Over 100 specialized dietitians writing a basic book on dietetics for thousands of colleagues all over the world is a wonderful initiative. Even better is that every 8 years this book is thoroughly reviewed and updated with the latest insights of relevance. A handful of non-dietitians are also found in the list of contributors, mostly because of their strong participation in the field of dietetics. Together, these aspects make this a handbook weighing almost 3 kg and containing everything the dietitian would like to know (and did not dare to ask?).
It is important to remember that this book is a handbook and should be used as such. Students and dietitians starting out can find much background material in the text and tables about treating patients. However, it is not particularly easy for the reader to find their way around the book as cross-referencing is to sections and paragraphs rather that to page numbers. However, by searching, the reader will always find other good information to read and finally find the answer to their question.
I decided that the best way to review this handbook was to try to use it. Therefore, I placed it beside me during work and when something came up I tried to find the background in the book. I made my students do the same thing. Doing this was amazing; I realized that just about everything is in the book, macro- and micronutrients, tables of information and also physiological background as well as lists of helpful names to get even further. The only element missing in this book is information about inborn errors of metabolism. In the mental illness chapter, phenylketronuria is briefly mentioned but others are completely missing. The dietetic management of these inborn errors could add another kg to the book but would make it even more complete, particularly considering the screening possibilities now available to identify these patients.
The book is produced in the UK and the dietary management described is focused upon UK food and food tables. However, this book is used globally and a wider focus might be merited. Also, I would challenge the contributors to consider whether all of the tables are required in the current digital era. For example, less important or outdated tables (e.g. protein and carbohydrate exchange lists) could be omitted. On the other hand, the list of e-numbers is useful to have to hand.
The only other critical point about the content relates to the consideration of the metabolism of protein. In the text I find that the idea that energy intake is required to prevent the breakdown of protein is still promoted. Actually, this idea is a hangover from the previous era and is something that should be more carefully considered in the current era of concern about obesity. In fact just feeding patients protein can be enough to prevent them from losing lean body mass, while providing carbohydrates and fat can sometimes cause more problems than benefits in ill patients (insulin resistance, elevation of NEFA, etc).
To conclude, I would like to compliment the editors in reaching the goal of revising the book. Split into five main sections (general dietetics, food and nutrients, nutritional needs, dietetic management of disease, acute trauma) and with a sixth section containing (mostly useful) tables it is a complete overview for dietitians. Some parts are highly detailed while others are more general, but overall this is an excellent book that is of immense use to the student and to the practising dietitian.
