Aim: To evaluate prediction formulae for determining energy requirements in critically ill underweight patients.

Subjects and Methods: Patients aged 18 years or older with BMI < 22 kg/m² who underwent indirect calorimetry in the intensive care unit of Yokohama Rosai Hospital were enrolled. Energy expenditure measured by indirect calorimetry (EE-IC) was compared with the predicted energy requirement calculated using a simple formula (weight × 25 kcal / day) and the total energy requirement calculated using the Harris-Benedict formula (TER-HB).

Results: Results of 21 patients (median BMI: 19.2 kg/m²) were obtained. The Pearson product-moment correlation coefficient between EE-IC and the predicted value calculated using the simple formula was 0.78 (95% confidence interval: 0.53 to 0.91) and that between EE-IC and TER-HB was 0.53 (95% confidence interval: 0.13 to 0.78). Mean differences and 95% limits of agreement by Bland-Altman analysis were smaller for the predicted value calculated using the simple formula than for TER-HB.

Conclusion: The simple formula could be useful for predicting energy requirements in critically ill underweight patients.

Aim: To elucidate changes in nutritional status over time following admission to a convalescent rehabilitation ward and factors associated with malnutrition after discharge.

Subjects and Methods: Patients who were discharged from the convalescent rehabilitation ward from April to August 2017 were investigated. A questionnaire including the Mini Nutritional Assessment-Short Form (MNA-SF) was distributed to the patients or family caregivers after discharge to compare nutritional status at admission, at discharge, and after discharge. Also, factors associated with malnutrition after discharge were analyzed.

Results: The subjects were 80 patients (mean age, 69.7 years). The prevalence of malnutrition gradually decreased over time : 56.3% at admission, 10.0% at discharge, and 3.8% after discharge. The post-discharge malnutrition group had lower scores for the Functional Independence Measure (FIM) and Food Intake LEVEL Scale at discharge than the well-nourished group. FIM at discharge, MNA-SF at discharge, post-discharge rehospitalization were explanatory factors for malnutrition after discharge (odds ratios 0.946, 0.755, and 9.921, respectively).

Conclusion: The nutritional status of patients admitted to the convalescent rehabilitation ward improved over time. Activities of daily living and nutritional status at discharge, and post-discharge rehospitalization were associated with malnutrition after discharge.

Objective: In this study, we aimed to elucidate the situation of selenium deficiency in patients with severe motor and intellectual disabilities (SMID) and to examine the effect of oral intake of jellified supplements containing selenium in SMID patients with low serum selenium.

Subjects and methods: We measured the serum selenium levels in 40 SMID patients. Furthermore, we compared the serum selenium level between before and after oral intake of the jellified supplements containing selenium for approximately 3 months in 21 SMID patients with a low serum selenium level (after excluding 1 patient for poor adherence).

Results: Estimated selenium intake was lower, and patients with a low serum selenium level were more in the oral intake group than in the enteral nutrition group. In the oral intake group, serum selenium levels were lower in the pureed diet group than in the finely chopped diet group, although there was no difference in estimated selenium intake between them. Moreover, the serum selenium levels were increased after receiving the selenium supplements in 17 of 21 patients with a low serum selenium level.

Conclusions: Serum selenium levels were lower in patients on a texture-modified diet than in those on enteral nutrition, even though the selenium intakes estimated from the menu were similar. Adequate selenium supplementation increased serum selenium levels, indicating that it is useful to use oral supplements containing selenium and a menu where some loss of selenium through preparation of texture-modified diets is taken into account.

Purpose: Our purpose was to investigate the actual situation of the nutrition management system in Japan.

Subjects and methods: We conducted a multiple-choice questionnaire survey via the Internet of 657 representatives and academic councilors of the Japanese Society for Clinical Nutrition and Metabolism (formerly, the Japanese Society for Parenteral and Enteral Nutrition). We asked them about the current situation of rounds and conferences involving the nutrition support team (NST), and difficulties and contradictions in the system related to regional cooperation.

Results: Responses were obtained from 265 individuals (40.3%; response rate by institution, 53.5%). The frequency of NST rounds, the number of patients, and the time spent varied depending on the function of the medical institution. In regional cooperation of nutrition management, there was a high need to provide nutrition management information at the time of discharge or hospital transfer, and nutrition evaluation by NST before admission and discharge. More than 50% of respondents thought that the information on the following was not sufficiently shared in regional cooperation: swallowing function, oral intake situation, enteral nutrition, and weight.

Conclusions: This study highlighted that NST medical fee points should be re-evaluated to reflect the function of individual medical institutions, and the system should be evaluated so that the medical fee points for the NST become applicable in the whole region, thereby promoting regional cooperation.