Decision Tree Model for Predicting Hospice Palliative Care Use in Terminal Cancer Patients / 한국호스피스완화의료학회지

Purpose@#This study attempted to develop clinical guidelines to help patients use hospice and palliative care (HPC) at an appropriate time after writing physician orders for lifesustaining treatment (POLST) by identifying the characteristics of HPC use of patients with terminal cancer. @*Methods@#This retrospective study was conducted to understand the characteristics of HPC use of patients with terminal cancer through decision tree analysis. The participants were 394 terminal cancer patients who were hospitalized at a cancer-specialized hospital in Seoul, South Korea and wrote POLST from January 1, 2019 to March 31, 2021. @*Results@#The predictive model for the characteristics of HPC use showed three main nodes (living together, pain control, and period to death after writing POLST). The decision tree analysis of HPC use by terminal cancer patients showed that the most likely group to use HPC use was terminal cancer patients who had a cohabitant, received pain control, and died 2 months or more after writing a POLST. The probability of HPC usage rate in this group was 87.5%. The next most likely group to use HPC had a cohabitant and received pain control; 64.8% of this group used HPC. Finally, 55.1% of participants who had a cohabitant used HPC, which was a significantly higher proportion than that of participants who did not have a cohabitant (1.7%). @*Conclusion@#This study provides meaningful clinical evidence to help make decisions on HPC use more easily at an appropriate time.

Decision Tree Model for Predicting Hospice Palliative Care Use in Terminal Cancer Patients / 한국호스피스완화의료학회지

Purpose@#This study attempted to develop clinical guidelines to help patients use hospice and palliative care (HPC) at an appropriate time after writing physician orders for lifesustaining treatment (POLST) by identifying the characteristics of HPC use of patients with terminal cancer. @*Methods@#This retrospective study was conducted to understand the characteristics of HPC use of patients with terminal cancer through decision tree analysis. The participants were 394 terminal cancer patients who were hospitalized at a cancer-specialized hospital in Seoul, South Korea and wrote POLST from January 1, 2019 to March 31, 2021. @*Results@#The predictive model for the characteristics of HPC use showed three main nodes (living together, pain control, and period to death after writing POLST). The decision tree analysis of HPC use by terminal cancer patients showed that the most likely group to use HPC use was terminal cancer patients who had a cohabitant, received pain control, and died 2 months or more after writing a POLST. The probability of HPC usage rate in this group was 87.5%. The next most likely group to use HPC had a cohabitant and received pain control; 64.8% of this group used HPC. Finally, 55.1% of participants who had a cohabitant used HPC, which was a significantly higher proportion than that of participants who did not have a cohabitant (1.7%). @*Conclusion@#This study provides meaningful clinical evidence to help make decisions on HPC use more easily at an appropriate time.

Zinc and Copper Status of Middle- and Old-Aged Women in Type 2 Diabetes

The purpose of this study was to assess the zinc and copper status of type 2 diabetic women and to analyse the relationship among zinc and copper status, and diabetic control indices of diabetes. The mean age of diabetes was 57.9 years old. The mean duration of diabetes was 8.0 +/- 6.5 years. The mean daily energy intake of diabetes was 1562 kcal. There were no significant differences of age, BMI, %body fat, nutritional intakes, total energy intake, and energy composition from carbohydrate, protein, and fat between diabetes (n = 50) and control group (n = 68). However, both zinc intake density (4.15 mg/1000 kcal) and zinc %RDA (62.0%) of diabetes were significantly lower than control group (p < 0.05, p < 0.01, respectively). The plasma zinc level was not significantly different between diabetes and control group (90 microgram/dl, 91 microgram/dl, respectively). The proportion of diabetic women whose plasma zinc levels were lower than 76 microgram/dl (borderline zinc deficiency) was 18.8%. This was about 38% higher than control group. It has been suggested that insulin secretion might decrease in borderline plasma zinc and copper deficiency and increase in normal plasma zinc and copper status. The urinary zinc excretion was twice higher in diabetes than in control group (p < 0.001). The urinary zinc loss was positively correlated with the duration of diabetes (p < 0.05), hyperglycemia (p < 0.001) and insulin resistance (p < 0.05). These results lead us to conclude that normal blood glucose level controlled by diet therapy could improve the hyperzincuria in diabetic women.

Relationship between Zinc Status and Obesity of Type 2 Diabetic Women / 대한지역사회영양학회지

Zinc is known to have important effects on insulin activity and to increase the body fat deposition. The purpose of this study was to investigate the zinc status and obesity in 50 type 2 diabetic women visiting public health center and hospital. The mean age was 57.9 +/- 6.9 years old. The mean of diabetic duration was 8.0 +/- 6.5 years. Body mass index (BMI) of diabetes was 23.2 +/- 2.3 kg/m2. There were no significant differences of mean age, anthropometric indices, and insulin level other than fasting blood sugar (p 10%) than in normal blood glucose (p< 0.001). Anthropometric indices were decreased in hyperglycemia. On the other hand, there were the tendency of increased urinary zinc in obese group for waist circumference and percent of body fat. These results suggested that controlled normal blood glucose could improve hyperzincuria and anthropometric changes in type 2 women diabeties.

Comparison of Nutrient Intake and Meal Service Satisfaction of Elderly at the Local Community Centers:Free and Reduced Meal Service Charge / 대한지역사회영양학회지

The purpose of this study was to compare the nutrient intake and foodservice satisfaction of homebound elderly had lunch at the local community centers by the difference of meal service charge. Two local community center with congregate meal service program located in Daegu and Gyongsan were selected; one with free of meal service charge (F), and the other with 500-1,000 won for meal service charge (K). According to the dietary assessment, energy and nutrient intakes of the 156 elderly subjects were as a whole under the Korean Recommended Dietary Allowance (RDA). Elderly of F service center showed higher % RDA for the selected nutrients and MAR (mean adequacy ratio) than those of K service center (p<0.001). Participants were satisfied with most of the congregation meal service from community center with different reasons such as 'tasty (K service center)' and 'free of charge (F service center)'. In conclusion, elderly had the lunch at the community center with free of meal service charge was poor nutrition status and lower socioeconomic level than the other type of community center in this area. Therefore, healthy menu for elderly should be developed and managed by professional dietitian, as well as its impact on health status of this group, and congregate meal service system might be extended to the homebound elderly of whole community with free of charge.

Comparison of Nutrient Intake and Meal Service Satisfaction of Elderly at the Local Community Centers:Free and Reduced Meal Service Charge / 대한지역사회영양학회지

The purpose of this study was to compare the nutrient intake and foodservice satisfaction of homebound elderly had lunch at the local community centers by the difference of meal service charge. Two local community center with congregate meal service program located in Daegu and Gyongsan were selected; one with free of meal service charge (F), and the other with 500-1,000 won for meal service charge (K). According to the dietary assessment, energy and nutrient intakes of the 156 elderly subjects were as a whole under the Korean Recommended Dietary Allowance (RDA). Elderly of F service center showed higher % RDA for the selected nutrients and MAR (mean adequacy ratio) than those of K service center (p<0.001). Participants were satisfied with most of the congregation meal service from community center with different reasons such as 'tasty (K service center)' and 'free of charge (F service center)'. In conclusion, elderly had the lunch at the community center with free of meal service charge was poor nutrition status and lower socioeconomic level than the other type of community center in this area. Therefore, healthy menu for elderly should be developed and managed by professional dietitian, as well as its impact on health status of this group, and congregate meal service system might be extended to the homebound elderly of whole community with free of charge.

The Relationship of Homocysteine, Vitamin B12, Vitamin B6 and Folate with Ischemic Heart Disease

BACKGROUND AND OBJECTIVES: An elevated serum homocysteine level is a risk factor of atherosclerosis. The relationship between homocysteine and antioxidant vitamins, and other cardiovascular risk factors, and between cardiovascular patients and controls, were evaluated. SUBJECTS AND METHODS: The study population consisted of 146 patients, with objectively first diagnosed ischemic heart disease, and 146 healthy sex and age matched controls. The serum levels of homocysteine, folate, vitamin B12 and vitamin B6 were measured. The correlation between the serum levels of homocysteine and those of folate, vitamin B6 and vitamin B12 were also evaluated. RESULTS: The serum homocysteine concentrations were significantly higher in the cardiovascular patients than in the matched controls (13.35+/-0.51 mmol/l vs. 11.43+/-0.37 mmol/l, p=0.003). However, there was no significant difference between the stable angina, unstable angina and myocardial infarction subgroups. From a multivariate analysis, the elevated homocysteine level was still associated with a low folate level (patient group;r=-0.380, p=0.000, control group;r=-0.229, p=0.000). The measured vitamin B12 level showed no correlation with the homocysteine level in the cardiovascular patients, but did in the controls (R2=0.066, p<0.05). The measured levels of vitamin B6 showed no correlation with the homocysteine level in either group. CONCLUSION: The serum homocysteine level was inversely correlated with the serum folate level; therefore, folic acid supplementation would be expected to improve the endothelial function, and may also reduce cardiovascular events in patients with ischemic heart disease.

A Study of Dietary Behavior and Serum Leptin Levels of Obese Children / 대한지역사회영양학회지

The purpose of this study was to investigate the relationship among serum leptin, nutritional status, and the obesity indices of 55 obese children in Daegu and Kyungpook area. Obesity was defined as fat percentage that exceed 25% of body fat mass. Energy and nutritional status were tended to be low, and dietary intake of calcium and iron were less than any other nutrients in all the subjects. Especially, beverage intake of obese group was more than non-obese group. The leptin level were significantly correlated with %RDA of energy (0.41, p < 0.001), protein (0.44, p < 0.001), phosphate (0.40, p < 0.001), iron (0.37, p < 0.001), vitamin A (0.31, p < 0.01), thiamin (0.40, p < 0.001), riboflavin (0.26, p < 0.05), niacin (0.51, p < 0.001), and vitamin C (0.24, p < 0.05). The leptin level were significantly correlated with MAR (mean adequacy ratio, r = 0.43, p < 0.001) and INQ (index of nutrient quality) of thiamin (r = 0.22, p < 0.05). Multiple regression analysis showed that %RDA of niacin in obese group (R2 = 0.208, p = 0.001) and total subjects (R2 = 0.257, p = 0.000), MAR (p = 0.003) and INQ (p = 0.048) of niacin in obese group (R2 = 0.255) and MAR (p = 0.000) and INQ of Ca (p = 0.024) in total subjects (R2 = 0.231) may be important independent predictors to leptin level. MAR showed a significantly positive correlation with %fat (r = 0.42, p < 0.01), BMI (r = 0.46, p < 0.01), RW (r = 0.44, p < 0.01), WHR (r = 0.39, p < 0.01) and, %RDA (p < 0.05, p < 0.01). These data indicated relationships among leptin level, nutrient intake, %RDA, MAR, and INQ in children.

A Study of Dietary Behavior and Serum Leptin Levels in Obese Children: The Relationship between the Obesity Index and the Serum Leptin Levels Based on Eating Habits and Eating Behaviors / 대한지역사회영양학회지

The purpose of this study was to investigate the relationship among eating habits, eating behaviors, obesity indices and serum leptin levels of 97 school children in the Daegu and Kyungpuk areas. The subjects consisted of 42 boys and 55 girls from the 4th and 5th grades. The prevalence rate of obesity was 63.6% in the males and 36.4% in the females. The nutritional status of the subjects was assessed using 24-hour dietary recalls and blood analyses. The mean serum leptin levels of the obese group (12.84 +/- 6.97 ng/ml) were significantly higher than those of the non-obese group (2.43 +/- 1.53 ng/ml)(p < 0.001). The mean eating behavior scores and MAR were significantly different in the two groups. Nutrient intakes were low and fell short of the RDA. Serum leptin levels showed a significant negative correlation with eating habit (r = -0.24) and eating behavior scores (r = -0.40)(p < 0.05, p < 0.001). It was speculated that nutritional intervention and education about the appropriate nutrient intake requirements of developing children might be necessary.

Comparison of Lifestyle and Nutrient Intake by Number of Components of Insulin Resistance Syndrome in the Daegu Community / 대한지역사회영양학회지

The purpose of this study was to figure out the characteristics of dietary habits and lifestyles related to the development of insulin resistance syndrome(IRS). The participants in this study were 595 adults with one or more abnormal data from a health examination and 215 normal adults. When IRS was defined as a condition in which the subjects have 2 or more abnormalities among obesity, hyperlipidemia, hypertension and hyperglycemia, the prevalence rate was 37.8%. We classified the 595 adults by the number of components of IRS components they had, the higher age and obesity index they had. Total cholesterol and glucose levels in the blood were also positively related to the number of IRS components. IRS subjects tended to practice less habitual drinking and more exercise and weight control. Coffee consumption and dining out frequency were also lower in the IRS group. An analysis of food habits by odds ratio indicated that total food score was better in the IRS group. However, it appeared that food habits such as \"frequent snacking\" and \"never rejecting offered foods\" need to be improved in IRS subjects. Other undesirable food habits were related to the consumption of eggs, dairy products, fried foods, garlic and onion. Dietary intake of Ca, Fe, riboflavin, Vit A, and energy were less than 75% of the Korean recommended allowance for more than half of the subjects. Nutrient intake was lower, Ca/P ratio from food intake was worse in the IRS group. Our results indicated that nutrition counseling for IRS need to be focused on balanced food intake to supply sufficient amount of each nutrient.

A Case of a Large Fibrin Clot Formed in a Plama Unit Collected by Donor Plasmapheresis / 대한수혈학회지

A large aggregate was found in a plasma unit collected by plasmapheresis at the Chungbuk Blood Center. The result of the screening test for the donor was normal. The aggregate was dissolved in 1N NaOH and 10% SDS and this aggregate was analyzed with UV spectrometer and NMR spectrometer. Most of the component of it was proved to be protein. The informations about this aggregate in plasmapheresis unit were asked to other institutes. Osaka Blood Center of Japanese Red Cross gave an information that the aggregate could be made by anticoagulant. When the aggregate was treated with the plasmin, the aggregate was dissolved completely. And the band regarded as fibrin was found in SDS-PAGE. An aggregate like this could be formed when the amount of anticoagulant is deficient in the collection of blood. To prevent the formation of the fibrin clot, the addition of the proper amount of anticoagulant has to be inspected.

The Effects of Type 1 diabetes on the Metabolism and Density of Bone in Children / 대한내분비학회지

BACKGROUND: The effects of type 1 diabetes mellitus on the metabolism and density of bone in children are still controversial. The aim of this study was to evaluate the effects of type 1 diabetes on markers of bone metaboism and BMD in children by analyzing BMI, HbA1c, biochemical markers, sex hormones, bone metabolism and BMD related factors. MRTHODS: We compared 36 patients (15 males, 21 females) with type 1 diabetes mellitus to 167 healthy children (84 males, 83 females) who lived in Taegu. We measured FBS, serum calcium, phosphorus, HbA1c, osteocalcin, testosterone and estradiol for analyzing the factors which influence on bone metabolism and BMD. BMD was measured at lumbar spine, femur and total body by DEXA. RESULTS: The BMI and serum level of osteocalcin were not different in both groups. Serum calcium level was significantly lower in the diabetic group than that of control group. BMD had no difference in both groups. There was no correlation between BMD and glycemic control (HbA1c) or duration of diabetes. There was good correlation (r=0.78, p<0.01) between serum testosterone level and BMD in male patient group. There was negative correlation (r=-0.4) between serum osteocalcin level and BMD. There was significant correlation (male: r=0.76, female: r=0.66) between lean body mass and BMD in both group. CONCLUSION: The BMD was not decreased significantly and bone turn-over was normal in children with noncomplicated type 1 diabetes mellitus, and BMD was not influenced by the duration or degree of metabolic control of diabetes. But, we need further study including other risk factors that have influences on BMD and bone metabolism in type 1 diabetes mellitu.

Postprandial Hypertriglyceridemia Following a Single High-Fat Meal in Patients with Coronary Artery Disease and Normal Subjects: The Significance of the Postprandial Hypertriglyceridemia and the Effects of Fibrate on the Postprandial Hypertriglyceridemia

BACKGROUND AND OBJECTIVES: It has been recently reported that coronary artery disease (CAD) is more correlated with postprandial triglyceride (TG) levels than fasting TG levels. We performed this study to compare the patients with CAD to age- and sex-matched controls in regard to postprandial TG levels and to know the effects of fenofibrate on postprandial TG levels. MATERIALS AND METHOD: Serum TG, total cholesterol (C), HDL-C and LDL-C were measured before, and 2, 4, 6, 8, and 24 hours after a high-fat meal in 22 patients (mean: 60 yr) with CAD and 12 normal subjects (mean: 54 yr). The same parameters were also serially measured after the high-fat meal plus fibrate in 10 patients with CAD (mean: 59 yr). RESULTS: he patients group without fibrate showed that more prolonged and exaggerated hypertriglyceridemia following the meal than normal subjects, especially 4 to 8 hours after the meal and that lower HDL-C throughout the test duration. These changes were also persisted when hyperlipidemic patients were excluded out of the patients group. The patients with fibrate did not show such a significant elevation of TG levels 4 to 8hours after the meal compared when normal subjects. The time to reach the peak TG levels after the meal was 4, 6, and 4 hours after the meal in normal subjects, patients with CAD, and fibrate group, respectively. CONCLUSION: Coronary artery disease is clearly related with postprandial hypertriglyceridemia than fasting TG levels and postprandial hypertriglyceridemia can be somewhat prevented by fibrate.

The Effect of Vitamin E on the Endothelial Function Following a Single High-Fat Meal in Normal Subjects, Patients with Coronary Heart Disease and Patients with Diabetes

BACKGROUND AND OBJECTIVES: The hyperlipidemia by a high-fat diet induce the endothelial dysfunction. We have performed this study to determine the relationship between postprandial hypertriglyceridemia and endothelial function and to know the effects of vitamin E on the endothelial function. MATERIALS AND METHOD: Endothelial function was measured by flow-mediated brachial artery vasodilation (FMD) as percent diameter changes. We have serially measured lipid profiles and FMD after a meal in normal subjects (10 males, mean:26 yr), which test was repeated according to types of meal (high-fat, low-fat and high-fat meal with 800 IU vitamin E). The second stage of this study is consisted of 10 patients with coronary artery disease (CAD, mean:50 yr) and 10 diabetes (DM, mean:48 yr). RESULTS: The serum triglycerides were significantly increased at 2 and 4 hours after a high-fat meal. The FMD was transiently decreased (p<0.001) to 7+/-4% and 7+/-2% at 2 and 4 hours only after a high-fat meal from 13+/-4% at fasting state. The FMD was inversely related with postprandial hypertriglyceridemia (r=0.52, p<0.05). The baseline FMD in patients with CAD and DM were all lower, 9+/-4% and 10+/-5% respectively, than 15+/-2% of normal subjects. The FMD in patients with CAD were improved to 13+/-4%, 13+/-4% and 11+/-6% at 2, 4, and 6 hours after a meal plus vitamin E, respectively. The FMD in diabetic patients were not decreased as same manor in normal subjects. CONCLUSION: The vitamin E can prevent the endothelial dysfunction which is induced by postprandial hypertriglyceridemia in normal subjects and can improve the endothelial dysfunction in patients CAD as well as DM.

The Development and Evaluation of a Simple Semi-quantitative Food Frequency Questionnaire to Assess the Dietary Intake of Adults in Large Cities / 대한지역사회영양학회지

Using data obtained from 1,473 adults aged 18-68 yrs, residing in large cities and by use of a semi-quantitative food frequency questionnaire, we assessed the relative importance of various foods as indicators of both the amount and the variability of selected nutrient intake to develop a simple food frequency questionnaire. Since Cronbach's alpha value of the questionnaire including 78 food items was 0.76, the reliability of this questionnaire was acceptable. A large fraction of the variability of nutrient intake in this population could be explained by the small number of food items. The estimation of dietary nutrient intake such as total calories or protein content, which are derived from almost all foods, will require more food items with nutrients such as calcium or vitamin A, which are concentrated in a few food items. A dietary history ascertaining the intake of as few as 5-19 food items mighted be all needed in order to determent the association between disease outcome and the intake of a single nutrient. There was certainly a high level of agreement with nutrient intake by the sbujects who were cross-classified by quartiles of nutrient indices based on all the food items(78) and by quartiles of nutrient indices based on food items selected by stepwise multiple regression for selected nutrients. The data provided further evidence that useful information on dietary intake over an extended period can be obtained by a simple and relatively inexpensive food frequency questionnaire.

Relationships Among Pubertal Development, Anthropometric Measurement, Bone Mineral Density in Males and Females 7-23 Years of Age / 대한내분비학회지

Background: Maximizing peak bone mass is advocated as a way to prevent osteoporosis. As a prerequisite to the elaboration of any preventive program aimed at rnaximizing peak bone mass, it is important to determine how the rate of skeletal growth at elinically relevant sites, such as lumbar spine(LS), femoral neck(FN), proceeds in relation to age and pubertal stages in both sexes. The present study was performed to measure bone mineral density(BMD) of Korean children and adolescents and to assess the influence of age, sex, puberty and body size on bone mineral density (BMD) during the period of bone growth. Method: Lumbar spine(LS), femoral neck(FN) BMD were measured in 199 healthy males and fernales 7~23 years of age using dual energy x-ray absorptiometry(DEXA), Tanner staging(TS) was used to assess stage of puberty. Results: Anthropometric measurements generally increased with tanner stage in both sexes. Sex differences were observed. In males, compared to females there were significantly higher in height(TS1, TS3, TS4, TS5), weight(TS1, TS3, TS5), dorsal hand skinfold thickness(TS1, TS5), and lean body mass(TS1, TS3, TS4, TS5): while in females, compared to males there were significantly higher in BMI(TS4), skinfold thickness except dorsal hand and fat %(TS3-TS5), and total fat mass(TS3, TS4)(p