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brief contents PART ONE NUTRITION BASICS 1 1 What Nourishes You? 1 2 The Basis of a Healthy Diet 37 3 Human Digestion and Absorption 79 4 Metabolism 111 PART TWO THE ENERGY-YIELDING NUTRIENTS AND ALCOHOL 149 5 Carbohydrates 149 6 Lipids 191 7 Proteins 235 8 Alcohol 271 PART THREE THE VITAMINS AND MINERALS 295 9 The Fat-Soluble Vitamins 295 10 The Water-Soluble Vitamins 335 11 Water and the Major Minerals 381 12 Trace Minerals 425 PART FOUR ENERGY BALANCE AND IMBALANCE 465 13 Energy Balance and Weight Control 465 14 Nutrition for Fitness and Sports 515 15 Eating Disorders: Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder, and Other Conditions 553 PART FIVE NUTRITION APPLICATIONS IN THE LIFE CYCLE 581 16 Pregnancy and Breastfeeding 581 17 Nutrition from Infancy through Adolescence 615 18 Nutrition during Adulthood 657 PART SIX PUTTING NUTRITION KNOWLEDGE INTO PRACTICE 689 19 Safety of Food and Water 689 20 Undernutrition Throughout the World 729 contents About the Authors xvii Preface to the Instructor xix Preface to the Student xxiv Textbook Tour xxvi Supplement Tour xxix PART ONE NUTRITION BASICS 1 1 What Nourishes You? 1 Chapter Outline 1 Case Scenario 1 Chapter Objectives 2 Refresh Your Memory 2 Nutrition and Your Health 2 What Actually Is Nutrition? 2 Nutrients Come from Food 2 Why Study Nutrition? 3 Interest in the Field of Nutrition Has a Long History 5 Classes and Sources of Nutrients 7 Carbohydrates 8 Lipids 8 Proteins 10 Vitamins 10 Minerals 11 Water 11 Nutrient Composition of Diets and the Human Body 11 Energy Sources and Uses 12 Current State of the North American Diet 14 Assessing the Current North American Diet 14 What Influences Our Food Choices? 14 Improving Our Diets 15 Health Objectives for the United States for the Year 2010 Include Numerous Nutrition Objectives 17 Using Scientific Research to Determine Nutrient Needs 18 Asking Questions and Generating Hypotheses 20 Laboratory Animal Experiments 21 Human Experiments 21 Expert Opinion Using Research to Answer a Question?Does Calcium Really Help with Weight Loss? Dr. Robert DiSilvestro, Ph.D. 22 Peer Review of Experimental Results 24 Follow-Up Studies 25 How to Use This Knowledge to Evaluate Nutrition Claims and Advice 26 Case Scenario Follow-Up 28 Nutrition Focus Genetics and Nutrition 29 Summary 33 Study Questions 33 Annotated References 33 Take Action Examine Your Eating Habits More Closely 35 Take Action Create Your Family Tree for Health-Related Concerns 36 2 The Basis of a Healthy Diet 37 Chapter Outline 37 Case Scenario 37 Refresh Your Memory 38 Chapter Objectives 38 A Food Philosophy That Works 38 Variety Means Eating Many Different Foods 39 Balance Means Not Overconsuming Any Single Type of Food 39 Moderation Refers Mostly to Portion Size 40 Nutrient Density Focuses on Nutrient Content 40 Energy Density Especially Influences Energy Intake 41 Expert Opinion The Importance of Energy Density in the Diet Barbara J. Rolls, Ph.D. 43 States of Nutritional Health 45 Desirable Nutrition 45 Undernutrition 45 Overnutrition 46 How Can Your Nutritional State Be Measured? 46 Analyzing Background Factors 46 Evaluating the ABCDEs 47 Recognizing the Limitations of Nutritional Assessment 47 Concern about the State of Your Nutritional Health Is Important 48 Setting Nutrient Needs?Dietary Reference Intakes (DRIs) 49 Estimated Average Requirements (EARs) 49 Recommended Dietary Allowances (RDAs) 50 Adequate Intakes (AIs) 51 Estimated Energy Requirements (EERs) 51 Tolerable Upper Intake Levels (Upper Levels, or ULs) 51 Appropriate Uses of the DRIs 52 Daily Values (DVs): The Standards Used for Food Labeling 53 Reference Daily Intakes (RDIs) 54 Daily Reference Values (DRVs) 54 Using the Daily Values 54 Recommendations for Food Choice 56 MyPyramid?A Menu-Planning Tool 56 Dietary Guidelines?Another Tool for Menu Planning 62 Case Scenario Follow-Up 69 Nutrition Focus Using Food Labels in Diet Planning 70 Summary 74 Study Questions 74 Annotated References 75 Take Action Does Your Diet Meet MyPyramid Recommendations? 76 Take Action Are You Putting the Dietary Guidelines into Practice? 77 Take Action Applying the Nutrition Facts Label to Your Daily Food Choices 78 3 Human Digestion and Absorption 79 Chapter Outline 79 Case Scenario 79 Refresh Your Memory 80 Chapter Objectives 80 The Cell Is the Basis of Human Physiology 80 Organization of the Human Body 81 The Physiology of Digestion 82 The Flow of Digestion 84 A Closer Look at Enzymes in Digestion 89 Gastrointestinal Hormones?A Key to Orchestrating Digestion 90 Gastrointestinal Control Valves: Sphincters 90 Gastrointestinal Muscularity: Mixing and Propulsion 91 Nutrition Focus When the Digestive Processes Go Awry 93 Case Scenario Follow-Up 96 The Physiology of Absorption 99 Absorptive Cells 100 Types of Absorption 100 Portal and Lymphatic Circulation in Absorption 101 Enterohepatic Circulation 101 Absorption Is Completed in the Large Intestine 103 Storage Capabilities of the Body 104 Expert Opinion Probiotics and Human Health Steve Hertzler, Ph.D., R.D. 106 Summary 108 Study Questions 108 Annotated References 109 Take Action Are You Taking Care of Your Digestive Tract? 110 Take Action Investigate Over-the-Counter Medications for Treating Common GI Tract Problems 110 4 Metabolism 111 Chapter Outline 111 Case Scenario 111 Refresh Your Memory 112 Chapter Objectives 112 Metabolism: Chemical Reactions in the Body 112 Anabolic and Catabolic Reactions 113 Stages of Energy Production 113 Energy for the Cell 113 Adenosine Triphosphate (ATP) as an Energy Source 114 Oxidation-Reduction Reactions: Key Processes in Energy Metabolism 116 The Role of Enzymes and Vitamins in Oxidation-Reduction Reactions 117 ATP Production 117 Carbohydrate Metabolism 119 Glycolysis 119 Transition Reaction 122 Citric Acid Cycle 122 The Electron Transport Chain 123 Expert Opinion Does a Metabolic Advantage Exist for the High- Protein Diet? Andrea C. Buchholz, Ph.D., R.D., and Dale A. Schoeller, Ph.D. 127 Aerobic Respiration 128 Glycogen Metabolism 129 Anaerobic Respiration 129 Anaerobic Glycolysis 129 Aerobic and Anaerobic Respiration 130 Lipolysis: Fat Breakdown 130 Making ATP from Fatty Acids 131 Carbohydrate: Aids Fat Metabolism 132 Ketogenesis is Producing Ketone Bodies from Fatty Acids 132 Lipogenesis: Building Fatty Acids 133 Protein Metabolism 134 Producing Glucose from Amino Acids and Other Compounds 134 Gluconeogenesis from Typical Fatty Acids Is Not Possible 135 Disposing of Excess Amino Groups from Amino Acid Metabolism 136 What Happens Where: A Review 137 Regulating Metabolism 138 The Liver 139 Enzymes 139 Hormones 140 ATP Concentrations 140 Vitamins and Minerals 140 Fasting and Feasting 141 Fasting 141 Feasting 141 Case Scenario Follow-Up 142 Nutrition Focus Inborn Errors of Metabolism 143 Summary 145 Study Questions 145 Annotated References 146 Take Action Put Your Knowledge of Metabolism into Practice 148 Take Action Reinforce Your Knowledge of Metabolism 148 PART TWO THE ENERGY-YIELDING NUTRIENTS AND ALCOHOL 149 5 Carbohydrates 149 Chapter Outline 149 Case Scenario 149 Refresh Your Memory 150 Chapter Objectives 150 Carbohydrates?An Introduction 150 Structures and Functions of Simple Carbohydrates 151 Monosaccharides: Glucose, Fructose, and Galactose 151 Disaccharides: Maltose, Sucrose, and Lactose 152 Oligosaccharides: Raffinose and Stachyose 154 Structures and Functions of the More Complex Carbohydrates 154 Digestible Polysaccharides: Starch and Glycogen 155 Indigestible Polysaccharides: Fibers 156 Carbohydrate Digestion and Absorption 158 Digestion 158 Absorption 160 Functions of Glucose and Other Sugars in the Body 161 Yielding Energy 161 Sparing Proteins from Use as an Energy Source 161 Preventing Ketosis 162 Functions of Fiber 162 Carbohydrate Needs 164 The Carbohydrate Continuum 164 How Much Fiber Do We Need? 164 Expert Opinion Fiber?Finally a Nutrient Joanne L. Slavin, Ph.D., R.D. 165 Health Concerns Related to Carbohydrate Intake 168 Problems with High-Fiber Diets 168 Problems with High-Sugar Diets 169 Sugars and Refined Starches and the Metabolic Syndrome 173 Problems with Lactose Intake, Especially for Some People 173 Case Scenario Follow-Up 174 Nutrition Focus When Blood Glucose Regulation Fails 175 Carbohydrates in Foods 181 Nutritive Sweeteners 181 Alternative Sweeteners 183 Summary 186 Study Questions 186 Annotated References 187 Take Action Estimate Your Fiber Intake 189 Take Action Can You Choose the Sandwich with the Most Fiber? 190 6 Lipids 191 Chapter Outline 191 Case Scenario 191 Refresh Your Memory 192 Chapter Objectives 192 Lipids: Common Properties and Main Types 192 Fatty Acids: The Simplest Form of Lipids 193 Essential Fatty Acids 194 Effects of a Deficiency of Essential Fatty Acids 199 Triglycerides 199 Roles of Triglycerides in the Body 200 Providing Energy for the Body 200 Storing Energy for Later Use 200 Insolating and Protecting the Body 201 Transporting Fat-Soluble Vitamins 201 Phospholipids 201 Sterols 203 Fat Digestion and Absorption 204 Digestion 204 Absorption 206 Fats Carried in the Bloodstream 207 Carrying Dietary Fats Utilizes Chylomicrons 207 Transporting Lipids Mostly Made by the Body Uses Very-Low-Density Lipoproteins 207 Nutrition Focus Lipoproteins and Cardiovascular Disease 212 Another Dimension of Fat: Properties in Food 217 Fat in Food Provides Some Satiety and Flavor 217 Expert Opinion Atherosclerosis: An Update Bernhard Hennig, Ph.D., R.D. 218 Hydrogenation of Fatty Acids in Food Production Increases Trans Fatty Acid Content 220 Fat Rancidity Limits Shelf Life of Foods 222 Emulsifiers Improve Many Food Products 222 Recommendations for Fat Intake 223 Fats in Food 225 Fat Replacement Strategies Are Available 227 Fat Is Hidden in Some Foods 229 Wise Use of Reduced-Fat Foods Is Important 229 Case Scenario Follow-Up 230 Summary 230 Study Questions 231 Annotated References 231 Take Action Are You Eating a Diet That Includes Many Saturated Fat and Trans Fatty Acid Sources? 233 Take Action Applying the Nutrition Facts Label to Your Daily Food Choices 234 7 Proteins 235 Chapter Outline 235 Case Scenario 235 Refresh Your Memory 236 Chapter Objectives 236 Proteins?Vital to Life 236 Amino Acids 237 Amino Acid Form and Function 237 Transamination and Deamination 238 Essential and Nonessential Amino Acids in Perspective 238 Proteins?Amino Acids Bonded Together 240 Protein Synthesis 241 Protein Organization 244 Denaturation of Proteins 244 Protein Digestion and Absorption 245 Digestion 245 Absorption 247 Functions of Proteins 248 Producing Vital Body Structures 248 Protein Turnover?Adapting to Changing Condition 248 Maintaining Fluid Balance 250 Contributing to Acid-Base Balance 250 Forming Hormones and Enzymes 251 Contributing to Immune Function 251 Forming Glucose 251 Providing Energy 251 Contributing to Satiety 251 Protein Needs 252 Does Eating a High-Protein Diet Harm You? 255 Protein in Foods 255 The Value of Plant Protein 255 Expert Opinion A New Appreciation for the Nut in Nutrition Penny M. Kris-Etherton, Ph.D., R.D. 256 A Closer Look at Soy Protein 259 Evaluation of Protein Quality 259 Nutrition Focus Vegetarian Diets 261 Case Scenario Follow-Up 263 Protein-Energy Malnutrition 264 Kwashiorkor 264 Marasmus 265 Kwashiorkor and Marasmus Malnutrition in the Hospital 266 Summary 266 Study Questions 267 Annotated References 267 Take Action Protein and the Vegetarian 269 Take Action Meeting Protein Needs When Dieting to Lose Weight 270 8 Alcohol 271 Chapter Outline 271 Case Scenario 271 Refresh Your Memory 272 Chapter Objectives 272 Alcohol?An Introduction 272 How Alcoholic Beverages Are Produced 273 Alcohol Metabolism 274 Alcohol Dehydrogenase Pathway 276 Microsomal Ethanol Oxidizing System (MEOS) 277 Catalase Pathway 277 Benefits of Moderate Alcohol Use 278 Health Problems from Alcohol Abuse 278 A Closer Look at Cirrhosis 281 Why Does Alcohol Abuse Typically Lead to Cirrhosis? 281 Expert Opinion Alcohol and Nutrition Charles H. Halsted, M.D. 282 Guidance Regarding Alcohol Use 282 Alcohol Dependency and Abuse 284 Genetic Influences 284 The Effect of Gender 284 Ethnicity and Alcohol Abuse 284 Other Conditions 285 How Is Alcoholism Diagnosed? 285 Do You Have a Problem with Alcohol? 286 Treatment of Alcoholism 286 Nutrition Focus Binge Drinking 287 Case Scenario Follow-Up 290 Summary 290 Study Questions 291 Annotated References 291 Take Action Could You or Someone You Know Have a Problem with Alcoholism? 293 Take Action Investigate the Energy Cost of Alcohol Use 294 PART THREE THE VITAMINS AND MINERALS 295 9 The Fat-Soluble Vitamins 295 Chapter Outline 295 Case Scenario 295 Refresh Your Memory 296 Chapter Objectives 296 Vitamins: Vital Dietary Components 296 Historical Perspective on the Vitamins 297 Storage of Vitamins in the Body 298 Vitamin Toxicity 298 Malabsorption of Vitamins 298 The Fat-Soluble Vitamins 299 Absorption of the Fat-Soluble Vitamins 299 Distribution of the Fat-Soluble Vitamins 300 Vitamin A 300 Absorption, Transport, Storage, and Excretion of Vitamin A 301 Cellular Retinoid-Binding Proteins 301 Retinoid Receptors in the Nucleus 302 Functions of Vitamin A 302 Vitamin A Analogs for Acne 304 Possible Carotenoid Functions 304 Vitamin A in Foods 305 Vitamin A Needs 306 Vitamin A-Deficiency Diseases 306 Upper Level for Vitamin A 307 Vitamin D 309 Vitamin D3 Formation in the Skin 310 Absorption of Vitamin D2 from Food 310 Metabolism, Transport, Storage, and Excretion of Vitamin D 310 Functions of Vitamin D 310 Vitamin D in Foods 312 Vitamin D Needs 313 Vitamin D-Deficiency Diseases 313 Expert Opinion Miracle Vitamin D: Importance for Bone Health and Prevention of Common Cancers, Autoimmune Diseases, and Other Disorders Michael F. Holick, Ph.D., M.D. 314 Pharmacologic Use of Vitamin D Analogs 315 Upper Level for Vitamin D 316 Vitamin E 316 Natural and Synthetic Vitamin E 316 Absorption, Transport, Storage, and Excretion of Vitamin E 317 Functions of Vitamin E 317 Vitamin E in Foods 320 Vitamin E Needs 320 Vitamin E-Deficiency Diseases 321 Upper Level for Vitamin E 321 Vitamin K 322 Absorption, Transport, Storage, and Excretion of Vitamin K 322 Functions of Vitamin K 322 Dietary Sources of Vitamin K 323 Vitamin K Needs 323 Vitamin K-Deficiency Diseases 324 Nutrition Focus Nutrient Supplements: Who Needs Them and Why? 326 Case Scenario Follow-Up 330 Summary 330 Study Questions 331 Annotated References 331 Take Action Preservation of Vitamins in Foods 333 Take Action A Closer Look at Supplement Use 334 10 The Water-Soluble Vitamins 335 Chapter Outline 335 Case Scenario 335 Refresh Your Memory 336 Chapter Objectives 336 General Properties of the Water-Soluble Vitamins 336 B-Vitamin and Vitamin C Status of North Americans 337 Enrichment and Fortification of Foods with B-Vitamins 337 Thiamin 338 Absorption, Transport, Storage, and Excretion of Thiamin 338 Functions of Thiamin 338 Thiamin in Foods 340 Thiamin Needs 340 Thiamin-Deficiency Diseases 340 Riboflavin 341 Absorption, Transport, Storage, and Excretion of Riboflavin 341 Functions of Riboflavin 341 Riboflavin in Foods 342 Riboflavin Needs 342 Riboflavin-Deficiency Diseases 343 Niacin 343 Absorption, Transport, Storage, and Excretion of Niacin 343 Functions of Niacin 343 Niacin in Foods 344 Niacin Needs 346 Niacin-Deficiency Diseases 346 Pharmacologic Use of Niacin and Upper Level for Niacin 346 Pantothenic Acid 347 Absorption, Transport, Storage, and Excretion of Pantothenic Acid 347 Functions of Pantothenic Acid 348 Pantothenic Acid in Foods 348 Pantothenic Acid Needs 348 Pantothenic Acid-Deficiency Diseases 349 Biotin 349 Absorption, Transport, Storage, and Excretion of Biotin 349 Functions of Biotin 349 Sources of Biotin: Food and Microbial Synthesis 350 Biotin Needs 350 Biotin-Deficiency Diseases 350 Vitamin B-6 351 Absorption, Transport, Storage, and Excretion of Vitamin B-6 351 Functions of Vitamin B-6 351 Vitamin B-6 in Foods 352 Vitamin B-6 Needs 353 Vitamin B-6-Deficiency Diseases 353 Pharmacologic Use of Vitamin B-6 and Upper Level for Vitamin B-6 353 Folate 354 Absorption, Transport, Storage, and Excretion of Folate 355 Functions of Folate 355 Folate in Foods 356 Folate Needs and Dietary Folate Equivalents 356 Folate-Deficiency Disease 356 Case Scenario Follow-Up 359 Upper Level for Folate 359 Vitamin B-12 359 Absorption, Transport, Storage, and Excretion of Vitamin B-12 360 Functions of Vitamin B-12 362 Vitamin B-12 in Foods 362 Vitamin B-12 Needs 362 Vitamin B-12-Deficiency Diseases 362 Choline 363 Absorption, Transport, Storage, and Excretion of Choline 364 Functions of Choline 364 Choline in Foods 364 Choline Needs 364 Choline-Deficiency Diseases 364 Upper Level for Choline 364 Vitamin C 365 Absorption, Transport, Storage, and Excretion of Vitamin C 365 Functions of Vitamin C 365 Vitamin C in Foods 367 Vitamin C Needs 367 Vitamin C-Deficiency Diseases 368 Vitamin C Intake above the RDA 368 Upper Level for Vitamin C 368 Expert Opinion Vitamin C: Antioxidant and Pro-Oxidant Functions and the Keystone of Tight Control Mark Levine, M.D., and Sebastian J. Padayatty, M.R.C.P., Ph.D. 372 Nutrition Focus Vitamin-Like Compounds 374 Summary 376 Study Questions 376 Annotated References 377 Take Action Spotting Fraudulent Claims on the Internet 379 Take Action Spotting Fraudulent Claims in Popular Books for Sale at Health-Food Stores and Bookstores 380 11 Water and the Major Minerals 381 Chapter Outline 381 Case Scenario 381 Refresh Your Memory 382 Chapter Objectives 382 Water 382 Water in the Body?Intracellular and Extracellular Fluid 383 Functions of Water 386 Water in Foods 387 Water Needs 387 Water-Deficiency Diseases 387 Water Toxicity 391 Minerals 392 Absorption, Transport, and Excretion of Minerals 392 Functions of Minerals 393 Food Sources of Minerals 394 North Americans at Risk for Mineral Deficiencies 394 Toxicity of Minerals 394 Sodium (Na) 395 Absorption, Transport, Storage, and Excretion of Sodium 395 Functions of Sodium 395 Sodium in Foods 395 Sodium Needs 396 Sodium-Deficiency Diseases 396 Upper Level for Sodium 396 Potassium (K) 397 Absorption, Transport, Storage, and Excretion of Potassium 397 Functions of Potassium 397 Potassium in Foods 397 Potassium Needs 397 Potassium-Deficiency Diseases 398 Chloride (Cl) 398 Absorption, Transport, Storage, and Excretion of Chloride 398 Functions of Chloride 398 Chloride in Foods 399 Chloride Needs 399 Chloride-Deficiency Diseases 399 Upper Level for Chloride 399 Nutrition Focus Minerals and Hypertension 400 Expert Opinion A Close Look at the DASH Diet Marlene Most, Ph.D., R.D., F.A.D.A. 403 Calcium (Ca) 404 Absorption, Transport, Storage, and Excretion of Calcium 404 Functions of Calcium 406 Calcium in Foods 410 Calcium Needs 411 Calcium-Deficiency Diseases 411 Upper Level for Calcium 414 Case Scenario Follow-Up 415 Phosphorus (P) 415 Absorption, Transport, Storage, and Excretion of Phosphorus 415 Functions of Phosphorus 415 Phosphorus in Foods 416 Phosphorus Needs 416 Phosphorus-Deficiency Diseases 416 Upper Level for Phosphorus 416 Magnesium (Mg) 416 Absorption, Transport, Storage, and Excretion of Magnesium 416 Functions of Magnesium 417 Magnesium in Foods 417 Magnesium Needs 417 Magnesium-Deficiency Diseases 417 Upper Level for Magnesium 418 Sulfur (S) 418 Summary 420 Study Questions 420 Annotated References 420 Take Action How High Is Your Sodium Intake? 423 Take Action Working for Denser Bones 423 12 Trace Minerals 425 Chapter Outline 425 Case Scenario 425 Refresh Your Memory 426 Chapter Objectives 426 Trace Minerals?An Introduction 426 Research on Trace Minerals 427 Difficulties in Studying Trace Minerals 427 Trace Mineral Needs 427 Sources of Trace Minerals 428 Iron (Fe) 428 Absorption, Transport, Storage, and Excretion of Iron 428 Functions of Iron 431 Iron in Foods 432 Iron Needs 432 Iron-Deficiency Diseases 432 Upper Level for Iron 434 Expert Opinion Iron Overload: Too Much of a Good Thing Barbara A. Bowman, Ph.D. and Giuseppina Imperatore, M.D., Ph.D. 436 Zinc (Zn) 435 Absorption, Transport, Storage, and Excretion of Zinc 435 Functions of Zinc 436 Zinc in Foods 437 Zinc Needs 437 Zinc-Deficiency Diseases 438 Upper Level for Zinc 438 Copper (Cu) 439 Absorption, Transport, Storage, and Excretion of Copper 439 Functions of Copper 439 Copper in Foods 440 Copper Needs 440 Copper-Deficiency Diseases 440 Upper Level for Copper 440 Selenium (Se) 441 Absorption, Transport, Storage, and Excretion of Selenium 441 Functions of Selenium 441 Selenium in Foods 441 Selenium Needs 441 Selenium-Deficiency Diseases 442 Upper Level for Selenium 443 Case Scenario Follow-Up 443 Iodide (I) 443 Absorption, Transport, Storage, and Excretion of Iodide 443 Functions of Iodide 444 Iodide in Foods 444 Iodide Needs 444 Iodide-Deficiency Diseases 444 Upper Level for Iodide 445 Fluoride (F) 446 Absorption, Transport, Storage, and Excretion of Fluoride 446 Functions of Fluoride 446 Fluoride in Foods 447 Fluoride Needs 447 Upper Level for Fluoride 447 Chromium (Cr) 447 Absorption, Transport, Storage, and Excretion of Chromium 447 Functions of Chromium 448 Chromium in Foods 448 Chromium Needs 448 Chromium-Deficiency Diseases 448 Manganese (Mn) 448 Molybdenum (Mo) 449 Ultratrace Minerals 449 Boron (B) 449 Nickel (Ni) 452 Silicon (Si) 452 Arsenic (As) 452 Vanadium (V) 453 Summary 461 Study Questions 461 Annotated References 462 Nutrition Focus Nutrition and Cancer 454 Take Action Analyze Iron and Zinc Intake in a Sample Vegan Diet 464 Take Action Check Out Your Municipal Water Supply 464 PART FOUR ENERGY BALANCE AND IMBALANCE 465 13 Energy Balance and Weight Control 465 Chapter Outline 465 Case Scenario 465 Refresh Your Memory 466 Chapter Objectives 466 Energy Balance 466 Positive and Negative Energy Balance 467 Energy Intake 467 Energy Output 469 Basal Metabolism 469 Determination of Energy Use by the Body 472 Direct and Indirect Calorimetry 472 Estimates of Energy Needs 472 Why Am I Hungry? 473 Hypothalamus: Key Satiety Regulator 475 Satiety Regulation at Other Body Sites 476 Control of Feeding through Body Composition 476 Hormones That Affect Satiety 476 Nutrients in the Blood That Affect Satiety 477 Does Appetite Regulate What We Eat? 477 Hunger and Appetite in Perspective 477 Estimation of a Healthy Weight 478 Using Body Mass Index (BMI) to Set Healthy Weight 478 Expert Opinion Sorting Out Satiety and Weight Regulation: Hormones and Dietary Macronutrients Peter J. Havel, D.V.M., Ph.D. 479 Putting Healthy Weight into Perspective 481 Energy Imbalance 482 Estimating Body Fat Content and Diagnosing Obesity 482 Using Body Mass Index to Define Obesity 484 Using Body Fat Distribution to Further Evaluate Obesity 486 Why Some People Are Obese?Nature Versus Nurture 487 How Does Nature Contribute to Obesity? 488 Does the Body Have a Set Point for Weight? 488 Does Nurture Have a Role? 489 Nature and Nurture Together 489 Treatment of Overweight and Obesity 490 What to Look for in a Sound Weight-Loss Plan 490 Wishful Shrinking?Why Can?t Quick Weight Loss Be Mostly Fat? 492 Weight Cycling Is All Too Common 492 Weight Loss in Perspective 493 Control of Energy Intake: The Main Key to Weight Loss and Weight Maintenance 493 Regular Physical Activity: A Second Key to Weight Loss and Especially Important for Later Weight Maintenance 494 Behavior Modification: A Third Strategy for Weight Loss 495 Relapse Prevention Is Important 498 Social Support Aids Behavioral Change 498 Nutrition Focus Popular Diets?Why All the Commotion? 499 Case Scenario Follow-Up 502 Professional Help for Weight Loss 502 Medications for Weight Loss 502 Treatment of Severe Obesity 503 Treatment of Underweight 505 Summary 506 Study Questions 507 Annotated References 507 Take Action A Close Look at Your Weight Status 509 Take Action An Action Plan to Change or Maintain Weight Status 509 14 Nutrition for Fitness and Sports 515 Chapter Outline 515 Case Scenario 515 Refresh Your Memory 516 Chapter Objectives 516 The Close Relationship between Nutrition and Fitness 516 Designing a Fitness Program 518 Phase 1: Getting Started Means Getting Going 518 Phase 2: Achieving and Maintaining Even Greater Physical Fitness 518 Energy Sources for Muscle Use 521 Adenosine Triphosphate (ATP)?Immediately Usable Energy 521 Phosphocreatine: The Initial Resupply of Muscle ATP 521 Glucose: Major Fuel for Short-Term, High-Intensity and Medium-Term Exercise 522 Fat: The Main Fuel for Prolonged Low-Intensity Exercise 526 Protein: A Minor Fuel Source, Primarily for Endurance Exercise 527 The Body?s Response to Physical Activity 528 Specialized Functions of Skeletal Muscle Fiber Types 528 Adaptation of Muscles and Body Physiology to Exercise 528 Power Food: Dietary Advice for Athletes 529 Energy Needs 529 Carbohydrate Needs 530 Fat Needs 533 Protein Needs 534 Vitamin and Mineral Needs 534 Expert Opinion Does Increased Physical Activity Necessitate Antioxidant Supplements? Priscilla M. Clarkson, Ph.D. 536 A Focus on Fluid Needs 537 Fluid Replacement Strategies 539 Use of Sports Drinks 539 Specialized Dietary Advice for before, during, and after Endurance Exercise 540 Replenishing Fuel during Endurance Exercise 541 Carbohydrate Intake during Recovery from Prolonged Exercise 542 Case Scenario Follow-Up 543 Nutrition Focus Evaluating Ergogenic Aids to Enhance Athletic Performance 544 Summary 546 Study Questions 546 Annotated References 546 Take Action Meeting the Protein Needs of an Athlete?A Case Study 548 Take Action How Physically Fit Are You? 550 15 Eating Disorders: Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder, and Other Conditions 553 Chapter Outline 553 Case Scenario 553 Refresh Your Memory 554 Chapter Objectives 554 From Ordered to Disordered Eating Habits 554 Food: More Than Just a Source of Nutrients 555 Overview of Anorexia Nervosa and Bulimia Nervosa 555 Is There a Genetic Connection to Eating Disorders? 559 Anorexia Nervosa 559 Nutrition Focus The Personal Side of Eating Disorders 560 Profile of the Typical Person with Anorexia Nervosa 562 Early Warning Signs 562 Physical Effects of Anorexia Nervosa 563 Treatment of Anorexia Nervosa 565 Case Scenario Follow-Up 567 Bulimia Nervosa 568 Typical Behavior in Bulimia Nervosa 568 Health Problems Stemming from Bulimia Nervosa 570 Treatment of Bulimia Nervosa 570 Eating Disorders Not Otherwise Specified (EDNOS) 571 Binge-Eating Disorder 572 Other Examples of Disordered Eating 573 Expert Opinion The Female Athlete Triad Jackie Berning, Ph.D., R.D. 574 Prevention of Eating Disorders 574 Organizations to Help You Understand More about Eating Disorders 576 Summary 577 Study Questions 577 Annotated References 578 Take Action Assessing Risk of Developing an Eating Disorder 579 Take Action Helping Prevent Eating Disorders 580 PART FIVE NUTRITION APPLICATIONS IN THE LIFE CYCLE 581 16 Pregnancy and Breastfeeding 581 Chapter Outline 581 Case Scenario 581 Refresh Your Memory 582 Chapter Objectives 582 Planning for Pregnancy 582 Prenatal Growth and Development 583 Early Growth: The First Trimester Is a Very Critical Time 584 Expert Opinion Folic Acid Intervention: Public Health Outcomes Lynn B. Bailey, Ph.D. 586 Second Trimester 587 Third Trimester 588 Definition of a Successful Pregnancy 589 Increased Nutrient Needs to Support Pregnancy 590 Increased Energy Needs 590 Adequate Weight Gain 590 Increased Protein and Carbohydrate Needs 592 Increased Vitamin Needs 592 Increased Mineral Needs 592 Is there an Instinctive Drive During Pregnancy to Consume More Nutrients? 593 Food Plan for Pregnant Women 593 Use of Prenatal Vitamin and Mineral Supplements 595 Pregnant Vegetarians 595 Effect of Nutritional Status on the Success of Pregnancy 595 Prenatal Care and Counseling 596 Case Scenario Follow-Up 597 Physiological Changes of Concern during Pregnancy 597 Heartburn, Constipation, and Hemorrhoids 597 Nutrition Focus Effects of Other Factors on Pregnancy Outcome 598 Edema 601 Morning Sickness 601 Anemia 602 Gestational Diabetes 602 Pregnancy-Induced Hypertension 602 Breastfeeding 603 Ability to Breastfeed 603 Production of Human Milk 604 Let-Down Reflex 605 Nutritional Qualities of Human Milk 606 Food Plan for Women Who Breastfeed 606 Breastfeeding Today 608 Environmental Contaminants in Human Milk 610 The Breastfeeding of Preterm Infants 610 Summary 611 Study Questions 611 Annotated References 612 Take Action Targeting Nutrients Necessary for Pregnant Women 613 Take Action Putting Your Knowledge about Nutrition and Pregnancy to Work 614 17 Nutrition from Infancy Through Adolescence 615 Chapter Outline 615 Case Scenario 615 Refresh Your Memory 616 Chapter Objectives 616 Nutrition and Child Health: An Introduction 616 Infant Growth and Physiological Development 617 The Growing Infant 617 Effect of Undernutrition on Growth 618 Assessment of Infant Growth and Development 618 Brain Growth 620 Adipose Tissue Growth 620 Failure to Thrive 620 Infant Nutritional Needs 621 Formula Feeding for Infants 625 Development of Feeding Skills in Older Infants 626 Introduction of Solid Foods at About 6 Months of Age 628 Case Scenario Follow-Up 631 Health Problems Related to Infant Nutrition 632 Preschool Children: Nutrition Concerns 634 Nutrition Focus Food Allergies and Intolerances 635 Helping a Child Choose Nutritious Foods 637 Childhood Feeding Problems 638 Use of Multivitamin and Mineral Supplements 641 Other Nutritional Problems in Preschool Children 642 Modifications of Childhood Diets to Reduce Future Disease Risk 643 School-Age Children: Nutrition Concerns 644 Breakfast, Fat Intake, and Snacks 644 Type 2 Diabetes 646 Overweight and Obesity 646 Expert Opinion Are Savvy Marketers Contributing to the Obesity Epidemic in Children? Carol Byrd-Bredbenner, Ph.D., R.D., F.A.D.A. 648 The Teenage Years: Nutrition Concerns 650 Nutritional Problems and Concerns of Teens 650 A Closer Look at the Diets of Teenage Girls 651 Helping Teens Eat More Nutritious Foods 651 Working with the Teenage Mind-Set 652 Teenage Snacking Practices 652 Summary 653 Study Questions 653 Annotated References 654 Take Action Getting Young Bill to Eat 655 Take Action Evaluating a Teen Lunch 656 18 Nutrition during Adulthood 657 Chapter Outline 657 Case Scenario 657 Refresh Your Memory 658 Chapter Objectives 658 Nutrition and Adulthood: An Introduction 658 Compression of Morbidity 659 A Diet for the Adult Years 660 A Closer Look at Middle and Older Adulthood 661 Life Span 661 Life Expectancy 661 The Graying of North America 662 The Definition of Aging 662 Nutritional Implications of Aging 663 Decreased Appetite and Food Intake 663 Decline in Dental Health 666 Reduced Thirst Sensation 666 Fall in Gastrointestinal Tract Function 666 Changes in Liver, Gallbladder, and Pancreatic Function 666 Decline in Kidney Function 667 Reduced Immune Function 667 Reduced Lung Function 667 Reduced Hearing and Vision 667 Decrease in Lean Tissue 668 Increases in Fat Stores 669 Reduced Cardiovascular Health 669 Decline in Bone Health 669 Other Factors That Influence Nutrient Needs in Aging 670 Depression in Older Adults 670 Alcoholism in Older Adults 671 Alzheimer?s Disease 672 Nutrition Focus Complementary and Alternative Medicine Practices 673 Nutrient Needs and Dietary Planning in Middle and Older Adulthood 679 Community Nutrition Services for Older Adults 682 Expert Opinion Nutrition and Healthy Aging Katherine Tucker, Ph.D. 680 Case Scenario Follow-Up 684 Summary 685 Study Questions 685 Annotated References 685 Take Action Am I Aging Healthfully? 687 Take Action Helping Older Adults Eat Better 688 PART SIX PUTTING NUTRITION KNOWLEDGE INTO PRACTICE 689 19 Safety of Food and Water 689 Chapter Outline 689 Case Scenario 689 Refresh Your Memory 690 Chapter Objectives 690 Safety of Food and Water: Setting the Stage 690 What Are the Effects of Foodborne Illness? 691 Why Is Foodborne Illness So Common? 691 Food Preservation: Past, Present, and Future 694 Foodborne Illness: When Undesirable Microorganisms Alter Foods 695 General Rules for Preventing Foodborne Illness 695 Expert Opinion Food Safety?Why Should You Care? Lydia Medeiros Ph.D., R.D. 701 A Closer Look at the Primary Microorganisms That Cause Foodborne Illness 703 Case Scenario Follow-Up 710 Food Additives 711 Uses of Food Additives 711 Intentional versus Incidental Food Additives 711 The GRAS List 711 Synthetic Compounds 712 Tests of Food Additives for Safety 712 Approval for a New Food Additive 712 Common Food Additives 713 Risks of Food Additives 717 Substances That Occur Naturally in Foods and Can Cause Illness 717 Environmental Contaminants in Food 718 Lead 718 Dioxin 719 Mercury 719 Urethane in Some Alcoholic Beverages 719 Polychlorinated Biphenyls (PCBs) 720 Cadmium 720 Protection from Evironmental Toxins in Foods 720 Our Water Supply: Safety Issues 720 Bottled Water 721 Monitoring the Safety of Your Water 721 Options Regarding Your Water Source 722 Nutrition Focus Pesticides in Food 723 Summary 725 Study Questions 726 Annotated References 726 Take Action Can You Spot the Improper Food Safety Practices? 728 Take Action Take a Closer Look at Food Additives 728 20 Undernutrition Throughout the World 729 Chapter Outline 729 Case Scenario 729 Refresh Your Memory 730 Chapter Objectives 730 World Hunger: A Continuing Plague 730 World Hunger Today 731 Critical Life Stages When Undernutrition Is Devastating 734 General Effects of Semistarvation 736 Case Scenario Follow-Up 737 Undernutrition in the United States 737 Helping the Hungry in the United States 737 Socioeconomic Factors Related to Undernutrition 740 Possible Solutions to Poverty and Hunger in the United States 741 Undernutrition in the Developing World 742 Food/Population Ratio 742 War and Political/Civil Unrest 744 Rapid Depletion of Natural Resources 744 Inadequate Shelter and Sanitation 745 High External Debt 747 The Impact of AIDS Worldwide 747 Reducing Undernutrition in the Developing World 749 Expert Opinion Alleviating Food Insecurity and Hunger Hugo Melgar-Quiñonez, M.D., Ph.D., and Ana Claudia Zubieta, Ph.D. 752 Nutrition Focus The Role of Biotechnology in Expanding Worldwide Food Availability 754 Some Concluding Thoughts 751 Summary 756 Study Questions 757 Annotated References 757 Take Action Fighting World Undernutrition on a Personal Level 758 Take Action Joining the Battle against Undernutrition 758 Appendixes A-1 A Chemistry: A Tool for Understanding Nutrition A-1 B Detailed Depictions of Glycolysis, Citric Acid Cycle, Electron Transport Chain, Classes of Eicosanoids, and Homocysteine Metabolism A-26 C Human Physiology: A Tool for Understanding Nutrition A-31 D Dietary Advice for Canadians A-56 E The Exchange System: A Helpful Menu-Planning Tool A-65 F Exchange System Lists A-70 G Dietary Intake and Energy Expenditure Assessment A-78 H Fatty Acids, Including Omega-3 Fatty Acids, in Foods A-89 I The 1983 Metropolitan Life Insurance Company Height- Weight Table and Determination of Frame Size A-91 J Nutrition Calculations A-94 K Sources of Nutrition Information A-97 L English-Metric Conversions, and Metric and Household Units A-101 M Estimated Average Requirements for Nutrients A-103 N Food Composition Table A-106 Glossary G-1 Credits C-1 Index I-1
Library of Congress Subject Headings for this publication:
Nutrition.