Artificial Nutrition and Support in Clinical Practice

This 2001 textbook is a source of information for the formation of a clinical nutrition support service of excellence.

The practice of enteral and parenteral nutrition support has evolved significantly in recent years, in response to an increasing number of basic, preclinical, and clinical investigations in the field. This text by Payne-James et al. provides a comprehensive, practical, and state-of-the-art textbook that should be useful to multidisciplinary health care personnel (physicians, dietitians, pharmacists, and nurses) involved in the clinical diagnosis and the treatment of nutritional disorders in hospitalized and home patients, as well as patient-orientated investigators in this field. Although the trust of the book is primarily concerned with specialized nutrition support in clinical care and in specific disease states, other chapters provide basic and translational information on nutritional physiology and pathophysiology that will be useful to medical students, doctoral students, and postdoctoral trainees interested in nutrition science. The book is well organized; all chapters are written by acknowledged figures in nutrition support and nutrition/metabolism, and the majority of the chapters provide clear and useful tables and figures. The first 7 chapters outline general concepts of energy and protein metabolism in physiologic and specific pathophysiology situations. Subsequent chapters review both the prevalence and the consequences of malnutrition in hospital patients. These sections are followed by comprehensive reviews on the indications for specialized nutrition support, techniques of enteral and parenteral nutrient delivery, nutrient formulations, and complications of enteral and parenteral nutrition that are clearly outlined, with little repetition. One particularly well-done and practical chapter highlights methods and efficacy of oral diet administration and oral supplements in the hospital and postacute care setting. The latter and most extensive section of the book addresses altered nutritional needs and the role of specialized feeding for patients with specific diseases, including inflammatory bowel disease, short bowel syndrome, pancreatitis, cancer trauma, and sepsis. Specific requirements and administration techniques for children are explained in two excellent and concise chapters. The overall style is clear, concise and easy to read. One weakness is that subsections of several chapters deal with the subject matter of entire independent chapters. However, the editors have generally done a good job in limiting repetitions; in a book dealing with a specialized topic, some repetitions are unavoidable. For example, the chapter on malnutrition in hospitalized patients provides information supplied in the chapters on enteral nutrition, supplement use, and nutrition for patients in intensive care units. Similarly, much of the information about the prevalence and consequences of malnutrition in hospital patients in this chapter is repeated again in the chapter on the cost and effectiveness of nutrition support. Another minor problem is the inconsistent use of energy units (kilojoules vs kilocalories) in some chapters. The chapters tend to follow a consistent format, often beginning with a historical background, followed by the particular metabolic and physiologic alterations observed in the specific disease, a discussion on the experimental and clinical approaches to the nutritional treatment, and, finally, practical guidelines for the daily nutritional treatment of those patients (determined from both evidence-based data and the author's experience). Most chapters contain tables, figures, and/or algorithms that provide additional information, including summaries of relevant published studies and useful clinical guidelines. The chapter on nutritional support for patients with cancer is especially good in this regard. It includes a comprehensive discussion on what is known concerning metabolic changes caused by tumors themselves and by oncologic therapy, with many clarifying tables and figures. In addition, the different approaches to providing nutritional support to these patients are presented didactically, with an understanding discussion on the dilemma of nutritional support for terminal patients. Similarly, the chapters on nutritional support for