Future outlook of nutritional support Hideaki Saito Surgical Center, Department of Surgery, The University of Tokyo, Tokyo, Japan Many outstanding discoveries and techniques have revolutionized nutritional support during the last half century. These include : long-term total pareteral nutrition, amino acid solutions, intravenous fat emulsions, improved vascular and enteral access, simple nutritional assessment, early enteral nutrition, anabolic hormones and immunonutrition. However, much remains to be accomplished to improve nutritional support. Malnutrition is a persistent problem in hospitalized patients. Nutrition support is cosidered necessary if a patient is malnourished or at risk for developing malnutrition. However, there are unanswered basic questions concerning the method of evaluation nutritional status and the nutrient needs of individual patients. Appropriate use of parenteral and/or enteral nutrition is prerequisite for proper nutritional management. Nevertheless, even in US hospitals, parenteral nutrition is used unnecessarily. Although early enteral nutrition may be beneficial for many different types of patients, the optimal timing of the initiation of enteral nutrition is not known exactly. A nutrition support team way be helpful in promoting better nutritional assessment and appropriate use of nutritional support. Despite awareness of the importance of nutritional support as a part of patient treatment, there are numerous barriers to establishing nutritional support teams in hospitals. Recent research has revealed that specific nutritional methods modulate the immune response and can enhance immunity. More detailed knowledge of the molecular mechanisms underlying immune responses will characterize the future of immunonutrition. In addition, molecular methodologies in nutrition research will reveal the nutritional requirements of immune cells such as macrophages, neutrophils and lymphocytes, lading to direct applicability to future immunonutrition. Immunomodulatory effects of probiotics on the immune response will also be defined. Nutritional research is evolving. Translating research into practice is essential to improving nutritional support. The future of nutrition support must be based on valid science and adequate documentation of clinical efficacy. From "The 7th Congress of the PENSA Program & Abstract" Bali, Indonesia, August 24-26, 2001 Page : 1