Gyung-Ah Wie

Prevalence and risk factors of malnutrition among cancer patients according to tumor location and stage in the National Cancer Center in Korea

OBJECTIVE Although malnutrition is common in cancer patients in Korea, little attention is paid to its risks and consequences. This study was carried out to investigate the prevalence and risk factors of malnutrition in hospitalized cancer patients according to tumor location and stage. METHODS Of 14 972 cancer patients admitted to the National Cancer Center, screening examinations were carried out for 12 112 patients and nutritional status was assessed in 8895 patients. Information on age, sex, length of hospital stay, and tumor location and stage were collected from the electronic medical records system. The nutritional status of each subject was assessed using body mass index, serum albumin, total lymphocyte count, and diet and classified into three groups: high risk, moderate risk, and low risk of malnutrition. RESULTS About 61% of hospitalized patients were malnourished and the prevalence of malnutrition was higher in male patients with longer hospital stays (60.2%, P=0.0101) and readmitted patients (66.6%, P<0.0001). Patients with liver and lung cancer (86.6% and 60.5%, respectively) and patients with advanced cancer stage (60.5%, III or IV) had a higher prevalence of malnutrition than other patients (P<0.0001). Logistic regression analysis showed that patients with advanced cancer stage and longer hospital stay and readmitted patients were at a higher risk for malnutrition. CONCLUSION The prevalence of malnutrition in hospitalized cancer patients was high and varied across tumor location and stage. Early identification of malnutrition status is required for proper nutritional intervention during hospitalization.

Development and validation of a nutrition screening tool for hospitalized cancer patients

BACKGROUND & AIMS Although various nutrition screening tools are used, they are not specific for the screening of malnourished cancer patients. The objective of this study was to develop a nutrition screening tool that could be used to identify cancer patients at risk for malnutrition. METHODS Of 3010 cancer patients admitted to the National Cancer Center of Korea between April 1 and June 2, 2008, the nutritional status of 1057 patients was assessed by the Scored Patient-Generated Subjective Global Assessment (PG-SGA). Variables used in current nutrition screening tools were analyzed to select indices for a developing malnutrition screening tool for cancer patients (MSTC). The equation for the MSTC was established using receiver operating characteristics curves. Sensitivities and specificities of the MSTC were calculated using the PG-SGA as gold standard. RESULTS The MSTC was calculated as follows: [MSTC = -0.116 + (1.777 × intake change) + (1.304 × Eastern Cooperative Oncology Group performance status) + (1.568 × weight loss) + (-0.187 × body mass index)]. The MSTC had a sensitivity of 94.0%, a specificity of 84.2%, and high agreement (κ = 0.70, P < 0.0001) with the PG-SGA. CONCLUSIONS The MSTC appears to be a valid nutrition screening tool for determining nutritional risk in hospitalized cancer patients.

Red meat consumption is associated with an increased overall cancer risk: a prospective cohort study in Korea

Cancer is a leading cause of death, and the dietary pattern in Korea is changing rapidly from a traditional Korean diet to a Westernised diet. In the present study, we investigated the effects of dietary factors on cancer risk with a prospective cohort study. Among 26,815 individuals who participated in cancer screening examinations from September 2004 to December 2008, 8024 subjects who completed a self-administered questionnaire concerning demographic and lifestyle factors, and a 3 d food record were selected. As of September 2013, 387 cancer cases were identified from the National Cancer Registry System, and the remaining individuals were included in the control group. The hazard ratio (HR) of cancer for the subjects older than or equal to 50 years of age was higher (HR 1.80, 95% CI 1.41, 2.31; P< 0.0001) than that for the other subjects. Red meat consumption, Na intake and obesity (BMI ≥ 25 kg/m²) were positively associated with overall cancer incidence in men (HR 1.41, 95% CI 1.02, 1.94; P= 0.0382), gastric cancer (HR 2.34, 95% CI 1.06, 5.19; P= 0.0365) and thyroid cancer (HR 1.56, 95% CI 1.05, 2.31; P= 0.0270), respectively. Participants who had at least three dietary risk factors among the high intakes of red meat and Na, low intakes of vegetables and fruits, and obesity suggested by the World Cancer Research Fund/American Institute for Cancer Research at baseline tended to have a higher risk of cancer than the others (HR 1.26, 95% CI 0.99, 1.60; P= 0.0653). In summary, high intakes of red meat and Na were significant risk factors of cancer among Koreans.

Development of healthy Han-sik nutrition education program featuring consumption of Korean foods for prevention of metabolic syndrome in Korean adults

Metabolic syndrome is a cluster of metabolic risk factors associated with increased risk of cardiovascular diseases. Recently, the prevalence of metabolic syndrome has increased in Korea. The aim of this study was to develop a Healthy Hansik Nutrition Education Program (HHNEP) based on commonly recognized Korean foods in order to decrease metabolic syndrome risks. The target population of the HHNEP is adults with metabolic risk factors. The initial version of the HHNEP was developed based on a review of literature and various dietary guidelines by expert committees as well as the results of a survey on the perception of common Korean dishes and foods as Han-sik. The focus group discussion conducted of nine participants from the target population. After minor modification, the final version was developed. The contents included five sections : 1) aims, 2) introduction of Korean Food Guidance System, 3) cholesterol contents in food, 4) menu planning method using Han-sik, and 5) examples of daily Han-sik menu. The Han-sik list was selected based on the results from a Han-sik perception answered by 35 Korean adults aged 30-60 years using 517 frequently consumed Korean foods from the fourth Korea National Health and Nutrition Examination Survey. The nutrition education program was developed based on scientific evidence for the prevention of metabolic syndrome and focuses on tailoring education to an individual’s dietary problems. Educational method was developed by a group of expert committees based in planned behavior theory and related research results. The education method consisted of assessment of current diet, four face-toface nutrition education sessions over 8 weeks, and evaluation after 8 and 16 weeks. Initial version of nutrition education materials and methods was tested for feasibility by a select group of nine Korean healthy adults. Successful implementation of the program would include application by nutritional professionals at the health promotion center of the hospitals, public health center, and work sites. Intervention studies are needed to evaluate the feasibility and effectiveness of this program before large-scale applications. (Korean J Nutr 2012; 45(6): 552 ~ 561)

Associations of Dietary Antioxidants and Risk of Type 2 Diabetes: Data from the 2007–2012 Korea National Health and Nutrition Examination Survey

Antioxidants are suggested to decrease risk of type 2 diabetes (T2D) by preventing progressive impairment of pancreatic β-cell and endothelial function. This study was aimed to investigate the association between dietary antioxidants and risk of T2D in Korean adults based on a national representative data. A total of 24,377 adults (19–74 years) who completed one-day 24 h dietary recall and health examination were included. Dietary antioxidant intakes including α-carotene (p < 0.0001), lycopene (p = 0.0107), flavan-3-ols (p < 0.0001), and proanthocyanidins (p = 0.0075) were significantly higher in non-diabetic subjects than in diabetic subjects. After adjusting for confounding variables, the highest quartile group of α-carotene intake was associated with a 48% reduced risk of T2D in men (OR: 0.52, 95% CI: 0.34–0.80, p for trend = 0.0037) and a 39% reduced risk in women (OR: 0.61, 95% CI: 0.38–0.996, p for trend = 0.0377) compared to the lowest quartile group. Men in the highest quartile of β-carotene intake showed lower risk of T2D (OR: 0.64, 95% CI: 0.42–0.97), but no significant decreasing trend. However, the intakes of total carotenoids and other antioxidants showed no significant association with the risk of T2D. These findings suggest that a further comprehensive approach which considers overall dietary pattern is required.

Total Antioxidant Capacity from Dietary Supplement Decreases the Likelihood of Having Metabolic Syndrome in Korean Adults

This study was conducted to estimate antioxidant vitamin intake and total antioxidant capacity (TAC) from diet and dietary supplements and to examine their association with metabolic syndrome (MetS) in Korean adults. Out of 6308 adults 19~64 years old from the 2010~2011 Korea National Health and Nutrition Examination Survey, 1847 adults were classified as dietary supplement users and the other 4461 adults were classified as non-users. Antioxidant intake and TAC from diet and dietary supplements were estimated using dietary intake data and linked with the antioxidant and TAC database for common Korean foods. The prevalence of MetS was lower in dietary supplement users (odds ratio (OR) = 0.82; 95% confidence interval (CI), 0.68–0.98) than that in non-users. Among dietary supplement users, a lower prevalence of MetS was observed in the highest tertile for vitamin A (OR = 0.72; 95% CI, 0.53–0.99) and vitamin E (OR = 0.74; 95% CI, 0.55–0.99) intake than that in the lowest tertile among non-users. Subjects in the highest tertile of TAC among dietary supplement users showed a lower prevalence of MetS (OR = 0.72; 95% CI, 0.52–0.99) than non-users. The results imply that intake of vitamin A, vitamin E, and TAC from dietary supplements might have a protective effect on MetS among Korean adults.

The Role of Red Meat and Flavonoid Consumption on Cancer Prevention: The Korean Cancer Screening Examination Cohort

Markedly increased red meat consumption is a cancer risk factor, while dietary flavonoids may help prevent the disease. The purpose of this study was to investigate the associations of red meat and flavonoid consumption with cancer risk, based on data from 8024 subjects, drawn from the 2004–2008 Cancer Screening Examination Cohort of the Korean National Cancer Center. Hazard ratios (HRs) were obtained by using a Cox proportional hazard model. During the mean follow-up period of 10.1 years, 443 cases were newly diagnosed with cancer. After adjusting for age, there was a significant correlation between cancer risk and the daily intake of ≥43 g of red meat per day (HR 1.31; 95% CI 1.01, 1.71; p = 0.045), and total flavonoid intake tended to decrease cancer risk (HR 0.70; 95% CI 0.49, 0.99; highest vs. lowest quartile; p-trend = 0.073) in men. Following multivariable adjustment, there were no statistically significant associations between flavonoid intake and overall cancer risk in individuals with high levels of red meat intake. Men with low daily red meat intake exhibited an inverse association between flavonoid consumption and cancer incidence (HR 0.41; 95% CI 0.21, 0.80; highest vs. lowest; p-trend = 0.017). Additional research is necessary to clarify the effects of flavonoid consumption on specific cancer incidence, relative to daily red meat intake.

Erratum: The Role of Red Meat and Flavonoid Consumption on Cancer Prevention: The Korean Cancer Screening Examination Cohort; Nutrients 2017, 9, 938

The authors have requested the following corrections to their paper [...].

Identification of major dietary patterns in Korean adults and their association with cancer risk in the Cancer Screening Examination Cohort

Background/Objectives:Cancer is the primary cause of disease-related death in Korea. The purposes of this study were to confirm the major dietary patterns and to evaluate whether there were associations between these identified dietary patterns and the risk of cancer based on data from the Cancer Screening Examination Cohort (CSEC) 2004–2008 of the National Cancer Center (NCC) of Korea.Subjects/Methods:This study included 8 024 subjects who completed a written survey on demographics and lifestyles, as well as a 3-day dietary record. Dietary patterns were identified by factor analysis using the principal component analysis method. The associations between the identified dietary patterns and cancer risk were examined using Cox proportional hazards regression models.Results:During a median follow-up period of 9.0 years, 425 cancer cases were newly diagnosed. We identified 4 major dietary patterns (‘rice and kimchi’, ‘vegetables and fish’, ‘fruits and dairy’, and ‘meats and sweets’). There was a negative relation between ‘rice and kimchi’ pattern and the risk of non-gastrointestinal cancers only (highest vs. lowest tertile; multivariate-adjusted hazard ratio=0.60, 95% confidence interval=0.41, 0.88). The ‘fruits and dairy’ pattern tended to decrease the risk of cancer, and the preventive effect was noted only for gastrointestinal cancer risk. However, there was no association after adjusting for covariates.Conclusions:The traditional dietary pattern with high consumption of rice, kimchi, soybean paste and vegetables may decrease the cancer risk among Koreans, and strategies based on the dietary pattern may effectively reduce the cancer risk.