Dietary evaluation of a low-iodine diet in Korean thyroid cancer patients preparing for radioactive iodine therapy in an iodine-rich region

Dal Lae Ju,Young Joo Park,Hee-Young Paik,Min-Ji Kim,Seonyeong Park,Kyong Yeun Jung,Tae Hyuk Kim,Hun Sung Choi,Yoon Ju Song 한국영양학회 2016 Nutrition Research and Practice Vol.10 No.2

BACKGROUND/OBJECTIVES: Despite the importance of a low-iodine diet (LID) for thyroid cancer patients preparing for radioactive iodine (RAI) therapy, few studies have evaluated dietary intake during LID. This study evaluated the amount of dietary iodine intake and its major food sources during a typical diet and during LID periods for thyroid cancer patients preparing for RAI therapy, and examined how the type of nutrition education of LID affects iodine intake. SUBJECTS/METHODS: A total of 92 differentiated thyroid cancer patients with total thyroidectomy were enrolled from Seoul National University Hospital. All subjects completed three days of dietary records during usual and low-iodine diets before 131I administration. RESULTS: The median iodine intake was 290 ㎍/day on the usual diet and 63.2 ㎍/day on the LID. The major food groups during the usual diet were seaweed, salted vegetables, fish, milk, and dairy products and the consumption of these foods decreased significantly during LID. The mean energy intake on the LID was 1,325 ㎉, which was 446 ㎉ lower than on the usual diet (1,771 ㎉). By avoiding iodine, the intake of most other nutrients, including sodium, was significantly reduced during LID (P < 0.005). Regarding nutritional education, intensive education was more effective than a simple education at reducing iodine intake. CONCLUSION: Iodine intake for thyroid cancer patients was significantly reduced during LID and was within the recommended amount. However, the intake of most other nutrients and calories was also reduced. Future studies are needed to develop a practical dietary protocol for a LID in Korean patients.

Case Report : The Impact of Low Adherence to the Low-iodine Diet on the Efficacy of the Radioactive Iodine Ablation Therapy

( Dal Lae Ju ),( Young Joo Park ),( Hee Young Paik ),( Yoonju Song ) 한국임상영양학회 2015 Clinical Nutrition Research Vol.4 No.4

To improve the efficacy of radioactive iodine (RAI) therapy for differentiated thyroid cancer patients, a low-iodine diet (LID) prior to the therapy is recommended. In iodine-rich areas such as Korea, however, a strict LID is very difficult to maintain. We experienced the cases of three patients showing low adherence to the LID before initial RAI therapy, and analyzed the main food source supplying iodine during the LID, and examined the influence of the poorly maintained LID on the efficacy of RAI therapy. The dietary intake during the LID periods were assessed using three-day dietary records and remnant thyroid activ­ity after the second RAI administration was also evaluated. All patients’ mean daily iodine intake during two-week LID periods exceeded the 100 μg guideline set by the Korean Thyroid Association (median 110.9 μg, ranges 100.4-117.0 μg). Although the typical food sources of iodine intake are seaweeds in Korea, salted vegetables were the main contributor to the patients’ iodine intake during the LID periods. Remnant thyroid activity was shown on a follow-up scan in all of 3 patients suggesting low ef­ficacy of RAI therapy. In summary, the patients with low adherence to the LID guideline showed unsuccessful remnant ablation, and the main food source of iodine was salted vegetables. Further studies are necessary to examine the relationship between adherence of the LID and RAI efficacy according to dietary iodine intake levels, as well as food sources that cause low adher­ence to the LID. These data can then be used to develop more practical LID guidelines.

2010 당뇨병 환자를 위한 식품교환표 개정

주달래(Ju Dal Lae),장학철(Jang Hak Chul),조영연(Cho Young Yun),조재원(Cho Jae Won),유혜숙(Yoo Hye Sook),최경숙(Choi Kyung Suk),우미혜(Woo Mi Hye),손정민(Sohn Cheong Min),박유경(Park Yoo Kyoung),조여원(Choue Ryowon) 韓國營養學會 2011 Journal of Nutrition and Health Vol.44 No.6

A food exchange system for diabetes is a useful tool for meal planning and nutritional education. The first edition of the Korean food exchange lists was developed in 1988 and the second edition was revised in 1995. With recent changes in the food marketplace and eating patterns of Koreans, the third edition of food exchange lists was revised in 2010 by the Korean Diabetes Association, the Korean Nutrition Society, the Korean Society of Community Nutrition, the Korean Dietetic Association and the Korean Association of Diabetes Dietetic Educators through a joint research effort. The third edition is based on nutritional recommendations for people with diabetes and focuses on adding foods to implement personalized nutrition therapy considering individual preferences in diverse dietary environment. Foods were selected based on scientific evidence including the 2007 Korea National Health and Nutrition Examination Survey data analysis and survey responses from 53 diabetes dietetic educators. While a few foods were deleted, a number of foods were added, with 313 food items in food group lists and 339 food items in the appendix. Consistent with previous editions, the third edition of the food exchange lists included six food categories (grains, meat, vegetables, fats and oils, milk, and fruits). The milk group was subdivided into whole milk group and low fat milk. The standard nutrient content in one exchange from each food group was almost the same as the previous edition. Korea Food & Drug Administration's FANTASY (Food And Nutrient daTA SYstem) database was used to obtain nutrient values for each individual food and to determine the serving size most appropriate for matching reference nutrients values by each food group. The revised food exchange lists were subjected to a public hearing by experts. The third edition of the food exchange lists will be a helpful tool for educating people with diabetes to select the kinds and amounts of foods for glycemic control, which will eventually lead to preventing complications while maintaining the pleasure of eating. (Korean J Nutr 2011; 44(6): 577 ~ 591)

위절제술 후 영양 상태의 변화와 덤핑 증후군 발생에 대한 전향적 관찰 연구

나주리 ( Ju Ri Na ),서윤석 ( Yuhn Suk Suh ),공성호 ( Seong Ho Kong ),임정현 ( Jeong Hyun Lim ),주달래 ( Dal Lae Ju ),양한광 ( Han Kwang Yang ),이혁준 ( Hyuk Joon Lee ) 한국정맥경장영양학회 2014 한국정맥경장영양학회지 Vol.6 No.2

Purpose: The aim of this study was to investigate the change of nutritional status and the incidence of dumping syndrome aftergastrectomy for gastric cancer. Methods: From January 2013 to May 2014, 36 patients who underwent gastrectomy for gastric cancer were prospectively investigated in terms of nutritional status by body weight, anthropometric measurements, biochemical data, and Patient-Generated Subjective Global Assessment (PG-SGA). Dumping syndrome was assessed using a newly developed questionnaire based on the Japanese Society of Gastroenterological Surgery survey and Sigstad’s scoring system. Results: Body weight losses were 4.6%, 8.1%, and 6.9% at discharge, six months, and one year after discharge, respectively. Triceps skinfold thickness had no significance, however, mid-arm muscle circumference showed significant loss after gastrectomy. A part of the biochemical data showed significant change after gastrectomy, but almost indicated a restoring tendency within two months after discharge. In terms of PG-SGA, 33 patients (91.7%) were classified as A (well nourished) before surgery, however, the number of well-nourished patients showed a sharp decrease to 1 (2.8%) at two weeks after discharge, and then gradually increased to 25 (69.4%) at one year. The main obstacles against diet intake were reported as ‘early satiety’ and ‘anxiety’. The number of patients who had experience in at least one dumping syndrome related symptom was 21 (58.3%) at discharge, 26 (72.2%) at two months after discharge, and 11 (30.6%) at one year after discharge. Conclusion: Nutritional deficit as well as dumping syndrome is encountered in a large number of gastric cancer patients after gastrectomy. Postoperative nutritional support and personalized education seem to be very important during the postoperative period.

In-depth Medical Nutrition Therapy for a Woman with Diabetes: From Pregnancy to Delivery

( Miyoung Jang ),( Dal Lae Ju ),( Meera Kweon ),( Misun Park ) 한국임상영양학회 2016 Clinical Nutrition Research Vol.5 No.4

Diabetes in pregnancy is associated with higher rates of miscarriage, pre-eclampsia, preterm labor, and fetal malformation. To prevent these obstetric and perinatal complications, women with diabetes have to control levels of blood sugar, both prior to and during pregnancy. Thus, individualized medical nutrition therapy for each stage of pregnancy is essential. We provided in-depth medical nutrition therapy to a 38-year-old pregnant woman with diabetes at all stages of pregnancy up to delivery. She underwent radiation therapy after surgery for breast cancer and was diagnosed with diabetes. At the time of diagnosis, her glycated hemoglobin level was 8.3% and she was planning her pregnancy. She started taking an oral hypoglycemic agent and received education regarding the management of diabetes and preconception care. She became pregnant while maintaining a glycated hemoglobin level of less than 6%. We provided education program for diabetes management during the pregnancy, together with insulin therapy. She experienced weight loss and ketones were detected; furthermore, she was taking in less than the recommended amount of foods for the regulation of blood sugar levels. By giving emotional support, we continued the counseling and achieved not only glycemic control but also instilled an appreciation of the importance of appropriate weight gain and coping with difficulties. Through careful diabetes management, the woman had a successful outcome for her pregnancy, other than entering preterm labor at 34 weeks. This study implicated that the important things in medical nutrition therapy for pregnant women with diabetes are frequent follow-up care and emotional approach through the pregnancy process.

Intensive Nutrition Management in a Patient with Short Bowel Syndrome Who Underwent Bariatric Surgery

( Meera Kweon ),( Dal Lae Ju ),( Misun Park ),( Jihyeong Choe ),( Yun-suhk Suh ),( Eun-mi Seol ),( Hyuk-joon Lee ) 한국임상영양학회 2017 Clinical Nutrition Research Vol.6 No.3

Many individuals with short bowel syndrome (SBS) require long-term parenteral nutrition (PN) to maintain adequate nutritional status. Herein, we report a successful intestinal adaptation of a patient with SBS through 13 times intensive nutritional support team (NST) managements. A thirty-five-year-old woman who could not eat due to intestinal discontinuity visited Seoul National University Hospital for reconstruction of the bowel. She received laparoscopic Roux-en-Y gastric bypass (RYGB) due to morbid obesity in Jan 2013 at a certain hospital and successfully reduced her weight from 110 kg to 68 kg. However, after a delivery of the second baby by cesarean section in Jul 2016, most of small bowel was herniated through Peterson`s defect, and emergent massive small bowel resection was performed. Thereafter, she visited our hospital for the purpose of intestinal reconstruction. In Sep 2016, she received side-to-side gastrogastrostomy and revision of double barrel enterostomy. The remaining small bowel included whole duodenum, 30 cm of proximal jejunum, and 10 cm of terminal ileum. Pylorus and ileocecal valves were intact. The patient given only PN after surgery was provided rice-based soft fluid diet after 10 day of operation. Through intensive nutritional management care, she could start solid meals, and finally stop the PN and eat only orally at 45 days postoperatively. Three nutritional interventions were conducted over 2 months after the patient was discharged. She did not require PN during this period, and maintained her weight within the normal weight range. Similar interventions could be used for other patients with malabsorption problems similar to SBS.

Case Report : Early Postoperative 24-Hour Continuous Jejunostomy Feeding in Esophagectomy Patients

( Jeong Hyun Lim ),( Dal Lae Ju ),( Yoo Hwa Hwang ),( Chang Hyun Kang ) 한국임상영양학회 2014 Clinical Nutrition Research Vol.3 No.1

Esophagectomy can result in various postoperative nutrition-related complications that may impair the nutritional status of the patient. In our institution, we usually initiate 16-hour continuous jejunostomy feeding using an enteral feeding pump on postoperative day 2 as a routine protocol after esophagectomy. The target calorie intake was achieved in 6.7 days with this protocol, which is longer than that required with other recently reported feeding protocols. Accordingly, early jejunostomy feeding protocol, which starts on postoperative day 1 and continues for 24 hours was attempted. In the present report, we described 3 cases of early 24-hour continuous jejunostomy feeding after esophagectomy. The use of this new protocol reduced the duration required to achieve the target calorie intake as less than 5 days without any enteral feeding-related complications.

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.

한국인 상용 식품의 요오드 데이터베이스 업데이트와 이를 활용한 한국 성인의 요오드 섭취량 및 배설량 평가: 2013–2015 국민건강영양조사자료를 이용하여

최지연(Ji Yeon Choi),주달래(Dal Lae Ju),송윤주(YoonJu Song) 한국영양학회 2020 Journal of Nutrition and Health Vol.53 No.3

본 연구는 한국인의 상용 식품에 대한 요오드 데이터베이스를 개정하고, 버전을 달리하여 한국인의 요오드 섭취수준을 평가하였으며, 배설량을 이용하여 섭취량과의 상관성을 살펴보았다. 요오드 데이터베이스는 기존의 Han 등 [2]의 데이터베이스를 기초로 최신의 참고문헌들을 활용하여 개정하였다. 요오드 데이터베이스 구축은 상용 식품 목록에 분석값, 문헌값, 대체값, 결측값 등의 우선순위 순서로 요오드값을 적용하였고, 분석값은 총 166개 (19.4%), 문헌값 318개 (37.2%), 대체값 총 247개 (28.9%), 결측값 124개 (14.5%)이었다. 대체값은 레시피나 수분함량을 고려하여 계산하거나 유사식품들의 일반값을 생성하여 사용하였고, 일반값 생성 시 평균값과 최솟값을 선정하여 버전 1과 2로 구분하였다. 한국 성인의 요오드 섭취수준 평가는 제6기 국건영을 활용하였고, 요오드 섭취량의 중앙값은 전체의 경우 352.1 μg/일이었고 남자는 400.8 μg/일이며, 여자는 389.0 μg/일이었다. 이는 버전 2과 비교하여 조금 높았지만 큰 차이는 보이지 않았다. 전체 요오드 섭취량에 대한 식품군별 기여도의 경우 해조류 55.7%, 절임 채소류 16.0%, 우유 및 유제품류 6.9%이었고 버전 2에서도 순서는 동일하였다. 해조류 섭취 여부에 따라 해조류 섭취군과 미섭취군으로 나누어 평가한 결과, 해조류 섭취군의 요오드 섭취량의 중앙값은 495.7 μg으로 미섭취군의 241.2 μg보다 약 2배 이상 높았다. 해조류의 분석값 차이에 따른 요오드 섭취량의 차이를 살펴보기 위해 세부 버전을 사용하였고, 버전 1_1을 이용하였을 때의 요오드 섭취량의 중앙값은 478.1 μg으로 버전 1의 요오드 섭취량의 중앙값은 495.7 μg에 비해 낮았다. 요오드 섭취수준 평가는 해조류 미섭취군에서는 평균 필요량 (95 μg/일) 미만으로 섭취하는 비율이 남자 8.8%, 여자 8.1%로 높게 나왔고, 해조류 섭취군에서는 상한섭취량 (2,400 μg/일) 초과하여 섭취하는 비율이 남자 8.0%, 여자 6.3%로 높게 나타났다. 요오드 섭취량과 배설량 간의 상관성을 소변 요오드 배설량과 소변 속 크레아티닌의 비율을 이용하였고 섭취량과의 회귀계수는 버전 1은 0.11718, 버전 2는 0.11512이었고 모두 유의적 상관성을 나타내었다 (p < 0.0001). 이상의 결과에서 요오드 데이터베이스를 개정하고 데이터베이스 버전에 따라 한국의 요오드 섭취수준을 파악하였고, 해조류 섭취가 한국인의 주요한 급원 식품이었으며, 해조류 섭취 시 요오드 섭취의 과잉이, 해조류 미섭취 시 요오드 섭취의 부족이 나타날 수 있음을 제시하였다. 본 연구는 향후 요오드 데이터베이스의 지속적인 개정과 관리에 기초자료가 될 것으로 사료되고, 해조류 섭취 유무에 따른 요오드 섭취의 교육자료나 영양 프로그램 자료에 활용될 수 있을 것이며, 요오드 섭취와 연관성이 높은 갑상선 관련 질환과의 연구에도 활용될 수 있을 것으로 생각된다. Purpose: Variations in the iodine contents of foods is critical for estimating the iodine intake. This study aimed to update the iodine database of common Korean foods and evaluated the iodine intake in Korean adults. Methods: A list of 855 Korean foods was selected for the updated iodine database. The updated database was established with Version 1 and 2 by applying an average or minimum value for the imputed values. The iodine intake was estimated in 5,927 Korean adults using the data from the 2013–2015 Korea National Health and Nutrition Examination Survey. Results: The analytical values in the updated database were 166 (19.4%), followed in order by 318 (37.2%), 247 (28.9%), and 124 (14.5%) for the adapted, imputed, and missing values, respectively. The median of dietary iodine intake was 352.1 μg/day (± 2,166.1) and 343.4 μg/day (± 2,161.9) in Version 1 and 2 among the total population. The contribution rates of each food group to the iodine intake were 55.7% for seaweeds, which showed a similar trend in Version 2. When subjects were divided by consumption of seaweeds, the median iodine intake was 495.7 μg in the consumer group, which was almost double (241.2 μg) that of the non-consumer group. The proportion of subjects who consumed below the Estimated Average Requirement of iodine was 11.0% in the non-consumer group. In contrast, 11.6% in the consumer group of seaweed consumed above the Upper Level of iodine. When the dietary iodine and urinary iodine were examined, the regression coefficient was 0.11718 in Version 1 and 0.11512 in Version 2 after adjusting for age and sex. Conclusion: This study presented the variation of iodine intake in Korean adults by applying different versions of the iodine database. As the iodine intake can vary due to the highly variable concentrations in the major food sources, an iodine database is necessary to be monitored, and caution should be taken when the database is used in research.

24시간 회상법으로 조사한 연천지역 성인의 식생활 평가(1) : 영양소 섭취평가

이심열(Lee Sim Yeol),주달래(Ju Dal Lae),백희영(Paik Hee Young),신찬수(Shin Chan Soo),이홍규(Lee Hong Kyu) 韓國營養學會 1998 Journal of Nutrition and Health Vol.31 No.3