It is a great honor to present the 2015 Rhoads Lecture and to discuss strategies for high-quality nutrition therapy (NT), as well as to address the problem of malnutrition in Brazilian hospitals.Dr Rhoads is known for his outstanding achievements in nutrition care, and his unquestionable legacy is demonstrated by the translation of his many scientific papers and books into several languages. The importance of artificial nutrition in the overall care of a patient is reflected in Dr Rhoads's own words: "intravenous feeding is one of the rare things in Medicine that has turned out to be better than its sponsors anticipated." Moreover, when Dr Rhoads was awarded for his contributions and leadership in the field of nutrition, in his speech, he referred to a quote by Nobel laureate economist Milton Friedman: "success lies on the degree to which one's ideas and contributions become embedded in the body of knowledge that comprised one's discipline."1 Indeed, we are here to confirm the veracity of this statement regarding Dr Rhoads's scientific contributions.Accumulating evidence supports the utmost relevancy of artificial nutrition, including oral nutrition, enteral nutrition (EN), and parenteral nutrition (PN), as one of the cornerstones of patient care. Nonetheless, for the full success of NT to be achieved, it is imperative that standardized procedures be followed to prevent life-threatening associated complications and, above all, to avoid the "one-size-fits-all" practice of nutrition, which should be condemned by those following the evidence behind science.
History of NT in BrazilHere, the steps that have helped Brazil implement an NT practice are presented and discussed. The statements herein are based on the experience and data of the authors, although we also acknowledge and cite the work of other professionals who have contributed to the development of NT practice in Brazil. In combination, these scientific data highlight the importance of applying advances in laboratory research to the clinical setting to improve patient care. First, we review the history of clinical nutrition in Brazil, with a particular emphasis on the role of nutrition screening and nutrition assessment as demonstrated by a malnutrition prevalence study that encompassed 4000 patients.2 Next follows a discussion of to whom, when, and what NT should be administered, particularly regarding immunonutrition and parenteral lipid emulsions. Finally, strategies that have been used to implement hospital clinical nutrition are presented, with a focus on patients with short bowel syndrome (SBS) and obesity. The outcomes, costs, quality control, and education in clinical practice that are currently involved with these strategies are also presented, as well as how these strategies have the potential to affect perspectives.Very briefly, Brazil is a country that has approximately 200 million inhabitants, 10% of whom are elderly. Life expectancy
AbstractStrategies for improving nutrition therapy (NT) are of utmost importance in any healthcare system. The ...