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Dietary Reference Intakes (DRI)
The Dietar y Reference Intakes (DRI) include two sets of The DRI also include the Tolerable Upper Intake Level
nutrient intake goals for individuals—the Recommended (UL) that represents the estimated maximum daily amount
Dietary A llowance (RDA) and Adequate Intake (AI). The RDA of a nutrient that appears safe for most healthy people to con-
ref lects the average daily amount of a nutrient considered sume on a regular basis. Turn the page for a listing of the UL
adequate to meet the needs of most healthy people. If there for selected vitamins and minerals. Note that the absence of
is insufficient evidence to determine an RDA, an AI is set. a UL for a nutrient does not indicate that it is safe to consume
In a ddition, the Estimated Energy Requirement (EER) repre- in high doses, but only that research is too limited to set a UL.
sents the average dietary energy intake considered adequate Chapter 1 describes these DRI values in detail.
to maintain energy balance in healthy people.
Estimated Energy Requirements (EER), Recommended Dietary Allowances (RDA), and Adequate Intakes (AI) for Water,
Energy, and the Energy Nutrients
Linolenic Acidc
EERb (kcal/day)
Reference BMI
RDA (g/kg/day)
Height cm (in.)
Weight kg (lb)
Carbohydrate
Linoleic Acid
RDA (g/day) d
RDA (g/day)
Total Fiber
Reference
Reference
AI (g/day)
AI (g/day)
AI (g/day)
AI (g/day)
AI (L/day)
Total Fat
Protein
Protein
Water a
Energy
Age (yr)
Males
0–0.5 — 62 (24) 6 (13) 0.7e 570 60 — 31 4.4 0.5 9.1 1.52
0.5–1 — 71 (28) 9 (20) 0.8 f 743 95 — 30 4.6 0.5 11 1.20
1–3g — 86 (34) 12 (27) 1.3 1046 130 19 — 7 0.7 13 1.05
4–8 g 15.3 115 (45) 20 (44) 1.7 1742 130 25 — 10 0.9 19 0.95
9–13 17.2 144 (57) 36 (79) 2.4 2279 130 31 — 12 1.2 34 0.95
14–18 20.5 174 (68) 61 (134) 3.3 3152 130 38 — 16 1.6 52 0.85
19–30 22.5 177 (70) 70 (154) 3.7 3067h 130 38 — 17 1.6 56 0.80
31–50 22.5i 177 (70)i 70 (154)i 3.7 3067h 130 38 — 17 1.6 56 0.80
>50 22.5i 177 (70)i 70 (154)i 3.7 3067h 130 30 — 14 1.6 56 0.80
Females
0–0.5 — 62 (24) 6 (13) 0.7e 520 60 — 31 4.4 0.5 9.1 1.52
0.5–1 — 71 (28) 9 (20) 0.8 f 676 95 — 30 4.6 0.5 11 1.20
1–3g — 86 (34) 12 (27) 1.3 992 130 19 — 7 0.7 13 1.05
4–8 g 15.3 115 (45) 20 (44) 1.7 1642 130 25 — 10 0.9 19 0.95
9–13 17.4 144 (57) 37 (81) 2.1 2071 130 26 — 10 1.0 34 0.95
14–18 20.4 163 (64) 54 (119) 2.3 2368 130 26 — 11 1.1 46 0.85
19–30 21.5 163 (64) 57 (126) 2.7 2403j 130 25 — 12 1.1 46 0.80
31–50 21.5i 163 (64)i 57 (126)i 2.7 2403j 130 25 — 12 1.1 46 0.80
>50 21.5i 163 (64)i 57 (126)i 2.7 2403j 130 21 — 11 1.1 46 0.80
Pregnancy
1st trimester 3.0 +0 175 28 — 13 1.4 46 0.80
2nd trimester 3.0 +340 175 28 — 13 1.4 71 1.10
3rd trimester 3.0 +452 175 28 — 13 1.4 71 1.10
Lactation
1st 6 months 3.8 +330 210 29 — 13 1.3 71 1.30
2nd 6 months 3.8 +400 210 29 — 13 1.3 71 1.30
NOTE: BMI is calculated as the weight in kilograms divided height, and physical activity level. The values listed are based gFor energy, the age groups for young children are 1–2 years
by the square of the height in meters. For all nutrients, values on an “active” person at the reference height and weight and and 3–8 years.
for infants are AI. The glossary on the insert defines units of at the midpoint ages for each group until age 19. Chapter 8 hFor males, subtract 10 kcalories per day for each year of age
nutrient measure. Dashes (—) indicate that values have not and Appendix F provide equations and tables to determine above 19.
been determined. estimated energy requirements. iBecause weight need not change as adults age if activity is
aThe water AI includes drinking water, water in beverages, and cThe linolenic acid referred to in this table and text is the maintained, reference weights for adults 19 through 30 years
water in foods; in general, drinking water and other beverages omega-3 fatty acid known as alpha-linolenic acid. are applied to all adult age groups.
contribute about 70 to 80 percent, and foods, the remainder. d The values listed are based on reference body weights. jFor females, subtract 7 kcalories per day for each year of age
Conversion factors: 1 L = 33.8 fluid oz; 1 L = 1.06 qt; eAssumed to be from human milk. above 19.
1 cup = 8 fluid oz. fAssumed to be from human milk and complementary foods
bThe Estimated Energy Requirement (EER) represents the and beverages. This includes approximately 0.6 L (~2½ cups) SOURCE: Adapted from the Dietary Reference Intakes
average dietary energy intake that will maintain energy as total fluid including formula, juices, and drinking water. series, National Academies Press. National Academies of
balance in a healthy person of a given gender, age, weight, Sciences.
A
Recommended Dietary Allowances (RDA) and Adequate Intakes (AI) for Vitamins
RDA (mg/day)a
RDA (μg/day) b
RDA (μg/day) c
RDA (μg/day) d
RDA (mg/day)
RDA (mg/day)
RDA (mg/day)
RDA (μg/day)
Pantothenic
AI (mg/day)
AI (mg/day)
Vitamin B12
AI (μg/day)
AI (μg/day)
Vitamin B 6
Riboflavin
Vitamin A
Vitamin D
Vitamin C
Vitamin K
Vitamin E
RDA (mg/
RDA (mg/
Thiamin
Choline
Niacin
Folate
Biotin
day)e
acid
day)
Age (yr)
Infants
0–0.5 0.2 0.3 2 5 1.7 0.1 65 0.4 125 40 400 10 4 2.0
0.5–1 0.3 0.4 4 6 1.8 0.3 80 0.5 150 50 500 10 5 2.5
Children
1–3 0.5 0.5 6 8 2 0.5 150 0.9 200 15 300 15 6 30
4–8 0.6 0.6 8 12 3 0.6 200 1.2 250 25 400 15 7 55
Males
9–13 0.9 0.9 12 20 4 1.0 300 1.8 375 45 600 15 11 60
14–18 1.2 1.3 16 25 5 1.3 400 2.4 550 75 900 15 15 75
From Whitney/Rolfes, Understanding Nutrition, 13E. © 2013 Cengage Learning.

19–30 1.2 1.3 16 30 5 1.3 400 2.4 550 90 900 15 15 120
31–50 1.2 1.3 16 30 5 1.3 400 2.4 550 90 900 15 15 120
51–70 1.2 1.3 16 30 5 1.7 400 2.4 550 90 900 15 15 120
>70 1.2 1.3 16 30 5 1.7 400 2.4 550 90 900 20 15 120
Females
9–13 0.9 0.9 12 20 4 1.0 300 1.8 375 45 600 15 11 60
14–18 1.0 1.0 14 25 5 1.2 400 2.4 400 65 700 15 15 75
19–30 1.1 1.1 14 30 5 1.3 400 2.4 425 75 700 15 15 90
31–50 1.1 1.1 14 30 5 1.3 400 2.4 425 75 700 15 15 90
51–70 1.1 1.1 14 30 5 1.5 400 2.4 425 75 700 15 15 90
>70 1.1 1.1 14 30 5 1.5 400 2.4 425 75 700 20 15 90
Pregnancy
≤18 1.4 1.4 18 30 6 1.9 600 2.6 450 80 750 15 15 75
19–30 1.4 1.4 18 30 6 1.9 600 2.6 450 85 770 15 15 90
31–50 1.4 1.4 18 30 6 1.9 600 2.6 450 85 770 15 15 90
Lactation
≤18 1.4 1.6 17 35 7 2.0 500 2.8 550 115 1200 15 19 75
19–30 1.4 1.6 17 35 7 2.0 500 2.8 550 120 1300 15 19 90
31–50 1.4 1.6 17 35 7 2.0 500 2.8 550 120 1300 15 19 90
NOTE: For all nutrients, values for infants are AI. The glossary on the inside back cover b
Folate recommendations are expressed as dietary folate equivalents (DFE).
defines units of nutrient measure. c
Vitamin A recommendations are expressed as retinol activity equivalents (RAE).
a
Niacin recommendations are expressed as niacin equivalents (NE), except for d
Vitamin D recommendations are expressed as cholecalciferol and assume an absence of
recommendations for infants younger than 6 months, which are expressed as preformed adequate exposure to sunlight.
niacin. e
Vitamin E recommendations are expressed as α-tocopherol.
Recommended Dietary Allowances (RDA) and Adequate Intakes (AI) for Minerals
RDA (mg/day)
RDA (mg/day)
RDA (mg/day)
RDA (mg/day)
RDA (mg/day)
RDA (μg/day)
RDA (μg/day)
RDA (μg/day)
RDA (μg/day)
Molybdenum
Phosphorus
Manganese
Magnesium
AI (mg/day)
AI (mg/day)
AI (mg/day)
AI (mg/day)
AI (mg/day)
AI (μg/day)
Potassium
Chromium
Selenium
Chloride
Fluoride
Calcium
Sodium
Copper
Iodine
Zinc
Iron
Age (yr)
Infants
0–0.5 120 180 400 200 100 30 0.27 2 110 15 200 0.003 0.01 0.2 2
0.5–1 370 570 700 260 275 75 11 3 130 20 220 0.6 0.5 5.5 3
Children
1–3 1000 1500 3000 700 460 80 7 3 90 20 340 1.2 0.7 11 17
4–8 1200 1900 3800 1000 500 130 10 5 90 30 440 1.5 1.0 15 22
Males
9–13 1500 2300 4500 1300 1250 240 8 8 120 40 700 1.9 2 25 34
14–18 1500 2300 4700 1300 1250 410 11 11 150 55 890 2.2 3 35 43

19–30 1500 2300 4700 1000 700 400 8 11 150 55 900 2.3 4 35 45
31–50 1500 2300 4700 1000 700 420 8 11 150 55 900 2.3 4 35 45
51–70 1300 2000 4700 1000 700 420 8 11 150 55 900 2.3 4 30 45
>70 1200 1800 4700 1200 700 420 8 11 150 55 900 2.3 4 30 45
Females
9–13 1500 2300 4500 1300 1250 240 8 8 120 40 700 1.6 2 21 34
14–18 1500 2300 4700 1300 1250 360 15 9 150 55 890 1.6 3 24 43
19–30 1500 2300 4700 1000 700 310 18 8 150 55 900 1.8 3 25 45
31–50 1500 2300 4700 1000 700 320 18 8 150 55 900 1.8 3 25 45
51–70 1300 2000 4700 1200 700 320 8 8 150 55 900 1.8 3 20 45
>70 1200 1800 4700 1200 700 320 8 8 150 55 900 1.8 3 20 45
Pregnancy
≤18 1500 2300 4700 1300 1250 400 27 12 220 60 1000 2.0 3 29 50
19–30 1500 2300 4700 1000 700 350 27 11 220 60 1000 2.0 3 30 50
31–50 1500 2300 4700 1000 700 360 27 11 220 60 1000 2.0 3 30 50
Lactation
≤18 1500 2300 5100 1300 1250 360 10 13 290 70 1300 2.6 3 44 50
19–30 1500 2300 5100 1000 700 310 9 12 290 70 1300 2.6 3 45 50
31–50 1500 2300 5100 1000 700 320 9 12 290 70 1300 2.6 3 45 50
NOTE: For all nutrients, values for infants are AI. The glossary on the inside back cover defines units of nutrient measure.
Tolerable Upper Intake Levels (UL) for Vitamins
Vitamin B 6
Vitamin A
Vitamin D
Vitamin C
Vitamin E
(mg/day)c
(mg/day)a
(μg/day)a
(μg /day)b
(mg/day)
(mg/day)
(mg/day)
(μg /day)
Choline
Niacin
Folate
Age (yr)
Infants
0–0.5 — — — — — 600 25 —
0.5–1 — — — — — 600 38 —
Children

1–3 10 30 300 1000 400 600 63 200
4–8 15 40 400 1000 650 900 75 300
9–13 20 60 600 2000 1200 1700 100 600
Adolescents
14–18 30 80 800 3000 1800 2800 100 800
Adults
19–70 35 100 1000 3500 2000 3000 100 1000
>70 35 100 1000 3500 2000 3000 100 1000
Pregnancy
≤18 30 80 800 3000 1800 2800 100 800
19–50 35 100 1000 3500 2000 3000 100 1000
Lactation
≤18 30 80 800 3000 1800 2800 100 800
19–50 35 100 1000 3500 2000 3000 100 1000
a
The UL for niacin and folate apply to synthetic forms The UL for vitamin E applies to any form of supplemental
c
obtained from supplements, fortified foods, or a α-tocopherol, fortified foods, or a combination of the two.
combination of the two.
b
The UL for vitamin A applies to the preformed vitamin only.
Tolerable Upper Intake Levels (UL) for Minerals
Molybdenum
Phosphorus
Manganese
Magnesium
Vanadium
(mg/day)d
Selenium
(mg/day)
(mg/day)
(mg/day)
(mg/day)
(mg/day)
(mg/day)
(mg/day)
(mg/day)
(mg/day)
(mg/day)
(mg/day)
Chloride
Fluoride
Calcium
(μg/day)
(μg/day)
(μg/day)
(μg/day)
Sodium
Copper
Nickel
Iodine
Boron
Zinc
Iron
Age (yr)
Infants
0–0.5 — — 1000 — — 40 4 — 45 — — 0.7 — — — —
0.5–1 — — 1500 — — 40 5 — 60 — — 0.9 — — — —
Children
1–3 1500 2300 2500 3000 65 40 7 200 90 1000 2 1.3 300 3 0.2 —
4–8 1900 2900 2500 3000 110 40 12 300 150 3000 3 2.2 600 6 0.3 —
9–13 2200 3400 3000 4000 350 40 23 600 280 5000 6 10 1100 11 0.6 —
Adolescents
14–18 2300 3600 3000 4000 350 45 34 900 400 8000 9 10 1700 17 1.0 —
Adults
19–50 2300 3600 2500 4000 350 45 40 1100 400 10,000 11 10 2000 20 1.0 1.8
51–70 2300 3600 2000 4000 350 45 40 1100 400 10,000 11 10 2000 20 1.0 1.8
>70 2300 3600 2000 3000 350 45 40 1100 400 10,000 11 10 2000 20 1.0 1.8
Pregnancy
≤18 2300 3600 3000 3500 350 45 34 900 400 8000 9 10 1700 17 1.0 —
19–50 2300 3600 2500 3500 350 45 40 1100 400 10,000 11 10 2000 20 1.0 —
Lactation
≤18 2300 3600 3000 4000 350 45 34 900 400 8000 9 10 1700 17 1.0 —
19–50 2300 3600 2500 4000 350 45 40 1100 400 10,000 11 10 2000 20 1.0 —
d
The UL for magnesium applies to synthetic forms obtained from supplements or drugs SOURCE: Adapted with permission from the Dietary Reference Intakes for Calcium and
only. Vitamin D, © 2011 by the National Academies of Sciences, Courtesy of the National
NOTE: An upper Limit was not established for vitamins and minerals not listed and for Academies Press, Washington, D.C.
those age groups listed with a dash (—) because of a lack of data, not because these
nutrients are safe to consume at any level of intake. All nutrients can have adverse effects
when intakes are excessive.
Nutrition for Health
seventh edition and Health Care
Linda Kelly DeBruyne

Kathryn Pinna
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Linda Kelly DeBruyne, Kathryn Pinna
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Printed in the United States of America

Print Number: 01 Print Year: 2018
Linda Kelly DeBruyne
Kathryn Pinna
iii
About the Authors
Linda Kelly DeBruyne, M.S., R.D., received her B.S. and M.S. degrees
in nutrition and food science at Florida State University. She is a founding member
of Nutrition and Health Associates, an information resource center in Tallahassee,
Florida, where her specialty areas are life cycle nutrition and fitness. Her other
publications include the textbooks Nutrition and Diet Therapy and Health: Making
Life Choices. She is a registered dietitian and maintains a professional membership in
the Academy of Nutrition and Dietetics.
Kathryn Pinna, Ph.D., R.D., received her M.S. and Ph.D. degrees in nutrition
from the University of California at Berkeley. She taught nutrition, food science, and
human biology courses in the San Francisco Bay Area for over 25 years and also
worked as an outpatient dietitian, Internet consultant, and freelance writer. Her other
publications include the textbooks Understanding Normal and Clinical Nutrition and
Nutrition and Diet Therapy. She is a registered dietitian and a member of the American
Society for Nutrition and the Academy of Nutrition and Dietetics.
v
Brief Contents
Chapter 1 Chapter 13
Overview of Nutrition and Health 1 Nutrition Care and Assessment 379
Digestion and Absorption 39 Nutrition Intervention and Diet-Drug
Interactions 403
Chapter 3
Carbohydrates 67 Chapter 15
Enteral and Parenteral Nutrition Support 433
Chapter 4
Lipids 95 Chapter 16
Nutrition in Metabolic and Respiratory
Chapter 5
Stress 469
Protein 125
Chapter 17
Chapter 6
Nutrition and Upper Gastrointestinal
Energy Balance and Body Composition 147 Disorders 489
Weight Management 173 Nutrition and Lower Gastrointestinal
Disorders 513
Chapter 8
The Vitamins 199 Chapter 19
Nutrition and Liver Diseases 545
Chapter 9
Water and the Minerals 237 Chapter 20
Nutrition and Diabetes Mellitus 565
Chapter 10
Nutrition through the Life Span: Pregnancy and Chapter 21
Lactation 271 Nutrition and Cardiovascular Diseases 595
Nutrition through the Life Span: Infancy, Nutrition and Renal Diseases 625
Childhood, and Adolescence 303
Chapter 23
Chapter 12
Nutrition, Cancer, and HIV Infection 653
Nutrition through the Life Span: Later Adulthood 351
vii
viii
Contents
Preface xvi
The Vascular System 50
Acknowledgments xx The Lymphatic System 51
Transport of Lipids: Lipoproteins 51
Chapter 1
Overview of Nutrition and Health 1 Gastrointestinal Hormones and Nerve Pathways 53
Gastrointestinal Microbes 53
The System at Its Best 54
Six Classes of Nutrients 6 Nutrition in Practice Food Safety 57
kCalories: A Measure of Energy 6
Chapter 3
Dietary Reference Intakes 8
Acceptable Macronutrient Distribution Ranges 10 Carbohydrates 67
National Health Goals 11 Monosaccharides 68

National Trends 11 Disaccharides 69
Polysaccharides 69
Dietary Ideals 13
Dietary Guidelines for Americans 14
Fitness Guidelines 16
The USDA Food Patterns 18 Sugars 74
MyPlate 23 Alternative Sweeteners: Sugar Alcohols 78
Alternative Sweeteners: Nonnutritive Sweeteners 79
The Ingredient List 24
Nutrition Facts Panel 25 Carbohydrates: Disease Prevention
Claims on Labels 27 and Recommendations 81
Nutrition in Practice Finding the Truth about Carbohydrates: Food Sources 84
Nutrition 34
Carbohydrates: Food Labels and Health Claims 86
Nutrition in Practice The Glycemic Index in Nutrition
Chapter 2 Practice 90
Digestion and Absorption 39
Chapter 4
The Digestive Organs 40 Lipids 95
The Involuntary Muscles and the Glands 42
Digestion in the Mouth 45

Digestion in the Stomach 46 Triglycerides 97
Digestion in the Small and Large Intestines 46 Fatty Acids 98
Phospholipids 101
Sterols 101
The Small Intestine 48
Absorption of Nutrients 49
ix
Chapter 7
Fats and Heart Health 103
Recommendations 106 Weight Management 173
Finding the Fats in Foods 108 Genetics and Weight 174

Cutting Solid Fats and Choosing Unsaturated Environmental Stimuli 177
Fats 110
Nutrition in Practice Figuring Out Fats 117
Over-the-Counter Weight-Loss Products 180
Chapter 5 Other Gimmicks 180
Protein 125
Obesity Drugs 180
Surgery 181
The Structure of Proteins 126
Nonessential and Essential Amino Acids 127
A Healthful Eating Plan 182
Physical Activity 185
Behavior and Attitude 186
Protein Turnover 129 Weight Maintenance 188
Nitrogen Balance 129
Nutrition in Practice Fad Diets 195
Protein Deficiency 132 Chapter 8

Malnutrition 133
Protein Excess 134 The Vitamins 199
Protein and Amino Acid Supplements 135
Protein Recommendations and Intakes 136
Vitamin A and Beta-Carotene 203
Protein Quality 137 Vitamin D 207
Protein Sparing 138 Vitamin E 211
Protein on Food Labels 138 Vitamin K 212
Nutrition in Practice Vegetarian Diets 141
The B Vitamins 214
Chapter 6 Thiamin 216
Riboflavin 216
Energy Balance and Body Composition 147 Niacin 217
Pantothenic Acid and Biotin 218
Feasting 148 Vitamin B6 218
The Economics of Fasting 149 Folate 219
Vitamin B12 220
Energy In 152 Non–B Vitamins 222
Energy Out 152 Vitamin C 222
Estimating Energy Requirements 155 Nutrition in Practice Phytochemicals and Functional
Foods 229
Defining Healthy Body Weight 156
Body Composition 159 Chapter 9
How Much Body Fat Is Too Much? 160 Water and the Minerals 237
Health Risks of Underweight 161 Water Balance 238

Health Risks of Overweight and Obesity 162 Fluid and Electrolyte Balance 240
Guidelines for Identifying Those at Risk from Acid–Base Balance 241
Obesity 163
Other Risks of Obesity 163
Sodium 243
Nutrition in Practice Eating Disorders 166 Chloride 244
x Contents
Potassium 244
Calcium 245 Energy and Nutrient Needs 316
Phosphorus 249 Hunger and Malnutrition in Children 320
Magnesium 249 Lead Poisoning in Children 321
Sulfate 251 Food Allergy 322
Hyperactivity 324
Iron 251 Childhood Obesity 325
Zinc 256 Mealtimes at Home 330
Selenium 258 Nutrition at School 334
Iodine 259
Copper 260 Growth and Development during Adolescence 336
Manganese 260 Energy and Nutrient Needs 336
Fluoride 261 Food Choices and Health Habits 337
Chromium 261 Nutrition in Practice Childhood Obesity and
Other Trace Minerals 261 the Early Development of Chronic Diseases 345
Nutrition in Practice Vitamin and Mineral
Supplements 267 Chapter 12
Nutrition through the Life Span: Later
Chapter 10
Adulthood 351
Nutrition through the Life Span: Pregnancy
and Lactation 271 Slowing the Aging Process 353
Nutrition and Disease Prevention 355
Nutrition Prior to Pregnancy 272

Prepregnancy Weight 272 Cataracts and Macular Degeneration 356
Healthy Support Tissues 273 Arthritis 356
The Events of Pregnancy 274 The Aging Brain 357
Nutrient Needs during Pregnancy 276
Food Assistance Programs 281
Weight Gain 282 Energy and Energy Nutrients 360
Weight Loss after Pregnancy 283 Vitamins and Minerals 362
Physical Activity 284 Nutrient Supplements for Older Adults 363
Common Nutrition-Related Concerns of Pregnancy 285 The Effects of Drugs on Nutrients 364
Problems in Pregnancy 286
Practices to Avoid 288 Individual Preferences 365
Adolescent Pregnancy 291 Meal Setting 365
Depression 365
Nutrition during Lactation 292 Food Assistance Programs 365
Contraindications to Breastfeeding 294 Meals for Singles 366
Nutrition in Practice Encouraging Successful Nutrition in Practice Hunger and Community

Breastfeeding 300 Nutrition 373
Nutrition through the Life Span: Infancy, Nutrition Care and Assessment 379
Childhood, and Adolescence 303
How Illness Affects Nutrition Status 380
Responsibility for Nutrition Care 381
Nutrient Needs during Infancy 304 Identifying Risk for Malnutrition 382
Breast Milk 306 The Nutrition Care Process 383
Infant Formula 309
The Transition to Cow’s Milk 311
Introducing First Foods 311 Historical Information 385
Looking Ahead 314 Dietary Assessment 386
Mealtimes 315 Anthropometric Data 389
Contents xi
Biochemical Analyses 392 Chapter 16
Physical Examination 395 Nutrition in Metabolic and Respiratory Stress 469
Nutrition in Practice Nutritional Genomics 399
Hormonal Responses to Stress 471
Chapter 14 The Inflammatory Response 472
Nutrition Intervention and Diet-Drug
Interactions 403 Determining Nutritional Requirements 474
Approaches to Nutrition Care in Acute Stress 476
Care Planning 404

Approaches to Nutrition Care 406 Chronic Obstructive Pulmonary Disease 477
Respiratory Failure 480
Energy Intakes in Hospital Patients 408 Nutrition in Practice Multiple Organ Dysfunction
Modified Diets 409 Syndrome 486
Variations in the Diet Order 413
Chapter 17
Food Selection 414 Nutrition and Upper Gastrointestinal
Food Safety 414 Disorders 489
Improving Food Intake 414
Drug Effects on Food Intake 416 Dry Mouth 490

Drug Effects on Nutrient Absorption 416 Dysphagia 490
Dietary Effects on Drug Absorption 417 Gastroesophageal Reflux Disease 494
Drug Effects on Nutrient Metabolism 418
Dietary Effects on Drug Metabolism 419
Drug Effects on Nutrient Excretion 420 Dyspepsia 496
Dietary Effects on Drug Excretion 420 Nausea and Vomiting 497
Drug-Nutrient Interactions and Toxicity 420 Gastroparesis 497
Gastritis 498
Nutrition in Practice Complementary and Alternative Peptic Ulcer Disease 498
Therapies 424
Gastrectomy 500
Chapter 15 Bariatric Surgery 503
Enteral and Parenteral Nutrition Support 433 Nutrition in Practice Nutrition and Oral Health 509
Oral Supplements 434 Chapter 18

Candidates for Tube Feedings 435 Nutrition and Lower Gastrointestinal
Tube Feeding Routes 436
Enteral Formulas 438 Disorders 513
Administration of Tube Feedings 441
Medication Delivery during Tube Feedings 445 Constipation 514
Tube Feeding Complications 446 Intestinal Gas 516
Transition to Table Foods 446 Diarrhea 516
Candidates for Parenteral Nutrition 448 Fat Malabsorption 519

Venous Access 449 Bacterial Overgrowth 521
Parenteral Solutions 450 Lactose Intolerance 521
Administering Parenteral Nutrition 454
Managing Metabolic Complications 455 Pancreatitis 523
Cystic Fibrosis 524
Candidates for Home Nutrition Support 457
Planning Home Nutrition Care 457 Celiac Disease 526
Quality-of-Life Issues 458 Inflammatory Bowel Diseases 528
Nutrition in Practice Inborn Errors of Metabolism 463 Short Bowel Syndrome 531
xii Contents
Vitamin Supplementation and CHD Risk 603
Irritable Bowel Syndrome 534 Lifestyle Changes for Hypertriglyceridemia 605
Diverticular Disease of the Colon 535 Drug Therapies for CHD Prevention 605
Colostomies and Ileostomies 536 Treatment of Heart Attack 607
Nutrition in Practice Probiotics and Intestinal
Health 542 Stroke Prevention 608
Stroke Management 608
Chapter 19
Nutrition and Liver Diseases 545 Factors That Influence Blood Pressure 609
Factors That Contribute to Hypertension 609
Treatment of Hypertension 611
Fatty Liver 546
Hepatitis 547
Consequences of Heart Failure 614
Medical Management of Heart Failure 615
Consequences of Cirrhosis 549
Treatment of Cirrhosis 552 Nutrition in Practice Helping People with Feeding
Nutrition Therapy for Cirrhosis 552 Disabilities 620
Chapter 22
Nutrition in Practice Alcohol in Health and Disease 561
Nutrition and Renal Diseases 625
Chapter 20
Consequences of the Nephrotic Syndrome 627
Nutrition and Diabetes Mellitus 565 Treatment of the Nephrotic Syndrome 627
Symptoms of Diabetes Mellitus 566 Causes of Acute Kidney Injury 630

Diagnosis of Diabetes Mellitus 567 Consequences of Acute Kidney Injury 630
Types of Diabetes Mellitus 567 Treatment of Acute Kidney Injury 631
Prevention of Type 2 Diabetes Mellitus 569
Acute Complications of Diabetes Mellitus 569
Chronic Complications of Diabetes Mellitus 571 Consequences of Chronic Kidney Disease 633
Treatment of Chronic Kidney Disease 635
Kidney Transplants 640
Treatment Goals 573
Evaluating Diabetes Treatment 574
Nutrition Therapy: Dietary Recommendations 575 Formation of Kidney Stones 642
Nutrition Therapy: Meal-Planning Strategies 577 Consequences of Kidney Stones 643
Insulin Therapy 580 Prevention and Treatment of Kidney Stones 643
Antidiabetic Drugs 583 Nutrition in Practice Dialysis 648
Physical Activity and Diabetes Management 584
Sick-Day Management 585 Chapter 23
Nutrition, Cancer, and HIV Infection 653
Pregnancy in Type 1 or Type 2 Diabetes 586
Gestational Diabetes 586
How Cancer Develops 654
Nutrition in Practice The Metabolic Syndrome 591 Nutrition and Cancer Risk 655
Consequences of Cancer 658
Chapter 21 Treatments for Cancer 658
Nutrition and Cardiovascular Diseases 595 Nutrition Therapy for Cancer 661
Consequences of Atherosclerosis 597 Prevention of HIV Infection 665

Causes of Atherosclerosis 597 Consequences of HIV Infection 666
Treatments for HIV Infection 668
Nutrition Therapy for HIV Infection 669
Symptoms of Coronary Heart Disease 599
Evaluating Risk for Coronary Heart Disease 599 Nutrition in Practice Ethical Issues in Nutrition
Lifestyle Management to Reduce CHD Risk 600 Care 675
Contents xiii
Appendix A Aids to Calculation A-2 Chapter 19
a.1 Conversion Factors A-2 Man with Cirrhosis 556
a.2 Percentages A-2 Chapter 20
a.3 Weights and Measures A-3
Child with Type 1 Diabetes 585
Appendix B WHO: Nutrition Recommendations B-1
Woman with Type 2 Diabetes 587
Appendix C Choose Your Foods: Food Lists for
Chapter 21
Diabetes C-1
C.1 The Food Lists C-1 Patient with Cardiovascular Disease 614
C.2 Serving Sizes C-1 Chapter 22
C.3 The Foods on the Lists C-1 Woman with Acute Kidney Injury 632
C.4 Controlling Energy, Fat, and Sodium C-2 Man with Chronic Kidney Disease 640
C.5 Planning a Healthy Diet C-3
Chapter 23
Appendix D Physical Activity and Energy
Woman with Cancer 664
Requirements D-1
Man with HIV Infection 671
Appendix E Nutrition Assessment: Supplemental
Information E-1
E.1 Weight Gain during Pregnancy E-1 How To Features
E.2 Growth Charts E-1 Chapter 1
E.3 Measures of Body Fat and Lean Tissue E-2 Calculate the Energy a Food Provides 7
E.4 Nutritional Anemias E-8
Chapter 3
E.5 Cautions about Nutrition Assessment E-12
Reduce Intakes of Added Sugars 76
Appendix F Enteral Formulas F-1
Chapter 4
Glossary GL-1
Make Heart-Healthy Choices—by Food Group 110
Index I-1
Chapter 5
Calculate Recommended Protein Intakes 136
Case Studies
Chapter 6
Chapter 10
Estimate Energy Requirements 156
Woman in Her First Pregnancy 294
Chapter 7
Chapter 11
Apply Behavior Modification to Manage Body
Boy with Disruptive Behavior 324 Fatness 187
Chapter 12
Chapter 9
Elderly Man with a Poor Diet 366 Cut Salt Intake 243
Chapter 13 Add Calcium to Daily Meals 249
Nutrition Screening and Assessment 396 Add Iron to Daily Meals 257
Implementing Nutrition Care 407 Protect against Lead Toxicity 322
Injured Hiker Requiring Enteral Nutrition Support 448 Turn Convenience Foods into Nutritious Meals 368
Patient with Intestinal Disease Requiring Parenteral Stretch Food Dollars and Reduce Waste 375
Nutrition 456
Chapter 13
Chapter 16
Measure Length and Height 390
Patient with a Severe Burn 477 Measure Weight 390
Elderly Man with Emphysema 480 Estimate and Evaluate Changes in Body Weight 392
Chapter 17
Chapter 14
Woman with GERD 496 Estimate Appropriate Energy Intakes for Hospital
Nutrition Care after Gastric Surgery 503 Patients 408
Chapter 18 Help Hospital Patients Improve Their Food
Patient with Short Bowel Syndrome 533 Intakes 415
Young Adult with Irritable Bowel Syndrome 535 Prevent Diet-Drug Interactions 421
xiv Contents
Help Patients Improve Intakes with Oral Supplements 435 Follow a Fat-Restricted Diet 522
Help Patients Cope with Tube Feedings 442 Chapter 19
Plan a Tube Feeding Schedule 444 Help the Cirrhosis Patient Eat Enough Food 554
Administer Medications to Patients Receiving Tube Chapter 20
Feedings 446
Use Carbohydrate Counting in Clinical Practice 578
Express the Osmolar Concentration of a Solution 449
Chapter 21
Calculate the Macronutrient and Energy Content
of a Parenteral Solution 453 Implement a Heart-Healthy Diet 604
Reduce Sodium Intake 613
Chapter 16
Estimate Energy Needs Using Disease-Specific Stress Chapter 22
Factors 475 Help Patients Comply with a Renal Diet 640
Improve Acceptance of Mechanically Altered Foods 493 Increase kCalories and Protein in Meals 662
Manage Gastroesophageal Reflux Disease 496 Help Patients Handle Food-Related Problems 663
Alter the Diet to Reduce Symptoms of Dumping
Syndrome 502
Alter Dietary Habits to Achieve and Maintain Weight Loss
after Bariatric Surgery 505
Contents xv
Preface
We are pleased to present this seventh edition
Nutrition for Health and Health Care
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Changes for This Edition Chapter 7
xvi
Chapter 8
Chapter 16
Chapter 17
Chapter 9
acid regurgitation, heartburn, bloating, pernicious

anemia.
Chapter 18
Chapter 10
Chapter 11
Chapter 19
Chapter 20
Chapter 12
Chapter 13
Chapter 14
Chapter 21
Chapter 15
specialized nutrition support oral nutrition

support
Preface xvii
Chapter 22
protein-energy wasting.
hypocitraturia
Chapter 23
MindTap: Empower Your

Students
Features of this Text
Access Everything You Need

in One Place
Empower Students to Reach

their Potential
xviii Preface
Control Your Course— Ancillaries
and Your Content ●●
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Preface xix
Acknowledgments
xx
Overview of Nutrition
and Health
Chapter Sections and Learning Objectives (LOs)
1.1 Food Choices

LO 1.1 Describe the factors that influence personal food choices.
1.2 The Nutrients

LO 1.2 Identify which of the major classes of nutrients are organic and which
yield energy.
1.3 Nutrient Recommendations

LO 1.3 Describe the four categories of the Dietary Reference Intakes (DRI),
the Estimated Energy Requirement (EER), and the Acceptable Macronutrient
Distribution Ranges (AMDR).
1.4 National Nutrition Surveys

LO 1.4 Describe the ways in which the kinds of information collected by
researchers from nutrition surveys are used.
1.5 D
ietary Guidelines, Fitness Guidelines,
and Food Guides
LO 1.5 Explain how each of the dietary ideals can be used to plan a healthy
diet, and how the Dietary Guidelines and USDA Food Patterns help make diet
planning easier.
1.6 Food Labels

LO 1.6 Compare the information on food labels to make selections that meet
specific dietary and health goals.
1.7 Nutrition in Practice: Finding the Truth about Nutrition

LO 1.7 Discuss how misinformation and reliable nutrition information can be
identified.
chapter
Rosenfeld/Flirt/Corbis
1
Every day, several times a day, you make choices that will either
health
wellness
1.1 Food Choices

health: a range of states with physical,
nutrition
mental, emotional, spiritual, and social
components. At a minimum, health
means freedom from physical disease,
mental disturbances, emotional
distress, spiritual discontent, social
maladjustment, and other negative
states. At a maximum, health means
wellness.
wellness: maximum well-being; the cultural competence
top range of health states; the goal
of the person who strives toward
realizing his or her full potential Preference
physically, mentally, emotionally,
spiritually, and socially.
nutrition: the science of foods and the
nutrients and other substances they
contain, and of their ingestion, digestion,
absorption, transport, metabolism,
interaction, storage, and excretion. A
broader definition includes the study of bioactive food components phytochemicals
the environment and of human behavior
as it relates to these processes.
cultural competence: an awareness
and acceptance of one’s own and
others’ cultures, combined with the
skills needed to interact effectively
Habit
with people of diverse cultures.
bioactive food components:
compounds in foods (either nutrients
or phytochemicals) that alter client patient
physiological processes in the body.
client
2 CHAPTER 1 Overview of Nutrition and Health

FIGURE 1-1 The Health Line phytochemicals (FIGH-toe-CHEM-ih-
cals): compounds in plants that confer
No matter how well you maintain your health today, you may still be able to improve tomorrow. color, taste, and other characteristics.
Likewise, a person who is well today can slip by failing to maintain health-promoting habits. Some phytochemicals are bioactive
food components in functional foods.
Nutrition in Practice 8 provides details.
Wellness— foodways: the eating habits and
optimal physical,
mental, emotional, culinary practices of a people, region,
spiritual, and social health
or historical period.
Superior
ethnic diets: foodways and cuisines
level of typical of national origins, races,
health
cultural heritages, or geographic
Good
level of locations.
health
Moderate
level of
health
Marginal
level of
health
Death Poor
from level of
disease health
Associations
Ethnic Heritage and Regional Cuisines
foodways
ethnic diets Photo 1-1
Values
Monkey Business Images/Shutterstock.com
ecolabels
halal Ethnic meals and family gatherings

nourish the spirit as well as the
body.
Food Choices 3
TABLE 1-1 Selected Ethnic Cuisines and Food Choices
Protein
Grains Vegetables Fruit Foods Milk
Asian Millet, rice, Baby corn, bamboo Kumquats, Pork; duck and Soy milk
rice or wheat shoots, bok choy, loquats, lychee, other poultry;
Becky Luigart-Stayner/
noodles leafy greens (such as mandarin fish, octopus,
Encyclopedia/Corbis
amaranth), cabbages, oranges, sea urchin,
mung bean sprouts, melons, pears, squid, and
scallions, seaweed, persimmon, other seafood;
snow peas, straw plums soybeans, tofu;
mushrooms, water eggs; cashews,
chestnuts, wild yam peanuts
Mediterranean Bulgur, cous- Artichokes, Berries, dates, Fish and other Feta, goat,
cous, focaccia, cucumbers, figs, grapes, seafood, mozzarella,
Italian bread, eggplant, fennel, lemons, melons, gyros, lamb, parmesan, provo-
pastas, pita grape leaves, leafy olives, oranges, pork, sausage, lone, and ricotta
Photodisc, Inc./
Getty Images
pocket bread, greens, leeks, pomegranates, chicken, fava cheeses; yogurt

polenta, rice onions, peppers, raisins beans, lentils, and yogurt
tomatoes almonds, walnuts beverages
Mexican Hominy, Bell peppers, cactus, Avocado, Beans, refried Cheese, flan
masa (corn cassava, chayote, bananas, guava, beans, beef, (baked caramel
Photodisc/Getty Images
flour dough), chili pepper, corn, lemons, limes, goat, pork, custard), milk in
tortillas (corn jicama, onions, mango, oranges, chorizo, chicken, beverages
Mitch Hrdlicka/
or flour), rice summer squash, papaya, plantain fish, eggs

tomatoes, winter
squash, yams
Social Interaction
Emotional State
Marketing
Availability, Convenience, and Economy

Photo 1-2
wavebreakmedia/Shutterstock.com
Age
Nutrition is only one of the many factors

that influence people’s food choices.
Body Weight and Image
Medical Conditions
Health and Nutrition
whole foods: fresh foods such as

whole foods
vegetables, grains, legumes, meats,
and milk that are unprocessed or
minimally processed.
processed foods processed foods: foods that have been
intentionally changed by the addition
of substances, or a method of cooking,
preserving, milling, or such.
ultra-processed foods: foods that have
ultra-processed foods been made from substances that are
typically used in food preparation, but
not consumed as foods by themselves
(such as oils, fats, flours, refined
starches, and sugars) that undergo
further processing by adding a little,
if any, minimally processed foods, salt
and other preservatives, and additives
such as flavors and colors.
Food Choices 5
Review Notes
●● A person selects foods for many different reasons.
●● Food choices influence health—both positively and negatively. Individual food selections
neither make nor break a diet’s healthfulness, but the balance of foods selected over time
can make an important difference to health.
●● In the interest of health, people are wise to think “nutrition” when making their food choices.
1.2 The Nutrients
nutrients
nutrients: substances obtained from

food and used in the body to provide
energy and structural materials and to Six Classes of Nutrients
serve as regulating agents to promote
growth, maintenance, and repair.
Nutrients may also reduce the risks of
some diseases.
essential nutrients: nutrients a person
must obtain from food because the body
cannot make them for itself in sufficient
quantities to meet physiological needs.
essential nutrients
organic: in chemistry, substances or
molecules containing carbon–carbon Carbohydrates, Fats, and Proteins
bonds or carbon–hydrogen bonds. The
four organic nutrients are carbohydrate, organic
fat, protein, and vitamins.
energy-yielding nutrients: the nutrients energy-yielding nutrients
that break down to yield energy the
body can use. The three energy-yielding Vitamins, Minerals, and Water
nutrients are carbohydrate, protein,
and fat.
inorganic
inorganic: not containing carbon or
pertaining to living organisms. The two
classes of nutrients that are inorganic
are minerals and water.
calories: a measure of heat energy.
kCalories: A Measure of Energy
Food energy is measured in
kilocalories (1000 calories equal calories
1 kilocalorie), abbreviated kcalories or
kcal. One kcalorie is the amount of heat
necessary to raise the temperature of
organic
1 kilogram (kg) of water 18C. The scientific
use of the term kcalorie is the same as
the popular use of the term calorie. Metabolism

kilocalories kcalories energy density: a measure of the
energy a food provides relative to the
kcalorie kcal amount of food (kcalories per gram).
energy density
Energy Nutrients in Foods
Energy Storage in the Body
Alcohol, Not a Nutrient
Box 1-1 How to Calculate the Energy a Food Provides

To calculate the energy available from a food, multiply the number of To determine the percentage of kcalories from fat, for example,
grams of carbohydrate, protein, and fat by 4, 4, and 9, respectively. divide the 81 fat kcalories by the total 173 kcalories:
Then add the results together. For example, one slice of bread with
81 fat kcal 4 173 total kcal 5 0.468 (rounded to 0.47)
1 tablespoon of peanut butter on it contains 16 grams of carbohydrate,
7 grams of protein, and 9 grams of fat: Then multiply by 100 to get the percentage:
16 g carbohydrate 3 4 kcal/g 5 64 kcal 0.47 3 100 5 47%
7 g protein 3 4 kcal/g 5 28 kcal Dietary recommendations that urge people to limit fat intake to
20 to 35 percent of kcalories refer to the day’s total energy intake,
9 g fat 3 9 kcal/g 5 81 kcal not to individual foods. Still, if the proportion of fat in each food choice
Total 5 173 kcal throughout a day exceeds 35 percent of kcalories, then the day’s
total surely will, too. Knowing that this snack provides 47 percent of
From this information, you can calculate the percentage of kcalories its kcalories from fat alerts a person to the need to make lower-fat
each of the energy nutrients contributes to the total. selections at other times that day.
The Nutrients 7
Review Notes
●● Foods provide nutrients—substances that support the growth, maintenance, and repair of the
body’s tissues.
●● The six classes of nutrients are water, carbohydrates, fats, proteins, vitamins, and minerals.
●● Vitamins, minerals, and water do not yield energy; instead, they facilitate a variety of activities
in the body.
●● Foods rich in the energy-yielding nutrients (carbohydrates, fats, and proteins) provide the
major materials for building the body’s tissues and yield energy the body can use or store.
●● Energy is measured in kcalories.
Dietary Reference Intakes (DRI): a set
of values for the dietary nutrient intakes
of healthy people in the United States
and Canada. These values are used for
planning and assessing diets. 1.3 Nutrient Recommendations
Recommended Dietary Allowances
(RDA): a set of values reflecting the
average daily amounts of nutrients
considered adequate to meet the
known nutrient needs of practically all
healthy people in a particular life stage
and gender group; a goal for dietary
intake by individuals. Dietary Reference Intakes
Adequate Intakes (AI): a set of values
that are used as guides for nutrient
intakes when scientific evidence is
insufficient to determine an RDA.
Dietary Reference Intakes (DRI)
requirement: the lowest continuing
intake of a nutrient that will maintain
a specified criterion of adequacy.
Setting Nutrient Recommendations: RDA and AI

FIGURE 1-2 Nutrient Intake
Recommendations
The nutrient intake recommendations are set high Recommended Dietary Allowances (RDA)
enough to cover nearly everyone’s requirements Adequate Intakes (AI)
(the boxes represent people). The Estimated
Average Requirement (EAR) meets the needs of
about half of the population (shown here by the
red line). The Recommended Dietary Allowance
(RDA) is set well about the EAR, meeting the needs
of about 98 percent of the population (shown here
by the purple line).
Nutrients
requirement

deficient: in regard to nutrient intake,
deficient describes the amount below which
almost all healthy people can be
expected, over time, to experience
Facilitating Nutrition Research and Policy: EAR deficiency symptoms.
Estimated Average Requirements Estimated Average Requirements
(EAR) (EAR): the average daily nutrient
intake levels estimated to meet the
requirements of half of the healthy
individuals in a given age and gender
group; used in nutrition research and
policymaking and as the basis on which
RDA values are set.
Establishing Safety Guidelines: UL Tolerable Upper Intake Levels (UL):
a set of values reflecting the highest
Tolerable Upper Intake Levels (UL) average daily nutrient intake levels
that are likely to pose no risk of toxicity
to almost all healthy individuals in a
particular life stage and gender group.
As intake increases above the UL, the
potential risk of adverse health effects
Using Nutrient Recommendations increases.
groups
individuals
●●
FIGURE 1-3 Inaccurate versus Accurate View of Nutrient Intakes

The RDA (or AI) for a given nutrient represents a point that lies within a range of appropriate and reasonable intakes between toxicity and deficiency.
Both of these recommendations are high enough to provide reserves in times of short-term dietary inadequacies, but not so high as to approach
toxicity. Nutrient intakes above or below this range may be equally harmful.
1 1
UL
2
2
Intake
RDA AI
3
3
RDA EAR
4
Inaccurate Accurate
view view
Nutrient Recommendations 9
●●
●●
●●
●●
Setting Energy Recommendations

Estimated Energy Requirement (EER)
any
Acceptable Macronutrient Distribution Ranges
Acceptable Macronutrient Distribution Ranges (AMDR)
●●
●●
●●
Estimated Energy Requirement (EER):

the dietary energy intake level that is Review Notes
predicted to maintain energy balance ●● The Dietary Reference Intakes (DRI) are a set of nutrient intake values that can be used to
in a healthy adult of a defined age,
gender, weight, and physical activity plan and evaluate dietary intakes for healthy people.
level consistent with good health. ●● The Estimated Average Requirement (EAR) defines the amount of a nutrient that supports a
Acceptable Macronutrient Distribution specific function in the body for half of the population.
Ranges (AMDR): ranges of intakes (Continued )
for the energy-yielding nutrients that
provide adequate energy and nutrients
and reduce the risk of chronic disease.

(Continued)
●● The Recommended Dietary Allowance (RDA) is based on the EAR and establishes a goal for
dietary intake that will meet the needs of almost all healthy people.
●● An Adequate Intake (AI) serves a similar purpose as the RDA when an RDA cannot be
determined.
●● The Tolerable Upper Intake Level (UL) establishes the highest average daily nutrient intake
level that appears safe for almost all healthy people.

●● The Estimated Energy Requirement (EER) defines the energy intake level needed to maintain
energy balance in a healthy adult of a defined age, gender, weight, height, and physical activ-
ity level.
●● The Acceptable Macronutrient Distribution Ranges (AMDR) define the proportions contributed
by carbohydrate, fat, and protein to a healthy diet.
1.4 National Nutrition Surveys
malnutrition
What We Eat in America
What We Eat in America
National Health Goals

Healthy People
malnutrition: any condition caused by

deficient or excess energy or nutrient
intake or by an imbalance of nutrients.
Healthy People: a national public
health initiative under the jurisdiction
of the U.S. Department of Health and
National Trends Human Services (DHHS) that identifies
the most significant preventable threats
to health and focuses efforts toward
eliminating them.
National Nutrition Surveys 11

TABLE 1-2 Healthy People 2020 Nutrition and Weight Status Objectives
●● Increase the proportion of adults who are at a healthy weight
●● Reduce the proportion of adults who are obese
●● Reduce iron deficiency among young children and females of childbearing age
●● Reduce iron deficiency among pregnant females
●● Reduce the proportion of children and adolescents who are overweight or obese
●● Increase the contribution of fruit to the diets of the population aged 2 years and older
●● Increase the variety and contribution of vegetables to the diets of the population aged 2 years and older
●● Increase the contribution of whole grains to the diets of the population aged 2 years and older
●● Reduce consumption of saturated fat in the population aged 2 years and older
●● Reduce consumption of sodium in the population aged 2 years and older
●● Increase consumption of calcium in the population aged 2 years and older
●● Increase the proportion of worksites that offer nutrition or weight management classes or counseling
●● Increase the proportion of physician office visits that include counseling or education related to
nutrition or weight
●● Eliminate very low food security among children in U.S. households
●● Prevent inappropriate weight gain in youth and adults
●● Increase the proportion of primary care physicians who regularly measure the body mass index
of their patients
●● Reduce consumption of kcalories from solid fats and added sugars in the population age 2 years and
older
●● Increase the number of states that have state-level policies that incentivize food retail outlets
to provide foods that are encouraged by the Dietary Guidelines
●● Increase the number of states with nutrition standards for foods and beverages provided
to preschool-age children in childcare
●● Increase the percentage of schools that offer nutritious foods and beverages outside of school meals
Source: www.healthypeople.gov.
Review Notes
●● Nutrition surveys measure people’s food consumption and evaluate the nutrition status of
populations.
●● Information gathered from nutrition surveys serves as the basis for many major diet and nutri-
tion reports, including Healthy People.

TABLE 1-3 Leading Causes of Death
Dietary Guidelines, Fitness
1.5 in the United States
Guidelines, and Food Guides The diseases in bold italics are nutrition related.
overnutrition 1. Heart disease
undernutrition 2. Cancers
3. Chronic lung diseases
chronic diseases
4. Accidents
5. Strokes
6. Alzheimer’s disease
7. Diabetes mellitus
8. Pneumonia and influenza
9. Kidney disease
10. Suicide
Source: J. Xu and coauthors, Mortality in the United States,

2015, NCHS Data Brief 267, December 2016.
eating pattern
overnutrition: overconsumption of food

Dietary Ideals energy or nutrients sufficient to cause
disease or increased susceptibility to
disease; a form of malnutrition.
●●
undernutrition: underconsumption of
●● food energy or nutrients severe enough to
●● cause disease or increased susceptibility
●●
to disease; a form of malnutrition.
●● chronic diseases: diseases characterized
●● by slow progression, long duration, and
degeneration of body organs due in part
adequacy to such personal lifestyle elements as
poor food choices, smoking, alcohol use,
and lack of physical activity.
balance
eating pattern: customary intake of
foods and beverages over time.
adequacy: the characteristic of a
diet that provides all the essential
nutrients, fiber, and energy necessary
to maintain health and body weight.
balance: the dietary characteristic of
kcalorie (energy) control providing foods in proportion to one
another and in proportion to the body’s
needs.
nutrient density kcalorie (energy) control:
management of food energy intake.
nutrient density: a measure of the
nutrients a food provides relative
to the energy it provides. The more
nutrients and the fewer kcalories, the
higher the nutrient density.
Dietary Guidelines, Fitness Guidelines, and Food Guides 13

empty kcalories: kcalories provided
by added sugars and solid fats with
few or no other nutrients.
nutrient profiling: ranking foods
based on their nutrient composition.
moderation: the provision of enough,
but not too much, of a substance.
solid fats: fats that are not usually liquid
at room temperature; commonly found
in most foods derived from animals
and vegetable oils that have been
hydrogenated. Solid fats typically contain
more saturated and trans fats than most
oils (Chapter 4 provides more details). empty kcalories
added sugars: sugars, syrups, and other
kcaloric sweeteners that are added to
foods during processing or preparation
or at the table. Added sugars do not
include the naturally occurring sugars
found in fruit and in milk products.
variety: consumption of a wide selection
of foods within and among the major
food groups (the opposite of monotony).
nutrient profiling
moderation
solid fats added sugars
variety
Dietary Guidelines for Americans
Dietary Guidelines for Americans 2015–2020
Dietary Guidelines for Americans

2015–2020

TABLE 1-4 2015–2020 Dietary Guidelines for Americans: The Guidelines and Key Recommendations
The Guidelines
The following guidelines “encourage healthy eating patterns, recognize that individuals will need to make shifts in their food and beverage
choices to achieve a healthy pattern, and acknowledge that all segments of our society have a role to play in supporting healthy choices.”
1. Follow a healthy eating pattern across the lifespan. All food and beverage choices matter. Choose a healthy eating pattern at an appropriate
kcalorie level to help achieve and maintain a healthy body weight, support nutrient adequacy, and reduce the risk of chronic disease.
2. Focus on variety, nutrient density, and amount. To meet nutrient needs within kcalorie limits, choose a variety of nutrient-dense foods across
and within all food groups in recommended amounts.
3. Limit kcalories from added sugars and saturated fats and reduce sodium intake. Adopt an eating pattern low in added sugars, saturated
fats, and sodium. Cut back on foods and beverages higher in these components to amounts that fit within healthy eating patterns.
4. Shift to healthier food and beverage choices. Choose nutrient-dense foods and beverages across and within all food groups in place of less
healthy choices. Consider cultural and personal preferences to make these shifts easier to accomplish and maintain.
5. Support healthy eating patterns for all. Everyone has a role in helping to create and support healthy eating patterns in multiple settings
nationwide, from home to school to work to communities.
Key Recommendations
The following key recommendations provide more detailed tips on how individuals can establish healthy eating patterns to meet the guidelines.
Adopt a healthy eating pattern that accounts for all foods and beverages within an appropriate kcalorie level.
A healthy eating pattern includes:
●● A variety of vegetables from all of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other.
●● Fruit, especially whole fruit.
●● Grains, at least half of which are whole grains.
●● Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages.
●● A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products.
●● Oils.
A healthy eating pattern limits:
●● Saturated fats and trans fats to less than 10 percent of kcalories per day.
●● Added sugars to less than 10 percent of kcalories per day.
●● Sodium to less than 2300 milligrams per day.
●● If alcohol is consumed, it should be consumed in moderation—up to one drink per day for women and up to two drinks per day for men—and only
by adults of legal drinking age.
Meet the Physical Activity Guidelines for Americans (health.gov/paguidelines).
Note: These guidelines and key recommendations are designed for individuals 2 years of age or older and should be applied in their entirety; they are interconnected, and
each dietary component can affect the others.
Source: U.S. Department of Health and Human Services and U.S. Department of Agriculture, 2015–2020 Dietary Guidelines for Americans, 8th ed. (2015): health.gov
/dietaryguidelines/2015/guidelines/.
preventable

Photo 1-3
Fitness Guidelines
VILevi/Shutterstock.com
Physical activity helps you look
good, feel good, and have fun,
and it brings many long-term
health benefits as well.
●● More restful sleep
●● Improved nutritional health
●● Improved body composition
●● Improved bone density
●● Enhanced resistance to colds and other infectious diseases
●● Lower risks of some types of cancers
●● Stronger circulation and lung function
●● Lower risks of cardiovascular disease
●● Lower risks of type 2 diabetes
aerobic physical activity: activity in ●● Reduced risk of gallbladder disease

which the body’s large muscles move
in a rhythmic manner for a sustained
period of time. Aerobic activity, also
called endurance activity, improves
cardiorespiratory fitness. Brisk
walking, running, swimming, and
bicycling are examples.

●● Lower incidence and severity of anxiety and depression moderate-intensity physical
activity: physical activity that
requires some increase in breathing
●● Stronger self-image and/or heart rate and expends 3.5
to 7 kcalories per minute. Walking
at a speed of 3 to 4.5 miles per hour
●● Long life and high quality of life in the later years (about 15 to 20 minutes to walk one
mile) is an example.
vigorous-intensity physical activity:
physical activity that requires a
large increase in breathing and/or
heart rate and expends more than
7 kcalories per minute. Walking at
health a very brisk pace (.4.5 miles per
aerobic physical activity hour) or running at a pace of at least
moderate-intensity physical activity vigorous-intensity physical activity 5 miles per hour are examples.
fitness: the characteristics that
enable the body to perform physical
activity; more broadly, the ability
to meet routine physical demands
with enough reserve energy to rise
to a physical challenge; the body’s
fitness ability to withstand stress of all
kinds.
TABLE 1-5 American College of Sports Medicine’s Guidelines for Physical Activity
© David Hanover Photography
© David Hanover Photography

Steve Cole/Photodisc/
Getty Images
Cardiorespiratory Strength Flexibility
Type of Aerobic activity that uses large- Resistance activity that is performed at Stretching activity that uses the major
activity muscle groups and can be maintained a controlled speed and through a full muscle groups
continuously range of motion
Frequency 5 to 7 days per week 2 or more nonconsecutive days per week 2 to 7 days per week
Intensity Moderate (equivalent to walking at a Enough to enhance muscle strength Enough to feel tightness or slight
pace of 3 to 4 miles per hour)a and improve body composition discomfort
Duration At least 30 minutes per day 8 to 12 repetitions of 8 to 10 different 2 to 4 repetitions of 15 to 30 seconds

exercises (minimum) per muscle group
Examples Running, cycling, swimming, inline Pull-ups, push-ups, weight-lifting, Yoga

skating, rowing, power walking, cross- pilates
country skiing, kickboxing, jumping rope;
sports activities such as basketball,
soccer, racquetball, tennis, volleyball
a
For those who prefer vigorous-intensity aerobic activity such as walking at a very brisk pace (>4.5 mph) or running (5 mph), a minimum of 20 minutes per day, 3 days
per week is recommended.
Sources: American College of Sports Medicine position stand, Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and
neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise, Medicine and Science in Sports and Exercise 43 (2011): 1334–1359; W. L. Haskell
and coauthors, Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart As-
sociation, Medicine and Science in Sports and Exercise 39 (2007): 1423–1434.

food group plan: a diet-planning tool The USDA Food Patterns
that sorts foods into groups based on
nutrient content and then specifies
that people should eat certain
food group plan USDA Food Patterns
amounts of food from each group.
USDA Food Patterns: the USDA’s
food group plan for ensuring dietary
adequacy that assigns foods to five
major food groups.
legumes (lay-GYOOMS, LEG-yooms):
plants of the bean and pea family with
seeds that are rich in protein compared
with other plant-derived foods.
Recommended Amounts
not
weekly
Notable Nutrients
Legumes

TABLE 1-6 USDA Food Patterns: Healthy U.S.-Style Eating Pattern
Food 1600 1800 2000 2200 2400 2600 2800 3000
Group kcal kcal kcal kcal kcal kcal kcal kcal
Fruit 1 1/2 c 1 1/2 c 2c 2c 2c 2c 2 1/2 c 2 1/2 c
Vegetables 2c 2 1/2 c 2 1/2 c 3c 3c 3 1/2 c 3 1/2 c 4c
Grains 5 oz 6 oz 6 oz 7 oz 8 oz 9 oz 10 oz 10 oz
Protein foods 5 oz 5 oz 5 1/2 oz 6 oz 6 1/2 oz 6 1/2 oz 7 oz 7 oz
Milk 3c 3c 3c 3c 3c 3c 3c 3c
Oils 5 tsp 5 tsp 6 tsp 6 tsp 7 tsp 8 tsp 8 tsp 10 tsp
Limit on kcalo- 130 kcal 170 kcal 270 kcal 280 kcal 350 kcal 380 kcal 400 kcal 470 kcal
ries available
for other uses*
*The limit on kcalories for other uses describes how many kcalories are available for foods that are not in nutrient-dense forms.
Source: U.S. Department of Health and Human Services and U.S. Department of Agriculture, 2015–2020 Dietary Guidelines for Americans, 8th ed.
(2015): health.gov/dietaryguidelines/2015/guidelines/.
TABLE 1-7 Estimated Daily kCalorie

Needs for Adults
Sedentarya Activeb
Women
19–25 yr 2000 2400
26–30 yr 1800 2400
31–50 yr 1800 2200
51–60 yr 1600 2200

●● More
611 yr 1600 2000
●● Less trans fewer Men
19–20 yr 2600 3000

Nutrient-Dense Choices
21–35 yr 2400 3000
36–40 yr 2400 2800
41–55 yr 2200 2800
56–60 yr 2200 2600
61–75 yr 2000 2600
761 yr 2000 2400
within
a
Sedentary describes a lifestyle that includes only the
activities typical of day-to-day life.
each group b
Active describes a lifestyle that includes physical activity
equivalent to walking more than 3 miles per day at a rate
of 3 to 4 miles per hour, in addition to the activities typical
of day-to-day life. In addition to gender, age, and activity
level, energy needs vary with height and weight (see
Chapter 6).

FIGURE 1-4 USDA Food Patterns: Food Groups and Subgroups
Fruit
Consume a variety of fruit, and choose whole or cut-up fruit more often than
fruit juice.
Limit fruit that contains solid fats and/or added sugars:
Polara Studios, Inc.

1 c fruit =
1 c fresh, frozen, or canned fruit
½ c dried fruit
1 c 100% fruit juice
Vegetables
Consume a variety of vegetables each day, and choose from all five subgroups
several times a week.

1 c vegetables =
1 c cut-up raw or cooked vegetables
1 c cooked legumes
1 c vegetable juice
2 c raw, leafy greens
Limit these vegetables that contain solid fats and/or added sugars:
Grains
Make most (at least half) of the grain selections whole grains.
Limit these grains that contain solid fats and/or added sugars:
1 oz grains =
1 slice bread
½ c cooked rice, pasta, or cereal
1 oz dry pasta or rice
1 c ready-to-eat cereal
3 c popped popcorn
(Continued)

FIGURE 1-4 USDA Food Patterns: Food Groups and Subgroups (continued)
Protein foods
Choose a variety of protein foods from the three subgroups, including seafood
in place of meat or poultry twice a week.

1 oz protein foods =
1 oz cooked lean meat, poultry, or seafood Limit these protein foods that contain solid fats and/or added sugars:
1 egg
¼ c cooked legumes or tofu
1 tbs peanut butter
½ oz nuts or seeds
Milk and milk products
Make fat-free or low-fat choices. Choose other calcium-rich foods if you don’t
consume milk.
Limit these milk products that contain solid fats and/or added sugars:
1 c milk or milk product =

1 c milk, yogurt, or fortified soy milk
1½ oz natural cheese
2 oz processed cheese
Oils
Use oils instead of solid fats, when possible.
trans
Limit these solid fats:
Matt Farruggio Photography

1 tsp oil =
1 tsp vegetable oil
1 tsp soft margarine
1 tbs low-fat mayonnaise
2 tbs light salad dressing

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definitely ascertained. It may be an assumption that time will prove to
be unwarranted that all the Leptomedusae pass through a
Calyptoblastic hydrosome stage.
Fam. Aequoreidae.—In this family the hydrosome stage is not

known except in the genus Polycanna, in which it resembles a
Campanulariid. The sense-organs of the Medusae are statocysts.
The radial canals are very numerous, and the genital glands are in
the form of ropes of cells extending along the whole of their oral
surfaces. Aequorea is a fairly common genus, with a flattened
umbrella and a very rudimentary manubrium, which may attain a size
of 40 mm. in diameter.
Fam. Thaumantiidae.—The Medusae of this family are

distinguished from the Aequoreidae by having marginal ocelli in
place of statocysts. The hydrosome of Thaumantias alone is known,
and this is very similar to an Obelia.
Fam. Cannotidae.—The hydrosome is quite unknown. The

Medusae are ocellate, but the radial canals, instead of being
undivided, as in the Thaumantiidae, are four in number, and very
much ramified before reaching the ring canal. The tentacles are very
numerous. In the genus Polyorchis, from the Pacific coast of North
America, the four radial canals give rise to numerous lateral short
blind branches, and have therefore a remarkable pinnate
appearance.
Fam. Sertulariidae.—In this family the hydrothecae are sessile, and

arranged bilaterally on the stem and branches. The general form of
the colony is pinnate, the branches being usually on opposite sides
of the main stem. The gonophores are adelocodonic. Sertularia
forms more or less arborescent colonies, springing from a creeping
stolon attached to stones and shells. There are many species,
several of which are very common upon the British coast. Many
specimens are torn from their attachments by storms or by the trawls
of fishermen and cast up on the sand or beach with other zoophytes.
The popular name for one of the commonest species (S. abietina) is
the "sea-fir." The genus has a wide geographical and bathymetrical
range. Another common British species frequently thrown up by the
tide in great quantities is Hydrallmania falcata. It has slender spirally-
twisted stems and branches, and the hydrothecae are arranged
unilaterally.
The genus Grammaria, sometimes placed in a separate family, is

distinguished from Sertularia by several characters. The stem and
branches are composed of a number of tubes which are
considerably compressed. The genus is confined to the southern
seas.
Fam. Plumulariidae.—The hydrothecae are sessile, and arranged

in a single row on the stem and branches. Nematophores are always
present. Gonophores adelocodonic. This family is the largest and
most widely distributed of all the families of the Hydrozoa. Nutting
calculates that it contains more than one-fourth of all the Hydroids of
the world. Over 300 species have been described, and more than
half of these are found in the West Indian and Australian regions.
Representatives of the family occur in abundance in depths down to
300 fathoms, and not unfrequently to 500 fathoms. Only a few
species have occasionally been found in depths of over 1000
fathoms.
The presence of nematophores may be taken as the most

characteristic feature of the family, but similar structures are also
found in some species belonging to other families (p. 277).
The family is divided into two groups of genera, the Eleutheroplea

and the Statoplea. In the former the nematophores are mounted on
a slender pedicel, which admits of more or less movement, and in
the latter the nematophores are sessile. The genera Plumularia and
Antennularia belong to the Eleutheroplea. The former is a very large
genus, with several common British species, distinguished by the
terminal branches being pinnately disposed, and the latter,
represented by A. antennina and A. ramosa on the British coast, is
distinguished by the terminal branches being arranged in verticils.
The two most important genera of the Statoplea are Aglaophenia

and Cladocarpus. The former is represented by a few species in
European waters, the latter is only found in American waters.
Fam. Hydroceratinidae.—The colony consists of a mass of

entwined hydrorhiza, with a skeleton in the form of anastomosing
chitinous tubes. Hydrothecae scattered, tubular, and sessile.
Nematophores present. Gonophores probably adelocodonic.
This family was constituted for a remarkable hydroid, Clathrozoon

wilsoni, described by W. B. Spencer from Victoria.[317] The zooids
are sessile, and spring from more than one of the numerous
anastomosing tubes of the stem and branches. The whole of the
surface is studded with an enormous number of small and very
simple dactylozooids, protected by tubular nematophores. Only a
few specimens have hitherto been obtained, the largest being 10
inches in height by 4 inches in width. In general appearance it has
some resemblance to a dark coloured fan-shaped Gorgonia.
Fam. Campanulariidae.—The hydrothecae in this family are

pedunculate, and the gonophores adelocodonic.
In the cosmopolitan genus Campanularia the stem is monosiphonic,

and the hydrothecae bell-shaped. Several species of this genus are
very common in the rock pools of our coast between tide marks.
Halecium is characterised by the rudimentary character of its
hydrothecae, which are incapable of receiving the zooids even in
their maximum condition of retraction. The genus Lafoea is
remarkable for the development of a large number of tightly packed
gonothecae on the hydrorhiza, each of which contains a blastostyle,
bearing a single gonophore and, in the female, a single ovum. This
group of gonothecae was regarded as a distinct genus of Hydroids,
and was named Coppinia.[318] Lafoea dumosa with gonothecae of
the type described as Coppinia arcta occurs on the British coast.
Perisiphonia is an interesting genus from deep water off the Azores,

Australia, and New Zealand, with a stem composed of many distinct
tubes.
The genus Zygophylax, from 500 fathoms off the Cape Verde, is of
considerable interest in having a nematophore on each side of the
hydrotheca. According to Quelch it should be placed in a distinct
family.
Ophiodes has long and very active defensive zooids, protected by

nematophores. It is found in the Laminarian zone on the English
coast.
Fam. Eucopidae.—The hydrosome stage of this family is very

similar to that of the Campanulariidae, but the gonophores are free-
swimming Medusae of the Leptomedusan type.
One of the best-known genera is Obelia, of which several species

are among the commonest Hydroids of the British coast.
Clytia johnstoni is also a very common Hydroid, growing on red

algae or leaves of the weed Zostera. It consists of a number of
upright, simple, or slightly branched stems springing from a creeping
hydrorhiza. When liberated the Medusae are globular in form, with
four radial canals and four marginal tentacles, but this Medusa, like
many others of the order, undergoes considerable changes in form
before it reaches the sexually mature stage.
Phialidium temporarium is one of the commonest Medusae of our

coast, and sometimes occurs in shoals. It seems probable that it is
the Medusa of Clytia johnstoni.[319] By some authors the jelly-fish
known as Epenthesis is also believed to be the Medusa of a Clytia.
Fam. Dendrograptidae.—This family includes a number of fossils

which have certain distinct affinities with the Calyptoblastea. In
Dictyonema, common in the Ordovician rocks of Norway, but also
found in the Palaeozoic rocks of North America and elsewhere, the
fossil forms fan-shaped colonies of delicate filaments, united by
many transverse commissures, and in well-preserved specimens the
terminal branches bear well-marked uniserial hydrothecae. In some
species thecae of a different character, which have been interpreted
to be gonothecae and nematophores respectively, are found.
Other genera are Dendrograptus, Thamnograptus, and several

others from Silurian strata.
Order V. Graptolitoidea.
A large number of fossils, usually called Graptolites, occurring in
Palaeozoic strata, are generally regarded as the skeletal remains of
an ancient group of Hydrozoa.
In the simpler forms the fossil consists of a delicate straight rod

bearing on one side a series of small cups. It is suggested that the
cups contained hydroid zooids, and should therefore be regarded as
the equivalent of the hydrothecae, and that the axis represents the
axis of the colony or of a branch of the Calyptoblastea. In some of
the forms with two rows of cups on the axis (Diplograptus), however,
it has been shown that the cups are absent from a considerable
portion of one end of the axis, and that the axes of several radially
arranged individuals are fused together and united to a central
circular plate. Moreover, there is found in many specimens a series
of vesicles, a little larger in size than the cups, attached to the plate
and arranged in a circle at the base of the axes. These vesicles are
called the gonothecae.
The discovery of the central plate and of the so-called gonothecae
suggests that the usual comparison of a Graptolite with a Sertularian
Hydroid is erroneous, and that the colony or individual, when alive,
was a more or less radially symmetrical floating form, like a Medusa,
of which only the distal appendages (possibly tentacles) are
commonly preserved as fossils.
The evidence that the Graptolites were Hydrozoa is in reality very

slight, but the proof of their relationship to any other phylum of the
animal kingdom does not exist.[320] It is therefore convenient to
consider them in this place, and to regard them, provisionally, as
related to the Calyptoblastea.
The order is divided into three families.
Fam. 1. Monoprionidae.—Cups arranged uniserially on one side of

the axis.
The principal genera are Monograptus, with the axis straight, curved,
or helicoid, from many horizons in the Silurian strata; Rastrites, with
a spirally coiled axis, Silurian; Didymograptus, Ordovician; and
Coenograptus, Ordovician.
Fam. 2. Diprionidae.—Cups arranged in two or four vertical rows on

the axis.
Diplograptus, Ordovician and Silurian; Climacograptus, Ordovician

and Silurian; and Phyllograptus, in which the axis and cups are
arranged in such a manner that they resemble an ovate leaf.
Fam. 3. Retiolitidae.—Cups arranged biserially on a reticulate axis.
Retiolites, Ordovician and Silurian; Stomatograptus, Retiograptus,

and Glossograptus, Ordovician.
Fossil Corals possibly allied to Hydrozoa.
Among the many fossil corals that are usually classified with the
Hydrozoa the genus Porosphaera is of interest as it is often
supposed to be related to Millepora. It consists of globular masses
about 10-20 mm. in diameter occurring in the Upper Cretaceous
strata. In the centre there is usually a foreign body around which the
coral was formed by concentric encrusting growth. Running radially
from pores on the surface to the centre, there are numerous tubules
which have a certain general resemblance to the pore-tubes of
Millepora. The monomorphic character of these tubes, their very
minute size, the absence of ampullae, and the general texture of the
corallum, are characters which separate this fossil very distinctly
from any recent Hydroid corals. Porosphaera, therefore, was
probably not a Hydrozoon, and certainly not related to the recent
Millepora.
Closely related to Porosphaera apparently are other globular,

ellipsoidal, or fusiform corals from various strata, such as Loftusia
from the Eocene of Persia, Parkeria from the Cambridge Greensand,
and Heterastridium from the Alpine Trias. In the last named there is
apparently a dimorphism of the radial tubes.
Allied to these genera, again, but occurring in the form of thick,

concentric, calcareous lamellae, are the genera Ellipsactinia and
Sphaeractinia from the Upper Jurassic.
Another important series of fossil corals is that of the family

Stromatoporidae. These fossils are found in great beds of immense
extent in many of the Palaeozoic rocks, and must have played an
important part in the geological processes of that period. They
consist of a series of calcareous lamellae, separated by considerable
intervals, encrusting foreign bodies of various kinds. Sometimes they
are flat and plate-like, sometimes globular or nodular in form. The
lamellae are in some cases perforated by tabulate, vertical, or radial
pores, but in many others these pores are absent. The zoological
position of the Stromatoporidae is very uncertain, but there is not at
present any very conclusive evidence that they are Hydrozoa.
Stromatopora is common in Devonian and also occurs in Silurian

strata. Cannopora from the Devonian has well-marked tabulate
pores, and is often found associated commensally with another coral
(Aulopora or Syringopora).
Order VI. Stylasterina.

The genera included in this order resemble Millepora in producing a
massive calcareous skeleton, and in showing a consistent
dimorphism of the zooids, but in many respects they exhibit great
divergence from the characters of the Milleporina.
The colony is arborescent in growth, the branches arising frequently

only in one plane, forming a flabellum. The calcareous skeleton is
perforated to a considerable depth by the gastrozooids,
dactylozooids, and nutritive canals, and the gastropores and
dactylopores are not provided with tabulae except in the genera
Pliobothrus and Sporadopora. The character which gives the order
its name is a conical, sometimes torch-like projection at the base of
the gastropore, called the "style," which carries a fold of the
ectoderm and endoderm layers of the body-wall, and may serve to
increase the absorptive surface of the digestive cavity. In some
genera a style is also present in the dactylopore, in which case it
serves as an additional surface for the attachment of the retractor
muscles. The pores are scattered on all aspects of the coral in the
genera Sporadopora, Errina, and Pliobothrus; in Spinipora and
Steganopora the scattered dactylopores are situated at the
extremities of tubular spines which project from the general surface
of the coral, the gastropores being situated irregularly between the
spines. In Phalangopora the pores are arranged in regular
longitudinal lines, and in Distichopora they are mainly in rows on the
edges of the flattened branches, a single row of gastropores being
flanked by a single row of dactylopores on each side. In the
remaining genera the pores are arranged in definite cycles, which
are frequently separated from one another by considerable intervals,
and have, particularly in the dried skeleton, a certain resemblance to
the calices of some of the Zoantharian corals.
In Cryptohelia the cycles are covered by a lid-like projection from the

neighbouring coenenchym (Fig. 136, l 1, l 2). The gastrozooids are
short, and are usually provided with a variable number of small
capitate tentacles. The dactylozooids are filiform and devoid of
tentacles, the endoderm of their axes being solid and scalariform.
The gonophores of the Stylasterina are situated in large oval or

spherical cavities called the ampullae, and their presence can
generally be detected by the dome-shaped projections they form on
the surface of the coral. The female gonophore consists of a saucer-
shaped pad of folded endoderm called the "trophodisc," which
serves the purpose of nourishing the single large yolk-laden egg it
bears; and a thin enveloping membrane composed of at least two
layers of cells. The egg is fertilised while it is still within the ampulla,
and does not escape to the exterior until it has reached the stage of
a solid ciliated larva. All the Stylasterina are therefore viviparous.
The male gonophore has a very much smaller trophodisc, which is
sometimes (Allopora) prolonged into a columnar process or spadix,
penetrating the greater part of the gonad. The spermatozoa escape
through a peculiar spout-like duct which perforates the superficial
wall of the ampulla. In some genera (Distichopora) there are several
male gonophores in each ampulla.
The gonophores of the Stylasterina have been regarded as much

altered medusiform gonophores, and this view may possibly prove to
be correct. At present, however, the evidence of their derivation from
Medusae is not conclusive, and it is possible that they may have had
a totally independent origin.
Distichopora and some species of Stylaster are found in shallow

water in the tropics, but most of the genera are confined to deep or
very deep water, and have a wide geographical distribution. No
species have been found hitherto within the British area.
Fig. 136.—A portion of a branch of Cryptohelia ramosa, showing the lids l 1 and l
2 covering the cyclosystems, the swellings produced by the ampullae in the
lids amp1, amp2, and the dactylozooids, dac. × 22. (After Hickson and
England.)
A few specimens of a species of Stylaster have been found in

Tertiary deposits and in some raised beaches of more recent origin,
but the order is not represented in the older strata.
Fam. Stylasteridae.—All the genera at present known are included

in this family.
Sporadopora is the only genus that presents a superficial general

resemblance to Millepora. It forms massive, branching white coralla,
with the pores scattered irregularly on the surface, and, like many
varieties of Millepora, not arranged in cyclosystems. It may, however,
be distinguished at once by the presence of a long, brush-like style
in each of the gastropores. The ampullae are large, but are usually
so deep-seated in the coenenchym that their presence cannot be
detected from the surface. It was found off the Rio de la Plata in 600
fathoms of water by the "Challenger."
In Errina the pores are sometimes irregularly scattered, but in E.

glabra they are arranged in rows on the sides of the branches, while
in E. ramosa the gastropores occur at the angles of the branches
only. The dactylopores are situated on nariform projections of the
corallum. The ampullae are prominent. There are several
gonophores in each ampulla of the male, but only one in each
ampulla of the female. This genus is very widely distributed in water
from 100 to 500 fathoms in depth.
Phalangopora differs from Errina in the absence of a style in the

gastropore; Mauritius.—Pliobothrus has also no style in the
gastropore, and is found in 100-600 fathoms of water off the
American Atlantic shores.
Distichopora is an important genus, which is found in nearly all the

shallow seas of the tropical and semi-tropical parts of the world, and
may even flourish in rock pools between tide marks. It is nearly
always brightly coloured—purple, violet, pale brown, or rose red. The
colony usually forms a small flabellum, with anastomosing branches,
and the pores are arranged in three rows, a middle row of
gastropores and two lateral rows of dactylopores on the sides of the
branches. There is a long style in each gastropore. The ampullae are
numerous and prominent, situated on the anterior and posterior
faces of the branches. Each ampulla contains a single gonophore in
the female colony and two or three gonophores in the male colony.
Spinipora is a rare genus from off the Rio de la Plata in 600 fathoms.
The branches are covered with blunt spines. These spines have a
short gutter-like groove at the apex, which leads into a dactylopore.
The gastropores are provided with a style and are situated between
the spines.
Steganopora[321] from the Djilolo Passage, in about 600 fathoms, is

very similar to Spinipora as regards external features, but differs
from it in the absence of styles in the gastropores, and in the wide
communications between the gastropores and dactylopores.
Stylaster is the largest and most widely distributed genus of the

family, and exhibits a considerable range of structure in the many
species it contains. It is found in all the warmer seas of the world,
living between tide marks at a few fathoms, and extending to depths
of 600 fathoms. Many specimens, but especially those from very
shallow water, are of a beautiful rose or pink colour. The corallum is
arborescent and usually flabelliform. The pores are distributed in
regular cyclosystems, sometimes on one face of the corallum only,
sometimes on the sides of the branches, and sometimes evenly
distributed. There are styles in both gastropores and dactylopores.
Allopora is difficult to separate from Stylaster, but the species are

usually more robust in habit, and the ampullae are not so prominent
as they are on the more delicate branches of Stylaster. It occurs at
depths of 100 fathoms in the Norwegian fjords. A very large red
species (A. nobilis) occurs in False Bay, Cape of Good Hope, in 30
fathoms of water. In this locality the coral occurs in great submarine
beds or forests, and the trawl that is passed over them is torn to
pieces by the hard, thick branches, some of which are an inch or
more in diameter.
Astylus is a genus found in the southern Philippine sea in 500

fathoms of water. It is distinguished from Stylaster by the absence of
a style in the gastropore.
Cryptohelia is an interesting genus found both in the Atlantic and

Pacific Oceans at depths of from 270 to about 600 fathoms. The
cyclosystems are covered by a projecting lid or operculum (Fig. 136,
l 1, l 2). There are no styles in either the gastropores or the
dactylopores. The ampullae are prominent, and are sometimes
situated in the lids. There are several gonophores in each ampulla of
the female colony, and a great many in the ampulla of the male
colony.
CHAPTER XI
HYDROZOA (CONTINUED): TRACHOMEDUSAE—NARCOMEDUSAE—
SIPHONOPHORA
Order VII. Trachomedusae.

The orders Trachomedusae and Narcomedusae are probably closely
related to one another and to some of the families of Medusae at
present included in the order Calyptoblastea, and it seems probable
that when the life-histories of a few more genera are made known
the three orders will be united into one. Very little is known of the
hydrosome stage of the Trachomedusae, but Brooks[322] has shown
that in Liriope, and Murbach[323] that in Gonionema, the fertilised
ovum gives rise to a Hydra-like form, and in the latter this exhibits a
process of reproduction by gemmation before it gives rise to
Medusae. Any general statement, therefore, to the effect that the
development of the Trachomedusae is direct would be incorrect. The
fact that the hydrosomes already known are epizoic or free-
swimming does not afford a character of importance for distinction
from the Leptomedusae, for it is quite possible that in this order of
Medusae the hydrosomes of many genera may be similar in form
and habits to those of Liriope and Gonionema.
The free border of the umbrella of the Trachomedusae is entire; that

is to say, it is not lobed or fringed as it is in the Narcomedusae. The
sense-organs are statocysts, each consisting of a vesicle formed by
a more or less complete fold of the surrounding wall of the margin of
the umbrella, containing a reduced clapper-like tentacle loaded at its
extremity with a statolith.
Fig. 137.—Liriope rosacea, one of the Geryoniidae, from the west side of North
and Central America. Size, 15-20 mm. Colour, rose. cp, Centripetal canal;
gon, gonad; M, mouth at the end of a long manubrium; ot, statocyst; t,
tentacle; to, tongue. (After Maas.)
This statocyst is innervated by the outer nerve ring. There appears to

be a very marked difference between these marginal sense-organs
in some of the best-known examples of Trachomedusae and the
corresponding organs of the Leptomedusae. The absence of a stalk
supporting the statolith and the innervation of the otocyst by the
inner instead of by the outer nerve ring in the Leptomedusae form
characters that may be of supplementary value, but cannot be
regarded as absolutely distinguishing the two orders. The statorhab
of the Trachomedusae is probably the more primitive of the two
types, and represents a marginal tentacle of the umbrella reduced in
size, loaded with a statolith and enclosed by the mesogloea.
Intermediate stages between this type and an ordinary tentacle have
already been discovered and described. In the type that is usually
found in the Leptomedusae the modified tentacle is still further
reduced, and all that can be recognised of it is the statolith attached
to the wall of the statocyst, but intermediate stages between the two
types are seen in the family Olindiidae, in which the stalk supporting
the statolith passes gradually into the tissue surrounding the statolith
on the one hand and the vesicle wall on the other. The radial canals
are four or eight in number or more numerous. They communicate at
the margin of the umbrella with a ring canal from which a number of
short blind tubes run in the umbrella-wall towards the centre of the
Medusa (Fig. 137, cp). These "centripetal canals" are subject to
considerable variation, but are useful characters in distinguishing the
Trachomedusae from the Leptomedusae. The tentacles are situated
on the margin of the umbrella, and are four or eight in number or, in
some cases, more numerous. The gonads are situated as in
Leptomedusae on the sub-umbrella aspect of the radial canals.
In Gonionema murbachii the fertilised eggs give rise to a free-

swimming ciliated larva of an oval shape with one pole longer and
narrower than the other. The mouth appears subsequently at the
narrower pole. The larva settles down upon the broader pole, the
mouth appears at the free extremity, and in a few days two, and later
two more, tentacles are formed (Fig. 138).
At this stage the larva may be said to be Hydra-like in character, and

as shown in Fig. 138 it feeds and lives an independent existence.
From its body-wall buds arise which separate from the parent and
give rise to similar Hydra-like individuals. An asexual generation thus
gives rise to new individuals by gemmation as in the hydrosome of
the Calyptoblastea. The origin of the Medusae from this Hydra-like
stage has not been satisfactorily determined, but it seems probable
that by a process of metamorphosis the hydriform persons are
directly changed into the Medusae.[324]
Fig. 138.—Hydra-like stage in the development of Gonionema murbachii. One of

the tentacles is carrying a worm (W) to the mouth. The tentacles are shown
very much contracted, but they are capable of extending to a length of 2
mm. Height of zooid about 1 mm. (After Perkins.)
In the development of Liriope the free-swimming larva develops into
a hydriform person with four tentacles and an enormously elongated
hypostome or manubrium; and, according to Brooks, it undergoes a
metamorphosis which directly converts it into a Medusa.
There can be very little doubt that in a large number of

Trachomedusae the development is direct, the fertilised ovum giving
rise to a medusome without the intervention of a hydrosome stage.
In some cases, however (Geryonia, etc.), the tentacles appear in
development before there is any trace of a sub-umbrella cavity, and
this has been interpreted to be a transitory but definite Hydroid
stage. It may be supposed that the elimination of the hydrosome
stage in these Coelenterates may be associated with their
adaptation to a life in the ocean far from the coast.
During the growth of the Medusa from the younger to the adult
stages several changes probably occur of a not unimportant
character, and it may prove that several genera now placed in the
same or even different families are stages in the development, of the
same species. In the development of Liriantha appendiculata,[325] for
example, four interradial tentacles appear in the first stage which
disappear and are replaced by four radial tentacles in the second
stage.
As with many other groups of free-swimming marine animals the

Trachomedusae have a very wide geographical distribution, and
some genera may prove to be almost cosmopolitan, but the majority
of the species appear to be characteristic of the warmer regions of
the high seas. Sometimes they are found at the surface, but more
usually they swim at a depth of a few fathoms to a hundred or more
from the surface. The Pectyllidae appear to be confined to the
bottom of the sea at great depths.
The principal families of the Trachomedusae are:—

Fam. Olindiidae.—This family appears to be structurally and in
development most closely related to the Leptomedusae, and is
indeed regarded by Goto[326] as closely related to the Eucopidae in
that order. They have two sets of tentacles, velar and exumbrellar;
the statocysts are numerous, two on each side of the exumbrellar
tentacles. Radial canals four or six. Manubrium well developed and
quadrate, with distinct lips. There is an adhesive disc on each
exumbrellar tentacle.
Genera: Olindias, Olindioides, Gonionema (Fig. 139), and Halicalyx.
As in other families of Medusae the distribution of the genera is very

wide. Olindias mülleri occurs in the Mediterranean, Olindioides
formosa off the coast of Japan, Gonionema murbachii is found in
abundance in the eel pond at Wood's Holl, United States of America,
and Halicalyx off Florida.
Two genera may be referred to in this place, although their

systematic position in relation to each other and to other Medusae
has not been satisfactorily determined.
Fig. 139.—Gonionema murbachii. Adult Medusa, shown inverted, and clinging to

the bottom. Nat. size. (After Perkins.)
Limnocodium sowerbyi is a small Medusa that was first discovered in

the Victoria regia tanks in the Botanic Gardens, Regent's Park,
London, in the year 1880. It has lately made its appearance in the
Victoria regia tank in the Parc de la Bête d'Or at Lyons.[327] As it
was, at the time of its discovery, the only fresh-water jelly-fish known,
it excited considerable interest, and this interest was not diminished
when the peculiarities of its structure were described by Lankester
and others. It has a rather flattened umbrella, with entire margin and
numerous marginal tentacles, the manubrium is long, quadrate, and
has four distinct lips. There are four radial canals, and the male
gonads (all the specimens discovered were of the male sex) are sac-
like bodies on the sub-umbrellar aspect of the middle points of the
four radial canals. In these characters the genus shows general
affinities with the Olindiidae. The difficult question of the origin of the
statoliths from the primary germ layers of the embryo and some
other points in the minute anatomy of the Medusa have suggested
the view that Limnocodium is not properly placed in any of the other
orders. Goto,[328] however, in a recent paper, confirms the view of
the affinities of Limnocodium with the Olindiidae.
The life-history of Limnocodium is not known, but a curious Hydroid

form attached to Pontederia roots was found in the same tank as the
Medusae, and this in all probability represents the hydrosome stage
of its development. The Medusae are formed apparently by a
process of transverse fission of the Hydroid stock[329] similar in
some respects to that observed in the production of certain
Acraspedote Medusae. This is quite unlike the asexual mode of
formation of Medusae in any other Craspedote form. The structure of
this hydrosome is, moreover, very different to that of any other
Hydroid, and consequently the relations of the genus with the
Trachomedusae cannot be regarded as very close.
Limnocodium has only been found in the somewhat artificial

conditions of the tanks in botanical gardens, and its native locality is
not known, but its association with the Victoria regia water-lily seems
to indicate that its home is in tropical South America.
Limnocnida tanganyicae is another remarkable fresh-water Medusa,
about seven-eights of an inch in diameter, found in the lakes
Tanganyika and Victoria Nyanza of Central Africa.[330] It differs from
Limnocodium in having a short collar-like manubrium with a large
round mouth two-thirds the diameter of the umbrella, and in several
other not unimportant particulars. It produces in May and June a
large number of Medusa-buds by gemmation on the manubrium, and
in August and September the sexual organs are formed in the same
situation.
Fig. 140.—Limnocnida tanganyicae. × 2. (After Günther.)
The fixed hydrosome stage, if such a stage occurs in the life-history,

has not been discovered; but Mr. Moore[331] believes that the
development is direct from ciliated planulae to the Medusae. The
occurrence of Limnocnida in Lake Tanganyika is supposed by the
same authority to afford a strong support to the view that this lake
represents the remnants of a sea which in Jurassic times spread
over part of the African continent. This theory has, however, been
adversely criticised from several sides.[332]
The character of the manubrium and the position of the sexual cells
suggest that Limnocnida has affinities with the Narcomedusae or
Anthomedusae, but the marginal sense-organs and the number and
position of the tentacles, showing considerable similarity with those
of Limnocodium, justify the more convenient plan of placing the two
genera in the same family.
Fam. Petasidae.—The genus Petasus is a small Medusa with four

radial canals, four gonads, four tentacles, and four free marginal
statorhabs. A few other genera associated with Petasus show simple
characters as regards the canals and the marginal organs, but as
very little is known of any of the genera the family may be regarded
as provisional only. Petasus is found in the Mediterranean and off
the Canaries.
Fam. Trachynemidae.—In this family there are eight radial canals,

and the statorhabs are sunk into a marginal vesicle. Trachynema,
characterised by its very long manubrium, is a not uncommon
Medusa of the Mediterranean and the eastern Atlantic Ocean. Many
of the species are small, but T. funerarium has sometimes a disc two
inches in diameter. Homoconema and Pentachogon have numerous
very short tentacles.
Fam. Pectyllidae.—This family contains a few deep-sea species

with characters similar to those of the preceding family, but the
tentacles are provided with terminal suckers. Pectyllis is found in the
Atlantic Ocean at depths of over 1000 fathoms.
Fam. Aglauridae.—The radial canals are eight in number and the

statorhabs are usually free. In the manubrium there is a rod-like
projection of the mesogloea from the aboral wall of the gastric cavity,
covered by a thin epithelium of endoderm, which occupies a
considerable portion of the lumen of the manubrium. This organ may
be called the tongue. Aglaura has an octagonal umbrella, and a
manubrium which does not project beyond the velum. It occurs in the
Atlantic Ocean and Mediterranean Sea.
Fam. Geryoniidae.—In this family there are four or six radial canals,
the statorhabs are sunk in the mesogloea, and a tongue is present in
the manubrium. Liriope (Fig. 137) is sometimes as much as three
inches in diameter. It has a very long manubrium, and the tongue
sometimes projects beyond the mouth. There are four very long
radial tentacles. It is found in the Atlantic Ocean, the Mediterranean
Sea, and the Pacific and Indian Oceans. Geryonia has a wider
geographical distribution than Liriope, and is sometimes four inches
in diameter. It differs from Liriope in having six, or a multiple of six,

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Nutrition for Health and Health Care -

From Whitney/Rolfes, Understanding Nutrition, 13E. © 2013 Cengage Learning.

From Whitney/Rolfes, Understanding Nutrition, 13E. © 2013 Cengage Learning.

From Whitney/Rolfes, Understanding Nutrition, 13E. © 2013 Cengage Learning.

Tolerable Upper Intake Levels (UL) for Minerals

Linda Kelly DeBruyne

Product Assistant: Lauren R. Monz

Intellectual Property Project Manager:

Photo Researcher: Nishabhanu Beegan, Library of Congress Control Number: 2018946256

Text Researcher: Sriranjani Ravi,

Printed in the United States of America

National Health Goals 11 Monosaccharides 68

Digestion in the Mouth 45

Finding the Fats in Foods 108 Genetics and Weight 174

Nutrition in Practice Fad Diets 195

Protein Deficiency 132 Chapter 8

Health Risks of Underweight 161 Water Balance 238

Nutrition Prior to Pregnancy 272

Nutrition in Practice Encouraging Successful Nutrition in Practice Hunger and Community

Care Planning 404

Drug Effects on Food Intake 416 Dry Mouth 490

Oral Supplements 434 Chapter 18

Candidates for Parenteral Nutrition 448 Fat Malabsorption 519

Symptoms of Diabetes Mellitus 566 Causes of Acute Kidney Injury 630

Consequences of Atherosclerosis 597 Prevention of HIV Infection 665

Changes for This Edition Chapter 7

acid regurgitation, heartburn, bloating, pernicious

specialized nutrition support oral nutrition

MindTap: Empower Your

Features of this Text

Access Everything You Need

Empower Students to Reach

You Need Them

1.1 Food Choices

1.2 The Nutrients

1.3 Nutrient Recommendations

1.4 National Nutrition Surveys

1.6 Food Labels

1.7 Nutrition in Practice: Finding the Truth about Nutrition

1.1 Food Choices

2 CHAPTER 1 Overview of Nutrition and Health

Ethnic Heritage and Regional Cuisines

ethnic diets Photo 1-1

halal Ethnic meals and family gatherings

pocket bread, greens, leeks, pomegranates, chicken, fava cheeses; yogurt

or flour), rice summer squash, papaya, plantain fish, eggs

Availability, Convenience, and Economy

4 CHAPTER 1 Overview of Nutrition and Health

Nutrition is only one of the many factors

Body Weight and Image

Health and Nutrition

whole foods: fresh foods such as

1.2 The Nutrients

nutrients: substances obtained from

6 CHAPTER 1 Overview of Nutrition and Health

Energy Nutrients in Foods

Energy Storage in the Body

Alcohol, Not a Nutrient

Box 1-1 How to Calculate the Energy a Food Provides

16 g carbohydrate 3 4 kcal/g 5 64 kcal 0.47 3 100 5 47%

Setting Nutrient Recommendations: RDA and AI

8 CHAPTER 1 Overview of Nutrition and Health

FIGURE 1-3 Inaccurate versus Accurate View of Nutrient Intakes

1.7 Nutrition in Practice: Finding the Truth about Nutrition

FIGURE 1-3 Inaccurate versus Accurate View of Nutrient Intakes

Duration At least 30 minutes per day 8 to 12 repetitions of 8 to 10 different 2 to 4 repetitions of 15 to 30 seconds

Examples Running, cycling, swimming, inline Pull-ups, push-ups, weight-lifting, Yoga

TABLE 1-7 Estimated Daily kCalorie