编辑推荐From The New England Journal of MedicineHippocrates said, "Let food be your medicine," and hundreds of Internet sites echo his maxim, usually as part of a sales pitch for supplements, pet foods, or other products. Diet was indeed the cornerstone of medical practice for some 2000 years, but for most of that time patients died like flies anyway, and the best one could say for the various dietary treatments was that they killed fewer people than the other medical and surgical procedures of the day. In our evidence-based era, doctors have grown skeptical of Hippocrates's precept, and many conditions that were formerly treated with diet are nowadays treated predominantly with drugs. The domain of academic nutrition has shrunk since the heady days when the vitamins were discovered, and the medical curriculum usually contains no more than a token course in nutrition if the subject is taught at all. In contrast, patients have embraced functional foods and dietary supplements to prevent and cure a wide variety of ills, creating a market that is now worth over $30 billion per year in the United States. Sales of supplements in the United States were bolstered by a 1994 law that largely abolished oversight by the Food and Drug Administration, and manufacturers of supplements are therefore free to imply that their products cure anything from loneliness to cancer. Thus, quackery abounds. However, many patients have a genuine critical interest in finding out what diet can do for them, and for that reason alone medical professionals should keep abreast of the subject. But there is another reason: there are quite a few dietary regimens that really work. To name some: two fish meals a week are as effective as statins in preventing death among patients with cardiac disease; diets high in fruits, vegetables, and low-fat dairy products are as effective as drugs in controlling hypertension; and there is a real possibility that dietary changes may reduce the risk of major cancers. Every doctor should therefore have at least one book at hand that summarizes the salient dietary facts and fallacies. But is Nutrition in the Prevention and Treatment of Disease that book? The book does have a number of things going for it. It is geared to clinical practice and implementation, and it is strong on the topics of patients' behavior and how to influence it, as well as how to evaluate the success or failure of nutritional interventions. For instance, the chapter called "Tools and Techniques to Facilitate Eating Behavior Change" teaches physicians step by step how to talk to and especially how to listen to a patient, so that one can turn his or her initial stage of precontemplation ("Quit nagging me") into contemplation ("Why should I?"), followed by preparation ("Where can I go to learn . . . ?"), then action ("I am doing it but . . . "), and finally maintenance ("I don't have to think about it much anymore"). More than half of the 84 authors list dietetics as their first degree, which may explain the affinity with practice; for instance, the chapter on enteral nutrition gives handy tricks for tube placement, and the chapter on gastrointestinal symptoms lists medications for excess gas. Unfortunately, the book is stronger on implementation than on science. Some of the authors are prominent researchers, but most are not, and as a consequence some chapters lack the balance and the nuances that can be learned only at the front line of research. Thus, a well-organized chapter by Slattery and Caan on nutrition and colon cancer gives a sober and balanced -- though still positive -- summary of this difficult field, but another chapter blandly states that increased intake of fiber has been shown to be helpful in decreasing the risk of colorectal cancer. The chapter on supplements awards the designation "supported by scientific evidence" to herbal treatments of doubtful efficacy, such as ginkgo for dementia and saw palmetto for benign prostatic hypertrophy. A helpful chapter on analysis, presentation, and interpretation of dietary data explains how obese people underreport their intake of "sinful" foods, including cakes, soft drinks, and sugars, but elsewhere it is stated that consumption of sugar does not lead to increased body weight, a conclusion that rests largely on studies in which obese people reported low intakes of sugar-rich foods. The book clearly has its positive sides. It is strong on strategies for dietary modification and on cultural and socioeconomic influences on eating and exercise behavior. Unlike earlier textbooks, it has a large section on the genetic influences on nutritional health. The 8-by-11-in. format is handy; the weight, at 2.1 kg, is manageable; and the organization into sections and chapters is clear. The index is reasonably comprehensive, although its organization into four levels demands that you know fairly precisely what you are looking for. Many chapters, though not all, end with a brief summary. On the other hand, most chapters are rather long on text and short on illustrations. Also, my check of six randomly selected references against PubMed showed errors in three, which raises some worries about accuracy in general. Nutrition in the Prevention and Treatment of Disease is a useful additional resource for nutritional investigators and for dietitians involved in research, but it is not authoritative enough to serve as the sole source on nutritional science. John Wesley preached that one book was knowledge enough for him, but that book was the Bible. There is no bible of nutritional science, and therefore it is always a good idea to check multiple sources. The ones that I have within reach are Modern Nutrition in Health and Disease, edited by Shils et al. (Philadelphia: Lippincott Williams and Wilkins, 1999), even though it is unmanageably heavy; Biochemical and Physiological Aspects of Human Nutrition, edited by Stipanuk (Philadelphia: W.B. Saunders, 2000), in case I really need to know how things work; and Truswell's ABC of Nutrition (London: BMJ Books, 1999), in case I need something fast. I am not sure that I will keep Nutrition in the Prevention and Treatment of Disease as close at hand as these other books. Martijn B. Katan, Ph.D. Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to the Hardcover edition. Review PRAISE FOR THE FIRST EDITION: "With Nutrition in the Prevention and Treatment of Disease, instructors have access to one comprehensive text to demonstrate the nutrition link to disease. ...it is a text a nutrition professional can feel confident in recommending to their clinical and community nutrition colleagues, as well as to dietetics students, epidemiologists and medical students." --JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION "It is strong on strategies for dietary modification and on cultural and socioeconomic influences on eating and exercise behavior. Unlike earlier textbooks, it has large sections on the genetic influences on nutritional health. ...is a useful additional resource for nutritional investigators and for dietitians involved in research." --THE NEW ENGLAND JOURNAL OF MEDICINE "Written by nutrition researchers and dieticians with extensive clinical experience, this book is a useful addition to the clinical nutritionist's bookshelf." --AMERICAN JOURNAL OF CLINICAL NUTRITION "...an excellent and timely addition to the field of clinical nutrition. ...A valuable resource, not only for nutrition students, but also for practicing nutrition professionals." --CHOICE "...provides an excellent overview of clinical nutrition, integrating the collective role of diet, genetics, environment, and behavior in healt and disease. ...All in all, this text is a comprehensive contribution to the field of clinical nutrition and provides an excellent reference for practitioners, researchers, and advanced nutrition students." --INFORM Review PRAISE FOR THE FIRST EDITION: "With Nutrition in the Prevention and Treatment of Disease, instructors have access to one comprehensive text to demonstrate the nutrition link to disease. ...it is a text a nutrition professional can feel confident in recommending to their clinical and community nutrition colleagues, as well as to dietetics students, epidemiologists and medical students." --JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION "It is strong on strategies for dietary modification and on cultural and socioeconomic influences on eating and exercise behavior. Unlike earlier textbooks, it has large sections on the genetic influences on nutritional health. ...is a useful additional resource for nutritional investigators and for dietitians involved in research." --THE NEW ENGLAND JOURNAL OF MEDICINE "Written by nutrition researchers and dieticians with extensive clinical experience, this book is a useful addition to the clinical nutritionist's bookshelf." --AMERICAN JOURNAL OF CLINICAL NUTRITION "...an excellent and timely addition to the field of clinical nutrition. ...A valuable resource, not only for nutrition students, but also for practicing nutrition professionals." --CHOICE "...provides an excellent overview of clinical nutrition, integrating the collective role of diet, genetics, environment, and behavior in healt and disease. ...All in all, this text is a comprehensive contribution to the field of clinical nutrition and provides an excellent reference for practitioners, researchers, and advanced nutrition students." --INFORM |
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