Manual of Nutritional Therapeutics. Fourth Edition. (Book Reviews).

Alpers D, Stenson W, Bier D, Lippincott Williams and Wilkins Pty Ltd, Philadelphia, 2002, 644 pages, $101.20, ISBN 0-7817-3122-4

The title of this book reflects its type--it is a very compact, solid manual, with over 600 pages of quite small type in a book only a little larger than a typical novel. It is an update of the third edition, published six years ago, and the authors state that it is designed as a reference source for healthcare workers such as physicians, nurses and dietitians in various disciplines and for students at all levels within these. The authors are medically qualified, holding academic positions in geriatrics, medicine and paediatrics. They have research interests in nutrition.

The manual is composed of four sections plus appendices. The first section is on general concepts of nutrition, including some public health nutrition for the general adult population and the second is a section on nutrients. The third section on therapeutic nutrition includes chapters on nutritional planning for patients with protein and calories deficiency, enteral (including oral) nutrition therapy and parenteral nutrition therapy. The final section on management by use of diets has chapters on restrictive diets, dietary management of diabetes, renal disease and hyperlipidaemia, obesity, wasting diseases and alternative nutritional therapy.

Each chapter is concise and contains many tables, summaries and comparisons of data from a variety of sources which can be very useful as the reader does not have to search for these. The book aims to include practical advice and in some places these are very useful summaries. It is particularly useful for practitioners who wish to gain a quick overview of a topic in a reasonably detailed way but it does assume an understanding of disease and basic sciences. This edition has been updated with new materials including web sites of major nutrition related organisations. The reference lists are quite extensive but are relatively selective, focussing more on medical journals and US government reports (for example the sections on the use of the glycaemic index in diabetes), rather than on the broader nutrition field generally. The current debates in nutritional therapies are acknowledged but the manual adopts a fairly conservative approach and is US focussed, which would require an understanding by readers of diffe rences between the US and other countries.

The strength of this book lies in its conciseness and the sheer wealth of information it contains in a single small volume. It has an excellent table of contents. Although possibly not deliberate, it would be especially useful for constructing dietary prescriptions for use within acute care, and for quickly updating practitioners in theoretical constructs. The comparison tables are especially useful. The book does contain some useful tips, but not sufficient for the implementation phase of nutritional management in the ambulatory care sector as it does not include behaviour change, lifestyle management, and other strategies needed for successful nutrition outcomes in the longer term. The appendix containing dietary guides for patient use demonstrates this problem, giving lists of 'allowed' and 'not allowed' foods with some general guidelines.

Because of the wealth of information it contains, this book would appeal to generalist nutrition practitioners especially those working in acute care and to students of medical nutrition therapy in particular. It is of lesser value to specialist dietitians except as a reference tool for other areas of practice, and to nursing students. The price is reasonable as this is a specialist book and its size belies its content. For sole practitioners, libraries and students this would be a valuable addition.