Book review

CLINICAL NUTRITION: EARLYINTERVENTION

D. Labadarios and C. Pichard, Karger, 2002,

Hardback, 315 pages, £103.70, ISBN 3805574193.

This comprehensive 300 page book is the pro-

ceedings of the 7th Nestle Nutrition Workshop,

Clinical Nutrition: Early Intervention and forms

part of the Nestle Nutrition Workshop Series. As

part of the Clinical and Performance Programme

specialists in biochemistry, body composition,

intensive care, medicine, nutrition, paediatrics,

physiology and surgery were brought together

from all over the world for 4 days in Stellenbosch,

South Africa in 2001.

The first few chapters of this 17-chapter book

relate to the impact of genotype on metabolic

alterations during inflammation and nutritional

outcome and on the role of fatty acids and gene

expression in inflammation. The authors depict

clearly and graphically many of the mechanisms

discussed in the text, which increases the chapters’

readability in what is a technical subject.

The target audience for this book is higher

education institutions/postgraduate libraries who

have postgraduate students and those dietitians/

nutritionists who have a specific interest in body

composition, inflammatory response, vitamins,

anti-oxidants, mineral metabolism and nutritional

repletion. At times the text is heavy going with

many basic science issues explored. However there

is very good diagrammatic representation of

complex issues.

The book follows the same format throughout

with each author providing comprehensive papers

based on their presentation, followed by a list of

up-to-date references and finally a narrative of the

discussion which took place from the participants

of the workshop.

Throughout the entire book the discussion

section was an insight into the minds of the ex-

perts who were present and allowed open intel-

lectual discussion to be recorded in a fashion

which makes the reader feel that they were there.

In reviewing this book, this was by far the most

useful component as it illustrates the here-and-

now thinking in nutrition science and allows open

debate in issues which are controversial. It is also

an interesting opportunity to read examples of

good practice from around the world and from the

perspectives of different professions.

This is illustrated in the chapter on ‘Timing of

Nutritional Support’ by Professor Chiorelo, a

surgical intensive care expert from Switzerland,

who reviews comprehensively the rationale and

effects of early feeding the intensive care unit

(ICU) using both enteral and parenteral routes

and concludes that:

1. There is no evidence that short periods of

starvation of up to 5–7days are deleterious in

most critical care patients who do not have a

pre-existing malnutrition.

2. Reasonable evidence that early enteral nutrition

is beneficial in patients with severe trauma,

particularly abdominal, major burns and after

liver transplantation.

3. It is difficult to identify the proper effects of

early feeding from that of specific nutrients

including glutamine and others.

4. Early parenteral feeding has no place in ICU

patients without pre-existent malnutrition.

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The following four pages are then dedicated to

the discussion between many eminent individuals

from the world of nutrition discussing examples of

best practice from their own hospitals and deba-

ting the evidence from which these conclusions

have been drawn. The topics covered in the dis-

cussion range from acceptable volumes for gastric

aspirates and the placement of post-pyloric feed-

ing tubes to the role of good glycaemic control in

improving mortality in ICU patients. This is

received therefore as a well-balanced report of

current thinking on nutritional support.

There are two excellent chapters on ‘Vitamin

and Anti-oxidant Supplementation: Critical Eval-

uation of Clinical Outcomes’ and ‘Trace Elements:

Contribution to the Efficacy of Nutritional Sup-

port’ written respectively by Professor Beaufrere

(France) and Professor Alan Shenkin (UK). These

two chapters relate micronutrient science to clin-

ical practice and through the review of key

research studies offers a depth which enables the

reader to learn about the subject area in an easily

assimilated way.

This text has a well-structured layout and the

discussion sections enhance its usefulness to cli-

nicians as opposed to its target audience of

nutrition scientists. It is a book that will be fre-

quently dipped into and offers an insight into

some of the nutrition research questions which

remain to be answered.

Lynne Douglas, MPhil, SRD

Lead Therapist, Research Development and

Clinical Effectiveness, Edinburgh Royal Infirmary,

Edinburgh, UK

E-mail: lynne.douglas@luht.scot.nhs.uk

Book review294

� The British Dietetic Association Ltd 2003 J Hum Nutr Dietet, 16, pp. 293–294