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Biomedical subjects

Dan L Waitzberg

Publications and source records attributed to Dan L Waitzberg.

18 recordsLinked to original sources
PubMed2006

Postsurgical infections are reduced with specialized nutrition support.

OBJECTIVE: The objective was to examine the relationship between pre-, peri-, and postoperative specialized nutritional support with immune-modulating nutrients and postoperative morbidity in patients undergoing elective surgery. METHODS: Studies were identified by searching MEDLINE, review article bibliographies, and abstracts and proceedings of scientific meetings. All randomized clinical trials in which patients were supplemented by the IMPACT formula before and/or after elective surgery and the clinical outcomes reported were included in the meta-analysis. Seventeen studies (n=2,305), 14 published (n=2,102), and 3 unpublished (n=203), fulfilled the inclusion criteria. Ten studies (n=1,392) examined the efficacy of pre- or perioperative IMPACT supplementation in patients undergoing elective surgery, whereas 7 (n=913) assessed postoperative efficacy. Fourteen of the studies (n=2,083) involved gastrointestinal (GI) surgical patients. Postoperative complications, mortality, and length of stay in hospital (LOS) were major outcomes of interest. RESULTS: IMPACT supplementation, in general, was associated with significant (39%-61%) reductions in postoperative infectious complications and a significant decrease in LOS in hospital by an average of 2 days. The greatest improvement in postoperative outcomes was observed in patients receiving specialized nutrition support as part of their preoperative treatment. In GI surgical patients, anastomotic leaks were 46% less prevalent when IMPACT supplementation was part of the preoperative treatment. CONCLUSION: This study identifies a dosage (0.5-1 l/day) and duration (supplementation for 5-7 days before surgery) of IMPACT that contributes to improved outcomes of morbidity in elective surgery patients, particularly those undergoing GI surgical procedures. The cost effectiveness of such practice is supported by recent health economic analysis. Findings suggest preoperative IMPACT use for the prophylaxis of postoperative complications in elective surgical patients.

Adjuvants, Immunologic↗
PubMed2005

Immunohistochemical assessment of mucosal cytokine profile in acetic acid experimental colitis.

UNLABELLED: Experimental colitis induced by acetic acid has been used extensively as a model for intestinal inflammatory disease. Colonic tissue lesions of intestinal inflammatory disease patients seem to be related to the increased local production of pro-inflammatory cytokines (IL-1, IL-6, TNF-alpha, and IFN-gamma). PURPOSE: To assess the cytokine expression pattern identified through immunohistochemistry in colonic mucosa after experimental colitis induced by acetic acid and establish the relationship between this pattern and the presence of macroscopic lesions. MATERIALS AND METHODS: Adult male Wistar rats (n = 39) were divided at random into 4 groups: NC45 and NC24 (control without colitis; sacrificed at 45 minutes and 24 hours, respectively); and WC45 and WC24 (with experimental colitis induced by acetic acid; sacrificed at 45 minutes and 24 hours, respectively). Macroscopic and microscopic alterations in colonic tissue were evaluated, and cytokine expression was assessed through immunohistochemistry. RESULTS: After 24 hours, IL-1 expression was greater in the groups with colitis when compared to the groups without colitis. IL-4 expression was higher in the WC45 group. There was an increase in both INF-gamma and IL-6 related to the presence of necrosis of the colonic mucosa in the groups with colitis for both periods evaluated. CONCLUSION: The immunohistochemical technique was efficient for the analysis of various cytokine expressions in the colonic tissue. There was an increase in the IL-1 pro-inflammatory cytokines as well as in IL-6 and IFN-gamma associated with the presence of colonic necrosis. Experimental colitis induced by acetic acid is a useful model for the development of studies assessing the role of cytokines in the inflammation of mucosa as well as anti-cytokine therapies.

Acetic Acid↗
PubMed2005

Basal energy expenditure and diet- induced modifications to thermogenesis in short bowel syndrome.

BACKGROUND & AIM: The influence of food intake on diet-induced thermogenesis, in the absence of parenteral nutrition, has not been assessed in short bowel syndrome (SBS) patients. We studied basal energy expenditure (BEE) and diet-induced thermogenesis in SBS patients (n=8) and paired healthy adult volunteer controls (n=8). METHODS: Energy expenditure was measured by indirect calorimetry (IC) before and after control diet intake. All study participants received oral control diet randomly given in 3 doses (A=1.0, B=1.5 and C=2.0)x1/6 of BEE calories. Bioelectric impedance was assessed. Pairing criteria for controls were: age, sex, body mass index. RESULTS: No significant differences were found between SBS and paired healthy control groups in relation to absolute BEE (P=0.146) and when it was adjusted for body mass index, lean and fat body mass (P=0.861, 0.208 and 0.574, respectively). All diets promoted thermogenesis in both groups. The interaction between the control diet (A, B and C) and SBS and healthy control groups for diet induced thermogenesis presented a significant difference (P=0.026). When comparing groups (SBS vs healthy controls) in relation to the control diet (B and C) we observed: P=0.030 and 0.004, respectively. CONCLUSION: In patients with SBS it was observed that: (1) BEE measured by IC in absolute values or adjusted by lean body mass is similar to healthy control group; (2) Diet-induced thermogenesis was lower than the healthy control group for higher caloric diets (B and C).

Adult↗
PubMed2005

A new swivel model for parenteral and enteral infusion in rats.

BACKGROUND: In experimentation with rats submitted to enteral and parenteral infusions for medium to long periods it is necessary to use swivels. With the objective of developing a new biocompatible, safe, efficient, and low cost swivel, the medical and engineering teams of the University of São Paulo joined forces. MATERIAL AND METHODS: After defining the characteristics and criteria for the mechanical design, the new swivel was developed and bench tested for flow, rotation and sealing. Later it was evaluated on rats, after catheterization of jugular vein and stomach (by gastrostomy) for infusion of different solutions at certain concentrations and infusion rates (mean 6.73 days of infusion). RESULTS: The new swivel consisted of two sections of common plastic syringes for injection, together with the rubber seals, a plunger, and a hypodermic needle. The syringe with a slightly smaller diameter rotates inside the larger diameter syringe interconnected with a needle sealed by their respective rubber rings. The bench and animal tests did not reveal any functional defects. There were no blockages or leaks in the swivel and it was reused three times without losing its mechanical properties, after being hygienized and sterilized with ethylene oxide. The cost of producing this swivel is estimated to be no more than $3 US. CONCLUSION: The cooperation between the departments of medical research and mechanical engineering enabled the development of a swivel that is simple and inexpensive to make, yet fully meets the needs of parenteral and enteral infusion in rats. The authors present detailed instructions for the construction of this new swivel.

Animals↗
PubMed2005

Limitations and validation of bioelectrical impedance analysis in morbidly obese patients.

PURPOSE OF REVIEW: Several factors limit the use of bioelectrical impedance analysis as a valid predictor of the amount of body fat in morbidly obese individuals. The purpose of this review is to examine the theory and assumptions that may limit the use of bioelectrical impedance analysis in such individuals. RECENT FINDINGS: There is currently insufficient validation of bioelectrical impedance analysis equations in obese individuals with body mass indices greater than 34 kg/m. Several factors limit the application of bioelectrical impedance analysis in morbidly obese individuals. Obese individuals have a relatively high amount of extracellular water and total body water, which may overestimate fat-free mass and underestimate fat mass. Central body fat will generally overestimate the percentage of fat-free mass and underestimate the percentage of fat mass in overweight and obese adults with the use of prediction formulas developed in normal weight individuals. SUMMARY: A relatively increased amount of total body water and a relative increase in extracellular water will result in an underestimation of the percentage of body fat and an overestimation of fat-free mass in the morbid obesity state. A different body build disposition (mainly in those with severe abdominal obesity) will result in an overestimation of the percentage of body fat. New equations are needed to validate bioelectrical impedance analysis in morbidly obese patients.

Body Composition↗
PubMed2004

Fasting breath hydrogen concentration in short bowel syndrome patients with colon incontinuity before and after antibiotic therapy.

OBJECTIVE: Nutrition success in short bowel syndrome (SBS) depends on the intake nutrients and the intestinal absorption capacity. An evaluation of energy expenditure and oxidation of substrate can be obtained with indirect calorimetry by measuring O(2) and CO(2) in the respiration. Elevated colonic fermentation can occur in SBS, producing H(2) and CO(2), which can also be eliminated through respiration and as a consequence affect the results from indirect calorimetry. The objective of this study was to determine the fasting breath H(2) concentration and alterations before and after antibiotic therapy in patients with severe SBS with colon in continuity. METHODS: The study was conducted in two phases. In phase 1, the fasting breath H(2) concentrations were measured in 10 patients with severe SBS with colon incontinuity and a control group of 10 healthy volunteers. In phase 2, the fasting breath H(2) concentrations were re-evaluated after treatment for 7 d with antibiotics in six patients with high rates of H(2). The analyses were performed with a gas chromatograph (microanalyzer DP; Quintron Instruments, Milwaukee, WI, USA), with results of breath hydrogen and methane concentration expressed in parts per million (ppm). RESULTS: In phase 1, the levels of fasting breath H(2) were higher in the patients with severe SBS with colon incontinuity than in the healthy controls (32.00 +/- 17.77 versus 5.30 +/- 3.31 ppm; P < 0.001), with 7 of 10 patients presenting levels of H(2) above the normal rate (12 ppm). The presence of an ileocecal valve did not modify the results significantly. In phase 2, all six patients treated with antibiotics presented normalization in the levels of fasting breath H(2) (from 43.50 +/- 6.90 ppm to 1.33 +/- 1.03 ppm; P < 0.001) and concomitant improvement in the gastrointestinal symptoms. CONCLUSIONS: In relation to the healthy controls, patients with SBS with colon incontinuity presented higher levels of fasting breath H(2). Antibiotic therapy normalized the levels of fasting breath H(2) and improved the gastrointestinal symptoms. We suggest that the breath H(2) test may be performed routinely in patients with SBS to diagnose elevated intestinal fermentation, prevent errors in the interpretation of the indirect calorimetry, and treat eventual associated gastrointestinal symptoms.

Adult↗
PubMed2004

Costs of patients under nutritional therapy: from prescription to discharge.

PURPOSE OF REVIEW: This review will discuss the financial cost of the decisions taken regarding the nutritional therapy of hospitalized patients compared with those treated at home. To facilitate comprehension, the authors present a concise introduction to the general concepts of economic health studies, including a glossary of technical terms. RECENT FINDINGS: From a revision of the literature, economic aspects are underscored involving the cost of malnutrition, the maintenance of work in a nutritional support team, the use of nutritional therapy in home-care programmes, and in the use of nutritional therapy as a prophylactic action against surgical complications. SUMMARY: Hospital malnutrition burdens the system financially by provoking a higher rate of surgical complications, mortality and longer hospital stays. Investment in nutritional therapy provides economic returns. The cost of the creation and maintenance of the nutritional support team is easily offset by the resources generated by the team itself. Nutritional therapy in home-care is highly advantageous. In Brazilian trials, groups of surgical patients receiving nutritional therapy within the integrated hospital-home model demonstrated a cost 2.6 times less than the conventional group (exclusively intra-hospital treatment). The adoption of preoperative immunomodulatory nutritional therapy in patients undergoing elective surgery as a prophylactic against postoperative surgical complications presented a 2.24 times reduction in the total treatment cost. The search for the ideal model of nutritional therapy is based on the binomial of quality and cost. The prescription of nutritional therapy has a favourable impact on financial and resource-generating aspects of the institution, when practised by properly trained groups.

Cost-Benefit Analysis↗
PubMed2003

[Immunonutrition in experimental colitis: beneficial effects of omega-3 fatty acids].

BACKGROUND: Recent data have given emphasis to the benefits of immunonutrition with omega-3 fatty acids (n-3 FA) in various clinical situations. This work presents the results of parenteral administration of different lipid emulsions in experimental acute colitis and reviews the pertinent literature. METHODS: Seventy-four adult male Wistar rats were randomized in six groups that had 10% acetic acid-induced colitis (except CS). During 7 days, control groups CS (without colitis) and CC (with colitis) received physiological solution and the others received specific lipid emulsion by a central venous catheter (0.5 mL/h). The n-3/n-6 FA ratio and lipidic compositions were: group L--1:7.7 (LCT, n = 12), M--1:7.0 (MCT and LCT, n = 12), LW-3--1:4.5 (LCT plus FO, n = 12) and MW-3--1:3.0 (MCT and LCT plus FO, n = 13). Rats were evaluated to assess abdominal and intestinal alterations, macrophage cellularity and colonic concentrations of LTB4, LTC4, PGE2 and TXB2. RESULTS: N-3 FA treated rats (LW-3 and MW-3) presented less inflammatory abdominal alterations than CC rats. Mucosal ulcer formation in MW-3 group was the only comparable to CS group. Only CS, M and MW-3 rats presented smaller cellularity than CC group. Comparing to CC group, there were found smaller averages of LTB4 in CS, LW-3 and MW-3 groups, of PGE2 in CS, M and MW-3 groups, and of TXB2 in CS and MW-3 groups. LTC4 averages were not different. CONCLUSIONS: 1) LCT-containing lipid emulsion with low n-3/n-6 ratio do not modify inflammatory colitis derived manifestations; 2) the association of MCT/LCT-containing lipid emulsion with fish oil with high n-3/n-6 ratio impels great beneficial impact, attenuating morphological and inflammatory consequences and decreasing colonic concentrations of proinflammatory mediators.

Animals↗
PubMed2003

The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis.

Malnutrition has been identified as affecting patient outcome. The purpose of this study was to correlate the nutritional status of hospitalized patients with their morbidity, mortality, length of hospital stay and costs. The patients were nutritionally assessed within the first 72 h of hospital admission. The patients' charts were surveyed on the incidence of complications and mortality. Hospital costs were calculated based on economic tables used by insurance companies. Multivariate logistic regression analysis and the Cox regression model were used to identify possible confounding factors. A P<0.05 was considered statistically significant. The mean age was 50.6+/-17.3 years with 50.2% being male. The incidence of complications in the malnourished was 27.0% [Relative risk (RR)=1.60]. Mortality in the malnourished patients was 12.4% vs 4.7% in the well nourished (RR = 2.63). Malnourished patients stayed in the hospital for 16.7+/-24.5 days vs 10.1+/-11.7 days in the nourished. Hospital costs in malnourished patients were increased up to 308.9%. It was concluded that malnutrition, as analyzed by a multivariate logistic regression model, is an independent risk factor impacting on higher complications and increased mortality, length of hospital stay and costs.

Analysis of Variance↗
PubMed2003

Can bioelectrical impedance analysis identify malnutrition in preoperative nutrition assessment?

OBJECTIVE: Malnutrition is characterized by changes in cellular membrane integrity and alterations in fluid balance, both of which can be detected by bioelectrical impedance analysis (BIA). We investigated whether BIA-measured variables could detect malnutrition, as defined by the Subjective Global Assessment (SGA), in preoperative surgical patients. METHODS: We prospectively evaluated 279 patients hospitalized for elective gastrointestinal surgery during the first 72 h after admission. BIA estimates were used to derive body cell mass, ratio of extracellular mass to body cell mass, and phase angle. Malnutrition diagnosed with these measures was compared with the SGA score. Receiver operating characteristic curves also were formulated to explore alternative cutoff points for one measure, phase angle. RESULTS: A linear trend for means across SGA categories was found for all indicators used, except percentage of body cell mass. However, there was only fair overall agreement between SGA and BIA estimates. The receiver operating characteristic curves for phase angle suggested that the test was too sensitive or too specific. No alternative cutoff points resulted in suitable tests that could provide an alternative to SGA. CONCLUSIONS: Although not in close agreement with SGA, the results suggested that there are some alterations in tissue electrical properties with malnutrition that can be detected by BIA. New cutoff points may be needed for application of BIA as a complementary method in the nutrition assessment of surgical patients.

Adolescent↗
PubMed2003

Nutritional assessment in the hospitalized patient.

PURPOSE OF REVIEW: Malnutrition is highly prevalent in hospitalized patients. Despite this, it is not routinely assessed in most hospitals worldwide. One of the reasons that might explain this fact is that there is no gold-standard nutritional assessment tool, and much has been written advocating this or that technique. The main topic of this review is discussion of the advantages and disadvantages of each of the available tools. RECENT FINDINGS: Several studies have recently reinforced the relationship between poor nutritional status and higher incidences of complications, mortality, length of hospital stay and costs. Therefore, it is of the utmost importance to be able to diagnose malnutrition early. SUMMARY: The evaluation of nutritional status is a broad topic that encompasses several clinical variables. In order to be ideal, the method should be able to predict patient outcome, should be able to be performed by most care-givers, should be inexpensive, and should not be time-consuming. Unfortunately, most nutritional assessment instruments were published with insufficient details regarding their intended use and method of derivation, and with an inadequate assessment of their effectiveness. Therefore, health professionals should be critical when defining which instrument should be adopted by an institution, and several factors should be taken into consideration.

Anthropometry↗
PubMedDate not supplied

Nutrition support in Brazil: past, present, and future perspectives.

The history of nutrition support in Brazil is parallel to its development in the world. Inspired by the publications of the surgical group headed by Professor Rhoads at the University of Pennsylvania, a group of Brazilian physicians pioneered the beginning of parenteral nutrition (PN) therapy. The Brazilian Society of Parenteral and Enteral Nutrition (SBNPE) was officially founded in 1975. Soon, scientific contributions started to appear, reflected by articles in the Journal of Parenteral and Enteral Nutrition and other journals and by books. In many states of Brazil, nutrition support services were created to carry out scientific and educational activities. The relationship with the American Society of Parenteral and Enteral Nutrition was fundamental in the development of clinical nutrition in Brazil because of the strong scientific exchange between the United States and Brazil. However, after the stimulating initial launching, momentum slowed because of the lack of medical awareness and inadequate reimbursement. In Brazil, the federal government is responsible for the majority of health care, but enteral nutrition was not reimbursed. In response to this situation, a study in 4000 hospitalized patients was undertaken in Brazil. It was reported that nearly half of them presented with malnutrition, and > 12% had severe malnutrition. These alarming results were decisive in persuading the Brazilian government to begin reimbursement for enteral nutrition. Today, Brazilian hospitals that assist public health system patients receive reimbursement for enteral nutrition. However, it is required to have an officially registered nutrition support team and a certified and approved facility for enteral feeding preparation. Considering that low nutrition prescription in Brazil could be the result of lack of nutrition education (not required in most medical schools), the SBNPE participated in the creation of 2 very effective, practical, and dynamic courses for the basic teaching of clinical nutrition. These courses were created by the Latin American Federation of Parenteral and Enteral Nutrition: the TNT (Total Nutrition Therapy) Course and the CINC Course (Interdisciplinary Course in Clinical Nutrition). These 2 courses are available to members of all Latin American countries and are regularly offered by the SBNPE to its members all over Brazil. Altogether, > 4000 physicians, dietitians, nurses, and pharmacists have been introduced to the basic principles and practice of clinical nutrition. It is clear that the outstanding ideas of Professors Rhoads, Dudrick, and Wilmore and other collaborators from this group in the field of clinical nutrition have grown and flourished in Brazil.

Brazil↗
PubMedDate not supplied

New parenteral lipid emulsions for clinical use.

Routine use of parenteral lipid emulsions (LE) in clinical practice began in 1961, with the development of soybean oil (SO) - based LE. Although clinically safe, experimental reports indicated that SO-based LE could exert a negative influence on immunological functions. Those findings were related to its absolute and relative excess of omega-6 polyunsaturated fatty acids (PUFA) and the low amount of omega-3 PUFA and also to its high PUFA content with an increased peroxidation risk. This motivated the development of new LE basically designed along the reduction of omega-6 PUFA and the omega-3 PUFA addition in order to obtain balanced levels of the omega-6/omega-3 ratio. The new LE for clinical use (available in Europe and South America) are differentiated by their content in polyunsaturated (omega-6 and omega-3), monounsaturated, and saturated fatty acids (FA), as well as FA source of their origin, including soy, coconut, olive, and fish oil. This article presents the new LE nutrition and energy functions but also its biochemical, metabolic, and immunomodulating aspects, according to their FA content. LE at 20% when infused from 1.0 to 2.0 g/kg body weight/day rates, either alone or in association with amino acids and glucose, are safe and well tolerated in routine clinical practice. LE combining SO with medium-chain triglycerides and/or olive oil have less omega-6 PUFA and are better metabolized, with less inflammatory and immunosuppressive effects than in relation to pure SO-based LE. The omega-3 PUFA used alone or as component of a new and complex LE (soy, MCT, olive and fish oil) has demonstrated anti-inflammatory and immunomodulatory effects.

Fat Emulsions, Intravenous↗
PubMedDate not supplied

Study of morbidity in orthotopic small intestine transplantation with Wistar rats. Experimental study.

BACKGROUND: Transplantation of the small intestine is a surgical procedure currently under investigation for its possible application in the treatment of patients with short bowel syndrome, aiming at the reintroduction of an oral diet. AIM: To define the morbidity and mortality of intestinal transplantation in small animals using microsurgery. Intra and postoperative morbidity and mortality were studied in Wistar rats submitted to orthotopic intestinal allotransplantation. MATERIAL AND METHOD: The animals were divided into three groups: group A (37 donor animals), group B (37 recipient animals), and group C (10 control animals). Group B was divided into three subgroups according to survival time. Subgroup TI consisted of animals that died during surgery or due to causes directly related to surgical intervention, subgroup T2 consisted of animals that died between the 4th and 29th postoperative day, and subgroup T3 consisted of animals that survived after 30 days. Transplanted animals were evaluated in terms of surgical technique used (vascular and intestinal anastomosis), graft quality, surgical time, and clinical parameters. The animals that died by the 29th postoperative day were submitted to autopsy and the remaining ones were sacrificed after 30 days. RESULT: There was a high rate of complication of a surgical nature. Early mortality rate, i.e., mortality up to the third postoperative day, was 54% with vascular anastomosis being the major cause of death. Surgical time was evaluated in a restricted and homogeneous group and showed a strong prognostic value in terms of successful transplantation. Clinical parameters such as weight loss, reduction of ingestion, reduction of motor activity and diarrhea were directly correlated with acute rejection. CONCLUSION: The experimented intestinal transplant is a procedure companied by considerable morbidity and mortality due to surgical complications in postoperative period, vascular anastomosis and total surgical time.

Animals↗
PubMedDate not supplied

Inflammatory bowel diseases: principles of nutritional therapy.

Inflammatory Bowel Diseases - ulcerative colitis and Crohn's disease- are chronic gastrointestinal inflammatory diseases of unknown etiology. Decreased oral intake, malabsorption, accelerated nutrient losses, increased requirements, and drug-nutrient interactions cause nutritional and functional deficiencies that require proper correction by nutritional therapy. The goals of the different forms of nutritional therapy are to correct nutritional disturbances and to modulate inflammatory response, thus influencing disease activity. Total parenteral nutrition has been used to correct and to prevent nutritional disturbances and to promote bowel rest during active disease, mainly in cases of digestive fistulae with high output. Its use should be reserved for patients who cannot tolerate enteral nutrition. Enteral nutrition is effective in inducing clinical remission in adults and promoting growth in children. Due to its low complication rate and lower costs, enteral nutrition should be preferred over total parenteral nutrition whenever possible. Both present equal effectiveness in primary therapy for remission of active Crohn's disease. Nutritional intervention may improve outcome in certain individuals; however, because of the costs and complications of such therapy, careful selection is warranted, especially in patients presumed to need total parenteral nutrition. Recent research has focused on the use of nutrients as primary treatment agents. Immunonutrition is an important therapeutic alternative in the management of inflammatory bowel diseases, modulating the inflammation and changing the eicosanoid synthesis profile. However, beneficial reported effects have yet to be translated into the clinical practice. The real efficacy of these and other nutrients (glutamine, short-chain fatty acids, antioxidants) still need further evaluation through prospective and randomized trials.

Colitis, Ulcerative↗
PubMedDate not supplied

Total nutritional therapy: a nutrition education program for physicians.

OBJECTIVE: Almost half of all hospitalized patients are malnourished with low physician awareness or implementation of nutrition support. To address this problem, a 2-day immersion course in clinical nutrition for physicians was developed by the Latin American Federation of Parenteral and Enteral Nutrition (FELANPE) with support from Abbott Laboratories. The goal of Total Nutritional Therapy (TNT) is to help physicians utilize this nutrition knowledge to increase their awareness of malnutrition and implementation of nutritional therapy. Since 1997, over 8,000 physicians have completed the TNT course in 16 Latin American countries. RESEARCH METHODS & PROCEDURES: During 1999 and 2000, 675 participants responded to a survey 6 months after having completed the TNT course to determine what impact the course had on the use of nutrition assessment, nutrition support teams, or nutrition consultations in their clinical practice, and if they had participated in any nutrition association or conferences. RESULTS: The majority of physicians who completed the survey increased their use of nutrition assessment and time dedicated to nutrition therapy, and increased the number of their patients placed on nutrition therapy. CONCLUSIONS: The TNT course has been shown to be an efficient model of clinical nutrition education for general physicians. The course should be considered as part of the training of medical residents.

Education, Medical, Graduate↗