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Volume 28 Number 06

December 2006

TABLE OF CONTENTS
2	Guest Editor’s Perspective Marcia Kalista Richards, MPH, RD, CNSD This issue of Support Line presents the efforts of those who participated in the Writers Mentoring Program this year.
2	Chair's Column Susan Brantley, MS, RD, CNSD FNCE in Hawaii is a pleasant memory for ADA members who were able to attend. The company and atmosphere were exceptional. Many DNS members attended the Opening Night Luau as guests of DNS, and what a treat that event was! Great food, toe-tapping bands, and happy dietitians made the party special! Thanks to all DNS members who attended and made it a point to say hello!
3	Parenteral Nutrition in Adult Hematopoietic Stem Cell Transplantation: The Evolution of Clinical Practice Jenny Torino, MS, RD Hematopoietic stem cell transplantation (HSCT) may have adverse nutritional consequences due to gastrointestinal (GI) toxicity caused by the preparative conditioning and other complications, including opportunistic infections, graft-versus-host disease (GVHD), hepatic veno-occlusive disease, and hypermetabolism. Parenteral nutrition (PN) has been used to deliver nutrition to this population. Early studies reported positive outcomes after administering prophylactic pretransplant PN, but subsequent studies have found that not all patients require PN, and the risks may outweigh the benefits. This article provides an overview of the nutritional implications of HSCT and examines the research available regarding indications for nutrition support.
9	Inquire Here Donna Odom Questions and answers.
10	Nutrition Management of Enterocutaneous Fistulas Therese Austin, MS, RD, CNSD Enterocutaneous fistula (ECF) has been a documented complication of surgery, malignancy, and gastrointestinal disease for many decades. Mortality associated with fistulas has been very high, ranging from 45% to 60%, but has improved over the decades, possibly due to the use of parenteral nutrition (PN) and improved surgical techniques (1,2). Recent reports cite a mortality of 6% to 48% (3). Malnutrition was a major cause of mortality, but adequate nutrition support by means of PN or enteral nutrition (EN) and the use of octreotide has improved the prognosis.
17	Alcohol and the Liver Renee Walker, RD, CNSD Chronic and excessive alcohol consumption causes liver damage through oxidative stress. Cessation of alcohol consumption is crucial to halt progression and minimize complications of liver disease. Alcoholic liver disease (ALD) compromises nutritional status by altering metabolism, absorption, and digestion of protein, vitamins, and minerals. Micronutrient supplementation, especially of thiamin and folic acid, is recommended. Refeeding syndrome is common in patients with ALD, and precautions must be taken to prevent metabolic shifts during nutrition repletion.
24	Superior Mesenteric Artery Syndrome Dinaz Italia, MS, RD, CNSD Superior mesenteric artery syndrome (SMAS) is an uncommon cause of intestinal obstruction that develops in the horizontal portion of the duodenum between the superior mesenteric artery and the aorta. It occurs most often in patients with a history of rapid weight loss that causes a decrease in the size of the retroperitoneal fat pad, which results in narrowing of the third portion of the duodenum. Symptoms of SMAS include abdominal pain, early satiety, and postprandial nausea and vomiting that could lead to further weight loss and malnutrition. The nutrition support professional plays an important role in the treatment of patients with SMAS because nutrition-related factors, specifically significant weight loss, are often the cause of the disorder. An appropriate oral or nutrition support regimen is essential to promote weight gain, which can lead to resolution of the symptoms associated with SMAS. This article discusses the symptoms, diagnosis, treatment, and nutritional implications of SMAS.

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Viewpoints and statements in these materials do not necessarily reflect the policies and/or official positions of The American Dietetic Association or DNS.

SUPPORT LINE (ISSN 1067-3768) is published bi-monthly. $50 for individual non-member subscriptions, $100 for institutions per year (plus postage surcharges for international subscriptions). Newsletter subscriptions are available to interested parties who are ineligible for ADA membership. Published by Dietitians in Nutrition Support, a dietetic practice group of The American Dietetic Association (ADA), 120 S. Riverside Plaza, Suite 2000, Chicago, IL 60606. Send requests for subscriptions to Jamie Diamond, MS, RD, CNSD, 3850 Galt Ocean Drive, Apt. 2009, Fort Lauderdale, FL 33308. For address changes: Please submit name and address changes directly to the Membership Team of the American Dietetic Association using the address change card in the Journal of the American Dietetic Association. SUPPORT LINE is indexed in the Cumulative Index to Nursing and Allied Health Literature.

FOR THIS ISSUE:

Editor

M. Patricia Fuhrman, MS, RD, FADA, CNSD
Coram, Inc.
1932 Prospector Ridge Drive
Ballwin, MO 63011
314/656-5016

Managing Editor

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

Associate Editors

Marcia Kalista-Richards, MPH, RD, CNSD
Slatington, PA

Neha Parekh, MS, RD, CNSD
Cleveland, OH

Marsha Stieber, MSA, RD, CNSD
Mesa, AZ

Contributing Editors

Gail Cresci, MS, RD, CNSD
Augusta, GA

Lora N. Day, MA, RD, CNSD
Dallas, TX

Jamie Diamond, MS, RD, CNSD
Ft. Lauderdale, FL

Reviewers

Therese Austin, MS, RD, CNSD
Cleveland, OH

Britta Brown, RD, CNSD
Minneapolis, MN

Rhonwyn Curtis-Nicholson, MS, RD, CNSD
San Diego, CA

Marianne Duda, MS, RD, CNSD
St. Petersburg, FL

Carrie Earthman, PhD, RD
St. Paul, MN

Kelly Eiden, MS, RD, CNSD
St. Louis, MO

Dema Halasa Esper, MS, RD, CNSD
Pittsburgh, PA

Cynthia Hamilton, MS, RD, CNSD
Cleveland, OH

Jennifer Lefton, MS, RD, CNSD
Miami Beach, FL