Table of contents for Wardlaw's perspectives in nutrition / Carol Byrd-Bredbenner ... [et al.].

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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.