The new england journal of medicine

2318 n engl j med 350;22 www.nejm.org may 27, 2004

diatric diabetology. One dire prediction from the
Centers for Disease Control and Prevention is that
if the current rate of obesity continues, diabetes will
eventually develop in one in three children who were
born in 2000. Although relatively little is known
about type 2 diabetes in youth, this book the first
of its kind about the topic provides valuable in-
formation on the epidemiology, pathophysiology,
genetics, and possible treatment of this relentless
metabolic disease.
Type 2 Diabetes in Childhood and Adolescence is at-
tractively produced, with excellent illustrations
and references. Of particular note is the books
international scope. Indeed, the two chapters re-
garding the Asian experience with the disease are
of particular interest. In young Japanese patients,
the incidence of type 2 diabetes is higher than it is
in young whites, and coeditor Kaichi Kida de-
scribes well the clinical phenotype of the Japanese
child who presents with the disease. I also recom-
mend the chapter entitled Long-term Outcomes
of Type 2 Diabetes in Adolescence, which pro-
vides an extensive and detailed analysis of the inci-
dence of both retinopathy and nephropathy. Rather
frightening are the data showing that type 2 diabe-
tes is the chief cause of nephropathy among young
people in Japan.
The drawing on the cover of the book illustrates
the cascade of events that ultimately leads to type 2
diabetes, from insulin resistance (frequently as a
consequence of obesity) to impaired glucose tol-
erance to greater insulin resistance and deficien-
cy and, ultimately, to diabetes. However, only two
chapters deal with the pathophysiology of the dis-
ease perhaps a reflection of the lack of studies in
this age group. One topic that the book does not
address is the role of gestational diabetes in early-
onset disease in children. Also, the book would
have gained in comprehensiveness from devoting
a chapter to the Pima Indians of Arizona, who re-
portedly have the highest prevalence of type 2 dia-
betes in the world.
Aside from these criticisms, this book is easy to
read and is generally filled with useful and practical
information. I recommend it to any pediatric dia-
betologist who desires a perspective on type 2 dia-
betes in youth.
Sonia Caprio, M.D.
Yale University School of Medicine
New Haven, CT 06520
sonia.caprio@yale.edu
pediatric allergy:
principles and practice
Edited by Donald Y.M. Leung, Hugh A. Sampson, Raif S. Geha,
and Stanley J. Szefler. 688 pp., illustrated. St. Louis, Mosby, 2003.
$91.95. ISBN 0-323-01802-5.
his necessary and long-overdue
textbook on allergic disorders in infants and
children covers a wide range of topics, thus ensur-
ing a good overview of the entire field. It covers food
allergy extensively in nine well-written chapters,
whose topics range from the mechanisms of mu-
cosal immunity to the diagnosis and management
of food allergy. Of particular note is the chapter on
the prevention of atopy, in which various contro-
versies are well presented and discussed.
The 12 chapters in the section on asthma ex-
pertly cover immunopathology, new directions in
research, and the clinical aspects of asthma. Chap-
ters on the unique features of the education of pa-
tients about asthma and the promotion of adher-
ence to treatment and self-management highlight
the multidisciplinary approach needed for optimal
treatment of the child with asthma. Rhinitis and
drug allergies are discussed in less detail, and read-
ers may have to refer to larger textbooks for more
comprehensive information.
As a bonus, sections on pediatric immunology
and immunodeficiency have been included. Con-
sistent with the rest of the textbook, these sections
are concise and offer practical algorithms and ta-
bles. However, in contrast to the comprehensive
and balanced treatment of the major problems in
childhood allergy, the chapters on immunology re-
flect the experience of practitioners at only a single
center.
This book should appeal to trainees in pediat-
rics and related specialties because of its uniformly
well-written text and well-organized format. The
key concepts boxes throughout each chapter are
invaluable for highlighting important points and
summarizing information.
Chaim Roifman, M.D.
Hospital for Sick Children
Toronto, ON M5G 1A8, Canada
chaim.roifman@sickkids.ca
Book Reviews Copyright 2004 Massachusetts Medical Society.
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