LETTERS To the Editor: I would like to call to your attention a factual error that appeared in the April 1991 issue of Nutrition in Clinical Practice. In the article entitled &dquo;Enteral Feeding and Infection in the Immunocompromised Patient&dquo; (1991;6:55-64), wine is listed in Table 2 as one of a number of foods found to contain bacteria, including some that are commonly regarded as pathogens. According to the author, these foods were found to contain more than &dquo;...10~ CFU/ml of coagulase-negative staphylococci or Streptococcus viridans and 104 CFU/ml of Bacillus spp diphtheroids, or micro-
cocci...&dquo; This is the first report I have
in which staph, strep, diphtheroids are alleged to have been isolated from wine. Because no experimental data appeared in the article, I telephoned the author to discuss her procedures and results. She informed me that wine had not actually been tested. Wine had been included in the &dquo;Nonacceptable&dquo; list because wine is known to sometimes contain yeast and/or acetic acid bacteria or lactic acid bacteria. There may be reasons for excluding wine from a patient’s diet, but bacterial content is not one of them. One of the author’s references describes a study in which wine was tested: no microbial growth was found (Pizzo PA, Purvis DS, Waters C. Microbiological evaluation of food items. J Am Diet Assoc 1982;81:272-9). seen
or
example of a clinical practice, not as a report of food microbial content. Nonpasteurized alcoholic beverages were excluded from testing and inclusion in the diet because alcoholic beverages are rarely required by our patient population. Gaile Moe, RD, CD Seattle
REFERENCES 1. Moe G. Enteral
feeding and infection in the immunocompromised patient. NCP 1991;6:55-64.
To the Editor: We are writing in regard to our recently published article entitled &dquo;Glutamine Content of Whole Proteins : Implications for Enteral Formulas&dquo; (Techniques and Procedures, NCP 1992;7:77-80). We regret that we incorrectly calculated the range for grams of glutamine per 1000 kcal (4200 kJ) in Table 3 for the
product Replete (Clintec Nutrition, Deerfield, IL). The correct range is 5.43 to 7.99 g of glutamine/4200 kJ; because the product is 1.0 kcal/mL, both columns identical. appreciate Dr. Hugh Tucker’s (Research Development and Technologies, Clintec Nutrition) bringing this error to our attention. Unfortunately, our calculations were based on a Clintec-published source card that incorrectly stated that Replete contained 1500 kcal/1000 mL, rather than the correct 1000 kcal/1000 mL. We therefore request a statement of errata. The glutamine ranges for Replete in Table 3, page 89, should be corrected as follows: are now
We
John Meidell
Microbiologist, Heublein, Madera, California
Inc.
Response from the Author: I thank Mr. Meidell for the information concerning the microbial content of wine and provide clarification of the low microbial diet listed in Table 2.1 Table 2 reflected the low-microbial diet in use at the Fred Hutchinson Cancer Research Center at the time of publication. The diet was derived largely from actual food culturing done within the institution. A small number of foods, such as raw vegetables and raw or undercooked meats and poultry, however, were not cultured for the obvious reason that the microbial load of these foods would preclude inclusion on a lowmicrobial diet. The foods that were listed as not acceptable in the diet were excluded on the basis of
With this correction, it is necessary to revise the second paragraph in the Conclusion, which listed the average minimum and maximum glutamine contents of the enteral formulas listed in Table 3. This sentence should now read, &dquo;The average glutamine ranges from minimum of 3.55 g/4200 kJ&dquo; (no change) &dquo;to a maximum of 7.99 g/4200 kJ&dquo; (rather than a maximum of 5.15 g/4200 kJ, as previously stated). Thus, in patients being fed 8400 kJ/d, Replete is now the only whole-protein formula listed in Table 3 that provides a daily dose of glutamine (10.86 to 15.98 g of glutaa
growth exceeding 103 CFU/ml coagulase-negative staphylocci or Streptococcus viridans, Bacillus spp, and 104 CFU/ml diphtheroids or Micrococcus spp or the growth of any other organism. The low-microbial diet described in that article was included to provide an 133
Downloaded from ncp.sagepub.com at Bobst Library, New York University on June 22, 2015
134
mine/8400 kJ), which approximates the 12- and 20-g parenteral doses of supplemental glutamine that have been shown to be beneficial in surgical patients. However, we cautioned in the article about comparing enteral and parenteral studies in relationship to glu-
article was written, Ross Laboratories (Columbus, OH) has introduced an elemental diet (Alitraq) enriched with free glutamine. Alitraq contains 14.2 g of free glutamine/4200 kJ. Thank you for your assistance.
tamine content. In addition, the last sentence of the second paragraph in the Conclusion states that Vivonex TEN (Norwich Eaton, Norwich, NY) is currently the only commercially available enteral formula that contains free glutamine. However, since the time that this
Wendy S. Swails, RD, CNSD Stacey J. Bell, MS, RD, CNSD George L. Blackburn, MD, PhD New England Deaconess Hospital
Corrected Table 3. Estimated
Boston
glutamine content of selected whole-protein enteral formulas
*
Clintec Nutrition, Deerfield, IL; Mead Johnson, Evansville, IN; O’Brien/KMI, Cambridge, MA; Ross Laboratories, Columbus, OH; Sandoz Nutrition, Minneapolis; Sherwood Medical, St Louis.
Downloaded from ncp.sagepub.com at Bobst Library, New York University on June 22, 2015
cocci...&dquo; This is the first report I have
in which staph, strep, diphtheroids are alleged to have been isolated from wine. Because no experimental data appeared in the article, I telephoned the author to discuss her procedures and results. She informed me that wine had not actually been tested. Wine had been included in the &dquo;Nonacceptable&dquo; list because wine is known to sometimes contain yeast and/or acetic acid bacteria or lactic acid bacteria. There may be reasons for excluding wine from a patient’s diet, but bacterial content is not one of them. One of the author’s references describes a study in which wine was tested: no microbial growth was found (Pizzo PA, Purvis DS, Waters C. Microbiological evaluation of food items. J Am Diet Assoc 1982;81:272-9). seen
or
example of a clinical practice, not as a report of food microbial content. Nonpasteurized alcoholic beverages were excluded from testing and inclusion in the diet because alcoholic beverages are rarely required by our patient population. Gaile Moe, RD, CD Seattle
REFERENCES 1. Moe G. Enteral
feeding and infection in the immunocompromised patient. NCP 1991;6:55-64.
To the Editor: We are writing in regard to our recently published article entitled &dquo;Glutamine Content of Whole Proteins : Implications for Enteral Formulas&dquo; (Techniques and Procedures, NCP 1992;7:77-80). We regret that we incorrectly calculated the range for grams of glutamine per 1000 kcal (4200 kJ) in Table 3 for the
product Replete (Clintec Nutrition, Deerfield, IL). The correct range is 5.43 to 7.99 g of glutamine/4200 kJ; because the product is 1.0 kcal/mL, both columns identical. appreciate Dr. Hugh Tucker’s (Research Development and Technologies, Clintec Nutrition) bringing this error to our attention. Unfortunately, our calculations were based on a Clintec-published source card that incorrectly stated that Replete contained 1500 kcal/1000 mL, rather than the correct 1000 kcal/1000 mL. We therefore request a statement of errata. The glutamine ranges for Replete in Table 3, page 89, should be corrected as follows: are now
We
John Meidell
Microbiologist, Heublein, Madera, California
Inc.
Response from the Author: I thank Mr. Meidell for the information concerning the microbial content of wine and provide clarification of the low microbial diet listed in Table 2.1 Table 2 reflected the low-microbial diet in use at the Fred Hutchinson Cancer Research Center at the time of publication. The diet was derived largely from actual food culturing done within the institution. A small number of foods, such as raw vegetables and raw or undercooked meats and poultry, however, were not cultured for the obvious reason that the microbial load of these foods would preclude inclusion on a lowmicrobial diet. The foods that were listed as not acceptable in the diet were excluded on the basis of
With this correction, it is necessary to revise the second paragraph in the Conclusion, which listed the average minimum and maximum glutamine contents of the enteral formulas listed in Table 3. This sentence should now read, &dquo;The average glutamine ranges from minimum of 3.55 g/4200 kJ&dquo; (no change) &dquo;to a maximum of 7.99 g/4200 kJ&dquo; (rather than a maximum of 5.15 g/4200 kJ, as previously stated). Thus, in patients being fed 8400 kJ/d, Replete is now the only whole-protein formula listed in Table 3 that provides a daily dose of glutamine (10.86 to 15.98 g of glutaa
growth exceeding 103 CFU/ml coagulase-negative staphylocci or Streptococcus viridans, Bacillus spp, and 104 CFU/ml diphtheroids or Micrococcus spp or the growth of any other organism. The low-microbial diet described in that article was included to provide an 133
Downloaded from ncp.sagepub.com at Bobst Library, New York University on June 22, 2015
134
mine/8400 kJ), which approximates the 12- and 20-g parenteral doses of supplemental glutamine that have been shown to be beneficial in surgical patients. However, we cautioned in the article about comparing enteral and parenteral studies in relationship to glu-
article was written, Ross Laboratories (Columbus, OH) has introduced an elemental diet (Alitraq) enriched with free glutamine. Alitraq contains 14.2 g of free glutamine/4200 kJ. Thank you for your assistance.
tamine content. In addition, the last sentence of the second paragraph in the Conclusion states that Vivonex TEN (Norwich Eaton, Norwich, NY) is currently the only commercially available enteral formula that contains free glutamine. However, since the time that this
Wendy S. Swails, RD, CNSD Stacey J. Bell, MS, RD, CNSD George L. Blackburn, MD, PhD New England Deaconess Hospital
Corrected Table 3. Estimated
Boston
glutamine content of selected whole-protein enteral formulas
*
Clintec Nutrition, Deerfield, IL; Mead Johnson, Evansville, IN; O’Brien/KMI, Cambridge, MA; Ross Laboratories, Columbus, OH; Sandoz Nutrition, Minneapolis; Sherwood Medical, St Louis.
Downloaded from ncp.sagepub.com at Bobst Library, New York University on June 22, 2015
