Propensity Score Matching을 이용한 위암과 대장암 환자들의 수술 전후 영양상태 변화의 비교

윤승훈,계봉현,김형진,전경화,강원경,조현민,진형민 한국정맥경장영양학회 2017 한국정맥경장영양학회 학술대회집 Vol.2017 No.-

Background: Patients with cancers arising from gastrointestinal tract may have some major risks to affect their nutritional conditions; cancer itself, absorption of nutrients and secretion of enzymes, passage disturbance of intestinal content from tumor, or surgery for gastrointestinal tract. Because most patients with gastrointestinal cancers undergo the curative surgery, the consideration on the change of their nutritional status according to the each time point (preoperative vs postoperative) may be very important. Purpose: In this study, we intended to investigate the change of the nutritional status after curative surgery in patients with gastric cancer (GC) or colorectal cancer (CRC) using various nutritional screening tools at each time point (preoperative vs postoperative). Also, we intended to compare our data related to nutritional issues among the types of surgery in GC and CRC group respectively. Materials & Methods: In our hospital, total 407 patients (206 patients with GC and 201 patients with CRC) underwent surgery for their diseases between July 2011 and June 2012. Of these, 195 patients with GC and 176 patients with CRC underwent curative resection. We tried to match patients from two groups using the propensity score. After matching patients with the propensity score, we analyzed the data from 170 patients (85 patients in GC group and 85 patients in CRC group). And then, we retrospectively evaluated patients` nutritional status at the time of admission for surgery and discharge after surgery with 4 nutritional screening tools including malnutrition screening tool for cancer patients (MSTC), the Seoul National University Bundang Hospital Nutritional Screening Tool (SNUBH-NST), Malnutrition Universal Screening Tool (MUST), and Nutritional Risk Screening (NRS) 2002. Although significance was defined as P ≤ 0.05, P ≤ 0.1 was regarded as marginal significance. Results: There was no postoperative mortality in our study. In preoperative period, the nutritional status in GC group was slightly better than that in CRC group according to MUST (P<0.001) and NRS 2002 (P=0.079). The preoperative risk of malnutrition was not related to incidence of postoperative morbidity. In both groups, the postoperative nutritional status was significantly impaired, compared with the preoperative status. In contrast to before the surgery, the postoperative nutritional status of CRC patients was significantly better than that of GC patients according to the MSTC (P=0.004) and MUST (P=0.007). At the time of hospital discharge after surgery, the incidence of lower serum albumin level (P=0.002) and more than 5% weight loss (P=0.013) were higher in GC group than in CRC group. Comparing the postoperative nutritional status among the type of surgery in each group, total gastrectomy in GC group (P=0.015) and proctectomy with diverting stoma in CRC (P=0.06) were related to more than 5% weight loss. Conclusions: The gastrointestinal cancer surgery might affect the postoperative nutritional status negatively, especially in GC surgery. Therefore, we should realize that the consecutive assessments of nutritional status and the appropriated nutritional supports are necessary to enhance the recovery after surgery and to introduce the additional oncological care on time.

간암환자의 영양상태와 치료결과와의 관련성

한부,김영옥 한국식품영양학회 2000 韓國食品營養學會誌 Vol.13 No.5

This study was conducted to investigate the association between initial nutritional status and treatment outcome of hepatoma patients. Initial nutritional status was measured based on weight, serum albumin and total lymphocyte counts. Treatment outcome was measured in the three categories such as complication, treatment status at discharge and mortality. The study subjects were 120 patients with hepatoma cancer admitted at a university hospital in Seoul. The information about initial nutritional status and treatment outcome was collected from medical records. Chi-square test was used to test the association between initial nutritional status and treatment outcome. As a result, 76.6% of the subjects were classified as the nutritional risk group based on initial nutritional status. Prevalence of complication was higher in nutritional risk group Ⅰ and Ⅱ than that in non-risk group(p<0.05). Death rate of the nutritional risk group was significantly higher than that of non-risk group(p<0.001). The findings suggest the strong association between the initial nutritional status and treatment outcome of hepatoma cancer.

Effects of nutritional status and support on the survival of COVID-19 patients in a single tertiary-center intensive care unit in Korea: a case-control study

( Na Gyeong Lee ),( Hye Jin Kim ),( Ji Gyeong Kang ),( Do Hyeon Jeon ),( Mi Seung Kwak ),( So Hyun Nam ) 한국정맥경장영양학회 2023 한국정맥경장영양학회지 Vol.15 No.1

Purpose: It is important to understand the nutritional status of critically ill COVID-19 patients and to provide adequate associated support. We attempted to determine how nutritional status and the amount of nutritional support provided to critically ill patients affect their survival. Methods: We retrospectively reviewed the medical records of patients admitted to the intensive care unit of Dong-A University Hospital between January and December 2021. We divided the patients into survivors and those who died during COVID-19 treatment and compared and analyzed their clinical parameters, nutrition-related indicators, nutritional status, and nutritional support. Results: Of 70 patients reviewed, 57 survived. Mortality was higher in the older group (P=0.006). The patients who underwent ventilator, extracorporeal membrane oxygenation, or continuous renal replacement therapy showed higher mortality. Nutritional status at the time of admission and the nutritional requirements did not differ among patient groups. However, the actual amounts of calories (P<0.001) and protein (P=0.019) supplied were lower in the mortality group. Serum C-reactive protein level was higher (P=0.002) and serum albumin level was lower in those who did not survive (P<0.001) compared with surviving patients at discharge. Conclusion: We did not determine whether the initial nutritional status of patients with COVID-19 affected their survival due to various factors associated with the severity of the disease. However, given the similarities between disease severity and nutritional status at the time of admission, our results indicate that adequate nutritional support can contribute to survival in critically ill COVID-19 patients with pneumonia.

여자노인의 영양상태 평가 및 건강관리를 위한 Nutritional Risk Index (NRI) 비교 분석

양은주(Yang Eun Ju) 韓國營養學會 2009 Journal of Nutrition and Health Vol.42 No.3

Nutritional assessment for the elderly can identify health status and morbidity. However, development of Nutritional Risk Index (NRI) remains limited for elderly because of difficulties in understanding physiological mechanism of elderly. This study was performed to analyze and develop Nutritional Risk Index for Korean elderly Women (Geriatric Nutritional Risk Index, GNRI). Based on literature review, factors for NRI were identified and indices were assessed by a cross-sectional survey. The survey involved Korean elderly women (≥ 60, n = 94) in Gwangju area, and socio-demographics, lifestyle characteristics, health conditions, dietary intakes based on 24h- recall, anthropometric measures (wt, ht, BMI, waist, hip, WHR, body protein, body fat, abdominal fat, and triceps skinfold thickness), and clinical biochemistry parameters (systolic blood pressure, diastolic blood pressure, cholesterol, HDL-cholesterol, triglyceride, total protein, albumin, prealbumin, hemoglobin, hematocrit, fasting blood glucose, HbA1c, ferritin, Zn, Ca, Na, K, Vit E, Vit B₁₂, folate, C-reactive protein) were examined relation to nutritional risk index. Based on literature review and data analyses, three NRIs were categorized (NRI Ⅰ, NRI Ⅱ, NRI Ⅲ) and used for further analysis. NRI Ⅰ was related to having metabolic syndrome, NRI Ⅱ was related to serum albumin and body weight, and NRI Ⅲ was related to food habit and health concerns. Abdominal fat (%) of elderly was correlated with each NRIs. NRI Ⅱ was correlated with nutritional deficiency and higher tendency of inflammatory response, and NRI Ⅲ was correlated with nutritional status which tend to be lower on aging (protein, folate, Vit B₁₂). NRI can serve as a useful tools in assessing health risk and nutritional status. Some modification of items in NRI and validity study are need to apply to Korean elderly.

일부 농촌지역 노인의 간이 영양상태 조사

한혜자,김남초 노인간호학회 2007 노인간호학회지 Vol.9 No.1

Purpose: The purpose of this study was to provide basic information for developing programs to maintain and improve the physical health of the elders living in rural areas. Methods: For this study, 200 male and female elders were selected through convenient sampling. The researchers visited the home of each elder and collected data by using the mini-nutritional assessment tool developed by Guigoz, Vellas & Garry (1996). Real numbers and percentages, means and standard deviations, t-test, ANOVA and Scheffe' test were used to analyze the data. SAS was the computer program used in this study. Results: For nutritional status, 57% of the subjects were well-nourished, 41%, at risk for malnutrition and 2%, under nutrition. However, the average score for nutritional status was satisfactory at 24.03 points. The nutritional status of the elders was different according to their gender and age. Nutritional status was better in men than in women and better for those their 60s compared to those their 70s or 80s. Conclusion: The nutritional status of elders in rural areas was assessed to be satisfactory; however, the nutritional status deteriorated as they got older. This result suggests the necessity of more thorough nutrition management for older elders by health care providers in rural areas.

Evaluation of Oral Nutritional Supplementation in the Management of Frailty among the Elderly at Facilities of Community Care for the Elderly

( Woori Na ),( Jiyu Kim ),( Hyeji Kim ),( Yeji Lee ),( Bonghee Jeong ),( Sung Pyo Lee ),( Cheongmin Sohn ) 한국임상영양학회 2021 Clinical Nutrition Research Vol.10 No.1

Adequate nutritional intake in elderly individuals improves frailty. Elderly individuals may exhibit improvements in frailty with the use of community care facilities. Therefore, this study evaluated the effects of nutritional intervention in elderly subjects at community care facilities receiving oral nutritional supplements (ONSs) and determined their nutritional status. Sixty-two elderly individuals using community care facilities were divided into the experimental group (EG) (before [n = 31]/after [n = 28]) and control group (CG) (before [n = 31]/after [n = 25]). Subjects in both groups were treated with ONSs (200 mL/200 kcal) for 90 days. However, those in the EG received the product with increased protein; vitamins A, C, D, and E; phosphorus; calcium; and zinc. The data collected included anthropometric data, dietary assessment findings, frailty status (Korean version of the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight questionnaire), and nutritional status (Mini Nutritional Assessment, MNA). The changes in the two groups were analyzed using the Mann-Whitney U Wilcoxon signed-rank test. Nutritional intervention increased the weight, body mass index, and lean body mass in the EG (p < 0.05). Protein, calcium, and iron levels increased only in the EG (p < 0.05). The MNA score increased and sum of frailty indicators improved in the EG, and the increase in the MNA score in the EG was greater than that in the CG. This study verified the improved anthropometric data and dietary intake in the EG. Thus, the higher number of pre-frailty elderly individuals at facilities of community care indicates the need for adequate nutritional supplementation for frailty management.

동종 조혈모세포 이식 전후 영양상태 평가

박미영(Park Mi Young),박정윤(Park Jeong Yun) 대한종양간호학회 2012 Asian Oncology Nursing Vol.12 No.1

Purpose: This study was performed to identify the pre-and post-transplant nutritional assessment for patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Methods: The subjects of this study were 25 patients undergoing allogeneic HSCT. The data collection was performed from January 31st to March 31st, 2011. The Patient-Generated Subjective Global Assessment (PG-SGA), anthropometrics and biochemical test were collected from the time they entered the isolation unit until they left. Results: Pre-transplant nutritional assessment status indicated moderate malnutrition which scored 7.32±1.68 in PG-SGA. There were 22 patients (88.0%) with moderate malnutrition and 3 patients (12.0%) with severe malnutrition. Post-transplant nutritional assessment indicated severe malnutrition status which scored 11.92±3.26 in PG-SGA. Pre-and post-transplant nutritional assessment displayed significant differences (p<.001) in PG-SGA score. Hematopoietic stem cell transplantation led to a deterioration of patients' nutritional status. Pre-transplant patients were already in malnutrition status and patients undergoing allogeneic HSCT were at risk for malnutrition. Conclusion: Pre-and post-transplant patients were categorized as having undernutritional and malnutritional status. Pre-transplant nutrition status impacted on post-transplant nutritional status. Health care personnel should pay attention to patient's nutrition status when undergoing allogeneic HSCT with appropriate nutritional assessment tools.

Association of Nutritional Status with Cognitive Stage in the Elderly Korean Population: The Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer’s Disease

장재원,김예신,최용호,이종민,윤보라,박경원,김시은,김희진,윤수진,정지향,김은주,정나연,황지혜,강주희,홍진용,최성혜 대한신경과학회 2019 Journal of Clinical Neurology Vol.15 No.3

Background and Purpose Epidemiological studies have suggested the presence of strong correlations among diet, lifestyle, and dementia onset. However, these studies have unfortunately had major limitations due to their inability to fully control the various potential confounders affecting the nutritional status. The purpose of the current study was to determine the nutritional status of participants in the Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer’s Disease (KBASE) and to identify clinical risk factors for being at risk of malnutrition or being malnourished. Methods Baseline data from 212 participants [119 cognitively unimpaired (CU), 56 with mild cognitive impairment (MCI), and 37 with dementia] included in the KBASE database were analyzed. All participants underwent a comprehensive cognitive test and MRI at baseline. The presence of malnutrition at baseline was measured by the Mini Nutritional Assessment score. We examined the cross-sectional relationships of clinical findings with nutritional status using multiple logistic regression applied to variables for which p<0.2 in the univariate analysis. Differences in cortical thickness according to the nutritional status were also investigated. Results After adjustment for demographic, nutritional, and neuropsychological factors, participants with dementia had a significantly higher odds ratio (OR) for being at risk of malnutrition or being malnourished than CU participants [OR=5.98, 95% CI=1.20–32.97] whereas participants with MCI did not (OR=0.62, 95% CI=0.20–1.83). Cortical thinning in the at-risk/ malnutrition group was observed in the left temporal area. Conclusions Dementia was found to be an independent predictor for the risk of malnutrition compared with CU participants. Our findings further suggest that cortical thinning in left temporal regions is related to the nutritional status.

농촌주민의 건강상태와 영양지식ㆍ태도ㆍ실천과의 관계

조유향(Yoo-Hyang Cho),정해옥(Hae-Ok Jung) 한국보건교육건강증진학회 2006 보건교육건강증진학회지 Vol.23 No.1

Objectives: This study is to investigate and to test the overall level of nutritional knowledge . attitude . practice and health status of the residents in rural area. Methods: The interview survey was performed in March 2004 with structured questionnaires to 510 respondents of the residents who lived in Muan-Gun of Jeonnam province. The questionnaire was the abridged Scale of the Nutritional KnowledgeㆍAttitudeㆍPractice(SNKA) and health status as the morbidity, subjective health status, health management, and health examination. The covariate, F-test or t-test, and Chi-squire method were used for some of the cross-sectional data. Results: Average weight of nutritional knowledge was 10.64±5.98 by SNKA of the 20 items(0-20). Average weight of nutritional attitudeㆍpractice was 64.59±7.72 by SNKA of the 20 items(20-80). The level of the nutritional knowledge was lower than the level of the nutritional attitudeㆍpractice. 77.3% of the respondents have been health management, 49.6% of the respondents have been health examination. A majority of the respondents(31.3%) had disease, while 13.5% of the respondents had chronic disease, and 17.8% of the respondents had acute disease. The level of nutritional knowledge and general characteristics was positively correlated while the relationships were positive between nutritional knowledge and health status, and between nutritional attitude . practice and health status. Conclusion: These results suggested that education programs of the nutritional knowledge were necessary for the residents of rural area. And behavior change of the nutritional knowledge were necessary for the residents of rural area. Further research would be required to specify the necessities and operation researches.

우리나라 노인의 구강건강상태 및 관리행태와 주관적 건강상태와의 관련성: 제7기 국민건강영양조사(2016-2018)를 이용하여

홍주희 ( Joo Hee Hong ),이용재 ( Yongjae Lee ),김태현 ( Taehyun Kim ),김노을 ( Roeul Kim ),정우진 ( Woojin Chung ) 한국보건행정학회 2021 보건행정학회지 Vol.31 No.1

Background: It is getting important to improve the oral health status of the elderly because oral health status may affect their health status of the whole body. In this respect, we aimed to explore the association of oral health status and behavior factors with self-rated health status by sex. Methods: Using the data from the 7th Korea National Health and Nutrition Examination Survey for health surveys and oral examinations (2016-2018), we analyzed a total of 3,070 people aged 65 or older (men: 1,329; women: 1,741). Our dependent variable, self-rated health status, was divided into two groups: not good (bad and very bad) and good (very good, good, and fair), whereas our independent variables of interest were oral health status and behavior factors. In addition to descriptive analysis and the Rao-Scott chi-square test, reflecting survey characteristics, we conducted hierarchical multivariable logistic regression analyses adjusted for socio-demographics and health status and behavior factors. All analyses were stratified by sex. Results: The proportion of people having ‘not good’ self-rated health was 36.5% in women but 24.5% in men. In a model adjusted for all covariates, the self-rated health status showed significant association with the self-rated oral health status. For example, in men, the risk of having ‘not good’ self-rated health was high in people having ‘poor’ (odds ratio [OR], 5.31; 95% confidence interval [CI], 2.34-12.03) self-rated oral health status and in those having ‘fair’ (OR, 4.03; 95% CI, 1.68-9.70) in comparison with those having ‘good’ self-rated oral health status. Dental status regarding speaking difficulty seemed to be very important in influencing self-rated health status. For instance, in women, compared to people having ‘no discomfort’ speaking difficulty, the risk of having ‘not good’ self-rated health was high in people having ‘not bad’ (OR, 1.60; 95% CI, 1.14-2.24) and ‘discomfort’ (OR, 1.79; 95% CI, 1.30-2.47) speaking difficulty. The covariates significantly associated with the risk of having ‘not good’ self-rated health were: physical activity, chronic disease, stress, and body mass index in both sexes; health insurance type and drinking only in men; and economic activity only in women. Conclusion: Oral health status and behavioral factors were associated with self-rated health status among the elderly, differently by sex. This suggests that public health policies toward better health in the elderly should take their oral health status and oral health behaviors into account in a sex-specific way.