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Box 783 Tufts-New England Medical Center 750 Washington Street Boston, MA 02111 E-mail: jdwyer1{at}lifespan.org
Written by nutrition researchers and dietitians with extensive clinical experience, this book is a useful addition to the clinical nutritionist’s bookshelf. The book emphasizes brief updates and commentaries. Basic concepts that undergird practice, clinical nutrition intervention, and disease-specific prevention and treatment strategies are discussed in a manner that it is likely to stimulate a science-based approach. The book should help to speed the integration into clinical practice of newer findings regarding genetic, behavioral, and environmental influences on the prevention and treatment of disease.
The book begins with chapters on basic principles and concepts, including those that are relevant in studying the relation between diet, nutrition, and disease. Methodologies for dietary assessment, determination of energy requirements, and physical assessment are discussed. Overviews of methods used in nutritional epidemiology and in the analysis, presentation, and interpretation of dietary data are presented. Next, nutrition interventions, including their theoretical bases; some tools and techniques for facilitating dietary change; and lessons learned from clinical trials are considered. Procedures for evaluating nutrition interventions are summarized, and an overview of biomarkers for measuring exposures or tracking interventions is presented.
The importance of genetic factors in the development of disease and in the response to dietary interventions is underscored in chapters discussing lipid disorders, obesity, cancers, and inborn errors of metabolism. Although nutrients from food and supplements are well described in most nutrition texts, some of the newer forms in which they are delivered are not. Thus, chapters on oral nutritional supplements, parenteral and enteral nutrition, and herbal and botanical supplements are welcome.
The chapters on disease-specific interventions for prevention and treatment cover most major diseases with dietary implications. The coverage of cardiovascular disease includes chapters on dietary macronutrients and other dietary components and on cardiovascular risk. Nutritional factors involved in the prevention and management of hypertension and congestive heart failure are discussed in detail. Breast, colon, prostate, and lung cancers and general considerations in the treatment of patients with cancer are examined. The association between obesity and the risk of diabetes mellitus sets the stage for discussions of the nutritional management of type 1, type 2, and gestational diabetes. Obesity is addressed with an overview of treatments and interventions and more-detailed attention to the roles of physical activity and macronutrient intake in the control of body weight. Behavioral risk factors for obesity and the role of taste and appetite in the regulation of body weight are also discussed. Common gastrointestinal symptoms and gastrointestinal diseases, such as lactose intolerance, inflammatory bowel disease, short-bowel syndrome, and liver disease, are covered. Other major diseases, including renal disease, Parkinson disease, Alzheimer disease, osteoporosis, osteomalacia, the eating disorders, cystic fibrosis, and immunodeficiency syndromes, are also covered. The book concludes with a discussion of nutritional guidelines to maintain health.
Several changes are recommended for the book’s next edition. First, a brief list of key references for additional reading would be helpful. Second, because dietary reference intakes are now available for nearly all nutrients and other components in food, more attention should be given to the use of these values in assessing and planning intakes. Third, the many generic or disease-specific functional scales, health-related quality of life assessment, and outcome indicators need more attention. Fourth, more information on the human genome and the language of genetics and examples of the genetics of diabetes and hypertension would be helpful. Fifth, fortified foods and "functional" food ingredients are popular and should be given attention. Finally, more coverage on combinations of hypoenergetic diets and pharmacologic agents would further strengthen the obesity section.
The book complements more basic clinical nutrition texts by providing an overview of the role of nutrition in risk reduction and disease treatment that is a useful addition to university and hospital libraries. It will also be a good addition to the syllabi of undergraduate and graduate courses in clinical nutrition.