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This is the fourth issue of TOP NUTRITION NEWSLETTER in 1998. Although I would like to include a lot of photos and graphics for your convenience and enjoyment, the internet connection speed today does not allow me to create a heavy file. The April 1998 Edition is devoted to several interesting issues in nutrients and factors related in immunity and nutrition. Although several factors are related to the aetiology of immunodeficiency states, protein calorie malnutrition is still the highest incidence of acquired immunodeficiency syndrome.

Improvements in health care and nutrition in this century have increased life expectancy for most people. One result is that the elderly are the fastest-growing segment of our population. Elderly people experience significantly greater morbidity and mortality from infectious diseases than the general population. This apparent susceptibility to infection in the elderly has been attributed to a decline of immune function with age, termed "immune senescence." This review "Alterations of Immune Defense Mechanisms in the Elderly: The Role of Nutrition" highlights the changes in immune responses that develop with aging and examines the role of nutritional factors in maintaining immune competency in the elderly.

The Trauma Research Center at the University of Texas Medical School in Houston is a multi-institutional, multidisciplinary research unit supported by the NIGMS of the NIH. It is in its seventh year of operation, and currently involves the research efforts of basic and clinical scientists at the University of Texas Medical Schools in Houston and Dallas, and the University of Texas-MD Anderson Cancer Institute in Houston. The Center's major focus is to elucidate the role of the gut in the pathogenesis of multisystem organ failure. Glutamine appears to be essential in restoring the early phase of the mucosal immune systems response to antigenic challenge after irradiation anergy. Prior feeding with a liquid complete essential amino acid diet also had a beneficial effect on subsequent exposure to the infectious parasite Trichinella spiralis when compared to prior feeding with a solid control diet.We will follow up the latest results of this project "Gut Trauma-Nutritional Preservation of Mucosal Immunity".

Why immune-enhancing formulas are so important for the critically-ill patients? During this financial crisis in Thailand , we should seriously consider the important facet of immune-enhancing formulas in terms of financial implication. Although they cost substantially more than conventional formulas, if they reduce the number of days in the ICU, length of hospital stay, use of antibiotics, etc, they may actually reduce the overall cost of the hospitalization. Although the data by Kudsk et al indicated a mean reduction in hospital charges by about $30,000 per patient, hospital charges are not actual hospital costs. Thus pharmacoeconomic models need to be developed to further evaluate this issue. Finally, how should these formulas be given in regard to timing after injury? Kudsk et al started feedings within 2 or 3 days after admission for most patients, and the therapy was continued for a mean of 10 days.It will be very interesting to judge this valuable review "Immune-enhancing formulas: Are they beneficial in critically ill patients? NCP 1997;12:51-62."

Those who want to update their clinical nutrition knowledge, check the abstracts of Journal of Parenteral and Enteral Nutrition, March-April 1998 issue and get only the interesting article from your library.(JPEN Abstracts: March-April 1998 issue)

What did you miss if you didn’t attend the 22nd Clinical Congress in Orlando? The debut of the Premier Sessions, reports on nutrition on the Internet, and a chance to meet Mickey Mouse. But don’t despair, your colleagues have filed the following reports which are updated nutrition topics from American Society of Parenteral and Enteral Nutrition. Jonathan E. Rhoads Lecture entitled, “Host Defense, Infection, and Nutrition: Yesterday, Today, and Tommorrow” is the most valuable lecture on nutrition and immunity.The use of both enteral and parenteral nutrition in similar groups has not shown convincing improvement. However, trauma patients were a different story. There is compelling data in this subset to show that early enteral nutrition and immune modulating formulas are beneficial.

Wish you will enjoy updated information. I will try to update this important issue whenever I can. The information era is not "NO INFORMATION, BUT TOO MUCH INFORMATION". I have selected only the most reliable sources for you. If you have different opinions, please do not hesitate to e-mail [shwewin@thai-otsuka.co.th].