, a high body mass index (BMI), and a high drinking rate. The intake of energy, protein, fat, calcium, and phosphorus was significantly higher in the metabolic syndrome group than in the normal group, and the intake of ß-carotene, vitamin C, and folic acid was significantly low. The intake of cholesterol, fatty acid, saturated fatty acid, and polyunsaturated fatty acid was also higher in the metabolic syndrome group. Higher BMI, alcohol consumption, intake of fat, total fatty acid or saturated fatty acid increased the risk of metabolic syndrome, but fiber, vitamin C, or folic acid intake lowered the risk.Weight management and balanced nutritional intake should be emphasized to prevent metabolic syndrome and to improve the condition in patients with colorectal cancer.

The Clinical Effects of Dendropanax Morbifera on Postmenopausal Symptoms: Review Article.

Postmenopausal women aged 50s generally experience gradual changes in body such as decline in antioxidant and estrogen levels as the body ages. To overcome these aging-associated changes, the needs for health functional foods are increasing. Dendropanax morbifera (DM) have antioxidant effects, anti-inflammatory against cancer cells, antidiabetic, and antiatherogenic effect which are associated with postmenopausal symptoms. We analyzed clinical effects of DM on aging-related symptoms by reporting their antioxidant, anticancer and inflammatory activity, etc. and their bioactivity. Data sources EMBASE, SCOPUS, PubMed, Web of Science, and Google Scholar databases were searched up to August 2016 for studies investigating medicinal plants in prevention and treatment of diabetes. The search terms were "Dendropanax morbifera". The reference lists of articles were also reviewed for additional relevant studies. Extracts of DM have various efficacy such as antioxidant, anti-cancer, anti-inflammatory activity and anti-thrombotic effect.

Role Identification of Passiflora Incarnata Linnaeus: A Mini Review.

Some species of traditional herbal medicine has a history of use, most traditional natural herbs have been used for various diseases such as diabetes, hypertension, and obesity. Among them, Passiflora incarnata L. is a traditional natural medicine, flowers as well as berries, roots, and leaves have been used as a medicine. It has been used as a natural medicine for the treatment of insomnia and anxiety for a longtime in Europe, and it has been used primarily for sedation tea in North America. Moreover, Passiflora incarnata L. is widely used anti-asthmatic, analgesic and sedation in Brazil. In other words, Passiflora incarnata L. has been used to treat a sedative, dysmenorrhea, insomnia, cancer, etc. in many countries. Present review of the plants showed a wide range of pharmacological activity in anxiolytic relax the clinical disease, such as anti-inflammatory, anxiety and antioxidant. In addition, Passiflora incarnata L. affects menopause symptoms such as vasomotor symptoms, insomnia, and depression. This review aims to provide the latest information on specific functional components of Passiflora incarnata L. especially the results of clinical trials will provide new insights into opportunities for the future development of natural medicines and doors will be used for purposes of analysis.

Comparison in Adherence to Osteoporosis Guidelines according to Bone Health Status in Korean Adult.

BACKGROUND: Osteoporosis one of the most serious disease to decrease the quality of life and cause economic loss. Thus, prevention of osteoporosis has become an important health concern. The study examined in adherence to osteoporosis guidelines and compared the levels of adherence to osteoporosis guidelines between bone health status in Korean adult. METHODS: This study used data from a nationally represented sample of Koreans (n=3,419) from 2008 to 2011 Korea National Health and Nutrition Examination Survey. We were divided into three groups by T-score: normal, osteopenia and osteoporosis. Assessment of adherence level was based on 5 components of osteoporosis guidelines, considering intake of sodium, calcium and protein, smoking and regular exercise. RESULTS: The sex, body mass index, income and educational level did not significantly differ between three groups. Deficient intake of calcium was significantly associated with a threefold greater odds in osteoporosis group (OR 3.6; 95% confidence interval [CI] 2.52-5.22). Excessive protein intake was significantly increased the risk only in osteoporosis group compared to the normal group (OR 1.71; 95% CI 1.15-2.62). Smoking increased the risk in osteoporosis group compared to the normal group (OR 2.88; 95% CI 1.75-4.76), osteoporosis group compared to the osteopenia group (OR 2.69; 95% CI 1.61-4.55). CONCLUSIONS: Nutritional factor (intake of calcium and protein) and lifestyle-related factor (smoking and exercise) must be accompanied the management for bone health. An adherence of guidelines is considered very important for the prevention of osteoporosis.

Hypertension and age at onset of natural menopause in Korean postmenopausal women: Results from the Korea National Health and Nutrition Examination Survey (2008-2013).

OBJECTIVES: Menopause is a natural phenomenon of aging, although the timing and management of menopause can significantly affect a woman's quality of life. It is therefore important to identify measures to ensure a healthy menopause. We set out to investigate the association between hypertension and early menopause in Korean women. STUDY DESIGN: This cross-sectional study was based on 2008-2013 data from the Korea National Health and Nutrition Examination Survey (KNHANES). Of the 53,829 participants surveyed, 13,584 women were selected. We analyzed the contents of the health interview, health examination, and nutrition survey. MAIN OUTCOME MEASURE: The main outcome was defined based on hazard ratios (HR) to identify the effects of hypertension on age at onset of menopause. RESULTS: Among postmenopausal women (n=6650), the mean age at onset of menopause was 50.4 years. Premenopausal hypertension was statistically significantly associated with age at menopause, oral contraceptive usage, household income, education level, occupation, marital status and smoking and drinking habits. With lower age at diagnosis of hypertension, HRs for menopause tended to be higher, and hypertension diagnosed before age 40 years conferred a statistically significantly higher HR (Model 1, HR=2.32, 95% CI=1.87-2.88; Model 2, HR=2.31, 95% CI=1.86-2.86; Model 3, HR=2.23, 95% CI=1.80-2.77; Model 4, HR=2.00, 95% CI=1.52-2.63). CONCLUSION: Premature menopause is strongly associated with lifestyle factors, in combination with incomplete management of chronic diseases. Our findings support the hypothesis that younger age at diagnosis of hypertension is associated with younger age at onset of menopause in Korean women.