Aim: Pulmonary rehabilitation for COPD patients needs comprehensive intervention including nutritional management. In this study, we investigated the validity of a new method for calculating energy expenditure and the effectiveness of high-intensity exercise in pulmonary rehabilitation.

Subjects and Methods: Thirty-two hospitalized patients with COPD received pulmonary rehabilitation for 4 weeks. Daily energy intake was recorded from a dietary survey, and energy expenditure was calculated using a formula. Changes in body composition and their effects on pulmonary rehabilitation were also examined.

Results: A correlation was found between change in body weight and energy balance, indicating that the new method is a valid method for calculating energy expenditure in hospitalized patients with COPD receiving exercise intervention. The results also showed that high-intensity exercise improved physical function and subjective symptoms while maintaining body weight.

Conclusions: The new method for calculating energy expenditure is a valid method and high-intensity exercise therapy is effective for pulmonary rehabilitation in COPD patients.

Aim: The aim of this study was to investigate the effectiveness of early nutritional support using thickened oral rehydration fluids led by a registered dietitian in collaboration with the dysphagia management team in the treatment of pneumonia.

Subjects and Methods: Fasted inpatients with pneumonia who were on parenteral nutrition were assessed for swallowing function to determine the viscosity of ingestible fluids. In multi-professional collaboration, a nutritional management plan with early introduction of thickened fluids was implemented.

Results: Of 34 patients in total, those who did not undergo swallowing assessment (n=9), died (n=1), or were discharged or transferred (n=10) were excluded, and the remaining patients were assigned to either the early intervention group (n=6) or the control group (n=8) for comparison. The amount of oral energy intake and the proportion of oral water intake to the required water intake were significantly higher, and the medical costs including the costs of parenteral nutrition and antibiotics were lower in the early intervention group compared with the control group.

Conclusion: This study suggested that the registered dietitian-led early intervention with nutritional support using thickened oral rehydration fluids can contribute to the improvement of therapeutic effect and medical economics, which may also lead to a reduced burden on doctors.

Aim: The prognostic nutritional index (PNI) is a prognostic predictor calculated from serum albumin (ALB) concentration and total peripheral lymphocyte count. This study investigated problems of the PNI associated with changes in the serum ALB measurement method in patients with chronic liver disease.

Subjects and Methods: Participants were 144 patients with chronic liver disease who visited our hospital from March 2018 to October 2018, and 364 healthy controls who visited our health checkup center from January 2017 to July 2018. The electrophoresis method and the modified bromocresol purple method were used to measure serum ALB concentration.

Results: Both serum ALB concentration and PNI value were significantly higher when the electrophoresis method was used than when the modified bromocresol purple method was used. Differences in serum ALB concentration and PNI value between the methods tended to increase with disease severity.

Conclusion: The PNI is a good comprehensive prognostic indicator, but it should be noted that the PNI value can vary depending on the method used to measure serum ALB concentration, and we should pay attention to the evaluation.

Objective: Gastric cancer surgery patients are aging year by year. Dysphagia is an important issue that causes postoperative oral intake and complications. We investigated the relationship between tongue pressure before the start of oral intake before and after surgery, objective evaluation of swallowing function by swallowing endoscopy, and aspiration pneumonia.

Subjects and Methods: We examined 54 patients aged 70 years or older who had no history of respiratory complications, were diagnosed with gastric cancer, and underwent surgical treatment. Postoperatively, the patients were divided into 6 patients in group A with pneumonia and 48 patients in group B without pneumonia. The score evaluations of age at surgery, stage, surgical procedure, surgical time, bleeding volume, postoperative respiratory complications, tongue pressure, and swallowing endoscopy were compared between the two groups.

Results: The swallowing endoscopic evaluation was significantly higher in group A both before and after surgery. On the other hand, no significant correlation was found between tongue pressure and aspiration pneumonia.

Conclusion: Preoperative and postoperative dysphagia is associated with the development of aspiration pneumonia. Early swallowing rehabilitation intervention is important to prevent complications.

Aim: Perioperative nutritional management in dialysis patients is a key determinant of surgical outcomes, but its actual status is not known. We used a medical database to retrospectively investigate postoperative nutritional management in dialysis patients after gastrointestinal resection.

Subjects and Methods: Data of dialysis patients who underwent gastrointestinal resection between 2009 to 2018 were aggregated by route of nutritional management. Daily intravenous intakes of calories, amino acids, and fats were calculated in patients who did not receive oral or enteral nutrition. The percentages of patients who achieved the dietary intake targets shown in the "Dietary recommendations for dialysis patients" (calories ≥ 30 kcal/kg; amino acids ≥ 0.9 g/kg) on postoperative day 7 were then calculated.

Results: Among the 1,471 subjects, the proportion receiving oral nutrition on postoperative day 7 reached 80%. Of the patients who did not receive oral or enteral nutrition, the percentages achieving the dietary intake targets by intravenous nutrition were only 13.4% for calories and 7.7% for amino acids. The percentage of patients prescribed fat emulsion was only 23.2%.

Conclusion: Current postoperative intravenous nutrition support for dialysis patients not receiving oral or enteral nutrition tends to be insufficient. Increased prescription of calories and amino acids with use of fat emulsion is needed.