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Book Review |
Department of Human Nutrition and Food Science
California State Polytechnic University and Department of Molecular Medicine
City of Hope National Medical Center & Beckman Research Institute
Pomona, California
Usha Ramakrishnan, ed. Boca Raton, FL: CRC Press, 2000.
Nutritional anemias are prevalent in developing countries, although nutritional anemias persist in even the most developed countries. Thus, Nutritional Anemias is a timely addition to the CRC Series in Modern Nutrition. The text is well organized thematically, moving from an historical background through etiologies and life cycle issues. Anemia is often difficult to define accurately, and the etiology may be indeterminate due to the multifactorial nature of the problem. This text provides good insight into the complexities of anemia, from diagnosis to impact on lifestyle. The public health policy issues of supplementation, fortification and food-based approaches to correcting nutrient deficiencies are addressed in detail.
The book is divided into three parts: epidemiology and assessment, functional consequences and therapeutic strategies. The first chapter establishes the historical backdrop for detection and treatment of anemias. The second and third chapters tackle the definition, etiologies, prevalence and assessment of nutritional anemias. Although soundly written, these chapters would be enhanced by a review of the nutritional biochemistry of erythropoiesis, including mineral-mineral interactions and flow diagrams of the assessment process for anemias. A more detailed treatment of the analyses for iron status would help the non-clinical reader understand better the clinical assessment process. A future edition would be more satisfying to the researcher or clinician were it to discuss the differential diagnosis of nutritional and pathological anemias and the interaction of anemia with generalized malnutrition secondary to hunger or disease.
The second part of the book addresses the functional consequences of nutritional anemias throughout the life cycle, from pre-natal issues to adulthood. However, because the prevalence of anemia in some elderly populations approaches that of type 2 diabetes, the reader is regrettably left to wonder if there are additional or exacerbated functional consequences for the geriatric population. Apart from this minor omission, the chapters on functional consequences are valuable.
The last part of the book addresses the pros and cons of public policy implementation to reduce the prevalence of nutritional anemias. Three excellent chapters present the benefits and pitfalls of supplementation, fortification and food-based approaches to improving the nutrition of a population, and one addresses the role of preventing intestinal infections in improving anemias. The main problem with this part is the omission of recent experiences with folate fortification of grain products around the world, any of which would make an important case study. However, given the length of the publishing cycle, the authors cannot be faulted for this, as results of long-term studies have only begun to be published in the last few years.
Nutritional Anemias is a significant source of information about anemias throughout the life cycle, although there is some repetition and there are some issues which might have been considered. The book is compiled with a definite slant towards public health issues—the last two-thirds of the book address functional life issues and therapeutic measures mainly from the policy and public health perspective. Although this text is intended as a resource for researchers and clinicians as well as public health professionals, it is better suited in its current form to the public health practitioner and policymaker.
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