Annals of Clinical Nutrition and Metabolism

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

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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Perioperative nutritional practices and pediatric nutrition support team implementation in Korea: a cross-sectional study
Dayoung Ko, Honam Hwang, Hee-Beom Yang, Joong Kee Youn, Hyun-Young Kim
Ann Clin Nutr Metab.2025; 17(3): 181. CrossRef

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Perioperative Nutritional Support: Seung Jong Oh; J Clin Nutr 2021;13(1):7-11. Published online June 30, 2021; DOI: https://doi.org/10.15747/jcn.2021.13.1.7

Abstract PDF: Malnutrition in surgical patients is a prevalent problem. As the geriatric population gradually increases, surgeons need to be more careful in preventing the risk of iatrogenic malnutrition. Delayed wound healing, exposure to infection, pressure sores, gastrointestinal bacterial overgrowth, and immunosuppression in malnourished patients can be prevented or diminished with active nutritional support. Preoperative nutritional assessment and support, as well as adequate postoperative nutrition, will improve surgical outcomes, which in turn will lead to fewer postoperative complications, shorter hospital stays, and lower medical costs. The success of surgery depends not only on technical surgical skills but also on metabolic interventions that take into account the patient’s ability to deliver the metabolic load and provide adequate nutritional support.

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Nutritional Support and Wound Healing: Chi-Min Park; J Clin Nutr 2020;12(2):21-25. Published online December 31, 2020; DOI: https://doi.org/10.15747/jcn.2020.12.2.21

Abstract PDF: Wound healing is a coordinated process of sequential events consisting of four phases: hemostasis, inflammation, proliferation, and remodeling. Many factors can affect each phase of this process and have a harmful or beneficial effect on wound healing. Nutrition is closely associated with the wound healing process and is one of the major influencing factors on the outcomes of wound healing. Malnutrition and nutrient deficiencies could adversely affect wound healing and delay it. Many kinds of nutrients can enhance the healing process. Physicians should always assess every patient’s nutritional status to determine nutritional deficiencies. This will enable supplementation, thereby enhancing wound healing. Herein, we review the relationship between nutrition and wound healing, and the effects and mechanisms of each nutrient that is closely related to the wound healing process.

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Nutritional Therapy Related Complications in Hospitalized Adult Patients: A Korean Multicenter Trial: Eun-Mi Seol, Kye Sook Kwon, Jeong Goo Kim, Jung-Tae Kim, Jihoon Kim, Sun-Mi Moon, Do Joong Park, Jung Hyun Park, Je Hoon Park, Ji Young Park, Jung-Min Bae, Seung Wan Ryu, Ji-Young Sul, Dong Woo Shin, Cheung Soo Shin, Byung Kyu Ahn, Soo Min Ahn, Hee Chul Yu, Gil Jae Lee, Sanghoon Lee, A Ran Lee, Jae Young Jang, Hyun Jeong Jeon, Sung Min Jung, Sung-Sik Han, Suk-Kyung Hong, Sun-Hwi Hwang, Yunhee Choi, Hyuk-Joon Lee; J Clin Nutr 2019;11(1):12-22. Published online June 30, 2019; DOI: https://doi.org/10.15747/jcn.2019.11.1.12

Abstract PDF

Purpose:

Nutritional therapy (NT), such as enteral nutrition (EN) or parenteral nutrition (PN), is essential for the malnourished patients. Although the complications related to NT has been well described, multicenter data on symptoms in the patients with receiving NT during hospitalization are still lacking.

Methods:

Nutrition support team (NST) consultations, on which NT-related complications were described, were collected retrospectively for one year. The inclusion criteria were patients who were (1) older than 18 years, (2) hospitalized, and (3) receiving EN or PN at the time of NST consultation. The patients’ demographics (age, sex, body mass index [BMI]), type of NT and type of complication were collected. To compare the severity of each complication, the intensive care unit (ICU) admission, hospital stay, and type of discharge were also collected.

Results:

A total of 14,600 NT-related complications were collected from 13,418 cases from 27 hospitals in Korea. The mean age and BMI were 65.4 years and 21.8 kg/m². The complications according to the type of NT, calorie deficiency (32.4%, n=1,229) and diarrhea (21.6%, n=820) were most common in EN. Similarly, calorie deficiency (56.8%, n=4,030) and GI problem except for diarrhea (8.6%, n=611) were most common in PN. Regarding the clinical outcomes, 18.7% (n=2,158) finally expired, 58.1% (n=7,027) were admitted to ICU, and the mean hospital days after NT-related complication were 31.3 days. Volume overload (odds ratio [OR]=3.48) and renal abnormality (OR=2.50) were closely associated with hospital death; hyperammonemia (OR=3.09) and renal abnormality (OR=2.77) were associated with ICU admission; “micronutrient and vitamin deficiency” (geometric mean [GM]=2.23) and volume overload (GM=1.61) were associated with a longer hospital stay.

Conclusion:

NT may induce or be associated with several complications, and some of them may seriously affect the patient’s outcome. NST personnel in each hospital should be aware of each problem during nutritional support.

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Provision of Enteral Nutrition in the Surgical Intensive Care Unit: A Multicenter Prospective Observational Study
Chan-Hee Park, Hak-Jae Lee, Suk-Kyung Hong, Yang-Hee Jun, Jeong-Woo Lee, Nak-Jun Choi, Kyu-Hyouck Kyoung
Annals of Clinical Nutrition and Metabolism.2022; 14(2): 66. CrossRef
Pathophysiology and protective approaches of gut injury in critical illness
Chang Yeon Jung, Jung Min Bae
Yeungnam University Journal of Medicine.2021; 38(1): 27. CrossRef
Nutrition Support Team Reconsultation During Nutrition Therapy in Korea
Eun‐Mi Seol, Yun‐Suhk Suh, Dal Lae Ju, Hye Jung Bae, Eunjung Kim, Hyuk‐Joon Lee
Journal of Parenteral and Enteral Nutrition.2021; 45(2): 357. CrossRef

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Role of Postoperative Parenteral Nutrition in Elective Surgery; Selection of Patients and Conditions for Postoperative Parenteral Nutrition: Jong Won Kim; Surg Metab Nutr 2018;9(1):1-4. Published online June 30, 2018; DOI: https://doi.org/10.18858/smn.2018.9.1.1

Abstract PDF: Postoperative early enteral nutrition or early oral ingestion is recommended in surgical patients. In this situation, this study examined the role of parenteral nutrition in the postoperative period in patients undergoing elective surgery. The nutritional status should be assessed before surgery and in the case of malnutrition, nutritional support should be provided before surgery to obtain good results. More than 2 weeks of insufficient nutritional support after surgery may worsen the patient’s progress. Therefore, it is recommended to start nutritional care if the oral intake is not appropriate until 7 days or 5 to 7 days after surgery. Enteral nutrition is related to the quick restoration of the bowel function and reduction of infection-related complications. Therefore, enteral nutrition has priority. On the other hand, depending on the patient’s condition, it may not be possible to perform enteral nutrition, and the uniform implementation of the early enteral nutrition may be a burden to the patient. Parenteral nutrition has the advantage that it can supply nutrition without being affected by the intestinal condition, and it can be calculated to supply as much energy as required. The situation, where parenteral nutrition is required after elective surgery, could be summarized as 1) the patients who underwent nutritional therapy before surgery and could not tolerate oral intake or enteral nutrition after surgery. or 2) in the case where enteral nutrition did not satisfy 50% of the demand at 7 days after surgery, and it is judged that this situation should continue for 7 days.

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Association of Nutrition Status-Related Indices and XELOX Chemotherapy Compliance in Gastric Cancer Patients: Sang Hyun Park, Geum Jong Song, Myoung Won Son, Sun Wook Han, Sang Ho Bae, Sung Yong Kim, Moo Jun Baek, Moon Soo Lee; Surg Metab Nutr 2017;8(2):36-40. Published online December 30, 2017; DOI: https://doi.org/10.18858/smn.2017.8.2.36

Abstract PDF: Purpose:
Cancer-associated malnutrition is common in gastric cancer patients and affects their response to treatment. This study evaluated pre-operative and pre-chemotherapy nutritional status-related indices associated with compliance in post-operation state gastric cancer patients receiving chemotherapy.
Materials and Methods:
We retrospectively reviewed medical records of patients with gastric cancer undergoing curative D2 resection between August 2014 and July 2016. A total of 51 patients who underwent adjuvant chemotherapy with a regimen of capecitabine and oxaliplatin (XELOX) were screened. Nutritional status assessment included body weight (BW), body mass index (BMI), serum albumin, serum total protein, hemoglobin, and total lymphocyte count (TLC).
Results:
Twenty-six patients had stage II gastric cancer, and 25 patients had stage Ⅲ gastric cancer according to the guidelines of the American Joint Committee on Cancer. Eighty-two percent of patients completed their chemotherapy according to the therapy protocol. However, 49% of patients were subjected to drug dose reduction, and 18% of patients needed to cease therapy. We found that pre-chemotherapy serum albumin level was significantly associated with completion of chemotherapy (P=0.043), and there was no significant relationship of BW, BMI, serum total protein, hemoglobin, and TLC with compliance of chemotherapy.
Conclusion:
Our study results suggest that patients with a low serum albumin level are highly susceptible to discontinuation of chemotherapy. Thus, serum albumin concentration could be used as a predictor of successful completion of chemotherapy before starting treatment.

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Clinical Characteristics of Sarcopenia and Cachexia: Seung-Wan Ryu; J Clin Nutr 2017;9(1):2-6. Published online June 30, 2017; DOI: https://doi.org/10.15747/jcn.2017.9.1.2

Abstract PDF

Sarcopenia, which is defined as a decrease in skeletal muscle mass and strength with aging, is an important risk factor in clinical medicine that is associated with mortality, and poor surgical and nonsurgical outcomes. Sarcopenia is now recognized as a multifactorial geriatric syndrome. Cachexia is defined as a metabolic syndrome with inflammation as the key feature, so cachexia can be an underlying condition of sarcopenia. Recently, cachexia has been defined as a complex metabolic syndrome associated with an underlying illness and characterized by the loss of muscle mass with or without a loss of fat mass. These two conditions overlap but are not the same. In clinical practice, many factors related to sarcopenia (decreased food intake, inactivity, and decreased hormones) are reported frequently in patients with cachexia. On the contrary, systemic inflammation, the core feature of cachexia, can also be present in apparently healthy older sarcopenic patients. This suggests that new therapeutic approaches, alone or in combination, may be appropriate in both conditions.

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Clinical Implication of Sarcopenia in Patients with Inflammatory Bowel Disease
Seong-Eun Kim
The Korean Journal of Gastroenterology.2018; 71(6): 308. CrossRef

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Nutrition Therapy for Adult Intestinal Failure Patients: Hyo Jung Park; J Clin Nutr 2016;8(3):72-76. Published online December 31, 2016; DOI: https://doi.org/10.15747/jcn.2016.8.3.72

Abstract PDF: Intestinal failure (IF) is a condition, in which the intestinal function or length remaining is below the minimum amount required for the absorption of sufficient nutrients and fluid to maintain normal life. The nutritional supply of IF depends on the anatomical site, length, and function of the remaining bowel. The goals of nutritional therapy for patients with IF are to achieve bowel adaptation to absorb nutrients sufficiently to live a healthy life with the current intestinal condition, and to promote the enteral autonomy to control nutrient digestion, absorption, excretion, and bowel movement. To stabilize and recover the patient’s nutrition condition after a huge bowel resection, the intestinal rehabilitation team (IRT) for individual nutritional therapy should be established. IRT carefully monitors the changes in body weight, medication use, patient’s symptoms, nutrient deficiency, hydration status, function of the remaining bowel, degree of bowel adaptation, adverse effects due to nutritional therapy, and enteral balance. To achieve intestinal adaptation and enteral autonomy through complicated and difficult nutritional intensive therapy in IF patients, it is essential to manage the patients through multidisciplinary collaboration involving physicians, pharmacists, dietitians, and nurses.

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Characteristics and Clinical Course of Patients Who Received Enteral or Parenteral Nutrition in Tertiary Referral Hospitals in Korea: Eunmi Seol, Yun-Suhk Suh, Dal Lae Ju, Hye Jung Bae, Hyuk-Joon Lee; J Clin Nutr 2016;8(2):58-65. Published online August 31, 2016; DOI: https://doi.org/10.15747/jcn.2016.8.2.58

Abstract PDF

Purpose:

The purposes of this study are to evaluate clinical characteristics of malnourished patients who received nutritional therapy and to compare their clinical courses according to nutritional support team (NST) consultation in tertiary referral hospital in Korea.

Methods:

From June 2014 to May 2015, 43,954 admitted patients who were more than 18 years old were retrospectively investigated. Characteristics of patients who received enteral nutrition (EN) or parenteral nutrition (PN) for more than 3 days (nutritional therapy group) were compared to the patients without nutritional therapy (control group). In addition, clinical courses according to NST consultation (NST group and non-NST group) were compared through propensity score matching (PSM).

Results:

EN or PN was applied in 4,599 patients for more than 3 days (nutritional therapy group: 10.5%). For characteristics, there were significant differences between two groups (nutritional therapy group vs. control group) with age, male proportion, body weight, body mass index. All laboratory data at admission were significantly worse in nutritional therapy group. And for clinical courses, there were significant differences in length of stay (LOS), rate of intensive care unit (ICU) admission, LOS in ICU, Acute Physiology and Chronic Health Enquiry (APACHE II) score, days of nutritional therapy, mortality rate. NST consultation was made in 39% of nutritional therapy group. Among departments, Thoracic Surgery showed the highest rate of NST consultation (68.5%) otherwise Neurosurgery showed the lowest rate (18.7%). When PSM between NST group vs. non-NST group were made, significant differences was shown only in the rate of ICU admission, EN or PN support days, cholesterol at discharge.

Conclusion:

In tertiary referral hospital in Korea, more than 10% of patients still needed active nutritional therapy. NST consultation rate varies among departments. We failed to find significant differences between NST group and non-NST group.

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Early nutritional support for inpatients reduces admission rates to intensive care units in Korea: a single-center case-control study
Hyun Suk Kim, Jae Do Yang, Se Wung Han, Mi Rin Lee, Da-Sol Kim, Sejin Lee, Seon-Hyeong Kim, Chan-Young Kim
Annals of Clinical Nutrition and Metabolism.2024; 16(2): 57. CrossRef
Report on the Current Trend of Commercial Enteral/Parenteral Nutrition in Outpatient
Hyun Ji Lee, Hyo Jung Park, Seon Young Chung, Myung Sook Min, Ok Soon Jeong, Ja Kyung Min
Journal of Korean Society of Health-System Pharmacists.2023; 40(2): 211. CrossRef
Nutritional Status of Intensive Care Unit Patients According to the Referral to the Nutrition Support Team and Compliance with the Recommendations
Yunjin Sohn, Taisun Hyun
Korean Journal of Community Nutrition.2022; 27(2): 121. CrossRef
Physician Compliance with Nutrition Support Team Recommendations: Effects on the Outcome of Treatment for Critically Ill Patients
Hyon-Ju Yon, Eun-Suk Oh, Ji Young Jang, Ji Yun Jang, Hongjin Shim
Journal of Acute Care Surgery.2022; 12(1): 1. CrossRef
Path Analysis for Delirium on Patient Prognosis in Intensive Care Units
Sunhee Lee, Sun-Mi Lee
Journal of Korean Academy of Nursing.2019; 49(6): 724. CrossRef

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