understanding-normal-and-clinical-nutrition-8th-edgnv64.pdf

 Dietary Reference Intakes (DRI) T he Dietary Reference Intakes (DRI) include two sets of values that serve as goals for nutrient intake—Recommended Dietary Allowances (RDA) and Adequate Intakes (AI). The RDA reflect the average daily amoun...

 Dietary Reference Intakes (DRI) T he Dietary Reference Intakes (DRI) include two sets of values that serve as goals for nutrient intake—Recommended Dietary Allowances (RDA) and Adequate Intakes (AI). The RDA reflect the average daily amount of a nutrient considered adequate to meet the needs of most healthy people. If there is insufficient evidence to determine an RDA, an AI is set. AI are more tentative than RDA, but both may be used as goals for nutrient intakes. (Chapter 1 provides more details.) In addition to the values that serve as goals for nutrient intakes (presented in the tables on these two pages), the DRI include a set of values called Tolerable Upper Intake Levels (UL). The UL represent the maximum amount of a nutrient that appears safe for most healthy people to consume on a regular basis. Turn the page for a listing of the UL for selected vitamins and minerals. Estimated Energy Requirements (EER), Recommended Dietary Allowances (RDA), and Adequate Intakes (AI) for Water, Energy, and the Energy Nutrients t, t, igh ) igh y) ay /d cid c I y) d /m 2 BM e da we /d he y) A ( rat /d id al/ da da kg ) ) ) ) a y) c r (kg ence cm ence kg ence ay ay ay ay yd AI fibe AI ic a AI nic da g/ g/ g/ (kc ) AI fat ) /d /d oh ter a RD n n ) EE y (in A( A( (lb (L/ ole ole tei tei erg Rb (g (g (g (g fer fer fer tal tal rb Pro Pro RD RD Wa Lin Lin Ca Age(yr) En Re Re Re AI To To Males 0–0.5 — 62 (24) 6 (13) 0.7e 570 60 — 31 4.4 0.5 9.1 1.52 0.5–1 — 71 (28) 9 (20) 0.8f 743 95 — 30 4.6 0.5 11 1.2 1–3g — 86 (34) 12 (27) 1.3 1046 130 19 — 7 0.7 13 1.05 4–8g 15.3 115 (45) 20 (44) 1.7 1742 130 25 — 10 0.9 19 0.95 9–13 17.2 144 (57) 36 (79) 2.4 2279 130 31 — 12 1.2 34 0.95 14–18 20.5 174 (68) 61 (134) 3.3 3152h 130 38 — 16 1.6 52 0.85 19–30 22.5 177 (70) 70 (154) 3.7 3067h 130 38 — 17 1.6 56 0.8 31–50 3.7 3067h 130 38 — 17 1.6 56 0.8 50 3.7 3067h 130 30 — 14 1.6 56 0.8 Females 0–0.5 — 62 (24) 6 (13) 0.7e 520 60 — 31 4.4 0.5 9.1 1.52 0.5–1 — 71 (28) 9 (20) 0.8f 676 95 — 30 4.6 0.5 11 1.2 1–3g — 86 (34) 12 (27) 1.3 992 130 19 — 7 0.7 13 1.05 4–8g 15.3 115 (45) 20 (44) 1.7 1642 130 25 — 10 0.9 19 0.95 9–13 17.4 144 (57) 37 (81) 2.1 2071 130 26 — 10 1.0 34 0.95 14–18 20.4 163 (64) 54 (119) 2.3 2368 130 26 — 11 1.1 46 0.85 19–30 21.5 163 (64) 57 (126) 2.7 2403i 130 25 — 12 1.1 46 0.8 31–50 2.7 2403i 130 25 — 12 1.1 46 0.8 50 2.7 2403i 130 21 — 11 1.1 46 0.8 Pregnancy 1st trimester 3.0 0 175 28 — 13 1.4 25 1.1 2nd trimester 3.0 340 175 28 — 13 1.4 25 1.1 3rd trimester 3.0 452 175 28 — 13 1.4 25 1.1 Lactation 1st 6 months 3.8 330 210 29 — 13 1.3 25 1.3 2nd 6 months 3.8 400 210 29 — 13 1.3 25 1.3 NOTE: For all nutrients, values for infants are AI. Dashes indicate that values have not been c The linolenic acid referred to in this table and text is the omega-3 fatty acid known as alpha- determined. linolenic acid. a The water AI includes drinking water, water in beverages, and water in foods; in general, d The values listed are based on reference body weights. drinking water and other beverages contribute about 70 to 80 percent, and foods, the remainder. e Assumed to be from human milk. Conversion factors: 1 L  33.8 fluid oz; 1 L  1.06 qt; 1 cup  8 fluid oz. f Assumed to be from human milk and complementary foods and beverages. This includes b The Estimated Energy Requirement (EER) represents the average dietary energy intake that will approximately 0.6 L (~3 cups) as total fluid including formula, juices, and drinking water. maintain energy balance in a healthy person of a given gender, age, weight, height, and physical g For energy, the age groups for young children are 1–2 years and 3–8 years. activity level. The values listed are based on an “active” person at the reference height and weight h For males, subtract 10 kcalories per day for each year of age above 19. and at the midpoint ages for each group until age 19. Chapter 8 and Appendix F provide equa- i For females, subtract 7 kcalories per day for each year of age above 19. tions and tables to determine estimated energy requirements. SOURCE: Adapted from the Dietary Reference Intakes series, National Academies Press. Copyright 1997, 1998, 2000, 2001, 2002, 2004, 2005 by the National Academies of Sciences. A  Recommended Dietary Allowances (RDA) and Adequate Intakes (AI) for Vitamins da acid ay e ay a ay b ay c ) ) ) ) ) ) ) ) ) ay ay ay ay ay d ay y) y) y) (m nic ) ) /d /d /d /d /d /d μg 2 /d /d /d ay da A ( B6 A( 1 da B RD avin AI in D RD in C RD in A nK mg mg mg mg mg mg RD n E AI the /d /d μg μg g/ g/ RD in RD in RD in g/ AI ne (μg (μg i i n A( A( A( A( A( A( A( iam am am RD e (m tin am am am am am o ofl ( oli i lat nt ac RD Rib Bio Vit Vit Vit Vit Vit Vit Vit Ch Th AI AI Pa Fo Ni Age (yr) Infants 0–0.5 0.2 0.3 2 5 1.7 0.1 65 0.4 125 40 400 5 4 2.0 0.5–1 0.3 0.4 4 6 1.8 0.3 80 0.5 150 50 500 5 5 2.5 Children 1–3 0.5 0.5 6 8 2 0.5 150 0.9 200 15 300 5 6 30 4–8 0.6 0.6 8 12 3 0.6 200 1.2 250 25 400 5 7 55 Males 9–13 0.9 0.9 12 20 4 1.0 300 1.8 375 45 600 5 11 60 14–18 1.2 1.3 16 25 5 1.3 400 2.4 550 75 900 5 15 75 19–30 1.2 1.3 16 30 5 1.3 400 2.4 550 90 900 5 15 120 31–50 1.2 1.3 16 30 5 1.3 400 2.4 550 90 900 5 15 120 51–70 1.2 1.3 16 30 5 1.7 400 2.4 550 90 900 10 15 120 70 1.2 1.3 16 30 5 1.7 400 2.4 550 90 900 15 15 120 Females 9–13 0.9 0.9 12 20 4 1.0 300 1.8 375 45 600 5 11 60 14–18 1.0 1.0 14 25 5 1.2 400 2.4 400 65 700 5 15 75 19–30 1.1 1.1 14 30 5 1.3 400 2.4 425 75 700 5 15 90 31–50 1.1 1.1 14 30 5 1.3 400 2.4 425 75 700 5 15 90 51–70 1.1 1.1 14 30 5 1.5 400 2.4 425 75 700 10 15 90 70 1.1 1.1 14 30 5 1.5 400 2.4 425 75 700 15 15 90 Pregnancy ≤18 1.4 1.4 18 30 6 1.9 600 2.6 450 80 750 5 15 75 19–30 1.4 1.4 18 30 6 1.9 600 2.6 450 85 770 5 15 90 31–50 1.4 1.4 18 30 6 1.9 600 2.6 450 85 770 5 15 90 Lactation ≤18 1.4 1.6 17 35 7 2.0 500 2.8 550 115 1200 5 19 75 19–30 1.4 1.6 17 35 7 2.0 500 2.8 550 120 1300 5 19 90 31–50 1.4 1.6 17 35 7 2.0 500 2.8 550 120 1300 5 19 90 NOTE: For all nutrients, values for infants are AI. The glossary on the inside back cover defines units c Vitamin A recommendations are expressed as retinol activity equivalents (RAE). of nutrient measure. d Vitamin D recommendations are expressed as cholecalciferol and assume an absence of adequate a Niacin recommendations are expressed as niacin equivalents (NE), except for recommendations exposure to sunlight. for infants younger than 6 months, which are expressed as preformed niacin. e Vitamin E recommendations are expressed as -tocopherol. b Folate recommendations are expressed as dietary folate equivalents (DFE). Recommended Dietary Allowances (RDA) and Adequate Intakes (AI) for Minerals ) ) ) ) ) ) ) ) ay ay ay ay ay ay ay ay A ( num y) y) y) y) y) y) ) /d /d /d /d A ( rus A( m (m ese /d /d /d ay /d da da da da da da AI mium AI sium RD esiu mg mg mg mg m /d μg μg μg RD de μg RD ho AI ide g/ g/ g/ g/ n g/ g/ AI ide AI m AI m RD r u a (μg e ine A( lyb A( A( A( A( p u (m (m (m (m i (m gn ng diu lor tas len pp or ro os lci c n RD RD RD RD Mo Iod Ma Zin Ma Flu Iro Ch Co Ch Ca Ph Po So AI Se Age (yr) Infants 0–0.5 120 180 400 210 100 30 0.27 2 110 15 200 0.003 0.01 0.2 2 0.5–1 370 570 700 270 275 75 11 3 130 20 220 0.6 0.5 5.5 3 Children 1–3 1000 1500 3000 500 460 80 7 3 90 20 340 1.2 0.7 11 17 4–8 1200 1900 3800 800 500 130 10 5 90 30 440 1.5 1.0 15 22 Males 9–13 1500 2300 4500 1300 1250 240 8 8 120 40 700 1.9 2 25 34 14–18 1500 2300 4700 1300 1250 410 11 11 150 55 890 2.2 3 35 43 19–30 1500 2300 4700 1000 700 400 8 11 150 55 900 2.3 4 35 45 31–50 1500 2300 4700 1000 700 420 8 11 150 55 900 2.3 4 35 45 51–70 1300 2000 4700 1200 700 420 8 11 150 55 900 2.3 4 30 45 70 1200 1800 4700 1200 700 420 8 11 150 55 900 2.3 4 30 45 Females 9–13 1500 2300 4500 1300 1250 240 8 8 120 40 700 1.6 2 21 34 14–18 1500 2300 4700 1300 1250 360 15 9 150 55 890 1.6 3 24 43 19–30 1500 2300 4700 1000 700 310 18 8 150 55 900 1.8 3 25 45 31–50 1500 2300 4700 1000 700 320 18 8 150 55 900 1.8 3 25 45 51–70 1300 2000 4700 1200 700 320 8 8 150 55 900 1.8 3 20 45 70 1200 1800 4700 1200 700 320 8 8 150 55 900 1.8 3 20 45 Pregnancy ≤18 1500 2300 4700 1300 1250 400 27 12 220 60 1000 2.0 3 29 50 19–30 1500 2300 4700 1000 700 350 27 11 220 60 1000 2.0 3 30 50 31–50 1500 2300 4700 1000 700 360 27 11 220 60 1000 2.0 3 30 50 Lactation ≤18 A 1500 2300 5100 1300 1250 360 10 13 290 70 1300 2.6 3 44 50 19–30 1500 2300 5100 1000 700 310 9 12 290 70 1300 2.6 3 45 50 31–50 1500 2300 5100 1000 700 320 9 12 290 70 1300 2.6 3 45 50 B  Tolerable Upper Intake Levels (UL) for Vitamins y) c y) a ay b ay a g/ B6 (μg in D y) y) y) (μg in A (m in C (m in E ) ) ) ay da da da (m in da da (m ne /d /d (m in /d am e am am am am g/ g/ g/ g/ oli lat ac (μg Vit Vit Vit Vit Vit Ch Fo Ni Age (yr) Infants 0–0.5 — — — — — 600 25 — 0.5–1 — — — — — 600 25 — Children 1–3 10 30 300 1000 400 600 50 200 4–8 15 40 400 1000 650 900 50 300 9–13 20 60 600 2000 1200 1700 50 600 Adolescents 14–18 30 80 800 3000 1800 2800 50 800 Adults 19–70 35 100 1000 3500 2000 3000 50 1000 70 35 100 1000 3500 2000 3000 50 1000 Pregnancy ≤18 30 80 800 3000 1800 2800 50 800 19–50 35 100 1000 3500 2000 3000 50 1000 Lactation ≤18 30 80 800 3000 1800 2800 50 800 19–50 35 100 1000 3500 2000 3000 50 1000 a The UL for niacin and folate apply to synthetic forms b TheUL for vitamin A applies to the preformed vitamin only. obtained from supplements, fortified foods, or a combination c TheUL for vitamin E applies to any form of supplemental of the two. -tocopherol, fortified foods, or a combination of the two. Tolerable Upper Intake Levels (UL) for Minerals /d num g/ rus da m da e y) d s y) y) y) (m ium y) y) y) y) y) y) y) y) (m esiu (m ane ) ) ) ) (μg um (μg de (m ho ay ay (m de ay ay (m ide da da da da da da da da da da (m m (m m (μg er lyb ine d /d /d /d (m l (m n p i i u ng gn g/ g/ g/ g/ g/ cke g/ g/ diu g/ g/ g/ g/ len pp lor or na ro os lci c n (μg Mo Iod (m (m Ma Zin Ma Flu Iro Co Bo Ch Ph Va Ca So Se Ni Age (yr) Infants 0–0.5 —e —e — — — 40 4 — 45 — — 0.7 — — — — 0.5–1 —e —e — — — 40 5 — 60 — — 0.9 — — — — Children 1–3 1500 2300 2500 3000 65 40 7 200 90 1000 2 1.3 300 3 0.2 — 4–8 1900 2900 2500 3000 110 40 12 300 150 3000 3 2.2 600 6 0.3 — 9–13 2200 3400 2500 4000 350 40 23 600 280 5000 6 10 1100 11 0.6 — Adolescents 14–18 2300 3600 2500 4000 350 45 34 900 400 8000 9 10 1700 17 1.0 — Adults 19–70 2300 3600 2500 4000 350 45 40 1100 400 10,000 11 10 2000 20 1.0 1.8 70 2300 3600 2500 3000 350 45 40 1100 400 10,000 11 10 2000 20 1.0 1.8 Pregnancy ≤18 2300 3600 2500 3500 350 45 34 900 400 8000 9 10 1700 17 1.0 — 19–50 2300 3600 2500 3500 350 45 40 1100 400 10,000 11 10 2000 20 1.0 — Lactation ≤18 2300 3600 2500 4000 350 45 34 900 400 8000 9 10 1700 17 1.0 — 19–50 2300 3600 2500 4000 350 45 40 1100 400 10,000 11 10 2000 20 1.0 — d The UL for magnesium applies to synthetic forms obtained from supplements or drugs only. SOURCE: Adapted with permission from the Dietary Reference Intakes series, National Academies Press. e Source of intake should be from human milk (or formula) and food only. Copyright 1997, 1998, 2000, 2001, 2002, 2005 by the National Academy of Sciences. Courtesy of the NOTE: An Upper Limit was not established for vitamins and minerals not listed and for those age groups National Academies Press, Washington, D.C. listed with a dash (—) because of a lack of data, not because these nutrients are safe to consume at any level of intake. All nutrients can have adverse effects when intakes are excessive. C U N D E R S TA N D I N G N O R M A L A N D C L I N I C A L Nutrition Eighth Edition S H A RO N R A DY RO L F E S | K AT H RY N P I N N A | E L L I E W H I T N E Y Australia Brazil Japan Korea Mexico Singapore Spain United Kingdom United States  Understanding Normal and Clinical © 2009, 2006 Wadsworth, Cengage Learning Nutrition, Eighth Edition ALL RIGHTS RESERVED. No part of this work covered by the copyright herein Sharon Rady Rolfes, Kathryn Pinna, may be reproduced, transmitted, stored or used in any form or by any means Ellie Whitney graphic, electronic, or mechanical, including but not limited to photocopying, Publisher: Yolanda Cossio recording, scanning, digitizing, taping, Web distribution, information net- works, or information storage and retrieval systems, except as permitted Development Editor: Anna Lustig under Section 107 or 108 of the 1976 United States Copyright Act, without Assistant Editor: Elesha Feldman the prior written permission of the publisher. 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Locate your local office at: Compositor: Lachina Publishing Services international.cengage.com/region Cengage Learning products are represented in Canada by Nelson Education, Ltd. For your course and learning solutions, visit academic.cengage.com Purchase any of our products at your local college store or at our preferred online store www.ichapters.com Printed in Canada 1 2 3 4 5 6 7 12 11 10 09 08  To Ellie Whitney, my mentor, partner, and friend, with much appreciation for believing in me, sharing your wisdom, and giving me the opportunity to pursue a career more challenging and rewarding than any I could have imagined. Sharon To David Stone, for years of love, friendship, and assistance with numerous academic and musical pursuits. Kathryn To the memory of Gary Woodruff, the editor who first encouraged me to write. Ellie About the Authors Sharon Rady Rolfes received her M.S. in nutrition and food science from Florida State University. She is a founding member of Nutrition and Health Asso- ciates, an information resource center that maintains a research database on over 1000 nutrition-related topics. Her other publications include the college textbooks Understanding Nutrition and Nutrition for Health and Health Care and a multimedia CD-ROM called Nutrition Interactive. In addition to writing, she occa- sionally teaches at Florida State University and serves as a consultant for various educational projects. Her volunteer work includes coordinating meals for the hungry and homeless and serving on the steering committee of Working Well, a community initiative designed to help local businesses improve the health and well-being of their employees. She maintains her registration as a dietitian and membership in the American Dietetic Association. Kathryn Pinna received her M.S. and Ph.D. degrees in nutrition from the University of California at Berkeley. She has taught nutrition, food science, and biology courses in the San Francisco Bay Area for over 20 years. She has also worked as an outpatient dietitian, Internet consultant, and freelance writer. Her other publications include the textbooks Nutrition for Health and Health Care and Nutrition and Diet Therapy. She is a registered dietitian and a member of the Amer- ican Society for Nutrition and the American Dietetic Association. Ellie Whitney grew up in New York City and received her B.A. and Ph.D. degrees in English and Biology at Radcliffe/Harvard University and Washington University, respectively. She has lived in Tallahassee since 1970, has taught at both Florida State University and Florida A&M University, has written newspaper columns on environmental matters for the Tallahassee Democrat, and has authored almost a dozen college textbooks on nutrition, health, and related top- ics, many of which have been revised multiple times over the years. In addition to teaching and writing, she has spent the past three-plus decades exploring out- door Florida and studying its ecology. Her latest book is Priceless Florida: The Nat- ural Ecosystems (Pineapple Press, 2004). Brief Contents CHAPTER 1 An Overview of Nutrition 2 HIGHLIGHT Nutrition Information and Misinformation—On the Net and in the News 30 CHAPTER 2 Planning a Healthy Diet 36 HIGHLIGHT Vegetarian Diets 64 CHAPTER 3 Digestion, Absorption, and Transport 70 HIGHLIGHT Common Digestive Problems 92 CHAPTER 4 The Carbohydrates: Sugars, Starches, and Fibers 100 HIGHLIGHT Alternatives to Sugar 132 CHAPTER 5 The Lipids: Triglycerides, Phospholipids, and Sterols 138 HIGHLIGHT High-Fat Foods—Friend or Foe? 172 CHAPTER 6 Protein: Amino Acids 180 HIGHLIGHT Nutritional Genomics 207 CHAPTER 7 Metabolism: Transformations and Interactions 212 HIGHLIGHT Alcohol and Nutrition 238 CHAPTER 8 Energy Balance and Body Composition 248 HIGHLIGHT Eating Disorders 270 CHAPTER 9 Weight Management: Overweight, Obesity, and Underweight 280 HIGHLIGHT The Latest and Greatest Weight-Loss Diet—Again 315 CHAPTER 10 The Water-Soluble Vitamins: B Vitamins and Vitamin C 322 HIGHLIGHT Vitamin and Mineral Supplements 360 CHAPTER 11 The Fat-Soluble Vitamins: A, D, E, and K 368 HIGHLIGHT Antioxidant Nutrients in Disease Prevention 390 CHAPTER 12 Water and the Major Minerals 396 HIGHLIGHT Osteoporosis and Calcium 431 CHAPTER 13 The Trace Minerals 440 HIGHLIGHT Phytochemicals and Functional Foods 469 CHAPTER 14 Life Cycle Nutrition: Pregnancy and Lactation 476 HIGHLIGHT Fetal Alcohol Syndrome 511 CHAPTER 15 Life Cycle Nutrition: Infancy, Childhood, and Adolescence 514 HIGHLIGHT Childhood Obesity and the Early Development of Chronic Diseases 554 CHAPTER 16 Life Cycle Nutrition: Adulthood and the Later Years 560 HIGHLIGHT Hunger and Community Nutrition 583 CHAPTER 17 Nutrition Care and Assessment 588 HIGHLIGHT Nutrition and Immunity 609 vi BRIEF CONTENTS CHAPTER 18 Nutrition Intervention 614 HIGHLIGHT Foodborne Illnesses 632 CHAPTER 19 Medications, Herbal Products, and Diet-Drug Interactions 640 HIGHLIGHT Anemia in Illness 657 CHAPTER 20 Enteral Nutrition Support 662 HIGHLIGHT Inborn Errors of Metabolism 682 CHAPTER 21 Parenteral Nutrition Support 686 HIGHLIGHT Ethical Issues in Nutrition Care 704 CHAPTER 22 Metabolic and Respiratory Stress 708 HIGHLIGHT Multiple Organ Dysfunction Syndrome 727 CHAPTER 23 Upper Gastrointestinal Disorders 730 HIGHLIGHT Dental Health and Chronic Illness 750 CHAPTER 24 Lower Gastrointestinal Disorders 754 HIGHLIGHT Probiotics and Intestinal Health 783 CHAPTER 25 Liver Disease and Gallstones 786 HIGHLIGHT Food Allergies 806 CHAPTER 26 Diabetes Mellitus 810 HIGHLIGHT The Metabolic Syndrome 836 CHAPTER 27 Cardiovascular Diseases 840 HIGHLIGHT Feeding Disabilities 868 CHAPTER 28 Renal Diseases 872 HIGHLIGHT Dialysis 896 CHAPTER 29 Cancer and HIV Infection 900 HIGHLIGHT Complementary and Alternative Medicine 921 APPENDIX A Cells, Hormones, and Nerves A-1 APPENDIX B Basic Chemistry Concepts B-1 APPENDIX C Biochemical Structures and Pathways C-1 APPENDIX D Measures of Protein Quality D-1 APPENDIX E Nutrition Assessment: Supplemental Information E-1 APPENDIX F Physical Activity and Energy Requirements F-1 APPENDIX G Exchange Lists for Diabetes G-1 APPENDIX H Table of Food Composition H-1 APPENDIX I WHO: Nutrition Recommendations Canada: Guidelines and Meal Planning I-1 APPENDIX J Healthy People 2010 J-1 APPENDIX K Enteral Formulas K-1 Contents CHAPTER 1 Food Labels 54 The Ingredient List 55 An Overview of Nutrition 2 Serving Sizes 55 Nutrition Facts 55 Food Choices 3 The Daily Values 56 The Nutrients 5 Nutrient Claims 58 Nutrients in Foods and in the Body 6 Health Claims 59 The Energy-Yielding Nutrients: Structure-Function Claims 59 Carbohydrate, Fat, and Protein 7 Consumer Education 60 The Vitamins 10 H I G H L I G H T 2 Vegetarian Diets 64 The Minerals 10 Water 11 The Science of Nutrition 11 CHAPTER 3 Conducting Research 11 Analyzing Research Findings 14 Digestion, Absorption, Publishing Research 15 and Transport 70 Dietary Reference Intakes 16 Establishing Nutrient Recommendations 16 Digestion 71 Establishing Energy Recommendations 18 Anatomy of the Digestive Tract 72 Using Nutrient Recommendations 18 The Muscular Action of Digestion 74 Comparing Nutrient Recommendations 19 The Secretions of Digestion 76 The Final Stage 78 Nutrition Assessment 20 Nutrition Assessment of Individuals 20 Absorption 80 Nutrition Assessment of Populations 22 Anatomy of the Absorptive System 80 A Closer Look at the Intestinal Cells 81 Diet and Health 24 Chronic Diseases 24 The Circulatory Systems 83 Risk Factors for Chronic Diseases 24 The Vascular System 83 The Lymphatic System 84 HIGHLIGHT 1 Nutrition Information and Misinformation—On the Net and in the News 30 The Health and Regulation of the GI Tract 86 Gastrointestinal Bacteria 86 Gastrointestinal Hormones and Nerve Pathways 86 CHAPTER 2 The System at Its Best 88 HIGHLIGHT 3 Common Digestive Problems 92 Planning a Healthy Diet 36 Principles and Guidelines 37 Diet-Planning Principles 37 CHAPTER 4 Dietary Guidelines for Americans 39 Diet-Planning Guides 41 The Carbohydrates: Sugars, USDA Food Guide 41 Starches, and Fibers 100 Exchange Lists 47 The Chemist’s View of Carbohydrates 101 Putting the Plan into Action 48 The Simple Carbohydrates 102 From Guidelines to Groceries 48 viii CONTENTS Monosaccharides 102 Recommended Intakes of Fat 160 Disaccharides 103 From Guidelines to Groceries 161 The Complex Carbohydrates 105 HIGHLIGHT 5 High-Fat Foods—Friend or Foe? 172 Glycogen 105 Starches 105 Fibers 106 CHAPTER 6 Digestion and Absorption of Carbohydrates 107 Carbohydrate Digestion 108 Protein: Amino Acids 180 Carbohydrate Absorption 108 The Chemist’s View of Proteins 181 Lactose Intolerance 110 Amino Acids 181 Glucose in the Body 111 Proteins 183 A Preview of Carbohydrate Metabolism 112 Digestion and Absorption of Protein 185 The Constancy of Blood Glucose 113 Protein Digestion 185 Health Effects and Recommended Intakes Protein Absorption 185 of Sugars 117 Proteins in the Body 187 Health Effects of Sugars 117 Protein Synthesis 187 Controversies Surrounding Sugars 119 Roles of Proteins 189 Recommended Intakes of Sugars 121 A Preview of Protein Metabolism 193 Health Effects and Recommended Intakes Protein in Foods 195 of Starch and Fibers 122 Protein Quality 195 Health Effects of Starch and Fibers 122 Protein Regulations for Food Labels 196 Recommended Intakes of Starch and Fibers 124 Health Effects and Recommended Intakes From Guidelines to Groceries 125 of Protein 196 HIGHLIGHT 4 Alternatives to Sugar 132 Protein-Energy Malnutrition 196 Health Effects of Protein 199 Recommended Intakes of Protein 201 CHAPTER 5 Protein and Amino Acid Supplements 202 The Lipids: Triglycerides, HIGHLIGHT 6 Nutritional Genomics 207 Phospholipids, and Sterols 138 The Chemist’s View of Fatty Acids and Triglycerides 139 CHAPTER 7 Fatty Acids 140 Triglycerides 142 Metabolism: Transformations Degree of Unsaturation Revisited 142 and Interactions 212 The Chemist’s View of Phospholipids and Sterols 145 Chemical Reactions in the Body 214 Phospholipids 145 Breaking Down Nutrients for Energy 217 Sterols 146 Glucose 219 Digestion, Absorption, and Transport of Lipids 147 Glycerol and Fatty Acids 222 Lipid Digestion 147 Amino Acids 224 Lipid Absorption 149 Breaking Down Nutrients for Energy—In Summary 226 Lipid Transport 150 The Final Steps of Catabolism 227 Lipids in the Body 153 Energy Balance 230 Roles of Triglycerides 153 Feasting—Excess Energy 232 Essential Fatty Acids 154 The Transition from Feasting to Fasting 233 A Preview of Lipid Metabolism 155 Fasting—Inadequate Energy 233 Health Effects and Recommended Intakes of Lipids 156 HIGHLIGHT 7 Alcohol and Nutrition 238 Health Effects of Lipids 156  CONTENTS ix CHAPTER 8 Underweight 307 Problems of Underweight 307 Energy Balance and Body Weight-Gain Strategies 307 Composition 248 HIGHLIGHT 9 The Latest and Greatest Weight-Loss Diet—Again 315 Energy Balance 249 Energy In: The kCalories Foods Provide 250 Food Composition 250 CHAPTER 10 Food Intake 251 Energy Out: The kCalories the Body Expends 253 The Water-Soluble Vitamins: Components of Energy Expenditure 254 B Vitamins and Vitamin C 322 Estimating Energy Requirements 256 The Vitamins—An Overview 323 Body Weight, Body Composition, and Health 258 The B Vitamins—As Individuals 326 Defining Healthy Body Weight 258 Thiamin 327 Body Fat and Its Distribution 260 Riboflavin 328 Health Risks Associated with Body Weight Niacin 331 and Body Fat 263 Biotin 333 HIGHLIGHT 8 Eating Disorders 270 Pantothenic Acid 335 Vitamin B6 336 Folate 338 CHAPTER 9 Vitamin B12 342 Non-B Vitamins 345 Weight Management: Overweight, The B Vitamins—In Concert 346 Obesity, and Underweight 280 B Vitamin Roles 347 B Vitamin Deficiencies 348 Overweight and Obesity 281 B Vitamin Toxicities 349 Fat Cell Development 282 B Vitamin Food Sources 349 Fat Cell Metabolism 282 Set-Point Theory 283 Vitamin C 350 Vitamin C Roles 351 Causes of Overweight and Obesity 283 Vitamin C Recommendations 352 Genetics 284 Vitamin C Deficiency 353 Environment 286 Vitamin C Toxicity 353 Problems of Overweight and Obesity 288 Vitamin C Food Sources 354 Health Risks 288 HIGHLIGHT 10 Vitamin and Mineral Perceptions and Prejudices 289 Supplements 360 Dangerous Interventions 289 Aggressive Treatments for Obesity 292 Drugs 292 CHAPTER 11 Surgery 292 Weight-Loss Strategies 294 The Fat-Soluble Vitamins: Eating Plans Physical Activity 295 299 A, D, E, and K 368 Environmental Influences 302 Vitamin A and Beta-Carotene 369 Behavior and Attitude 303 Roles in the Body 370 Weight Maintenance 305 Vitamin A Deficiency 372 Prevention 306 Vitamin A Toxicity 374 Public Health Programs 306 Vitamin A Recommendations 374 x CONTENTS Vitamin A in Foods 374 Vitamin D 377 CHAPTER 13 Roles in the Body 377 The Trace Minerals 440 Vitamin D Deficiency 378 Vitamin D Toxicity 379 The Trace Minerals—An Overview 441 Vitamin D Recommendations and Sources 379 Iron 442 Vitamin E 381 Iron Roles in the Body 442 Vitamin E as an Antioxidant 382 Iron Absorption and Metabolism 443 Vitamin E Deficiency 382 Iron Deficiency 445 Vitamin E Toxicity 382 Iron Toxicity 447 Vitamin E Recommendations 382 Iron Recommendations and Sources 449 Vitamin E in Foods 383 Iron Contamination and Supplementation 450 Vitamin K 383 Zinc 452 Roles in the Body 384 Zinc Roles in the Body 452 Vitamin K Deficiency 384 Zinc Absorption and Metabolism 452 Vitamin K Toxicity 385 Zinc Deficiency 453 Vitamin K Recommendations and Sources 385 Zinc Toxicity 454 Zinc Recommendations and Sources 454 The Fat-Soluble Vitamins—In Summary 385 Zinc Supplementation 455 HIGHLIGHT 11 Antioxidant Nutrients in Disease Prevention 390 Iodine 455 Selenium 457 Copper 458 CHAPTER 12 Manganese 459 Fluoride 460 Water and the Major Minerals 396 Chromium 461 Water and the Body Fluids 397 Molybdenum 462 Water Balance and Recommended Intakes 398 Blood Volume and Blood Pressure 401 Other Trace Minerals 462 Fluid and Electrolyte Balance 402 Contaminant Minerals 463 Fluid and Electrolyte Imbalance 406 Closing Thoughts on the Nutrients 463 Acid-Base Balance 406 HIGHLIGHT 13 Phytochemicals and The Minerals—An Overview 408 Functional Foods 469 Sodium 410 Chloride 413 Potassium 414 CHAPTER 14 Calcium 416 Life Cycle Nutrition: Pregnancy Calcium Roles in the Body 416 Calcium Recommendations and Sources 418 and Lactation 476 Calcium Deficiency 421 Nutrition prior to Pregnancy 477 Phosphorus 422 Growth and Development during Pregnancy 478 Magnesium 423 Placental Development 478 Sulfate 425 Fetal Growth and Development 478 Critical Periods 480 HIGHLIGHT 12 Osteoporosis and Calcium 431  CONTENTS xi Maternal Weight 483 Food Choices and Health Habits 545 Weight prior to Conception 484 Problems Adolescents Face 546 Weight Gain during Pregnancy 484 H I G H L I G H T 1 5 Childhood Obesity and the Early Exercise during Pregnancy 486 Development of Chronic Diseases 554 Nutrition during Pregnancy 487 Energy and Nutrient Needs during Pregnancy Vegetarian Diets during Pregnancy and Lactation 488 492 CHAPTER 16 Common Nutrition-Related Concerns of Pregnancy 492 Life Cycle Nutrition: Adulthood High-Risk Pregnancies 493 The Infant’s Birthweight 493 and the Later Years 560 Malnutrition and Pregnancy 494 Nutrition and Longevity 562 Food Assistance Programs 495 Observation of Older Adults 563 Maternal Health 495 Manipulation of Diet 564 The Mother’s Age 497 The Aging Process 565 Practices Incompatible with Pregnancy 498 Physiological Changes 566 Nutrition during Lactation 500 Other Changes 568 Lactation: A Physiological Process 501 Energy and Nutrient Needs of Older Adults 569 Breastfeeding: A Learned Behavior 502 Water 569 Maternal Energy and Nutrient Needs during Lactation 502 Energy and Energy Nutrients 569 Maternal Health 504 Vitamins and Minerals 570 Practices Incompatible with Lactation 505 Nutrient Supplements 571 HIGHLIGHT 14 Fetal Alcohol Syndrome 511 Nutrition-Related Concerns of Older Adults 572 Vision 572 CHAPTER 15 Arthritis 573 The Aging Brain 574 Life Cycle Nutrition: Infancy, Food Choices and Eating Habits of Older Adults 575 Childhood, and Adolescence 514 Food Assistance Programs 576 Nutrition during Infancy 515 Meals for Singles 577 Energy and Nutrient Needs 515 HIGHLIGHT 16 Hunger and Community Breast Milk 518 Nutrition 583 Infant Formula 520 Special Needs of Preterm Infants Introducing Cow’s Milk 522 522 CHAPTER 17 Introducing Solid Foods 523 Nutrition Care and Assessment 588 Mealtimes with Toddlers 525 Nutrition in Health Care 589 Nutrition during Childhood 526 Effects of Illness on Nutrition Status 589 Energy and Nutrient Needs 526 Responsibility for Nutrition Care 590 Hunger and Malnutrition in Children 530 Nutrition Screening 591 The Malnutrition-Lead Connection 532 The Nutrition Care Process 593 Hyperactivity and “Hyper” Behavior 532 Food Allergy and Intolerance 533 Nutrition Assessment 595 Childhood Obesity 535 Historical Information 595 Mealtimes at Home 539 Food Intake Data 596 Nutrition at School 541 Anthropometric Data 599 Biochemical Data 601 Nutrition during Adolescence 543 Medical Tests and Procedures 604 Growth and Development 543 Physical Examinations 604 Energy and Nutrient Needs 544 HIGHLIGHT 17 Nutrition and Immunity 609 xii CONTENTS CHAPTER 18 CHAPTER 20 Nutrition Intervention 614 Enteral Nutrition Support 662 Implementing Nutrition Care 615 Enteral Formulas 663 Documenting Nutrition Care 615 Types of Enteral Formulas 664 Approaches to Nutrition Care 617 Formula Characteristics 665 Determining Energy Requirements 619 Enteral Nutrition in Medical Care 666 Dietary Modifications 621 Oral Use of Enteral Formulas 666 Modified Diets 621 Indications for Tube Feedings 666 Alternative Feeding Routes 624 Feeding Routes 667 Nothing by Mouth (NPO) 625 Formula Selection 669 Meeting Water Needs 671 Foodservice 626 Menu Planning 626 Administration of Tube Feedings 671 Food Selection 626 Safe Handling 671 Food Preparation and Delivery 627 Initiating and Progressing a Tube Feeding 672 Food Safety 628 Medication Delivery through Feeding Tubes 675 Improving Food Intake 628 Tube Feeding Complications 675 Transition to Table Foods 676 HIGHLIGHT 18 Foodborne Illnesses 632 HIGHLIGHT 20 Inborn Errors of Metabolism 682 CHAPTER 19 CHAPTER 21 Medications, Herbal Products, Parenteral Nutrition Support 686 and Diet-Drug Interactions 640 Indications for Parenteral Nutrition 687 Medications in Disease Treatment 641 Parenteral Solutions 690 Risks from Medications 642 Parenteral Nutrients 690 Patients at High Risk of Adverse Effects 643 Solution Preparation 691 Herbal Products 644 Administering Parenteral Nutrition 694 Effectiveness and Safety of Herbal Products 644 Insertion and Care of Intravenous Catheters 694 Use of Herbal Products in Illness 646 Administration of Parenteral Solutions 696 Diet-Drug Interactions 648 Discontinuing Intravenous Feedings 696 Drug Effects on Food Intake 648 Managing Metabolic Complications 697 Drug Effects on Nutrient Absorption 648 Nutrition Support at Home 698 Dietary Effects on Drug Absorption 650 Candidates for Home Nutrition Support 698 Drug Effects on Nutrient Metabolism 650 Planning Home Nutrition Care 699 Dietary Effects on Drug Metabolism 651 Quality-of-Life Issues 700 Drug Effects on Nutrient Excretion 651 Dietary Effects on Drug Excretion 652 HIGHLIGHT 21 Ethical Issues in Nutrition Care 704 Diet-Drug Interactions and Toxicity 652 HIGHLIGHT 19 Anemia in Illness 657  CONTENTS xiii CHAPTER 22 Malabsorption Syndromes Fat Malabsorption 760 760 Metabolic and Respiratory Bacterial Overgrowth 761 Conditions Affecting the Pancreas 763 Stress 708 Pancreatitis 764 Cystic Fibrosis 765 The Body’s Responses to Stress and Injury 709 Conditions Affecting the Small Intestine 767 Hormonal Responses to Stress 710 Celiac Disease 767 The Inflammatory Response 710 Inflammatory Bowel Diseases 768 Nutrition Treatment of Acute Stress 712 Short Bowel Syndrome 771 Determining Nutritional Requirements 712 Conditions Affecting the Large Intestine 774 Approaches to Nutrition Care in Acute Stress 715 Irritable Bowel Syndrome 774 Patients with Burn Injuries 715 Diverticular Disease of the Colon 776 Nutrition and Respiratory Stress 717 Colostomies and Ileostomies 777 Chronic Obstructive Pulmonary Disease 717 HIGHLIGHT 24 Probiotics and Intestinal Respiratory Failure 721 Health 783 HIGHLIGHT 22 Multiple Organ Dysfunction Syndrome 727 CHAPTER 25 CHAPTER 23 Liver Disease and Gallstones 786 Fatty Liver and Hepatitis 787 Upper Gastrointestinal Fatty Liver 788 Disorders 730 Hepatitis 789 Cirrhosis 790 Conditions Affecting the Esophagus 731 Consequences of Cirrhosis 791 Dysphagia 731 Treatment of Cirrhosis 793 Gastroesophageal Reflux Disease 734 Medical Nutrition Therapy for Cirrhosis 794 Conditions Affecting the Stomach 738 Liver Transplantation 797 Dyspepsia 738 Nausea and Vomiting 739 Gallbladder Disease 798 Gastritis 739 Types of Gallstones 798 Peptic Ulcer Disease 740 Consequences of Gallstones 799 Risk Factors for Gallstones 800 Gastric Surgery 741 Treatment for Gallstones 800 Gastrectomy 742 Bariatric Surgery 745 HIGHLIGHT 25 Food Allergies 806 HIGHLIGHT 23 Dental Health and Chronic Illness 750 CHAPTER 26 CHAPTER 24 Diabetes Mellitus 810 Overview of Diabetes Mellitus 811 Lower Gastrointestinal Disorders 754 Symptoms of Diabetes Mellitus 812 Common Intestinal Problems 755 Diagnosis of Diabetes Mellitus 812 Constipation 755 Types of Diabetes Mellitus 813 Intestinal Gas 758 Prevention of Type 2 Diabetes Mellitus 815 Diarrhea 758 Acute Complications of Diabetes Mellitus 815 Chronic Complications of Diabetes Mellitus 817 xiv CONTENTS Treatment of Diabetes Mellitus 818 Treatment Goals 818 CHAPTER 28 Evaluating Diabetes Treatment 819 Renal Diseases 872 Body Weight Concerns 820 Medical Nutrition Therapy: Nutrient Functions of the Kidneys 873 Recommendations 821 The Nephrotic Syndrome 874 Medical Nutrition Therapy: Meal-Planning Consequences of the Nephrotic Syndrome 875 Strategies 822 Treatment of the Nephrotic Syndrome 875 Insulin Therapy 823 Antidiabetic Drugs 828 Acute Renal Failure 878 Causes of Acute Renal Failure 878 Physical Activity and Diabetes Management 828 Consequences of Acute Renal Failure 878 Sick-Day Management 830 Treatment of Acute Renal Failure 879 Diabetes Management in Pregnancy 830 Pregnancy in Type 1 or Type 2 Diabetes 831 Chronic Kidney Disease 880 Consequences of Chronic Kidney Disease 881 Gestational Diabetes 831 Treatment of Chronic Kidney Disease 882 HIGHLIGHT 26 The Metabolic Syndrome 836 Kidney Transplants 886 Kidney Stones 888 CHAPTER 27 Formation of Kidney Stones Consequences of Kidney Stones 889 889 Cardiovascular Diseases 840 Prevention and Treatment of Kidney Stones 891 HIGHLIGHT 28 Dialysis 896 Atherosclerosis 841 Consequences of Atherosclerosis 842 Development of Atherosclerosis Causes of Atherosclerosis 843 842 CHAPTER 29 Coronary Heart Disease (CHD) 845 Cancer and HIV Infection 900 Symptoms of Coronary Heart Disease 845 Evaluating Risk for Coronary Heart Disease 845 Cancer 901 How Cancer Develops 901 Therapeutic Lifestyle Changes for Lowering CHD Risk 847 Nutrition and Cancer Risk 903 Lifestyle Changes for Hypertriglyceridemia 852 Consequences of Cancer 905 Vitamin Supplementation and CHD Risk 854 Treatments for Cancer 906 Drug Therapies for CHD Prevention 854 Medical Nutrition Therapy for Cancer 907 Treatment of Heart Attack 855 HIV Infection 911 Hypertension 856 Consequences of HIV Infection 911 Factors That Influence Blood Pressure 856 Treatments for HIV Infection 913 Factors That Contribute to Hypertension 857 Medical Nutrition Therapy for HIV Infection 915 Treatment of Hypertension 858 HIGHLIGHT 29 Complementary and Alternative Heart Failure 861 Medicine 921 Consequences of Heart Failure 861 Medical Management of Heart Failure 862 Stroke 863 Stroke Prevention 863 Stroke Management 864 HIGHLIGHT 27 Feeding Disabilities 868  CONTENTS xv APPENDIX A Cells, Hormones, and Nerves A-1 Glossary GL-1 APPENDIX B Basic Chemistry Concepts B-1 Index IN-1 APPENDIX C Biochemical Structures Aids To Calculation W and Pathways C-1 Dietary Reference Intakes (Inside Front Covers) APPENDIX D Measures of Protein Quality D-1 Daily Values For Food Labels APPENDIX E Nutrition Assessment: Supplemental (Inside Back Cover, Left) Information E-1 Body Mass Index (BMI) (Inside Back Cover, Right) APPENDIX F Physical Activity and Energy Requirements F-1 APPENDIX G Exchange Lists for Diabetes G-1 APPENDIX H Table of Food Composition H-1 APPENDIX I WHO: Nutrition Recommendations Canada: Guidelines and Meal Planning I-1 APPENDIX J Healthy People 2010 J-1 APPENDIX K Enteral Formulas K-1 xvi CONTENTS HOW TO BOXES Chapter 18 Estimate the Energy Requirements of a Hospital Patient 621 Chapter 1 Help Hospital Patients Improve Their Food Intakes 629 Think Metric 8 Prevent Foodborne Illnesses 636 Calculate the Energy Available from Foods 9 Chapter 19 Determine Whether a Website Is Reliable 31 Reduce the Risks of Adverse Effects from Medications 644 Find Credible Sources of Nutrition Information 33 Prevent Diet-Drug Interactions 653 Chapter 2 Chapter 20 Compare Foods Based on Nutrient Density 38 Help Patients Accept Oral Formulas 666 Calculate Personal Daily Values 57 Help Patients Cope with Tube Feedings 673 Chapter 5 Determine the Formula Volumes to Administer Make Heart-Healthy Choices—by Food Group 163 in Tube Feedings 674 Calculate a Personal Daily Value for Fat 165 Administer Medications to Patients Receiving Tube Feedings 675 Understand “% Daily Value” and “% kCalories from Fat” 167 Chapter 21 Chapter 6 Express the Osmolar Concentration of a Solution 689 Calculate Recommended Protein Intake 201 Calculate the Macronutrient and Energy Content Chapter 8 of a Parenteral Solution 692 Estimate Energy Requirements 257 Calculate the Nonprotein kCalorie-to-Nitrogen Ratio 693 Determine Body Weight Based on BMI 261 Chapter 22 Chapter 9 Estimate the Energy Needs of a Critical Care Patient 714 Compare Foods Based on Energy Density 297 Chapter 23 Chapter 10 Improve Acceptance of Mechanically Altered Foods 735 Understand Dose Levels and Effects 325 Manage Gastrointestinal Reflux Disease 737 Evaluate Foods for Their Nutrient Contributions 329 Alter the Diet to Reduce Symptoms of Dumping Syndrome 744 Estimate Niacin Equivalents 333 Alter Dietary Habits to Achieve and Maintain Weight Loss Estimate Dietary Folate Equivalents 339 after Bariatric Surgery 746 Distinguish Symptoms and Causes 350 Chapter 24 Chapter 12 Follow a Fat-Restricted Diet 763 Cut Salt (and Sodium) Intake 411 Estimate Your Calcium Intake 420 Chapter 25 Help the Person with Cirrhosis Eat Enough Food 795 Chapter 13 Estimate the Recommended Daily Intake for Iron 449 Chapter 26 Use Carbohydrate Counting in Clinical Practice 824 Chapter 15 Plot Measures on a Growth Chart 516 Chapter 27 Protect against Lead Toxicity 533 Assess a Person’s Risk of Heart Disease 847 Detect, Evaluate, and Treat High Blood Cholesterol 848 Chapter 16 Implement a Heart-Healthy Diet 853 Estimate Energy Requirements for Older Adults 570 Reduce Sodium Intake 860 Identify Food Insecurity in a U.S. Household 584 Plan Healthy, Thrifty Meals 585 Chapter 28 Help Patients Comply with a Renal Diet 886 Chapter 17 Measure Length and Height 600 Chapter 29 Measure Weight 600 Increase kCalories and Protein in Meals 908 Estimate and Evaluate %IBW and %UBW 602 Help Patients Handle Food-Related Problems 910  CONTENTS xvii CASE STUDIES Chapter 25 Carpenter with Cirrhosis 796 Chapter 17 Chapter 26 Nutrition Screening and Assessment 605 Child with Type 1 Diabetes 831 Chapter 18 School Counselor with Type 2 Diabetes 832 Implementing Nutrition Care 629 Chapter 27 Chapter 20 Computer Programmer with Cardiovascular Disease