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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This project was funded by the U.S. Department of Health and Human Services, Health Care Financing Administration Contract No. 500-98-0275. Any opinion, findings, conclusions, or recommendations expressed in this publication are those of the Institute of Medicine committee and do not necessarily reflect the view of the funding organization.
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THE NATIONAL ACADEMIES
National Academy of Sciences
National Academy of Engineering
Institute of Medicine
National Research Council
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.
COMMITTEE ON NUTRITION SERVICES FOR MEDICARE BENEFICIARIES
VIRGINIA A. STALLINGS (Chair),
Division of Gastroenterology and Nutrition, The Children’s Hospital of Philadelphia, Pennsylvania
LAWRENCE J. APPEL,
Welch Center for Prevention, Epidemiology and Clinical Research, John Hopkins School of Hygiene and Public Health, Baltimore, Maryland
JULIA A. JAMES, Principal,
Health Policy Alternatives, Washington, D.C.
GORDEN L. JENSEN,
Division of Gastroenterology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee
ELVIRA Q. JOHNSON,
Clinical Nutrition Services, Cambridge Health Alliance, Massachusetts
JOYCE K. KEITHLEY,
Rush University College of Nursing, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois
ESTHER F. MYERS,
60th Diagnostics and Therapeutics Squadron/ SGOD, United States Air Force, Travis Air Force Base, California
F. XAVIER PI-SUNYER,
Division of Endocrinology, Diabetes, and Nutrition, St. Luke’s/Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York
Health Management and Policy, University of Michigan, Ann Arbor
Nutrition Services and Dietetic Internship, University of California at San Francisco
DAVID B. REUBEN,
Division of Geriatrics, University of California, Los Angeles
ROBERT S. SCHWARZ,
Division of Geriatrics Medicine, University of Colorado, Denver
Nutrition Consultation Service, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois
LINDA G. SNETSELAAR,
Department of Preventive Medicine and Environmental Health, University of Iowa, Iowa City
ROMY GUNTER-NATHAN, Study Director
GERALDINE KENNEDO, Project Assistant
CARMIE CHAN, Project Assistant
EDEN RAUCH, Intern (June to August 1999)
FOOD AND NUTRITION BOARD
CUTBERTO GARZA (Chair),
Division of Nutrition, Cornell University, Ithaca, New York
JOHN W. ERDMAN, JR. (Vice-Chair),
Division of Nutritional Sciences, College of Agricultural, Consumer and Environmental Sciences, University of Illinois at Urbana-Champaign
LARRY R. BEUCHAT,
Center for Food Safety and Quality Enhancement, University of Georgia, Griffin
Center for Human Nutrition, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland
FERGUS M. CLYDESDALE,
Department of Food Science, University of Massachusetts, Amherst
ROBERT J. COUSINS,
Center for Nutritional Sciences, University of Florida, Gainesville
JOHANNA T. DWYER,
Frances Stern Nutrition Center, New England Medical Center and Tufts University, Boston, Massachusetts
SCOTT M. GRUNDY,
Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas
CHARLES H. HENNEKENS,
Boca Raton, Florida
ALFRED H. MERRILL, JR.,
Department of Biochemistry, Emory Center for Nutrition and Health Sciences, Emory University, Atlanta, Georgia
Child Nutrition Programs and Nutrition Policy, Food Research and Action Center, Washington, D.C.
ROSS L. PRENTICE,
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
A. CATHARINE ROSS,
Department of Nutrition, The Pennsylvania State University, University Park
ROBERT M. RUSSELL,
Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
ROBERT E. SMITH,
R.E. Smith Consulting, Inc., Newport, Vermont
VIRGINIA A. STALLINGS,
Division of Gastroenterology and Nutrition, The Children’s Hospital of Philadelphia, Pennsylvania
STEVE L. TAYLOR,
Department of Food Science and Technology and Food Processing Center, University of Nebraska, Lincoln
ALLISON A. YATES, Director
GAIL E. SPEARS, Administrative Assistant
GARY WALKER, Financial Associate
Appreciation is due to the many individuals and groups who were instrumental in the development of this report. First and foremost, many thanks are extended to the committee who volunteered countless hours to the research, deliberations, and preparation of the report. Their dedication to this project and to a very stringent time line was commendable, and the basis of our success.
Many consultants also provided assistance and reviewed drafts of specific chapters. In particular, appreciation and thanks are extended to Rowan Chlebowski, MD, Division of Medical Oncology and Hematology, Harbor UCLA Medical Center, Torrance, CA; Bess Dawson-Hughes, MD, Calcium and Bone Metabolism Laboratory, Tufts University, Boston; Rosanna Gibbons, MS, RD, Consultant Dietitian in Home Care, Baltimore, Maryland; Talat Alp Ikizler, MD, Division of Nephrology, Vanderbilt University Medical Center, Nashville; John Kostis, MD, University of Medicine and Dentistry of New Jersey; and Andrew S. Levey, MD, Division of Nephrology, New England Medical Center, Boston.
The report was also independently reviewed in its entirety by many individuals who were chosen for their diverse perspectives and technical expertise to assure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. These individuals included Bruce R. Bistrian, MD, PhD, Division of Clinical Nutrition, Beth Israel Deaconess Medical Center, Boston; Ronni Chernoff, PhD, RD, FADA, Geriatric Research Education and Clinical Center, John L. McClellan Memorial Veterans Hospital, Little Rock; Cutberto Garza, MD,
PhD, Vice-Provost, Cornell University; Stanley Gershoff, PhD, Professor of Nutrition, Emeritus, Tufts University, Boston; Margaret M. Heitkemper, PhD, RN, FAAN, Department of Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, Seattle; Jerome P. Kassirer, MD, Editor in Chief Emeritus, New England Journal of Medicine, Boston; Penny Kris-Etherton, PhD, RD, Department of Nutrition, Pennsylvania State University, University Park; Lauren LeRoy, PhD, Grantmakers in Health, Washington, DC; John E. Morley, MD, Division of Geriatric Medicine, St. Louis Veterans Affair Medical Center; Henry Riecken, PhD, Professor of Behavioral Sciences, Emeritus, University of Pennsylvania, Philadelphia; Louise B. Russell, PhD, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Jersey; and Philip J. Schneider, RPh, MS, College of Pharmacy, The Ohio State University, Columbus.
Many individuals also volunteered significant time and effort to address and to educate the committee at its workshop and public meeting. Workshop speakers included Bess Dawson-Hughes, MD and Ernest Schaefer, MD of Tufts University, Boston; Linda Delahanty, MS, RD of the Massachussets General Hospital, Boston; V. Annette Dickinson, PhD of the Council for Responsible Nutrition, Washington DC; Marion Franz, MS, RD of the International Diabetes Center, Minneapolis; Samual Klein, MD of Washington University, School of Medicine, St. Louis; William Mitch, MD of Emory University, Atlanta; Tom Prohaska, PhD of the University of Chicago; Dennis Sullivan, MD of the University of Arkansas, Little Rock; and Mackenzie Walser, MD of Johns Hopkins University, Baltimore.
In addition, organizations that provided either oral or written testimony to the committee included the American College of Health Care Administrators; the American College of Nutrition; the American Dietetic Association; the American Society for Clinical Nutrition; the American Society for Enteral and Parenteral Nutrition; Fresnisus Medical Care, North America; and the National Kidney Foundation.
Other individuals who deserve special thanks are Tate Erlinger, PhD of Johns Hopkins University for his special assistance with the NHANES III database, Lisa Prosser, MS of Harvard University for sharing her prepublication data on cost analysis of dietary interventions, Marilyn Field, PhD of the Health Care Services Division, Institute of Medicine for her guidance throughout the report process, and Joan DaVanzo, PhD, Allen Dobson, PhD, and Namrata Sen, MHA of The Lewin Group for their patience and number-crunching abilities.
So, it is apparent that many individuals from a variety of clinical and scientific backgrounds provided timely and essential support for this project. Yet, we would have never succeeded without the efforts, skills,
and grace that was provided in large measure by Romy Gunter-Nathan, MPH, RD, our study director for this project, from Geraldine Kennedo, Project Assistant, and from Allison Yates, PhD, RD, Director, Food and Nutrition Board, Institute of Medicine.
Lastly, as the chair, may I express my sincere appreciation to each member of this committee for your extraordinary commitment to the project and for the wonderful opportunity to work with you on this important task for the medical and nutrition community and for the Medicare beneficiaries whose care we were asked to consider.
Virginia A. Stallings, MD
Committee on Nutrition Services for Medicare Beneficiaries
Effects of Undernutrition on Functional Status in the Elderly,
Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome,
NUTRITION SERVICES IN POST-ACUTE, LONG-TERM CARE AND IN COMMUNITY-BASED PROGRAMS