Book Review

Nutrition in Women's Health

N Engl J Med 1996; 334:1481-1482May 30, 1996

Article

Nutrition in Women's Health
By Debra A. Krummel and Penny M. Kris-Etherton. 582 pp. Gaithersburg, Md., Aspen, 1996. $49. ISBN: 0-8342-0682-X

For the first time, the most recent dietary guidelines for Americans focus on the interactive roles of exercise and diet in health promotion and disease prevention. The Joint Commission on Accreditation of Healthcare Organizations now requires health professionals to provide nutritional intervention, to recognize the importance of drug–nutrient interactions, and to educate patients about diet and health. Not surprisingly, Nutrition in Women's Health fills a tremendous void in the field of nutrition medicine.

The book is written by highly qualified nutritionists for practicing nutritionists and other health care professionals. Thanks to the comprehensive references and index, it can also serve as a textbook for medical students and physicians, who find themselves answering more and more queries from patients about nutrition. The extensive tables, charts, and figures are handy references for counseling patients and outlining the status of current research.

The first section addresses nutritional issues important throughout the life cycle. The chapters dealing with adolescence, pregnancy, and aging are excellent. The second section covers the role of nutrition in preventing chronic diseases of particular concern to women: obesity, cardiovascular disease, osteoporosis, diabetes, and cancer. It offers superb resources for the education and treatment of patients. The final section is a comprehensive report on women's health research at the National Institutes of Health, including the Women's Health Initiative. The chapter on menu planning for women takes into consideration the need to increase nutrient density and lower caloric intake through the intake of small portions of predominantly plant-based foods. Throughout the book, the editors amply support the argument that the unique genetics and metabolism of women dictate sex-specific nutritional needs. However, much of the information and advice given is applicable to both men and women, allowing the book to work as a general nutrition reference.

The editors, who are experts in the field of cardiovascular disease, thoroughly review the prevalence, risk factors, prevention, and treatment of America's number-one killer. Studies published as recently as 1994 were examined, a rare feat for such a broad, multiauthored work. The editorial effort itself merits commendation. The chapters are uniformly well written and illustrated. Remarkably, little author bias can be detected in the book, with the possible exception of the chapter on diabetes. Here, a point is raised about the liberalization of the American Diabetes Association's Dietary Guidelines for the Diabetic; the author notes that, for patients with non-insulin-dependent diabetes, a high-carbohydrate, low-fat diet can result in persistently elevated plasma triglyceride and very-low-density lipoprotein concentrations, depressed high-density lipoprotein cholesterol concentrations, hyperinsulinemia, and reduced glycemic control. Thus, the plan recommended for diabetes management emphasizes an individualized diet based on metabolic status and lifestyle requirements.

In a time of comprehensive disease management, physicians must be confident in both their use of applied nutrition and patient counseling. Until medical education catches up with progress in nutrition research and public health initiatives, books such as Nutrition in Women's Health will be essential to meeting the national objectives set forth in Healthy People 2000.

George L. Blackburn, M.D., Ph.D.
Harvard Medical School, Boston, MA 02115