GASTROENTEROLOGY 2004;127:16411644

PRINT AND MEDIA REVIEWS

Ian S. Grimm, M.D.
Print and Media Review Editor
University of North Carolina at Chapel Hill
Division of Digestive Diseases and Nutrition
Chapel Hill, North Carolina

Handbook of Clinical Nutrition and Aging.Edited by Connie

Watkins Bales and Christine Seel Ritchie. 720 pp. $145.00.
Totowa, New Jersey, Humana Press, 2003. ISBN 1-58829055-7. Web address for ordering: www.humanapress.com
The Handbook of Clinical Nutrition and Aging is one of a
series of books on Nutrition and Health from Humana Press
that now totals 26 publications between 1997 and 2004. The
stated goals of the series which is edited by Adrianne Bendich,
PhD include: (1) a synthesis of the state of the science; (2)
timely, in-depth review by leading researchers; (3) extensive,
up-to-date reference lists; (4) a detailed index; (5) relevant
tables and figures; and (6) balanced, data-driven answers to
patient and health professionals questions.
This book comprises 31 chapters organized into 4 sections.
A section on Trends in Nutrition and Health in Older Adults
includes chapters on global graying and nutritional trends,
creating a continuum of nutrition services, progression from
physiological aging to disease, and status of nutrition in older
adults in Europe. A section on Fundamentals of Geriatric
Nutrition includes chapters on nutritional assessment and
support in chronic disease management, common nutrient
deficiencies in older adults, and dietary supplements for health
maintenance and risk reduction. A section entitled Geriatric
Syndromes: Nutritional Consequences and Potential Opportunities includes chapters on vision, taste, and smell, hearing,
sarcopenia, and frailty, pressure ulcers, dementia, and end-oflife care. The final and longest section entitled Clinical Topics
includes chapters on vascular disease, pulmonary disease, cancer, endocrine disorders, alimentary tract disorders, renal disorders, musculoskeletal disorders, and infectious diseases and
immunity. Most of the 31 chapters conclude with a very
helpful section listing recommendations for clinicians.
For the most part this book fulfills the goals for the series
including those listed above. It provides a comprehensive
summary of available data relating to nutrition and aging.
Because the population of patients is getting older, any healthcare professional involved with adult patients will find this a
useful resource. There is considerable variation in the effectiveness of the chapters. Particularly informative and worth
reading even in the absence of owning the book are Chapter 7,
Dietary Supplements for Health Maintenance and Risk Factor
Reduction; Chapter 8, Nutrition and the Aging Eye; Chapter
9, Loss of Taste, Smell and Other Senses with Age, Effects of
Medication (includes a 54 page table listing effects of drugs on
the senses); Chapter 12, The Relationship of Nutrition and
Pressure Ulcers; Chapter 14, Nutrition and End-of-Life Care;
Chapter 16, Nutritional Management of Hypertension in the

Elderly; Chapter 23, Oral Health and Nutrition; Chapter 25,

Gastrointestinal Senescence and Digestive Diseases of the Elderly; Chapter 26, Provision for Enteral and Parenteral Support; and Chapter 29, Nutritional and Pharmacological Aspects of Osteoporosis.
My chief criticism of the book is the tendency of some
chapter writers to accept uncritically the notion that because
many markers of undernutrition are associated with poor
outcome, improvement of nutrition status will improve outcome. By now it should be widely recognized that all such
markers, including serum albumin, weight, other anthropomorphic measurements, serum transthyretin, total lymphocyte
count, and many others are markers of disease severity as well
as nutrition status. They may even be more sensitive markers
of disease severity and comorbidity than markers currently in
use for those purposes. Therefore, we do not know to what
extent the poor outcomes associated with these markers is due
to poor nutritional status, and how much is due to underlying
disease severity or comorbidity and therefore may not respond
at all to an improvement in nutrition status. This uncertainty
is best resolved by randomized, controlled, clinical trials comparing the effects of interventions that prevent or improve
under nutrition with no such intervention. Some chapters
would have benefited from a more thorough review of all such
published data. This is especially true of Chapter 5, Nutritional Assessment and Support in Chronic Disease Management; Chapter 19, Nutrition and Chronic Obstructive Pulmonary Disease; Chapter 20, Nutritional Requirements
Following Cancer Treatment/Surgery; and Chapter 27, Nutrition in Chronic Renal Disease and Renal Failure.
A few other quibbles: The high prevalence of vitamin B12
deficiency in the elderly population is mentioned in several
chapters but none recommend that clinicians routinely screen
older patients for this vitamin deficiency. I also did not note
acknowledgment that many individuals with low serum B12
levels have no apparent neurological or hematological abnormality, nor was there any discussion of the need for, or ethical
appropriateness of, a randomized controlled trial of treatment
versus no treatment of such individuals. Two statements in
Chapter 5 concerning peripheral parenteral nutrition (PPN)
that, the provision of adequate fat is precluded by the requirement for lower osmolarity. This renders PPN inadequate
to sustain long-term energy requirements. are both incorrect.
In the same chapter, the contention that mucosal atrophy
leading to bacterial translocation is a source of morbidity
following prolonged periods of total bowel rest is not nearly as
evident in humans as the authors suggest.

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PRINT AND MEDIA REVIEWS

Bottom Line: A useful book with many excellent chapters

appropriate for health professionals, policy makers, and others
interested in disease prevention or in care of older patients.

WILLIAM D. HEIZER, M.D.

Division of Gastroenterology and Hepatology
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Diet and Human Immune Function.Edited by David A. Hughes,
L. Gail Darlington, Adrianne Bendich. 488 pp. $145.00.
Totowa, New Jersey, Humana Press, 2003. ISBN 1-58829206-1. Web address for ordering: www.humanpress.com
This book provides an excellent overview of the complicated
field of nutrition and immune function. The primary audience
for this book would be nutritionists interested in the area of
immunology. Written at a basic level, scientists trained in
immunology might find the book too superficial, although it
would provide a good starting point from which immunologists might gain insights into how to incorporate host nutritional status into their studies.
The book begins with an overview on the basics of immunology, followed by a chapter discussing the methods used to
assess the human immune response. This is important information for the non-immunologist to have to understand the
later chapters that delve into the specifics of nutritional effects
on the immune response. Although these chapters are easily
understood, it would have been helpful for the authors to
include diagrams/figures that would help orient the novice to
the complexity of the immune response. Following the general
introduction chapters, 3 additional overview chapters are provided to discuss the effects of infection on nutrition and
immune status, and the effects of nutrition on the immune
status of the neonate and the elderly. These are important
chapters, for they remind the reader that the results of nutritional studies utilizing adult populations may not translate
into younger or older populations.
Following the overview, the book is organized into 4 sections: vitamins and immune responses, minerals and immune
responses, nutrition, immunity and disease, and environmental
stressors. Both the vitamin and mineral sections are well
described. Particularly nice are the chapters that include diagrams of immune function that help to explain the nutritionalimmune interactions (e.g., Figure 1 in the Iron chapter). The
inclusion of a chapter on the effects of multivitamin supplementation was an excellent idea. Many studies report single
nutrient interactions with the immune response, but clearly
multiple vitamin (and mineral) interactions are closer to the
real world, where individuals often take multivitamin and
mineral supplements.
In the Nutrition, Immunity and Disease section, the editors
chose to focus on rheumatoid arthritis, osteoporosis, HIV,
probiotics, and dietary fat and cancer. Although the editors
clearly had to limit the amount of material they could include,
perhaps selection of additional models might have more inter-

GASTROENTEROLOGY Vol. 127, No. 5

esting and illustrative. For example, inflammatory bowel disease is an area of high research interest with regard to nutritional effects on immune modulation of this disease. In
addition, the chapter on dietary fat should have included a
discussion of the role of lipid rafts and their modulation by
dietary fat. This is in area of intense research interest, particularly because many immune receptors require lipid rafts for
their function.
The final section, Environmental Stressors, includes chapters
on the effects of exercise, air pollution, drugs, and undernutrition in the context of military training. These sections add
a unique component to this book, and demonstrate that the
effects of nutrition on the immune response may be different in
the context of these other stressors.
All of the chapters in this book, with the exception of the
introductory one, have a take-home message section that
provides key points delivered in short bullet summaries. This
is quite helpful in summarizing the overall intent and highlights of the chapter. Although a different author(s) wrote each
chapter, in general, the writing style is easy to read and
comprehend. The tables and figures provided are helpful,
although as mentioned previously, more descriptive figures
would have increased the usefulness of this book.
Overall, this book does a good job of reaching its target
audience, and will be useful both for nutritionists, physicians
who are interested in understanding the relationship between
diet and immune function, as well as immunologists who want
to delve into the area of nutrition. It provides enough detail for
researchers to get a handle on the field, but provides the
information in a clear and easily understandable way. The
influence of diet on immune function is a rapidly expanding
field as more and more research is carried out in this area.
Because nutritionists do not often learn immunology, and
because immunologists and infectious disease specialists do not
often study nutrition, Diet and Human Immune Function serves
a basic primer in this area and provides both specific references
and related books and websites for the reader who wishes to
study further.
Bottom Line: A basic primer on diet and immunity.

MELINDA A. BECK, Ph.D.

School of Medicine
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Molecular Pathogenesis of Cholestasis.Edited by Michael Trauner
and Peter L.M. Jansen. 379 pp. 135.00. Dordrecht, The
Netherlands: Kluwer, 2003. 2ISBN 0-3064-8240-1. Web address for ordering: www.wkap.nl
This book has the stated aim to provide a cutting-edge
overview on the molecular pathogenesis of cholestasis. To
achieve this aim, the editors solicited 25 chapters from colleagues who have contributed to the explosion of new information and concepts in hepatocellular and cholangiocytic
transport and their impairment in cholestatic disease.