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409 FSHN, PO 110370
University of Florida
Gainesville, FL 32611
E-mail: prb{at}ufl.edu
The 11 chapters (336 pages) and 6 appendixes that make up this 824-page book are a bit overwhelming at first glance. However, the reader is soon impressed with the great care and careful organization used by the 3 authors to present both the problems of disease-related malnutrition and the approaches that have been used to treat it. The book presents a huge amount of information in a single cohesive style, which makes the work much easier to comprehend than the usual collection of works that are obviously put together by committee.
The authors state that they desired to "...collect, rationalize and highlight a wide range of information to help health care professionals make decisions..." They used standard procedures for undertaking systematic reviews and meta-analyses, and then they presented the detailed data in appendixes, which allows the evidence and the conclusions to be traceable and verifiable by the reader. In addition to the inclusion of extensive data tables, most of the chapters have summary graphics that are also presented in a unified style and that do a creditable job of giving the reader a big-picture view to go along with the detailed evidence-based approach.
Chapter one introduces a "new conceptual framework" for considering disease-related malnutrition that emphasizes the function of tissues rather than their mass. It also considers potential windows of opportunity that permit nutritional modulation of function over various periods of time. Chapter 2 summarizes an extensive clinical database of disease-related malnutrition in a variety of patients’ groups in different health care settings; data tables are provided in Appendix 1. Patients are grouped according to body mass index or according to disease diagnosis. The authors focus on the hospital and the community as the 2 predominant health care settings. Chapter 3 discusses the causes of disease-related malnutrition (data tables in Appendix 2), and chapter 4 discusses the consequences.
Chapters 5 through 9 provide a multilayered evidence base for the treatment of disease-related malnutrition. The methods used by the authors to establish the evidence base are detailed in chapter 5. Treatments involving oral nutrition supplements (data tables provided in Appendix 3 for the hospital setting and in Appendix 4 for the community setting) are presented in chapter 6, and treatments involving enteral tube feeding (data tables provided in Appendix 5 for the hospital setting and in Appendix 6 for the community setting) are presented in chapter 7. Chapter 8 provides a combined analysis of the use of oral nutrition supplements and enteral tube feeding. Chapter 9 discusses the use of parenteral nutrition to treat disease-related malnutrition, but the evidence in this chapter is less detailed and complete than is the evidence presented for oral nutrition supplements and for enteral tube feeding.
The authors identify many limitations in the design and execution of studies in the published literature. Chapter 10 provides an excellent practical guide to planning, undertaking, and reporting clinical nutrition trials. It has just the right amount of broad principles and philosophy blended with detailed suggestions and lists. For example, the chapter directs the reader to the CONSORT statement website (Internet: www.consort-statement.org), which is an important research tool that takes an evidence-based approach to improve the quality of reports of randomized trials.
Chapter 11 provides an overview of disease-related malnutrition and some suggested directions for future research. Because of the geographic location of the 3 authors, it is not surprising that many of the nutrition products discussed are more representative of the United Kingdom and Europe than of other locations. The book represents a very complete work as of December 2001, the time at which the data collection was completed. It is the completeness of this work that makes it outstanding; however, the book would probably be more widely used if its content were also available in an online database format that could be easily searched and updated.