Perspectives in nutrition / Gordon M. Wardlaw, Jeffrey S. Hampl.

Includes bibliographical references and index.

Contents

Part one: Nutrition Basics
1 What Nourishes You? 1
Case Scenario 1
Refresh Your Memory 2
Chapter Objectives 2
Nutrition and Your Health 3
What Actually Is Nutrition? 3
Nutrients Come from Food 3
Why Study Nutrition? 3
Classes and Sources of Nutrients 5
Carbohydrates 6
Lipids 7
Proteins 8
Vitamins 8
Minerals 9
Water 9
Nutrient Composition of Diets and the Human Body 9
Energy Sources and Uses 10
Interest in the Field of Nutrition Has a Long History 12
Current State of the North American Diet 13
Assessing the Current North American Diet 14
What Influences These Food Choices? 14
Improving Our Diets 16
Health Objectives for the United States for the Year 2010 Include
Numerous Nutrition Objectives 16
Using Scientific Research to Determine Nutrient Needs 19
Expert Opinion Who Are North America?s Nutrition Experts? Anne M. Smith, Ph.D.,
R.D. 20
Asking Questions and Generating Hypotheses 22
Laboratory Animal Experiments 22
Human Experiments 23
Peer Review of Experimental Results 24
Follow-up Studies 25
How to Use This Knowledge to Evaluate Nutrition Claims and Advice 25
Summary 28
Study Questions 28
Annotated References 28
Take Action 30
Nutrition Perspective Genetics and Nutrition 31

2. The Basis of a Healthy Diet 35
Case Scenario 35
Refresh Your Memory 36
Chapter Objectives 36
A Food Philosophy That Works 37
Variety Contributes to Diet Adequacy 37
Balance Means Not Overconsuming Any One Food 38
Moderation Refers Mostly to Portion Size 39
Nutrient Density Can Also Help Guide Food Choice 40
Energy Density Especially Influences Energy Intake 41
States of Nutritional Health 42
Desirable Nutrition 42
Undernutrition 42
Overnutrition 43
How Could Your Nutritional State Be Measured? 44
Analyzing Background Factors 44
Evaluating the ABCDEs 44
Recognizing the Limitations of Nutritional Assessment 45
Concern About Your Nutritional State of Health Is Important 46
Setting Nutrient Needs--Dietary Reference Intakes (DRIs) 46
Estimated Average Requirements (EARs) 47
Recommended Dietary Allowances (RDAs) 48
Adequate Intakes (AIs) 48
Estimated Energy Requirements (EERs) 49
Tolerable Upper Intake Levels (Upper Levels or ULs) 49
Appropriate Uses of the DRIs 49
Daily Values (DVs): The Standards Used for Food Labeling 50
Reference Daily Intakes (RDIs) 50
Daily Reference Values (DRVs) 50
Daily Values in Perspective 52
From Nutrient Recommendations to Food Choices 53
The Food Guide Pyramid--A Menu-Planning Tool 53
Dietary Guidelines for Americans--Another Tool for Menu Planning 59
Expert Opinion What Should I Eat to Live Longer? David Klurfeld, Ph.D. 62
Case Scenario Follow-up 62
What Do Food Labels Have to Offer Diet Planning? 64
Exceptions to Food Labeling 67
Health Claims on Food Labels 67
Summary 68
Study Questions 69
Annotated References 69
Take Action 71
Nutrition Perspective Ethnic Influences on the North American Diet 73

3. Human Digestion and Absorption 79
Case Scenario 79
Refresh Your Memory 80
Chapter Objectives 80
The Cell Is the Basis of Human Physiology 81
Organization of the Human Body 82
The Physiology of Digestion 83
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
The Physiology of Absorption 93
Absorptive Cells 94
Types of Absorption 94
Portal and Lymphatic Circulation in Absorption 94
Enterohepatic Circulation 95
Absorption Is Completed in the Large Intestine 96
Storage Capabilities of the Body 97
Expert Opinion Probiotics, Prebiotics, and Human Health, Steve Hertzler, Ph.D.,
R.D. 98
Summary 100
Study Questions 100
Annotated References 101
Take Action 102
Nutrition Perspective When the Digestive Processes Go Awry 103
Case Scenario Follow-up 104

4. Metabolism 107
Case Scenario 107
Refresh Your Memory 108
Chapter Objectives 108
Metabolism? Chemical Reactions in the Body 109
Energy for the Cell 109
Cells Use Adenosine Triphosphate (ATP) as an Energy Source 110
Oxidation-Reduction Reactions/Key Processes in Energy Metabolism 112
Carbohydrate Metabolism Begins with Glycolysis 113
Glycolysis? Glucose to Pyruvate 113
Where Is the ATP? 114
Lactate Production Is the Endpoint of Anaerobic Glycolysis 115
The Citric Acid Cycle Completes Glucose Catabolism 117
Pyruvate to Acetyl-CoA Is an Irreversible Step 117
The Citric Acid Cycle 117
The Electron Transport Chain Is the Primary Site for ATP Synthesis 120
Glycogen Metabolism 122
Lypolysis: Fat Breakdown 122
Carbohydrate Aids Fat Metabolism 123
Ketogenesis: Producing Ketone Bodies from Fatty Acids 123
Lipogenesis: Building Fatty Acids 124
Case Scenario Follow-up 124
Protein Metabolism 125
Gluconeogenesis: Producing New Glucose Molecules from Amino Acids and Other
Compounds 125
Expert Opinion Why Is an Understanding of Energy Metabolism Important? Michael
Keenan Ph.D. 126
Disposing of Excess Amino Groups from Amino Acid Metabolism 128
What Happens Where? A Review 129
Regulating Metabolism 130
Summary 131
Study Questions 133
Annotated References 133
Take Action 134
Nutrition Perspective Inborn Errors of Metabolism 135

Part two: The energy-yielding nutrients and alcohol
5. Carbohydrates 137
Case Scenario 137
Refresh Your Memory 138
Chapter Objectives 138
Carbohydrates?An Introduction 139
Structures and Functions of Simple Carbohydrates 139
Monosaccharides: Glucose, Fructose, and Galactose 139
Disaccharides: Maltose, Sucrose, and Lactose 140
Oligosaccharides: Raffinose and Stachyose 142
Structures and Functions of the More Complex Carbohydrates 142
Digestible Polysaccharides: Starch and Glycogen 142
Indigestible Polysaccharides: Fibers 144
Carbohydrate Digestion and Absorption 146
Digestion 146
Absorption 147
Functions of Glucose and Other Sugars in the Body 149
Yielding Energy 149
Sparing Proteins from Use as an Energy Source 149
Preventing Ketosis 149
Expert Opinion The Benefits of a High-Carbohydrate Diet, William E. Connor, M.D.
150
Functions of Fiber 151
Carbohydrate Needs 153
How Much Fiber Do We Need? 153
Problems with High-Fiber Diets 157
Moderating Intake of Simple Sugars Is Important for Many of Us 157
Problems with High-Sugar Diets 157
Moderation in Lactose Intake Is Important for Some People 162
Case Scenario Follow-up 163
Carbohydrates in Foods: Food Sweeteners 163
Nutritive Sweeteners 163
Alternative Sweeteners 164
Summary 167
Study Questions 167
Annotated References 167
Take Action 169
Nutrition Perspective When Blood Glucose Regulation Fails 171

6. Lipids 177
Case Scenario 177
Refresh Your Memory 178
Chapter Objectives 178
Lipids: Common Properties and Main Types 179
Fatty Acids: The Simplest Form of Lipids 179
Essential Fatty Acids 181
Effects of a Deficiency of Essential Fatty Acids 182
Triglycerides 183
Expert Opinion A Closer Look at Omega-3 and Omega-6 Fatty
Acids and Related Eicosanoids, Kenneth S. Broughton, Ph.D. 184
Providing Energy for the Body 186
Storing Energy for Later Use 186
Insulating and Protecting the Body 187
Transporting Fat-Soluble Vitamins 187
Phospholipids 187
Sterols 188
Fat Digestion and Absorption 189
Digestion 190
Absorption 192
Fats Carried in the Bloodstream 192
Carrying Dietary Fats Utilizes Chylomicrons 192
Transporting Lipids Mostly Made by the Body Uses Very-Low-Density Lipoproteins
Another Dimension of Fat?Properties in Food 197
Fat in Food Provides Satiety and Flavor 197
Hydrogenation of Fatty Acids Aids in Food Formulation but Increases Trans Fatty
Acid Content 197
Fat Rancidity Limits Shelf Life of Foods 200
Fats Act as Emulsifiers 200
Recommendations for Fat Intake 201
Fats in Food 205
Fat Replacement Strategies 206
Hidden Fat 207
Wise Use of Reduced-Fat Foods 209
Case Scenario Follow-up 209
Summary 210
Study Questions 210
Annotated References 211
Take Action 213
Nutrition Perspective Cardiovascular Disease 215

7. Proteins 223
Case Scenario 223
Refresh Your Memory 224
Chapter Objectives 224
Protein--An Introduction 225
Proteins--Vital to Life 225
Amino Acid Form Determines Function 225
Transamination and Deamination 227
Putting Essential and Nonessential Amino Acids in Perspective 227
part two The Energy-Yielding Nutrients and Alcohol Proteins--Amino Acids Bonded
Together 229
Protein Synthesis 230
Protein Turnover 232
Protein Organization 232
Denaturation of Proteins 234
Protein Digestion and Absorption 235
Digestion 235
Absorption 236
Functions of Proteins 237
Producing Vital Body Constituents 237
Maintaining Fluid Balance 238
Contributing to Acid-Base Balance 239
Forming Hormones and Enzymes 239
Contributing to Immune Function 239
Forming Glucose 239
Providing Energy 239
Protein Needs 240
Does Eating a High-Protein Diet Harm You? 243
Expert Opinion A New Appreciation for the Nut in Nutrition, Penny M. Kris-
Etherton, Ph.D., R.D. 244
Protein in Foods 244
The Value of Plant Protein 245
A Closer Look at Soy Protein in Particular 246
Evaluation of Protein Quality 246
Protein-Energy Malnutrition 248
Kwashiorkor 248
Marasmus 249
Kwashiorkor and Marasmus Malnutrition in the Hospital 250
Summary 251
Study Questions 251
Annotated References 252
Take Action 253
Nutrition Perspective Vegetarian Diets 255
Case Scenario Follow-up 258

8. Alcohol 259
Case Scenario 259
Refresh Your Memory 260
Chapter Objectives 260
Alcohol?An Introduction 261
How Alcoholic Beverages Are Produced 261
Alcohol Metabolism 262
Alcohol Dehydrogenase Pathway 263
Microsomal Ethanol Oxidizing System (MEOS) 265
Benefits of Moderate Alcohol Use 266
Health Problems from Alcohol Use 268
A Closer Look at Cirrhosis 268
Expert Opinion Alcohol and Nutrition, Charles H. Halsted, M.D. 270
Other Problems Associated with Alcohol Abuse 272
Problem Drinking in the Workplace 272
Operation of Motor Vehicles and Related Equipment 272
Sexually Transmitted Diseases 272
Unplanned Pregnancy 272
Children of Alcoholics 273
Guidance Regarding Alcohol Use 273
Alcohol Dependency and Abuse 273
Alcoholism Diagnosis 275
Do You Have a Problem with Alcohol? 275
Treatment of Alcoholism 276
Case Scenario Follow-up 277
Summary 278
Study Questions 278
Annotated References 278
Take Action 280
Nutrition Perspective Binge Drinking 282
Contents vii

part three: The Vitamins and Minerals
9. The Fat-Soluble Vitamins 285
Case Scenario 285
Refresh Your Memory 286
Chapter Objectives 286
Vitamins: Vital Dietary Components 287
Historical Perspective on the Vitamins 287
Storage of Vitamins in the Body 288
Vitamin Toxicity 288
Malabsorption of Vitamins 288
Preservation of Vitamins in Foods 289
Absorption of the Fat-Soluble Vitamins 289
Vitamin A 291
Absorption, Transport, Storage, and Excretion of Vitamin A 292
Cellular Retinoid-Binding Proteins 292
Nuclear Retinoid Receptors 293
Functions of Vitamin A 293
Vitamin A in Foods 295
Expert Opinion Carotenoids and Human Health: Beyond Conversion to Vitamin A,
Thomas W.-M. Boileau, Ph.D., and John
W. Erdman, Jr., Ph.D. 296
Vitamin A Needs 297
Vitamin A Deficiency 298
Vitamin A Toxicity 298
Vitamin D 300
Vitamin D Formation in the Skin 301
Absorption and Formation of Vitamin D from Food 302
Metabolism, Transport, and Storage of Vitamin D 302
Functions of Vitamin D 302
Vitamin D in Foods 303
Vitamin D Needs 304
Vitamin D Deficiency 304
Pharmacologic Use of Vitamin D 305
Vitamin D Toxicity 305
Vitamin E 305
Absorption, Transport, Storage, and Excretion of Vitamin E 306
Functions of Vitamin E 306
Vitamin E in Foods 309
Vitamin E Needs 309
Vitamin E Deficiency 310
Vitamin E Toxicity 310
Vitamin K 310
Absorption, Transport, Storage, and Excretion of Vitamin K 311
Functions of Vitamin K 311
Vitamin K in Foods 311
Vitamin K Needs 311
Vitamin K Deficiency 313
Summary 314
Study Questions 314
Annotated References 315
Take Action 317
Nutrition Perspective Nutrient Supplements: Who Needs Them? 319
Case Scenario Follow-up 321

10. The Water-Soluble Vitamins 323
Case Scenario 323
Refresh Your Memory 324
Chapter Objectives 324
General Properties of the Water-Soluble Vitamins 325
B-Vitamin and Vitamin C Status of North Americans 325
Enrichment and Fortification of Foods with B-Vitamins 326
Thiamin 327
Absorption, Transport, Metabolism, and Excretion of Thiamin 327
Functions of Thiamin 327
Expert Opinion Looking Beyond the Water-Soluable Vitamins: Phytochemicals in
Health Promotion and Disease Prevention, Clare M. Hasler, Ph.D. 328
Thiamin in Foods 330
Thiamin Needs 330
Thiamin?Deficiency Diseases 331
Riboflavin 331
Absorption, Transport, Metabolism, and Excretion of Riboflavin 331
Functions of Riboflavin 332
Riboflavin in Foods 332
Riboflavin Needs 332
Riboflavin Deficiency 332
Niacin 333
Absorption, Transport, Storage, and Excretion of Niacin 333
Functions of Niacin 333
Niacin in Foods 334
Niacin Needs 335
Niacin Deficiency 335
Pharmacologic Use and Toxicity of Niacin 336
Pantothenic Acid 336
Functions of Pantothenic Acid 336
Pantothenic Acid in Foods 337
Pantothenic Acid Needs 337
Biotin 337
Functions of Biotin 338
Sources of Biotin: Food and Microbial Synthesis 338
Biotin Needs 338
Biotin Deficiency 339
Vitamin B-6 339
Absorption, Metabolism, Excretion, and Storage of Vitamin B-6 339
Functions of Vitamin B-6 339
Vitamin B-6 in Foods 340
Vitamin B-6 Needs 340
Vitamin B-6 Deficiency 340
Pharmacologic Use of Vitamin B-6 and Toxicity 341
Folate 341
Metabolism, Absorption, Storage, and Excretion of Folate 342
Functions of Folate 342
Folate in Foods 343
Folate Needs and Dietary Folate Equivalents 343
Folate Deficiency 344
Case Scenario Follow-up 346
Toxicity of Folate 346
Vitamin B-12 347
Absorption, Transport, and Storage of Vitamin B-12 347
Functions of Vitamin B-12 348
Vitamin B-12 in Foods 349
Vitamin B-12 Needs 349
Vitamin B-12 Deficiency 349
A Closer Look at Homocysteine Metabolism: Integrating Your Nutrition Knowledge
350
Choline 350
Absorption, Metabolism, and Excretion of Choline 352
Functions of Choline 352
Choline in Foods 352
Choline Needs 352
Choline Deficiency 352
Choline Toxicity 352
Vitamin C 352
Absorption, Metabolism, Storage, and Excretion of Vitamin C 353
Functions of Vitamin C 353
Vitamin C in Foods 355
Vitamin C Needs 355
Vitamin C Deficiency 356
Vitamin C Intake Above the RDA 356
Toxicity of Vitamin C 356
Vitamin-Like Compounds 357
Carnitine 357
Inositol 358
Taurine 359
Lipoic Acid 360
Summary 360
Study Questions 361
Annotated References 361
Take Action 363
Nutrition Perspective Nutrition and Cancer 364

11. Water and the Major Minerals 371
Case Scenario 371
Refresh Your Memory 372
Chapter Objectives 372
Water 373
Water in the Body--Intracellular and Extracellular Fluid 373
Functions of Water 375
Water in Foods 376
Water Needs 376
Water Deficiency 378
Water Toxicity 380
Minerals 381
Absorption, Transport, and Excretion of Minerals 381
Functions of Minerals 382
Food Sources of Minerals 383
North Americans at Risk for Mineral Deficiencies 383
Toxicity of Minerals 383
Sodium (Na) 383
Absorption, Transport, Storage, and Excretion of Sodium 383
Functions of Sodium 384
Sodium in Foods 384
Sodium Needs 385
Sodium Deficiency 385
Toxicity of Sodium 386
Potassium (K) 387
Absorption, Transport, and Excretion of Potassium 387
Functions of Potassium 387
Potassium in Foods 387
Potassium Needs 387
Potassium Deficiency 387
Toxicity of Potassium 387
Chloride (Cl) 388
Absorption, Transport, and Excretion of Chloride 388
Functions of Chloride 388
Chloride in Foods 388
Chloride Needs 388
Chloride Deficiency 388
Toxicity of Chloride 388
Calcium (Ca) 389
Absorption, Transport, Storage, and Excretion of Calcium 389
Functions of Calcium 390
Calcium in Foods 393
Calcium Supplements 393
Calcium Needs 396
Calcium Deficiency 396
Toxicity of Calcium 399
Expert Opinion The Many Benefits of Calcium in Your Diet, Gregory Miller, Ph.D.,
F.A.C.N. 394
Case Scenario Follow-up 399
Phosphorus (P) 400
Absorption, Transport, and Excretion of Phosphorus 400
Functions of Phosphorus 400
Phosphorus in Foods 400
Phosphorus Needs 400
Phosphorus Deficiency 401
Toxicity of Phosphorus 401
Magnesium (Mg) 401
Absorption, Transport, Storage, and Excretion of Magnesium 401
Functions of Magnesium 401
Magnesium in Foods 402
Magnesium Needs 402
Magnesium Deficiency 402
Toxicity of Magnesium 402
Sulfur (S) 404
Summary 404
Study Questions 404
Annotated References 405
Take Action 407
Nutrition Perspective Minerals and Hypertension 409

12. Trace Minerals 413
Case Scenario 413
Refresh Your Memory 414
Chapter Objectives 414
Trace Minerals--An Introduction 415
Research on Trace Minerals 415
Difficulties in Studying Trace Minerals 415
Nutrient Needs for Trace Minerals 416
Trace Minerals in Foods 416
Iron (Fe) 417
Absorption, Transport, Storage, and Excretion of Iron 417
Functions of Iron 419
Iron in Foods 420
Iron Needs 420
Iron Deficiency 421
Iron Toxicity 422
Expert Opinion Iron Overload: Too Much of A Good Thing, Barbara A. Bowman, Ph.D.
and Giuseppina Imperatore, M.D., Ph.D. 424
Zinc (Zn) 423
Absorption, Transport, Storage, and Excretion of Zinc 423
Functions of Zinc 426
Zinc in Foods 426
Zinc Needs 426
Zinc Deficiency 426
Toxicity of Zinc 427
Copper (Cu) 427
Absorption, Transport, Storage, and Excretion of Copper 428
Functions of Copper 428
Copper in Foods 428
Copper Needs 429
Copper Deficiency 429
Toxicity of Copper 429
Selenium (Se) 430
Absorption, Transport, Storage, and Excretion of Selenium 430
Functions of Selenium 430
Selenium in Foods 431
Selenium Needs 431
Selenium Deficiency 431
Toxicity of Selenium 432
Case Scenario Follow-Up 432
Iodide (I) 432
Absorption, Transport, Storage, and Excretion of Iodide 433
Functions of Iodide 433
Iodide in Foods 433
Iodide Needs 434
Iodide Deficiency 434
Toxicity of Iodide 435
Fluoride (F) 435
Absorption, Transport, Storage, and Excretion of Fluoride 436
Functions of Fluoride 436
Fluoride in Foods 437
Fluoride Needs 437
Toxicity of Fluoride 437
Chromium (Cr) 438
Absorption, Transport, Storage, and Excretion of Chromium 438
Functions of Chromium 438
Chromium in Foods 438
Chromium Needs 438
Chromium Deficiency 438
Toxicity of Chromium 439
Manganese (Mn) 439
Molybdenum (Mo) 439
Ultratrace Minerals 440
Boron (B) 440
Nickel (N) 440
Silicon (Si) 442
Arsenic (As) 442
Vanadium (V) 442
Summary 443
Study Questions 444
Annotated References 444
Take Action 446
Nutrition Perspective Modern Mineral Status Research: Searching for Subtleties
447


part four Energy Production and Energy Balance
13. Energy Balance and Weight
Control 451
Case Scenario 451
Refresh Your Memory 452
Chapter Objectives 452
Energy Balance 453
Positive and Negative Energy Balance 453
Energy Intake 453
Energy Use 455
Determination of Energy Use by the Body 457
Direct and Indirect Calorimetry 458
Estimates of Energy Needs 459
Why Am I Hungry? 460
Hypothalamus: A Satiety Regulator 460
Satiety Regulation at Other Body Sites 462
Control of Feeding Through Body Composition 463
Does Appetite Regulate What We Eat? 463
Hormones That Affect Satiety 463
Nutrients in the Blood That Affect Satiety 464
Hunger and Appetite in Perspective 464
Estimation of a Healthy Weight 464
Using Body Mass Index (BMI) to Set Healthy Weight 465
Putting Healthy Weight into Perspective 466
Energy Imbalance 467
Estimating Body Fat Content and Diagnosing Obesity 468
Using Body Fat Distribution to Establish Obesity 471
Using Age of Onset in the Evaluation of Obesity 471
Why Some People Are Obese--Nature Versus Nurture 472
How Does Nature Contribute to Obesity? 472
Does the Body Have a Set Point for Weight? 473
Does Nurture Have a Role? 474
Nature and Nurture Together 474
Treatment of Obesity 476
Some Basic Premises 476
Wishful Shrinking--Why Can?t Quick Weight Loss Be Mostly Fat? 477
What to Look for in a Sound Weight-Loss Diet 478
Expert Opinion Why Is Weight Management So Difficult? Sachiko St. Jeor, Ph.D.,
R.D. 478
What to Look for in a Sound Weight-Loss Diet 478
Control of Energy Intake--The First Key to Weight Loss 481
Regular Physical Activity--A Second Key to Weight Loss and Especially Important
for Later Weight Maintenance 482
Behavior Modification--A Third Strategy for Weight Loss 484
Relapse Prevention Is Important 484
Social Support Aids Behavioral Change 486
Professional Help for Weight Loss 486
Pharmacotherapy for Weight Loss 486
Treatment of Severe Obesity 487
Treatment of Underweight 489
Summary 490
Study Questions 491
Annotated References 491
Take Action 493
Nutrition Perspective Popular Diets--Why All the Commotion? 499
Case Scenario Follow-up 502

14. Nutrition for Fitness and Sports 503
Case Scenario 503
Refresh Your Memory 504
Chapter Objectives 504
The Close Relationship Between Nutrition and Fitness 505
Energy Sources for Muscle Use 506
Adenosine Triphosphate (ATP)--Immediately Usable Energy 506
Phosphocreatine: The Initial Resupply of Muscle ATP 507
Expert Opinion Your Exercise Prescription, Sheri A. Melton, Ph.D. 508
Glucose: Major Fuel for Short-Term, High-Intensity and Medium-Term Exercise 509
Fat: The Main Fuel for Prolonged Low-Intensity Exercise 513
Protein: A Minor Fuel Source, Primarily for Endurance Exercise 514
The Body?s Response to Physical Activity 515
Specialized Functions of Skeletal Muscle Fiber Types 515
Adaptation of Muscles and Body Physiology to Exercise 515
Power Food: Dietary Advice for Athletes 516
Energy Needs 516
Carbohydrate Needs 517
Fat Needs 520
Protein Needs 520
Vitamin and Mineral Needs 521
Fluid Needs 523
Meals Before Endurance Events Should Emphasize Carbohydrate 526
Carbohydrate Intake During Recovery from Prolonged Exercise 527
Case Scenario Follow-up 528
Summary 528
Study Questions 529
Annotated References 529
Take Action 531
Nutrition Perspective Evaluating Ergogenic Aids to Enhance Athletic Performance
534

15. Eating Disorders: Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder,
and Other Conditions 539
Case Scenario 539
Refresh Your Memory 540
Chapter Objectives 540
From Ordered to Disordered Eating Habits 541
Food: More Than Just a Source of Nutrients 541
Overview of Anorexia Nervosa and Bulimia Nervosa 542
Is There a Genetic Connection to Eating Disorders? 544
Anorexia Nervosa 545
Profile of the Typical Person with Anorexia Nervosa 546
Early Warning Signs 547
Physical Effects of Anorexia Nervosa 548
Treatment of Anorexia Nervosa 550
Case Scenario Follow-up 552
Bulimia Nervosa 552
Typical Behavior in Bulimia Nervosa 553
Health Problems Stemming from Bulimia Nervosa 554
Treatment of Bulimia Nervosa 555
Eating Disorders Not Otherwise Specified (EDNOS) 556
Binge-Eating Disorder 556
Other Examples of Disordered Eating 558
Female Athlete Triad 558
Baryophobia 559
Expert Opinion A Closer Look at the Female Athlete Triad, Jackie Berning, Ph.D.,
R.D. 560
Prevention of Eating Disorders 561
Books and Organizations to Help You Understand More About Eating Disorders 562
Books 562
Organizations and Self-Help Groups 563
Summary 563
Study Questions 564
Annotated References 564
Take Action 566
Nutrition Perspective Eating Disorders: A Sociological Perspective 567

16. Pregnancy and Breastfeeding 569
Case Scenario 569
Refresh Your Memory 570
Chapter Objectives 570
Planned Pregnancy 571
Prenatal Growth and Development 571
Early Growth--The First Trimester Is a Very Critical Time 572
Second Trimester 573
Third Trimester 574
Definition of a Successful Pregnancy 574
Increased Nutrient Needs to Support Pregnancy 575
Increased Energy Needs 575
Increased Protein and Carbohydrate Needs 577
Increased Vitamin Needs 577
Increased Mineral Needs 578
Is There an Instinctive Drive During Pregnancy to Consume More Nutrients? 578
Food Plan for Pregnant Women 579
Use of Prenatal Vitamin and Mineral Supplements 579
Pregnant Vegetarians 580
Effect of Nutrition on the Success of Pregnancy 581
Effects of Nutritional and Other Factors on Pregnancy Outcome 582
Beyond the Nutrients 582
Prenatal Care and Counseling 584
Case Scenario Follow-up 585
Physiological Changes That Can Cause Discomfort in Pregnancy 585
Heartburn, Constipation, and Hemorrhoids 585
Edema 586
Morning Sickness 586
Anemia 586
Gestational Diabetes 587
Pregnancy-Induced Hypertension 587
Breastfeeding 588
Ability to Breastfeed 588
Production of Human Milk 588
Let-Down Reflex 589
Nutritional Qualities of Human Milk 590
Food Plan for Women Who Breastfeed 592
Breastfeeding Today 593
Expert Opinion Supporting Breastfeeding, Mary Ellen Rivero, M.S., R.D. 594
Environmental Contaminants in Human Milk 597
Can a Preterm Infant Be Breastfed? 597
Summary 598
Study Questions 598
Annotated References 599
Take Action 601
Nutrition Perspective Fetal Alcohol Syndrome 603

17. Nutrition from Infancy Through Adolescence 605
Case Scenario 605
Refresh Your Memory 606
Chapter Objectives 606
Nutrition and Child Health--An Introduction 607
Infant Growth and Physiological Development 607
The Growing Infant 607
Effect of Under nutrition on Growth 608
Assessment of Infant Growth and Development 608
Brain Growth 610
Adipose Tissue Growth 610
Failure to Thrive 610
Infant Nutritional Needs 611
Formula Feeding for Infants 615
Development of Feeding Skills in Older Infants 617
Introduction of Solid Foods at About 6 Months of Age 618
Case Scenario Follow-up 621
Health Problems Related to Infant Nutrition 622
Preschool Children 624
How to Help a Child Choose Nutritious Foods 625
Childhood Feeding Problems 626
Do Children Need a Multivitamin and Mineral Supplement? 628
Nutritional Problems in Preschool Children 630
Modifications of Childhood Diets to Reduce Future Disease Risk 631
Vegetarianism in Childhood 631
School-Age Children 632
Breakfast, Fat Intake, and Snacks 632
Type 2 Diabetes 633
Obesity 633
Expert Opinion Obesity and Type 2 Diabetes in Childhood: Lessons from the Pima
Indians, Arline D. Salbe, Ph.D., R.D. 634
The Teenage Years 636
Nutritional Problems and Concerns of Teens 637
A Closer Look at the Diets of Teenage Girls 638
Helping Teens Eat More Nutritious Foods 638
Overcoming the Teenage Mind-Set 638
Are Teenage Snacking Practices Harmful? 639
Summary 639
Study Questions 640
Annotated References 640
Take Action 642
Nutrition Perspective Food Allergies and Intolerances 644

part six Putting Nutrition Knowledge into Practice
19. Food Safety 681
Case Scenario 681
Refresh Your Memory 682
Chapter Objectives 682
Setting the Stage 683
Effects of Foodborne Illness 683
Why Is Foodborne Illness So Common? 683
Food Preservation--Past, Present, and Future 685
Foodborne Illness: When Undesirable Microorganisms Alter Foods 689
General Rules for Preventing Foodborne Illness 689
Expert Opinion Food Safety--Why Should You Care? Lydia Medeiros, Ph.D., R.D. 690
A Closer Look at the Primary Microorganisms That Cause Foodborne Illness 695
Case Scenario Follow-up 701
Food Additives 702
Why Are Food Additives Used? 702
Intentional Versus Incidental Food Additives 702
The GRAS List 702
Are Synthetic Compounds Always Harmful? 703
Tests of Food Additives for Safety 703
Approval for a New Food Additive 703
Common Food Additives 704
Substances That Occur Naturally in Foods and Can Cause Illness 708
Environmental Contaminants in Foods 709
Lead 709
Dioxin 710
Mercury 710
Urethane in Some Alcoholic Beverages 711
Polychlorinated Biphenyls (PCBs) 711
Protection from Environmental Toxins in Foods 711
Summary 711
Study Questions 712
Annotated References 712
Take Action 714
Nutrition Perspective Pesticides in Food 715

18. Nutrition During Adulthood 647
Case Scenario 647
Refresh Your Memory 648
Chapter Objectives 648
Nutrition and Adulthood--An Introduction 649
Compression of Morbidity 649
Diet for the Adult Years 650
Are Adults Following Current Dietary Recommendations? 653
Middle and Older Adulthood 653
Life Span 654
Life Expectancy 654
The Graying of North America 654
What Actually Is Aging? 655
Hypotheses About the Causes of Aging 656
Effects of Aging on Nutritional Health 656
Decreased Appetite and Food Intake 657
Decline in Dental Health 659
Reduced Thirst Sensation 659
Fall in Gastrointestinal Tract Function 659
Changes in Liver, Gallbladder, and Pancreatic Function 659
Decline in Kidney Function 660
Reduced Immune Function 660
Reduced Lung Function 660
Reduced Hearing and Vision 660
Decrease in Lean Tissue 661
Increases in Fat Stores 661
Reduced Cardiovascular Health 661
Decline in Bone Health 662
Other Factors That Influence Nutrient Needs in Aging 663
Depression in Older Adults 664
Alcoholism in Older Adults 664
Alzheimer?s Disease 664
Nutrient Needs in Middle and Older Adulthood 665
Expert Opinion Nutrition and Older Adults--Why Should You Care? Nancy S.
Wellman, Ph.D., R.D., F.A.D.A. 666
Community Nutrition Services for Older Adults 669
Case Scenario Follow-up 669
Summary 671
Study Questions 671
Annotated References 671
Take Action 673
Nutrition Perspective Complementary and Alternative Medicine Practices 675

20. Undernutrition Throughout the World 719
Case Scenario 719
Refresh Your Memory 720
Chapter Objectives 720
World Hunger: A Continuing Plague 721
World Hunger Today 721
Critical Life Stages When Undernutrition Is Particularly Devastating 724
General Effects of Semistarvation 726
Case Scenario Follow-up 727
Undernutrition in the United States 727
Helping the Hungry in the United States: A Historical Perspective 728
Socioeconomic Factors Related to Undernutrition 730
Possible Solutions to Hunger in the United States 731
Expert Opinion Food Security, David H. Holben, Ph.D., R.D. 732
Undernutrition in the Developing World 734
Food/Population Ratio 734
War and Political/Civil Unrest 737
Rapid Depletion of Natural Resources 738
Cultural Attitudes Toward Certain Foods 739
Inadequate Shelter and Sanitation 739
High External Debt 741
The Impact of AIDS 741
Reducing Undernutrition in the Developing World 743
Some Concluding Thoughts 744
Summary 745
Study Questions 746
Annotated References 746
Take Action 748
Nutrition Perspective The Role of Biotechnology in Expanding Worldwide Food
Availability 750
Appendixes
A Chemistry: A Tool for Understanding Nutrition A-2
B Detailed Depictions of Glycolysis, the Citric Acid Cycle, and the Electron
Transport Chain A-28
C Human Physiology: A Tool for Understanding Nutrition A-32
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 Caffeine Content of Foods A-94
K Sources of Nutrition Information A-96
L English-Metric Conversions and Metric and Household Units A-101
M Estimated Average Requirements for Macronutrients and Micronutrients A-103
N Food Composition Table A-106
Answers to Critical Thinking Questions NA-1