Clinical Nutrition: Early Intervention (Nestlé Nutrition Workshop Series Clinical Performance Program, Vol 7),

edited by Demetre Labadarios and Claude Pichard, 2002, 316 pages, hardcover, $217.50. S Karger AG, Basel, Switzerland.

Adult & Paediatric Gastroenterology
Barts & The London
Turner Street
London E1 2AD
United Kingdom
E-mail: i.r.sanderson{at}qmul.ac.uk

This volume presents the proceedings of a workshop that took place in South Africa in 2001. Despite the use of "Early Intervention" in the title, only one article seriously discusses the timing of nutritional intervention. This excellent report by Chioléro et al examines the various hypotheses by which early intervention might improve clinical outcome. The main thrust of the book is a review of the mechanisms by which nutrition can act as a therapeutic modality. Within this context, the volume contains some real gems. The only weak articles are those in which the authors were asked to discuss a subject that was too broad for the available space.

Two excellent chapters discuss evidence-based nutrition. The article by Soeters et al addresses the problems of evidence-based medicine. The authors discuss the lack of data in situations in which trials would be unethical or impossible to achieve because of recruitment difficulties or the need for very large sample sizes. The temptation to support one’s argument by citing the lack of evidence against it is ever-present. A recurring theme in the book is the effect of nutrition on the immune system. Several authors discuss the appropriateness of immune and inflammatory responses and whether nutrients could improve these responses. Grimble discusses the genetics of the inflammatory processes and further discusses the genetics of an individual person's response to the modulation of that response by nutrition. Thus, genes not only regulate the inflammation, but they also control the ability of the nutritionist to intervene. It will be a challenge to predict which patients will benefit from nutritional interaction on the basis of their DNA sequences. Several authors cite evidence that certain persons mount an inappropriate and damaging inflammatory response in the intensive care setting. A question that was not explicitly asked is whether each person has the optimal makeup for a particular insult. Poor outcomes occur only when the genetic background and the insult are mismatched. Thus, persons who die in intensive care units may be those who would have survived other inflictions in other circumstances. Each chapter finishes with the discussion that took place after the talk. These discussions make for stimulating reading and reveal other concepts waiting to break free. One example of this is the acute phase response, its importance in survival, and its interaction with nutrition. Another example is the question of the real benefits of inflammation in times of illness. Is it only beneficial in acute insults, as one participant suggested, or is chronic inflammation an essential defense mechanism? The poor outcome of treating chronic amebiasis with steroids makes one suspect that we do not understand all the benefits of the inflammatory process.

In summary, reading the book was an enjoyable experience. No attempt was made by the editors to group the chapters by common themes; however, this did not detract from the freshness of the text, which is the book's greatest strength.