In this review, topics with scientific strength, topical interest, and controversy were selected. Over the past 50 years,
malnutrition has become increasingly recognized as a cause of increased morbidity and mortality in hospital patients. From 1970 to 1980,
parenteral nutrition was advocated as the most appropriate form of nutritional
therapy for hospital patients. Since then,
parenteral nutrition has been replaced by
enteral nutrition as the best way of delivering nutrients to hospital patients. The timing of
enteral nutrition has been debated. Should it be instituted early, within the first 24 hours? In addition,
enteral nutrition containing immune-enhancing nutrients such as
arginine,
omega-3 fatty acids,
glutamine, and
nucleotides has been advocated for
critically ill patients. The relative merits of enteral versus
total parenteral nutrition continue to be debated. Questions about possible complications related to
enteral nutrition have been raised. Patients are at risk of
nosocomial pneumonia from aspiration and at risk of bowel
ischemia because
enteral nutrition increases intestinal oxygen consumption.
Steroids are often used to treat
Crohn disease, but because of undesirable side effects, various techniques have been used to reduce
steroid dependency.
Enteral nutrition has been advocated as a way of reducing
steroid dependency. Finally,
enteral nutrition is routinely used to feed demented patients and those in a
vegetative state. It is not clear whether this practice alters outcome or quality of life.