Today, malnourishment among hospitalized patients can be readily recognized and treated.
Growing up on a farm, Bruce Bistrian, MD, PhD, was fascinated by food and nutrition. He pursued these interests by becoming a physician-scientist whose training included a stint in Haiti, where he observed striking similarities between patients there and in rural New England. The common thread was malnourishment. Early in his career, Bistrian met George Blackburn, MD, PhD, a Kansas native with a similar passion for understanding the role of nutrition in patient care. In 1974, Bistrian and Blackburn published the results of a seminal study which estimated an alarming protein-calorie malnutrition rate of 50 percent among general surgical patients. This would prove to be the field’s first early recognition of the extensive prevalence of protein calorie malnutrition associated with disease.From there, Bistrian and Blackburn developed a nutritional assessment and remediation program to ensure the adequate nourishment of critically ill, hospitalized patients. Their approach, which resulted in shortened hospital stays, included the development of “medical foods” that could be taken intravenously or by feeding tube. “The most common problem in critically ill patients is infection,” said Bistrian. With the understanding that surgical patients are often hyperglycemic – and thus more prone to infection – the two developed an immune-enhancing formula made up of fish oil, structured lipids (for better absorption) and medium-chain fatty acids. In 1997 this novel formula became the basis for a product named IMPACT, sold worldwide by Novartis and, in 1999, Optimental, sold by Ross.Today, malnourishment among hospitalized patients can be readily recognized and treated, thanks in large part to the meteoric rise in parenteral and enteral nutrition spurred by Bistrian and Blackburn and their early understanding of the important role nutrition plays to the health of critically ill patients.