Search PubMed⌕ Search

Biomedical subjects

M E Shils

Publications and source records attributed to M E Shils.

At least 19 recordsLinked to original sources

Deliberations and evaluations of the approaches, endpoints and paradigms for magnesium dietary recommendations.

The working group on magnesium considered a number of issues relevant to establishing allowances and to providing other pertinent information on this ion for the next edition of the Recommended Dietary Allowances (RDA). An accurate and specific marker for assessing the importance of magnesium nutriture in health and disease remains to be identified. Thus, it is unknown whether marginal magnesium depletion results in a disease. Although it is apparent that abnormal serum concentrations are unusual and obvious signs of acute depletion of magnesium are absent in the U.S. populace, one cannot assume that the associated cellular and intracellular pool sizes are optimal for health. There is a need for systematic studies of these and other parameters in healthy individuals with controlled intakes and during depletion. To address the question of how magnesium allowances should be set, previous editions of the RDA that included magnesium were reviewed; this review indicated the need for the adoption of objective criteria for acceptance of published balance studies and the inclusion in the discussion of an analysis of the balance studies and the specific calculations used in establishing the RDA. Such criteria and evaluations should be placed in a technical addendum to allow readers to evaluate the data. It is recommended that future RDA Committees consider expressing metabolic balance data on a basis other than weight, e.g., energy expenditure, lean body mass or body cell mass. Claims that magnesium nutriture has a role in preventing or ameliorating chronic disease such as heart disease and hypertension need to be critically evaluated if they are to be used to set the next RDA. The pharmacologic effects of magnesium are significant and need to be recognized. Because excess oral magnesium can be toxic to persons with advanced renal disease, more attention should be given to this topic by future RDA Committees.

Adolescent↗

National Dairy Council Award for Excellence in Medical and Dental Nutrition Education Lecture, 1994: nutrition education in medical schools--the prospect before us.

The criteria usually used for evaluating the state of nutrition education in our medical schools include the numbers of schools with required nutrition courses, attendance at nutrition electives, student satisfaction with their nutrition teaching, and the number of postgraduate clinical nutrition programs. These criteria indicate either no change or actual decreases over the years. More important, barriers persist that exclude essential nutrition education for all students in the clinical years. This pessimistic evaluation is tempered by events that, if properly addressed, may lead to improvement. Changes in the traditional medical curriculum are occurring in an increasing number of schools. More curriculum planning, execution, and oversight by interdepartmental faculty (problem-based and small-group learning); a greater emphasis on health promotion and disease prevention; and expansion of primary care offer the potential for more emphasis on nutrition education. This will not happen automatically but requires a vigorous effort by the Society and its members to become involved in the reform movement.

Awards and Prizes↗

Nutrition in the curriculum: medical experience.

Nutrition in the Curriculum--Medical experience, current practices, and educational status in U.S. medical schools are briefly reviewed. There continues to be a need for more adequate instruction of clinical nutrition to physicians in training and in practice. A major problem is the failure to provide patient oriented, case-related, nutrition teaching in the clinical years to all clinical clerks. Desirable changes are listed to help achieve better training in this field.

Clinical Clerkship↗

Bone disease in prolonged parenteral nutrition: osteopenia without mineralization defect.

A metabolic bone disease characterized by a mineralization defect, low plasma 1,25(OH)2D, and hypercalciuria has been described in patients receiving prolonged total parenteral nutrition (TPN). Because the practice of TPN differs from center to center, we investigated 13 home TPN patients to determine whether they had similar or different bone abnormalities. They had received TPN for a mean period of 51 +/- 38 mo. Bone pain occurred in six patients and two had multiple vertebral and rib fractures (with trauma in one patient). Bone pain was mild to moderate and not incapacitating. Bone histomorphometry showed reduced bone volume, reduced osteoid with normal resorption and calcification rates. These abnormalities were associated with hypercalciuria, but the plasma levels of 1,25(OH)2D were normal. Abnormalities in bone metabolism in this group of patients suggest a fundamental decrease in bone matrix-formation rather than a mineralization defect as the underlying mechanism.

Adult↗

Historical aspects of minerals and vitamins in parenteral nutrition.

Advances in knowledge of the requirements for vitamins and minerals have been essential in the success of total parenteral nutrition (TPN) for improving or maintaining good nutritional status for increasing periods of time. The availability of all known vitamins by the late 1940's and advances in vitamin technology resulted in stable single-vitamin or multivitamin solutions for i.v. use. Improved physician experience in vitamin usage and modified and more complete formulations are reflected in improved patient treatment. However, requirements for certain vitamins in hypermetabolic states and for prolonged use remain to be elucidated. TPN has also focused attention on the needs for macro- and microminerals. It has emphasized the importance of electrolytes, including inorganic phosphate, in human nutrition. Changes in the sources of amino acids from protein hydrolysates to crystalline amino acids have resulted in increasingly purified solutions essentially free of trace elements. This has focused attention on human requirements and the need for provision of increasing numbers of these ions.

Amino Acids↗

Nutrition and cancer.

Nutrition and cancer interact at several levels. Both dietary deficiencies and dietary excesses have been linked with changes in prevalence of certain human cancers. With respect to one particular nutrient, riboflavin, a dietary deficiency may decrease the development of spontaneous tumors in experimental animals but increase carcinogenesis due to certain agents. Cancer itself has profound effects upon nutritional status, and neoplastic tissue appears in general to resist dietary deficiency more effectively than normal tissues. Nutrition has a major role in therapy of cancer, but as an adjunct to the treatment plan rather than as an alternative. Parenteral nutrition, either peripheral or total, can provide support that is critically needed when patients cannot eat or swallow, have obstruction or malabsorption, or are otherwise unable to utilize dietary nutrients in adequate amounts. The advent of home parenteral nutrition now provides a means for long-term rehabilitation of cancer patients.

Animals↗

Laetrile.

Explore the source record for details and available documents.

Amygdalin↗

A prospective randomized clinical trial of total parenteral nutrition in children with cancer.

A prospective randomized clinical trial was undertaken to test the efficacy of total parenteral nutrition (TPN) among previously untreated children receiving abdominal/pelvic irradiation with or without adjuvant chemotherapy who were at risk for weight loss, malnutrition, and complications from treatment. Children were evaluated by weight/height determinations, anthropomorphic measurements, and laboratory studies. TPN was associated with an improved nutritional status during therapy as compared with control patients on ad libitum intake. However, when TPN was discontinued, weight declined and there were no differences among treated and control patients detected at three-month follow-up. Likewise there was no obvious effect from TPN on tolerance to therapy in the adequately nourished child. TPN as initial supportive therapy should be reserved for those children who are malnourished or marginally malnourished at the time of presentation. Close nutritional assessment during treatment is essential since approximately 25% of children undergoing abdominal/pelvic radiotherapy with chemotherapy can be expected to become malnourished during an initial course of therapy.

Adolescent↗

Comparison of morbidity in children requiring abdominal radiation and chemotherapy, with and without total parenteral nutrition.

We evaluated the effectiveness of total parenteral nutrition and placing the "bowel at rest," as compared to that of ad libitum food intake, on nutritional status and tolerance to combined chemotherapy and radiotherapy in a randomized, prospective trial in children with previously untreated malignancy requiring abdominal and pelvic irradiation and chemotherapy. Administration of TPN was found to be safe and efficacious in maintaining the children in good nutritional status during combined therapy; one-third of the control patients became malnourished and required TPN. There was no beneficial effect of "bowel at rest" and TPN on the ability of patients to tolerate combined therapies in terms of decreased toxicity; however, use of TPN was associated with improved adherence to chemotherapy schedules. Following termination of TPN or ad libitum food intake, and while receiving chemotherapy, the majority of the children who had previously received TPN lost significant weight. To date there has been no difference in mortality rate between the control and TPN groups. Although we conclude that TPN per se had little beneficial effect beyond that of maintaining good nutritional status, every child undergoing intensive combined therapy should have early and periodic assessments of nutritional status, so that the early signs of malnutrition can be detected, and the adverse effects of malnutrition can be prevented by nutritional replenishment, by TPN, or by other methods.

Abdominal Neoplasms↗