Preface

Our purpose in creating this text is to provide acompilation of current knowledge in clinical nutritionand an overview of the rationale and science base of itsapplication to practice in the prevention and treatmentof disease. The first section addresses basic principlesand concepts that are central to clinical nutritionresearch methodology. Because nutrition information isgathered from a variety of study designs, researchmethodology, epidemiology, and intervention studiesare reviewed, coupled with data analysis, interventiontechniques, and application of behavioral principles tonutrition intervention. The use of biomarkers to moni-tor nutrition intervention is an example of a rapidlyexpanding field in research methodology. Throughoutthese chapters, new areas of study are discussed withthe perspective that the application of the scientificmethod is by definition an evolutionary process.Specific examples, drawn from recently publishedreports, bring the principles to life.

The second section covers areas of study that con-tribute to knowledge in clinical nutrition, includingdisease-relevant biochemistry, metabolism, dietary fac-tors within tissues and cells, and attitudes about foodand the eating patterns and behaviors of targeted indi-viduals or groups. This section presents a rich array oftopics that cover areas of general interest and nutritionguidelines.

New to the third edition is a section on dietary bioac-tive compounds for health, which explores bioactivecomponents present in edible plants of particular inter-est for the prevention of disease. Their widespread usehas the potential to impact human health on the popula-tion level. Uses of these compounds are explored in cog-nition, eye disease, and obesity. Also, physiologicalfactors that enhance digestion, absorption, and metabo-lism bring a greater understanding of bioactives to over-all health.

Clinical nutrition is the aspect of nutrition sciencethat is related to the development, progression, ormanagement of disease, as differentiated from theissues of normal requirements, cellular functions, andactivities. Interventions range from efforts to maintainhealth during short-term illness to optimization ofhealth status in individuals at risk for or diagnosedwith chronic diseases and to major nutritional and die-tary modifications as specific or adjuvant treatmentsfor disease. The first condition addressed is the ever-growing concern with overweight and obesity. As withmany of the following disease groups, this groupingbegins with a chapter on the genetics of human obesityand moves on to issues related to treatment, the role ofphysical activity, nutrient-related considerations, child-hood and adolescent issues, and environmental queuescontrolling energy intake. New to the obesity section isa chapter on the management of patients who haveundergone surgical treatment for obesity.

Cardiovascular disease, also a condition closelyrelated to nutrition, is summarized in three chaptersthat examine genetic considerations, lipid disorders,and hypertension. Closely related to obesity and car-diovascular disease is diabetes mellitus. It is interestinghow many of the clinical nutrition areas interrelate:Obesity is a risk factor for cardiovascular disease anddiabetes, whereas diabetes is an independent risk fac-tor for cardiovascular disease. Dietary intake or nutri-tional status may be altered as a result of disease or bythe treatment modalities that are used, such as surgicaltreatments or medical management strategies, includ-ing prescription medications. The altered needs mustbe met by dietary or nutrition interventions in order toprevent malnutrition and the associated consequencesthat contribute to morbidity and mortality.

Nutrition intervention can be a critical component ofdisease prevention, an important aspect of disease

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management, or the primary treatment for disease.This is exemplified by the chapters dealing with can-cer, beginning again with a discussion of the geneticcomponents, followed by a discussion of malignanciesthat have connections to nutrition and specific nutri-ents. Gastrointestinal diseases, especially the newerknowledge about diet and microflora of the gastroin-testinal tract, demonstrate the importance of foodchoices in disease prevention, treatment, and manage-ment. The bone health chapters cover three importanttopics linked by the nutrients calcium and vitamin Dand tell an important story of the value of early nutri-tion on health in later years.

Generating and analyzing data that summarize die-tary intake and its association with disease are valuabletasks in treating disease and developing disease pre-vention strategies. Well-founded medical nutritiontherapies can minimize disease development andrelated complications. Providing scientifically sound,creative, and effective nutrition interventions ischallenging and rewarding. We plan to update ourknowledge and its application through future editionsof this text.

Ann M. CoulstonCarol J. Boushey

Mario G. Ferruzzi

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