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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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.2025; 74(15): 1349. CrossRef
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; 40(6): 1598. CrossRef
Nanoformulations Loaded with Phytochemicals for Combating Wound Infections and Promoting Wound Healing: Current Applications and Innovations
Panoraia I. Siafaka, Androulla N. Miliotou, Mehmet Evren Okur, Gökçe Karaotmarlı Güven, Ioannis D. Karantas, Neslihan Üstündağ Okur
Applied Sciences.2025; 15(10): 5413. CrossRef
Combining Topical Oxygen and Negative-Pressure Wound Therapy: New Insights from a Pilot Study on Chronic Wound Treatment
Bartosz Molasy, Mateusz Frydrych, Rafał Kuchciński, Stanisław Głuszek
Journal of Clinical Medicine.2025; 14(15): 5564. CrossRef
Undifferentiated connective tissue dysplasia and skin: what to do? Dietitian’s position
E. A. Nikitina, S. V. Orlova, T. T. Batysheva, N. V. Balashova, M. V. Alekseeva
Medical alphabet.2025; 1(19): 60. CrossRef
Nutritional Immunity in Wound Infection: Unveiling the Role of Dietary Elements in Host–Pathogen Interaction
Chaoming Chen, Xuanfan Hu, Da He, Xuemei He, Lan Shen
Food Science & Nutrition.2025;[Epub] CrossRef
Role of Nutrients and Diet in Wound Healing: The Emerging Paradigm for Effective Therapy
Aishik Banerjee, Arup Ghosh, Subhrajyoty Basu, Soumitra Sahana, Amit Kundu, Sumanta Mondal
Current Indian Science.2025;[Epub] CrossRef
Assessment of energy requirements in patients with obesity: A narrative review
Cagney Cristancho, Kris M. Mogensen, Malcolm K. Robinson
Nutrition in Clinical Practice.2025;[Epub] CrossRef
Lueyang Black‐Boned Chicken and Black Bean Soup Promoting the Acute Healing of Skin Wounds, Accompanying Special Flavor Substances
Mengya Zhao, Zining Luo, Pengyan Tong, Yining Jia, Xin Yang, Jing Liu, Fangyu Long
Food Chemistry International.2025;[Epub] CrossRef
Cancer-Related Malnutrition and Oxidative Stress in Colorectal Cancer Surgery: A Narrative Review of Pathophysiology and Postoperative Outcomes
Andrii Zahorodnii, Alicja Jelska, Paulina Głuszyńska, Hady Razak Hady
Antioxidants.2025; 14(11): 1289. CrossRef
UCI Sports Nutrition Project: The Role of Nutrition in the Prevention and Management of Illnesses and Injuries in Elite Cycling
Patrick B. Wilson, David B. Pyne, Adrian Rotunno
International Journal of Sport Nutrition and Exercise Metabolism.2025; : 1. CrossRef
Clinical Impact of Nutritional Intervention on Pressure Injury Healing in a Paraplegic Patient: A Case Report
Young ran Kim, Mi young Jang, Jun ho Park
Clinical Nutrition Research.2025; 14(4): 241. 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

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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

Abstract PDF

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
Nutritional Management of Liver Failure in the Intensive Care Unit
Zsófia Verzár, Rudolf Kiss, Csaba Pál Bálint, Annamária Pakai, Tímea Csákvári
Medicina.2025; 61(7): 1210. CrossRef
Comprehensive care of the patient with Refeeding Syndrome
Magdalena Kwiatkowska, Dominika Krupnik, Fabian Wesołek, Agnieszka Jonczyk, Łukasz Krzych
Polish Journal of Surgery.2025; 97(5): 64. 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

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

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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Associations between antioxidant vitamin intake and mental health in Swedish adolescents: a cross-sectional study
Martina Pensa, Karin Kjellenberg, Emerald Heiland, Örjan Ekblom, Gisela Nyberg, Björg Helgadóttir
European Journal of Nutrition.2025;[Epub] CrossRef
A Study of Nutritional and Sensory Qualities of Pea Protein Isolate Beverages with a View to Their Potential Use in Patients with Psychiatric Disorders
Lasma Plocina, Ilze Beitane
Foods.2025; 14(17): 2991. 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

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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Incidence and Risk Factors of Dysphagia After Cardiac Surgery: A Scoping Review
Christos Kourek, Vania Labropoulou, Emilia Michou, Stavros Dimopoulos
Journal of Clinical Medicine.2025; 14(12): 4279. CrossRef

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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

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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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

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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Current practices and challenges in nutrition support team activities, 2025 in Korea: a multicenter cross-sectional descriptive study: So Hyun Nam; Ann Clin Nutr Metab 2025;17(2):97-103. Published online August 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0026

Abstract PDF Supplementary Material: Purpose
This study aimed to evaluate the current practices, activities, and challenges of nutrition support teams (NSTs) in Korea. The assessment was conducted as part of the 4th NST Leadership Program of the Korean Society of Surgical Metabolism and Nutrition held in 2025, which seeks to foster leadership and enhance team functionality.
Methods
A nationwide survey was conducted in February 2025 among 54 NST members from 44 institutions. The survey explored team composition, consultation volume, educational programs, barriers to implementation, institutional support, and reimbursement challenges.
Results
Of the 44 participating hospitals, most (86.4%) operated a single NST, with multidisciplinary physician involvement from over three specialties in 77.2% of cases. Inpatient referrals to NSTs were generally low, with less than 10% at 63% of institutions. Only 40.9% had an individual office, and formal incentive systems were reported in 18.1% of hospitals. Educational programs for in-hospital staff were limited (29.5%), and less than half conducted regular academic meetings. Rates of adoption of NST recommendations varied widely, with barriers including a lack of engagement from attending physicians, failure to review the recommendations, and department-specific clinical policies. Efforts to promote NST activation included computerized prescription systems, automated referral workflows, staff education, and quality improvement initiatives. Participants focused on sharing effective NST cases, building incentives, exchanging clinical insights, clarifying team roles and leadership, and developing unified practice guidelines.
Conclusion
NSTs in Korea are well established but face ongoing challenges in collaboration and sustainability. Continued leadership and policy support are crucial for enhancing team performance and improving patient outcomes.

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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

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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Development of the Korean enhanced recovery after surgery audit program
Soo-Hyuk Yoon, Jae-Woo Ju, Ho-Jin Lee, Jeesun Kim, Min Jung Kim, Ji Won Park, Do Joong Park, Seung Yong Jeong
Scientific Reports.2025;[Epub] CrossRef
Optimizing postoperative pain management in minimally invasive colorectal surgery
Soo Young Lee
Annals of Coloproctology.2024; 40(6): 525. CrossRef

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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

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
Efficacy of preoperative immunonutrition in malnourished patients undergoing colorectal cancer surgery: a study protocol for a multicenter randomized clinical trial
Soo Young Lee, Chang Hyun Kim, Gi Won Ha, Soo Yeun Park, In Jun Yang, Jin Soo Kim, Gyung Mo Son, Sung Il Kang, Sung Uk Bae
Trials.2025;[Epub] 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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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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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

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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The impact of Lactiplantibacillus plantarum on the cream composition: Insight into changes of vitamin D3 content and fatty acid composition
Tetiana Dyrda-Terniuk, Viorica Railean, Aleksandra Bogumiła Florkiewicz, Justyna Walczak-Skierska, Mateusz Kolankowski, Joanna Rudnicka, Dorota Białczak, Paweł Pomastowski
International Dairy Journal.2025; 161: 106118. CrossRef
Palmitoleic and oleic fatty acids as biomarkers for coronary heart disease: A predictive model
Guangzhou Wang, Lin Zhou, Zhengfang Wang, Asmaa Ali, Liang Wu
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Jéssica Vidal Damasceno, Anderson Garcez, Andressa Anelo Alves, Isabella Rosa da Mata, Simone Morelo Dal Bosco, Juliano Garavaglia
Critical Reviews in Food Science and Nutrition.2025; : 1. CrossRef
Evaluation of the Nutritional Value of Prunus dulcis Blossoms and the Antioxidant Compounds of Their Extracted Oil Using Green Extraction Method
Theodoros Chatzimitakos, Vassilis Athanasiadis, Konstantina Kotsou, Ioannis Makrygiannis, Eleni Bozinou, Stavros I. Lalas
Applied Sciences.2024; 14(5): 2001. CrossRef
Oleic Acid and Succinic Acid: A Potent Nutritional Supplement in Improving Hepatic Glycaemic Control in Type 2 Diabetic Sprague–Dawley Rats
Kemmoy G. Lattibeaudiere, Ruby Lisa Alexander-Lindo, Mozaniel Oliveira
Advances in Pharmacological and Pharmaceutical Sciences.2024;[Epub] CrossRef

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Postoperative gut dysbiosis and its clinical implications, with an emphasis on probiotic strategies in gastric cancer patients undergoing gastrectomy: a narrative review: Cheong Ah Oh; Ann Clin Nutr Metab 2025;17(2):114-124. Published online August 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0023

Abstract PDF: Purpose
This review explores alterations in gut microbiota following gastrointestinal surgery, with a focus on gastrectomy for gastric cancer, and evaluates the therapeutic potential of probiotics in restoring microbial balance and reducing postoperative complications, including infections, inflammation, immune dysfunction, and cancer recurrence.
Current concept
Gastrointestinal surgery disrupts gut microbial homeostasis via surgical stress, oxygen exposure, altered bile flow, and perioperative antibiotic use. Gastrectomy, in particular, induces marked changes in the microbiota, including increased oral-origin and aerotolerant bacteria, decreased short-chain fatty acid–producing species, and elevated bile acid-transforming organisms. These alterations contribute to complications such as small intestinal bacterial overgrowth, surgical site infections, postoperative ileus, nutrient malabsorption, and potentially a higher risk of colorectal cancer. Probiotics—especially strains of Lactobacillus, Bifidobacterium, and Clostridium—have demonstrated beneficial effects by modulating the gut ecosystem, enhancing epithelial barrier integrity, and regulating immune and metabolic pathways. Randomized clinical trials support using probiotics in improving gastrointestinal recovery, reducing systemic inflammation, restoring microbial diversity, and shortening hospital stays after gastrectomy. Multi-strain probiotic formulations, particularly when administered perioperatively, show the greatest promise. However, safety concerns remain, especially for immunocompromised or critically ill patients, underscoring the need for rigorous clinical oversight and adherence to regulatory standards such as the European Food Safety Authority’s Qualified Presumption of Safety guidelines.
Conclusion
Postoperative dysbiosis is a modifiable factor in adverse surgical outcomes. Probiotic supplementation offers promising therapeutic potential in patients undergoing gastrectomy, though optimal strains, dosing, and timing remain to be determined. Tailored, evidence-based strategies may ultimately enhance both recovery and long-term outcomes after gastric cancer surgery.

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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

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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Strengthening collaboration: introducing the contributions of Japanese Society for Surgical Metabolism and Nutrition to Annals of Clinical Nutrition and Metabolism
Ye Rim Chang
Ann Clin Nutr Metab.2025; 17(2): 95. CrossRef

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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

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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Elevated triglyceride-glucose index and risk of thymoma-associated myasthenia gravis: a prospective analysis from the UK Biobank
Kangle Zhu, Jingwei Shi, Jingwei Zhao, Yi Zhao, Yao Zhang, Wuji Zhang, Mingjun Wei, Chu Zhou, Rusong Yang, Zhengcheng Liu, Zhuo Liu, Zhixiang Shen
Cardiovascular Diabetology.2025;[Epub] CrossRef

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Definition, assessments, and current research on sarcopenia in children: a narrative review: Min-Jung Bang; Ann Clin Nutr Metab 2024;16(2):49-56. Published online August 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.2.49

Abstract PDF

Purpose: Sarcopenia is a well-established prognostic factor for the clinical outcomes of adult patients with cancer and chronic diseases and correlates with increased intensive care unit admissions and prolonged hospital stays. However, research on sarcopenia in children is limited due to its undefined criteria and a lack of studies exploring its impact on clinical outcomes.
Current concept: The challenges in pediatric sarcopenia research include the absence of standardized body composition methods to quantify muscle mass and muscular function, as well as inconsistencies in definitions. Additionally, there is a lack of age- and gender-specific normative data, particularly for young children and infants. Most studies also lack assessments of muscle function, which can lead to bias and misclassification of sarcopenia. The field is further hindered by poor study quality, limited outcome-focused research, and a dearth of longitudinal data. While some studies suggest that various diseases can affect children’s lean muscle mass, few have linked changes in muscle mass to clinical outcomes.
Conclusion: The existing literature on pediatric sarcopenia and its relationship with medical and surgical outcomes is sparse and indicates poorer outcomes associated with sarcopenia. Although extensive research has established a link between sarcopenia and adverse outcomes in adults, information on its impact in pediatric populations remains scarce. Further studies are needed to elucidate the association between muscle mass and outcomes in pediatric surgical patients.

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Newer Insights on the Occurrence of Sarcopenia in Pediatric Patients with Cancer: A Systematic Review of the Past 5 Years of Literature
Georgios Kiosis, Despoina Ioannou, Kanellos Skourtsidis, Vasilis Fouskas, Konstantinos Stergiou, Dimitrios Kavvadas, Theodora Papamitsou, Sofia Karachrysafi, Maria Kourti
Cancers.2025; 17(19): 3188. 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: 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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Evaluation of the modified Nutrition Risk in Critically Ill score in Korean critically ill patients with COVID-19: a retrospective cohort study: Won Ho Han, Jong-Mog Lee, Jae Hoon Lee, Hyun Mi Lee, Ji-Yeon Kim, Mok Young Jang, Sung-Sik Han; Ann Clin Nutr Metab 2025;17(2):125-131. Published online August 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0009

Abstract PDF Supplementary Material: Purpose
We evaluated the efficacy of the modified Nutrition Risk in Critically Ill (mNUTRIC) score for malnutrition screening and its association with mortality in intensive care unit (ICU) patients with COVID-19.
Methods
The nutritional status of 129 COVID-19 ICU patients admitted between February 2021 and May 2022 was assessed using American Society for Parenteral and Enteral Nutrition/Academy of Nutrition and Dietetics (ASPEN/AND) criteria. The sensitivity, specificity, and clinical correlations of the mNUTRIC score were analyzed.
Results
Of the 129 patients, 35 (27.1%) met the ASPEN/AND malnutrition criteria. Multivariable analysis identified the mNUTRIC score, underlying malignancy, and mechanical ventilation as significant factors associated with malnutrition. The mNUTRIC score had a sensitivity of 77.1% and specificity of 63.8% (area under the curve [AUC], 0.71; 95% confidence interval [CI], 0.62–0.79) for diagnosing malnutrition, improving to 88.6% and 80.9%, respectively, after adjusting for malignancy and ventilation (AUC, 0.89; 95% CI, 0.82–0.95). Patients with a low mNUTRIC score had a mortality rate of 2.9% and a median ICU stay of 7.7 days (range, 0–84.2 days), whereas those with a high score (≥5) had a mortality rate of 13.1% and a median ICU stay of 10.2 days (range, 1.4–88.5 days) (P=0.046 and P=0.011, respectively).
Conclusion
The mNUTRIC score is an effective screening tool for malnutrition in ICU patients with COVID-19, especially those with malignancy or requiring mechanical ventilation, and is strongly associated with mortality and length of ICU stay.

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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: 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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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

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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Development of the Korean enhanced recovery after surgery audit program
Soo-Hyuk Yoon, Jae-Woo Ju, Ho-Jin Lee, Jeesun Kim, Min Jung Kim, Ji Won Park, Do Joong Park, Seung Yong Jeong
Scientific Reports.2025;[Epub] CrossRef
Perioperative nutrition practices in gastrointestinal cancer surgery: A nationwide survey among German surgical departments
Rahel Maria Strobel, Katharina Beyer, Johannes Christian Lauscher, Marc Martignoni, Christoph Reißfelder, Tim Vilz, Arved Weimann, Maria Wobith
Langenbeck's Archives of Surgery.2025;[Epub] CrossRef

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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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Effects of an Early Promoting Mobility Program on Postoperative Recovery Outcomes in People with Critical Illness after Major Abdominal Surgery: A Quasi-experimental Study
Tarrana Termkunanon, Piyawan Pokpalagon, Suchira Chaiviboontham
Pacific Rim International Journal of Nursing Research.2025; 29(4): 696. CrossRef

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Body composition assessment using bioelectrical impedance analysis and computed tomography in patients who underwent pancreatoduodenectomy in Korea: a before and after study: Juwan Kim, Seung-seob Kim, Ho Kyoung Hwang, Chang Moo Kang, Kyung Sik Kim, Sung Hyun Kim; Ann Clin Nutr Metab 2023;15(3):72-80. Published online December 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.3.72

Abstract PDF Supplementary Material

Purpose: This study focuses on the need for standardized body composition measurements in the hepatobiliary-pancreatic field. It evaluates and compares the effectiveness of bioelectrical impedance analysis (BIA) and computed tomography (CT) scans in assessing body composition of patients undergoing pancreatoduodenectomy (PD), aiming to establish correlations among different body composition indexes.
Methods: Ninety-seven patients who underwent PD between August 2022 and March 2023, were enrolled in this study. Muscular and fatty parameters related to BIA and CT were assessed both preoperatively and on postoperative day 6. The correlation between each parameter related to muscle fat was analyzed according to the measurement modalities.
Results: There was an increase of skeletal muscle area (SMA), total muscle area, and low attenuated muscle area after surgery. Skeletal muscle mass (SMM) measured using BIA exhibited a strong correlation with the SMA and normal attenuated muscle area (NAMA) measured using CT (r=0.86, P<0.001; r=0.76, P<0.001). The trunk muscle measured using BIA demonstrated moderate to strong correlations with SMA and NAMA measured using CT (r=0.84 P<0.001; r=0.73, P<0.001). Body fat measured using BIA and total fat area (TFA) measured using CT showed strong correlations (r=0.74, P<0.001). In the postoperative analysis, a similar trend was observed (SMM vs. SMA: r=0.80, P<0.001; SMM vs. NAMA: r=0.70, P<0.001), (trunk muscle vs. SMA: r=0.79, P<0.001; trunk muscle vs. NAMA: r=0.69, P<0.001), and (body fat vs. TFA: r=0.83, P<0.001).
Conclusion: BIA, akin to CT, serves as a valuable tool for assessing body composition ratios in patients undergoing PD.

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Morphomics in esophageal cancer: Validation and association with muscular and cardiorespiratory fitness
Watson Hua-Sheng Tseng, Shu-Chun Huang, Stewart C Wang, Jules Lin, Peng Zhang, Yu-Chen Liu, Yin-Kai Chao, Chien-Hung Chiu
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef

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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: 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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Comparison of a volume-based feeding protocol with standard feeding for trauma patients in intensive care units in Korea: a retrospective cohort study: Juhong Park, Yesung Oh, Songhee Kwon, Ji-hyun Lee, Mihyang Kim, Kyungjin Hwang, Donghwan Choi, Junsik Kwon; Ann Clin Nutr Metab 2023;15(1):22-29. Published online April 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.1.22

Abstract PDF

Purpose: Although early enteral nutrition for critically ill patients is essential, it is difficult to provide enteral nutrition to trauma patients in early hospitalization stages due to frequent surgeries and examinations. We aimed to identify the effect of achieving early enteral nutrition goals and improving outcomes through a volume-based feeding (VBF) protocol for trauma patients.
Methods: Patients who were admitted to the trauma intensive care units (TICUs) of the Ajou University Hospital from January 2020 to September 2021 and received enteral tube feeding for at least 7 days were studied. An institution-specific VBF protocol was developed, and nurses were trained in its execution. We retrospectively compared outcomes, such as in-hospital mortality and initial nutritional goal achievement, between the new and standard protocols.
Results: Among 2,935 patients, 109 met the inclusion criteria. Of these, 64 patients received nutrition through VBF, with no feeding intolerance symptoms. The VBF group started enteral nutrition approximately 16.9 hours earlier and group achieved 80% of the target calorie and protein intake approximately one day faster than the control group (n=45). The average calorie supply per body weight per day was 4.9 kcal/kg/day more in the VBF group. An increase of 0.2 g/kg/day was also observed in protein uptake. However, mortality and adverse hospital events did not differ between the groups.
Conclusion: The VBF protocol for patients admitted to the TICU increased the initial nutrient supply without risk of feeding intolerance, but there was no improvement in major clinical outcomes, including mortality and adverse hospital events.

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Early initiation of gastric tube feeding: ultrasound assessment. A prospective interventional study
Islam M. Elbardan, Ahmed A. Alla Ossman, Nada El Kayal, Assem A. ElRazek Abd-Rabih
Research and Opinion in Anesthesia & Intensive Care.2024; 11(4): 270. CrossRef

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Kumamoto Earthquake NST activity report: food problems in evacuation shelters in comparison with convalescent facilities: Joji Kotani, Isamu Yamada, Takahiro Ueda; Ann Clin Nutr Metab 2024;16(3):173-180. Published online December 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.3.173

Abstract PDF: Purpose: It aims to investigate the contents of food supplies, gastrointestinal symptoms, and stated preferences of evacuees during the first two weeks after the earthquake.
Methods: Thirty-four evacuees from evacuation shelters and 12 evacuees from geriatric care facilities were surveyed. Subjective and comprehensive nutritional assessment questionnaires were administered to the evacuees, and their dissatisfaction and preferences were also recorded in an open-ended format.
Results: Weight decreased, remained unchanged, increased, or was unknown for 4, 24, 6, and 0 evacuees from the shelters and in 0, 8, 1, and 3 evacuees from the facilities. The number of respondents who reported a decrease, change, or decrease in food intake was 4, 22, and 1 from the evacuation centers and 1, 10, and 1 from the facilities, indicating a large number of changes in the evacuation centers. Reasons for weight gain included “feeling that they should not leave food behind,” “eating a lot of high-calorie food,” and “eating sweets and cup noodles.” Constipation was the most common gastrointestinal symptom (n=5) in the evacuation centers, while diverse symptoms were reported from the facilities. Constipation in the facilities was thought to be related to the high carbohydrate content of the food. Only two respondents were satisfied with the shelter, and the majority complained of dissatisfaction. The most common complaints were “I don’t like bread in the morning (I prefer rice);” “Too sweet;” and “Onigiri (rice ball) is too big,” but there were also complaints about the eating environment on the floor, such as “I lose [my] appetite when eating on the floor due to abdominal pressure” (I prefer to eat on a chair at a table). The majority of the respondents in the facilities did not have any complaints. All of the respondents in the shelters expressed a wide variety of food preferences, including vegetables, rice in the morning, meat, fruit, and foods that were not available due to lack of refrigeration, such as carbonated beverages and ice cream. Some respondents expressed that they were tired of being given food unilaterally and having no choice, such as “I want to choose my own food” and “I want a vending machine [to choose my own food].” There were almost no requests for food at the facilities, and the majority of the respondents were satisfied with their situation. The food was supplied by volunteers and the Self-Defense Forces, which were out of sync with the needs of the evacuees at the evacuation center. However, at the facilities, food was sent to a geriatric care facility in a remote area that accounted for the needs of the victims.
Conclusion: Evacuees were grateful for the food supplies immediately after the disaster, but gradually became dissatisfied. Meals are one of the pleasures in evacuation centers and are important for reducing mental stress. Evacuation centers should consider the needs of evacuees when providing food to evacuees.

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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: 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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Comparative assessment of nutritional characteristics of critically ill patients at admission and discharge from the neurosurgical intensive care unit in Korea: a comparison study: Eunjoo Bae, Jinyoung Jang, Miyeon Kim, Seongsuk Kang, Kumhee Son, Taegon Kim, Hyunjung Lim; Ann Clin Nutr Metab 2023;15(3):97-108. Published online December 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.3.97

Abstract PDF

Purpose: Patients in neurosurgical (NS) intensive care units (ICUs) experience considerable energy and protein deficits associated with adverse outcomes. This study aimed to compare the nutritional status of patients at admission to (baseline) and discharge from the NS ICU.
Methods: This was a single-center, retrospective, before and after study of patients admitted in the NS ICU of the CHA Bundang Medical Center, from January 31, 2019, to February 28, 2020. All anthropometric data, biochemical data, clinical data, and dietary data were collected during the NS ICU stay. Specifically, we investigated the cumulative caloric deficit rate, phase angle and skeletal muscle index as indicators of lean muscle mass, and nitrogen balance according to demographic and clinical characteristics.
Results: A total of 140 NS patients were studied. Calf circumference decreased from 31.4±4.2 cm at baseline to 30.2±4.0 cm at discharge (P<0.001). Energy supply rate increased from 44.4% at baseline to 89.2% at discharge. Phase angle (PhA) patients with an modified Nutrition Risk in the Critically ill (mNUTRIC) score≤5 group had significantly lower PhA values than those with an mNUTRIC score>5 (P=0.005).
Conclusion: Although clinical and dietary parameters of patients in the NS ICU improved from baseline to discharge, anthropometric and biochemical markers of lean muscle mass and nutritional status decreased. PhA and nitrogen balance difference values were significantly different between those with an mNUTRIC score≤5 and those with an mNUTRIC score>5. These data indicate that the nutritional risk of critically ill patients increases during hospitalization in the NS ICU.

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A Review on the Effects of Multiple Nutritional Scores on Wound Healing after Neurosurgery.
Jingqian Ye, Bo Ning , Jianwen Zhi
International Journal of Biology and Life Sciences.2025; 9(2): 82. CrossRef
Transition from Enteral to Oral Nutrition in Intensive Care and Post Intensive Care Patients: A Scoping Review
Gioia Vinci, Nataliia Yakovenko, Elisabeth De Waele, Reto Stocker
Nutrients.2025; 17(11): 1780. CrossRef

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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

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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Effect of Standard Care Pathway Implementation on Clinical Outcomes and Protocol Utilization in Infants With Gastroschisis
Alexandra Barone-Camp, Ana Ibarra Meraz, Samantha Bothwell, Sage A. Vincent, Theresa Grover, Stephanie Bourque, Kimberly Vollrath, Jose Diaz-Miron, Shannon Acker
Journal of Pediatric Surgery.2025; 60(11): 162499. CrossRef

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Strengthening collaboration: introducing the contributions of Japanese Society for Surgical Metabolism and Nutrition to Annals of Clinical Nutrition and Metabolism: Ye Rim Chang; Ann Clin Nutr Metab 2025;17(2):95-96. Published online August 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0022

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Improving the usability of lipid emulsions and optimizing their user-friendliness: a narrative review: Keisuke Kubota, Natsuko Ichikawa, Kazuhiro Isoda, Misato Enomoto, Miyoko Kosugi, Mari Tanabe, Naoya Sakuraba, Sayuri Endo, Atsushi Suzuki, Masanori Hashimoto; Ann Clin Nutr Metab 2025;17(2):104-113. Published online August 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0015

Abstract PDF: Purpose
Reluctance to administer lipid emulsions to patients receiving treatment, or as recommended by a nutritional support team, often stems from various restrictions or concerns about potential adverse effects. This paper aims to discuss the appropriate clinical use of lipid emulsions to enhance both patient safety and convenience.
Current concept
We conducted a literature review to assess the importance of nutritional therapy and nutritional intervention, the advantages and disadvantages of lipid-emulsion administration, the current situation in Japan, and differences between lipid formulations. Here, we address issues regarding lipid-emulsion use, including: administration rate, drug mixing, administration in critically ill patients, and early postoperative use. Our findings suggest the following solutions to each issue: although a rate below 0.1 g/kg/hr is generally recommended, faster administration is possible if needed, depending on the case; administration via a piggy tube to basic infusion formulations is unproblematic; second- and third-generation fat emulsions are safe for critically ill patients, though soybean oil should be used with caution; and while fat emulsion administration is feasible immediately after surgery, due to endogenous energy mobilization, it is preferable to initiate administration from the third to fourth postoperative day.
Conclusion
The provisional conclusions of this study are as follows: the introduction of medium-chain triglyceride formulations and fish oil (second- and third-generation lipid emulsions), which are not yet available in Japan, is urgently needed; and individualized administration is essential due to substantial interindividual variability in lipid emulsion usage.

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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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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: 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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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: 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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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: 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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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

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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Development of a Japanese version of the Short Bowel Syndrome-Quality of Life (SBS-QoL) scale: Yuko Tazuke, Mayu Suzuki, Sae Kikuchi, Kaori Ishiguro, Hiroomi Okuyama; Ann Clin Nutr Metab 2025;17(2):132-138. Published online August 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0016

Graphical Abstract Abstract PDF: Purpose
The Short Bowel Syndrome‐Quality of Life (SBS‐QoL) scale is a reliable and sensitive instrument developed to measure and evaluate the quality of life (QoL) in adult patients with short bowel syndrome (SBS). In Japan, increasing attention has been given to the assessment of QoL in patients with SBS; however, no Japanese‐language SBS‐specific scale is currently available. This study aimed to develop a Japanese version of the SBS‐QoL based on the original English version.
Methods
A provisional Japanese version was created in accordance with the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force, utilizing a process of forward translation, adjustment, and back translation.
Results
Cognitive debriefing using the provisional Japanese version was conducted with six Japanese patients with SBS. Based on these results, the Japanese wording was evaluated and revised, leading to the creation of the final Japanese version.
Conclusion
The Japanese SBS‐QoL, which has been confirmed to possess linguistic equivalence with the original English version, is expected to support the treatment of Japanese SBS patients, ultimately aiming to improve their QoL.

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Successful introduction of ERAS in pancreaticoduodenectomy: what is real minimally invasive surgery?: Toshimi Kaido, Yosuke Miyachi, Koichiro Mitsuoka, Mariko Sambommatsu; Ann Clin Nutr Metab 2025;17(2):156-161. Published online August 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0014

Graphical Abstract Abstract PDF: Purpose
The introduction of Enhanced Recovery After Surgery (ERAS) protocols for pancreaticoduodenectomy (PD) has been considered challenging due to factors such as preexisting malnutrition, sarcopenia, the complexity of the surgery, and the high incidence of postoperative complications, including postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE). This study aimed to determine whether ERAS could be implemented in PD to achieve shorter postoperative hospital stays.
Methods
Our novel approach consists of three components. Preoperatively, we routinely assess patients' muscle strength and nutritional status and initiate exercise and nutritional interventions for those identified with sarcopenia or malnutrition. Intraoperatively, we perform pancreaticojejunostomy using a modified Blumgart’s technique with our stent placement policy and utilize new gastrojejunostomy methods to prevent DGE. Principles of postoperative management are early ambulation, early oral intake, and early drain removal. Since April 2020, we have employed this strategy and retrospectively evaluated its effectiveness. We enrolled 71 consecutive patients who underwent open PD with curative intent. Various surgical outcomes, including postoperative hospital stay, were analyzed.
Results
There were 41 men and 30 women, with a median age of 70 years. Preoperative diagnoses included pancreatic head cancer in 31, distal bile duct cancer in 12, and others. Median intraoperative blood loss was 310 mL. Grade B POPF occurred in four patients (6%). No cases of DGE were observed. The median postoperative hospital stay was 8 days (range, 6–26 days).
Conclusion
We successfully implemented ERAS protocols in PD and achieved a significantly reduced postoperative hospital stay. We propose that this approach is “real minimally invasive surgery," regardless of the surgical technique used.

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The enteral feeding tube access route in esophageal cancer surgery in Japan: a retrospective cohort study: Hiroyuki Kitagawa, Keiichiro Yokota, Tsutomu Namikawa, Kazuhiro Hanazaki; Ann Clin Nutr Metab 2025;17(1):58-65. Published online April 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0003

Graphical Abstract Abstract PDF

Purpose
Feeding catheter jejunostomy is a useful access route for early enteral nutrition during esophageal cancer surgery. However, it may lead to postoperative bowel obstruction associated with feeding jejunostomy (BOFJ). To prevent BOFJ, we introduced feeding catheter duodenostomy via the round ligament in 2018. This study aimed to compare the incidence of BOFJ and postoperative body weight changes between feeding catheter jejunostomy and duodenostomy.
Methods
A total of 109 patients who underwent thoracoscopic esophagectomy and gastric tube reconstruction for esophageal cancer at Kochi Medical School Hospital between March 2013 and November 2020 were included. Preoperative patient characteristics (age, sex, preoperative weight, body mass index, cancer stage, and preoperative treatment), surgical outcomes (operative time, blood loss, and postoperative complications [wound infection, pneumonia, anastomotic leakage, BOFJ]), and body weight changes at 1, 3, 6, and 12 months post-surgery were compared between the jejunostomy (J) and duodenostomy (D) groups.
Results
The D group consisted of 35 patients. No significant differences were observed between the groups regarding age, sex, weight, body mass index, cancer stage, operative time, postoperative complications, or duration of tube placement. However, the D group had a significantly lower rate of preoperative chemotherapy (45.7% vs. 78.4%, P=0.001) and lower operative blood loss (120 mL vs. 150 mL, P=0.046) than the J group. All 12 cases of BOFJ occurred in the J group. Furthermore, the D group experienced a significantly lower weight loss ratio at 1 month postoperatively (93.9% vs. 91.8%, P=0.039).
Conclusion
In thoracoscopic esophagectomy, feeding duodenostomy may prevent bowel obstruction and reduce early postoperative weight loss without increasing operative time compared with feeding catheter jejunostomy.

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Strengthening collaboration: introducing the contributions of Japanese Society for Surgical Metabolism and Nutrition to Annals of Clinical Nutrition and Metabolism
Ye Rim Chang
Ann Clin Nutr Metab.2025; 17(2): 95. CrossRef

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Pneumothorax due to malpositioned nasogastric enteral feeding tube: Hyebeen Kim, Suk-Kyung Hong; Ann Clin Nutr Metab 2024;16(2):87-88. Published online August 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.2.87

PDF

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Peripheral vein infusions of amino acids prevent early postoperative weight loss after robot-assisted radical transmediastinal esophagectomy: a retrospective study in Japan: Tomonori Narita, Kazuhiko Fukatsu, Satoshi Murakoshi, Reo Inoue, Kenichi Kono, Midori Noguchi, Nana Matsumoto, Shoh Yajima, Koichi Yagi, Yoshifumi Baba; Ann Clin Nutr Metab 2025;17(2):149-155. Published online August 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0012

Graphical Abstract Abstract PDF Supplementary Material: Purpose
Postoperative body weight loss (PBWL) is linked to poor long-term outcomes following esophagectomy for esophageal cancer, making perioperative nutrition critically important. Although minimally invasive procedures such as robot-assisted radical transmediastinal esophagectomy (RA-TME) have become more prevalent, less attention has been paid to perioperative nutritional management. This study evaluates the impact of intravenous (IV) amino acid infusions on PBWL in patients undergoing RA-TME.
Methods
We retrospectively analyzed 155 patients who underwent RA-TME for esophageal or esophagogastric junction cancer at our hospital between 2011 and 2022. Patients were divided into two groups: AA(+) (n=73, received IV amino acids between postoperative days 1–6) and AA(–) (n=82, did not receive IV amino acids). Oral or enteral nutrition was withheld until postoperative day 6. We compared nutrient intake, postoperative outcomes, and nutritional status between groups.
Results
Patient backgrounds, surgical outcomes, and complication rates were similar in both groups. However, the AA(+) group received significantly greater energy and nutrient intake. PBWL at 2 weeks post-surgery was significantly lower in the AA(+) group than in the AA(–) group (6.50% vs. 8.15%, P=0.0091).
Conclusion
IV amino acid infusion may help mitigate early PBWL after RA-TME.

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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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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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Optimizing nutritional support in upper gastrointestinal surgery: A comprehensive review of feeding jejunostomy techniques and outcomes
Ioana Alexandra Prisacariu, Konstantinos Eleftherios Koumarelas, Konstantinos Argyriou, Alexandros Charalabopoulos, Grigorios Christodoulidis
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef

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Perioperative outcomes of older adult patients with pancreatic cancer based on nutritional status: a retrospective cohort study: Takanori Morikawa, Masaharu Ishida, Masamichi Mizuma, Kei Nakagawa, Takashi Kamei, Michiaki Unno; Ann Clin Nutr Metab 2025;17(1):66-74. Published online April 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.001

Abstract PDF

Purpose
This study investigated the effects of preoperative nutritional status on postoperative outcomes in older adult patients with pancreatic adenocarcinoma.
Methods
The background and perioperative factors of patients who underwent pancreatectomy for pancreatic adenocarcinoma between 2007 and 2020 were retrospectively analyzed.
Results
Patients aged 75 years or over (older adults) were significantly associated with hypertension, upfront surgery, and lower prognostic nutritional index. In addition, these patients had a significantly lower rate of portal vein resection, less blood loss, and shorter operation time than patients aged less than 75 years (non-older adults). During the postoperative course, older adult patients had a higher rate of pneumonia and lower overall survival than younger patients, although recurrence‐free survival was comparable. In addition, older adult patients showed preoperative malnutrition as a risk factor for postoperative in‐hospital death.
Conclusion
Surgical treatment for pancreatic cancer in older adult patients was performed safely. However, preoperative malnutrition is a risk factor for in‐hospital death and such patients require nutritional support and less‐invasive surgery.

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Citations to this article as recorded by

Strengthening collaboration: introducing the contributions of Japanese Society for Surgical Metabolism and Nutrition to Annals of Clinical Nutrition and Metabolism
Ye Rim Chang
Ann Clin Nutr Metab.2025; 17(2): 95. CrossRef

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22 Download
1 Crossref

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

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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Strengthening collaboration: introducing the contributions of Japanese Society for Surgical Metabolism and Nutrition to Annals of Clinical Nutrition and Metabolism
Ye Rim Chang
Ann Clin Nutr Metab.2025; 17(2): 95. CrossRef

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Insulinotropic action of L-carnitine and branched-chain amino acids following energy intake in healthy, young Japanese women: a non-randomized controlled trial: Yoichi Sakurai, Hideyuki Namba, Satoshi Odo; Ann Clin Nutr Metab 2025;17(2):139-148. Published online August 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0011

Abstract PDF: Purpose
The present study uses healthy human volunteers to examine the insulinotropic action of L-carnitine and branched-chain amino acids (BCAAs) after energy intake.
Methods
A total of 39 young, healthy human volunteers were assigned to receive oral doses of either L-carnitine alone (L group, n=10) or L-carnitine combined with a single or long-term continuous dose of BCAAs. Controls (C group, n=16) received none of these. L-carnitine was administered orally at 1,000 mg/d for 14 days, and BCAA was administered orally either once just before exercise (L+SB group, n=6), or every day for 14 days (L+CB group, n=7) until 2 days before the experiment. After overnight fasting, 200 kcal of glucose and oral nutritional supplement were administered to prevent hypoglycemia. Blood glucose, free-fatty acid, and serum insulin levels were measured to examine the insulinotropic action before and after exercise.
Results
Blood glucose and serum insulin levels in the L group were significantly lower than those in the C group. While the serum insulin levels were higher after energy administration than those in the fasting state in all groups, these were significantly higher in the L+SB group and in the L+CB group compared with those in the L group. The insulinotropic action after energy intake remained even after the repeated administration of BCAA discontinued 2 days before the experi¬ment and even after serum BCAA levels remained the same.
Conclusion
While the insulinotropic action appeared after a single dose of BCAA, it was also potentiated by long-term repeated oral administration of BCAA.

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Multi-biomarker approach to metabolic syndrome and associated diseases in Turkey: a cross sectional study: Semra Can Mamur, Omer Colak, Selma Metintas, Inci Arikan, Mehmet Kara; Ann Clin Nutr Metab 2023;15(3):88-96. Published online December 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.3.88

Abstract PDF: Purpose: Biomarker for cardiovascular diseases (CVDs) are important in the clinical monitoring of individuals with metabolic syndrome (MetS). The use of these biomarkers in combination may be predictive of CVDs. This study aimed to demonstrate the ability of multiple biomarkers to predict MetS, diabetes mellitus (DM), and CVDs. The use of multiple biomarkers instead of a single biomarker may be more useful in early diagnosis. We investigated the use of a multi-biomarker approach in MetS and associated diseases.
Methods: The study was performed by selecting control (n=30), MetS (n=30), MetS+DM (n=30), and MetS+CVD (n=30) groups from data of the Eskisehir Healthy Hearts Project conducted from January 2008 to October 2009 in Turkey. We recorded serum level of biomarkers, including lipid profile, liver enzyme, paraoxonase, arylesterase and arginase to find their difference among the groups.
Results: Compared to the control group, gamma-glutamyl transferase (GGT) and arginase levels increased, while paraoxonase and arylesterase activity and high-density lipoprotein–cholesterol levels were low in the patient groups (P<0.001). A negative correlation was observed between paraoxonase and arylesterase activity and MetS.
Conclusion: We believe that the combined use of biomarkers, including GGT, arginase, paraoxonase, and arylesterase, may be useful in predicting diseases such as MetS and CVDs.

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Perioperative nutritional practices and attitudes among gastrointestinal oncologic surgeons in Korea: a nation-wide survey study: Dae Hoon Kim, Jeong-Meen Seo, Min-Gew Choi; Ann Clin Nutr Metab 2023;15(3):81-87. Published online December 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.3.81

Abstract PDF Supplementary Material: Purpose: This study aimed to investigate the current perioperative nutritional practices and attitudes among gastrointestinal (GI) oncologic surgeons in Korea. Evidence-based perioperative nutritional practices are not well-established in this field.
Methods: A nationwide survey was conducted with 24 items, targeting GI oncologic surgical faculty members from March 2022 to April 2022 through social networking service messaging and email. Whole target number was 3,421.
Results: Out of responding 161 GI surgeons, 83.9% were male and 16.1% were female, and about 49.7% were in their 40s. When asked about their hospital policies, 67.1% reported the existence of formal nutritional screening programs. However, the execution and analysis of these programs varied considerably. Most surgeons conducted preoperative nutritional screening, with albumin testing the most frequently performed. In addition, nutritional supplementation—primarily protein drinks—was given before surgery. The duration for which these supplements were used varied from ≤3 days to 4–7 days. Most respondents recognized the importance of addressing nutritional deficiencies in patients with GI tumors; however, when asked about immunonutrition, 89.4% of surgeons admitted having limited knowledge.
Conclusion: Although there is recognition of the importance of evidence-based nutrition practices in GI and oncologic surgery programs, this study reveals limited implementation of such practices. This study highlights a considerable opportunity to leverage existing positive surgeon beliefs and published data on the benefits of perioperative nutrition to enhance surgical nutrition practices and to improve patient outcomes in Korea.

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Changes in mineral and vitamin profiles after bariatric surgery in Korea: a before and after study: Jong Seob Park, Sang-Moon Han; Ann Clin Nutr Metab 2023;15(2):51-56. Published online August 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.2.51

Abstract PDF: Purpose: Bariatric surgery induces nutritional deficiencies that require long-term monitoring and supplementation. This study aimed to evaluate the status of vitamins and minerals pre-operation and 2 years post-operation and to compare the findings according to type of bariatric surgery.
Methods: The study enrolled 302 patients who underwent bariatric surgery, adjustable gastric band (AGB), sleeve gastrectomy (SG), or Roux-en-Y gastric bypass (RYGB) between 2013 and 2017 in the CHA Gangnam Medical Center and the Seoul Medical Center, Korea. Minerals and vitamin status was assessed at baseline (pre-operatively) until 2 years after bariatric surgery.
Results: Mean age was 34.1±8.3 years, 256 patients (84.8%) were female, and mean body mass index was 35.3±5.7 kg/m². Vitamin B1, vitamin B12, and folic acid levels were significantly different at 1 and 2 years after surgery compared to baseline. Hemoglobin, hematocrit, high-density lipoprotein, iron, calcium, and magnesium levels did not differ significantly during the study period.
Conclusion: Although enrolled patients had no clinical symptoms of nutritional deficiences, several indicators related to nutrition decreased at 2 years after bariatric surgery. Despite variations in the alteration of laboratory results across three surgical interventions, namely SG, AGB, and RYGB, a consistent reduction in fasting blood sugar was observed subsequent to the surgical procedures.

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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

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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Strengthening collaboration: introducing the contributions of Japanese Society for Surgical Metabolism and Nutrition to Annals of Clinical Nutrition and Metabolism
Ye Rim Chang
Ann Clin Nutr Metab.2025; 17(2): 95. CrossRef

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Impact of immune-supplementation on muscle health and inflammation status of South Indian patients who have undergone gastrointestinal resection: a pilot randomized-controlled study: Nivedita Pavithran, Catherine Bompart, Alisa Alili, Sudheer Othiyil Vayoth; Ann Clin Nutr Metab 2024;16(2):78-86. Published online August 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.2.78

Abstract PDF: Purpose: Gastrointestinal (GI) resection significantly impacts nutritional and physical health, causing stress and inflammation that increase energy needs. Post-operative caloric intake often falls short, disrupting protein homeostasis and compromising muscle health. Nutritional supplementation is crucial to reduce inflammation and maintain muscle health. This study aimed to evaluate the impact of a three-week oral nutritional immuno-supplement (IMM) intervention compared to a control (CTL) on post-operative inflammatory status and muscle health in patients receiving limb and chest physiotherapy from June to August 2023.
Methods: A randomized, controlled, blinded cohort of 20 patients (ages 30–75) undergoing GI surgery was established. Participants were recruited on the day of surgery and assigned to either the CTL, which received standard protein supplementation, or the IMM group, which received protein immune-enriched supplementation for three weeks. All participants also received chest and limb physiotherapy. Follow-up and data collection were conducted at three post-surgery time points: 3 days, 7 days, and 3 weeks. Assessments included body composition, handgrip strength, basal metabolic rate, 24-hour dietary intake, and C-reactive protein (CRP) levels.
Results: Fifteen patients completed the study (IMM=9, CTL=6). After three weeks of supplementation, the IMM group showed a significant increase in lean mass percentage and handgrip strength, along with a significant decrease in CRP levels, compared to the CTL.
Conclusion: A 3-week oral immuno-supplement provided to patients post-GI resection, in conjunction with limb and chest physiotherapy, is more effective in reducing inflammation and preserving muscle health compared to standard protein supplementation.

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