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Volume 35 Number 2 April 2013
TABLE OF CONTENTS
2Guest Editor's Column
Paula Charuhas Macris, MS, RD, CSO, CD, FADA
Children with chronic diseases often have altered nutrient requirements and need specialized nutrition support to promote normal growth and development. Parenteral and enteral nutrition has improved the health outcomes and quality of life for many pediatric patients with complex medical issues.
2Chair's Column
Gail Cresci, PhD, RD, LD, CNSD
The spring season is upon us, and life is bursting fully and brightly. I find it unbelievable that this is my last column to write as Chair of Dietitians in Nutrition Support (DNS). I am proud to reflect upon all the wonderful activities occurring within this fabulous Dietetics Practice Group (DPG).
3Advanced Practice Residency in Nutrition Support Therapy
Jennifer Wooley, MS, RD, CNSC, Cindy Hamilton, MS, RD, LD
Introduction Dietitians in Nutrition Support (DNS), in alignment with the Advancement in Dietetic Careers Initiative of the Academy of Nutrition and Dietetics, is developing an advanced practice residency (APR). The programmatic goal of the residency is to provide training, skills, and mentorship to create advanced practice nutrition support dietitians who can deliver safe and evidence-based medical nutrition therapy to patients across the health care continuum.
5Nutrition Support of the Pediatric Oncology Patient
Lisa Cherry, MS, RD, CNSC, Lindsay Rypkema, RD, CNSC
Cancer is the most common cause of disease-related deaths in children younger than the age of 15 years (1,2). Fortunately, survival rates in children have increased over the past few decades. Current statistics from the National Cancer Society estimate that childhood cancer survival rates have increased from 58% for children diagnosed from 1975 to 1977 to 83% for those diagnosed between 2002 and 2008 (3).
12Nutrition Management of Pediatric Chronic Kidney Disease
Brandis Roman, MS, RD, CNSD
Chronic kidney disease (CKD) results in electrolyte, fluid, and metabolic abnormalities that significantly affect nutrition status, particularly in pediatric patients who experience rapid periods of growth and development. It is difficult to measure the prevalence of undernutrition in this population because of differing definitions used in published reports. However, growth failure and poor nutrition status are common in children with CKD for a variety of reasons, including poor intake and metabolic and hormonal abnormalities. There is no "gold standard" for measuring nutrition status in patients with renal impairment. Therefore, the clinician must synthesize information gleaned from the nutritional intake history, anthropometric measurements, and various biochemical markers to arrive at a conclusion about nutrition status. Optimization of oral intake via energy-dense foods, nutrition supplements, and fortified formulas is the first line of treatment for the malnourished patient. Enteral supplementation should be considered in some patients, particularly infants and young children. Intradialytic parenteral nutrition is an option for those receiving hemodialysis.
22Clostridium difficile-associated Diarrhea and Probiotic Therapy: What is the Evidence?
Mary Rath, RD, LD, CNSC, Gail Cresci, PhD, RD, LD, CNSD
Diarrhea is a common adverse effect of antibiotic administration. Antibiotics disrupt the colonic microbiota, causing dysbiosis that negatively alters carbohydrate metabolism and antimicrobial activity in the colon, leading to osmotic diarrhea or diarrhea caused by pathogenic bacterial overgrowth (1). The dysbiosis caused by antibiotic therapy has resulted in toxinproducing Clostridium difficile becoming the primary diarrheic pathogen in hospitalized patients (2,3). In the United States, an estimated 25% to 30% of cases of antibioticassociated diarrhea (AAD) in hospitalized patients involve C difficile (4). The rising incidence is concerning because C difficile infection complicates and prolongs hospital stays as well as increases health care costs, morbidity, and mortality. Various treatments have been studied over the past decade to potentially prevent, treat, and improve outcomes related to AAD and C difficileassociated diarrhea (CDAD), including probiotic therapy. This article reviews the evidence supporting the use of probiotics in treating CDAD.

Copyright 2013 Dietitians in Nutrition Support.

All material appearing in SUPPORT LINE is covered by copyright and may be photocopied or otherwise reproduced for noncommercial scientific or educational purposes only, provided the source is acknowledged. Written consent from the managing editor is required for any other purpose.

Viewpoints and statements in these materials do not necessarily reflect the policies and/or official positions of The Academy of Nutrition and Dietetics or DNS.

SUPPORT LINE (ISSN 1067-3768) is published bi-monthly. $60 for individual non-member subscriptions, $120 for institutions per year (plus postage surcharges for international subscriptions). Newsletter subscriptions are available to interested parties who are ineligible for Academy membership. Published by Dietitians in Nutrition Support, a dietetic practice group of The Academy of Nutrition and Dietetics , 120 S. Riverside Plaza, Suite 2000, Chicago, IL 60606. For address changes: Please submit name and address changes directly to the Membership Team of the Academy of Nutrition and Dietetics using the address change card in the Journal of the Academy of Nutrition and Dietetics. SUPPORT LINE is indexed in the Cumulative Index to Nursing and Allied Health Literature.


FOR THIS ISSUE:

Editor

Mandy L. Corrigan, MPH, RD, CNSC
265 Scenic Cove Lane
St. Charles, MO 633036

Managing Editor

Deborah K. Kuhlman
921 N. Western Avenue
Park Ridge, IL 60068
847/692-3407

Associate Editors

Susan Brantley, MS, RD, CNSC, LDN

Kathy Logan Coughlin,, MS, RD, CNSD

Associate Editor, Continuing Education:

Neha Parekh, MS, RD, CNSD

Associate Editor, Writer's Mentoring:

Rebecca Brody, PhD, RD, LD, CNSC

Contributing Editor, Inquire Here:

Gail Cresci, PhD, RD, CNSD

Membership/Subscriptions:

Cheryl Thompson, PhD, RD, CNSD