Future of research in clinical nutrition Michael Meguid, Prof. of Surgery, Director of Surgical Research, Director of the Nutritional Support Team, University Hospital, Upstate Medical University, Syracuse, New York. In the past 50 years the evolution of applied nutrition to the hospitalized patient has focused on recognizing the patient who is at high risk for developing complications whilst hospitalized, ensuring that the patient receives adequate nutrient support by developing the hardware and the solutions for delivery either enterally or parenterally. Literally thousands of patients have been studied to emphasize that hospitalization caused by a primary disease is in general associated with deterioration of a patient's metabolic parameters. This has led to the recognition of the necessity for providing nutrition as part of the general care of the patient. Regrettably, this lesson has had to be relearned repeatedly and needs continuous emphasis. One cannot help feel that need to reemphasize past-learned lessons persists, so that new generations of health care providers are appropriately educated. In looking at the future, continued partnership with industry is critical because it is industry that facilitates the advancement of scientific achievement. They remain an integral and valued partner. It is difficult to predict in which realm of hospital-based nutrition the cogent advances will occur. Could it be that the delivery system in the forms of enteral or parenteral catheters can be improved? Is it likely that the efficacy of current macro- and micro-nutrient solutions can be enhanced? Given that in these two realms of nutrition support are at our current maximum efficiency it is not likely that significant quantitative advances will occur. Certainly it is hoped that newer varieties of nutrient solutions, e.g., short-chain fatty acids will become more widely available. I believe that the area of maximum growth and reward in the future of research in clinical nutrition lies in the use of hormones and adjuvant therapy. And, in the advances that are likely to occur from a greater understanding of the biochemistry and physiology of disease-related problems. These include the areas of catabolism, anabolism, and the regulation of food intake in the critically ill patients. Finally, the endemic of obesity sweeping the world will result in obese patients with illnesses being admitted to our hospital wards. Providing nutritional support for these individuals or treating these individuals primarily for their obesity-related diseases is a challenge and will occupy a great deal of effort and resources of the future of clinical nutrition. From "PENSA 2003" Cidade de Goa, India, November 6-8, 2003 : Page 102