Psychosocial aspects of nutritional support.

The relationship between an individual's social, psychological, and cultural environment and his or her nutritional status is one of both cause and effect. Cultural patterns, economic stability, and attitudes toward health and disease all affect an individual's eating behavior. Similarly, illness or treatments that interfere with usual nutritional behaviors can affect an individual's emotional well-being and social relationships. We have discussed some of the symbolic and social meanings of food and have described how these are challenged by the necessity for "artificial feedings." We have suggested that an understanding of the interaction among the cultural and social factors involved in eating is important in helping to provide comprehensive care to patients requiring nutritional intervention as part of treatment for a medical or surgical disease. In addition, we have presented a description of anorexia nervosa as an example of an illness in which the primary symptoms involve the use of deviant eating behaviors as a way to meet psychological needs. The psychosocial context of food and of obtaining nutrition seem in many ways to be quite obvious, but we must make a conscious effort not to take for granted or to overlook the impact the psychological, social, and cultural environment has upon our patients receiving nutritional therapies.

Gastrointestinal disease: nutritional implications.

The management of patients with gastrointestinal disease must include attention to nutritional status. It has been documented that morbidity and mortality previously considered common in these patients can be reduced significantly. Perhaps the largest contribution that advances in nutritional support have made is the reduction in the frequency of surgical intervention. Remission of inflammatory bowel disease, closure of fistulas, intestinal adaptation, and prevention of malnutrition in complicated pancreatitis with the use of nutritional therapies help to avoid the complications of operative procedures.