Annals of Clinical Nutrition and Metabolism

Role of nutrition in wound healing and nutritional recommendations for promotion of wound healing: a narrative review: Myoungjean Ju, Yoonhong Kim, Kyung Won Seo; Ann Clin Nutr Metab 2023;15(3):67-71. Published online December 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.3.67

Purpose: Addressing both malnutrition and wound healing requires strategic intervention. However, guidelines for adequate nutrition for a variety of wounds are lacking. Based on the latest literature review, we summarize the role of nutrition in each stage of wound healing and nutritional recommendations for wound healing.
Current concept: Wounds undergo three healing phases: inflammatory, proliferative, and remodeling. The inflammatory phase involves clotting and cleaning the wound. The proliferative phase builds the wound bed through tissue growth. In the remodeling phase, collagen strength increases. Proper nutrition is crucial throughout. During inflammation, calcium, vitamin K, A, and E, zinc, and proteins are essential. In proliferation, amino acids, B vitamins, lipids, zinc, and iron play key roles. During remodeling, vitamins C and E, zinc, and water are critical for collagen synthesis and skin cell maturation. Vulnerable groups like the elderly, newborns, and obese patients need proper nutrition for skin maintenance. For pressure ulcers with malnutrition risk, recommendations are 30–35 kcal/kg/day energy, 1.25–1.5 g/kg/day protein, and 30 mL/kg water. Supplements might be added if regular meals don’t meet needs. For diabetic foot ulcers, despite common deficiencies, the 2019 International Working Group on the Diabetic Foot advises against prioritizing nutritional interventions over standard care due to limited high-quality evidence.
Conclusion: Despite limited guidelines, nutrition assessment is vital for wound evaluation. A multidisciplinary approach is key, emphasizing nutrition’s role in wound healing. Implementing nutritional interventions tailored to the wound and the individual’s nutritional status is essential. This comprehensive strategy ensures the best wound care outcomes.

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Implementing a screening protocol for food insecure patients within a long‐term acute care hospital (LTACH): A community health needs assessment (CHNA)
Molly MacDonald, Christopher Stimson, Marti Samsel, Tina Gross
Nutrition in Clinical Practice.2025;[Epub] CrossRef
Impact of Epigenetics, Diet, and Nutrition-Related Pathologies on Wound Healing
John Hajj, Brandon Sizemore, Kanhaiya Singh
International Journal of Molecular Sciences.2024; 25(19): 10474. CrossRef
Electrospun-based nanofibers as ROS-scavenging scaffolds for accelerated wound healing: a narrative review
Mohammad Ebrahim Astaneh, Narges Fereydouni
International Journal of Polymeric Materials and Polymeric Biomaterials.2024; : 1. CrossRef

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Recent advances in refeeding syndrome in critically ill patients: a narrative review: Sang Woo Ha, Suk-Kyung Hong; Ann Clin Nutr Metab 2024;16(1):3-9. Published online April 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.1.3

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Purpose: The aim of this article is to provide a narrative review of the most recent studies on refeeding syndrome (RS) in critically ill patients and to summarize recent advancements that can be referenced in the treatment of these patients.
Current concept: RS in critically ill patients is a potentially lethal nutrition-related condition leading to sudden death. Initiation of food intake after a period of fasting can trigger rapid electrolyte uptake due to increased insulin release, leading to a decline in serum electrolytes with thiamine. This depletion may cause severe complications, such as cardiac arrhythmias, respiratory failure, seizures, and even death. The incidence of RS varies significantly, ranging from 7.4%–89%. Despite updates in diagnostic criteria over time, there remains a crucial need for criteria applicable to critically ill patients with underlying disorders such as metabolic derangement and organ dysfunction. To prevent RS, it is strongly recommended to start food intake after a fast at 20%–25% of estimated goals, gradually increasing the intake over several days. Close monitoring and electrolyte supplementation—especially of phosphorus, potassium, magnesium, and thiamine—are crucial, especially in critically ill patients. If electrolyte imbalances persist, slowing down or halting the progression of nutrition should be considered.
Conclusion: Clinicians should continue their efforts to promptly identify high-risk patients and to provide prevention and treatment for RS, particularly during the initiation of nutritional therapy in critically ill patients. Developing evidence-based protocols through further well-designed research is essential for effectively managing critically ill patients at risk of RS.

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Nutrition in the critically ill in resource-limited settings/low- and middle-income countries
Mervyn Mer, Martin W. Dünser
Current Opinion in Clinical Nutrition & Metabolic Care.2025; 28(2): 181. CrossRef

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Nutritional support for critically ill patients by the Korean Society for Parenteral and Enteral Nutrition — part I: a clinical practice guideline: Seung Hwan Lee, Jae Gil Lee, Min Kwan Kwon, Jiyeon Kim, Mina Kim, Jeongyun Park, Jee Young Lee, Ye Won Sung, Bomi Kim, Seong Eun Kim, Ji Yoon Cho, A Young Lim, In Gyu Kwon, Miyoung Choi, KSPEN Guideline Committee; Ann Clin Nutr Metab 2024;16(3):89-111. Published online December 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.3.89

Abstract PDF Supplementary Material ePub

Purpose: Nutritional support for adult critically ill patients is essential due to the high risk of malnutrition, which can lead to severe complications. This paper aims to develop evidence-based guidelines to optimize nutritional support in intensive care units (ICUs).
Methods: The Grading Recommendations, Assessment, Development and Evaluation process was used to develop and summarize the evidence on which the recommendations were based. Clinical outcomes were assessed for seven key questions.
Results: We recommend the following: (1) initiate enteral nutrition (EN) within 48 hours after treatment as it is associated with improved outcomes, including reduced infection rates and shorter ICU stays; (2) early EN is preferred over early parenteral nutrition due to better clinical outcomes; (3) the use of supplementary parenteral nutrition to meet energy targets during the first week of ICU admission in patients receiving early EN is conditionally recommended based on patient-specific needs; (4) limited caloric support should be supplied to prevent overfeeding and related complications, particularly in the early phase of critical illness; (5) higher protein intake is suggested to improve clinical outcomes, such as muscle preservation and overall recovery; (6) additional enteral or parenteral glutamine is conditionally recommended against due to the lack of significant benefit and potential harm; and (7) fish oil-containing lipid emulsions is conditionally recommended due to their potential to enhance clinical outcomes, including reduced infection rates and shorter ICU stays.
Conclusion: These evidence-based recommendations can improve clinical outcomes and support healthcare providers in making informed decisions about nutritional interventions in the ICU.

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Enteral Nutrition Versus a Combination of Enteral and Parenteral Nutrition in Critically Ill Adult Patients in the Intensive Care Unit: An Overview of Systematic Reviews and Meta-Analysis
Paraskevi Papanikolaou, Xenophon Theodoridis, Androniki Papaemmanouil, Niki N. Papageorgiou, Alexandra Tsankof, Anna-Bettina Haidich, Christos Savopoulos, Konstantinos Tziomalos
Journal of Clinical Medicine.2025; 14(3): 991. CrossRef

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Mental health and micronutrients: a narrative review: Hyun Wook Baik; Ann Clin Nutr Metab 2024;16(3):112-119. Published online December 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.3.112

Abstract PDF ePub: Purpose: It aims to summarizes the evidence for the association between specific individual nutrients and mental disorders, focusing on vitamin B12 and related B vitamins, vitamin D, probiotics, and zinc.
Current concept: Vitamin D deficiency is linked to depression, anxiety, and cognitive decline. Vitamin D enhances serotonin synthesis, has anti-inflammatory and neuroprotective effects, and regulates the hypothalamic-pituitary-adrenal axis and circadian rhythms. Vitamin B12 deficiency causes neurological dysfunction, mood disorders, cognitive decline, and psychotic symptoms, especially in the elderly. Vitamin B12 is involved in myelin formation, neurotransmitter synthesis, and preventing homocysteine-related neurodegeneration. Zinc deficiency affects neurotransmitters, neurogenesis, and antioxidant function, contributing to depression, anxiety, and cognitive impairment. Zinc supplementation improves symptoms and increases brain-derived neurotrophic factor levels. The gut-brain axis involves bidirectional communication between the gut microbiome and the central nervous system via the vagus nerve, enteric nervous system, immune system, and neuroendocrine pathways. Probiotics can modulate the gut microbiome to improve depression, anxiety, stress response, and cognitive function by influencing neurotransmitter production, reducing inflammation, and supporting the gut-brain connection.
Conclusion: Nutritional interventions, including vitamin D, B12, zinc, and probiotics, show promise as adjunctive therapies or preventive strategies for mental disorders. These nutrients have specific mechanisms of action on brain function and the gut-brain axis. Further research is needed to establish optimal dosage, timing, and administration methods for these nutritional approaches in supporting mental health.

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A practical guide for enteral nutrition from the Korean Society for Parenteral and Enteral Nutrition: Part I. prescribing enteral nutrition orders: Ye Rim Chang, Bo-Eun Kim, In Seok Lee, Youn Soo Cho, Sung-Sik Han, Eunjung Kim, Hyunjung Kim, Jae Hak Kim, Jeong Wook Kim, Sung Shin Kim, Eunhee Kong, Ja Kyung Min, Chi-Min Park, Jeongyun Park, Seungwan Ryu, Kyung Won Seo, Jung Mi Song, Minji Seok, Eun-Mi Seol, Jinhee Yoon, Jeong Meen Seo, for KSPEN Enteral Nutrition Committee; Ann Clin Nutr Metab 2025;17(1):3-8. Published online April 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0002

Abstract PDF ePub

Purpose
This study aimed to develop a comprehensive practical guide for enteral nutrition (EN) designed to enhance patient safety and reduce complications in Korea. Under the leadership of the Korean Society for Parenteral and Enteral Nutrition (KSPEN), the initiative sought to standardize EN procedures, improve decision-making, and promote effective multidisciplinary communication.
Methods
The KSPEN EN committee identified key questions related to EN practices and organized them into seven sections such as prescribing, delivery route selection, formula preparation, administration, and quality management. Twenty-one experts, selected based on their expertise, conducted a thorough literature review to formulate evidence-based recommendations. Drafts underwent peer review both within and across disciplines, with final revisions completed by the KSPEN Guideline Committee. The guide, which will be published in three installments, addresses critical elements of EN therapy and safety protocols.
Results
The practical guide recommends that EN orders include detailed elements and advocates the use of electronic medical records for communication. Standardized prescription forms and supplementary safety measures are outlined. Review frequency is adjusted according to patient condition—daily for critically ill or unstable patients and as dictated by institutional protocols for stable patients. Evidence indicates that adherence to these protocols reduces mortality, complications, and prescription errors.
Conclusion
The KSPEN practical guide offers a robust framework for the safe delivery of EN tailored to Korea’s healthcare context. It emphasizes standardized protocols and interdisciplinary collaboration to improve nutritional outcomes, patient safety, and operational efficiency. Rigorous implementation and monitoring of adherence are critical for its success.

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Bridging evidence and clinical practice: a practical guide for enteral nutrition from the Korean Society for Parenteral and Enteral Nutrition
Suk-Kyung Hong
Ann Clin Nutr Metab.2025; 17(1): 1. CrossRef

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Dysphagia and quality of life: a narrative review: Jung Mi Song; Ann Clin Nutr Metab 2024;16(2):43-48. Published online August 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.2.43

Abstract PDF ePub: Purpose: Dysphagia is a chronic health condition that causes impairment of eating and drinking functions. It occurs in various diseases such as stroke, neurodegenerative disease, brain tumor, and head and neck cancer, and can also occur during the normal aging process.
Current concept: As patients experience symptoms of dysphagia, they no longer feel the pleasure of eating, depression and anxiety increase, and self-esteem decreases. Prolonged loss of appetite can lead to malnutrition, which can lead to death due to serious complications such as aspiration pneumonia and airway obstruction. Dysphagia reduces quality of life by affecting basic activities of daily living, limitations in social life, nutritional deficiencies, and mood disorders.
Conclusion: Accordingly, I plan to conduct a literature review on the quality of life of patients with dysphagia. First, to determine the relationship between quality of life and sociodemographic, physical health, and mental health characteristics of patients with dysphagia. I also aim to review quality of life measurement tools and intervention programs for patients with dysphagia.

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Bridging evidence and clinical practice: a practical guide for enteral nutrition from the Korean Society for Parenteral and Enteral Nutrition: Suk-Kyung Hong; Ann Clin Nutr Metab 2025;17(1):1-2. Published online April 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0008

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Perioperative nutritional practice of surgeons in Korea: a survey study: Ji-Hyeon Park, Mi Ran Jung, Sang Hyun Kim, Hongbeom Kim, Gyeongsil Lee, Jae-Seok Min, Heung-Kwon Oh, Jung Hoon Bae, Yoona Chung, Dong-Seok Han, Seung Wan Ryu, The External Relation Committee of the Korean Society of Surgical Metabolism and Nutrition; Ann Clin Nutr Metab 2024;16(3):134-148. Published online December 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.3.134

Abstract PDF Supplementary Material ePub: Purpose: Enhanced recovery after surgery (ERAS) protocols advocate reduced fasting and early nutrition to improve recovery in surgical patients. However, data on ERAS implementation among Korean surgeons performing major abdominal surgeries remain sparse.
Methods: A survey conducted by the External Relation Committee of the Korean Society of Surgical Metabolism and Nutrition assessed perioperative nutritional practices among 389 Korean general surgeons from February to September 2023. The survey covered preoperative fasting, carbohydrate drinks, nasogastric tube use, postoperative dietary progression, parenteral nutrition (PN), and oral supplements, yielding 551 responses stratified by specialty.
Results: More than 80% of respondents practiced “midnight NPO (Nil Per Os)” fasting, often at the anesthesiology department’s request, while 70%–80% reported no use of preoperative carbohydrate drinks. Most surgeons began dietary progression with water on postoperative day one, advancing to a liquid or soft diet by day two. PN was routinely prescribed by 49% of respondents, with a common dosage of 1,000–1,500 kcal/d. Oral supplements were selectively provided, with 21% of surgeons prescribing them universally.
Conclusion: The results reveal significant variability in perioperative nutrition practices across Korean surgical specialties, with many adhering to traditional practices despite ERAS guidelines. These findings highlight a need for standardized guidelines in Korea to optimize perioperative nutritional support and improve patient recovery outcomes following major abdominal surgeries.

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Nutritional therapy for critically ill children: Eunju Ha; Ann Clin Nutr Metab 2024;16(2):21-21. Published online August 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.2.21

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Perioperative nutrition support: a narrative review: Rajeev Joshi, Asma Khalife; Ann Clin Nutr Metab 2023;15(2):40-45. Published online August 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.2.40

Abstract PDF ePub

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.

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Nutritional intervention for weight loss in presurgical phase – case study
Ana-Maria Damian
The Romanian Journal of Nutrition.2024; 4(4): 4. CrossRef

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Development of a pre- and re-habilitation protocol for gastrointestinal cancer surgery: Eun Young Kim, Jung Hoon Bae, Jiseon Kim, Eun Joo Yang, Sang-Jae Park, In Kyu Lee, on behalf of the Task Force Team for Development and Trial Application of Pre/Rehabilitation Protocol in GI Cancer Surgery; Ann Clin Nutr Metab 2025;17(1):25-40. Published online April 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0001

Abstract PDF Supplementary Material ePub: Purpose
Surgical resection is the primary curative treatment for gastrointestinal (GI) cancer; however, it is associated with high postoperative complication rates and impaired recovery. Frailty, malnutrition, and sarcopenia increase morbidity and mortality, underscoring the need for perioperative rehabilitation programs. Standardized rehabilitation protocols during the perioperative period are currently lacking in Korea. We aimed to develop an evidence-based rehabilitation protocol for GI cancer patients to enhance postoperative outcomes and facilitate clinical implementation.
Methods
A multidisciplinary task force team comprising experts in surgery, clinical nutrition, and rehabilitation medicine conducted a systematic literature search and comprehensive review from 2012 to 2022 to develop a standardized pre- and re-habilitation protocol for GI cancer surgery. The protocol underwent external validation and subsequent refinements before being finalized through expert consensus.
Results
The protocol development process was organized into four consecutive phases: keyword selection, literature review and case report form development, initial protocol drafting, and external validation leading to the final version of the protocol. The final version of the rehabilitation protocol is presented in the main text and included as Supplements.
Conclusion
This protocol provides a standardized clinical guideline based on the latest evidence-based pre- and re-habilitation strategies and is designed for seamless integration into routine clinical practice. By facilitating proactive rehabilitation interventions, it aims to improve outcomes in GI cancer patients who are at high risk of postoperative complications, functional decline, and malnutrition.

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Micronutrient deficiencies in copper, zinc, and vitamin D as predictors of clinical outcomes in critically ill surgical patients in Korea: a retrospective cohort study: Jiae Kim, Yanghee Jun, Ye Rim Chang, Jong-Kwan Baek, Hak-Jae Lee, Hyewon Han, Suk-Kyung Hong; Ann Clin Nutr Metab 2024;16(3):158-167. Published online December 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.3.158

Abstract PDF ePub: Purpose: To investigate the prevalence of copper, zinc, and vitamin D deficiencies in surgical intensive care unit (SICU) patients and the associations between those deficiencies and clinical outcomes.
Methods: We conducted a retrospective study of 210 patients admitted to the SICU of Asan Medical Center between June 2020 and June 2022. Micronutrient levels were measured within 7 days of SICU admission. Primary outcomes were the mortality rate, length of SICU stay, hospital stay duration, and mechanical ventilation duration.
Results: Copper deficiency was found in 35% (68/193), zinc deficiency in 52% (100/193), and severe vitamin D deficiency in 46% (82/179) of patients. Copper-deficient patients showed a significantly higher mortality rate (25.0% vs. 12.8%, P=0.044), longer hospital stays (57.8±47.0 vs. 45.2±36.6 days, P=0.041), and extended mechanical ventilation duration (26.9±23.3 vs. 18.8±15.7 days, P=0.012). Zinc deficiency was associated with higher C-reactive protein levels (16.2±9.5 vs. 11.5±8.8 mg/dL, P=0.001) and lower prealbumin levels (6.5±2.8 vs. 9.9±5.6 mg/dL, P<0.001). Severe vitamin D deficiency (<10 ng/mL) was not significantly associated with mortality or other clinical outcomes (mortality: <10 ng/mL vs. ≥10 ng/mL, 13% vs. 18%, P=0.583).
Conclusion: Micronutrient deficiencies are prevalent in SICU patients. Copper deficiency significantly correlated with poor clinical outcomes, and zinc deficiency showed a strong association with inflammatory markers. Early assessment and supplementation of micronutrients could be beneficial for critically ill surgical patients.

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The impact of nutritional intervention by a nutrition support team on extrauterine growth restriction in very low birth weight infants in Korea: a retrospective cohort study: Seung Yun Lee, Hye Su Hwang, Waonsun Im, Hyojoung Kim, Mi Lim Chung; Ann Clin Nutr Metab 2024;16(3):149-157. Published online December 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.3.149

Abstract PDF ePub: Purpose: Achieving proper weight gain through adequate nutrition is critically important in very low birth weight (VLBW) infants. Despite recent active nutritional interventions, growth restriction is still common in VLBW infants. We aimed to determine whether nutritional intervention by a nutrition support team (NST) mitigated extrauterine growth restriction (EUGR) in VLBW infants.
Methods: We retrospectively reviewed the medical records of VLBW infants admitted to Haeundae Paik Hospital between March 2010 and February 2024. EUGR was defined as a decrease in the weight-for-age-z-score>1.2 from birth to the postconceptional age of 36 weeks, using Fenton growth charts.
Results: Among the 603 enrolled VLBW infants, 434 (72.0%) were diagnosed with EUGR. When comparing the control and nutritional intervention groups, the incidence of EUGR was significantly lower in infants in the intervention group (80.6% vs. 62.8%, P<0.00). Intervention group infants started enteral feeding earlier and reached half and full enteral feeding earlier (P<0.05). In addition, intravenous protein and lipid supply started sooner, increased at a faster rate, and reached peak concentrations sooner in the intervention group (P<0.05).
Conclusion: Nutritional intervention by an NST resulted in a significant decrease in the development of EUGR in VLBW infants.

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Preoperative consumption of a carbohydrate drink before laparoscopic cholecystectomy is safe and beneficial in Korea: a non-randomized controlled study: Yoo Jin Choi, Yoonhyeong Byun, Seong Mi Yang, Ho-Jin Lee, Hongbeom Kim; Ann Clin Nutr Metab 2023;15(1):15-21. Published online April 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.1.15

Abstract PDF Supplementary Material ePub

Purpose: Overnight fasting prior to elective surgery is the traditional way of avoiding the risk of aspiration during anesthesia induction. However, it causes mental and metabolic stress to patients. Therefore, we investigated the safety and potential benefits of the preoperative consumption of a carbohydrate drink.
Methods: This was a single-center prospective, nonrandomized study with questionnaire. Patients scheduled for elective laparoscopic cholecystectomy were included. There was no restriction on age, underlying diseases, and biliary drainage prior to surgery. They were preoperatively given either a carbohydrate drink or were instructed to fast from midnight before surgery. Perioperative emotional status was measured using the visual analog scale.
Results: The 132 patients completed the questionnaire, with 68 receiving the carbohydrate drink and 64 following nil per oral after-midnight instruction. There were no postoperative complications related to preoperative drink consumption or the cholecystectomy procedure itself in both groups. There were no significant differences in all the assessed feelings postoperatively except that preoperative discomforts, such as hunger and thirst, were significantly more alleviated in the group of preoperative consumption of a carbohydrate drink.
Conclusion: Preoperative consumption of a carbohydrate drink was found to be safe and effective in alleviating preoperative discomfort in elective surgery patients, including older patients and those with underlying comorbidities, who were at greater risk for aspiration. Therefore, we recommend considering preoperative drink consumption as an alternative to traditional overnight fasting in elective surgery patients.

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MODERN CONCEPT OF POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING URGENT LAPAROSCOPIC CHOLECYSTECTOMY
O. PYLYPENKO, O. KRAVETS
Pain anesthesia and intensive care.2024; (4(109)): 55. CrossRef

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The 2024 Korean Enhanced Recovery After Surgery guidelines for colorectal cancer: Kil-yong Lee, Soo Young Lee, Miyoung Choi, Moonjin Kim, Ji Hong Kim, Ju Myung Song, Seung Yoon Yang, In Jun Yang, Moon Suk Choi, Seung Rim Han, Eon Chul Han, Sang Hyun Hong, Do Joong Park, Sang-Jae Park, The Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition; Ann Clin Nutr Metab 2024;16(2):22-42. Published online August 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.2.22

Abstract PDF Supplementary Material ePub

The Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition was established to develop ERAS guidelines tailored to the Korean context. This guideline focuses on creating the most current evidence-based practice guidelines for ERAS based on systematic reviews. All key questions targeted randomized controlled trials (RCTs) exclusively. If fewer than two RCTs were available, studies using propensity score matching were also included. Recommendations for each key question were marked with strength of recommendation and level of evidence following internal and external review processes by the committee.

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Optimizing postoperative pain management in minimally invasive colorectal surgery
Soo Young Lee
Annals of Coloproctology.2024; 40(6): 525. CrossRef

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Pathogenesis, risk factors, and management of postoperative delayed gastric emptying after distal gastrectomy: a narrative review: Cheong Ah Oh; Ann Clin Nutr Metab 2025;17(1):9-17. Published online April 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0007

Abstract PDF ePub: Purpose
This narrative review elucidates the complex pathogenesis, key risk factors, and effective management strategies for postoperative delayed gastric emptying (DGE) following distal gastrectomy with D2 lymphadenectomy, a definitive procedure for middle and lower gastric cancer. It also explores opportunities for improved prevention and innovative treatment options. Current concept: DGE significantly disrupts gastric motility and presents with symptoms such as early satiety, postprandial fullness, nausea, vomiting, and gastric atony. Although rarely fatal, DGE hampers oral intake, prolongs hospital stays, and diminishes quality of life. Current evidence indicates that DGE is a multifactorial disorder resulting from an interplay of vagal nerve disruption, damage to smooth muscle and interstitial cells of Cajal, imbalances in gastrointestinal hormones, and postoperative gut microbiome dysbiosis. Patient-specific factors, including advanced age, poor nutritional status, diabetes, and preoperative pyloric obstruction, along with surgical factors (most notably Billroth II reconstruction), further increase the risk of DGE. Management involves dietary modifications, prokinetic agents (such as metoclopramide and selective 5-HT4 agonists like prucalopride), and gastric decompression.
Conclusion
DGE is a challenging complication following gastrectomy that demands a deeper understanding of its underlying mechanisms to improve patient outcomes. Emerging therapies, including microbiota modulation and advanced pharmacological agents, offer promising new treatment avenues.

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Effects of enteral nutrition formulas with varying carbohydrate amounts on glycemic control in diabetic mice: Yukari Miki, Kazuo Hino; Ann Clin Nutr Metab 2025;17(1):85-93. Published online April 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0006

Abstract PDF ePub: Purpose
This study evaluated the effects of an 8‑week liquid diets with different carbohydrate contents–64% energy in HINE E‑Gel (ST) and 50% energy in HINE E‑Gel LC (LC)–on glycemic control and nutritional status in a mouse model of type 2 diabetes mellitus (db/db mice). The objective was to determine whether reducing carbohydrate intake within the Dietary Reference Intakes for Japanese people improves glycemic control indices, addressing the evidence gap in regarding the long‑term safety and efficacy of low‑carbohydrate enteral nutrition in patients with diabetes.
Methods
db/db mice (n=10 per group) and non‑diabetic db/m mice (n=4) as controls were fed ST, LC, or AIN‑93G diets ad libitum for 8 weeks. The diets primarily differed in carbohydrate content (64% in ST vs. 50% in LC). Blood glucose and glycated hemoglobin (HbA1c), plasma glucose and glycoalbumin, organ weights, and renal function markers were measured weekly or at 4 and 8 weeks. Histopathological examinations of the liver and kidneys were performed at 8 weeks.
Results
At 8 weeks, the LC group showed significantly lower plasma glucose (P=0.0051) and glycoalbumin (P=0.0013) levels compared to the ST group, with a trend toward lower HbA1c (P=0.0514). Although body weight was significantly higher in the LC group (P=0.0038), there were no significant differences between the ST and LC groups in caloric intake, renal function, or histopathological findings.
Conclusion
Reducing carbohydrate intake to 50% of total energy within dietary guidelines may improve glycemic control in diabetic mice, suggesting the need for further long‑term evaluation for clinical applications.

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Selenium deficiency and supplementation in infants: a narrative review: Ji Young Lee, Min Jung Kang, Hyun Jeong Kim, Sung Yun Suh, Yoon Sook Cho, Sook Hee An; Ann Clin Nutr Metab 2023;15(1):8-14. Published online April 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.1.8

Abstract PDF ePub: Purpose: This review aims to provide an overview of the factors and clinical outcomes associated with selenium deficiency and the guidelines on the optimal selenium supplementation in infants.
Current concept: Selenium is a cofactor required to maintain the activity of glutathione peroxidase and is an essential trace element in the human body. Selenium is involved in many stages of oxidative injury within the human body. In severe cases, selenium deficiency may lead to cardiomyopathy. Particularly in infants, the risk factors for selenium deficiency are preterm birth and long-term parenteral nutrition. Several studies have been conducted on the relationship between selenium deficiency and bronchopulmonary dysplasia, retinopathy of prematurity, and sepsis, all of which are common diseases in preterm infants. In the past, 2–3 mcg/kg/day of intravenous selenium supplementation was recommended in preterm infants with selenium deficiency. However, recent studies have suggested that only 2–3 mcg/kg/day can prevent further decreases of selenium level in the blood of preterm infants, and that higher supplementation of 1.5–4.5 mcg/kg/day or 7 mcg/kg/day is necessary to reach the level of healthy infants at term. The recommended dose of selenium through enteral nutrition for preterm infants is 1.3–4.5 mcg/kg/day or 5–10 mcg/kg/day, depending on the guideline.
Conclusion: Adequate selenium administration is required for adequate nutritional support in infants to prevent selenium deficiency, and more studies should be conducted to establish dosing guidelines considering risk factors in preterm infants.

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Incidence and risk factors of nonalcoholic fatty liver disease after pancreaticoduodenectomy in Korea: a multicenter retrospective cohort study: Chang-Sup Lim, Hongbeom Kim, In Woong Han, Won-Gun Yun, Eunchae Go, Jaewon Lee, Kyung Chul Yoon, So Jeong Yoon, Sang Hyun Shin, Jin Seok Heo, Yong Chan Shin, Woohyun Jung; Ann Clin Nutr Metab 2024;16(3):125-133. Published online December 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.3.125

Abstract PDF ePub: Purpose: This study aimed to investigate the incidence, risk factors, and clinical course of nonalcoholic fatty liver disease (NAFLD) following pancreaticoduodenectomy, focusing on the role of adjuvant chemotherapy and other metabolic changes.
Methods: A retrospective analysis was conducted on 189 patients who underwent pancreaticoduodenectomy between 2013 and 2016. NAFLD was diagnosed using computed tomography (CT) imaging, defined as a liver-to-spleen attenuation ratio <0.9. Sarcopenia and sarcopenic obesity were assessed using preoperative CT scans. Logistic regression analysis was performed to identify risk factors for NAFLD development.
Results: The cumulative incidence of NAFLD increased over time, with rates of 15.9% at one year, 20.4% at three years, and 35.2% at five years post-pancreaticoduodenectomy. Adjuvant chemotherapy was identified as the only significant independent predictor of NAFLD development (odds ratio, 2.74; 95% confidence interval, 1.16-6.70; P=0.023). No significant associations were found between NAFLD and pancreatic enzyme replacement therapy (PERT), sarcopenia, or sarcopenic obesity. Serial analysis of NAFLD status in long-term survivors revealed dynamic changes, with some patients experiencing spontaneous remission or recurrence.
Conclusion: NAFLD is a common, progressive complication following pancreaticoduodenectomy, particularly in patients receiving adjuvant chemotherapy. Although no significant associations with PERT or sarcopenia were observed, these areas warrant further investigation. Long-term monitoring and targeted management strategies are recommended to address NAFLD in this population. Future prospective studies are needed to elucidate the natural history and contributing factors of NAFLD after pancreaticoduodenectomy.

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Association between decreased dietary intake during hospitalization and long-term weight loss in postoperative gastric cancer patients over 75 years of age: a retrospective cohort study: Daiki Tabe, Isao Miyajima, Akira Tsukada; Ann Clin Nutr Metab 2025;17(1):75-84. Published online April 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0004

Abstract PDF ePub: Purpose
Weight loss following gastrectomy is a significant concern, and maintaining adequate nutrition is necessary, especially given the growing number of older adult patients. This study examined the relationship between postoperative food intake and long-term weight loss in postgastrectomy patients aged ≥75 years.
Methods
Out of 88 patients who underwent gastrectomy for gastric cancer at our institute, 46 were aged ≥75 years. These patients were divided into two groups: one with an average energy intake exceeding 50% of the basal metabolic rate and one with an intake below 50% of the basal metabolic rate. The percentage change in body weight up to 6 months post-surgery was compared between the groups.
Results
In the group with higher dietary intake, the rate of weight change at 3 and 6 months postoperatively was lower, and fewer patients received postoperative adjuvant chemotherapy.
Conclusion
Poor postoperative food intake may serve as a predictor of weight loss up to 3 months following surgery in postgastrectomy patients aged ≥75 years.

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Comparison of efficacy of enteral versus parenteral nutrition in patients after esophagectomy in Malaysia: a prospective cohort study: Ramizah Mohd Shariff, Sze Chee Tee, Shukri Jahit Mohammad, Khei Choong Khong; Ann Clin Nutr Metab 2025;17(1):41-49. Published online April 1, 2025; DOI: https://doi.org/10.15747/ACNM.24.016

Graphical Abstract Abstract PDF: Purpose
This study aims to assess the effectiveness of enteral versus parenteral feeding in patients after esophagectomy.
Methods
This a prospective cohort study of post-esophagectomy intensive care unit (ICU) patients over 12 months in the National Cancer Institute, Malaysia. Early enteral feeding followed the Enhanced Recovery After Surgery protocol, and parenteral nutrition (PN) was considered if there was a risk for conduit ischemia. It compared the effectiveness of enteral versus PN following esophagectomy, and assessed the correlations between biochemical nutritional markers and hospital lengths of stay or ventilation days.
Results
It included two cohorts receiving PN (n=11) or enteral nutrition (EN) (n=11) following elective esophagectomy. Preoperative weight, body mass index, and Subjective Global Assessment were higher in the EN group (P=0.033, P=0.021, P=0.031, respectively). Nutritional interruption occurred more frequently in the EN group (63.7%) compared to the PN group (P=0.001). Mean levels of energy and protein received were 93.1 kcal/kg and 1.4 g/kg for PN versus 92.4 kcal/kg and 1.2 g/kg for EN (P=0.893, P=0.036). The median lengths of ICU stay (P=0.688) and postoperative stay (P=0.947) between groups showed no significant difference. In addition, 30-day mortality (P=0.214) and other postoperative complications (P>0.05) were comparable in the two groups.
Conclusion
Early initiation of supplementary PN due to significant interruption in EN led to higher protein intake compared to the EN group. However, there were no significant differences in postoperative outcomes, including 30-day mortality, ICU length of stay, and ventilation days. PN ensures adequate nutritional intake, especially in terms of protein delivery, without adversely affecting postoperative recovery and clinical outcomes.

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Efficacy of high-protein diet protocol and education after distal gastrectomy for gastric cancer patients to prevent loss of lean body mass in Korea: a non-randomized controlled study: Hee Kyung Yoon, Sun Ae Kim, Ji Yoon Han, Dong Jin Kim; Ann Clin Nutr Metab 2024;16(1):10-19. Published online April 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.1.10

Abstract PDF Supplementary Material ePub: Purpose: We studied whether active education of patients about the importance of a high-protein diet can prevent lean body mass loss after gastrectomy for gastric cancer.
Methods: In the study group, intensive high protein diet education and monitoring was performed immediate post operative, 1, 3, and 6 months after surgery. Study group patients were compared with data from the control group formed using propensity matching with the study group for age, sex, resection extent, and TNM stage. Clinicopathologic factors were compared between the groups, and changes in quality of life (QOL) and lean body mass between preoperative levels and 6 months after surgery were assessed.
Results: Among the 100 patients, 31 patients from each group were matched with propensity matching. The groups had no significant clinicopathologic differences. Although the changes in QOL scale and body composition did not differ statistically between the groups, a favorable trend was observed in the study group. Six months after surgery, the mean change in the QOL scale, which measured physical, role, emotional, cognitive, and social functioning, decreased less than the control group or even increased in the study group. In the body composition analysis, the study group showed greater reductions in weight, body mass index, fat mass, and body fat percentage than the control group, and their lean body mass and skeletal muscle mass decreased less.
Conclusion: A high-protein diet protocol and education might increase patient QOL and prevent a decrease in lean body weight 6 months after distal gastric resection.

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Role of preoperative immunonutrition in patients with colorectal cancer: a narrative review: Soo Young Lee, Hyeung-min Park, Chang Hyun Kim, Hyeong Rok Kim; Ann Clin Nutr Metab 2023;15(2):46-50. Published online August 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.2.46

Abstract PDF ePub

Purpose: Colorectal cancer surgery presents challenges due to surgical stress and immunosuppression, leading to postoperative complications. Nutrition is crucial for colorectal cancer patients who are prone to malnutrition. This study aims to provide a comprehensive review of the role of preoperative immunonutrition in colorectal cancer surgery.
Current concept: Preoperative immunonutrition, consisting of immunonutrients such as arginine, ω-3 fatty acids, and nucleotides, has emerged as a potential strategy to enhance surgical outcomes by modulating immune responses and reducing complications. Current guidelines recommend preoperative oral nutritional supplements for major abdominal surgery and immunonutrition for nutritionally high-risk patients. Meta-analysis have demonstrated significant decreases in infectious complications and hospital stay durations with preoperative immunonutrition. However, limitations such as publication bias and heterogeneity in the previous studies should be considered. Further research should focus on the optimal timing, duration, and amount of immunonutrition; the patient populations that would benefit most; and the integration of immunonutrition into enhanced recovery after surgery protocols.
Conclusion: While preoperative immunonutrition shows promise, additional research is crucial to refine protocols and establish optimal clinical practice utilization.

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The 2024 Korean Enhanced Recovery After Surgery (ERAS) guidelines for colorectal cancer: a secondary publication
Kil-yong Lee, Soo Young Lee, Miyoung Choi, Moonjin Kim, Ji Hong Kim, Ju Myung Song, Seung Yoon Yang, In Jun Yang, Moon Suk Choi, Seung Rim Han, Eon Chul Han, Sang Hyun Hong, Do Joong Park, Sang-Jae Park
Annals of Coloproctology.2025; 41(1): 3. CrossRef
The 2024 Korean Enhanced Recovery After Surgery guidelines for colorectal cancer
Kil-yong Lee, Soo Young Lee, Miyoung Choi, Moonjin Kim, Ji Hong Kim, Ju Myung Song, Seung Yoon Yang, In Jun Yang, Moon Suk Choi, Seung Rim Han, Eon Chul Han, Sang Hyun Hong, Do Joong Park, Sang-Jae Park
Annals of Clinical Nutrition and Metabolism.2024; 16(2): 22. CrossRef

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Efficacy of monounsaturated fatty acids in reducing risk of the cardiovascular diseases, cancer, inflammation, and insulin resistance: a narrative review: Ki Hyun Kim, Yoonhong Kim, Kyung Won Seo; Ann Clin Nutr Metab 2023;15(1):2-7. Published online April 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.1.2

Abstract PDF ePub

Purpose: The purpose of this review is to explore the potential benefits of monounsaturated fatty acids (MUFAs), specifically those found in olive oil, on weight loss, cardiovascular disease, cancer, inflammation, and insulin resistance. Additionally, this review examines the use of olive oil–based intravenous lipid emulsions (ILEs) in providing parenteral nutrition to patients with diverse needs.
Current concept: MUFAs, found in olive oil, nuts, and some animal foods, have been found to have numerous health benefits. A diet high in MUFAs can aid in weight loss and reduce the risk of cardiovascular disease. Olive oil, in particular, has been linked to a lower risk of cancer, inflammation, and insulin resistance. In addition, olive oil–based ILEs have been utilized for over two decades and are well tolerated by patients requiring parenteral nutrition.
Conclusion: A diet rich in MUFAs, specifically from olive oil, can provide numerous health benefits, including weight loss and reducing the risk of cardiovascular disease, cancer, inflammation, and insulin resistance. Additionally, olive oil–based ILEs have been shown to effectively provide nutrients to diverse populations requiring parenteral nutrition and have demonstrated the ability to preserve immune function and induce less lipid peroxidation than other ILEs. Further research is needed to fully understand the potential benefits of MUFAs and olive oil-based ILEs, but current evidence suggests that they may be a valuable addition to a healthy diet and medical treatment.

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International Dairy Journal.2025; 161: 106118. CrossRef
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Perioperative nutritional management to improve long-term outcomes in critically ill perioperative organ transplant patients: a narrative review: Toshimi Kaido; Ann Clin Nutr Metab 2025;17(1):18-24. Published online April 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0005

Abstract PDF ePub: Purpose
This review examines the significance of perioperative nutritional management in organ transplantation, with a particular focus on liver transplantation. Organ transplant recipients often experience malnutrition and sarcopenia due to nutritional and metabolic abnormalities associated with organ dysfunction. Because transplantation is a highly invasive procedure, optimizing perioperative nutritional care is critical for improving short-term outcomes and reducing postoperative infection-related mortality. Current concept: Recent clinical investigations have shown that liver transplant recipients, who are frequently afflicted with end-stage liver disease and uncompensated cirrhosis, are particularly vulnerable to protein-energy malnutrition and secondary sarcopenia. Our analysis identified low pre-transplant nutritional status and the absence of preoperative branched-chain amino acid supplementation as independent risk factors for post-transplant sepsis. In response, we developed a customized nutritional therapy protocol that incorporates precise body composition analysis, serial measurements of biochemical markers (including prealbumin, zinc, and the branched-chain amino acid/tyrosine ratio), and targeted supplementation with branched-chain amino acids, zinc acetate, and synbiotics. Early initiation of enteral nutrition coupled with postoperative rehabilitative interventions resulted in improved outcomes. In addition, stratified body composition parameters correlated with survival differences and informed revised transplantation criteria.
Conclusion
Tailored perioperative nutritional management and rehabilitative strategies are essential for improving early postoperative outcomes in liver transplantation. These findings underscore the need for proactive nutritional assessment and intervention, which may represent a breakthrough in transplant prognosis. Future research should refine nutritional protocols and integrate novel biomarkers, while education and interdisciplinary collaboration remain crucial for enhancing transplant outcomes and reducing complications.

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Triglyceride-glucose index predicts future metabolic syndrome in an adult population, Korea: a prospective cohort study: Min-Su Park; Ann Clin Nutr Metab 2024;16(3):168-172. Published online December 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.3.168

Abstract PDF ePub: Purpose: The triglyceride-glucose (TyG) index has been proposed as a reliable surrogate marker for insulin resistance. This study aimed to assess the utility of the TyG index in predicting the future presence of metabolic syndrome (MetS) in an adult population.
Methods: A total of 3,241 adults aged 40–70 years were included in this cross-sectional study. MetS was diagnosed based on the modified National Cholesterol Education Program Adult Treatment Panel III criteria, which requires the presence of at least three of the following components: abdominal obesity, elevated blood pressure, dysglycemia, hypertriglyceridemia, and low high-density lipoprotein cholesterol.
Results: In comparison to the homeostasis model assessment of insulin resistance (HOMA-IR), the TyG index exhibited superior diagnostic performance, with a higher area under the receiver operating characteristic curve of 0.854 vs. 0.702 for HOMA-IR. The 95% confidence interval for the TyG index was narrower, reflecting a more consistent predictive ability. Sensitivity for the TyG index was 79.7%, while specificity was 79.3%, compared to HOMA-IR, which showed a sensitivity of 52.7% and specificity of 78.3%.
Conclusion: The TyG index is a highly effective and robust tool for identifying individuals at risk for MetS, demonstrating superior sensitivity and predictive accuracy over HOMA-IR. This index could be a valuable clinical marker for early detection of MetS, aiding in the prevention and management of associated metabolic disorders.

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Changes in perceptions of taste after bariatric surgery: a narrative review: Young Suk Park; Ann Clin Nutr Metab 2024;16(3):120-124. Published online December 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.3.120

Abstract PDF ePub: Purpose: Bariatric surgery effectively treats severe obesity, leading to significant weight loss and improved comorbidities. However, many patients experience postoperative alterations in taste perception, affecting food selection and eating behavior. This narrative review examines the current understanding of taste perception changes following bariatric surgery, including patterns, potential mechanisms, impact on weight loss outcomes, and implications for patient care.
Current concept: Changes in taste perception are frequently reported after bariatric procedures, with prevalence rates from 36% to 72%. Common alterations involve decreased preference and increased sensitivity to sweet and fatty tastes, potentially leading to reduced calorie intake and healthier food choices. Persistence of these changes varies and may depend on surgery type, with Roux-en-Y gastric bypass patients often experiencing more substantial effects than sleeve gastrectomy patients. Potential mechanisms include alterations in gut hormone secretion (e.g., GLP-1, peptide YY, ghrelin), modifications in neural pathways (e.g., vagus nerve), and shifts in the gut microbiome. These factors may collectively influence taste sensitivity and preferences, contributing to weight loss outcomes. Altered reward processing may reduce the appeal of high-calorie foods.
Conclusion: Alterations in taste perception are common after bariatric surgery and may significantly impact dietary behaviors, weight loss, and quality of life. While exact mechanisms are not fully understood, changes in gut hormones, neural pathways, and microbiota are likely involved. Patient counseling and postoperative management of bariatric surgery patients should address potential changes in taste. Further research is needed to elucidate the long-term impacts of taste alterations on weight-loss maintenance and nutritional status.

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Early nutritional support for inpatients reduces admission rates to intensive care units in Korea: a single-center case-control study: Hyun Suk Kim, Jae Do Yang, Se Wung Han, Mi Rin Lee, Da-Sol Kim, Sejin Lee, Seon-Hyeong Kim, Chan-Young Kim; Ann Clin Nutr Metab 2024;16(2):57-65. Published online August 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.2.57

Abstract PDF Supplementary Material ePub: Purpose: Early nutritional support (ENS) for critically ill patients is promoted by many studies. However, there is a lack of data evaluating its necessity in general wards. This study aims to determine the impact of ENS on patients in general wards.
Methods: Patients aged 18 and above, admitted to the Jeonbuk National University Hospital in Jeonju from January 2020 to December 2020, who were eligible for nutritional support and hospitalized for at least 7 days were included in the study. We divided the patients into two groups: the ENS group, who received nutritional support within 48 hours of admission, and the control group, who received it after 48 hours.
Results: Among 1,077 patients, 146 met the inclusion criteria. The ENS group (n=38) and the control group (n=108) were compared retrospectively. There was a significant age difference between the two groups (P=0.028). The admission ratio to the intensive care unit (ICU) in the ENS group was significantly lower than that in the control group (10.2% vs. 26.3%, P=0.019). The calorie support rate (%) and protein support rate (%) in the ENS group were significantly higher than in the control group (50.12%±23.30% vs. 38.56%±18.02%, P=0.006; 44.61%±25.07% vs. 32.07%±22.76%, P=0.002, respectively). After propensity score matching, the ENS was significantly associated with ICU low admissions (odds ratio 0.08, 95% confidence interval 0.01–0.69, P=0.022).
Conclusion: A future multi-center study considering underlying diseases is needed to provide additional scientific evidence to support the effects of ENS.

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A comprehensive overview of enhanced recovery after surgery: Sang Hyun Shin; Ann Clin Nutr Metab 2024;16(1):1-2. Published online April 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.1.1

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Impact of postoperative nutritional status on the patients’ clinical outcomes and knee biomechanics following total knee arthroplasty in Japan: a prospective cohort study: Kenichi Kono, Tetsuya Tomita, Takaharu Yamazaki, Masashi Tamaki, Shuji Taketomi, Ryota Yamagami, Reo Inoue, Yuki Taniguchi, Sakae Tanaka, Kazuhiko Fukatsu; Ann Clin Nutr Metab 2025;17(1):50-57. Published online April 1, 2025; DOI: https://doi.org/10.15747/ACNM.24.019

Graphical Abstract Abstract PDF Supplementary Material: Purpose
The impact of postoperative nutritional status on clinical outcomes and biomechanics following total knee arthroplasty remains largely unknown. This study aimed to assess this question using the prognostic nutritional index to evaluate the nutritional status of orthopedic participants.
Methods
Patients with knee osteoarthritis who underwent total knee arthroplasty (n=49) in Japan were divided into two groups based on their 1-week postoperative prognostic nutritional index. Group L patients had a prognostic nutritional index <40, whereas Group H comprised patients with a prognostic nutritional index ≥40. Postoperative improvements in Knee Injury and Osteoarthritis Outcome Score were evaluated. The patients performed squats under single-fluoroscopic surveillance in the sagittal plane for biomechanical evaluation. A two-dimensional/three-dimensional registration technique was employed to measure the tibiofemoral kinematics. The axial rotation of the femoral component relative to the tibial component and the anteroposterior translation of the medial and lateral femorotibial contact points were measured.
Results
Group H showed significantly higher pain scores than Group L at 12 and 36 months postoperatively and a significantly higher symptom score at 36 months postoperatively. The kinematic comparison revealed that the axial external rotation in Group L was larger than that in Group H from 70° to 80° with flexion. Moreover, in the medial anteroposterior translation, Group L was more anteriorly located than Group H, with flexion beyond 30°.
Conclusion
The results suggest that a high postoperative nutritional status significantly improved pain and other symptoms and was associated with better knee biomechanics following total knee arthroplasty.

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