Stephen L. Wolman

Nutritional assessment: A comparison of clinical judgement and objective measurements

24. Statement of an expert panel. Guidelines for essential trace element preparations for parenteral use. JAMA 1979;241:2051 25. Kurkus J, Alcock NW, Shils ME. Manganese content of large volume parenteral solutions and of nutrient additives. JPEN 1984;8:254 26. Shike M, Richie M, Shils ME. Manganese studies in long term home TPN patients. Clin Res 1986;34:804A 27. ASCN/ASPEN Working Group: Klein GL, Alfrey AA, Shike M, et al. Parenteral nutrition drug products containing aluminum as an ingredient: response to FDA notice of intent. Am J Clin Nutr 1991;53:399 28. Winters RW, Heird WC, Dell RB. History of parenteral nutrition in pediatrics with emphasis on amino acids. Fed Proc 1984;43:1407 29. Schuberth O, Wretlind A. Intravenous infusion of fat emulsions, phosphatides and emulsifying agents. Clinical and experimental studies. Acta Chir 1961; 278(suppl):3 30. Wretlind A. Complete intravenous nutrition. Theoretical and experimental background. Nutr Metab 1972;14(suppl):1 31. Shils ME, Wright WL, Turnbull A, et al. Long-term parenteral nutrition through an external arteriovenous shunt. N Engl J Med 1970;283:342 32. Scribner BH, Cole JJ, Christopher, et al. Long term parenteral nutrition: the concept of an artificial gut. JAMA 1970;212:457 33. Jeejeebhoy KN, Zohrab WJ, Langer M, et al. Total parenteral nutrition at home for 23 months, without complications and with good rehabilitation. Gastroenterology 1973;65:811 34. Shils ME. A program for total parenteral nutrition at home. Am J Clin Nutr 1975;28:1429 35. Howard L, Michalek AV. Home parenteral nutrition. Annu Rev Nutr 1984;4:69 36. Vacanti JP, Langer R. Tissue engineering: the design and fabrication of living replacement devices for surgical reconstruction and transplantation. Lancet 1999; 354(suppl 1):32

Evaluating the Accuracy of Nutritional Assessment Techniques Applied To Hospitalized Patients: Methodology and Comparisons

Herein we describe a methodology which can be used to evaluate the predictive accuracy of nutritional assessment techniques. We use this methodology to compare seven techniques of nutritional assessment in terms of their ability to predict one nutrition associated hospital complication (infection) by dividing a sample of 59 surgical patients into high risk and low risk groups. One technique was subjective global assessment (SGA) of the patients nutritional status on admission to hospital. Five techniques were single objective measurements (albumin, transferrin, delayed cutaneous hypersensitivity, anthropometry, and creatinine-height index). The 7th technique was the prognostic nutritional index. The best combination of sensitivity (0.82) and specificity (0.72) was found with SGA. The second best combination (0.88 and 0.45) was found by using either the prognostic nutritional index or creatinine-height index. We also found that combining the five objective measurements with SGA into a single index did not increase the discriminatory (or predictive) power over that of SGA alone in a clinically significant way. We conclude that a larger study comparing these approaches should be undertaken to confirm these findings and to develop methods which improve the predictive properties of SGA.

Antioxidant vitamin supplementation in Crohn's disease decreases oxidative stress. a randomized controlled trial.

OBJECTIVE:We showed previously that patients with Crohns disease (CD) had increased oxidative stress and lower antioxidant vitamins compared with healthy controls. This is despite inactive or mildly active disease and maintenance therapy. The aim of this study was to evaluate in these patients the effects of antioxidant vitamin supplementation on oxidative stress.METHODS:This is a randomized controlled trial where stable but oxidatively stressed CD subjects (n = 57) were supplemented with vitamins E (800 IU) and C (1000 mg) or their placebo for 4 wk. Oxidative stress measured by breath pentane and ethane output, plasma lipid peroxides, and F2-isoprostane was assessed at baseline and at 4 wk. Disease activity was also monitored by measuring CD activity index and plasma orosomucoid.RESULTS:During supplementation, plasma vitamin C and α-tocopherol increased and all indices of oxidative stress decreased significantly. Disease activity remained stable.CONCLUSIONS:In this population, vitamin E and C supplementation resulted in a significant reduction in oxidative stress. This suggests that patients with inactive or mildly active CD can be oxidatively stressed and have increased requirement in antioxidant vitamins.

Critical evaluation of the role of clinical assessment and body composition studies in patients with malnutrition and after total parenteral nutrition.

verely malnourished patient, the exact rec-ognition of early and subtle malnutrition isnot as simple. Furthermore, the results ofsuch marginal deficiency are not clearlyknown. Since the recognition and knowledgeof the effects of early malnutrition are bothimportant in defining the need for nutritionalsupport, several investigators have attemptedto study this area. They have related a varietyof parameters of anthropometry and bio-chemistry

Protein Conversion to Glucose: An Evaluation of the Quantitative Aspects

The amount of glucose that can be synthesized from a protein depends on its amino acid (AA) composition. This value is about 60 g from 100 g of liver or muscle protein and is based on a knowledge of the total AA content and the proportion of each AA that can be converted to pyruvate. The maximum quantity of glucose in grams that can be synthesized from administered AA solutions is the sum of the products of the number of moles of each AA times its percent convertible to pyruvate times the molecular weight of that AA.