Clinical Nutrition.

Gibney MJ, Elia M, Ljungqvist O, Dowsett J, eds. Blackwell Publishing, Oxford, 2005, 480 pages, $98.95, ISBN 0-632-05626-6

  What is the matter with Mary Jane?
  She's perfectly healthy and hasn't a pain,
  and it's lovely rice pudding again!
  What is the matter with Mary Jane?
  When We Were Very Young. AA Milne 1924.

Most nutrition textbooks are at best stodgy fare--a little like rice pudding. Not so, Clinical Nutrition from the Nutrition Society textbook series. If you want to know what the matter was with Mary Jane, it is possible that her TH2 response may have been skewed towards rice with resulting gastrointestinal allergy, as outlined by Simon Murch in a superb chapter on adverse reaction to food.

This is a wonderful textbook, which is extraordinary value for money It is multi-authored with mainly British and Western European authors. It is comprehensive and has multiple tables and illustrations. There is a pleasing consistency of style and prolixity is avoided. Key messages are given at the start of each chapter and the text is faithful to the message. It is up-to-date; references are usually up to and including 2003. Only two chapters give websites as well as references, these are on nutritional support and the last textual item at the back of the last chapter on illustrative cases directs us to the websites of the major nutritional journals.

I was particularly impressed with the overnutrition chapter and the chapter on nutrition support in cancer. The former is comprehensive; it includes up-to-date information on orexigenic and anorexigenic hormones and cytokines, obesity syndromes and genome-wide searches on obesity yet at the same time it does not neglect social policy or bariatric surgery There is also quite the best summary on nutritional assessment I have ever read, contributed by Khursheed Jeejeebhoy, the doyen of gastroenterological clinical nutrition and former Chief at Toronto General Hospital, known affectionately to generations of trainees as the 'Jeej'. The textbook is by no means encyclopaedic and the treatment sections should serve as signposts, rather than as a procedural. I found most things nutritional which I have had to exercise my mind on recently, including the subjective global assessment for nutrition and eosinophilic oesophagitis (a major cause of morbidity in children) when I dipped into the book.

My criticisms, which may appear carping, are minor. The paediatric chapter and references to children are concessionary. There is nothing particular on individual infant formulae or modifications thereof, or indeed, on the ESPGHAN guidelines on alteration of formulae. Lactose intolerance gets a passing mention despite most of the world's population being afflicted and fully 50% of this is in a telescoped section on irritable bowel syndrome. Prebiotics seem almost as an afterthought to be sandwiched in a table and probiotics do not get a mention. The oddly titled chapter on the gastrointestinal tract does not do coeliac disease justice. There is no mention of tissue transglutiminase antibodies or indeed, the possibility of pre-digesting gluten or genetically modifying wheat. This chapter would have been improved with a brief mention of other malabsorption syndromes such as intestinal lymphangiectasia, transporter defects such as oasthouse syndrome and enzyme deficiencies such a trehalase and sucrase isomaltase deficiency The section on anorexia nervosa seems to be predominantly a psychological overview. Refeeding syndrome is neglected in this chapter. The exploration of the beauty myth and heroin chic advertising as contributory causes to anorexia nervosa would have been worth a longer look. You would also be excused for thinking that the kicking against the pricks resistance to nasogastric tube feeding, which is often problematic in these girls, is non-existent.

I was impressed with the chapter on ethics. This is an extremely useful inclusion. It is written by a surgeon and as a result is pragmatic. The International Convention on the Rights of the Child, which basically states that appropriate nutrition is a fundamental right, would reinforce points and one area that is not mentioned is the problem of both overnutrition or undernutrition in the intellectually impaired, that is, should a child or adult with Prader Willi syndrome be considered for bariatric surgery? The illustrative cases in the last chapter are extremely good and I could not fault the management of these cases. I would have included a few more children's cases and a little less inflammatory bowel disease.

The ultimate question--if I had not been given this textbook, would I buy it? Yes, I would and I would not normally buy a nutrition textbook.

Richard Couper, FRACP 

Paediatric Gastroenterologist, University of Adelaide 

Department of Paediatrics, Women's and Children's Hospital

North Adelaide, South Australia, Australia