An extended clinical nutrition investigation, like the monounsaturated fat study reported in this issue, requires a controlled environment for the results to be valid. The metabolic unit at the Dallas Veterans Administration Medical Center provides the setting, the expertise and the patients to carry out such investigations.

Dr. Scott Grundy, head of the Center for Human Nutrition, has an appointment at both UTHSCD and the VAMC. He directs the staff of the metabolic unit at the Dallas VAMC--a unit that is unusual because it is used chiefly for nutrition studies. Its ten beds are occupied throughout the year, and about four protocols a year are completed. Grundy is currently doing further investigation on monounsaturated fats, and UTHSCD diabetes specialist Dr. Roger Unger is conducting a study of nutrition in diabetes.

The day-to-day implementation of a protocol--the detailed outline of steps to be carried out during the study--is performed by a team of friendly professionals who believe in the importance of nutrition investigation. Their tasks are complicated by the fact that each of the ten patients may be at a different point in one of several protocols.

Head Nurse Julio Borroto, with 11 years experience on the metabolic unit, and R.N. Peggy Tim see that the protocols are carefully followed. Each patient must receive the appropriate diet and have his blood drawn for testing at prescribed intervals. Before the blood samples can be sent to the laboratory, they must be mixed with special chemicals and refrigerated to preserve the plasma. After the tests are complete, the results are entered into the computerized database for the study.

"Because the patients are not acutely ill and because they are here for long periods of time, we go outside the professional approach to build friendship and trust," says Borroto. "We tell a patient that, although we cannot cure him, we are doing all we can to find the cause of his disorder. We can usually send him home with a solid knowledge of his problem and a regimen tailored to his needs."

Two other team members are registered dietitian Susan Cortez and food service worker Alice Williams. Cortez is responsible for determining the makeup of a diet to fulfill a protocol--which liquid or solid foods will furnish the specified percentages of protein, carbohydrate and fat. Williams cooks the food or mixes the formulas for all meals served in the unit. In addition, Cortez counsels the patients about nutrition and tailors the diets for them to follow when they leave the hospital.

To see to the patients' other medical problems, the metabolic unit has the assistance of Dr. David Hyman and physician's assistant Sherie Webb. As Webb explains, "Most of the patients on the metabolic unit have chronic diseases related to the study being done. They are seldom acutely ill when they are here, but there is always the possibility they could become so.

Besides, they may have other medical problems that can be treated while they are on the unit. Our job is to guard the general health of the patient." The patient who takes part in a study like the one reported makes a real commitment because he must live at the hospital for two or three months. The ten patients on the VAMC's metabolic unit have private rooms, access to occupational and recreational therapy and a game room. The atmosphere is relaxed and there is good camaraderie among the patients, who are treated as part of the medical "team."

The Dallas VAMC's metabolic unit has recently been remodeled. An expansion is planned within the next five years.