The Nutrition Support Team (NST) based on the new “Potluck Party Method (PPM)” was devised in 1998 by Higashiguchi. The first trial operation of all-department NST using PPM was started at Suzuka General Hospital in Japan. The successful result of this trial resulted in the introduction in 2001 of the NST project by Japanese Society for Parenteral and Enteral Nutrition (JSPEN). This NST project has been widely accepted throughout the country; in only 5 years, 920 hospitals have participated in this project, and 658 hospitals have been operating NSTs under JSPEN authorization. Additionally, 137 hospitals have also been authorized to operate NSTs by Japan Society for Metabolism and Clinical Nutrition (JSMCN). The Japan Council for Nutritional Therapy (JCNT) was founded in September 2004 as a third party for fairly evaluating the quality of NST operation in each hospital. In addition, the medical fee was revised in Japan in April 2006, and a new medical fee for nutritional support of \120/day was newly established, making it necessary to improve the quality of NST in the near future.
Enteral nutrition (EN) has recently been replacing parenteral nutrition (PN) in Japanese hospitals as a development of the nutritional support team (NST), since it has proved beneficial for shortening the admission period and reducing its cost. We focus in this study on the increasing application of immuno-nutritional (IN) preparations that are used to prevent and improve lowered immune functions and to reduce infectious complications. The theoretical background is investigated and appropriate methods for the application of IN preparations are discussed. The directions of use for IN preparations have not yet been established in Japan, whereas such directions exist in USA, and there are some problems to be solved in Japan for their wider use. However, there are an increasing number of reports suggesting that IN preparations would be equally effective for Japanese patients as they are for USA patients. The proposal of appropriate directions for their use in the near future would clarify their efficacy for Japanese patients.
The physical properties, taste preference and effect on blood glucose level were compared between pudding sweetened by sugar and erythritol. The disturbing denaturation that occurred during heating was less with erythritol than with sugar, endowing the erythritol gel with greater rupture stress and greater elastic modulus than the sugar gel. The erythritol gel had a smaller rupture strain than the sugar gel, resulting in no significant difference in the sensory evaluation of texture between the pudding samples. There was no significant difference in the evaluated sweetness between the pudding samples, although the lighter yellow color of the erythritol pudding was a demerit. Eating the sugar pudding increased the blood glucose level, but eating the erythritol pudding did not. The erythritol pudding contained about 50% less energy than the sugar pudding. These results suggest that the erythritol-sweetened pudding was suitable as a dietary sweet for diabetic patients.
The effect on the nutritional status of elderly patients with chronic dysphagia was assessed of a diet with the texture modified by gelatin. The subjects were 26 chronic stage rehabilitation inpatients (18 males and 8 females with a mean age±SD of 73.0±13.0). We assessed the hematological and biochemical data, anthropometric measurements, nutritional intake and occurrence of aspiration pneumonia before and after intervention with the modified-texture diet. There were no significant changes in any of the nutritional parameters over a 6-month period before the dietary intervention. However, the albumin, pre-albumin and total cholesterol levels during the 6-month period after the dietary intervention were significantly higher than those at the starting point. Similarly, BMI, arm circumference and energy intake adequacy during the 6-month period after the dietary intervention were significantly higher than those at the starting point. The occurrence of aspiration pneumonia during the 6-month period after the intervention was significantly lower than that at the starting point. These results show that the nutritional status was improved by the dietary intervention, while the occurrence of aspiration pneumonia was prevented. It is suggested that the diet with the texture modified by gelatin was effective for the treatment of chronic dysphagia.