Rationale: Cancer survivors were advised to follow the cancer prevention recommendations to prevent of cancer recurrence or chronic diseases after treatment. We evaluated the adherence to the WCRF/AICR Cancer Prevention Recommendations and Metabolic Syndrome(MetS) risk in Korean cancer survivors.

Adequate nutritional support is crucial in preventing complications and improving outcomes in critically ill patients. Extracorporeal membrane oxygenation (ECMO) is a mode of supportive care for patients with respiratory and/or cardiac failure. ECMO patients frequently exhibit a hypermetabolic state characterized by protein catabolism and insulin resistance, which can lead to malnutrition. Nutritional therapy is a vital component of intensive care, but its optimal administration for ECMO patients is unknown. This case report aims to provide insights into effective nutritional management for critically ill patients undergoing ECMO therapy. The patient was a 72-year-old male with a history of gastric and lung cancer who underwent a lobectomy complicated by bronchopleural fistula, postoperative bleeding, pneumonia, and acute respiratory distress syndrome (ARDS). The patient's nutritional status was assessed indicating a high risk of malnutrition, using the modified Nutrition Risk in the Critically Ill (mNUTRIC) Score. Nutritional support was administered based on the recommendations of European Society for Clinical Nutrition and Metabolism (ESPEN) and the American Society for Parenteral and Enteral Nutrition (ASPEN), with energy requirements set at 25-30 kcal/kg/d and protein requirements set at 1.2-2.0 g/kg/day. The patient received parenteral nutrition until the enteral nutrition target amount was reached, with zinc supplements for wound healing. The study highlights the need for further research on proactive and effective nutritional support for ECMO patients to improve compliance and prognosis.

Background The use of mobile apps for dietary evaluation avoids some of the disadvantages of costly and time-consuming traditional diet assessment. However, few studies have compared dietary intake data in smartphone apps with a conventional diet assessment. Objective This study aimed to compare the dietary data collected on energy and macronutrients (proteins, fats, and carbohydrates) consumed for 3 nonconsecutive days using both a mobile application (Noom) and a conventional dietary assessment tool (CAN Pro). Design This was a cross-sectional study. Participants/setting A total of 119 healthy adults (68 males and 51 females) aged 19 to 65 years were recruited from the National Cancer Center in Korea between May and September 2019. Main outcome measures The mean daily energy and macronutrient intake data were obtained for the dietary intakes consumed for 3 nonconsecutive days using Noom and CAN Pro. Statistical analysis performed The estimates of energy and macronutrient intake between the two tools were compared using correlation coefficients and crossclassification. Results Although mean daily fat intake and percent total energy from carbohydrate estimated by Noom were comparable with values provided by CAN Pro, mean daily estimated energy intake (kcal), protein (g, percent total energy), and carbohydrate (g) were significantly higher with Noom than with CAN Pro. The correlation coefficients ranged from 0.79 to 0.99 for crude intake and from 0.77 to 0.88 for energy-adjusted values of intake after adjustment for sex and age. The percentages of participants classified into quartiles of "exact agreement and plus adjacent" varied between 95% and 99% for crude intake and between 93% and 97% for energy-adjusted values of intake. Conclusions The findings indicate that Noom may be useful for monitoring the dietary intake of energy and macronutrients and reducing workload compared with a traditional dietary assessment in Korea. However, further research is needed to assess the validity and usability of Noom for estimating intake of micronutrients and other dietary components.

Background After gastrectomy, patients may experience the postgastrectomy syndrome and face difficulties adapting to everyday diet. Recently, human health coaching via a mobile application (app) has been used for obese patients or patients with chronic diseases, with significant improvements in clinical outcomes. The aim of this study is to evaluate and compare the effects of human health coaching via a mobile app and conventional face-to-face counseling in patients who underwent gastrectomy for gastric cancers. Methods This study is a single-institution, prospective randomized controlled trial comparing the mobile health and face-to-face counselling groups. After randomization, participants assigned to the mobile health coaching group will receive health coaching via a mobile app for 3 months after discharge, and the assigned coaches will provide personalized advice based on the self-recorded health data. Participants in the face-to-face group will have 1- and 3-months postoperative dietary consultations with a clinical dietitian. The primary endpoint is the food restriction score on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-STO22, and secondary endpoints included all other quality of life scale scores and nutritional parameters. The calculated sample size is 180, and the outcomes will be measured until 1-year post-surgery. Significance This study will show the efficacy of human health coaching via a mobile app on dietary adaptation in patients who underwent gastrectomy. A relational approach based on personal data and timely intervention using a mobile platform could reduce patients’ trial and error and improve quality of life. Trial registration ClinicalTrials.gov, NCT04394585 , Registered 19 May, 2020 –Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT040394585 .

OBJECTIVES:Accumulating evidence indicates anti-diabetic drug metformin has anti-cancer effect by controlling cancer metabolism. We evaluated whether addition of metformin to chemotherapy improved survival of lung cancer patients.MATERIALS AND METHODS:This randomized phase II study enrolled 164 patients with chemo-native, EGFR-ALK wild-type, stage IIIB/IV non-small-cell lung cancer (NSCLC). Patients were randomized to receive chemotherapy either with metformin (1000 mg twice daily) or alone every 3 weeks for six cycles. The patients received gemcitabine (1000 mg/m2) on days 1 and 8 and carboplatin (5 area under the curve) on day 1. Exploratory studies included serum metabolic panels, positron-emission tomography (PET) imaging, and genetic mutation tests for metabolism-related genes.RESULTS:Metformin group showed no significant difference in the risk of progression and death compared to control group (progression: hazard ratio [HR] = 1.01 [95% confidence interval (CI) = 0.72 - 1.42], P = 0.935; death: HR = 0.95 [95% CI = 0.67-1.34], P = 0.757). Squamous cell carcinoma (SqCC) had significantly higher fluorodeoxyglucose (FDG) uptake on baseline PET image than non-SqCC NSCLC (P = 0.004). In the SqCC with high FDG uptake, the addition of metformin significantly decreased the risk of progression and death (progression: HR = 0.31 [95% CI = 0.12-0.78], P = 0.013; death: HR = 0.42 [95% CI = 0.18-0.94], P = 0.035). The HDL-cholesterol level was significantly increased after the treatment in metformin group compared to control group (P = 0.011). The metformin group showed no survival benefit in the patients with hyperinsulinemia or patients whose insulin level was decreased after treatment.CONCLUSIONS:Addition of metformin to chemotherapy provided no survival benefit in unselected NSCLC patients. However, it significantly improved the survival of the selected patients with SqCC showing high FDG uptake. It suggests metformin shows the synergistic anti-tumor effect in the tumor which are highly dependent on glucose metabolism.

Rationale: Smokers are known to have poorer nutrient intake and lower diet quality than non -smokers, which increases the risk of disease. However, few studies have been conducted on the differences in diet quality according smoking status. This study examined the association between diet quality and smoking status in Korean men.

This study aimed to investigate the association between dietary flavonoid intake and the prevalence of obesity using body mass index (BMI), waist circumference, and percent body fat (%BF) according to sex among Korean adults. Based on the Korean Health and Nutrition Examination Survey 2008-2011, 23 118 adults in Korea were included. Dietary intakes were obtained using 24-h dietary recall data. A higher total intake of flavonoid was associated with a lower prevalence of obesity in women, based on %BF (odds ratio [95% confidence interval] = 0.82 [0.71-0.94]), and abdominal obesity (0.81 [0.71-0.92]). The intake of flavonols (0.88 [0.78-0.99]), flavanones (0.81 [0.72-0.92]), flavanols (0.85 [0.74-0.97]), isoflavones (0.85 [0.75-0.96]), and proanthocyanidins (0.81 [0.71-0.92]) was inversely associated with abdominal obesity, and a higher intake of flavanones (0.87 [0.76-0.99]) and proanthocyanidins (0.85 [0.75-0.98]) was associated with a lower prevalence of obesity, with respect to %BF in women. In contrast, the intake of flavonols (1.16 [1.02-1.33]), flavanones (1.18 [1.04-1.35]), and anthocyanidins (1.27 [1.11-1.46]) was positively associated with obesity based on BMI in men. In conclusion, high intake of dietary flavonoids may be associated with a decreased prevalence of abdominal obesity and obesity, based on %BF, among women. Novelty Higher flavonoid intake was associated with decreased prevalence of abdominal obesity and obesity based on %BF in Korean women. However, in men, the intake of flavonols, flavanones, and anthocyanidins was positively associated with obesity as given by BMI.

The enhanced recovery after surgery (ERAS) program aims to maximize the recovery of patients by minimizing pre- and postoperative complications and stress. The program recommends providing preoperative carbohydrate (CHO) supplements and starting an early postoperative diet to reduce the fasting duration. Based on these recommendations, we implemented preoperative CHO supplementation and initiated an early postoperative diet in patients undergoing laparoscopic colorectal resection. We observed 3 patients as follows: a non-ERAS case, preoperative ERAS case, and pre- and postoperative ERAS case. The preoperative well-being and compliance of patients improved after implementation of the ERAS program. Moreover, the length of hospital stay was reduced. Therefore, we consider that the ERAS program may be helpful for the recovery of patients undergoing laparoscopic colorectal resection.

Background: We aimed to assess the nutritional status of cancer patients according to site or treatment type. Methods: We prospectively evaluated the nutritional status of 1,588 patients based on cancer site and treatment type using the Patient-Generated Subjective Global Assessment tool. We also investigated length of stay (LOS), complication rates after surgery and quality of life (QoL). Results: The patients with esophageal, pancreaticobiliary, and lung cancer had higher malnutrition rates than those with stomach, liver, and colon cancer (52.9%, 47.6%, and 42.8% vs. 29.1%, 24.7%, and 15.9%, respectively; P < 0.05). Patients undergoing chemoradiotherapy (CRT) or supportive care had higher malnutrition rates than those undergoing surgery (35.2% or 68.6% vs. 12.3%; P < 0.05). Among patients undergoing surgery, malnourished patients had longer LOS and tended to have more complications than well-nourished patients (P < 0.05 and P = 0.146, respectively). Malnourished patients had also poorer QoL than well-nourished patients (P < 0.05). Conclusion: Malnutrition complicated more in patients with esophageal, pancreaticobiliary, or lung cancer than in those with stomach, liver, or colon cancer. Patients undergoing CRT or supportive care are more likely to be malnourished than those undergoing surgery. Malnutrition may increase LOS and impair QoL.

PURPOSE:The quality of bowel preparation is a major determinant of the quality of colonoscopy. This study evaluated lifestyle factors, including usual dietary style, associated with bowel preparation. METHODS:This retrospective study evaluated 1,079 consecutive subjects who underwent complete colonoscopy from December 2012 to April 2014 at National Cancer Center of Korea. Questionnaires on bowel preparation were completed by the subjects, with the quality of bowel preparation categorized as optimal (excellent or good) or suboptimal (fair, poor or inadequate). Lifestyle factors associated with bowel preparation were analyzed. RESULTS:The 1,079 subjects included 680 male (63.0%) and 399 female patietns (37.0%), with a mean age of 49.6 ± 8.32 years. Bowel preparation was categorized as optimal in 657 subjects (60.9%) and as suboptimal in 422 (39.1%). Univariate analyses showed no differences between groups in lifestyle factors, such as regular exercise, alcohol intake, smoking, and dietary factor. Body mass index (BMI) > 25 kg/m2 was the only factor associated with suboptimal bowel preparation on both the univariate (P = 0.007) and the multivariate (odds ratio, 1.437; 95% confidence interval, 1.104-1.871; P = 0.007) analyses. CONCLUSION:Most lifestyle factors, including dietary patterns, exercise, alcohol intake and smoking, were not associated with suboptimal bowel preparation in Koreans. However, BMI > 25 kg/m2 was independently associated with suboptimal bowel preparation. More intense preparation regimens before colonoscopy can be helpful in subjects with BMI > 25 kg/m2.

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.

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.

본 연구에서는 수도권에 위치한 일개 종합병원의 건강검진 수검자 중 대사증후군 위험요인을 두 가지 이상 보유한 346명을 대상으로 건강검진과 설문조사 자료, 한국인 상용식품의 총 항산화능 데이터베이스와 연계한 식사 자료를 분석하여 성별에 따라 대사증후군 환자 및 위험군의 식사 내 총 항산화능과 그에 따른 산화...

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.

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.

본 연구는 한국 성인의 항산화 비타민 섭취량과 대사증후군의 관련성을 분석하고자 하였다. 이를 위해 한국 성인 614명의 3일치 식사조사 자료를 한국인 상용식품의 항산화 비타민 함량 데이터베이스와 연계하여 항산화 비타민(비타민 A ( ${\mu}g$ RE, ${\mu}g$ RAE), 레티놀, 카로티노이드, 비타민 C, 비타민 E)의 섭...

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