Objective: A rapid increase in cases of nonalcoholic fatty liver disease (NAFLD) has become a clinical problem in recent years, and the fibrosis-4 (FIB4) index has been developed as a noninvasive method for evaluating liver stiffness. However, this method requires expensive medical equipment, so the development of an inexpensive evaluation method is desired. We examined whether bioelectrical impedance analysis (BIA) and hand grip strength measurement can be used to evaluate hepatic fibrosis in female NAFLD.

Participants and Methods: Between September 2014 and December 2016, 21 consecutive patients clinically diagnosed with NAFLD in our hospital by laboratory data and abdominal imaging were enrolled in this study. BIA and hand grip strength measurements were performed. We examined the correlations of the FIB4 index reflecting liver fibrosis with each item measured by BIA (phase angle, body cell mass, extracellular water / total body water ratio, skeletal muscle index, percent body fat, lower limb / upper limb muscle mass ratio) and with hand grip strength.

Results: The FIB4 index showed significant negative correlations with phase angle (r = -0.758, p < 0.0001) and between hand grip strength (r = -0.777, p < 0.0001) . The FIB4 index also showed a weak correlation with the following: body cell mass, ratio of extracellular water to total body water, and muscle mass ratio of the lower to upper limbs.

Conclusion: In female NAFLD, phase angle and hand grip strength may be useful for the simple evaluation of liver fibrosis.

Objective: There are very few reports on the eating situation and blood vitamin levels in elderly residents of long-term care facilities and the current status is unclear. So, we investigated eating conditions at such a facility and examined the effect of intake of nutritional supplements.

Methods: Eighteen elderly residents who agreed to participate. In addition to meals, they were provided with nutritional supplements (1 pack per day) for 28 days and then levels of various blood vitamins were compared between before and after the intervention.

Results: Although the rate of consuming a full portion was over 90% and the vitamin content of meals was adequate, levels were below the reference values for Vitamin B6 in 6 participants (33.3%) and for Vitamin D in all participants (100%). After the intervention, levels of both vitamins were significantly increased, and the number of participants with levels of Vitamin B₆ and Vitamin D below the reference values had decreased to 1 (5.6%) and 5 (27.8%), respectively.

Conclusion: Increasing the Vitamin B₆ and Vitamin D content in meals appears to be beneficial for elderly residents of long-term care facilities and providing nutritional supplements is a useful means to do this.

Objective: This retrospective study was carried out to investigate the relationship between the mid-upper arm circumference (MUAC) and controlling nutrition status (CONUT) score. The effects of age, sex, and presence of inflammation was evaluated.

Participants and Methods: Participants were 386 patients (223 men, 163 women ; mean age 77.6 years)who had a consultation with the nutrition support team (NST) at Iida Municipal Hospital. MUAC and biochemical parameters were measured at the start of NST intervention. Participants were divided into 4 groups according to severity of CONUT score:normal group (score 0-1), mild malnutrition group (score 2-4), moderate malnutrition group (score 5-8), and severe malnutrition group (score 9-12).

Results: MUAC was negatively and significantly correlated with CONUT score. Partial correlation analysis showed that the correlation between MUAC and CONUT score was still significant after controlling for age, sex, and C-reactive protein level (r =-0.181, p < 0.001). After adjustments for these confounding factors using analysis of covariance, MUAC was significantly smaller in the group with lower CONUT scores (p for trend = 0.022).

Conclusion: MUAC is associated with CONUT score independent of age, sex, and inflammation status. A lower CONUT score is associated with smaller MUAC. Our findings indicate that the anthropometric measurement MUAC is useful for nutrition assessment.

Objective: Gastroesophageal reflux, dumping syndrome, leak from a gastric fistula[[please confirm, and diarrhea are serious adverse events in enteral tube feeding via gastrostomy in pediatric patients. Semi-solid enteral nutrition formula with higher viscosity than liquid formula has recently been reported to be effective in reducing the occurrence of such adverse events. We examined the effects of semi-solid nutrition on alleviation of these adverse events and on gastric emptying in pediatric patients with gastrostomy.

Methods: Between July 2014 and June 2016, semi-solid nutrition (RACOL^®-NF Semi Solid for Enteral Use) was introduced for 53 patients with gastrostomy and the effects were retrospectively examined. We performed gastrointestinal scintigraphy to compare intragastric distribution and gastric emptying between liquid and semi-solid enteral nutrition formulas in 17 patients.

Results: After the introduction of semi-solid formula, symptoms disappeared in 81% of those with dumping syndrome (13/16), 80% of those with gastroesophageal reflux (8/10), and 100% of those with leak from a gastric fistula (1/1). Of the 17 patients who underwent gastrointestinal scintigraphy, the half-time of gastric emptying was significantly longer with semi-solid formula (60 min) than with liquid formula (30 min).

Conclusion: Semi-solid enteral nutrition slowed gastric emptying in the early stages of tube feeding, thereby preventing dumping syndrome. Gastroesophageal reflux was significantly alleviated because of the high viscosity of the semi-solid formula and consequent reduction in gastric residual volume.

Objective: Dysphagia often occurs after surgical resection of locally advanced head and neck cancer. Hence, an appropriate tube feeding formula must be selected for safe swallowing rehabilitation. Our hospital developed and introduced a new dysphagia diet in accordance with the Japanese Dysphagia Diet 2013 developed by the Dysphagia Diet Committee of the Japanese Society Dysphagia Rehabilitation. This study examined the effectiveness and safety of our new dysphagia diet.

Methods: In total, 99 patients with oral cancer who underwent resection and reconstruction from August 2012 to July 2016 were included; 47 patients used the conventional dysphagia diet (conventional group) and 52 used the new dysphagia diet (new group). The postoperative courses of the two groups were compared, including the period from the start of oral intake to removal of the nasogastric tube, the period from the start of oral intake to discharge, and the incidence of aspiration pneumonia.

Results: The median period from the start of oral intake to discharge was significantly shorter in the new group at 16.0 (12.3-25.0) days than in the conventional group at 22.0 (16.0-32.8) days (p = 0.002). In addition, the incidence of aspiration pneumonia tended to be lower in the new group (3.9%) than in the conventional group (10.6%; p = 0.19). In the subgroup of patients with aspiration pneumonia, the median period from the start of oral intake to removal of the nasogastric tube tended to be shorter in the new group (10.5 days) than in the conventional group (19.0 days; p = 0.43).

Conclusion: Our new dysphagia diet was introduced safely without increasing the incidence of aspiration pneumonia. The new diet offers an appropriate tube feeding formula for individual oral cancer patients according to the degree of dysphagia after surgery, and thus is expected to facilitate effective and safe swallowing rehabilitation.

Objective: To examine the clinical effects of Kumareha Power Rice on nutritional status and activities of daily living (ADL) in post-stroke patients.

Patients and Methods: A retrospective cohort study was conducted of 204 consecutive post-stoke patients who were admitted to our hospital from 2015 to 2016. We used propensity score-matched analysis to compare two groups of patients, those who were fed and those who were not fed Kumareha Power Rice (n = 38 in each group), a soft cooked rice supplemented with medium chain triglycerides and protein that do affect flavor or aroma. Twelve confounders used for matching included consciousness level, swallowing level, nutritional status, and ADL assessed using the motor domain of the Functional Independence Measure (FIM-motor). Univariate and multivariate analyses were performed to determine the association of Kumareha Power Rice with nutritional and functional outcomes.

Results: Of 204 patients (mean age 73 years;109 men), 127 had cerebral infarction, 62 had cerebral hemorrhage, and 15 had subarachnoid hemorrhage. After propensity score pair-matching, patients who were fed Kumareha Power Rice had higher energy intake, increased body weight and muscle mass, and better ADL and were more likely to have normal food intake rate at discharge than patients who were not fed Kumareha Power Rice (all p < 0.05). Multivariate analysis showed that feeding with Kumareha Power Rice was independently associated with FIM-motor score at discharge (β = 0.17, p = 0.02).

Conclusion: Kumareha Power Rice is effective in improving nutritional status and ADL in post-stroke patients.

Objective: To evaluate the tolerability and usefulness of an original fortified, high-energy rice containing medium chain triglycerides (MCT), whey protein, and starch in patients with respiratory disease.

Methods: Thirty patients who were hospitalized due to respiratory disease were randomly allocated to two dietary intervention groups (patterns A and B) and participated in a 10-day trial. Patients in group A were fed the fortified rice for lunch and regular rice for dinner for the first 5 days and then regular rice for lunch and the fortified rice for dinner on the last 5 days. Patients in group B were fed in the opposite cycle. The fortified rice was prepared by mixing cooked rice, MCT oil, MCT powder, starch, and protein powder.

Results: One patient withdrew from the study prior to data analysis and another patient withdrew consent after a fall in the hospital, so data for the remaining 29 patients were entered into the final analysis. Overall, both groups consumed more than 90% of the staple of rice that was served. The group consuming fortified rice had a significantly higher intake of energy, protein, and fat than the group consuming regular rice (p < 0.001). There was no difference between the two groups in the evaluation of taste.

Conclusion: The original fortified rice developed by our hospital was tolerated equally as well as regular rice by patients with respiratory disease and is effective for ensuring adequate intake of nutrients.

Objective: To extract a patient group at high risk of prolonged hospitalization for which the cost is covered by the diagnostic procedure combination (DPC) system, and to validate the appropriateness of the length of hospitalization specified in the DPC system.

Methods: We investigated all 657 inpatients who were discharged from April 2016 to March 2017 and whose medical costs were calculated using the DPC system. Various nutritional indexes were compared between the short-hospitalization group and the long-hospitalization group. A retrospective cohort study was carried out to determine the risk factors for long hospitalization. The length of period II in the DPC system was compared with the length of actual hospitalization to validate its appropriateness.

Results: Nutritional status in the long hospitalization group was significantly worse than that of the short hospitalization group. Poor Subjective Global Assessment scores and low serum albumin were independent risk factors for long hospitalization. The length of period II in the DPC system was significantly shorter than the actual length of hospitalization in the malnutrition group.

Conclusion: It is important to provide appropriate nutritional treatment to malnourished patients in order to reduce the length of hospitalization. Moreover, it is desirable to include nutritional status on admission as part of survey items when setting the length of hospitalization in the DPC system.