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magnesium, iron, copper, zinc, chromium, selenium, fluoride,iodine, and several other trace minerals. The potential foralcohol, illicit drugs, and cigarette smoking to impair mineralhealth also is evaluated.

The chapters in Part V (“Drug-Nutrient Interactions by LifeStage”) examine drug-nutrient interactions as they may changeduring life. The review of interactions during infancy and child-hood emphasizes the need for precision in dose prescription.The reader is reminded that the physical effect of a drugwhen in contact with infant formula or foods is an importantconsideration in efforts to avoid adverse drug-induced reac-tions. Potential interactions between drugs and herbal dietarysupplements in the young also are introduced. The review ofdrug-nutrient interactions during pregnancy and lactationconsiders placental transfer of drugs, drug effects on theembryo and fetus, expansion of maternal plasma volume,changes in maternal endocrine status, effects of drugs onmaternal appetite, nutrient absorption and renal function,effects of drugs on milk production, and the transfer of drugsto breast milk. Most of the discussion of drug-nutrient interac-tions in the elderly is confined to the final chapter in Part V.Older individuals may be at greater risk for experiencing suchinteractions because nutrient absorption, metabolism, andexcretion commonly decrease in those over 65 years of age,independent of drug status. The troubling issue of increasingreliance on polypharmacy is addressed.

The final part of the book (“Drug-Nutrient Interactions inSpecific Conditions”) examines the problem of drug-nutrientinteractions from the perspective of individuals with chronicdiseases or other special needs. The chapter on the nutritionaleffects of drugs onpatientswith cancer reflects theneed for sensi-tivity to the often precarious health balance being maintained bypeople with cancer. The unique needs of individuals followingorgan transplantation, individualswith immunesystemdisordersor chronic infections, and the impact of medications on theirnutritional health also are discussed. In particular, the changingnutritional impacts of the replacement of older drugswith neweragents to treat human immunodeficiency virus infection andtuberculosis are emphasized. This part of the book also containsa comprehensive overview of the human immune system, theeffects on the immune system of deficiencies in specific essentialnutrients, the effects of major diseases on the immune system(especially the autoimmune diseases, rheumatoid arthritis, type1 diabetes, and lupus), drugs used to treat immune systemdiseases, and disease-drug-nutrient interactions. The importanceof dietary supplementation with prebiotics and probiotics is dis-cussed in the context of autoimmune diseases of the GI tract.

Despite the complexity of the interactions among thehealthy and unhealthy human body, pharmaceuticals, andnutrition, the editors and authors of Handbook of Drug-Nutrient Interactions, Second Edition, have produced a text thatbalances extremely technical information with practical advice.As written in the “Foreword” by Gil Hardy, Ph.D., of the Univer-sity of Aukland, New Zealand, “Rational drug or nutritiontherapy requires a management plan based on the correct inter-pretation of the symptoms and knowledge of the physiologicalaction of the remedy.the physician must be aware of thepotential for both drug-drug and drug-nutrient interactionswithin the environmental, genetic and disease-related con-text.As a researcher and a teacher, I particularly appreciatethe accessibility and logical simplicity of this referencetext.The editors have performed an outstanding service toclinical pharmacology and pharmaconutrition.” The Handbookof Drug-Nutrient Interactions, Second Edition, provides health

care professionals in all areas of practice, research, and educa-tion with a powerful resource. All nutritionally-conscioushealth care professionals should have ready access to thiscompendium.

Michael J. Glade, Ph.D.Skokie, Illinois, USA

doi:10.1016/j.nut.2010.08.006

Preventive Nutrition: The Comprehensive Guide for HealthProfessionals, 4th Edition. Adrienne Bendich, Ph.D., andRichard J. Deckelbaum, M.D., eds. Humana Press, Totowa,New Jersey, 2010. ISBN: 978-1-60327-541-5 (hardbound);978-1-60327-542-2 (electronic).

According to the editors, the overriding driver for the timingof this 4th edition of Preventive Nutrition: The ComprehensiveGuide for Health Professionals was the publishing of the resultsfrom the Women’s Health Initiative (WHI), the largest placebo-controlled intervention study of postmenopausal women everundertaken. Two new chapters in this edition are devoted tothe presentation of the findings of this study. The dietary fatmodification component of the WHI examined outcomes forcoronary heart disease, breast cancer, and colorectal cancer,while the calcium and vitamin D arm evaluated risks for osteo-porotic fractures and colorectal cancer. Several other new chap-ters expand the scope of this 4th edition, including chapters onthe impact of human immunodeficiency virus (HIV) infectionon nutritional status, econutrition, cancers of the female andmale reproductive systems, the roles of micronutrients in sup-porting cognitive brain functions, and the relationships of nutri-tional practices to psychiatric health. In addition, there are fournew chapters reflecting the increasing interest in obesity anddiabetes, gastric acid physiology, and the nutritional conse-quences of the recent epidemic of proton pump inhibitor abuse,a chapter describing the role of the food industry in preventivenutrition, and a concluding chapter specifically written for prac-ticing health care providers that suggests a number ofapproaches that can facilitate the adoption of permanent benefi-cial dietary changes by their patients and clients.

The first section on “Global Issues” presents a synthesis byDr. Walter Willett of the results of over 100 epidemiologic andintervention studies that provide the basis for a positive publichealth perspective on the importance of preventive nutritionstrategies. The new discipline of econutrition, the study of foodinsecurity, undernutrition, and agrodiversity, is introduced. Thefinal chapter in this section examines the potential effects ofdrugs on nutritional status and nutrient absorption, metabolism,and excretion. This encyclopedic chapter, with more than 300publication citations, contains tables with practical listings ofinteractions between drugs and food intake and disposition,body weight, glucoregulation, and vitamin and mineral status.

The second section of the book (“Cancer Prevention”) exam-ines the importance of preventive nutrition to primary andsecondary cancer prevention. The chapter on diet and childhoodcancers updates the presentation in the first edition and suggeststhat multivitamin use during pregnancy can reduce the inci-dence of childhood leukemia and brain tumors. The results ofvirtually all of the epidemiologic studies of maternal diet,supplement use, and major childhood cancers published priorto 2010 have been tabulated. Gastric and esophageal cancers

Book reviews / Nutrition 26 (2010) 1207–1210 1209

are closely related to lifestyle factors, including alcohol andtobacco use; chronic consumption of very hot liquids; salted,pickled, and smoked foods; obesity; andHelicobacter pylori infec-tion, and are discussed in a comprehensive chapter that includesover 200 reference citations. The next chapter reviews the rela-tionships to breast cancer of genetics, lifestyle factors, obesity,physical activity, female hormone status, insulinemia, and die-tary components, including plant-based phytonutrients and phy-toestrogens. The next chapter summarizes the many dietaryfactors that have been associated with decreased risk of prostatecancer, including tomatoes, tomato carotenoids, vitamin E, andselenium. This chapter also discusses dietary fats, soy foods, phy-toestrogens, dairy products, vitamin D, calcium, zinc, and crucif-erous vegetables. The last chapter in this section reviews the useof dietary supplements (e.g., b-carotene, vitamin C, vitamin E,selenium, calcium, folic acid, and multivitamins) and their asso-ciationwith reduction in the incidence of most cancers as well astheir association with increased risk in self-induced highlyoxidizing physiologic environments.

Cardiovascular and cerebrovascular diseases are the focus ofthe third section (“Cardiovascular Disease Prevention”). For thepast 50 years, the consumption of long-chain u-3 polyunsatu-rated fatty acids (u-3 PUFA) has been associated with reducedrisk for developing cardiovascular disease. The potential mecha-nisms producing this risk reduction include anti-inflammatory,antiarrhythmic, and antiproliferative actions at the cellular leveland beneficial alterations in circulating triglyceride concentra-tions. This chapter contains a detailed description of the effectsof u-3 PUFA on lipids, lipoproteins, triglycerides, apolipopro-teins, and their turnover and metabolism. The next chapterdescribes the adverse effects of trans-fatty acids on the cardio-vascular system. Found in foods that contain hydrogenated oilsor fats that were subjected to hydrogenation during processing,trans-fatty acids impair lipid metabolism, lipoprotein resistanceto oxidation, platelet regulation, inflammatory responses, andendothelial functions. Excellent figures complement the text.The next chapter reviews the contributions of antioxidants andthe B-vitamins to the prevention of atherosclerosis, the majorcause of cardiovascular disease and the direct result of oxida-tively induced arterial inflammation. The final chapter in thissection examines the roles of the B-vitamins, especially folate,vitamin B6, and vitamin B12, in the prevention of cognitivedecline and vascular dementia.

All five chapters in the section on “Diabetes and Obesity” arenew to this edition. One of the motivating events that triggeredthe development of this 4th edition of Preventive Nutrition: TheComprehensive Guide for Health Professionalswas the terminationof the WHI. Although it was not planned as a study of diet andobesity, 38% of the women in the study were obese and another36% were overweight. The chapter that describes theWHI and itsfindings was written by WHI investigators and provides discus-sions of the difficulties that can be experienced when enrollinga large number of subjects and while attempting to sustain theirenthusiasm for participating in a clinical trial lasting 9 years. Thefigures and tables included in the chapter are excellent resourcesand this chapter serves as an important introduction to the nextfour chapters that explore diabetes and obesity.

The first of those chapters provides a detailed description ofthe development of diabetes, with an overview of carbohydratemetabolism, insulin resistance, guidelines for the diagnosis ofprediabetes, the metabolic syndrome, and type 2 diabetes. Thisintroduction is followed by the presentation of nutritional strat-egies for the treatment of prediabetic state and the prevention ofdiabetes. The findings from studies that varied dietary fat and

carbohydrate proportions, relied on drugs, altered the types offats that were fed, or altered the types of carbohydrates thatwere fed are reviewed from a critical perspective. The relativeimportance of gene-environmental interactions is assessed.Nutritional guidelines for normalization of insulin secretion areprovided.

The next two chapters in this section discuss the biology ofobesity and the growing problem of obesity in developing areasof the world. The significant interactions between white adiposetissue-originating adipokines (e.g., leptin, adiponectin, resistin,visfatin, and adipsin) and immune cells and cytokines involvedin the stages of inflammationand the consequencesof these inter-actions (e.g., inflammation-mediated dysregulation of insulinsynthesis, insulin resistance, type 2 diabetes) are described. Thenext chapter concerns the interactions between transitions indiets and foodavailability,work environments, political priorities,and health outcomes. The final chapter in this section reviews theconsequences of national initiatives to reduce obesity and cardio-vascular diseases by altering the types of fats that are consumedthrough taxation and other government programs.

The fifth section of the book (“Prevention of Major Disabil-ities: Improvement in Health Outcomes”) examines nutritionalstrategies for the prevention of osteoporosis, spontaneous bonefractures, gastric acid dysfunction, age-related eye diseases,and immune depression in the elderly. The findings from theWHI are placed in perspective and drug-induced alterations innutrient status are discussed. Another chapter describes thephysiology of the stomach, gastric acid secretion, and the effectsof hypochlorhydria on the absorption of essential nutrients. Theimportance of this new chapter is underscored by epidemiologicdata that demonstrate that the prevalent overuse of gastric acid-suppressing drugs may be contributing to increased risks forfractures and infections.

The development of cataract and age-related macular degen-eration, the role of nutrients (including carbohydrates) in theprevention of disease progression, and the lifestyle factors thataffect disease risk are examined in depth. The importance ofessential micronutrients in maintaining and enhancing immuneresponses in the elderly and the impacts of essential micronu-trient deficiencies are outlined. These chapters highlight theimportance of public health initiatives that increase sanitation,access to clean water, education, and economic security in addi-tion to food security.

A new chapter emphasizes the consequences of HIV infec-tion on nutritional status in well-fed and underfed individuals.Most of the data that form the basis for this chapter werecollected in Africa, where over half of all HIV-infected personslive. The facilitative role of undernutrition in the progression ofHIV infection, the effects of antiviral therapy on nutritionalstatus, and the gastrointestinal pathophysiology of AIDS areemphasized. This chapter also explores the effects of HIV infec-tion in women of childbearing potential who become pregnantand breast feed their infants (especially in Africa where infantfood choices may be limited). There also is a balanced reviewof the nutritional benefits and potential risks of antiretroviraltherapies, an examination of the results of studies in womenand children, and a review of ongoing programs that imple-ment a comprehensive team approach that addresses foodinsecurity, disease prevention, care of the HIV-infected patient,and disease treatment.

In the next section (“Optimal Pregnancy/Infant Outcomes”),an updated chapter continues to document the reductions inthe incidences of neural tubedefects, cardiovascular birth defects,cleft lip, limb reduction, and renal deformations that have

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followed the increased appreciation for the value of micronu-trients in improving pregnancy outcomes. New data concerningthe reduction in preterm births to women who have taken folicacid-containing dietary supplements are included. This updatedchapter is of great relevance because, for reasons unrelated tonutrition, the rate of preterm births continues to increase in theUS. The impacts of maternal nutritional status, especially energyundernutrition, deficiencies of iron, zinc, folate, calcium,u-3 fattyacids, cigarette smoking, or, paradoxically, maternal obesity, onthe risks for preterm birth or low birth weight are evaluated.Another newchapter covers prenatal nutrition and its associationwith adult mental health and documents the importance ofmaternal nutrition periconceptually and during the intervalsbetween pregnancies. For example, the results of epidemiologicstudies have linked severe maternal undernutrition during preg-nancy to the development of adult schizophrenia in offspring. Ananalysis of the data from the Dutch and Chinese famines is pre-sented that indicates that severe prolonged malnutritionincreases the incidences of neurodevelopmental disorders,including addictions and psychiatric disorders, in children,adolescents, and adults.

The unique final section of Preventive Nutrition: The Compre-hensive Guide for Health Professionals (“Nutrition TransitionsAround the World”) includes informative chapters detailingnutritional transitions in Latin America, Asia, and Africa. Fromthese reviews it is clear that obesity is of increasing concern inall developing countries and there are significant increases inthe incidence of childhood obesity as economies move throughthe transition from food scarcity to food abundance. The leastdeveloped countries suffer the double burden of coincidingmalnutrition and overconsumption and are little able to address

either challenge. However, some progress has been achieved inseveral of the “developing countries.” The two final chapters ofthis section (and of the book), new to the 4th edition, examinethe role of food companies with global reach in shaping thenutritional status of populations in economic transition andpoverty. These chapters reveal the critical importance of reach-ing the Millennium Development Goals of eradicating extremepoverty and hunger and provide readers with examples of previ-ously successful strategies. The last chapter reviews the impor-tance of educating health care providers about preventivenutrition strategies so that countries in transition can receivethe full benefit of the consequent health improvement. Finally,this chapter suggests methods for integrating preventive nutri-tion into overall clinical preventive services provided by anyhealth care professional.

Altogether, Preventive Nutrition: The Comprehensive Guide forHealth Professionals contains over 120 tables, graphs, and figures,more than 4000 reference citations, and a highly annotatedindex. This new edition will serve the reader well in guidingunderstanding of the complex interrelationships among nutri-tional status, organ system functioning, health status, age, sex,public health initiatives, and drug-nutrient interactions. In addi-tion, the interactions between genetic and environmental factorsand with existing comorbidities are delineated clearly and inways that can facilitate the successful integration of preventivenutrition into healthier lifestyles.

Michael J. Glade, Ph.D.Skokie, Illinois, USA

doi:10.1016/j.nut.2010.08.007