NUTRITION IN THE SURGICAL PATIENT

To the Editor:— In an editorial inThe Journalof Dec. 7, 1957, page 1830, entitled "Nutrition in the Surgical Patient," some statements are made which are disputable. The writer states that to maintain caloric equilibrium it is necessary to give 40 calories per kilogram to the average-sized individual. Thus, a male, aged 40, height 67 in. (170 cm.), weight 154 lb. (70 kg.), would have a daily expenditure of 2,800 calories. The basal caloric expenditure of such a patient is approximately 1,700 calories. Since physical activities are negligible postoperatively, the exogenous caloric output would barely reach 400 calories, making the total daily energy output 2,100 calories. Thus, only 30 calories, rather than 40, per kilogram are necessary to maintain caloric equilibrium. The writer further states: "After a subtotal gastrectomy... male patients who were maintained solely on sugar solutions during the postoperative period showed a five-day cumulative nitrogen deficit of