NUTRITION SUPPORT IN CLINICAL-PRACTICE - REVIEW OF PUBLISHED DATA ANDRECOMMENDATIONS FOR FUTURE-RESEARCH DIRECTIONS (REPRINTED FROM JPEN, VOL 21, PG 133-156, 1997)

In the last 30 years, marked advances in enteral feeding techniques, v enous access, and enteral and parenteral nutrient formulations have ma de it possible to provide nutrition support to almost all patients. De spite the abundant medical literature and widespread use of nutritiona l therapy, many areas of nutrition support remain controversial. There fore, the leadership at the National Institutes of Health, The America n Society for Parenteral and Enteral Nutrition, and The American Socie ty for Clinical Nutrition convened an advisory committee to perform a critical review of the current medical literature evaluating the clini cal use of nutrition support; the goal was to assess our current body of knowledge and to identify the issues that deserve further investiga tion. The panel was divided into five groups to evaluate the following areas: nutrition assessment, nutrition support in patients with gastr ointestinal diseases, nutrition support in wasting diseases, nutrition support in critically ill patients, and perioperative nutrition suppo rt. The findings from each group are summarized in this report. This d ocument is not meant to establish practice guidelines for nutrition su pport. The use of nutritional therapy requires a careful integration o f data from pertinent clinical trials, clinical expertise in the illne ss or injury being treated, clinical expertise in nutritional therapy, and input from the patient and his/her family.