Book Review

Nutritional Concerns of Women

N Engl J Med 1997; 336:1111-1112April 10, 1997

Article

Nutritional Concerns of Women
(Modern Nutrition.) Edited by Ira Wolinsky and Dorothy Klimis-Tavantzis. 335 pp. Boca Raton, Fla., CRC Press, 1996. $39.95. ISBN: 0-8493-8502-4

The nutritional needs of women merit special attention. Women have additional nutritional requirements during menarche, pregnancy, lactation, and menopause; are at higher risk than men for obesity, breast cancer, and osteoporosis; have long been neglected as research subjects because of such differences; and are special targets of advertising.

Even so, women are healthier than men. Women live longer, and although the three leading causes of death in women are the same as those in men — heart disease, cancer, and stroke — the rates of death from these conditions are much lower for women. This favorable health status, however, applies mainly to white women. For black women, life expectancy at birth is nearly six years shorter than that for white women, and death rates for the three leading causes of death are roughly 50 percent higher. These differences suggest the need for public health interventions targeted to black women.

Nutritional Concerns of Women provides a useful starting point for a discussion of nutritional issues affecting women's health. Its 16 chapters review a broad range of topics germane to women's nutritional health: dietary risk factors; conditions such as osteoporosis, anemias, obesity, eating disorders, cardiovascular disease, and cancers; life-cycle issues such as the premenstrual syndrome, use of oral contraceptives, pregnancy, lactation, and aging; social influences; and current policies and programs. The chapters, which vary in length, are organized into short subtitled sections that can be read rapidly and are mostly well referenced.

The chapters on osteoporosis and older women are especially comprehensive, and those on pregnancy and weight control summarize important points from recent reports by the Institute of Medicine. One chapter provides an impressive review of efforts to improve the nutritional status of women in the U.S. Army. Another chapter gives an especially competent overview of a large body of research on dietary risk factors. The final chapter provides useful information about policies, programs, and materials developed by federal agencies, professional organizations, the food industry, and trade associations and other groups with interests in women's health.

Taken together, the chapters achieve precisely what might be expected from the title; they describe diet-related health issues that concern women. However, these issues are not placed in a broad public health context, which would permit readers to decide whether dietary guidance and other policies should differ for women and men. The book presents comparative data in only the most cursory fashion and mentions issues related to minority women only in passing. The editors provide only a perfunctory, half-page introduction to explain their goals — to “facilitate nutritional recommendations for women and their caregivers and help American and Canadian women integrate nutrition and women's health issues into principles to follow in everyday life.” They do not explain how their choice of topics might be expected to achieve such goals.

Particularly disappointing is the discussion of breast cancer. Although this disease is not even the leading cause of cancer-related deaths in women (lung cancer is the leading cause), it is certainly a major cause of concern among most women of my acquaintance, not least because it often affects younger women. One chapter implies that dietary fat is the culprit; another finds the evidence for an association between fat and breast cancer weak at best. Such inconsistencies leave implications to the reader's discretion.

In their introduction, the editors ask readers to suggest topics that might be included in future editions. Several leap to mind: more comprehensive data on the relation between dietary intake and the risk of disease according to sex, age, and ethnic group; more comprehensive reviews of research on nutritional aspects of diabetes mellitus, sexually transmitted diseases, breast cancer, and problems related to alcohol; and a review of socioeconomic, racial, and ethnic factors that affect diet and health. A more comprehensive introduction and a concluding chapter that describes implications for dietary guidance, research, and public policy would also make this book an indispensable resource on a topic of great current interest.

Marion Nestle, Ph.D., M.P.H.
New York University, New York, NY 10012-1172