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Clinical Nutrition: Parenteral Nutrition 3rd ed.

Department of Human Nutrition and Food Science, California State Polytechnic University, Pomona and, GI Motility Program and Section of Nutrition, Cedars-Sinai Medical Center, Los Angeles

Clinical Nutrition: Parenteral Nutrition 3rd ed. edited by John L. Rombeau, MD, Rolando H. Rolandelli, MD, eds. Philadelphia: W.B. Saunders, 2001.

This edition updates advances in the continually evolving field of parenteral nutrition (PN) since the previous edition was published in 1993. This will be Dr. Rombeau’s final version of this text as editor; he has overseen this work from inception in 1986 to now and has directed the content to provide practical, state-of-the-art information on parenteral nutrition. The editors and the authors, from trauma physicians to pharmacists and dietitians to nurses, are personally involved in some aspect of nutrition and metabolism and provide unique perspectives on the topic. Information is consolidated under single topic headings where practical and, where a more thorough treatment warrants it, separated into distinct chapters for in-depth discussion.

While the treatment of parenteral nutrition is encyclopedic, the organization of the material is somewhat random. The early chapters meander topically, from history to metabolism in illness to requirements for lipids and trace elements to assessment to site access to parenteral formulas, and the remaining topics are not presented more logically. However, this work is intended not as a teaching text but as a comprehensive reference, so these minor organizational flaws do not detract from the information content or overall usefulness of the text.

The opening discussion of the history of clinical human nutrition, including parenteral nutrition, is a fascinating treatise that sets the background for the remainder of the text. The treatment of micronutrient deficiencies related to chronic PN is comprehensive and addresses the general issue very thoroughly. Since micronutrient interactions are increasingly receiving attention in human nutrition, it would have been useful to include more information on micronutrient interactions within the bag or within the body. Rather than group detailed information on specific deficiencies by disease, the editors chose to place this material in each disease-specific chapter so the reader could more easily locate the relevant information.

The classic applications of PN, from perioperative nutritional support to inflammatory bowel disease and short bowel syndrome, are well researched and reported. In addition, the role of PN in providing nutritional support to patients with a variety of metabolic diseases and other conditions is covered in great detail, making this text an essential reference for the metabolic support practitioner. One curious omission is the role of PN in ameliorating the effects of cancer cachexia or digestive tract cancers. One is left with the feeling that treatment of patients with these disorders is deemed medically futile.

The chapter on bone metabolism is comprehensive and well written, yet seems oddly out of place in this text. There is little mention of why bone metabolism is an important issue in the setting of parenteral nutrition. Does PN contribute to bone demineralization, or can bone demineralization be treated with PN?

The chapter on effects of PN on the small intestine is a fascinating review of current issues in maintaining the mucosal barrier to bacterial translocation. It would have been good to see a discussion of the role of dietary fat and gastrointestinal neuropeptides in intestinal adaptation. A more thorough and critical evaluation of clinical studies and therapeutic applications would have strengthened this already sound chapter.

The obese patient is typically overlooked when discussing nutritional support, even though these patients compose up to one third of the inpatient population. The chapter on the roles of PN in treating obesity and comorbid conditions provides excellent perspectives, from social aspects to metabolic corrections for estimating energy needs. The discussion of PN as an adjunct to reducing diets provides a clinical background for the insights into practical considerations like formula composition and delivery. The chapter also includes a thorough review of the constellation of risks peculiar to this patient population.

To their credit, the editors have included several chapters devoted to patient-centered issues. There is a comprehensive treatment of the issues surrounding home parenteral nutrition, including a separate chapter on financial issues. The text concludes quite fittingly with a discussion of ethical issues in parenteral nutrition.

In summary, Clinical Nutrition: Parenteral Nutrition is a comprehensive collection presenting the state-of-the-art parenteral nutrition knowledge for the next decade. Each chapter contains detailed reviews of the supporting science and clinical studies as well as discussions and interpretations of the practical applications of PN in the topical area. Health care professionals who work with patients that require PN, as well as medical faculty teaching nutrition and metabolism, should consider acquiring this volume to expand their medical or metabolic support libraries.

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