American Burn Association Presidential Address 2006 on Nutrition: Yesterday, Today, and Tomorrow

Traditionally, the most hypermetabolic of all surgical diseases, appropriate nutrition has formed the basis of modern burn care. Today, I would like to review some of the highlights of that history, of where we in burn care have already been in delivering nutritional support for our patients and to promote continued research for the future. I submit that much of the improvement in burn mortality during the last quarter century (Figure 1) has come in conjunction with improvements in nutrition. During my nearly 30-year involvement in burn care, I have had the opportunity to see dramatic changes in nutritional management, many the result of this Association's leaders. In the 1970s, it was well known that acutely injured patients could not use nutritional substrates for the first several days to a week after injury. There was, therefore, no need to feed them. Full nutrition was achieved when the team got around to it, often 7 to 10 days after the burn. Consequently, malnutrition was endemic, and burn patients often had the classical appearance of skin, bones, and a hank of hair.