Over two billion people, or more than one out of three individuals throughout the world, are at risk of iron, vitamin A and iodine deficiencies. Although countries of the Asia Pacific region have generally shown a remarkable decline in the proportion of malnourished children, micronutrient deficiencies remain significant public health problems. The World Summit for Children in 1990, and the FAO/WHO International Conference on Nutrition held in Rome in 1992, affirmed that the elimination of the various forms of micronutrient malnutrition would constitute a significant contribution to social, economic and public health development. Governments and non-governmental organisations from virtually all nations, together with the international development community, have made the elimination of iodine deficiency disorders and vitamin A deficiency important goals to be achieved by the end of the decade, along with a substantial reduction in the levels of iron deficiency anaemia. A further important factor in implementing multisectoral micronutrient interventions is the cost-effectiveness of such interventions. The three main complementary intervention strategies to controlling and preventing micronutrient deficiencies are: (i) food-based approaches such as fortification and dietary diversification; (ii) supplementation when appropriate; and (iii) public health measures to control infection, including incorporating micronutrients into other child survival activities such as immunisation. Much of the global experience in these strategies comes from countries of the Asia Pacific region, with some significant examples of success.
The state of Sarawak in Malaysia has a high prevalence of iodine deficiency disorders (IDD). This has been revealed through a review of goitre surveys that were carried out in the State from the early 1970s to the 1990s. The primary cause was low iodine intake. Contributory factors were low iodine content in the soil and water as well as high cassava consumption. Virtual elimination of IDD is one of the nutritional goals of the IDD prevention and control programs. The strategies adopted include the iodination of coarse salt, which is sold in the market by shopkeepers and also provided free from government health clinics; legislation requiring that salt sold in IDD-gazetted areas must be iodised; and the use of iodinators to iodise water supplied by the gravity-feed system to villages and boarding schools in rural areas. The indicators used in the monitoring and evaluation of the program include the availability of iodised salt in the market and households, iodine levels in water supply that had been fitted with iodinators, goitre volume measured by ultrasound, and urinary iodine excretion among school children.
Vitamin E was discovered over 75 years ago, yet it has been only recently recognized that human vitamin E deficiency occurs as a result of fat malabsorption syndromes, defects in lipoprotein metabolism, and defects in the gene for the *-tocopherol transfer protein. Although the frequency of human vitamin E deficiency is unknown, it is likely that it is very rare. In individuals at risk, it is clear that vitamin E supplements should be recommended to prevent deficiency symptoms. What about their use in normal individuals? Vitamin E supplementation in normal individuals is quite controversial. It has been assumed that usual dietary vitamin E intakes are adequate because human vitamin E deficiency is rare and experimental vitamin E deficiency difficult to produce in laboratory animals. A continuing problem in nutrition is whether nutrients have beneficial effects when consumed in amounts in excess of those 'required' by the body. For most vitamins, excess amounts are wasted and provide no added benefits. Indeed, some fat soluble vitamins can be stored and excess amounts become toxic. Antioxidant nutrients may, however, be different. Heart disease and stroke, cancer, chronic inflammation, impaired immune function, Alzheimer's disease: a case can be made for the role of oxygen-free radicals in the etiology of all of these disorders and even in aging itself. Do antioxidant nutrients counteract the effects of free radicals and thereby ameliorate these disorders? And if so, do large antioxidant supplements have beneficial effects beyond 'required' amounts or even in amounts beyond those that could be obtained from a well-balanced diet? These are questions for which not only scientists, but also the public, are eagerly awaiting the answers.
Infectious diseases transmitted by food have become a major public health concern in recent years. In the USA alone, there are an estimated 633 million cases each year. The list of responsible agents continues to grow. In the past 20 years some dozen new pathogens that are primarily food-borne have been identified. Fruits and vegetables, often from the global food market, have been added to the traditional vehicles of food-borne illness; that is, undercooked meat, poultry, seafood, or unpasteurized milk. Such products are minimally processed and have fewer barriers to microbial growth such as salt, sugar or preservatives. The evolution of the epidemiology of food-borne illness requires a rethinking of traditional, though still valid, solutions for their prevention. Among various strategies to prevent food-borne pathogens, use of dietary phytochemicals is promising. The major obstacle in the use of dietary phytochemical is the consistency of phytochemicals in different foods due to their natural genetic variation. We have developed a novel tissue-culture-based selection strategy to isolate elite phenolic phytochemical-producing clonal lines of species belonging to the family Lamiaceae. Among several species we have targeted elite clonal lines of thyme (Thymus vulgaris) and oregano (Origanum vulgare) against Escherichia coli and Clostridium perfrigens in fresh and processed meats. We are also evaluating high phenolic profile-containing clonal lines of basil (Ocimum basilicum) to inhibit gastric ulcer-causing Helicobacter pylori. Other elite lines of the members of the family Lamiaceae, rosemary (Rosmarinus officinalis) and salvia (Salvia officinalis) also hold promise against a wide range of food pathogens such as Salmonella species in poultry products and Vibrio species in seafood.
Fruits and vegetables of the human diet contain many of the over 600 carotenoid pigments that have been identified in plants. Led by work with beta-carotene, researchers have constantly been learning more about the metabolism of these compounds in the human body. Research work is now expanding beyond beta-carotene in an effort to understand what happens to all the pigments found in the human diet. This discussion briefly looks at research results on the carotenoids found in human serum as well as the effects of supplementation. Recent confusing results from large intervention trials with beta-carotene and lung cancer incidence are emphasized in relation to supplementation doses and beta-carotene source (synthetic vs. natural). The summation of results emphasizes the importance of the broad spectrum of carotenoids in the diet and relates to supplementation products currently being designed for the marketplace.
Obesity is common in non-insulin-dependent diabetes mellitus (NIDDM) patients; in Singapore in a cohort of 314 diabetics, 44.3% were overweight. Management of obesity in diabetics differs from that in non-diabetics in that it is more urgent; weight maintenance is more difficult and hypoglycaemic medication may cause weight changes. However, like in the non-diabetic, management of obesity in the diabetic requires a pragmatic and realistic approach. A team approach is required: the help of a nurse educator, a dietitian, behaviour modification therapist, exercise therapist and others are required. A detailed history, careful physical examination and relevant investigations are required to assess the severity of the diabetic state and to exclude an occasional underlying cause of the obesity in the obese NIDDM patient. Weight loss is urgent in the obese NIDDM patient, especially for those with android obesity. There must be a reduction in energy intake. Weight loss leads to an improvement in glucose tolerance and in insulin sensitivity, as well as to a reduction in lipid levels and to a fall in blood pressure in the hypertensive. Exercise is of limited short-term value measured in terms of weight reduction, except in the younger obese NIDDM patient; but it does allow improvement in overall metabolic control and, long-term, is critical for preferred weight maintenance. The biguanide, Metformin, is the hypoglycaemic drug of choice as it leads to consistent weight reduction. The sulphonylureas may cause weight gain. Insulin should be avoided where possible as it causes further weight gain. Other hypoglycaemic agents include Glucobay (alpha-glucosidase inhibitor) and Troglitazone (insulin sensitizer) which do not alter the weight. Orlistat (lipase inhibitor) is promising as it causes reduction of weight, blood glucose and lipid levels. Anti-obesity drugs (noradrenergic and serotonergic agents) have modest effects on weight reduction in the obese NIDDM patient; a widely-used preparation, Dexfenfluramine (Adifax), has been withdrawn because of side-effects. Surgery such as gastric plication is the last resort in treating the morbidly obese NIDDM patient. Against this background, the institution of life-long food and exercise habits which favour health, body composition and fat distribution are paramount in the prevention and minimization of expression of NIDDM. The discovery of leptin in 1994 has led to intense research into energy homeostasis in obesity; hopefully this will lead to better treatment of obesity in diabetics and non-diabetics.
This paper discusses the concept of the nutrition transition in detail. It commences with an overview of societies which are recognised as being in transition. The economic foundations of the transition from traditional to modern (and post-modern societies) will be emphasised. This will be followed by an examination of the nutrition problems and food habits associated with transitional societies. The public health context of such nutritional problems will also be described. Comparisons will be made between the food beliefs and habits held in traditional societies and those in transitional, modern and post-modern societies. It will be argued that nutritional and medical beliefs have come to play more extensive roles in non-traditional societies, most probably through the mass media. Changes in personal values associated with societal transition will be described in relation to the pursuit of luxury foods. Finally, some of the responses to the nutritional problems of transitional societies will be described. The essential roles of government and non-government organisations in moderating harmful effects of the global economy will be elucidated. It will be argued that the success of nutrition interventions such as food-based dietary guideline policies depend on the development of effective national and local social organisations.
Fat consumption at a national level is largely determined by the economic development of a country. Based on the data of nationwide nutrition surveys undertaken in China in 1982 and 1992, the average intake per capita per day of meat increased from 62.6 to 100.5 g in urban areas and from 22.9 to 37.6 g in rural areas. The consumption per capita per day of eggs increased from 15.5 to 29.4 g in urban areas and from 3.8 to 8.8 g in rural areas. The daily consumption of cooking oil was 12 g in 1982 and reached 22.4 g in 1992, while the consumption of animal fat remained stable. The average fat intake accounted for 18.1% of total energy intake in 1982 and 22.0% in 1992. The daily fat intake of Beijing urban residents was 92.9 g per capita per day in 1992, accounting for 32.7% of total energy intake, which was beyond the top limit suggested by the World Health Organisation. The change of disease patterns in Chinese people has been great during the past two decades. The mortality rate due to cerebro-cardiovascular disease accounted for 12.07% of deaths in 1957, and increased to 40.72% in 1994. The non-communicable chronic diseases (NCCD) accounted for approximately 70% of total deaths. Twenty-five percent of the total population and 60% of day care patients suffered from chronic diseases. The risk factors of NCCD are increasing in China and more attention should be given to the prevention and intervention of NCCD in the future.
Like Western populations, affluent urban populations in developing countries are facing the problem of dyslipidemia, an important risk factor of coronary heart disease. Our study of 453 affluent, urban Thai women revealed that the prevalences of type IIa, IIb, IV and V hyperlipoproteinemias were 32.5, 2.2, 2.4, and 0.4%, respectively. Based on a waist-over-hip circumference ratio (WHR) of > 0.8 and body mass index (BMI) of > 25.0 kg/m2 to indicate abdominal and overall obesity, respectively, the prevalences of abdominal obesity, overall obesity, and combined abdominal and overall obesity in these women were 32.9, 5.7, and 21.2%, respectively. Both BMI and WHR in these women had significantly positive influences on their serum triglyceride (TG) and apo B levels, and significantly negative influences on their serum HDL-cholesterol levels. Only BMI had a significantly positive influence on their serum total cholesterol (TC) and LDL-cholesterol levels but a significantly negative influence on their serum apo A-I levels. A lipid-lowering effect of linoleic acid was shown in 101 dyslipidemic women receiving dietary intervention for 8 weeks, evidenced by significantly negative relationships between their serum 18:2 n-6 levels and serum TC, LDL-C, TG, and apo B levels.
The effects of population pressure on agricultural sustainability in the delicate tropical and subtropical ecosystems have often been thought to explain high prevalence rates of malnutrition in rural South-East Asia. However, recent studies in rural Sarawak suggest that processes of modernisation have resulted in increased variations in energy nutritional status in adults. A contributory factor may be consumption of the areca nut (Malay pinang, of the palm Areca catechu). This is thought to influence energy balance through effects on appetite and resting metabolic rate. Body mass index (BMI, kg/m2) data for 325 Iban men and 438 non-pregnant Iban women, measured in 1990 and again in 1996, have been analysed in relation to areca use, smoking behaviour, socio-economic status, and reported morbidity. Body composition derived from skinfold thickness measurements for 313 men and 382 women was also analysed. The results suggest that use of areca nut is associated with significantly lower age-related increments in BMI and percentage body fat in women after allowing for age, smoking, reported morbidity, and confounding socio-economic factors. Therefore, the impact of recent economic and social development seen in rising prevalences of 'over-nutrition' may be modulated by use of the areca nut.
The protection against ethanol-induced lipid peroxidation is rendered by antioxidants such as vitamin E and glutathione (GSH) interacting with each other and also functioning independently. A study of the levels of GSH and activities of glutathione peroxidase (GP), glutathione reductase (GR) and glutathione transferase (GST) in the cerebral cortex (CC), cerebellum (CB) and brain stem (BS) of vitamin E-supplemented and -deficient rats subjected to ethanol administration for 30 days was carried out. Chronic ethanol administration to vitamin E-supplemented rats elevated GP, GR and GST activities in the three regions and GSH levels in the CB. Chronic ethanol administration to vitamin E-deficient rats elevated GR activity in the three regions and GP activity in the CC and CB, decreased GST activity in the CC and CB, but did not alter GSH levels compared with normal rats subjected to chronic ethanol administration. The results indicate that vitamin E helps to maintain GSH levels to combat increased peroxidation while its absence has a deleterious effect.
The data presented is part of the findings from a four-year collaborative research project between Universiti Putra Malaysia, the Institute for Medical Research and the Ministry of Health Malaysia. The project assessed the nutritional status of the major functional groups in Peninsular Malaysia. Mukim Sayong and Pulau Kemiri in the District of Kuala Kangsar, Perak were two of the subdistricts selected to represent small rubber holdings in Peninsular Malaysia. This paper attempts to analyse the socio-economic profile of the households and the nutritional status of children below 9 years of age. A total of 307 households were studied. Approximately 63% of the households were involved in rubber activities and the majority of them were hired tappers. The average monthly income of the households was RM467 and the income ranged between RM30 to RM2120. Based on the per capita poverty line income of RM84.38, it was found that 14.1% of the households earned less than RM42.19, which can be considered as hard-core poor, while 32.7% were poor (monthly per capita income between RM42.19 and RM84.38). Slightly more than half (52.7%) earned income above the poverty line. The average family size was 4.5, ranging from 1 through to 16. The majority of the heads of households (56.6%) had between 3 and 6 years of education, and 14.5% did not receive any formal education. The prevalence of stunting among children 05 years of age was 26%, while 31.5% were underweight and 3.8% wasted. Among children aged between 5 and 9 years, almost the same pattern of nutritional status was noted. The overall percentages of stunting, underweight and wasting among these children were 29.2%, 26.1% and 0.62%, respectively. Analysis on nutritional status according to income level showed a noticeable difference in the prevalence of malnutrition in children above and below the poverty line income. The Student's t-test indicated significant differences in weight-for-age and weight-for-height between the two poverty line income for children below 5 years of age. Pearson's correlation coefficient showed a significant correlation between height-for-age with household size (r = 0.26, P < 0.05), and monthly per capita income with weight-for-height (r = 0.25, P < 0.05). There was a highly significant correlation between acreage of land cultivated and weight-for-height (r = 0.42, P < 0.01), and weight-for-age (r = 0.25, P < 0.05). The findings indicated the influence of socio-economic factors on the nutritional status of children.
In protracted and recurrent conflict, Vietnamese people have learned to minimize food insecurity through governance, mutual social responsibility, infrastructure development, ecological sensitivity, agricultural diversification and emphasis on family needs and traditional food patterns. Drawing on this experience, in 1992 a National Plan of Action for Nutrition was devised. Its goals include increasing energy intake and reducing childhood malnutrition.
Both annual biomass production and biodiversity at any locality on earth are continually under threat as the population of Homo sapiens steadily increases, with the resultant pollution of atmosphere, soil and water. Today, environmental degradation and global warming (with its effect on evaporative aerodynamics and cellular respiration) have increased at an alarming rate. The ABP of all terrestrial plant communities (natural or cultivated) is slowly declining, thus reducing the energy supply of component plants and resident animals; in turn, the biodiversity of all the world's ecosystems, plant and animal, is threatened. The maintenance of biodiversity is important to human health for several reasons: (i) a varied food supply is essential to maintain the health of the omnivorous human species; (ii) a range of diverse food sources is necessary to safe-guard against climatic and pestilent disasters which may affect one or more of the food sources; (iii) a diversity of plants and animals may provide a rich source of medicinal material, essential for the extraction of undiscovered therapeutic compounds; (iv) intact ecosystems of indigenous plants and animals appear to act as a buffer to the spread of invasive plants and animals, and of pathogens and toxins, thus contributing to the health of populations nearby; and (v) the 'spiritual' values of exploring the diversity of plants, animals and ecosystems in an area appear to have a beneficial effect on mental health, strengthening the feeling of 'belonging to the landscape'. The variety of foods, their energy contents and food values, consumed throughout the year is amenable to scientific enquiry; as is the amount of energy expended in this collection or production. The control and management of food production and of water supplies, with attention to safety issues, has led to an improvement in life expectancy for a proportion of the world's population. The question is at what point might human health be disadvantaged by the present-day food-production systems. In order to achieve variety in food patterns is an agreed and internationally asserted Dietary Guideline, but the way in which, and the extent to which, this is or needs to be achieved is a pressing issue for biological science in general. It is a field of enquiry which may be identified as 'Eco-nutrition'.
In Jakarta there currently exists an elderly healthcare program which is implemented at community health posts, known as elderly clubs. Recently, an elderly needs assessment was done on active participants of such elderly clubs in Tebet, South Jakarta. Two out of six elderly clubs were selected for the survey: namely, Cempaka (CEC, n = 45) and Anggrek (AEC, n = 40). The need assessment consisted of demography, health, food patterns, environment, disease, physical disability, psycho-social status and family support systems. Approximately 85% of the elderly club participants were female and 15% were male. There were no significant differences between the two elderly clubs, except that CEC had more non-Javanese participants; a higher level of education among participants; more smokers; more women who lived with their husbands; and more participants with hypertension, arthritis, osteoporosis, diabetes and tooth loss. Psycho-social status of CEC was more normal for total potential scores than was AEC. Family support for the elderly was provided by two adult children. This rapid appraisal of the elderly could be a useful tool for developing specific community elderly programs.
In order to investigate the current health and nutrition status of mothers and children in Mongolia, a regionally stratified survey of 977 randomly sampled households was conducted during July and August 1997. The prevalence of children aged 660 months who demonstrated one or more of three main clinical signs (i.e. rachitic rosary, Harrison's groove and delayed closure of fontanelle) was found to be 69.8%. Although a nationwide supplementation programme exists, caretakers reported only 66.2% of children under 3 years of age had received at least one vitamin D supplement in the 6 months preceding the survey. The lack of adequate UV-B rays during the winter months (i.e. OctoberApril) and traditional swaddling of infants for a minimum of 3 months and a maximum of 912 months are likely to contribute to the prevalence of rickets in Mongolia. The high prevalence of rickets in Mongolian children is a serious public health concern. In addition to the adverse effects on growth, development and immune function, it is probably indicative of widespread subclinical vitamin D deficiency
Forty-one fresh fruits frequently consumed in the Taiwan area were analysed for their dietary fiber content by an enzymatic-gravimetric method. Total dietary fiber (TDF) of these fruits ranged from 0.2 g (per 100 g edible weight) in grapes to 8.6 g in eggfruit. In citrus fruit, the proportion of soluble fiber in TDF was more than 50%. However, in some fruits like guavas and waxapple, soluble fiber took less than 30% of TDF. Soluble fiber in almost all fruit was comprised of a large amount of uronic acids, while the composition of insoluble non-cellulose polysaccharides (INCP) varied a great deal. Mangos and pummelos of different varieties were different in their sugar composition of INCP. Insoluble non-cellulose polysaccharides of a crisp type of persimmon had more arabinose and galactose, but those of soft persimmon contained mainly xylose. These results show that different types of fruit are distinct in their composition and hence, the properties of their dietary fiber. These data are useful for dietary assessments in Taiwan and South-East Asia.
A cross-sectional study on iodine deficiency disorders (IDD) status was conducted in a known endemic area where three types of IDD intervention (iodized oil capsule, iodized salt and iodinated water) were employed. A total of 238 children of 810 years of age from eight public elementary schools were included in the study. In addition to selected socio-economic and anthropometric data, output (iodine level in salt, iodine content in drinking water, iodized oil coverage) and outcome (goiter by palpation, urinary iodine excretion (UIE) concentration) were assessed. The total goiter prevalence (all were in grade 1) was 19% (mild IDD). The median UIE concentration was 193.5 µg/L (iodine-replete condition). Iodized oil capsule coverage was 61%, and 55% of those children received their latest capsule less than 1 year prior to the time of the study. Iodine level in salt was 14.4 ± 9 p.p.m. The iodine level in iodine supplemented drinking water was 11.7 ± 8.2 µg/L, while in surface water it was 12.2 ± 4.7 µg/L. Goiter was not associated with any of the three types of iodine supplementation, while UIE level was significantly associated only with iodized salt (P < 0.001), which suggested that, despite some problems in the universal salt iodization program, iodized salt was the most effective agent of the IDD control program at the community level. However, more research is needed to better understand the impact indicators of IDD control programs.
The purpose of this study was to investigate the role of socio-economic status in the transition of food consumption and nutritional status in a Tianjin population and to identify some related underlying nutritional problems in this population. A random representative sample of appproximately nine million people in Tianjin was obtained using the stratified multistage cluster sampling method. A total of 2236 eligible subjects (1096 men and 1140 women) aged between 15 and 64 years were enrolled in the autumn of 1992. Food weighing plus a three-day food record method were used to assess food consumption and nutrient intakes. The population was categorized into four income groups by average per capita income and three educational groups by years of education. There were marked differences in daily mean consumption of foods among groups with different income levels and educational attainment after adjustment for confounding factors. The low income and/or least education group consumed more cereals while the high income and/or most educated group consumed more fruit, milk and meat. Due to the differences in food consumption, intakes of protein, fat, riboflavin, calcium, selenium, zinc and vitamin E increased while intakes of carbohydrate and manganese decreased with increasing levels of income and education. Vitamin A, calcium and riboflavin intakes were low in all groups classified by either income or education. Vitamin A intake was lower in the low income group than in the other three groups but intakes of calcium and riboflavin were higher in the high income and/or the most educated group than in the other groups. Socio-economic status plays an important role in food consumption and nutritional status in this population. Low intakes of vitamin A, calcium and riboflavin exist in all socio-economic groups. However, higher income and/or educational attainment contribute to increased intakes of calcium and riboflavin. Higher income also relates to an increased intake of vitamin A.
There are significant differences in the food consumption patterns of countries. In the lower income countries, most of the energy intake is derived from cereals and starchy roots. On the other hand, the intake of these carbohydrate foods is much lower in the economically developed countries and more of the energy is derived from added fats, alcohol, meat, dairy products and sweeteners. The contribution of energy from various food groups has changed markedly over the past three decades. With increasing national wealth there is a general tendency for the consumption of cereal foods to decline, whereas the consumption of added fats, alcohol, meat and dairy products has increased over the years. Similar changes have also been observed for Malaysia. These dietary alterations, as well as other lifestyle changes, have brought about a new nutrition scenario in many developing countries. These countries are now faced with the twin problems of malnutrition, that is, undernutrition among some segments of the population and diet-related chronic diseases in other groups; for example, obesity, hypertension, coronary heart disease, diabetes and various cancers. In Malaysia, deaths due to diseases of the circulatory system and neoplasms have been on the rise since the 1960s. The former has been the most important cause of death in the country for more than 15 years, with cancer ranking third for almost 10 years. Epidemiological data collected from different community groups showed increased prevalences of various risk factors amongst Malaysians. In view of the changed nutrition scenario in the country, intervention programmes have been reviewed accordingly. The Healthy Lifestyle (HLS) Programme was launched in 1991 as a comprehensive, long-term approach to combating the emerging diet-related chronic diseases. For six consecutive years one thematic campaign per year was carried out; namely, coronary heart disease (1991), sexually transmitted diseases (1992), food safety (1993), childhood diseases (1994), cancers (1995) and diabetes mellitus (1996). To further strengthen health promotion among the community, another series of activities to be carried out under the second phase of the HLS programme from 1997 to 2002 was launched within the framework of the National Plan of Action on Nutrition (NPAN) for Malaysia. In view of the importance of diet and nutrition in the causation and prevention of chronic diseases, the theme for the first year of this phase was Healthy Eating. It is clear that nutrition education for the community in order to inculcate a culture of healthy eating is the long-term solution. A series of guidelines have been prepared for dissemination to the public via a variety of media and approaches, and with the collaboration of various government and non-governmental organisations. The implementation of the programme is, however, a challenge to health and nutrition workers. There is a need to examine the strategies for nutrition education to ensure more effective dissemination of information. The challenge is to determine how best to promote healthy eating within the present scenerio of rapid urbanisation, 'western' dietary pattern influence, a whole barrage of convenience and 'health' foods, and nutrition misinformation. We would like to share our experiences in the approaches taken and our concerns with other countries in the region given that various opportunities exist for collaboration.
The provision of nutrition support to patients in hospital and at home has advanced significantly over the past decade. Enteral or parenteral nutrition can be safely administered in patients of any age, size or disease state when care is taken to individually tailor nutrition therapy and monitor for potential complications. Nutritional support is increasingly recognised as an integral component of disease treatment protocols. In the future, it is likely that nutrition support will increasingly focus on modifying specific metabolic effects of disease by disease-specific nutrient manipulation. Adjuncts to nutritional therapy, such as growth factors, may provide opportunities to enhance intestinal adaptation and modify the metabolic response to stress. Advances in enteral and parenteral nutrition delivery systems will continue to improve with the aim of providing safe, effective and socially acceptable techniques of delivering long-term nutrition support. Nutrition support teams have proven their cost-effectivenes in the past decade; however, they are under increasing pressure to adapt to ever changing healthcare systems. The next decade will provide challenges and opportunities not only for the enhancement of nutritional management but also for the provision of evidence that specific nutritional intervention improves clinical outcome.
The instigation of nutrition support, either via the enteral or parenteral route, in individuals unable to maintain adequate nutrition via oral means is based on the premise that such an intervention will reduce both morbidity and mortality and improve quality of life. While there is evidence that active nutrition support improves biochemical and physiological parameters, health professionals are being called upon to demonstrate the cost, benefits and outcomes of nutrition support in the face of budget constraints and increasing demands on health care. Cost savings have been made in hospital nutrition support through increased use of enteral rather than parenteral nutrition support, particularly in Intensive Care Units, and careful use of resources when planning enteral nutrition support. Nutrition support of critically ill and malnourished individuals can reduce morbidity and length of stay. Benefits of home nutrition support programs include avoidance of hospital bed costs and improved lifestyle and psychological well-being. Our experience and that of the literature will be reviewed.