Abstract
This remarkable short textbook does exactly what its title promises, i.e. it provides an overview of ‘The Principles and Practice of Nutritional Support’. The author is a senior clinical academic gastroenterologist, with over 30 years of experience both in nutritional research and the provision of nutritional support to a wide range of patients. He is therefore uniquely well qualified to write this single-author textbook – quite a rare feat in these days of super-specialization and rapidly produced multi-author collections of short monographs. One strength of this approach is a strong narrative style, and a sense of the author as teacher: a downside is an inevitable occasional tendency to promote personal opinion.
The book divides into three sections. The first, and perhaps the most interesting to all clinical biochemists is entitled ‘The Principles’. Potentially rather dry material on cell biology and nutritional physiology is presented in a way that is readily digestible by the reader. I particularly enjoyed the analogy of the malnourished body to a car engine, where nutritional depletion impairs the function of the spark plugs (proteins and micronutrients), engine (proteins, vitamins, mitochondrial function, etc.), chassis (structural proteins and minerals) and grease for the wheels (fluids and electrolytes) and flooding the engine with fuel causes the re-feeding syndrome. Upon this sound basis is built a description of the metabolic pathophysiology of illness and the principles of nutritional support, all in the same intelligent conversational style. The author clearly went to medical school before the modern vogue for problem-based learning! The text is interspersed throughout with pertinent and interesting photographs, figures and tables. The extensive references are wide-ranging and up to date (ranging from 1753 to 2015), including many that attest to the author’s own important contributions in the field.
I would recommend the second section ‘The Practice’ as a general introduction to clinical practice for any trainee beginning a clinical placement with a multidisciplinary nutrition team. Enteral and well as parenteral feeding techniques are covered, together with a substantial chapter on Home Parenteral Nutrition (HPN). Not all the material in this section, however, is consistent with standard UK practice, and there is very little detail on the assessment of nutritional requirements, monitoring of micronutrient status or management of line infection, so the book is no substitute for clinical experience supplemented by further reading.
The final section outlines the effect of diseases that affect the digestion, absorption and assimilation of nutrition (e.g. intestinal failure, pancreatitis and liver disease). A description of the complications of bariatric surgery is particularly salutary (including a patient who survived bowel ischaemia, was supported using HPN, received a successful small bowel transplant and again became obese!). The final chapter addresses the under-recognized topic of malnutrition and nutritional support in the elderly.
At just 241 pages, this book is a quick read over few days. As someone with many years’ experience working with nutrition teams, I found it an enjoyable refresher, and I will certainly recommend it to trainees as a rapid introduction to this important part of the chemical pathology and metabolic medicine curricula.