In keeping with the previous editions, the primary pur-
pose of
Medical Biochemistry, Fourth Edition,
is to present
the fundamentals of biochemistry and related materials
in a way that is useful to students pursuing medical and
other health-related careers. The book was conceived and
written with the hope that it would generate interest and en-
thusiasm among these students, particularly because bio-
chemistry has a crucial role in human health and dis-
ease. Since it is assumed that most students in medicine
and health-related fields eventually will apply biochemical
principles to the art of healing, discussion of the factual
information is integrated with frequent use of clinical ex-
amples and applications.
A vast number of constituents of the human body—
cells, enzymes, hormones, sugars, salts, vitamins, and
so forth—vary in normal and abnormal states of human
health. Understanding the metabolic and regulatory pro-
cesses that underlie metabolism is essential to any practice
of the healing arts and the relief of human suffering. I have
tried to keep this idea foremost.
Progress in biochemistry, molecular biology, cellular
biology, endocrinology, and other disciplines has been so
rapid and profound in the past 20 years that biochemistry
texts obsolesce rapidly. To maximize the usefulness of this
book, authors actively involved in research have written
several chapters dealing with the most rapidly changing
The overall organization of topics is designed to lead
the student logically through the biochemical organiza-
tion of cells. Emphasis is placed on the structures and
functions of the molecular components of cells and on
metabolic controls. The text begins with a discussion
of water, acids, bases, and buffers, amino acids, pro-
teins, and thermodynamics (Chapters 1-5). This is fol-
lowed by a detailed discussion of important aspects of
enzymology (Chapters 6-8). The broad subject of car-
bohydrate chemistry (Chapters 9-11, 13, 15, 16) is inte-
grated with chapters that discuss gastrointestinal digestion
(Chapter 12), oxidative phosphorylation (Chapter 14), and
protein metabolism (Chapter 17). Three chapters on lipids
(Chapters 18-20) are integrated with chapters covering
muscle systems (Chapter 21) and metabolic homeostasis
(Chapter 22).
The principles of molecular biology including nucleic
acid chemistry and the regulation of gene expression and
protein synthesis are presented in Chapters 23-26. These
chapters are followed by ones on nucleotide, hemoglobin,
and heme metabolism (Chapters 27-29). The endocrine
system and its organs are discussed in Chapters 30-34.
Molecular immunology is presented in Chapter 35, and the
biochemistry of blood coagulation appears in Chapter 36.
The last section discusses mineral and vitamin meta-
bolism and electrolyte balance (Chapters 37-39). Nine
appendices contain tables
of nutritional
clinical laboratory measurements that are important in
The importance of human nutrition is emphasized
throughout the text and has not been relegated to a sin-
gle chapter. Likewise, hereditary disorders are discussed
throughout, along with other clinical examples that re-
late the relevant biochemistry to diagnosis and treatment.
This book is not small, although conciseness consistent
with clarity was a primary goal. Detailed discussions of
experiments have, for the most part, been omitted, and dis-
cussion of more subtle points has been minimized. Ref-
erences provided at the end of each chapter will lead in-
terested students deeper into particular topics and case
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