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Books received

Book summaries

Community assessment of natural food sources of vitamin A: Guidelines for an ethnographic protocol. Lauren Blum, Pertti J. Pelto, Gretel H. Pelto, and Harriet V. Kuhnlein. International Nutrition Foundation for Developing Countries, Boston, Mass., USA, 1997. (ISBN 0-9635522-9-5) 139 pages, paperback. US$ 20.00 plus $3.00 shipping and handling ($13.00 air); US$ 12.00 plus $5.00 shipping and handling ($13.00 air) in developing countries.

This practical, step-by-step guide for conducting assessments in communities on the various aspects of natural food sources of vitamin A will create data helpful for programs that aim to alleviate vitamin A deficiency. The manual, prepared in cooperation with the Committee on Nutrition and Anthropology of the International Union of Nutritional Sciences, describes how to set up and manage the assessment process, as well as how to gather the essential data. Techniques are designed to answer key research questions on the local food system, the availability of sources of vitamin A-rich food and its use by those at special risk (pregnant and lactating women, infants, and young children), and cultural beliefs about food and the signs and symptoms of vitamin A deficiency. The manual is written in lay language and includes forms for data collection. It is designed for use by a field supervisor and two local research assistants over a six- to eight-week research period.

Culture, environment, and food to prevent vitamin A deficiency. Edited by Harriet V. Kuhnlein and Gretel H. Pelto. International Nutrition Foundation for Developing Countries, Boston, Mass., USA, 1997. (ISBN 0-9635522-7-9) 205 pages, paperback. US$ 12.00 plus $3.00 shipping and handling ($13.00 air); US$ 8.00 plus $5.00 shipping and handling ($13.00 air) in developing countries.

Aimed at development planners and students of nutrition, public health, anthropology, and human cultural ecology, this book discusses issues surrounding the use of natural sources of food for the prevention of vitamin A deficiency. During a two-year research process guided by the Committee on Nutrition and Anthropology of the International Union of Nutritional Sciences, a protocol was developed to evaluate the natural food sources of vitamin A in areas at risk for vitamin A deficiency. This book describes the creation of the ethnographic research tools and their testing in a broad range of cultures and environments in five developing countries. Chapters contributed by the research managers in these countries describe the suitability and generalizability of the research tools, the data generated, practical applications, and directions for policy. Many examples are given of helpful new information for planning programs at the local level for alleviating vitamin A deficiency. This is intended as a companion to Community Assessment of Natural Food Sources of Vitamin A: Guidelines for an Ethnographic Protocol, reviewed above.

Diet, nutrition and chronic disease. Lessons from contrasting worlds. Edited by Prakash S. Shetty and Klim McPherson. John Wiley & Sons, Chichester, UK, 1997. (ISBN 0-471-97133-2) 301 pages, hard-cover.

It is being increasingly recognized that diet and lifestyle changes that follow in the wake of industrialization, urbanization, and economic development dramatically increase the incidence of chronic non-communicable diseases. Developing countries that are in transition and shifting from rural to predominately urban areas are beginning to face the consequences of both nutritional deficits and excesses. The London School of Hygiene and Tropical Medicine convened their Sixth Annual Public Health Forum on this topic. The participants have written chapters that make this an interesting and timely book. Most chapters and the discussions of them are excellent.

Evaluation of certain veterinary drug residues in food. Forty-fifth report of the Joint FAO/WHO Expert Committee on Food Additives. Technical report series no. 864. World Health Organization, Geneva, 1996. (ISBN 94-4-120864-3) paperback. Available in English and French, Spanish in preparation. SwF 12.00, US$ 10.80; SwF 8.40 in developing countries.

Handbook of food analysis. Vol. 1. Physical characterization and nutrient analysis. Vol. 2. Residues and other food component analysis. Edited by Leo M. L. Nollet. Marcel Dekker, New York, 1996. (ISBN 0-8247-9684-5) 2040 pages, hardcover (two-volume set). US$ 195.00 per set plus $5.00 shipping and handling in the USA and Canada; US$ 10.00 shipping and handling in all other countries.

This massive two-volume set is a fairly comprehensive compilation of analytical methods and laboratory principles that every food chemist would find useful. The chapters are organized by analyte category and cover the important stepwise details of sample preparation, most of the analytical instruments and techniques that can be used, and specific safety and regulatory considerations. Where multiple methods are available for an analyte category, as they are in most cases, the relative advantages, accuracy, and reliability of each procedure are assessed.

The handbook covers an appropriate range of analytes from phytotoxins and mycotoxins, to residues and additives, and to nutrients, each category with its own chapter. The only noticeable gap in analytes was nutrient inorganics, although some of these are covered in the chapter on Metal Contaminants, and some others in the chapter on Determination of Cations and Anions by Capillary Electrophoresis. Other useful chapters are also included, such as sample preparation, chemometrics, physical and sensory characterization, and a general chapter devoted to instruments and techniques, independent of the analytes.

The book is well organized and well indexed. Because many food laboratories now combine food control with nutrient composition, the range of analytes covered makes this a very practical reference.

Barbara Burlingame
INFOODS Secretariat

The handbook provides practical guidelines for evaluating water- and sanitation-related hygiene practices. An evaluation of hygiene practices can be used for the purposes of project planning, monitoring, or final assessment of the project’s impact. The main focus is on the practical concerns of field personnel working in water supply, sanitation, and health or hygiene education projects who want to design and conduct their own evaluations of hygiene practices. It is designed to make qualitative research skills accessible to practitioners with little or no previous training in social sciences and emphasizes how to gather, review, and interpret qualitative information. The handbook was developed as a practical answer to the limitations of using a single method or instrument for information gathering, especially when trying to investigate sociocultural aspects of human behaviour that do not easily lend themselves to quantifiable measurement. It explores alternatives to the limitations of a questionnaire-based survey design by examining other tools for systematically gathering qualitative information. It includes the use of a variety of methods and tools that can be chosen and combined, appraisals of individual methods and tools to help in the selection of the most appropriate combinations of methods for the desired purpose, and examples from field experience of common mistakes and pitfalls. The use of a variety of sources and methods (triangulation) is advocated as the best way to obtain complete and reliable information on the issues under study. Incorporation of one or more of these methods would be appropriate for any nutrition survey.

Microlivestock. Little known animals with a promising future. Board on Science and Technology for International Development. National Research Council. National Academy Press, Washington, DC, 1991. (ISBN 0-309-04437-5) 449 pages, paperback. US$ 29.95.

This study by the Board on Science and Technology for International Development of the US National Research Council was published in 1991, but the information it contains continues to be valuable for small farmers in developing countries and the agricultural extension agents who advise them. It describes the potential for raising mainly different kinds of poultry and rodents, as well as microbreeds of common herbivores, many species of deer and antelope, and even iguanas and bees.

Nutritional abnormalities in infectious diseases. Effects on tuberculosis and AIDS. Edited by Christopher E. Taylor. Haworth Medical Press, Binghamton, N.Y., USA, 1997. (ISBN 0-7890-0019-9) 58 pages, paperback. US$ 17.95; US$ 22.00 outside the USA, Canada, and Mexico.

This slender volume based on papers from a symposium contains little new on the relationship between nutrition and tuberculosis, but it summarizes what has been known for decades and neglected in an era when chemotherapy for tuberculosis was usually effective regardless of the nutritional status of the patient. With the emergence of drug-resistant strains, the situation changed markedly, and good nutritional status became, once again, an important preventive and curative measure. A new element is the emergence of tuberculosis and other secondary infections as complications of HIV infection. Chapters in this book summarize the growing evidence for the importance of nutrition as a cofactor in tuberculosis and in other infections that are secondary complications of AIDS. Improved nutrition helps persons with AIDS to resist tuberculosis as a major complication and improves their ability to cope with other secondary infections through immunological and other cellular mechanisms that are discussed. Since both tuberculosis and AIDS also precipitate malnutrition, particularly protein malnutrition, in vulnerable individuals, assuring their good nutritional status requires skill and persistence. This book reinforces the importance of adequate nutrition as a public health measure to reduce the burden of infectious disease and also serves to motivate clinicians to pay more attention to malnutrition as a factor in the severity and outcome of infections.

Nutritional implications of macronutrient substitutes. Edited by G. Harvey Anderson, Barbara J. Rolls, and Daniel G. Steffen. Annals of the New York Academy of Sciences, Vol. 819. New York, 1997. (ISBN 1-57331-085-9) 253 pages, paperback. US$ 95.00 plus $5.00 shipping and handling.

This book is based on a 1996 conference to present the current state of scientific knowledge on the nutritional impact of macronutrient substitutes, intense sweeteners, and fat replacers. Such substitutes are entering the diets of consumers in industrialized countries and are penetrating the diets in developing countries as well. Potential benefits include the reduced energy density of foods, decreased fat intake, maintenance of dietary pattern and healthy weight, and increased nutrient density. The potential for adverse effects also needs consideration.

The increase in the availability of low- and no-fat foods is in direct response to public health recommendations that have generated consumer demand. The fat substitute may contain fewer calories because of a difference in the way that it is metabolized or because it is not well absorbed. This volume discusses safety and regulatory aspects, the association between macronutrient substitutes and energy balance, consumer attitudes and practices influencing the acceptance and rejection of new foods, and clinical experimental experience with the evaluation of macronutrient substitutes. The volume emphasizes repeatedly that macronutrient substitutes are only one tool in any overall strategy to relate diets to nutritional goals. Nutrition researchers, nutrition and health professionals, and food technologists from government, academia, and industry will find this volume useful if they are at all concerned with dietary habits and practices in relation to health.

Reasons for hope. Instructive experiences in rural development. Edited by Anirudh Krishna, Norman Uphoff, and Milton J. Esman. Kumarian Press, West Hartford, Conn., USA, 1997. (ISBN 1-56549-063-0) 322 pages, paperback.

This book is an extremely valuable series of summaries of rural programmes and interventions that have made a difference. Some are well known, such as the Grameen Bank in Bangladesh, the Amul Dairy Cooperative in India, and the Iringa Nutrition Project in Tanzania. Others have been summarized in available form for the first time. They provide extraordinarily valuable reading for anyone concerned with programmes to benefit the rural poor and for university-level seminars and courses in rural development that place people first.

Sociologies of food and nutrition. Wm. Alex Mc-Intosh. Plenum Publishing Corp., New York, 1996. (ISBN 0-306-45335) 314 pages, hardcover. US$ 45.00; US$ 54.00 outside the USA and Canada.

The introduction acknowledges in the first sentence that most sociologists have shown little interest in food. What little concern there has been, has been for production, not consumption. The author notes that “sociologists appear among the last to take an interest in famine, whereas medical scientists, geographers, economists, and anthropologists have written about famine for decades.” Perhaps this explains why there is so little of practical interest to contemporary nutrition and health workers in this volume.

Instead of describing the substantial body of useful social knowledge developed by nutritionally oriented social anthropologists and economists, the introduction states that “nonsociological approaches to nutrition provide us with extreme viewpoints.” It also states that “psychological, economic, and cultural approaches neglect the social nature of food.” Many relevant books, monographs, and articles, some of them reviewed or published previously in the Food and Nutrition Bulletin, refute these biased statements. The book may be of interest to sociologists because it suggests what sociologists should be considering and investigating, but it is unfortunate that it does not build on the substantial contributions of other social and health disciplines that have thus far paid far more attention to food and nutrition issues.

Book summaries

Breastfeeding: Biocultural perspectives. Patricia Stuart-Macadem and Katherine A. Dettwyler. Aldine de Gruyter, New York, 1995. 430 pages. US$ 31.95 (paper), US$ 65.95 (cloth).

This book provides a forum for anthropologists to make the arguments they are usually precluded from making in the arenas where breastfeeding battles are normally fought: the doctor’s office, the medical literature, domestic and international health policy meetings, and wherever popular culture is defined in the United States. The volume is longer on biology than culture, and that culture is essentially left at a phenomenological level. The book leans towards advocacy; seven papers and three commentaries provide evidence in support of a particular position, in contrast to the five papers that present a neutral analysis.

Chapter 1 (Stuart-Macadem) summarizes the book and introduces the argument that breastfeeding is the ultimate biocultural phenomenon. Quoting Baton et al. [I], the author points out that for 99% of our existence as humans, there have been no alternatives to breastfeeding (i.e., no domesticated plant or animal sources) for feeding infants. In Chapter 2, Dettwyler challenges medical “rules of thumb” for determining the appropriate age for cessation of breastfeeding. Most paediatricians in the United States suggest that breastfeeding should continue until the infant has tripled his or her birthweight, or for a period equivalent to gestation. Dettwyler examines the literature on primates and large mammals, and concludes that postponing weaning until the infant has quadrupled his or her birthweight is a more defensible practice. She notes that the oldest recommended weaning ages are derived from the one-third adult body-weight model, which, depending upon the size of the adult population, suggests weaning at four to six years for girls and five to seven years for boys. In Chapter 3, Stuart-Macadem reviews the palaeodietary evidence put forth in the work of Fogel et al. [2], which establishes that the tissues of living breastfed infants are enriched in ¹⁵N relative to their mothers’ tissues. An enrichment in 15N of total collagen was measured in almost all the bones tested from one-year-old infants, from several sites in North America (oldest 5500 B.P., youngest 100 A.D.), whereas a sharp decrease was noted between 18 and 20 months, corresponding presumably with the consumption of foods other than breast-milk. Strontium-calcium data, ethnographic analogies, genetic tracking of lactose intolerance, and demographic data are also briefly reviewed.

Fildes (Chapter 4) provides a few excerpts from her extensive work on the recorded history of infant feeding, which, although not original in this collection, are appropriately included here. Quandt’s paper (Chapter 5) provides an explanatory model to link environmental factors to breastfeeding behaviours, to lactational and associated physiology in the mother, and to the risk of infant health. The key intervening variable she names “breastfeeding style.” She reviews cross-cultural examples using this model. Van Esterik (Chapter 6) notes that this is the first time in history that industries have profited by placing more and more substances other than breastmilk in the infant’s mouth. The harm caused on a global basis by this substitution far outweighs the good. Van Esterik traces the growth of the grass-roots organizations (which eventually became international) behind the boycotts and explains the development of the code for marketing breastmilk substitutes. As one who has been attacked for taking a position, Van Esterik reminds anthropologists that it is a viable alternative to professional self-reflection. Dettwyler’s second chapter (Chapter 7) destroys the arguments concerning the “sexuality” of breastfeeding and, for that matter, the sexuality of breasts. Why can’t women breast-feed in public? Why must only tiny babies be nursed? Why can’t women say they enjoy nursing without being accused of being perverts? Dettwyler believes that the “nipple confusion” of the American (generalized to Western) public is the root of these problems. While agreeing in principle with the author, I suggest that just as breastfeeding serves multiple functions for children, human breasts them- selves probably serve multiple evolutionary functions. Communicating procreational readiness is probably one of them. This signal may have been given undue emphasis, but “Western” cultures were not the first to do so, unless the Song of Solomon and ancient Indian temple figures can be considered Western.

Woolridge (Chapter 8) suggests that it is fat intake, not calories and volume, that regulates intake during breastfeeding. Fat is the most variable component in breastmilk, and on an individual basis, it varies with pre-feed intervals, feeding frequency, and, most of all, breast emptying. Woolridge suggests that infants would regulate their overall nutrient intake if they were simply allowed to feed when they wanted to (baby-controlled breastfeeding), with mothers principally ensuring that the baby was correctly positioned on the breast. Cunningham (Chapter 9) reviews the international studies on infant morbidity and mortality, immunology, and overall health related to breastfeeding. Bottle-feeding is associated with a 10-fold increase in risk of mortality in developing countries, while the US data associate breastfeeding with 4 per 1, 000 fewer deaths. This is a good summary of studies for disorders of immune regulation and shows why humans cannot be compared to cows, llamas, or rats in terms of life-span and the protein content of milk (inverse relationship).

In an excellent review of factors associated with Sudden Infant Death Syndrome (SIDS), McKenna and Bernshaw (Chapter 10) provide some compelling evidence for why infant-parent co-sleeping may be protective. Infants who sleep with their mothers, which normally occurs only when the infant is breastfeeding, are awakened more often, sleep less overall, and spend less time in the deep, quiet stages of sleep when apnea and death occur. Infants also position themselves to be able to nurse and therefore spend more time on their backs. This chapter is particularly well referenced. Ellison (Chapter 11) summarizes the historic and current literature liking breastfeeding to fertility regulation, showing how each “hypothesis of the day” was replaced in the quest for the “critical nursing variable,” whether it was inter-bout intervals and total time nursing (measured in conjunction with hormonal fluctuations), finally using a longitudinal design. After in-depth reviews of many studies, Ellison concludes that today variation in breastfeeding behaviour appears to determine fertility more than do variations in maternal condition. This conclusion would undercut some of the argument supporting lactation as a natural birth spacer. The collection is rounded out by Micozzi’s (Chapter 12) well-referenced overview of the data demonstrating a protective effect of breastfeeding on breast cancer in both the infant and the mother. The weaker argument is that formula-fed infants have higher intakes of calories, fat, and protein than those who are breastfed and hence are more susceptible to cancers throughout their lives. The stronger argument establishes a link between higher estrogen levels (associated with the ovulatory period), and breast and uterine cancers. The prolonged interruption of ovulation by full breastfeeding is consistent with this hypothesis.

Any one of the three commentaries at the end could have been used for this review. Kitzinger (Chapter 13) raises social and cultural issues that were under evaluation, and Lawrence (Chapter 14) tidies up a few loose ends in breastfeeding science basics, while Fredrickson (Chapter 15) looks at the sloppy definitions of breastfeeding in most studies, discusses SIDS, and suggests that a large part of the US burden of disease, particularly fiscally, is caused by bottle-feeding.

Claudia Fishman Parvanta
Rollins School of Public Health
Emory University
Atlanta, GA, USA

1. Baton SB, Shostak M, Konner M. The Paleolithic prescription. New York: Harper & Row, 1988.

2. Fogel M, Tuross N, Owsley D. Nitrogen isotope tracers of human lactation in modern and archaeological populations. Annual report of the Director, Geophysical laboratory 1988-89; 2150: 111-7.

Stature, living standards, and economic development: Essays in anthropometric history. John Komlos. University of Chicago Press, Chicago, 1994. 247 pages, hardcover. US$ 35.50.

In the penultimate chapter (“Comment”), Stanley Engerman explains that the papers in this volume demonstrate the importance of human height studies for understanding the causes and consequences of economic and social change. About 20 years ago, a few economists and historians, including several of the authors of chapters in this book, pioneered a new field of research called “anthropometric history” (see references 1 and 2 for reviews of the development of this field). In the last chapter, editor John Komlos identifies the goal of anthropometric history as understanding economic development in the broad sense. The collection shows how far anthropometric history has come in the last 20 years.

A connection between stature and standard of living will come as no surprise to biological anthropologists who have been researching that connection for over a century. Franz Boas made the connection as explicitly as possible with his classic studies of migrants from various parts of Europe to America. What may come as a surprise, however, even to biological anthropologists, is that there is so much published research by historians and economists that uses stature information as its primary database for reconstructing economic development in the eighteenth and nineteenth centuries. These analyses are usually published in journals and books with the words “history” and “economic” in their titles and therefore may not be commonly read by biological anthropologists. This book reminds us that such research (which provides a wealth of data about height, and sometimes weight, in past centuries) is out there and should be considered by anthropologists, epidemiologists, and auxologists.

This volume provides a good starting place for learning about this field. It contains 10 primary papers that present the results of specific studies, followed by the two commentaries cited above. Among the principal essays are five papers on the heights of Europeans (from various countries), four chapters on the heights of Americans (both free and slave), and one chapter on heights of Japanese from 1885 to 1938. Professor James Tanner provides the introduction, entitled “Growth in Height as a Mirror of the Standard of Living.” It is the determination of “standard of living” that prompted the research presented in this collection. As Ted Shay, author of the chapter on Japan, notes, in 1952 the General Assembly of the United Nations endorsed Resolution 527, which called for an international consensus on the meaning and measurement of the standard of living. This simple-sounding directive has apparently proved impossible for economists to carry out. Criteria of economic well-being for industrialized nations, such as “gross national product” and “real wages,” have no cultural meaning, and the data for measuring such criteria for most historical periods are unavailable to us.

Height, however, is a human universal, and information on height is available in abundance both synchronically and historically (military recruits, students, slaves, and others were measured regularly). Height statistics are good indicators of living conditions, at least those associated with nutrition and health. Anthropometric historians argue that height is, therefore, one measure of choice to establish a standard of living. Komlos and colleagues use height to establish the “biological standard of living” to make the distinction between conventional economic measures and the research agenda of the anthropometric historians.

Anthropometric historians have confirmed some well-known facts about differences in physical “well-being” between human groups during the last 200 years. For example, they show the effects of social class on height. The upper classes were taller, and rural populations were also taller until the beginning of the twentieth century, when the urban populations became taller. The historians have also discovered some new information, such as the eighteenth-century attainment of nearly modern height in the Americas, the fact that adult male slaves of African origin were nearly as tall as their European masters, and that all Americans, both free and slave, were taller than their counterparts back in Europe or Africa. But here also lies the central problem, that is, how to interpret these findings. Did all American-living people, both free and slave, enjoy a higher standard of living than populations back in the “old country”? If one equates stature with living standard (biological or economic), then the answer is yes. Slaves on an American plantation may have disagreed. The “short” aristocrats of Europe may have lived at a higher material standard than the “tall” free farmers of rural America.

Despite the problems of interpreting the relationship of stature to standard of living, anthropometric data may reveal much about human adaptation to social, economic, and political change. To unlock that potential, however, will require a deeper understanding of the biology of stature than most anthropometric historians now possess. These scholars have a solid grasp on the meaning of amount of growth, but only a limited appreciation of normal variation in growth rates, maturation rates, and population variabilities in stature and other anthropometric traits. The authors use biological constructs, such as the body mass index, but do so in ways that are at times curious and at odds with the uses human biologists make of them. The main reason for these gaps in their knowledge is that, just as biological anthropologists do not read the journals and books of the historical economists, they do not read ours. A quick count of the literature cited in this book finds 329 references, of which only 27 are to works that this reviewer recognized as human biology or biological anthropology. Few references are made to important works on public health, epidemiology, and nutrition that would greatly aid in the interpretation of the historical data on stature. Thus, the biological base of anthropometric history is rather small.

Fortunately, the anthropometric historians want to expand their knowledge of human biology, and some appear willing to work with human biologists to do so. Such exchange would also benefit human biology, since the historians can provide both a wealth of data and a time depth that are often missing from human biological research.

Barry Bogin
Department of Behavioral Sciences
University of Michigan-Dearborn
Dearborn, Mich., USA

1. Fogel RW. Anthropometric history: notes on the first two decades of a new field of research. In: Hauspie R, Lindgren G, Falkner F, eds. Essays on auxology. Welwyn Garden City, UK: Castlemead, 1995: 271-84.

2. Steckel RH. Stature and the standard of living. J Econ Lit 1995; 33: 1903-40.