Two decades have passed since the publication of the Surgical Clinics of North America entitled, "Current Strategies in Surgical Nutrition" in June 1991, and almost five decades have elapsed since the initial investigative efforts were undertaken in the Harrison Department of Surgical Research at the University of Pennsylvania School of Medicine, which culminated in the demonstration of the first successful basic and clinical development of a practical, efficacious, and reasonably safe and affordable technique of total parenteral nutrition. This landmark contribution changed surgical and medical practice forever. No longer was it justifiable that malnourished or starving patients with serious or critical conditions, disorders, diseases, or injuries succumbed because they could not eat or receive their nutritional requirements adequately by tube feedings. Since 1967, it has been possible not only to expose in-patient starvation as the "skeleton in the hospital closet," but also mandatory that it be treated judiciously even by total intravenous feeding if necessary in order to minimize morbidity and mortality secondary to malnutrition and starvation, and to maximize the salvage and outcomes of critically ill patients.
The relevance of good nutritional status to the achievement of good clinical results was subsequently repeatedly demonstrated and established beyond a shadow of a doubt. Nutritional assessment also became more relevant and sophisticated, because the means were now available for clinicians to prevent, minimize, or correct the ravages of malnutrition and starvation under virtually all circumstances. Moreover, the successes associated with nutritional support by total parenteral nutrition served as the primary impetus for clinicians and scientists to learn more about individual nutrients, to improve nutrient constituents and formulations, and to design and develop new technology for nutrient delivery, monitoring, assessment, applications, and safety, etc.
Since the gastrointestinal tract has always been, is, and is highly likely to remain, the best means by which to be nourished, provided that it is in reasonably effective