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BOOK REVIEW |
Department of Medicine
University of California, Davis
UCD Medical Center
4150 V Street
Sacramento, CA 95817
E-mail: lberglund{at}ucdavis.edu
This is the first edition of a review on nutrition and heart disease and includes contributions from 35 authors, who represent both geographically and content-wise a wide area. The book contains 18 chapters and is divided into 4 sections. The first section focuses on heart disease prevention, the second section is devoted to nutrients and heart disease, a short third section addresses age and heart disease, and the fourth section is devoted to foods and macronutrients in heart disease. The focus of the text varies considerably, possibly because of the many topics covered and the many contributing authors. Thus, although some chapters focus on detailed experimental findings in animal models, other chapters deal with more generalized overviews and, in some cases, with recently conducted human diet studies. These variable approaches, while bringing different themes to the attention of the reader, also result in a somewhat uneven quality and focus of the text.
The first section has a nice overview of the role of the dietitian in reducing cardiovascular risk. This chapter is focused on evidence-based data from diet intervention studies and also provides useful contact information. Other chapters in this section are devoted to cardiovascular disease in China and sub-Saharan Africa and an overview of the Mediterranean diet. Some of the information on fish oils in the latter chapter overlaps information provided in a previous chapter. The section ends with a short summary of the Dutch MARGARIN Study, comparing different approaches to nutrition education.
The second section contains a comprehensive and rather brief overview of the role of micronutrients, including homocysteine, in heart disease; an entire chapter in this section is devoted to the role of folate and homocysteine in heart disease. The latter chapter is quite comprehensive, covering topics ranging from biochemistry to public health issues. The chapter on micronutrients has a very ambitious reference list, which is helpful for further reading. Other areas covered in this section include the relation between leptin and blood pressure and the contributions of retinol, ß-carotene, and 
-tocopherol to heart disease. The latter chapter provides a balanced overview of this controversial area and contains useful tables that summarize the results from both observational studies and randomized clinical trials.
The major thrust of the book is devoted to foods and macronutrients in heart disease, and initially, the role of flavonoids in hypertension is reviewed in a thorough fashion. This review is followed by a brief but focused chapter summarizing our current understanding of the interaction between carbohydrate intake and lipid metabolism, a very timely issue. The Mediterranean diet is then revisited, with a rather specific focus on endothelial activation and in vitro cell studies. The section also contains 3 comprehensive overviews of current controversies related to dietary soy, malnutrition, and the heart from a pediatric perspective and a chapter on plant sterols and stanols. The final chapter in this section contains an ambitious attempt to cover nonnutrient food factors and concludes with the insightful statement that "these factors function best when consumed as foods rather than supplements." Nevertheless, although the text is informative, it would have been helpful if some illustrations had been included. The last section of the book is devoted to aging and contains 2 chapters addressing cardiac dysfunction and the relation between inducible nitric oxide synthase and heart failure. These chapters are heavily focused on experimental data, and the link to nutrition is not entirely convincing.
Overall, the book is easy to read, but the text quality is somewhat uneven because of the book’s variable approach, with some chapters largely focused on experimental findings and others taking broader overviews. Although the subject area covered is extensive, it might be helpful in future revisions to ensure a more homogeneous format. On the whole, the book can be recommended to any reader interested in a broad overview of diet-related factors and heart disease.
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