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Offering a textbook for nutrition courses during the pre-clinical years, this work discusses the physiologic and metabolic interrelationships of all nutrients and their role in health maintenance, as well as the prevention and treatment of various diseases.
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Department of Surgery Wayne State University School of Medicine Detroit, Michigan
MARCEL DEKKER, INC. NEW YORK BASEL HONG KONG
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Library of Congress Cataloging-in-Publication Data
Sardesai, Vishwanath M., Introduction to clinical nutrition / Vishwanath M. Sardesai. p. cm. Includes index. ISBN 0-8247-9865-1 (acid-free paper) 1. Nutrition. 2. Dietetics. 3. Diet therapy 4. Nutritionally induced diseases. I. Title. [DNLM: 1. Nutrition. QU 145 S244i 1997] QP141.S332 1997 612.3--dc21 DNLM/DLC for Library of Congress97-42393 CIP
The publisher offers discounts on this book when ordered in bulk quantities. For more information, write to Special Sales/Professional Marketing at the address below.
This book is printed on acid-free paper.
Copyright 1998 by MARCEL DEKKER, INC. All Rights Reserved.
Neither this book nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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Current printing (last digit):
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PRINTED IN THE UNITED STATES OF AMERICA
Page iii
PREFACE
It is impossible to overestimate the tremendously important role that nutrition plays in the maintenance of human health, longevity, and community well-being. Dietary factors have been implicated in the etiology of at least four of the ten leading causes of death in the United States: heart disease, cancer, diabetes, and stroke. Nutrition is also crucial in many of the currently common problems such as obesity, hypertension, hypercholesterolemia, and osteoporosis. Since the advent of parenteral nutrition in clinical medicine, there has been renewed interest in nutrient requirements, especially the changes associated with bypassing the gastrointestinal tract.
Interest in nutritional information is not confined to the medical profession. Public interest in the subject is more evident today than ever before. Most individuals regard their physicians as the primary source of such information, yet in a recent extensive study of office-based primary care physicians, 68% stated that they had received inadequate nutritional training in medical school, and 86% indicated that more nutritional information should be taught as part of the basic medical curriculum.
Because doctors are admittedly not being trained to give adequate advice in this critical field, their patients have turned to unqualified, unregulated,
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self-claimed experts in nutrition. This has caused a tremendous increase in food faddism and outright fraud. A report by the Surgeon General stated that nutrition fraud is the leading example of health fraud at the present time.
In 1985 the Committee of the Food and Nutrition Board of the National Academy of Sciences was commissioned to evaluate the status of nutrition training and education of the nation's physicians. Its report stated that Nutrition education programs in U.S. medical schools are largely inadequate to meet the present and future demand of the medical profession. The Committee recommended that nutrition be a required course in every medical school in the United States and that a minimum of 25 classroom hours be devoted during preclinical years to the teaching of basic nutritional material. The National Nutrition Monitoring and Related Research Act of October 22, 1990, mandated that Students enrolled in U.S. medical schools, as well as physicians practicing in the United States, have access to adequate training in the field of nutrition and its relationship to human health.
Many medical schools have started to increase the number of hours for nutrition education, but a common concern among medical educators is how to teach all the materials currently known in the already overcrowded, information-dense curriculum. Another problem is the lack of a suitable nutrition textbook that covers, in sufficient detail, all topics of importance to medicine, and that focuses on the interaction of nutrition and disease. For example, to understand the significance of topics such as essential fatty acids, eicosanoids, and detoxication, both pertinent biochemistry and nutritional aspects have to be in one place.
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