Nutrition and metabolic support in the 21st century

New approaches to nutritional support are necessary to test therapies that may potentially enhance outcomes. Such approaches include the move to rely on the enteral route for nutrient delivery, the ability to reduce exogenous calories in our nutritional support systems, the need to utilize nutrients for their pharmacological effects, the ability to use growth factors to en hance nutrient efficacy, and the ability to institute nutritional supplemen tation before elective operations, thus practicing preventative nutrition. Testing these approaches in the years to come should allow us to identify m odalities that will permit us to move away from nutritional therapy as a su pportive modality and use it as a primary or secondary method of patient ca re.