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Department of Nutritional Sciences
University of Wisconsin, Madison
1415 Linden Drive
Madison, WI 53706
Correspondence: E-mail: ney{at}nutrisci.wisc.edu
The introduction of total parenteral nutrition in the 1960s helped to establish nutrition support as a specific therapeutic entity. The field of nutrition support is based on the tenets that nutrient depletion causes morbidity and mortality and that the prevention or correction of nutrient deficiencies can minimize or eliminate the adverse effects of malnourishment. Studies have generally not been able to show that parenteral nutrition improves the natural history of many diseases, in part because of the serious complications associated with this vital, but artificial, method of feeding as well as our limited understanding of the underlying mechanisms by which parenteral nutrients and stress alter metabolism.
The 3rd edition of Clinical Nutrition: Parenteral Nutrition continues the tradition of providing practitioners with state-of-the-art scientific information on nutrition support. The book reviews all of the core competencies needed to practice nutrition support and includes an authorship of dietitians, nurses, nutritionists, pharmacists, and physicians. Excellent practical information is provided. The in-depth discussions are timely and include comprehensive reference lists and many relevant figures and tables.
Thirty chapters are included in the book. The first 7 chapters review the history of parenteral nutrition, metabolic response to illness, metabolic assessment, parenteral access, and the nutrient components of parenteral nutrition solutions. The chapters on lipid emulsions and parenteral formulas are particularly well written and useful to practitioners. The chapter on metabolic assessment has an excellent discussion of the new technologies available for the assessment of body composition, including bioelectrical impedance analysis and magnetic resonance spectroscopy. The chapter on trace elements and vitamins includes detailed tables summarizing the assessment of essential inorganic and organic micronutrients. Chapters 8 and 9 review the common complications of parenteral nutrition: hepatobiliary disease and metabolic bone disease.
Eleven of the 30 chapters focus on the use of parenteral nutrition in a specific disease state, such as pancreatitis, gastrointestinal disease, short bowel syndrome, trauma, burns, AIDS, and obesity. Treatment algorithms are included for initiating parenteral nutrition in specific conditions. The use of subjective global assessment in identifying which patients might benefit from perioperative nutrition support is stressed. These chapters overlap some with the first 7 chapters regarding metabolic assessment, the components of parenteral nutrition solutions, and the lipid emulsions available. The text could have been shortened by organizing the chapters into 3 or 4 sections and then editing the text to reduce repetition.
Two chapters are devoted to parenteral nutrition in neonates and the general pediatric population, and 2 chapters are devoted to home parenteral nutrition, including a discussion of financial issues. A separate chapter is devoted to nutrient pharmacotherapy; the use of growth factors is discussed in several chapters. The last chapters review ethical issues in parenteral nutrition.
In summary, this is a comprehensive reference text on parenteral nutrition that continues the excellent tradition established in previous editions. The book is probably too specialized to be used as a textbook for a course in clinical nutrition; however, it is an excellent reference for nutrition support practitioners and nutrition researchers.