Nutrition support in clinical practice: review of published data and recommendations for future research directions. Summary of a conference sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition

Abstract

In the last 30 years, marked advances in enteral feeding techniques, venous access, and enteral and parenteral nutrient formulations have made it possible to provide nutrition support to almost all patients. Despite the abundant medical literature and widespread use of nutritional therapy, many areas of nutrition support remain controversial. Therefore, the leadership at the National Institutes of Health, The American Society for Parenteral and Enteral Nutrition, and The American Society for Clinical Nutrition convened an advisory committee to perform a critical review of the current medical literature evaluating the clinical use of nutrition support; the goal was to assess our current body of knowledge and to identify the issues that deserve further investigation. The panel was divided into five groups to evaluate the following areas: nutrition assessment, nutrition support in patients with gastrointestinal diseases, nutrition support in wasting diseases, nutrition support in critically ill patients, and perioperative nutrition support. The findings from each group are summarized in this report. This document is not meant to establish practice guidelines for nutrition support. The use of nutritional therapy requires a careful integration of data from pertinent clinical trials, clinical expertise in the illness or injury being treated, clinical expertise in nutritional therapy, and input from the patient and his/her family. (Journal of Parenteral and Enteral Nutrition 21:133-156, 1997).

Nutritional Assessment of Cancer Patients in Tehran, Iran

“…N Khoshnevis¹, F Ahmadizar 1 , M Alizadeh 2 , M E Akbari 3 * the incidence of treatment problems (Klein et al, 1997 ;Huhmann & Scuningham, 2005). Without proper screening, over half of the patients are not recognized as being at the risk of malnutrition or are not sent for treatment (Klein et al, 1997).…”

“…Without proper screening, over half of the patients are not recognized as being at the risk of malnutrition or are not sent for treatment (Klein et al, 1997).…”

No, the glycaemic target in the critically ill should not be ≤6.1 mmol/l

“…It should be pointed out that the patients who received PN in that study received ∼4,200 kJ (∼1,000 kcal) in excess of their estimated basal energy requirements. An advisory committee sponsored by the USA National Institutes of Health, the American Society for Parenteral and Enteral Nutrition and the American Society for Clinical Nutrition concluded that routine postoperative PN in malnourished surgical patients increases postoperative complications [10]. In a metaanalysis of 27 studies comparing PN with enteral nutrition and involving >1,800 patients, Braunschweig et al found a >50% higher incidence of infection in participants receiving PN, but no difference in mortality rate [11].…”

The effects of pre-operative nutrition on colon anastomosis healing in malnourished rats

“…The effects of malnutrition on various organ systems and wound healing have been evaluated in experimental and clinical studies; particularly, its effects on the gastrointestinal system have been emphasized (3,(6)(7)(8). Some clinical studies have indicated lower general complication rates by preoperative nutritional support in patients with malnutrition undergoing major gastrointestinal surgery (9)(10)(11). However, there is little experimental research on this topic.…”