Advances in Clinical Nutrition

The advent of any new and effective therapy is soon followed by large numbers of publications in which the indications and benefits are explored critically. It is not unexpected, therefore, that within five years of the first Bermuda Symposium on advances in parenteral nutrition that a second Symposium was considered appropriate to review progress and explore new areas of investigation, as well as enlarging the scope of the meeting to include enteral nutrition. The rate of progress can be judged by the number of subjects which were not discussed at the first Symposium. For example, home parenteral nutrition, computer assisted assessment and prescribing, Studies of body protein synthesis and breakdown and the role of branched-chain amino acids are all new subjects for this Symposium which were not covered at all in the first meeting. Much progress has also been made to our understanding of the biochemi- cal complications of parenteral nutrition and the problems related to long term access to the circulation. Nutritional care has become safer and more effective. There is an increasing awareness of the difficulties in making a true nutritional assessment in selecting patients for total parenteral nutrition and more attention has also been focussed on different approaches to enteral support in the management of undernourished patients. There is also continuing debate on the cost effectiveness of this expensive method of treatment and critics look in vain for evidence of efficacy based on controlled trials in specific groups of patients.