Nutrition

The use of nutrition for the medical patient, in the inpatient setting and at home, will likely continue to increase in the future. Each patient should be evaluated in an individualized but systematic fashion. Each patient in whom malnourishment is suspected should undergo a thorough assessment for the presence and degree of malnutrition with an accurate calculation of nutritional requirements. It is important to choose the correct method of delivery of nutrition, to monitor and recognize any complications or problems that may arise, and to tailor the nutritional therapy to the unique diseases that are encountered in medicine. Although increasingly new advances and changes are occurring in the field of nutrition, nutritional support and therapy are best delivered and supplied to the patient with a network of health care workers, including the physician, the nurse, the dietitian, the social worker, and pharmacist.     

Nutrition Management

Whether it is used as a primary, adjunct or palliative intervention, radiation therapy can have a deleterious effect on nutritional status. Routine and systematic screening for malnutrition with early and appropriate nutrition intervention can improve tolerance to therapy, reduce morbidity, increase nutrient intake and improve quality of life in patients undergoing radiation therapy. Medical nutrition therapy (MNT) integrates pharmacological intervention and dietary modification to manage symptoms that may affect nutrient intake. Fewer hospitalisations, a decrease in complications, reduction in weight loss, a greater sense of wellbeing and improved quality of life are additional benefits of nutrition support. For patients in whom toxicity is expected to substantially hinder oral intake for more than 1 week, more aggressive nutrition support may be indicated. The prophylactic placement of gastrointestinal feeding tubes has been shown to significantly reduce weight loss and the number of admissions for the complications of mucositis and dehydration in patients receiving radiation therapy. While controversy still exists regarding the use of antioxidants during cancer treatment, results of some studies suggest that supplementation with individual micronutrients and phytochemicals such as n-3 fatty acids, genistein or glutamine may not only help to reduce adverse effects but also act synergistically to enhance the effectiveness of radiation therapy in the cancer patient. Although these diet-derived agents have shown promising results in animal studies, further studies, particularly randomised, placebo-controlled, phase III clinical trials, are needed to define the role of dietary supplementation during cancer therapy.     

Clinical Nutrition

The following is the letter of transmittal accompanying the report of the first White House Conference on Food, Nutrition and Health, from Dr. Jean Mayer to President Nixon.