환자 영양 상태 파악을 위한 선별 검사와 영양 평가

허훈 ( Hur Hoon ) 한국정맥경장영양학회 2012 한국정맥경장영양학회지 Vol.5 No.1

A large part of patients admitted to hospital are undernourished and managed without nutritional support because of physician`s failure to assess the nutritional state of patients. Therefore, nutritional screening and assessment of patients for malnutrition could be key to improving the treatment outcomes. It is the aim of this paper to inform the concept of nutritional screening and assessment, and introduce tools for general use. Several tools such as nutritional risk screening 2002, nutritional risk classification and others are available for nutritional screening. A recent change of weight, diet history, and the level of serum albumin are mainly included in these assessment tools. After an evaluation using screening tools, physicians can decide whether to start nutritional support or perform nutritional assessment in addition. Subjective global assessment (SGA), developed in 1987, has been mainly used for nutritional assessment. This tool takes into account the past history about the diet, weight variation, the degree of individual activity and fever. Several clinical studies have supported the efficacy of SGA to predict nutritional outcomes. Physicians should devise a plan for nutritional support based on the results of nutritional assessment. In conclusion, nutritional screening and assessment is essential for the evaluation of the patients who require medical or surgical intervention, because the patient`s nutritional state can affect treatment outcomes. Therefore, physicians must take care to assess the nutritional state of patients before treatment using appropriate tools. Moreover, the most appropriate tool for nutritional assessment of Korean patients should be suggested through clinical studies. (JKSPEN 2013;5(1):2-9).

Issues and Directions in Developing Nutrition Education for Older Adults in Korea

Kim, Kyung-Won Korean Society of Community Nutrition 2000 Journal of community nutrition Vol.2 No.1

This paper presents the status of nutrition education for older adults in Korea, and examines considerations in developing effective nutrition education programs for the elderly based on literature reviews. Finally, strategies of nutrition education for older adults in Korea are examined. Status of nutrition education were examined by surveying 90 senior centers, and 46 public health centers providing nutrition services. Most senior centers(96%) provided health education programs, however, nutrition was only a part of health programs. Among the 41 public health centers which responded to the survey, 73.1% provided nutrition education for older adults. The frequently covered topics were prevention & management of hypertension/stroke, diabetes, nutritional management during later adulthood, and osteoporosis. Common barriers in planning and implementing elderly education were; lack of educational materials for older adults, reliance on lectures, difficulty in following-up. To develop effective nutrition education, four stages consisting of needs assessment, planning and implementation of programs, and evaluation should be carefully done. Needs assessment might be done using quantitative or qualitative assessment. Factors influencing nutrition behavior of older adults can be systematically examined using a theoretical approach such as the PRECEDE-PROCEED framework. Qualitative methods, such as focus group interviews, also provide insightful information regarding the needs of older adults. In planning nutrition education programs, physical and pshychological changes associated with aging should be considered. Literature regarding elderly education suggest that active participation or participatory learning is also effective for older adults. Educational materials are developed following the principle of KISS and pre-tested. Program evaluation has been rarely done in practice, although it provides valuable feedback to the program. Strategies for developing nutrition education for Korean elderly include; performing needs assessment, developing a standard program by topics in a logical and systematic way, developing programs for subgroups of elderly, applying diverse education methods developing educational materials for the elderly, evaluating programs using simple tools, and delivering a nutrition program as a part of health promotion program. Finally, the interaction and communication between researchers and practitioners is strongly recommended to ensure better nutrition education and services to the elderly.

Nutritional Assessment of the Older Population: Practical Application and Limitation

Yoon, Jin-Sook Korean Society of Community Nutrition 2000 Journal of community nutrition Vol.2 No.1

Evaluation of nutritional status is an essential element in providing appropriate intervention strategies to achieve the highest level of health, Nutritional assessment of the older population is complicated by many factors which do not significantly affect the nutritional status in young adults, therefore, it should be considered in two ways; community-dwelling elders group and hospitalized or institutionalized elderly group. To sort out the individuals with nutritional problems in a community efficiently, nutrition screening tools must be simple, relatively inexpensive, and applicable to a large number of subjects. Combination of tools and indicators such as 24-hour food recall, body weight and height, and questionnaires on eating practices, and the presence of chronic diseases is practically applicable as basic tools of nutritional screening of older age group. However, the lack of validated screening techniques remains a barrier in improving nutrition. Validation is only limited to energy, BMI, protein intake of the older populations living in western countries. Further refinement of nutritional assessment tools is demanded to figure out whether those are practically applicable to community-living older adults in Asian Society. A careful and systematic evaluation of nutritional assessment tools should be carried out prior to implementation of stepwise nutrition service to the heterogeneous older population. For an in-depth nutritional assessment at the individual level, we need to extend research efforts to clarify the requirements of nutrients due to aging and diseases. More cost-effective method that will allow rapid analysis of survey results are needed so that information can be readily available to policymakers.

Evidence-based Nutritional Intervention Protocol for Korean Moderate-Severe Obese Children and Adolescents

( Jieun Kim ),( Yoon Myung Kim ),( Han Byul Jang ),( Hye-ja Lee ),( Sang Ick Park ),( Kyung-hee Park ),( Hyunjung Lim ) 한국임상영양학회 2019 Clinical Nutrition Research Vol.8 No.3

Diet-related behavioral modification for healthy eating and lifestyle is required to improve childhood obesity. The present study aimed to develop customized nutritional intervention protocol and education program to find barriers to adhere healthy diet and lifestyle for moderate to severe obese children and adolescents and their families. Theoretical framework approaches can be used to change behavior and achieve goals. Previous studies that described the relationship between behavioral modification and nutrition education theory were reviewed. The social cognitive theory and transtheoretical model were employed with behavioral changes to target a healthful diet and lifestyle. The nutrition care process (NCP) model was adopted to customize nutrition care for the participants. Customized nutritional intervention protocol was developed following as the four steps of the NCP. Firstly, nutrition status of the participants was assessed by the nutrition expert. Nutrition problems were described as “inadequate energy intake,” “overweight/obesity,” or “food and nutrition-related knowledge deficit.” All nutrition sessions were designed for nutrition intervention to give nutritional knowledge and a practical mission in real life for individual goal setting and self-control. Meal planning, portion control, healthy snack selection and cooking with fruits and vegetables were consisted of five components of the nutrition education session. During each session, the participants and their families were interviewed by a nutrition expert for monitoring and evaluating diet-related goal setting and achievement outcomes. A theoretical and evidence-based nutritional intervention was developed for the secondary to tertiary prevention of childhood obesity. This nutrition intervention protocol and program might be helpful for the further research on childhood obesity.

Perioperative nutrition support: a narrative review

( Rajeev Joshi ),( Asma Khalife ) 한국정맥경장영양학회 2023 한국정맥경장영양학회지 Vol.15 No.2

Purpose: Proper nutrition and supplementation are paramount in surgical patients. Suboptimal nutrition status is increasingly recognized as an independent predictor of poor surgical outcomes. The purpose of this review is to highlight the need for nutritional protocols, with an emphasis on perioperative nutrition. Current concept: Perioperative nutrition support is considered an adjunctive strategy in most centers, although it is proven to be the key in improving surgical outcomes. There is a need to increase the standards and formulate policies and protocols to optimize perioperative nutrition support. Components of perioperative nutrition include nutritional screening and assessment, prehabilitation, preoperative metabolic optimization and carbohydrate loading, postoperative early enteral feeding and perioperative parenteral nutrition, immunonutrition and micronutrients, and oral nutritional supplementation vs. hospital-based kitchen feeds. Supplemental parenteral nutrition becomes valuable when enteral nutrition alone cannot fulfil energy needs. In patients in the surgical intensive care unit who are dealing with hemodynamic instability, high levels of serum lactate unrelated to thiamine deficiency, acidosis, significant liver dysfunction, high blood sugar, and high blood lipid levels, parenteral nutrition must be started with caution. In the post-surgery care ward, it is advisable to administer up to 30 kcal/kg/day and 1.2-2 g/kg/day of protein. Conclusion: The positive impact of comprehensive nutritional support and the importance of setting and executing standards must be highlighted. Emphasis should be placed on overcoming existing challenges in implementing nutrition therapy in current surgical practice, as better perioperative nutrition supports better surgical outcomes.

건강검진센터에서의 영양서비스 현황 및 요구도 조사

장지호(Chang Ji Ho) 韓國營養學會 2007 Journal of Nutrition and Health Vol.40 No.5

본 연구는 현재 건강검진센터에서 수행하고 있는 영양서비스 현황과 영양서비스의 요구도를 관찰하여 영양서비스 개선을 위한 방법을 모색하고 이를 영양평가 및 상담에 적용하여 영양서비스의 만족도를 높이는데 기여하고자 수행 하였다. 본 연구의 결과를 요약하면 다음과 같다. 1) 영양서비스의 경험이 있는 대상자는 상담군의 경우 58.5%, 비상담군의 경우 46.3%로 나타났다. 그 중 상담군 56.1%, 비상담군 43.9%가 개별상담을 받았고, 상담내용은 건강검진결과에 따른 결과상담이 가장 높았다. 영양지식 및 건강정보는 TV, 인터넷, 책, 잡지, 신문을 통해 얻는 경우가 많았으며, 영양사나 의사, 간호사 등 교육기관으로부터 정보를 얻는 비율은 낮았다. 2) 영양서비스를 받고 싶다고 생각한 적이 있는지에 대해 상담군 80.5%, 비상담군 73.2%가 긍정적으로 대답하 였으며, 두 군간의 유의적인 차이는 없었다. 영양서비스 경험과 영양서비스에 대한 생각은 양의 상관관계를 보였다 (r = 0.229, p < 0.01). 3) 영양평가의 필요성은 상담군의 경우 95.1%로 비상담군 80.5%에 비해 유의적으로 높게 나타났으며 (p < 0.05), 영양상담의 필요성은 상담군의 경우 97.6%, 비상담군의 경우 100%로 영양상담의 요구도가 높았으며, 두 군간의 유의적인 차이는 없었다. 또한, 영양서비스의 수단으로 개별 상담의 선호도가 가장 높았다. 4) 영양서비스 요구항목의 우선순위를 보면, 영양평가는 식사섭취열량평가가 가장 높았으며 (p = 0.000), 영양상담은 상담군의 경우 영양평가를 통해 출력된 영양소별 1일섭취량 결과를 바탕으로 개인별 맞춤 상담을 원했으며 (p= 0.031), 비상담군은 건진결과에 따른 식사요법에 대한 영양상담을 원하는 비율이 높았다 (p = 0.000). 영양결과지는 도표나 그래프를 이용하여 한 눈에 알아 볼 수 있도록 만들어지기 원하였으며 (p = 0.014), 리플릿이나 영양책자는 사진의 추가로 시각적인 효과를 높여달라는 요구도의 순위가 가장 높았다 (p = 0.014). 본 연구 결과를 바탕으로 건강검진센터의 영양서비스 개선을 위한 제언은 다음과 같다. 1) 영양평가시 영양문제파악을 위한 개개인의 영양상태평가 도구로써 보다 세밀한 평가가 이루어질 수 있도록 영양평가 도구 개발이 필요하겠다. 2) 현재 일부 정밀건강검진프로그램에서만 결과에 따라 개인별 식사요법이나 영양교육이 실시되고 있다. 그러나, 영양교육 및 다양한 영양서비스를 제공하는 것은 건강증진, 질병예방 측면에서 볼 때 큰 효과를 볼 수 있는 좋은 프로그램이며, 소비자들도 원하는 부분이다. 이에 다양한 영양 교육프로그램 개발을 통해 건진프로그램에 영양서비스 정착에 힘써야 할 것이며, 더불어 영양사의 자질 향상을 도모하는 것도 필요하리라 하겠다. 3) 영양평가결과지에 그래프나 도표 첨부, 영양자료나 리플릿 제작시 사진이나 그림, 건강기능식품에 대한 정보추가 등의 수정보완이 필요하겠다. 4) 본 연구를 통해 영양서비스 요구도 설문이 실시됨으로 써 차후에 다양한 건강검진프로그램 평가에 대한 기초자료를 제공할 수 있으며, 적극적인 차원에서의 건강검진프로그램 관리에 대한 기본적인 자료제공의 의의를 가질 수 있을 것으로 기대된다. 5) 본 연구는 영양서비스에 대한 평가에서 제한된 부분만을 분석하였으므로 앞으로는 여러 가지 평가도구가 개발되어야 하며 또한, 영양상담 내용을 행동에 옮기는데 필요한 구체적인 변수들의 규명과 분석이 진행되어야 하겠다. This study was done to analyze nutrition counseling services in health promotion center and to investigate demands of subjects for nutrition services. Data was collected through the survey of 90 subjects. The results were as follows. The results of people receiving nutrition services showed that 5S.5% of the counseling group and 46.4% of the non-counseling group answered having experience with nutrition services. And 50% of them received nutrition counseling through individual counseling. Diet therapy with health check-up results also appeared the highest in contents of nutrition counseling. As a source of nutrition information and health knowledge, subjects relied heavily or most on the TV, internet, books, magazines, and newspapers. On the other hand, they relied much less on advice from dietitians,nutritionists, medical doctors and nurses. The experience of receiving nutrition services and thinking about nutrition education related positively. It showed that the counseling group (95.1%) was significantly higher than the non-counseling group (80.5%) in necessity of nutrition assessment. But, necessity of nutrition counseling wasn't significantly different between the two groups. The method of nutrition counseling subjects preferred was individual consultation. The subjects answered to having need of analysis and evaluation of nutrient intake and calorie prescription in nutrition assessment and individual nutritional status results explanation in nutrition counseling. In conclusion all people visiting health promotion centers need nutrition service of some kind.

젊은 성인의 영양정보이해력 평가도구 개발 및 타당성 검증

안석영(Seokyoung Ahn),김보경(Bogyeong Kim),엄미향(Mihyang Um),박유경(Yookyung Park),계승희(Seunghee Kye) 한국영양학회 2020 Journal of Nutrition and Health Vol.53 No.2

본 연구는 젊은 성인을 대상으로 영양정보이해력을 평가할 수 있는 측정도구를 개발하기 위해 수행되었다. 영양정보이해력 평가를 위한 예비문항으로서 우선 7개 영역 65문항이 개발되었다. 작성된 예비문항을 영양전문가 5인에게 자문을 받아 불필요한 문항을 삭제하여 7개 영역 52문항으로 압축시켰다. 영양전문가 패널 20인을 대상으로 내용타당도 검증을 하였으며, Lawshe가 제안한 CVR값을 구하여 내용타당도 검증에 활용하였다. 평가도구 최종 항목으로서 총 6개 영역, 즉 식생활지침, 영양과 건강, 영양소, 다섯가지 식품군 (식품구성자전거), 영양표시, 질병 예방을 위한 영양관리를 포괄하는 30문항이 완성되었다. 이 평가도구를 이용하여 서울과 경인지역에 거주하는 성인 211명을 대상으로 신뢰도를 검증하기 위해 2주 간격으로 검사-재검사 (test-retest)를 실시하였으며, ICC값 (0.64–0.86)과 Cronbach’s α 계수(0.83–0.90)를 산출한 결과 모두 높은 수준으로 나타났다. 따라서 본 연구를 통해 개발된 도구는 영양정보이해력을 평가할 수 있는 적합한 내용을 담고 있으며, 신뢰도 또한 매우 높은 것으로 검증되어, 젊은 성인의 다양한 수준의 영양정보이해력을 판별할 수 있을 것으로 본다. 또한 본 연구를 통해 개발된 평가도구는 지역사회 영양중재 프로그램 계획 시 그리고 만성질환의 예방관리를 위한 영양교육을 위해 대상자의 영양정보이해력을 파악하는 진단도구로 활용될 수 있을 것이다. Purpose: This study was conducted to develop, validate, and assess the reliability of a questionnaire for nutritional literacy among young Korean adults. Methods: The draft questionnaire contained 65 items in 7 domains (i.e., dietary guideline, nutrition and health, nutrients, 5 food groups [food bicycle], nutrition labeling, portion size, and nutrition management for disease prevention). The authors developed a draft questionnaire based on a literature review. After multiple drafts, 52 items were retained and 13 were eliminated in the 7 domains according to professional advice from 5 nutrition experts. A panel of experts (n = 20) comprised of clinical dietitians and nutrition professors completed the content validity assessment, including quantitative and qualitative feedback. As the results, all items of the portion size were eliminated from the questionnaire. A sample of 211 young adults completed the test-retest reliability assessment. Test-retest reliability was evaluated using intraclass correlation coefficient (ICC) and inter-item reliability by Cronbach α coefficient. Results: The final questionnaire contained 30 items with 5 questions each on the dietary guideline, nutrition and health, nutrients, 5 food groups (food bicycle), nutrition labeling, and nutrition management for disease prevention. The Lawshe content validity ratio for domains ranged from 0.60 to 1.00. The ICC scores for questions ranged from 0.64 to 0.86. Cronbach’s α for domains ranged from 0.83 to 0.90 and for the overall questionnaire was 0.87. Conclusion: The questionnaire showed strong content validity, test-retest reliability, and high inter-item reliability, indicating that it is a useful tool for assessing nutritional literacy of young adults.

MNA 를 이용한 노인 환자의 영양상태 판정

정수현,손정민 대한지역사회영양학회 2005 대한지역사회영양학회지 Vol.10 No.5

The prevalence of undernutrition in hospital populations is known to be high. The presence of malnutrition is associated with depression, infections, sarcopaenia, falls, fractures, reduced autonomy and increased mortality. This study specifically examined the prevalence of malnutrition in patients aged 65 or older at the time of admission as determined by the Mini Nutritional Assessment (MNA) which has been a frequently used nutritional risk screening tools in detecting undernutrition in old people. This study was done for one hundred eight hospitalized geriatric patients in Seoul National University Bundang Hospital, Seoul, Korea. On admission baseline history, anthropometrics measurements, laboratory data and nutritional status by MNA were assessed. Length of hospital stay was obtained by reviewing medical charts. We used one-way analysis of variance to compare the differences in variables. Spearman’s rank correlation coefficients were calculated for associations between MNA and variables. On admission, 22.3% of patients were malnourished and 40.7% were at risk of malnutrition according to the MNA. Percent of ideal body weight, anthropometrics data, albumin, and hemoglobin were lower in the malnourished patients (p < 0.05). The malnourished patients stayed in the hospital 7.3 days longer, as compared with well nourished patients (p < 0.05). Percent of ideal body weight, albumin, hemoglobin and total cholesterol were correlated inversely with nutritional status according to MNA (p < 0.05). MNA can be used for nutritional assessment in Korean old people, because MNA significantly correlated with other nutritional assessment parameters, such as, anthropometric and laboratory data in hospitalized geriatric patients. The high prevalence of malnutrition in the elderly was observed and the presence of malnutrition on admission predicted a significant increase in the length of hospital stay in this study. Therefore further studies are needed to determine whether nutritional interventions in old people with low MNA scores can improve clinical outcomes during the hospital course. (Korean J Community Nutrition 10(5): 645 ~ 653, 2005)

Comparison of the Nutritional Status Assessment Methods for Hemodialysis Patients

( Zahra Sohrabi ),( Atefeh Kohansal ),( Hanieh Mirzahosseini ),( Moein Naghibi ),( Morteza Zare ),( Neda Haghighat ),( Marzieh Akbarzadeh ) 한국임상영양학회 2021 Clinical Nutrition Research Vol.10 No.3

Protein-energy wasting (PEW) is prevalent among hemodialysis (HD) patients and is associated with poor outcomes. There are various methods for nutritional status evaluation in HD patients. Each method has its own advantages and disadvantages. We aimed at comparing the method validities of normalized protein catabolic ratio (nPCR) and malnutrition universal screening tool (MUST) with subjective global assessment (SGA) in HD patients. We examined 88 HD patients using SGA and MUST questionnaires. The nPCRs were calculated using pre-dialysis and post-dialysis BUN and Kt/v. Also, PEW of patients was assessed based on the criteria of the International Society of Renal Nutrition and Metabolism. Methods' specificity, sensitivity, and precision rates were assessed. Correlations between methods were analyzed using Pearson-correlation. Based on the SGA, MUST, and nPCR methods, almost 41%, 30%, and 60% of patients had malnutrition, respectively. According to the criteria, more than 90% of patients had PEW. SGA was positively and significantly associated with MUST (p ≤ 0.001). Sensitivity for SGA, MUST, and nPCR methods were 100%,100%, 1.8%, and their specificity were 98%, 98%, and 4%, and their precision rates were 99.7%, 98.7%, and 3%, respectively. From various methods of nutritional assessment (SGA, MUST, and nPCR), compared to SGA as the common method of nutrition assessment in hemodialysis patients, MUST had the nearest specificity, sensitivity, and precision rate and nPCR method had the lowest ones. nPCR seems to be a flawed marker of malnutrition and it should be more investigated if MUST can be used instead of SGA.

Utility of Subjective Global Nutritional Assessment Tool for the Assessment of Malnutrition in Pediatric Patients with Chronic Liver Disease

Anwesha Ray,Srikanta Basu,Praveen Kumar 대한소아소화기영양학회 2023 Pediatric gastroenterology, hepatology & nutrition Vol.26 No.6

Purpose: Approximately 30% of children with chronic liver disease (CLD) are malnourished. However, proper assessment of their nutritional status is difficult. The subjective global nutritional assessment (SGNA) is a comprehensive approach that uses nutrition-focused history and examination, followed by grading of malnourishment. We aimed to study the prevalence of malnutrition in children with CLD using the SGNA tool. Methods: This cross-sectional observational study included patients aged <18 years with CLD. Nutritional assessments were recorded using SGNA tool. Conventional anthropometric measurements were performed and corroborated with nutritional status using SGNA tool. Results: A total of 85 children with CLD and mean age of 62 months were enrolled in this study. The prevalence of malnourished children according to SGNA was 34%; 22% were moderately malnourished and 12% were severely malnourished. We found statistically significant differences in anthropometric parameters among the three groups. A moderate degree of agreement was found between SGNA and weight-for-age (W/A) (p=0.020), midupper arm circumference (MUAC) (p<0.001), and triceps skin-fold thickness (TSF)-for-age (p=0.029). Furthermore, a fair degree of agreement was found between height-for-age (H/A) (p=0.001) and weight-for-height (W/H) (p<0.001). The sensitivity of W/A for detecting malnutrition was 93%, H/A was 90%, MUAC was 86%, and TSF was 88%. The sensitivity was much lower for W/H and body mass index for age (55% for both). Conclusion: In our study, more than one-third of children with CLD were malnourished. Nutritional assessment using SGNA is a reliable method for evaluating nutritional status and is significantly correlated with common anthropometric measurements.