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References and recommended reading

  1. Gottschlich MM (ed). The Science and Practice of Nutrition Support. Dubuque, IA: Kendall/Hunt Publishing, 2001
  2. Merritt RJ (ed). The A.S.P.E.N. Nutrition Support Practice Manual. Silver Spring, MD: ASPEN, 1998.
  3. Page CP, Hardin TC, Melnik G. Nutritional Assessment and Support, 2nd ed. Baltimore: Williams & Wilkins, 1994.
  4. Russell RM. Nutritional assessment. In: Wyngaarden JB, Smith LH Jr, Bennett JC, eds. Cecil Textbook of Medicine. Philadelphia: WB Saunders, 1992: 1151Ė1155.
  5. ASPEN Board of Directors. Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients. 1993.
  6. Rombeau John L, Rolandeli RH (eds). Clinical Nutrition: Parenteral nutrition, 3rd edition. Philadelphia: W.B. Saunders Co., 2001.
  7. Rombeau John L, Rolandeli RH (eds). Clinical Nutrition: Enteral and Tube Feeding, 3rd edition. Philadelphia: W.B. Saunders Co., 1997.
  8. Fischer JE. Total Parenteral Nutrition. 2nd ed. Boston: Little Brown, 1991.
  9. National Advisory Group. Safe practices for parenteral nutrition formulations. J Parenter Enteral Nutr 1998;22:49-66.
  10. Driscoll DF, Blackburn GL. Total parenteral nutrition 1990: A review of its current status in hospitalized patients, and the need for patient-specific feeding. Drugs 1990; 40:346-363.
  11. American Gastroenterological Association. Position Statement: Guidelines for the Use of Enteral Nutrition., 1994.

Links to ACPE accredited CE programs for nutrition support

Nutritional screening forms

From the Association of Community Cancer Centers. Please download all three documents.

Other nutrition support web sites


is a complex, high-molecular weight protein produced by the liver. It has a normal serum concentration of 3.5 to 5.5 g/dL and a serum half-life of 18 to 20 days. The measurement of serum albumin level is used as an indicator of nutritional status because it can reflect the presence or absence of a stress response.
is the use of body measurements for estimating subcutaneous fat and skeletal muscle stores as well as overall body composition.
Basal energy expenditure (BEE)
is the total energy expenditure in the resting state exclusive of eating and activity. It is estimated separately in male and female subjects with the Harris-Benedict equations.
Calorie-to-nitrogen ratio (C/N ratio)
describes the relationship between protein and calories. A normal C/N ratio is 150 to 250, but the optimal range is much narrower during nutrition support of the patient with acute metabolic stress.
Creatinine-height index (CHI)
is a ratio of a patientís 24-hour creatinine excretion and the expected normal creatinine excretion. CHI correlates with the degree of muscle depletion. Lean body mass may be evaluated with the CHI. CHI is calculated with the following formula: [(measured urinary creatinine x 100) / Ideal urinary creatinine fora given height].
Cyclical parenteral nutrition
is the administration of parenteral nutrients only at night. Home parenteral nutrition is generally administered this way.
Enteral nutrition
is nutrition provided by long-term (gastrostomy or jejunostomy) or short-term (nasogastric, nasoduodenal, or nasojejunal) tube feedings.
Harris-Benedict equation
is used to estimate and calculate basal energy expenditure (BEE). The Harris-Benedict equation for male subjects is: BEE (males) = 66.47 + 13.75(weight in kilograms) + 5.00(height in centimeters) - 6.76(age in years). The equation for female subjects is: BEE(females) = 655.10 + 9.60(weight in kilograms) + 1.85(height in centimeters) - 4.68(age in years).
Home parenteral nutrition (HPN)
is indicated for demonstrated small bowel failure and other diseases where hospitalization is not needed and there is potential for improving the patientís quality of life. Adequate care must exist in the home environment for HPN to be successful.
is another term for protein malnutrition.
is a significant loss of lean tissue or inadequate diet for a prolonged period in the setting of severe stress. It is a significant component of many diseases.
is another term for protein-calorie malnutrition.
Mid-arm muscle circumference (MAMC)
is an anthropometric value derived from the measurement of mid-arm circumference (MAC) and the triceps skinfold thickness (TSF). MAMC = MAC - 3.14(TSF).
Peripheral parenteral nutrition (PPN)
is an adjunctive nutritional intervention when central venous alimentation is not possible or necessary. PPN therapy is administered by the small superficial veins of the extremities where blood flow is a fraction of that which streams through the large central veins of the body, where TPN is usually provided.
Protein-calorie malnutrition
(also marasmus) is a type of malnutrition classically considered to be caused by dietary deficiency of protein and calories that develops over months and occasionally years. It is characterized by weight loss, reduced basal metabolism, depletion of subcutaneous fat and tissue turgor, bradycardia, and hypothermia. This type of malnutrition usually results from a mild injury response caused by chronic disease that produces anorexia or semistarvation, with loss of lean tissue.
Protein malnutrition
(also Kwashiorkor) is a type of malnutrition classically considered to be caused by dietary deficiency (particularly of protein) that develops over several weeks or months. It is characterized by hypoalbuminemia, anemia, edema, muscle atrophy, delayed wound healing, and impaired immunocompetence. In acute care hospitals in the developed world, a syndrome with important similarities (including rapid development of hypoalbuminemia, impaired immunocompetence, and delayed and ineffective wound healing) follows the stress response. It can be persistent and severe if feeding is not commenced within 7 to 10 days.
Refeeding syndrome
refers to the observation that patients with a loss greater than 30% of their usual weight may suffer cardiopulmonary failure with aggressive TPN therapy. This is thought to result from glucose-induced hypophosphatemia leading to cardiomyopathy; impaired cardiac performance due to cardiac malnutrition; and fluid retention producing volume overload when TPN is instituted. Severely malnourished patients should be given fat as 20%-30% of the daily caloric requirement initially, then reducing to 10% when the final infusion rate is reached.
Total parenteral nutrition (TPN)
is a means by which protein, energy, nutrient and metabolic requirements can be delivered by direct venous infusion for those patients who are unable to tolerate, absorb or accumulate sufficient nutrients by the usual enteral route.
Total energy expenditure (TEE)
is a measure of basal energy expenditure plus excess metabolic demands as a result of stress, the thermal effects of feeding, and energy expenditure for activity. TEE = BEE x activity factor x stress factor.
Triceps skinfold thickness (TSF)
is an anthropometric measurement made midway between the shoulder and elbow with skinfold calipers.

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