Nutrition and Diet Therapy, Evidence-based Applications. Fourth edition.

Nutrition and Diet Therapy, Evidence-based Applications. Fourth edition.

Lutz C, Przytulski K. F.A. Davis Company/Publishers, Philadelphia, 2006, 724 pages, $99.00, ISBN 0803613369

This soft-cover book aims to provide the beginning student with knowledge and fundamentals of nutrition related to the promotion and maintenance of optimal health. It focuses on practical applications designed to assist student to understand nutritional issues reported in the mass media. It is written to meet the educational needs of nursing students, dietetic assistants, dietetic technicians and others. The authors state the text can be used to teach a complete course or as a desk reference and students need no previous exposure to anatomy, physiology or medical terminology. Carroll Lutz has a professional nursing background and Karen Przytulski is a registered dietitian, and their practical experience is evident.

It is written in a very readable style, with text blocked into paragraphs and written in plain English, with many excellent diagrams, graphs, tables and figures. The book is written in three sections: the role of nutrients in the human body, family and community nutrition, and clinical nutrition. Each chapter commences with learning objectives, which could be used for teaching purposes. At the end of the chapter, there are case studies, including a nursing care plan, critical thinking questions, study questions and clinical analysis. The evidence cited is largely from North America but is relevant to dietetic practice, and the references at the end of each chapter are extensive and up-to-date, with most published after 2000.

There are three units: the role of nutrients in the human body, family and community nutrition, and clinical nutrition. Unit one deals with the role of health professionals and individualising nutrition care for patients, with the focus very much on nursing roles. The remaining chapters in this section cover the usual nutrients, macronutrients, vitamins and minerals, and the final chapter on digestion, absorption, metabolism and excretion.

Unit two covers the life cycle, pregnancy and lactation, infancy childhood and adolescence, and the mature adult, and the final three chapters focus on food management, nutrient delivery, including enteral and parenteral nutrition, and complementary therapies.

The final unit discusses food/nutrient and drug interactions, weight control, diabetes, cardiovascular disease, renal disease, gastrointestinal disease, cancer, stress, diet in HIV and AIDS, and nutrition care of the terminally ill.

The practical nature of each chapter makes this unit useful to both dietetic students and practitioners wishing to brush up their knowledge and techniques. The large detailed photographs of the technique for measuring the four main skinfold sites are excellent in the weight control section. The combination of evidence on obesity with practical strategies for management is also well covered. The diabetes section uses the American Diabetes Association nutritional recommendations from 2003, but there is excellent coverage of diabetes testing and medication action, including the use of insulin pumps.

The cardiovascular disease chapter ably covers the research debate on homocysteine and atherosclerosis and antioxidants in cardiovascular disease. The diagrams, tables and figures in the renal disease and gastrointestinal disease chapters are also excellent and could easily be cited for both student and patient teaching purposes. The section on cancer discusses the nutrition role in primary and secondary prevention, as well as tertiary treatment, including an adequate review of the literature on nutritional treatment of cachexia.

The appendices include exchange lists, abridged nutritive values of foods, nutritional assessment tools, and the Dietary Reference Intakes for Americans. This is followed by a glossary of terms used and an extensive index.

What are the criticisms of this text? Despite the claim that no previous medical science is required, it is unlikely that a complete novice would manage the complex descriptions of, for instance, osmolality and conversion of milliequivalents to milligrams. The other drawback for an Australian audience is the use of American imperial values, reference values and food guides.

Who should purchase it? The title suggests this is a text for dietitians and the content of the chapters is certainly relevant and useful for dietitians; however, the sections at the end of each chapter are angled at North American nursing practice. Dietitians are likely to be at the least annoyed by this and, at worst, put off the text altogether. Nurses are likely to find it too detailed to be of practical use and are unlikely, in the Australian context, to undertake the very detailed nutrition assessments and interventions described. The Australian equivalents of diet assistants and diet technicians would find the scientific and medical terminology too complex, without some background in nutrition science.

Overall, this text would find a place as an adjunct to more serious texts on nutrition and medical nutrition therapy because it combines the latest evidence with practice tips. It does raise some concerns about the overlap in nursing and nutrition and dietetic roles, by staking a claim for medical nutrition therapy squarely in the domain of nurses.

Susan Ash, PhD, FDAA (1,2)

(1) Associate Professor

Institute of Health and Biomedical Innovation 

Queensland University of Technology, Kelvin Grove and (2) Honorary Associate Professor Department of Nutrition and Dietetics Royal Brisbane and Women's Hospital Herston, Queensland, Australia