입원 환자용 초기 영양검색도구의 타당도 검증

김혜숙,이선희,김혜숙,권오란 한국영양학회 2019 Journal of Nutrition and Health Vol.52 No.4

Purpose: Poor nutrition in hospitalized patients is closely linked to an increased risk of infection, which can result in complications affecting mortality, as well as increased length of hospital stay and hospital costs. Therefore, adequate nutritional support is essential to manage the nutritional risk status of patients. Nutritional support needs to be preceded by nutrition screening, in which accuracy is crucial, particularly for the initial screening. To perform initial nutrition screening of hospitalized patients, we used the Catholic Kwandong University (CKU) Nutritional Risk Screening (CKUNRS) tool, originally developed at CKU Hospital. To validate CKUNRS against the Patient-Generated Subjective Global Assessment (PG-SGA) tool, which is considered the gold standard for nutritional risk screening, results from both tools were compared. Methods: Nutritional status was evaluated in 686 adult patients admitted to CKU Hospital from May 1 to July 31, 2018 using both CKUNRS and PG-SGA. Collected data were analyzed, and the results compared, to validate CKUNRS as a nutrition screening tool. Results: The comparison of CKUNRS and PG-SGA revealed that the prevalence of nutritional risk on admission was 15.6% (n=107) with CKUNRS and 44.6% (n=306) with PG-SGA. The sensitivity and specificity of CKUNRS to evaluate nutritional risk status were 98.7% (96.8~99.5) and 33.3% (28.1~39.0), respectively. Thus, the sensitivity was higher, but the specificity lower compared with PG-SGA. Cohen’s kappa coefficient was 0.34, indicating valid agreement between the two tools. Conclusion: This study found concordance between CKUNRS and PG-SGA. However, the prevalence of nutritional risk in hospitalized patients was higher when determined by CKUNRS, compared with that by PG-SGA. Accordingly, CKUNRS needs further modification and improvement in terms of screening criteria to promote more effective nutritional support for patients who have been admitted for inpatient care.

환자 영양 상태 파악을 위한 선별 검사와 영양 평가

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

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

입원환자를 위해 개발된 영양검색 도구의 타당성 검증

이정숙(Lee Jeong Sook),조미란(Cho Mi Ran),이금주(Lee Geum Ju) 韓國營養學會 2010 Journal of Nutrition and Health Vol.43 No.2

입원환자의 초기 영양관리를 위해 개발한 영양검색 도구의 타당성을 평가 하고자 입원 후 48시간 이내에 동일한 대상자에게 KNNRS, PG-SGA, NRS-2002를 수행하였으며 그 결과를 비교 평가하였다. 1) KNNRS, PG-SGA, NRS-2002를 이용한 영양검색 결과 영양상태 불량 및 영양불량 위험도가 높은 환자의 비율은 각각 28.7%, 51.3%, 48.5%로 나타났다. 2) 각 영양검색 도구에 따라 영양상태 불량 및 영양불량 위험도가 높은 것으로 나타난 환자는 영양상태 양호 및 영양불량 위험도가 낮은 환자에 비해 공통적으로 평균연령이 높고 BMI, 혈중 헤모글로빈, 총 임파구수, 알부민 수치가 유의적으로 낮았다. 3) KNNRS와 PG-SGA에 의한 영양상태 분류를 비교하였을 때 KNNRS에서 영양상태가 양호한 환자 545명 중 PG-SGA에 의해 영양상태가 양호한 환자는 331명이었다. KNNRS에서 영양상태가 불량한 환자 219명 중 PG-SGA에서도 영양상태가 불량한 환자는 178명이었다. 민감도와 특이도는 각각 60.7% (95%CI 54.2-67.0), 81.2% (95% CI 75.3-85.2)로 영양불량 상태를 판정하는데 두 도구가 임상적 관련성이 있는 것으로 사료된다. 두 도구 간 유사성 kappa 지수는 0.34로 KNNRS는 PG-SGA를 기준으로 타당한 검색도구로 검증되었다. 4) KNNRS와 NRS-2002에 의한 영양상태 분류를 비교 하였을 때 KNNRS에서 영양상태가 양호한 환자 540명 중 NRS-2002에 의해 영양불량 위험도가 낮은 환자는 312명이었다. KNNRS에서 영양상태가 불량한 환자 216명 중 NRS-2002에서 영양불량 위험도가 높은 환자는 139명이었다. 민감도와 특이도는 각각 57.8% (95%CI 53.4-60.9), 64.4% (95%CI 60.2-69.8)로 영양불량 상태를 판정하는데 두 도구가 임상적 관련성이 적은 것으로 사료된다. 두 도구 간 유사성은 kappa 지수 0.18로 낮게 나타났다. 5) KNNRS가 PG-SGA 결과와 비교 시 타당성이 검증되었으나 영양불량환자의 비율은 28.7%로 PG-SGA와 NRS-2002의 51.3%, 48.5%에 비해 낮았다. 보다 효과적이고 적극적인 초기 영양관리 중재를 위하여 영양불량 판정 기준의 수정 보완이 필요하다. 6) 영양검색 도구의 유효성과 영양관리의 효과를 검증하기 위하여 재원일수, 합병증 여부, 질병 예후, 사망여부와의 연계연구가 필요하다. Malnutrition has been associated with higher hospital costs, mortality, rates of complications and longer length of hospital stay. Several nutritional screening tools have been developed to identify patients with malnutrition risk. However, many of those require much time and labor to administer and may not be applicable to a Korean population. Therefore, the aim of this study was to develop nutritional screening tool for Korean inpatients. Then we compare nutritional screening tools that developed and previously described. Seven hundred sixty-four patients at hospital admission were screened nutritional status and classified as well nourished, malnutrition stage 1 or stage 2 by the KNNRS (Kyunghee Neo Nutrition Risk Screening), PG-SGA (Patient-Generated Subjective Global Assessment) and NRS-2002 (Nutritional Risk Screening-2002). The KNNRS, PG-SGA and NRS-2002 respectively classified 28.7%, 51.3%, 48.5% of patients as malnourished status. Compared to the PG-SGA, the KNNRS had sensitivity 60.7% (95% CI 54.2-67.0) and specificity 81.2% (95% CI 75.3-85.2). Agreement was fair between KNNRS and PG-SGA (k = 0.34). Compared to the NRS-2002, the KNNRS had sensitivity 57.8% (95% CI 53.4-60.9) and specificity 64.4% (95% CI 60.2-69.8). Agreement was poor between KNNRS and NRS-2002 (k = 0.18). These result should include that the KNNRS and PGSGA have clinical relevance and fair concordance. However the rate of malnourished patients by KNNRS were less than by PG-SGA. For more effectivity of nutritional screening and management, the criteria of KNNRS would be better revised.

입원환자의 영양검색도구

설은미 ( Eunmi Seol ),주달래 ( Dal Lae Ju ),이혁준 ( Hyuk-joon Lee ) 한국정맥경장영양학회 2016 한국정맥경장영양학회지 Vol.8 No.1

Malnutrition is a common problem in hospital settings. A poor nutritional status has been associated with higher rates of infection, poor wound healing, longer hospital stays, and higher hospital costs. Therefore, early recognition and timely treatment of malnutrition is vital. To identify malnourished individuals or those at risk of becoming malnourished, selecting and validated a uniform screening tool is clearly an important issue. Both the Nutritional Risk Screening-2002 (NRS-2002) and Malnutrition Universal Screening Tool (MUST) are recommended by the European Society for Parenteral and Enteral Nutrition (ESPEN) for a hospital setting. For older patients, the Mini Nutritional Assessment (MNA) is the recommended tool. Short Nutrition Assessment Questionnaire (SNAQ) and Malnutrition Screening Tools (MST) are brief and simple screening tools that use self-reported queries of variables that include weight loss and poor appetite. On the other hand, many of those require considerable time and labor to administer and may not be highly applicable to a Korean population. In Korea, most hospitals use a computerized nutritional screening system with a self-developed nutrition screening index. The variables for the tools, which are based on each hospital setting, include the objective data available in the patient``s medical records and limited information collected from the nursing admission questionnaire. The application of different tools hampers any comparison of the malnutrition prevalence between different settings and patients groups. In addition, the absence of a widely accepted malnutrition screening tool hinders both effective recognition and the treatment of malnutrition. Therefore, the development of uniform and valid screening tools and effective nutritional support programs for Korean malnourished patients is needed.

영양지원팀의 임상적 적용 방법

김은영 ( Eun Young Kim ),김주미 ( Ju Mee Kim ),김미형 ( Mi Hyung Kim ),권택수 ( Taek Su Kwon ),이혜승 ( Hye Seung Lee ),목희정 ( Hee Jung Mok ),홍정임 ( Jeong Im Hong ),김혜진 ( Hye Jin Kim ),김현경 ( Hyun Kyung Kim ),정성진 ( Sun 한국정맥경장영양학회 2013 한국정맥경장영양학회지 Vol.5 No.3

Purpose: Most hospitals have been reply to the consultation if the needed departments consult with the Nutritional Support Team (NST) for patient evaluation and management. However, as a common occurrence, some people requiring treatment cannot receive care due to lack of cognition of nutritional support and lack of resources for assessment of nutritional status. Methods: We provide an indication for screening of patients and for active nutritional support. Indications include symptoms that reflect the conditions of increasing nutritional requirement and decreasing nutritional supply. Two surgical wards and surgical intensive care unit were included and nursing teams recommended patients to the NST by interviewing inpatients if they met the indications. Results: We included 60 patients referred to the NST before applying for screening, from January 2005 to January 2009 and 44 patients selected for only five months by the NST after applying for screening. The number of consultations showed a slow decrease, 27 in 2005, 23 in 2006 to 10 in 2007, before applying for screening, but increased significantly to 44 for only five months after applying for screening. While the number of departments applying to the NST was five departments in 2005, six departments in 2006, and two departments in 2007, it increased significantly to eight departments. After applying for screening, the most common cause was ‘artificial nutrition longer than five days’ in 48.1%; the second cause was ‘poor nutrition status’ in 13.5%, and the third was ‘significant weight loss’ or ‘gastrointestinal function change’ in 8%. Moderate risk patients showed improvement and shifted to minor risk patients and normal patients. The rate of improvement was approximately 47.7%. Conclusion: The screening tools should be simple, as well as easy to use. Therefore, using this tool, we must actively select patients with poor nutrition and apply the screening tools rapidly. (J Korean Soc Parenter Enter Nutr 2013;5(3):117-121)

Nutritional Assessment and Nutritional Management for GI Cancer Patients

Mi Hyang Um,Yoo Kyoung Park Korean Society of Gastrointestinal Cancer 2014 Journal of digestive cancer reports Vol.2 No.1

Cancer, especially GI cancer itself and any associated treatments have profound effect on the patient's nutritional status. It is therefore very important to understand various nutritional issues in GI cancer patients for the cure and for increasing the compliance during the course of the treatment. Screening and identification of nutritional risk for the GI cancer patients is very essential and is plays a critical part of the treatment to help improve patient outcomes. Maintaining optimal nutritional status is an important goal in the management of individuals diagnosed, treated with cancer. Maintenance of adequate nutritional intake is important whether patients are undergoing active therapy, recovering from cancer therapy, or are in remission and striving to avoid cancer recurrence. The goals of nutrition therapy are to prevent or reverse nutrient deficiencies, preserve lean body mass, help patients better tolerate treatments and minimize nutrition-related side effects and complications, etc. Recent interest in clinical settings is also in maximizing quality of life of the patients which can also be modulated by appropriate nutrition.

Nutritional Assessment of the Older Population: Practical Application and Limitation

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

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

서울지역 의료기관의 임상영양서비스 현황조사

김혜진 ( Hye Jin Kim ),김은미 ( Eun Mi Kim ),이금주 ( Geum Ju Lee ),이정주 ( Jung Joo Lee ),임정현 ( Jung Hyun Lim ),이정민 ( Jung Min Lee ),전현정 ( Hyun Jung Jeon ),이해영 ( Hae Young Lee ) 대한영양사협회 2011 대한영양사협회 학술지 Vol.17 No.2

The purpose of this study was to investigate the status of clinical nutrition services at various medical centers in Seoul, Korea. A questionnaire was distributed to the departments of nutrition at 44 hospitals in Seoul on July 2009. Nutritional screening carried out at a rate of 59.1% at the medical centers, and a significant difference was found according to the type of center, from 100% in tertiary hospitals to 18.8% in normal hospitals. On annual average, the numbers of inpatients, inpatients for malnutritional screening, inpatients with malnutrition, and inpatients for malnutrition management were 15,169.5, 10,870.9, 2,224.8, and 1,546.2, respectively. On average the group nutrition education was done 36.1 times/year for diabetes, 8.2 times/year for cancer, and 1.9 times/year for renal disease, and the numbers of participants 423.1, 95.1, and 31.5, respectively. On average the individual nutrition education of inpatients with diabetes was done 135.4 times/year for ordered- type, and 119.3 times/year for unordered-type, 106.2 times/year for paid-type, and 148.5 times/year for unpaid-type. The mean fee for education and counseling was the highest for peritoneal dialysis (73,090.9 won) but the lowest for heart disease (23,609.1 won). On average the individual nutrition education of outpatients with diabetes was done 234.6 times/year for ordered-type, and 2.5 times/year for unordered-type, 204.4 times/ year for paid-type, and 32.7 times/year for unpaid-type. The mean fee for education and counseling was also the highest for peritoneal dialysis (63,500.0 won) but the lowest for heart disease (21,336.4 won). To implement more effective clinical nutrition service, a national medical insurance imbursement policy should be urgently instituted such that diseases left as unpaid are covered by health insurance, including all nutrition-related disease.

위절제 수술 후 합병증 발생에 있어 영양평가 및 검색 도구의 적합성 비교 연구

김윤 ( Yoon Kim ),김원경 ( Won Gyoung Kim ),이혁준 ( Hyuk Joon Lee ),박미선 ( Mi Sun Park ),이영희 ( Young Hee Lee ),공성호 ( Seong Ho Kong ),양한광 ( Han Kwang Yang ) 한국정맥경장영양학회 2011 한국정맥경장영양학회지 Vol.4 No.1

Purpose: This study aimed to evaluate the agreement of Seoul National University Hospital-Nutrition Screening Index (SNUH-NSI) and Nutrition Risk Screening-2002 (NRS- 2002) with patient generated-Subjective Global Assessment (PG-SGA) and the association between nutrition risk determined by these screening tools and operative morbidity after a gastrectomy for gastric cancer. Methods: This study enrolled 174 patients who had undergone a gastrectomy for gastric cancer at Seoul National University Hospital from March to July 2009. We assessed a nutrition risk by two nutrition screening tools (SNUH-NSI, NRS-2002) and a nutrition assessment tool (PG-SGA) at hospital admission. We collected general patient information, serum albumin level, cholesterol amount, total lymphocyte count, hemoglobin, and body mass index, operative method, hospital stay, and operative morbidity. Results: The mean age was 59.1±11.6 years, and 8.6% (n=15) of patients were assessed as having severe malnutrition by the PG-SGA. Agreement between the PG-SGA, SNUH-NSI (κ=0.498, P<0.001), and NRS-2002 (κ= 0.439, P<0.001) was moderate. Patients with a high risk of malnutrition by PG-SGA, SNUH-NSI, or those with advanced gastric cancer showed more operative morbidity (P<0.05). There were no relationships between a high risk of malnutrition by NRS-2002 and operative morbidity. On multivariate analysis, malnutrition by PG-SGA (OR 2.159, 95% CI 0.693∼6.721) or SNUH-NSI (OR 2.630, 95% CI 0.906∼7.638) had a tendency to show higher operative morbidity, but it was not a significant independent risk factor. Conclusion: Both SNUH-NSI and NRS-2002 had moderate agreement with PG-SGA. Severe malnutrition risk as assessed by SNUH-NSI had an association with operative morbidity as PG-SGA did. SNUH-NSI was expected to be a valuable and efficient screening tool to detect malnutrition risk as much as PG-SGA. (JKSPEN 2011;4(1): 7-15)

가정간호 대상자 영양상태 평가 도구의 타당도 검증

김경례 ( Kyoung Rye Kim ),김미예 ( Mi Ye Kim ) 한국정맥경장영양학회 2009 한국정맥경장영양학회지 Vol.2 No.1

Purpose: This study examined whether a nutritional assessment tool is valid for evaluating the nutritional status of home care patients and suggested its clinical usefulness. Methods: This study included 73 patients receiving home care services that were registered in a home care center. An investigator performed a clinical survey with physical measurements, history taking, and visual inspection at the first visit and obtained blood samples to assess biochemical albumin levels. which were taken to reflect nutritional status. Nutritional status was correlated with serum albumin level. Results: The albumin level was significantly higher for the good nutrition group than for the poor nutrition group. Conclusion: A nutritional assessment tool was validated for the evaluation of the nutritional status of home care patients and to predict poor nutrition. We suggest that further studies done on a larger scale be performed to generalize these study results. (KJPEN 2009;2(1):30-33)