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Ross Products Division
Abbott Laboratories
625 Cleveland Avenue, 105200-RP3-2
Columbus, OH 43215
E-mail:russell.merritt{at}abbott.com
This new book by a US pediatric gastroenterologist, a British pediatric gastroenterologist, and a British research dietitian is divided into 4 sections on dietary requirements, gastrointestinal disorders, hepatobiliary and pancreatic diseases, and nonenteric disorders (including food allergy, obesity, and anorexia nervosa) and an additional section containing an extensive (nearly 250 pages) series of appendixes covering diet and nutritional assessment. Visually pleasing halftone graphics are used liberally to help convey the teaching points. Another high point is the extensive series of appendixes with their multitude of generally complete and reasonably up-to-date tables related to the dietary management of diseases and to commercial products available for disease management, where appropriate.
The first chapter brings the reader immediately into a discussion of international recommendations for nutrient intakes. However, I felt the need for more guidance from the authors on the book's intended audience and use.
As a pediatric gastroenterologist who has spent most of his career in clinical nutrition and infant formula development, I found myself drawn more to the disease-oriented presentations than to the presentations devoted to nutrition and physiology. Although the transatlantic collaboration between the authors broadens the perspective, it complicates some topics, especially in regard to country-specific nutritional recommendations and drug and nutritional product availability. It is noteworthy that the new US daily reference intakes were not included. In the initial chapters on gastrointestinal disorders, there is some repetition related to covering aspects of medical conditions in the different sections devoted to the gut's handling of protein, fat, and carbohydrates. The discussion of arteriosclerosis seemed out of place in the nice summary chapter on inborn errors of metabolism.
The disease-focused chapters provide overviews of the diagnosis and management of pediatric gastrointestinal and nutritional disorders. The detail is sufficient to give the reader a reasonable understanding of the conditions and of approaches to their management but is not at a level that would make one feel comfortable managing patients on the basis of this text alone. Different conditions are presented in different levels of detail, which presumably reflect the specific interests of the 3 authors. Their unique perspectives similarly emerge in specific discussions, such as the importance placed on Helicobacter pylori infection and lactase deficiency as etiologic factors in recurrent abdominal pain and the circumscribed role given to soy infant formulas for managing feeding problems and allergies.
The book contains statements related to pediatric nutrition that do not reflect recent advances, and the book omits relevant recent material. For example, the description of essential fatty acids is almost exclusively focused on n-6 fatty acids, with little discussion of n-3 fatty acids. The authors do discuss corn oil and safflower oil as essential fatty acid supplements for cystic fibrosis. In one table, fish oil is presented as not having effects on blood lipids. No description of vitamin D toxicity is included in an otherwise competent discussion of fat-soluble vitamins. In the parenteral nutrition chapter, lipid emulsion based on cottonseed oil is described as if it were still in use, and a discussion of current methods to provide iron intravenously rather than intramuscularly is lacking. I also found certain medical recommendations, such as a statement that Salmonella typhi infections do not need to be treated with antibiotics, to be inconsistent with current practices. This volume will be of most use to nutritionists in Western countries involved in the dietary management of patients, to general physicians interested in an introduction to or review of pediatric gastroenterology and nutrition, and to medical students in pediatric clerkships.