ARTICLE IN PRESS

0020-7489/$ - se

doi:10.1016/j.ijn

�Tel.: +1 847

E-mail addr

International Journal of Nursing Studies 44 (2007) 1073–1074

Commentary

More research and education needed in acute care nutrition:A comment arising from Kubrak and Jensen’s (2007) review

Luke Curtis�

Norwegian American Hospital, 1328 Greenwood, Wilmette, IL 60091, USA

Received 17 October 2006; received in revised form 16 November 2006; accepted 16 November 2006

www.elsevier.com/locate/ijnurstu

Keywords: Acute care nutrition; Malnutrition; Mediterranean diet; Immunonutrition; Lymphoma; Bladder cancer

While much nutrition research has been published in

the last decade, most of these studies have examined

preventative nutrition and few studies have dealt with

the use of nutrition to treat acute care or status-post

major disease patients. Several studies have indicated

that good nutrition can significantly reduce morbidity

and mortality in acute care patients. Much more

research and education on acute care nutrition is needed.

I appreciated your excellent review article on the high

rates (13–78%) of malnutrition in acute care patients by

Kubrak and Jensen (2006). While there has been a large

amount of nutritional research published in the last

decade, most of these studies have examined preventa-

tive nutrition and few studies have dealt with the use of

nutrition to treat acute care or status-post major disease

patients. Most, but not all, of the sparse acute care

nutrition research has indicated that good nutrition can

significantly reduce both morbidity and mortality in

acutely ill patients.

A prospective study following 423 patients with a

previous myocardial infarction for about 46 months

reported that the risk of a recurrent myocardial infarct

was only 0.28 times as great in patients consuming a

‘‘Mediterranean Diet’’ as compared to those consuming

a prudent low-fat Western diet (p ¼ 0.0001) (De Lorgeril

et al., 1999). Such a Mediterranean diet is rich in fish,

olive oil, vegetables, fruits and whole grains (De Lorgeril

et al., 1999). A study of 290 patients with favorable non-

e front matter r 2006 Elsevier Ltd. All rights reserve

urstu.2006.11.004

256 3562.

ess: LukeTCurtis@aol.com.

Hodgkins lymphoma found that 5-year survival rates

were 90% (179/199) among patients who lost no weight,

but only 33% (30/91) among patients who lost more

than 5% of their pre-lymphoma weight (po0.0001)

(Dewys et al., 1980). A study of 65 bladder cancer

patients noted a 41% 5-year tumor recurrence rate

among patients given a vitamin and zinc supplement

with megadoses of vitamin A, B6, C, E and zinc as

compared to a 91% tumor recurrence rate among

patients given a supplement with only the US Recom-

mended Daily Allowance (RDA) of vitamins and zinc

(p ¼ 0.0014) (Lamm et al., 1994 ). A meta-analysis of

eleven published studies involving intensive care unit

(ICU) patients found that the use of ‘‘immunonutrition’’

enteral nutrition formulas (containing additional quan-

tities of omega-3 fatty acids, arginine, glutamine, zinc

and vitamins) resulting in a 46% lower risk of

nosocomial pneumonia as compared to patients given

standard formula (p ¼ 0.007) (Montejo et al., 2003). A

similar meta-analysis of 9 studies found that ICU

patients given immunonutrition enteral formulas had a

55% lower risk of bacteremia as compared to patients

given standard formula (p ¼ 0.0002) (Montejo et al.,

2003).

Much more research and education of health care

providers is needed on the use of nutrition in acutely ill

patients. Better acute nutritional care will save many

lives, prevent many complications and save significant

amounts of health care costs. I hope IJNS can publish

some more good articles on nutrition for acute care/post

major disease patients in the future!

d.

ARTICLE IN PRESSL. Curtis / International Journal of Nursing Studies 44 (2007) 1073–10741074

Conflict of Interest

None. I have no proprietary interest in any food or

food supplement companies.

References

De Lorgeril, M., Salen, P., Martin, J.L., Monjaud, I., Delaye,

J., Mamelle, N., 1999. Mediterranean diet, traditional risk

factors, and the rate of cardiovascular complications after

myocardial infarction. Circulation 99 (6), 779–785.

Dewys, W., Begg, C., Lavin, P., Band, P., Bennett, J., Bertino,

J., et al., 1980. Prognostic effect of weight loss prior to

chemotherapy in cancer patients. American Journal of

Medicine 69 (4), 491–497.

Kubrak, K., Jensen, L., 2006. Malnutrition in acute care

patients: a narrative review. International Journal of

Nursing Studies, in press.

Lamm, D., Riggs, D., Shriver, J., Van Gilder, P., Rach, J.,

DeHaven, J., 1994. Megadose vitamins in bladder cancer: a

double blind clinical trial. Journal of Urology 151 (1),

21–26.

Montejo, J.C., Zarazaga, A., Lopez-Martinez, J., Urrutia, G.,

Roque, M., Blesa, A.L., et al., 2003. Immunonutrition in the

intensive care unit. A systemic review and consensus

statement. Clinical Nutrition 22 (3), 221–233.