Public release date: 20-Sep-2010
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Contact: Ye-Ru Wang
wjg@wjgnet.com
86-105-908-0039
World Journal of Gastroenterology
New options for enteral nutrition in patients with severe acute pancreatitis
Severe acute pancreatitis (SAP) requires an adequate nutritional support. Enteral nutrition (EN) should be preferred to total parenteral nutrition in patients with SAP, as it is associated with reduced mortality and complications. However, in clinical practice EN is employed far less frequently than it should. The main obstacle to EN diffusion is that it is considered complicated, as to ensure full pancreatic rest, nutrition tubes should be placed in the jejunum, requiring often troublesome procedures. In the past few years, it has been proposed that EN through nasogastric (NG) tubes may be a simple, safe and equally valid alternative to nasojejunal tubes.
A research article published on August 7, 2010 in the World Journal of Gastroenterology addresses this question. The authors speculated that a pragmatic possibility in real-world clinical practice would be to employ NG feeding whenever tube migration to the jejunum of bedside inserted feeding tubes does not occur spontaneously. They therefore aimed at assessing the rate of spontaneous distal migration of EN tubes in patients with predicted SAP, to identify possible factors associated with it, and to compare the safety and tolerability of EN with an elemental formula in patients who started nutrition with a "proximal", NG or a "distal", naso-intestinal tube, depending on the success of spontaneous tube migration.
This is the first study of its kind observing the outcome of EN in SAP patients in a "real world" clinical setting, with the study protocol driven by the need to have more solid grounds in making clinical decisions about everyday medical care circumstances. Both the proximal and the distal enteral approaches resulted to be feasible, safe and effective in most patients. This issue has a relevant impact on everyday clinical practice as the main limit to EN usage in AP is the technical difficulty in obtaining small bowel access.
First Lady Michelle Obama is reportedly wrestling with at least 100 House Democrats who would rather not pass a re-authorization of the nation's school meals program if it means taking money from food stamp recipients.
The Senate approved the Healthy, Hunger-Free Kids Act, which would increase spending on child nutrition programs by $4.5 billion -- including a 6-cent-per-meal boost to the rate the federal government reimburses school lunch -- but said the only way to fund it without adding to the deficit was to remove $2.2 billion from the food stamp (now known as SNAP) program. Re-authorization of the Child Nutrition Act must now be approved by the House before authorization for the legislation currently in place expires.
The Senate's funding method is a bit like picking the pocket of one panhandler to put it in the hand of another. Yet the mainstream media has hailed these measly 6 cents as the first increase in the subsidized lunch reimbursement rate in three decades -- a false notion.
Apparently, no one in the press has actually bothered to read the rules governing the school meals program. If they had, they'd know that the disputed 6 cents are barely more than what the National School Lunch Program receives automatically each year by way of cost of living increases. This year, in fact, the reimbursement rate has already gone up 4 cents -- from $2.68 per lunch to $2.72 -- thanks to an adjustment in the Consumer Price Index.
Granted, school kitchens are broke and have been for a long time. According to the School Nutrition Association, schools that rely on the federal reimbursements to pay their expenses lose 35 cents on average with every lunch they serve, which helps explain why they feed kids sweetener-stuffed snacks instead of real food in order to comply with the USDA's calorie requirements.
The 6 cent increase would be laughable if it weren't so tragic. But more important in this stalled legislation is a provision that would, for the first time, give the USDA authority to regulate all foods sold in schools, possibly meaning an end -- finally -- to so-called "competitive foods," such as sugary drinks and candy in school vending machines and ice cream bars and fruit rollups in the deli line. That would go a long way toward addressing the obesity epidemic that Michelle Obama has pledged to end.
So I say, Keep your 6 cents. Let the nation's lunch ladies do what they've been doing for years that Congress can't -- live with what they've got. Congress can then continue doing what it does best -- spending money we don't have on wars we don't need. Somehow, the kids will survive.
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