Wardlaw’s perspectives in nutrition

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Wardlaw’s
PERSPECTIVES IN

Nutrition
Updated with 2015–2020 Dietary Guidelines for Americans
 Wardlaw’s
Perspectives in
Updated with 2015–2020 Dietary Guidelines for Americans

CAROL BYRD-BREDBENNER
Rutgers, The State University of New Jersey

GAILE MOE
Seattle Pacific University

JACQUELINE BERNING
University of Colorado at Colorado Springs

DANITA KELLEY
Western Kentucky University
WARDLAW’S PERSPECTIVES IN NUTRITION Updated with 2015-2020 Dietary Guidelines for Americans,
TENTH EDITION

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Library of Congress Cataloging-in-Publication Data

Names: Wardlaw, Gordon M. | Byrd-Bredbenner, Carol. | Moe, Gaile. | Berning,

Jacqueline R. | Kelley, Danita S.
Title: Wardlaw’s perspectives in nutrition.
Other titles: Perspectives in nutrition
Description: Tenth edition, updated with 2015-2020 dietary guidelines for
Americans / Carol Byrd-Bredbenner, Rutgers, The State University of New
Jersey, Gaile Moe, Seattle Pacific University, Jacqueline Berning,
University of Colorado at Colorado Springs, Danita Kelley, Western
Kentucky University. | New York, NY: McGraw-Hill Education, [2016] |
Includes bibliographical references and index.
Identifiers: LCCN 2016009387 | ISBN 9781259918377 (alk. paper)
Subjects: LCSH: Nutrition.
Classification: LCC QP141 .W38 2016b | DDC 612.3—dc23 LC record available at http://lccn.loc.gov/2016009387

The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a website
does not indicate an endorsement by the authors or McGraw-Hill Education, and McGraw-Hill Education does
not guarantee the accuracy of the information presented at these sites.

www.mhhe.com
Brief Contents
PART 1 NUTRITION BASICS
1 The Science of Nutrition 2
2 Tools of a Healthy Diet 38
3 The Food Supply 72
4 Human Digestion and Absorption 116

PART 2 ENERGY-YIELDING NUTRIENTS AND ALCOHOL

5 Carbohydrates 154
6 Lipids 190
7 Proteins 226
8 Alcohol 260

PART 3 METABOLISM AND ENERGY BALANCE

9 Energy Metabolism 284
10 Energy Balance, Weight Control,
and Eating Disorders 318
11 Nutrition, Exercise, and Sports 364

PART 4 VITAMINS AND MINERALS

12 The Fat-Soluble Vitamins 402
13 The Water-Soluble Vitamins 438
14 Water and Major Minerals 488
15 Trace Minerals 540
PART 5 NUTRITION APPLICATIONS IN THE LIFE CYCLE
16 Nutritional Aspects of Pregnancy and Breastfeeding 576
17 Nutrition during the Growing Years 616
18 Nutrition during the Adult Years 656

v
Meet the Author Team
C a r o l B y r d - B r e d b e n n e r, P h . D . , R . D . , FA N D , received her doctorate from
Pennsylvania State University. Currently, she is Professor in the Nutritional Sciences Department at
Rutgers, The State University of New Jersey. She teaches a wide range of undergraduate and graduate
nutrition courses. Her research interests focus on investigating environmental factors that affect dietary
choices and health outcomes. Dr. Byrd-Bredbenner has authored numerous nutrition texts, journal
articles, and computer software packages. She has received teaching awards from the American
Dietetic Association (now called the Academy of Nutrition and Dietetics), Society for Nutrition
Education, and U.S. Department of Agriculture. She was the recipient of the American Dietetic
Association’s Anita Owen Award for Innovative Nutrition Education Programs. She also was a Fellow
of the United Nations, World Health Organization at the WHO Collaborating Center for Nutrition
Education, University of Athens, Greece. She enjoys exploring food and culinary customs, traveling, diving, and gardening.

G a i l e L . M o e , P h . D . , R . D . , earned a doctorate in nutritional sciences at the

University of Washington. She is a registered dietitian who has worked in clinical nutrition,
research, and management, as well as education. She is currently Professor and Director
of the Didactic Program in Dietetics at Seattle Pacific University. She has published in
peer-reviewed journals in the areas of nutrition and cancer and media reporting of nutrition
research. Gaile enjoys swimming, cycling, walking, and hiking, along with learning about
culinary traditions, food, and food policy.

J a c q u e l i n e R . B e r n i n g , P h . D . , R . D . , C S S D , earned her doctorate in nutrition

from Colorado State University in Fort Collins, Colorado. She is currently Professor and
Chair of the Health Science Department at the University of Colorado at Colorado Springs
(UCCS), where she has won numerous teaching awards. Dr. Berning is published in the
area of sports dietetics and was the sport dietitian for the Denver Broncos for over 25 years,
Cleveland Indians for 18 years, and Colorado Rockies for 10 years. Currently she is the sport
dietitian for UCCS athletics and US Lacrosse. She is active in the Academy of Nutrition and
Dietetics, where she served as the chair of the Program Planning Committee for FNCE and
is currently Chair of the Appeals Committee. In 2014, Dr. Berning was awarded the Mary
Abbot Hess Award for Culinary Events for teaching the University of Colorado football team
how to grocery shop and cook. Additionally, she served 6 years as an ADA spokesperson and
is a former chair of the Sports, Cardiovascular, and Wellness Nutritionists dietetics practice
group. She enjoys walking, hiking, and gardening.

D a n i t a S a x o n K e l l e y, P h . D . , R . D . , earned her doctorate in nutritional sciences

from the University of Kentucky. She serves as Associate Dean of the College of Health and
Human Services and is a Professor in the Family and Consumer Sciences Department at
Western Kentucky University. Previously, Dr. Kelley was Director of the Didactic Program
in Dietetics at Western Kentucky University. She is a Past President of the Board of Directors
for the Kentucky Academy of Nutrition and Dietetics. Her scholarly work has focused
on healthy eating of adolescents, communication skills of dietetic students, histaminergic
activity and regulation of food intake, and dietary restriction effects on the antioxidant
defense system. She has received awards for teaching from the Kentucky Academy of
Nutrition and Dietetics and the Dietetic Educators of Practitioners of the Academy of
Nutrition and Dietetics. She enjoys singing, walking her dog, cheering for her family in
water-ski competitions, and watching her children participate in athletic and musical endeavors.

vi
 Preface

e T e n t h E dition of U p d a ted with

t o t h io n
Welcome r s p e c t iv e s in Nutrit m ericans curate,
la w ’s P e n e s f o r A
Ward ie t a r y G u ideli of providin
g an ac
– 2 0 2 0 D erved re p u ta ti o n
e have end
eavored
2015 ves in Nutr
ition has th
e ri c h ly d e s
to the dyna
mic field of
n u tr it io
oth studen
n . W
ts and instr
uctors.
to
Perspecti tful introdu
ction
this edition
for b
ur commitm us
ent
Wardlaw’s n d th o u g h e n ri c h in g in g , a n d o
epth, a ellence by dent learn ents, guide
d
current, in-d is tr a dition of exc s ir e to promote stu u c to rs and stud b een
o n th e d e in s tr t h a v e
to build up io n , o u r genuin o m m e n ts from h ilo s o p hy tha
n for nu tr it uctiv e c an d p and the
Our passio c o u p le d with constr a in ta in th e strengths th e s c ie n ce content
ccuracy, to m o f
scientific a l has been ccessibility
rt . O u r p rimary goa u e to e n h ance the a
in this eff o contin other
o f th is book yet d e n ts . , a s w ell as many
the hallm a rk ay’s s tu auth o rs to this
o f m a te rials for tod e v e ry d ay. For the e v o ti n g our careers
applicatio n ur liv e s n fo r d versial)
n d ly a ff ects all of o e c o m p elling reaso d s o m e ti mes contro
fo u is th (a n s for
Nutrition pro ers, and clinicians, this a rc h a n d provocative erstand its implication
research n res e und tion in
educators, ra p id p a c e of nutritio e la te s t re search and g re a te r o r less atten
dynamic fie
ld. The abreast of
th ve deserve
a lle n g e u s all to stay s to p ic s th at you belie
findings ch u
share with
a lt h . W e in vite you to
he
ition.
the next ed
alth!
To your he
er
-Bredbenn
Carol Byrd
Gaile Moe
Berning
Jacqueline
y
Danita Kelle

vii
Personalized,
Adaptive Learning
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viii
Digital efficacy study shows results!
Digital efficacy study final analysis showed students experience higher success rates when required to use LearnSmart.
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ix
Connecting Instructors
to Students
Saves students and instructors time while improving performance

McGraw-Hill Connect® Nutrition is a digital teaching and learning

environment that saves students and instructors time while improving
performance over a variety of critical outcomes.
• Auto-grade assessments and tutorials
Instructors can easily create customized assessments that will be automati-
cally graded. All Connect content is created by nutrition instructors, so it is
pedagogical, instructional, and at the appropriate level. Interactive ques-
tions using high-quality art from the textbook and animations and videos
from a variety of sources take students way beyond multiple choice.
• Gather assessment information
All Connect questions are tagged to a learning outcome, specific section
and topic, and Bloom’s level for easy tracking of assessment data.
• Access content anywhere, anytime
The media-rich eBook allows students to do full text searches, add notes
and highlights, and access their instructor’s shared notes and highlights.
• Streamline lecture creation
Presentation tools, such as PowerPoint® lecture outlines, including art,
photos, tables, and animations, allow instructors to customize their
lectures.

McGraw-Hill Connect® Insight is a powerful data analytics tool that allows instructors to leverage aggregated information
about their courses and ­students to provide a more personalized teaching and learning experience.

x
 and Students to
Core Concepts
LearnSmart Prep® is designed to get students ready for a forthcoming course by quickly
and effectively addressing prerequisite knowledge gaps that may cause p
­ roblems down
the road.

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ment System for quick and easy access to best-in-class content and learning tools.

Dietary Analysis Tool

NutritionCalc Plus is a suite of powerful dietary self-assessment tools that help students
track their food intake and activity and analyze their diet and health goals. Students and
instructors can trust the reliability of the ESHA database while interacting with a robust
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xi
Connecting Students to
Today’s Nutrition
Our Intended Audience
This textbook was developed for students pursuing nutrition and health science careers as
well as those wanting a better understanding of how nutrition affects their lives. Because
this course often attracts students from a broad range of majors, we have been careful to
include examples and explanations that are relevant to them and to include sufficient sci-
entific background to make the science accessible to them. The appendices help students
who wish to learn more or need assistance with the science involved in human physiology,
chemistry, and metabolism.
To better bridge the span of differing science backgrounds and to enhance student
interest and achievement of course objectives, we organized the presentation of the mate-
rial within chapters to flow seamlessly from concrete to abstract learning. In chapters focusing on nutrients, for example, con-
crete concepts, such as food sources of the nutrients and recommended intakes, are introduced early in the chapter to create
a framework for more abstract concepts, such as functions, digestion, and absorption.

Accurate, Current Science That Engages Students

The tenth edition continues the tradition of presenting scientific content that is reliable, accurate, and up-to-date. This edition
incorporates coverage of recent nutrition research, as well as the recent updates to consumer guidelines—Dietary Guidelines
for Americans, MyPlate, and Healthy People 2020. It also retains the in-depth coverage students need to fully understand
and appreciate the role of nutrition in overall health and to build the scientific knowledge base needed to pursue health-
related careers or simply live healthier lives. To enhance these strengths and promote greater comprehension, new research
findings and peer-reviewed references are incorporated and artwork is enhanced to further complement the discussions.
The presentation of complex concepts was scrutinized to increase clarity through the use of clear, streamlined, precise, and
student-friendly language. Timely and intriguing examples, illustrativeFirst analogies,
Pages clinical insights, historical notes, future
perspectives, and thought-provoking photos make the text enjoyable and interesting to students and instructors alike.

CLINICAL PERSPECTIVE

Hyp ertension and Nutrition

About 1 in 3 adults has high blood pressure
(hypertension).34 Blood pressure, measured in
millimeters of mercury (mm Hg), is the force of
the blood against artery walls. Simply put, it
measures how hard the heart is working and
what condition the arteries are in. It is expressed
as 2 numbers. The higher number is the systolic
blood pressure—the pressure in the arteries when
the heart beats. The second value is the diastolic
blood pressure—the pressure in the arteries
between beats when the heart relaxes. Optimal
blood pressure is less than 120 over 80 mm Hg.
Table 14-7 gives the blood pressure categories
currently in use for adults.
Causes of Hypertension
Diseases such as kidney disease, liver disease, and
diabetes can sometimes cause a condition known
as secondary hypertension. This occurs in about 5
to 10% of individuals with hypertension and is due
to the underlying disease. Most individuals with
hypertension, however, are classified as having
primary (essential) hypertension. Primary hyper-
tension develops over a period of years in response
to changes in the arteries, kidneys, and sodium/
potassium balance.29,30,35 As we age, our arteries
tend to narrow and become more rigid through
a process called arteriosclerosis. Additionally,
endothelial cells that line the arteries often release
increased renin, causing the formation of addi-
tional angiotensin II enzyme (see Fig. 14-9).
Angiotensin II is a powerful vasoconstrictor that
triggers the kidney’s retention of sodium and
water. Diets high in sodium and low in potassium
worsen these physiological changes. Over time, the
result is elevation of blood pressure.
Risk Factors for Hypertension
Age, race, obesity, and diabetes all affect the risk
of high blood pressure.34,35 As people increase in
age, so does blood pressure; over 90% of those
over age 55 will develop high blood pressure in
their lifetimes. African-Americans tend to develop
hypertension more often and at a younger age than
Whites. Obesity, especially abdominal obesity,
also increases the risk of developing high blood
pressure. An increase in fat mass adds extra blood
vessels, which increases the heart’s workload,
as well as blood pressure. Elevated blood insulin
concentration associated with insulin-resistant adi-
pose cells is another reason for this link to obesity.
Insulin increases sodium retention in the body and The risk of hypertension increases with age.
accelerates atherosclerosis. An estimated 65% of
people with diabetes also have hypertension.
Hypertension is a serious chronic disease Chapter 1 that cardiovascular disease, stroke, and
and health hazard. Recall from Chapter 6 that the kidney failure are leading causes of death. Unfor-
high pressure in the arteries damages the arteries tunately, hypertension is often a silent disease,
over time. Eventually, this high pressure damages with no warning signs or symptoms. This is why it

xii vasoconstrictors, substances that cause the arter-

ies to constrict, in response to arterial damage,
poor blood flow, stress, and other factors. Although
these events alone can result in increased blood
the “target organs” of hypertension—the heart,
brain, kidney, and eyes—increasing the risk of
is important to get your blood pressure checked
regularly. If hypertension is detected in its early
heart attack, stroke, dementia, kidney disease, stages, treatment is often more effective.
and vision loss (approximately 51% of all strokes
 Connecting with a Confirming Pages

Personal Focus 62
(e.g., lead and arsenic) and submit test results to the EPA. Water treatments vary, depend-
ing on the water source, but all water is disinfected, usually with a chlorine-based chemical.
Private water supplies, such as wells, are not regulated by the EPA but still should be tested
for chemical and microbial contaminants. Local health departments can give advice on test-
ing and keeping well water safe.
CHAPTER 3 The Food Supply 99

Bottled Water
Bottled water is a popular source of water. Many consumers are attracted to its convenience,
Confirming Pages

Applying Nutrition on a Personal Level

perceived health value, or taste. All bottled waters must list the source of the water on the
label. Sources include wells, spas, springs, geysers, and quite often the public water supply.
Some bottled water contains minerals, such as calcium, magnesium, and potassium, that
either occur naturally or are added by the bottling company to improve the water’s taste. The Bottled water is a convenient but relatively
water is carbonated when carbon dioxide gas naturally occurs in the water source (called expensive source of water. In most cases,
Confirming Pages
naturally sparkling water) or is added. Additives such as flavors and vitamins also are com- tap water is just as healthy a choice to meet

A key objective in nearly all introductory courses is for students to apply their new knowledge of nutrition to their own lives.
mon. Bottled waters are regulated by the FDA, which sets high standards for their purity. It
CHAPTER 5 Carbohydrates 177
periodically collects and analyzes samples, but not to the extent that municipal water sup-
water needs.

Practical applications clearly linked to nutritional science concepts are woven throughout each chapter to help students apply plies are monitored. Water that is bottled in a sanitary manner and kept sealed will not spoil,
although off-flavors may develop over time.

their knowledge to improving and maintaining their own
5.6 Health Concerns Related to Carbohydrate Intake
Threats to Safe Water
The U.S. enjoys one of the cleanest water supplies in the world, but there are numerous threats
CHAPTER 5 Carbohydrates 171
Raw milk has not undergone pasteurization,
the heat-treatment process that kills pathogenic
bacteria and makes milk safe to drink.

health and that of others for whom they are responsible, suchAs a part of a nutritious
to the safety of our water—agricultural runoff (animal waste, pesticides, fertilizer), inappro-
diet, adequate carbohydrate intake is important for maintaining
priate disposal of chemicals, municipal solid waste (containing bacteria, viruses, nitrates,
Pasteurization does not alter milk’s nutrient
content or make milk less healthy or allergenic.
health and decreasing the detergents,
risk of chronic disease. However,
leaking as
intowith many inadequate
nutrients,treatment
excessive
as future patients or offspring.
ake Action
synthetic household chemicals) waterways, of According to the FDA and the CDC, raw milk
intakes of differenthuman
formswastes,
of carbohydrate
and pollution can
frombe harmful
boats to overall
and ships (containshealth.
solvents,The
gas,following
detergents, dis-
raw can harbor dangerous bacteria and should
sewage), to name just a few. This makes regular testing of the water supply critical.
cussions will help you understand the risks of high intakes of different types of carbohydrates. not be consumed. Many states prohibit the
The EPA requires that the public be notified if water contamination is a danger to
• Take Action features in each chapter allow students to
sale of raw milk to consumers, and interstate
public health. For instance, nitrate contamination from fertilizer runoff is particularly dan- commerce is prohibited. From 1998 to 2010,
Very-High-Fiber Diets
gerous to infants because it prevents oxygen from circulating in the body. As related earlier, raw milk products caused 148 outbreaks with
Estimate Your Fiber Intakewater supplies (it is not affected by normal chlorination 2384 illnesses and 2 deaths. Learn more at
examine their own diets and health issues. Cryptosporidium
procedures).
Adequate fiber intake provides
can contaminate
Boiling tap water
many for abenefi
health minimumts. of 1 minute isvery
However, the best wayintakes
high to kill Cryptospo-
of fiber www.cdc.gov/foodsafety/raw-milk-index.html.
To ridium.
roughly Alternatively,
estimate your individuals
daily fiber can purchase
consumption, a waterthe
determine filter that screens
number of out this
servings that parasite.
you ate yesterday
(i.e., above 50 to 60 g/day)
Even thoughcan the
causeU.S.health
has onerisks. For example,
of the cleanest high in
water supplies fiber consumption
the world, illnesses
• Updated case studies showcase realistic scenarios and combined with from each food category listed here. Multiply the serving amount by the value listed and then add up the
low
fromfluid intake can
contaminated resultwater
drinking
total amount of fiber. How does your total
Over time, this maywhichcause hemorrhoids,
average
in hard,
as well
about 30 per year.
dryThe
do occur.
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stools
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rectalexperts
bleeding,
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note that
to eliminate.
water-related
increased
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outbreaks,
63 fiber intake for yesterday compare with the general recommenda-
data likelyexertion
underes-
Food recalls occur when food products are
found to be contaminated. Examples include
• Sliced apples, avocado pulp, and sliced
thought-provoking questions. tion of 25 tothe
timate
and pressure. In severe
38true
cases,
g ofnumber
could you do so?
fiber perofday
the combination
for women
illnesses
tribute to blockages in the intestine, requiring surgery.
andby
caused men,
of excess
respectively?
contaminated If you are not meeting your needs, how
water.
fiber and insuffi cient fluid may con- turkey for Listeria
• Bagged spinach and ground beef for E. coli

Very-high-fi Preventing
Foodber diets also Foodborne
may decreaseandthe Waterborne
absorption Illnesses
of certain minerals and increase • Spices, pot pies, peanut butter, and
Servings Grams
• New discussion of the Nutritional Care Process (Ch. 1) the risk of deficiencies. This
Safe food
Vegetables
andoccurs because
water supplies somea minerals
require canapproach.
“farm-to-fork” bind to fiAll
ber, which
those who prevents
grow our
hazelnuts for Salmonella
Recent food recall notifications are listed at
them from being food,
absorbed. In processors,
along with countries distributors,
where fiber and intake
consumers,is often greaterfor
are responsible than
food60 andg/day,
water
outlines for students the benefits of working with a nutrition
www.foodsafety.gov.
(Serving size: 1 cup raw leafy greens or ½ cup other vegetables) ______ × 2 ______
deficiencies of zinc and iron have been reported.
High fiberFruits
diets
CASE can be of concern in young children, elderly persons, and malnour-
size: 1STUDY
professional to improve their health and diet. (Serving whole fruit; ½ grapefruit; ½ cup berries or cubed fruit; ¼ cup dried fruit)
ished individuals, all of whom may not eat adequate amounts of foods and nutrients. For
Beans, lentils, split peas Aaron and his wife attended an international
______ × 2.5 ______
wife did not. He also had some salads, garlic bread, and a sweet coconut
these individuals, high fiber intakes may cause a sense of fullness and reduce their overall
(Serving size: ½ cup cooked)
potluck on a warm July afternoon. Their dessert. The couple returned home at______ × 7 went to bed. At 2______
11 P.M. and A.M.,
intake of foods, energy, and nutrients.contribution was Argentine beef, a stewlike dish. Aaron knew something was wrong. He had severe abdominal pain and had
Nuts, seeds
(Serving size: ¼ cup; 2 tbspThey followed
peanut the recipe and the cooking time
butter) to make a mad dash to the toilet. He ______
spent most
× 2.5of the next 3 hours in the
______
carefully, removed the dish from the oven at 1 P.M., bathroom with diarrhea. By dawn, the diarrhea had subsided and he was
High Sugar Whole
Diets grains and kept it warm by wrapping the pan in a towel. feeling better. He ate a light breakfast and felt fine by noon. It’s very likely
(Serving size: 1 slice whole-wheat
They drovebread,
to the ½ cupand
party whole-wheat
set the dish pasta,
out on brownthat
rice,
Aaron contracted foodborne illness from the Argentine beef. What
For many Americans,
or other sugars
the whole
buffet tableconstitute
grain; ½Pbran
at 3 orawhole-grain
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was part
to be ofattheir
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served n)4 P.M.,diets.
but the In fact, on
guests average,
precautions 13% foodborne illness
for avoiding ______
were×ignored
2.5 by Aaron and ______
the
of the calories Refi
consumed
ned
weregrains by themselves
enjoying U.S. adults arethat
so much from added
no one sugars.
began to eat until 6Daily
P.M. intake
rest ofis
theabout
people 335
at the party? How might this case study be rewritten to
17
kcal for men and 239
(Serving kcal
Aaronsize:
made1for
slicewomen.
sure he sampled
bread; the Teens
½ cup Argentine consume
beef
pasta, rice, orthey hadabout
other prepared,
processed 360
but kcal
his
grain; of ned
added
½ substantially
refi sugars
reduce
bagel the risk
or muffi n) of foodborne illness?
______ ×1 ______
per day.18 Recall that most
Breakfast cereals of the sugar we eat comes from foods and beverages to which
sugar has been(Serving addedsize: duringcheckprocessing
package for servingand/orsizemanufacturing.
and grams of fiber Major per serving)sources of added High______
carbohydrate beverages______
× fiber per can contribute to

Applying Nutrition to Career and More

tooth decay. serving
sugar are soft drinks, cakes, cookies, fruit punch, and dairy desserts, such as ice cream.
Total grams of fiber = ______
Although sugars supply calories, they usually provide little else and often replace the
Copyright 1999. Consumers Union of U.S., Inc. Yonkers, NY 10703-1057, a nonprofit organization. Adapted from “Fiber: Strands of Protection” with permission
intake ofbyr21413_ch03_072-115_new.indd
more fromnutritious
the August 1999foods. Children
99 of Consumer
issue Reports onand
Health adolescents
® areonly.typically
for educational purposes at greatest risk of
www.ConsumerReports.org/health. 04/09/14 5:10 pm

overconsuming sugar and empty calories. Dietary surveys indicate that many children and Confirming Pages
• Expert Perspectives from the Field features examine cutting-edge topics and demonstrate how adolescents are drinking an excess of sugar-sweetened beverages and too little milk. Milk
contains calcium and vitamin D, both of which are essential for bone health. Thus, substi-
emerging, and sometimes controversial, research results affect nutrition knowledge and practice. tuting sugared drinks for milk can compromise bone development and health. HISTORICAL
High 5.4intakes Functions
of sugars also ofcan Carbohydrates
increase the risk ofin the gain
weight Body and obesity. (However, PERSPECTIVE
• Clinical Perspectives highlight the role of nutrition in the prevention and treatment of disease. These it is important to note that, although obesity is a risk factor for type 2 diabetes, high sugar3,8
The digestible and indigestible carbohydrates in our diets have vital functions in our bodies.
diets do not directly cause diabetes.) The “supersizing” trend noted in food and beverage Photographing Atoms
These diverse functions are critical to normal metabolism and overall health.
topics will be especially interesting to students planning careers in dietetics or health-related fields. promotions is contributing to this concern. For example, in the 1950s, a typical soft drink
serving wasDigestible
a 6.5-ounceCarbohydrates
bottle. Today, a 20-ounce bottle is a typical serving. This change
Discovering the molecular layout of biologically
important molecules is critical to understanding
an allergic reaction in a person do not come children.15,17 After the child is born, the following
alone contributes 170 extra calories of sugar to the diet. Drinking 1 bottle per9day for a year Food their allergies and food
function and intolerances are notThe
treating disease. the

• Global Perspectives discuss concepts related to critical health and nutrition issues around the world. in contact with the food
Most of to digestible
the be served tocarbohydrates
that steps
in our may
amounts to 62,050 extra calories and a 17- to 18-pound (7.75 to 8.25 kg) weight gain.
individual. Eventheytrace amounts
provide of an allergen
a primary source guidelines
dietshelp
are
are
prevent
broken
especially
food
down allergies.
important
to TheseAs glucose,
glucose.
anfor families
same. Food
as a result
allergies and
biochemist
of exposure
Crowfoot
cause an immune response
crystallographer
to certain
Hodgkin
Dorothy
food components,
developed new x-ray
The sugar in cakes, cookies, andofice energy,
cream sparealso protein
supplies fromextrause asenergy, energy which source, pro- and
These timely features also aim to engage students with thought-provoking challenges. can cause a reaction.
motes weight prevent
gain.
To prevent cross-contact,
ketosis. with a history of any type of allergy.
Although dieters may be choosing more low fat and fat-free snack
anything that will be used to prepare an allergen-
typically techniques
(see Chapter
proteins. In that
contrast,
4) are caused
the structure
food intolerances
permitted
by an
of over 100
her to determine
individual’s
molecules, including
products, these
free meal (e.g.,
usually
Providing are made
Energy
hands, workspace,
with substantial
pans, utensils,
• Feedamounts
babies only ofbreast
addedmilk sugar in order
or infant formula to pro-inability to digest certain food components,
insulin, vitamin B-12, vitamin D, and penicillin.
duce a dessert with anthoroughly
acceptable taste and texture. until they The areresulting product
at least 6 months old.often is a high
• Historical Perspectives heighten awareness of critical discoveries and events that have affected plates) shouldThe
calorie
preparingfood
thecells
main function
be washed
thatand
equals
allergen-freecells or the
of
meal.
of glucose
even
before is to act as a source of energy for body cells. In fact, red blood
Unlike exceeds
central nervous
foodborne the•system
Delay feeding
energy content
derive
cowof
almost
milkthe and milk products
original
all their energy high from
until
fatglucose.
usually due
foodGenerally,
Hertoworklow with
amounts
larger amounts
diabetes. Knowing
of specifi
insulin
of the
c enzymes.
improved
an offending
treatment of
structurefood
of vitamin
product it was designed to replace. infants are at least 1 year of age.
our understanding of nutritional science. cookingHigh
Glucose
illness pathogens,
fatty
suchalso
intakes
an allergenicacids
fuels
as bacteria
oftoenergy
food meetdoes
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muscle
andnotsugar
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cells and other
and viruses,
render(especially
needs, •
body cells, although many of these cells rely are
Serve
especially during egg
fructose)whites only
havelight
rest and after
been children
associated
activity. reach
Recall with age
on required
con-intolerance
that glucose
B-12toadvanced
bloodthan
produce the
to trigger
health.
oursymptoms
Learn
knowledge
allergic
of of
food
moresymptoms.
its role in
about thisFood Nobel Prize
provides 4 the
kcalrisk
of energy per gram. 2 years.
ditions thatharmless.
its allergens increase 16 of cardiovascular disease—namely, increased blood levels ofallergies winner tend toat bewww.nobelprize.org/nobel_prizes/
far more life threatening than
• Keep diets free of peanuts, tree nuts, fish, and
• Perspective on the Futures address emerging trends affecting nutrition science and practice. triglycerides
have suggested
increased
and LDL-cholesterol
The prevalence of food allergies hasand decreased levels of HDL-cholesterol. Studies alsofood intolerances.
a potential
in the last 20 years.15link between
Although
shellfish until children are at least 3 years old.
the increased consumption of sugar-sweetened bev-
difficult 338
chemistry/laureates/1964/hodgkin-bio.html.
PART 3 Metabolism and Energy Balance
The American Academy of Allergy and
erages anditenergy
to estimate, withapproximately
appears that an increased 6 torisk of type Many 2 diabetes and Metabolic
young children Syndrome.25
with food allergies

• Each major heading in the chapters is numbered and cross-referenced to the end-of-chapter 7% of children and
allergies. 15
Confirming
It is unclear 171
byr21413_ch05_154-189.indd
Pages
1 to 2% of adults have food
why some people develop
outgrow them.15,18 Thus, parents should not
assume that the allergy will be long-lasting.
Immunology has a 24-hour toll-free hot line (800-
822-2762) to answer questions about food allergies
04/09/14 5:10 pm
and help direct people to specialists who treat
summary and study questions to make it easy to locate and prioritize important concepts. allergies and what steps might help decrease the
risk of developing food allergies. Although some
Allergies to certain foods (e.g., milk, egg, soy,
wheat) are more likely to be outgrown than are
allergy problems. Free information
Table
on food allergies is available by contacting
studies have shown that women can help prevent
byr21413_ch05_154-189.indd
or delay the 177
onset of food allergies in their child
allergies to other foods (e.g., peanuts, tree nuts,
fish, and shellfish).15 Those with allergies may
on the Future
The Food Allergy & Anaphylaxis Network 04/09/14 5:11 pm
at www.foodallergy.org. Save
by avoiding peanuts and tree nuts during their be tested by physicians periodically to determine The common wisdom that eating 3500 kcal less
CHAPTER 10 Energy Balance, Weight Control, and Eating Disorders 341 pregnancy and lactation, currently it appears whether they have outgrown the allergy. If so,
than you need will result in the loss of 1 pound
Save
that maternal dietary restrictions do not play a the food(s) can be reintroduced into the diet and
significant role in preventing food allergies in their eaten safely. has come under great scrutiny. Weight-loss Save
research models based on thermodynamics, Save
mathematics, physics, and chemistry indicate Save
Knowledge Check many more than 3500 calories may be stored in
1. What are the symptoms of food allergies? Save
a pound of body fat. Researchers are working
xpert Perspective from the Field 2. Which foods cause most food allergies?
3. What steps can parents take to help prevent food allergies in their children?
to build and validate more accurate weight-loss
prediction models.57 Learn more at www.pbrc. Save
Tailoring a Healthy Eating Plan to Fit Your Lifestyle Confirming Pages edu/research-and-faculty/calculators/weight-loss- Save
predictor. Save
According to Dr. Judith Rodriguez,* finding a weight loss you like to eat or the concerns you have about your diet in the
diet that suits your lifestyle is the key to controlling weight left column and consider the descriptions/characteristics of the Save
and eating a healthy diet. In her book The Diet Selector, diet program in the center column. Finally, take a look at the diet
Dr. Rodriguez groups diets based on common principles to CLINICAL
help PERSPECTIVE
resources GL
listed in the last column to help BAL
you achieve the diet PERSPECTIVE Save
consumers match their lifestyles with popular diets. Find what changes that are important to you.
How big is your foott pprint? Save
Spot-reducing by using diet and physical
Eating Pattern/ F o o d b o r n e Il l n e ss C an B e Dead l y Growing evidence indicates that what we eat may affect not only our personal health but also that of the environment. Many scientists believe that meat rich Save
Lifestyle Characteristics/Descriptions Resources activity is not possible. “Problem” local fat
diets and the agricultural practices that support the production of food for these diets negatively affect the environment. For instance, producing food for
deposits
nonvegetarian diets (especially beef-based diets) uses more water, fossil fuel energy, fertilizer, pesticides, and can bethan
acres of farmland reduced in diets.
vegetarian size,29 however, Save
Enjoy eating a variety These diets develop and manage • The New Sonoma Diet by Connie Guttersen, PhD, RD
Meat rich diets also cause with
greater emissions of greenhouse
can take gases, such as carbon dioxide, methane, and nitrous oxide, which are associated with global
of foods from different healthy eating patterns. Foodborne illness often means a few hours or
• Cinch by Cynthia Sass,• Listeriosis.
MPH, RD Listeria monocytogenes bacteria breathing a ventilator. Recovery
using lipectomy (surgical removal of fat).
even a few days of discomfort and then the ill- cause listeriosis, a rare, but serious, disease.30 Scientists
warming. weeksare
to concerned
months, and that
aboutcontinued
30% of those with warming may, in turn, decrease agricultural productivity, reduce farmers’ incomes, and increase
global
food groups in a • Intuitive Eating by Evelyn
ness resolves on its own. In some cases, though,
Tribole, RD
Listeriosis begins with muscle aches, fever,
global andinsecurity.
food GBS 31
do not fully recover, experiencing lifelong This procedure carries some risks and is Save
reasonable balance • Change One by John Hastings, Peter Jaret,
to the Mindy Hermann, pain, RD weakness, and/or paralysis.
xiii
foodborne illness causes more serious medical nausea. It can spread nervous system,
problems, which can have lifelong effects. High-
Not all scientists agree with these findings and concerns, however. Some believe that consuming a small amount
causing severe headache, stiff neck, loss of • Reactive arthritis. Foodborne illness caused by
designed
of dairyto help
and/or a person
meat lose
may actually about
increase 4 to
land
Would like to manage These diets have specific eating • Healthy Eating
risk populations—infants and young children, the for Lower Blood Pressure by Paul
use
balance, and confusion. Pregnant women and Gayler
effi ciency, thereby protecting environmental resources
Salmonella, Shigella, Campylobacter, and others and promoting food security.32
They point out that high
8 lbquality farmland is required to grow fruits,
per treatment.
lifestyle diseases patterns and foods to consume • Prevent
elderly, pregnant women and theirafetuses,
Second and Hearttheir
Attack
fetusesbyareJanet Bond
particularly Brill,
vulnerable— PhD,
vegetables, andRD, LD
grains,
can whereas
cause meat
reactive and dairy
arthritis. products can be produced on the more widely available, lower quality land. Even though diets containing meat use
This condition
through diet based on certain diseases or risk
those of
with impaired • immune
The Cancer
systems—haveFighting
the listeriosisby
Kitchen canRebecca Katzmore
cause miscarriage, land, they can
premature feed develops
usually more people2 to 6because
weeks afterof the
theinitial
greater availability of lower quality farmland. It appears that diets have different “agricultural land footprints,”
A pedometer is a low-cost device that perform
disease. • DASH
greatest risk of serious complications
Dietlikeforthese: delivery,by
Hypertension Thomas
infection J. Moore,
in the fetus, and fetal Mark
depending on Jenkins
death. infection of
the amount and causes inflammation
plant-based throughout food they contain. Supporters of mixed animal/vegetable–based diets point out that vegetarian diets
and animal-based
 Making Visual 134 PART 1 Nutrition Basics

Connections
4 Vitamins and Minerals

Food sources of vitamin A. In Adult women RDA = 700 μg

Figure 4-16

1
Major sites of absorption along the GI tract. Note that some synthesis
and absorption of vitamin K and biotin takes place in the large intestine.

Organ

Stomach
Primary Nutrients Absorbed

Alcohol (20% of total)

Plate food groups, yellow is used Adult men RDA = 900 μg RDA RDA Water (minor amount)

k is used for substances that do Daily Value = 1000 μg* adult adult
Dynamic, Accurate Artwork
o food groups (e.g., candy, salty women men 2 Small intestine Calcium, magnesium, iron, and other minerals
Glucose
Amino acids
Margarine, 2 tbsp Fats
Vitamins
More than 1000 drawings, photographs, and Beef
tables in the text were critically analyzed to identify how each could be enhanced
liver, 3 oz Water (70 to 90% of total)
Alcohol 540%
(80% of total)
and refined to help students more easily master complex scientific concepts. Bile acids
Cheddar cheese, 3 oz
Liver 1 Stomach
Fat-free milk, 1 cup 3
• Many illustrations were updated Pancreas
or replaced to inspire student
Large intestine Sodium
Potassium
inquiry and
Sweet potato, 1⁄ cup Gallbladder
comprehension 2and to promote interest and retention of information. 205%
Some fatty acids
Vitamin K and biotin (synthesized by microorganisms
2 Carrots, 1⁄ cup in the large intestine)
• Many illustrations were redesigned
2 Small
3 to use brighter colors Gases
Large
intestine
and a more attractive,
Water (10 to 30% of total)
Kale, 1⁄2 cup
contemporary style. Othersintestine
were fine-tuned to make them clearer and easier to follow.
Broccoli,
Navigational 1⁄ cup
aids 2 show where a function occurs and put it in perspective of the whole
KEY
body. Spinach, 1⁄2 cup Anus
Protein
Romaine lettuce, 1⁄2 cup
Vegetables
132 PART 1 Nutrition Basics
Fruits Acorn squash, 1⁄2 cup
Grains Apricot, 1⁄2 cup feces—this is how cholesterol, one of the components of bile,
Figure 4-17 Nutrient is removed
absorption relies on 4 from the body. The pancreas produces about 5 to
Dairy Mango, 1⁄ cup 2
major absorptive processes. 1 Passive6 diffusion
cups (1.5 liters) of pancreatic juice per day. This juice is an
(in green) is diffusion of nutrients across the (basic) mixture of sodium bicarbonate (NaHCO3) and
alkaline
Oils Peach, ⁄ cup
1
2
absorptive cell membranes. 2 Facilitated
enzymes. The sodium bicarbonate neutralizes the acidic chyme
diffusion (in blue) uses a carrier protein to
arriving from the stomach, thereby protecting the small intes-
Other move nutrients down a concentration gradient.
% Daily Value
3 Active absorption 0% tine
(in red)Pages
Confirming involves a 50%
from damage by 100%
acid. Digestive 150%
enzymes from 200%
the pan- Confirming Pages
creas include pancreatic amylase (to digest starch), pancreatic
carrier protein as well as energy to move (500(to digest
lipase
g) (1000
fat), and
g) (1500
several proteases
g)
(to
μ
(2000
digest pro-
g) μ μ μ
nutrients (against a concentration gradient) 4
Ductscells.
into absorptive from liver 2
4 Phagocytosis and tein). Pancreatic enzymes break large macronutrient mol-
1
*Calculated from International Units. pinocytosis (in gray and orange) are forms of
active transport in which the absorptive cell
ecules into smaller subunits.
56 PART 1 Nutrition Basics Common bile duct 3CHAPTER 2 Tools of a Healthy Diet 57
membrane forms an invagination that engulfs a
Accessory Pancreatic duct
Gallbladder pancreatic duct
nutrient to bring it into the cell. Gastrointestinal Hormones:
2.4 Dietary Guidelines for Americans alcoholism, and foodborne illness. The Dietary Guidelines also guide government nutri-
A Key to Orchestrating Digestion
tion programs, research, food labeling, and nutrition education and promotion. For exam-
Another term, retinol equivalent (RE), is an older unit of measurement for vitamin A
The diets of many people in the U.S. and Canada are too high in calories, fat, saturated fat, ple, the Dietary Guidelines provide the scientific basis for the design of federal nutrition
The remarkable
assistance programs, such as the USDA’s work school
of breakfast
the digestive
and lunch programs, SNAP
Duodenum
activity. The RE was based Critical
16
Thinkingthat carotenoids made a greater contribution
on the assumption
trans fat, cholesterol, sugar, salt, and alcohol. Many consume insufficient amounts of whole
grains, fruits, and vegetables. These dietary patterns put many of us at risk of major chronic (Supplemental Nutrition Assistance Program), and the WIC Program (Special Supplemen-
tal Nutrition
system requires the careful regulation and
Program for Women, Infants, and Children). In addition, MyPlate is based
Interior of
absorptive cell
to vitamin A needs than is now known to be the case. Nutrient databases may contain this
“killer” diseases, such as cardiovascular disease and cancer. In response to concerns about
Thesince
the prevalence of these killer disease patterns, every 5 years medical
1980,history
the U.S.of a young girl who
Department on the coordination
recommendations of theofDietary
several processes,
Guidelines (see the including
next section in this chapter).
ERG
EN ED
Y
Hepatopancreatic A basic the
premiseproduction
of the Dietaryand release
Guidelines is thatof hormones
nutrient needs should be met primar-
S
older RE standard because it will take some time to update these resources.
of Agriculture
sphincter
published
(USDA) and U.S. Department of Healthis and Human Services
the Dietary Guidelines for Americans (Dietary Guidelines, for short).
(DHHS) have
greatly underweight shows that she ily by consuming foods.17 Foods
throughout the provide
length anofarraythe ofGInutrients
tract.and other compounds that U
Five
The Dietary Guidelines are the foundation of thehad U.S.three-quarters of her policy
Jejunum
government’s nutrition small intestine may have beneficial effects on health. In certain cases, fortified foods and dietary supple-
hormones, part of orthe endocrine system, play
To compare the older RE or IU standards with current RAE recommendations, assume
and education. They reflect what scientific experts believeremoved
is theafter
mostshe was injured
accurate and up-in a car ments may be useful sources
key roles amounts.
less than recommended
of one
in thisThese
more
regulation:
nutrients that
gastrin,
practices are
otherwise
especiallysecretin,
might be consumed
important for people whose
in
to-date scientific knowledge about nutritious diets, physical activity,
accident. and how
Explain related healthy
this accounts for her typical food choices lead to a diet that cannot meet nutrient recommendations, such as for
Figure 2-6 Key recommendations from the
latest Dietary Guidelines for Americans.
that, for any preformed vitamin A in a food or added to food, 1 RE (3.3 IU) 5 1 RAE.
lifestyle choices. The Dietary Guidelines are designed to meet nutrient needs while reduc-
underweight condition, even though her calcium.
cholecystokinin (CCK), somatostatin and
However, dietary supplements are not a substitute for a healthful diet.
ing the risk of obesity, hypertension, cardiovascular disease, type 2 diabetes, osteoporosis, glucose-dependent insulinotropic peptide (Table
There is no easy way to convert RE or IU units to RAE units for foods that naturally contain
Figure 4-15 The common bile duct from the livermedical chart shows
and gallbladder and that she eats well.
the pancreatic duct join 4-4). To illustrate their functions, let’s follow a
together at the hepatopancreatic sphincter to deliver bile, pancreatic enzymes, and bicarbonate to
turkeyVariety
sandwich through theIndigestive system:
Dietary2015–2020
Dietary Guidelines Guidelines 2015–2020
provitamin A carotenoids. A general rule of thumb is to divide the older values for foods
the duodenum.
Healthy
Healthy Eating Eating
Pattern Pattern Components
Components and Variety and Nutrient-Density
Nutrient-Density A HealthyInEating
A Healthy Eating Pattern
Pattern Calorie
Calorie Balance In ABalance
HealthyInEating
A Healthy Eating Pattern
Pattern

containing carotenoids by 2,1.and As youthen do the conversion from RE to IUis produced

to RAE, as shown in
1. Follow
1. Follow a healthy a healthy
eating pattern eating
acrosspattern
the across the Consume
Consume a healthy a healthy
eating eating
pattern thatpattern
accountsthat
foraccounts
all foods for
andall foods andwithin
beverages beverages
an within an Dairy Dairy • Calorie needs• Calorie needs vary
vary depending depending
a person’s age,a person’s age,
lifespan.
lifespan. All food All foodchoices
and beverage and beverage
matter.choices matter.
appropriate appropriate
calorie level.calorie level. eat a turkey sandwich (or even just think about it), gastrin by cells • Include fat-free• Include
and low-fatfat-free(1%)anddairy,
low-fat sex, height,
(1%) dairy, including sex, height, weight,
including and level weight, and level
of physical of physical activity.
activity.
Choose
eatinga pattern
healthy eating
at an pattern at an
Choose a healthy • Eating
• Eating patterns patterns
are the are theofcombination
combination of foods
foods and drinks thatand in the stomach. Gastrin signals other stomach cells to release HCl and pepsinogen
drinks that
a person eats aover
person
time.eats over time. milk, yogurt,
milk, yogurt, cheese, or fortifiedcheese,soyorbeverages
fortified soy beverages• Monitor body • Monitor
weight and body weight
adjust and intake
calorie adjust calorie intake
appropriate
appropriate calorie level tocalorie
maintain
maintain a healthy bodyaweight,
level toand
help achieve
healthysupport
help achieve and
body weight, • Nutritional •needs
support nutrient
nutrient
Table 12-1. There also is no easy
Nutritional needs
should be metshould be met
primarily fromprimarily
foods. from foods. waydigestion).
(for protein to do this calculation
After thorough mixing, theforturkey
food containing
sandwich, now chyme,a ismixture of (commonly called
• Those who• doThose
(commonly
“soymilk”).
not consume
called “soymilk”).
who dodairy not consume
productsdairy products
and expenditure andinexpenditure
physical activity
achieveaand
achieve and maintain
in physical
maintain
healthy weight.
activity
over time to over time to
a healthy weight.
adequacy, and adequacy,
reduce theand riskreduce the risk of chronic disease. • Individuals
aim to should aim to meet their
needsnutrient
throughneeds through
eating healthy
patternseating patterns that include should
foodsconsume foodsthe that provide
of the range of
preformed vitamin A and carotenoids. released in smallGenerally speaking,
small intestine.these foods contain less vitamin
of chronic disease. • Individuals should meet their nutrient healthy that include should consume that provide range
Eating patternsEating
are thepatterns are theofcombination
combination foods and of foods and nutrient-densenutrient-dense
foods. foods. amounts into the nutrients generallynutrients
obtainedgenerally
from obtained from dairy, including
dairy, including
• Children and • adolescents
Children and areadolescents
encouragedare toencouraged to
maintain caloriemaintain
balancecalorie
to supportbalance to support normal
normal
drinks eats
drinks that a person that over
a persontime.eats over time. A healthy • Nutrient-dense
A healthy • Nutrient-dense
foods contain foods 2. As chyme is gradually released from the stomach into the small intestine, gastrin pro-
contain
vitamins, vitamins,
minerals, fiber,minerals,
and other fiber, and other protein, calcium, protein,
potassium, calcium, potassium, magnesium,
magnesium, growth andwithout
growth and development development without promoting
promoting
eating pattern eating
includes
dairy,
dairy, grains, and
pattern
fruits, includes
oilsgrains,
vegetables,
and saturated
and limits
fruits,
protein,
oils and limits A than
vegetables, protein, naturally occurring
enterohepatic
fats, saturated fats, effects. the RE
naturally
effects.
substances
circulation orrecycling
occurring
Continual IU values suggest.
thatsubstances
may havethat may health
positive have positive health
duction slows and the small intestine secretes secretin and CCK. Both hormones trig-
vitamin D.
Protein Foods
vitamin D.
Protein Foods
excess weight excess
•
gain. weight gain.
Overweight or obese
• Overweight or obese children and adolescents children and adolescents
trans fats, addedtrans fats,and
sugar, added sugar, and sodium.
sodium. • Foods from• allFoods of the from
food all
ger the release of enzyme- and bicarbonate-containing pancreatic juices that digest of theshould
groups food groups
be should be
of compounds
• Fortified • Fortified
foods between
foods
and dietary and dietary
supplements the small
supplements
may be useful intestine
may be useful in providing
in providing eaten in nutrient-dense
eaten in nutrient-dense forms. forms. • Include
• Include a variety of proteina variety
foods of in
protein foods in should change should
eating and change eatingactivity
physical and physical activity
2. Focusnutrient
2. Focus on variety,
amount.
on variety,
To meet
nutrient
density, and density, and one or
andmore one or more
nutrients
the liver. that
Bile nutrients
otherwise
is an that
mayotherwise
examplebe consumed
of may
a be consumed in less
in less
recycled carbohydrate, fat, and protein and reduce the acidity of the intestinal contents. Fat
Vegetables Vegetables
nutrient-densenutrient-dense
forms. forms. behaviors
behaviors to maintain
gain
or to maintain
reduce
while (increases
rateor
linear growth
of reduce
weight rate of weight
(increases in height)
amount. To meet nutrient needsnutrient needs within calorie than recommended
within calorie than recommended
amounts. amounts. • Seafood, meats, • Seafood,
poultry,meats, poultry,
eggs, nuts, eggs,
seeds, soynuts, seeds, soy gain while linear growth in height)
limits, choose alimits, choose a variety of nutrient-dense foods compound. in the small intestine (from the mayonnaise and the turkey) further stimulates the
• Include
• Include a variety a varietyfrom
of vegetables of vegetables
all 5 from all 5 products, and legumesproducts,(beans and legumes (beans
may andbe peas) may be continues, so that continues,
they can soreduce
that they bodycanmass
reduce body mass

Vitamin A Needs
variety of nutrient-dense foods and peas)
• All forms of• foods,
All forms of foods,
including fresh,including
canned, fresh,
dried,canned,
and frozen, dried,canand frozen, can vegetable
vegetable subgroups: dark subgroups:
green, reddark andgreen,
orange,red and orange, included. index (BMI)
index (BMI) percentile and percentile
move toward and amove toward a
across and withinacross and within
all food groupsallinfood groups in included.
be included inbe included
healthy in healthy
eating patterns. eating patterns. legumes (beanslegumes (beans and peas), starchy, and• other.
recommendedrecommended
amounts. Nutrient amounts. denseNutrient
foods dense foods and peas), starchy, and other. Consume at • least
Consume at least 8 ounce-equivalents
8 ounce-equivalents of seafood of seafoodhealthy range. healthy range.
provide vitamins,provide vitamins,
minerals, minerals,
and other and other substances
substances • Healthy •
eatingHealthy
patterns eating
are patterns
adaptable are
and adaptable
can be and
tailored can
to be
an tailored to an • All fresh, •
frozen,All fresh,
canned, frozen,
and canned,
dried optionsand dried
in options in
per week to ensureper week to ensure
adequate adequate
essential essential fatty acids.
fatty acids. • Before
• Before becoming becoming
pregnant, women pregnant,
are women are
that contributethat contribute
to good health,toand goodhavehealth,
limited individual’s socio-cultural
and have limited individual’s socio-cultural and personal preferences.
and personal preferences. cooked or rawcooked forms, or raw forms,
including vegetableincluding
juicesvegetable juices nuts
• Unsalted • Unsalted
or seeds should nuts orbe seeds
eaten should
in smallbe eaten in small encouraged toencouraged
achieve andto achieveaand
maintain maintain a healthy
healthy
amounts of solid amounts of solid
fats, added fats, refined
sugars, added sugars, refined
In cystic fibrosis, the most common lethal can be part of can be part
a healthy of a pattern.
eating healthy eating pattern. portions and used portions and used
to replace otherto protein
replace foods.
other protein foods.weight. weight.
starch,All
starch, and sodium.
grains, seafood,grains,
and
eggs, seafood,
sodium. All
vegetables,
beans andeggs,
vegetables,
fruits,
peas,beans
whole fruits, whole inheritedThe RDA for vitamin A isCASE
A healthy
A healthy eating pattern
and peas, unsalted • A variety of• vegetables
unsalted
eating
genetic
A variety from
includes:
of vegetables
900 μg
disease
all of thefrom
Retinol Activity Equivalents (RAE) per day for adult
STUDY
pattern includes:
in White populations,
all of the subgroups—dark
subgroups—dark green, red andgreen,orange, redlegumes
and orange, legumes
(beans and (beans and
• Choose nutrient-dense
• Choose nutrient-dense
limited additions,limited
forms (i.e., those
suchadditions, such as
as salt, butter,
formswith(i.e., those
orsalt,
• with
Choose lean
butter, or creamy
creamy
• meats.
Choose lean meats.
• Intakeforms
• Intake of processed of processed
of meat,forms poultry,of meat,
• Women who
and poultry, and gain weight within
• are
Women
gain
pregnantwhoare areencouraged
pregnant are
gestational weight gain weight gain
weight within gestational
toencouraged to

peas),thick,
men and 700 μg RAE per day for adult women.2 At this intake, adequate body stores of
starchy,sticky
nuts and seeds,nuts and seeds,
fat-free fat-free
and low-fat and low-fat dairy
dairy peas), mucus
starchy,
and other. and builds
other. up in organs, sauces). sauces).
seafood can beseafoodaccommodated can be accommodated
as long as as long as guidelines.
• Choose lower sodium varieties of frozen or guidelines.
products,
meatsand andlean meats areand poultry are • Choose lower sodium varieties of frozen or
products, and lean poultry especially the lungs andespecially
• Fruits, pancreas.
• Fruits,
whole This
fruits. buildup
especially whole fruits. Elise is a 20-year-old college
cannedsophomore. Over the last few months,
canned vegetables.
vegetables.
sodium,she sodium,
has
saturated fats, saturated
added sugars, fats, and/or
added sugars,
total and/or total
• Obese adults • should
Obesechangeadults should
eating andchange eating and physical
physical
nutrient-densenutrient-dense
foods when prepared foods when with prepared
little with little calories
calories are within limitsareofwithin
healthy limits
eatingof healthy eating
or no added solidor no
and sodium. and sodium.
added
fats, sugars,solid fats, sugars,
refined starches, refined starches,
vitamin A are maintained in healthy adults. The Daily Value used on food packages and
prevents pancreatic enzymes
• Grains, • Grains,
at least half ofatwhich
from
• Fat-free
• Fat-free or low-fat
small intestine. If the condition
least are
reaching halfwhole
or including
dairy,
ofthe
low-fat dairy,
is not treated,
which are whole grains.
grains.
milk,including milk, yogurt,
yogurt, cheese, and/orcheese, and/or
been experiencing regular
FruitsboutsFruits
• All fresh, •
of esophageal burning, pain, and
canned,All fresh,
frozen, canned,
in the back of her mouth. This usually happens after a large lunch
and driedfrozen,
forms andand dried forms and
a sour taste
patterns.
or dinner.
patterns.
activity
activity behaviors
gain and/or
gain and/or promote
behaviors
to prevent
weight promote
to prevent
additional
loss. weight loss.
additional weight
weight

Oils Oils • Overweight•adultsOverweight

should not adultsgainshould not gain additional
additional
supplements is 5000 IU, or about 1000 μg. At present, there is no DRI for beta-carotene or
fortified soy beverages.
fortified soy beverages. 100% fruit 100%
juice can fruit
be juice
part of can
a be
healthy part of
eating a healthy eating
3. Limit calories3. Limit
fromcalories
added sugars from added and sugars and • aAlthough not oils
a food
are group,
part ofoils are part of weightwithand those
riskwith CVD risk
saturated fatssodium
and reduce sodium intake.
malabsorption of •nutrients, weight
A variety of•protein
A variety loss,
of protein
foods, andfoods,
including including
seafood, seafood,
lean meats andlean meats and poultry,Elise often takes an over-the-counter
poultry, pattern. antacid to relieve these•unpleasant
pattern.
Although not food group, weight and those CVD
saturated fats and reduce intake. healthy eating
healthy eating patterns because patterns
they arebecause
the they are the factors (e.g.,and
factors (e.g., hypertension hypertension and
• ofAt least half of the recommended fruit intake
any of the other provitamin A carotenoids.1 The average intakes of adult men and women
Consume an eating
low in pattern low in added sugars, malnutrition occur.eggs, Most legumes eggs,
(beans
individuals legumes
and with (beans
peas), andand
nuts,
cystic peas), andand
seeds, nuts,
soyseeds, and soy products. symptoms. However, the
products. • At least half
symptoms the
haverecommended
worsened fruit intake
and Elise has decided to
major source of acids
essential
and fatty acids and
Consume an eating pattern added sugars, major source of essential fatty hyperlipidemia)hyperlipidemia)
should change should change
should come from should come
whole from whole fruits.
fruits.
saturated fats, saturated
and sodium. fats,Cut
andbacksodium. Cut back on foods
on foods • Oils. • Oils. vitamin E. vitamin E. eatingactivity
eating and physical and physical activity
and beverages andhigherbeverages
in thesehigher in thesetocomponents to
components
fibrosis are prescribed pancreatic enzyme visit the university health center.
• Select • fruit
canned Selectoptions
cannedthat fruitareoptions
lowestthat in are lowest in
• Healthy oils• areHealthyextracted oils from
are extracted from behaviors
behaviors to lose weight.to lose weight.
amounts that fit amounts
4. Shift food
that fit within
within healthy
to healthier
healthy eating patterns.
eating patterns.
food and beverage
in North America currently meet DRI guidelines for vitamin A.
replacements, which A healthy
• Saturated fats
A healthy
eating
are taken righteating
pattern
• Saturated
and trans fats
limits:
before
fats,and
pattern limits:
trans
added fats, added
sugars, sodium, sugars, sodium, and alcohol.
and alcohol.
added sugars. added sugars.
The nurse practitioner at the center tells Elise it is good she came in for a checkup
Grains Grains
plantsbecause
peanut, safflower,
plants
(e.g., canola,
peanut,
she (e.g.,olive,
corn, canola, corn, olive,
safflower,
soybean, and soybean, and
• Tomost
• To lose weight,
need to reduceneed
losepeople
the number
weight, most people
to reduce the number
4. Shift to healthier and beverage eating. An enteric coating protects the enzymes suspects Elise is experiencing heartburn and acidwhole
• Include indigestion,
• Include
grains and whole but
limit she
grains
the andmight
intake of thealso
limit intakebe experiencing
sunflower
of oils),sunflower
and are oils), and are of calories fromoffoods
calories andfrom foods and
choices. Choose choices. Choose nutrient-dense
nutrient-dense foods and foods and • Consume less • Consume less than
than 10 percent of 10 percent
calories perofday
calories per day from
from saturated fats.saturated fats. naturally
refined grainsmade and products made naturally present
with refined in nuts,present in nuts, beverages and increase
beverages across beverages
and within across and within
all food groupsallinfood groups in from destruction by stomach
• Choose foods
acid.
• Choose
with nofoods
Maintaining
with no trans fats.
trans fats.
gastroesophageal reflux disease (GERD). Whatrefined grains
types ofand products
lifestyle and with
dietary refined changes may help
seeds, seafood,seeds,olives,seafood,
and olives, and
beverages and increase
grains, especiallygrains,
thoseespecially those high
high in saturated in saturated fats,
fats, physical activity.
physical activity.
place of
place of less healthy less healthy
choices. Consider choices. Consider cultural
cultural good nutritional status • Consume helps prevent
• Consume
less than the
less
10 percent than
of 10 percent
calories perofday fromreduce
calories or prevent
per daysugars.
added from heartburn and GERD? What
added sugars. types
added sugars,ofand/or
medications
added sugars,
sodium,and/or suchare especially
assodium,
cookies, helpful
avocados.in treating
such as cookies, avocados.
• Eating
• Eating patterns patterns that contain
that contain
and personal
and personal preferences topreferences
make theseto make these shifts
shifts cakes, and some snack foods. • Coconut oil, • palm
Coconut kerneloil, oil,palm kernel oil,
cakes, and some snack foods.
easier to
easier to accomplish andaccomplish
maintain. and maintain. respiratory infections • Consume common in2300
• Consume
less than thoseless with2300
than
milligrams (mg) milligrams
per day of (mg) this
sodium. problem?
per day of sodium.
• At least half • ofAt least
grain half of
intake grain be
should intake
whole should be whole and palm
and palm oil intake is notoil intake is not
1200 to each
1200 to 1500 calories 1500day calories each day
can help most canwomen help lose
most women lose
cystic fibrosis. • If alcohol is •consumed, If alcohol itis should
consumed, it should be consumed in moderation—up to part of this recommendation
Table 12-1 Conversion Values for Retinol Activity Equivalents
5. Support
5. Support healthy eating healthy
patterns eating
for patterns
all. for all. be consumed in moderation—up to grains. grains. part of this recommendation
weight safely. weight safely.
Everyone has aEveryone has a role
role in helping in helping
to create and to create and 1 drink per day 1 drink per day
for women forupwomen
and and up
to 2 drinks pertoday
2 drinks per day for men—and
for men—and • Refined grains • Refined
should be grains should be enriched.
enriched. because these because
oils are high these oils are high
in saturated fats. • Eating
• Eating patterns patterns that contain
that contain
support healthysupport healthy eating
eating patterns patterns in multiple
in multiple only by adults only by adults
of legal drinking of age.
legal drinking age. • Whole grains • should
Wholeinclude
grains should
some grains,includesuch some grains,insuch saturated fats.
1500 to each
1500 to 1800 calories 1800day calories each day
settings
settings nationwide, fromnationwide,
home to from school home
to to school to as some wholegrainas some wholegrainbreakfast
ready-to-eat ready-to-eat breakfast • Oils should• replaceOils should replace solid fats
solid fats
rather thantobeing added to the diet. help most menhelp safely most
losemen safely lose
work to communities. cereals, that havecereals,
beenthat have with
fortified beenfolic acid. with folic rather
fortified acid. than being added the diet.
1 Retinol Activity Equivalent (RAE) 1 IU Vitamin A Activity
work to communities. weight. weight.

5 1 μg retinol 5 0.3 μg retinol

xiv 5 12 μg beta-carotene 5 3.6 μg beta-carotene
byr18378_ch02_038-071.indd 56
5 24 μg alpha-carotene and beta-cryptoxanthin 03/29/16 07:36 PM
5 7.2 μg alpha-carotene and
byr18378_ch02_038-071.indd 57 03/29/16 07:36 PM
 CHAPTER 9 Energy Metabolism 291

Glucose
ATP
• C
 oordinated color schemes and drawing styles
keep presentations consistent and strengthen the
~ ~
1 1
The 1st step of glycolysis is to activate the glucose molecule by attaching a
ADP phosphate group to it. The attached phosphate group is supplied by ATP,
educational value of the artwork. Color-coding and
~
which means that energy is required for this step and that ADP is formed.

Glucose
6-phosphate directional arrows in figures make it easier to follow
events and reinforce interrelationships.
522 PART 4 Vitamins and Minerals
ATP
~ ~ Milk provides good amounts of many of the During times of growth, total osteoblast activity exceeds osteoclast activity, so we • In many flgures, process descriptions appear in the
make more bone than we break down. This also can occur when bone is put under high
body of the figure. This pairing of the action and an
nutrients needed for building bone. Drinking milk
ADP during childhood (the bone-building years) is stress—a right-handed tennis player, for example, builds more bone in that arm than in the
~ associated with a lower risk of fracture later in life. left arm. Most bone is built from infancy through the late adolescent years. Calcium recom-
Fructose
1,6-bisphosphate
The tooth consists 2of a hard, yellowish tissue 2
called dentin, which is covered with enamel in
mendations are set high during these times to support this bone-building activity. Small
increases in bone mass continue between 20 and 30 years of age. Genetic background con-
Fructose 1,6-bisphosphate
trols up is split in half
to 80% of the variation to peak
in the formbone
2 3-carbon molecules,built.56
mass ultimately
explanation walks students step-by-step through the
the crown and cementum in the root. Enamel, the
hardest substance in the body, is almost entirely
hydroxyapatite crystals. Produced before the tooth
each of which
dihydroxyacetone
converted into
generally
has 1 phosphate—glyceraldehyde
Throughout
is replaced about
adulthood, bone remodeling
phosphate.
glyceraldehyde
becomes more
years.57 However,
every 10Dihydroxyacetone
3-phosphate.
dominant in
3-phosphate

Thus,
both men
is ongoing.
phosphate
beginning
step 4
and
and

onward
women.
In fact, most of the adult skeleton
is eventually
in middle age, osteoclast activity
occurs
This can result in a total loss
process and increases the teaching effectiveness of
Dihydroxyacetone
Glyceraldehyde
3-phosphate
erupts, enamel is not a living tissue and, unlike
phosphate
bone, does not undergo remodeling. Enamel can
of for
twice about
each25% of bone,
molecule depending
of glucose thaton long the person lives.57 Women experience even
how glycolysis.
enters
greater bone loss when estrogen levels fall in menopause because estrogen inhibits bone these flgures.
be easily damaged by acids produced by bacteria breakdown by decreasing osteoclast activity. Women can experience an additional 20% loss
NAD+
3 in the mouth from the metabolism3 of sugars and of bone in the first 5 to 7 years following menopause.56,57 Absent or irregular menses in
NADH + H+ carbohydrates. This damage is known asAdentaldehydrogenase
reduced,
caries, or cavities. Repairing dental caries requires forming
enzyme
younger
2 NADH
female
oxidizes
women, eachcan
which
2 H+(see
+triad
athlete
of occur
the 2 because
. A phosphate
Chapter 11),
3-carbonofmolecules.
molecule
signal lowis added
NADweight,
very low body
to levels
estrogen
is eating disorders, or the
each and a likelihood of substan- • Intriguing chapter opening photos pique students’
the skills of a dentist. The number of dental caries molecule.
3-carbon
curiosity by featuring seemingly unrelated topics that
tial bone loss before middle age. When the rate of bone loss exceeds the rate at which bone is
~ in the U.S. population has declined because of rebuilt, bone mass and bone strength decline and the risk of fracture rises greatly. Significant
the addition of fluoride to some municipal water bone mass loss, known as osteoporosis, is discussed in Clinical Perspective: Osteoporosis.
ADP
draw connections between the photo and nutrition.
supplies, bottled water, and oral care products.
~ 4 4
Fluoride helps strengthen the enamel and makes
This it
is the one synthesis of the high-energy compound ATP in the pathway.
more resistant to acids. It also helps remineralize Blood Clotting
ATP enamel in the earliest stages of damage.
~ ~ Calcium ions participate in several reactions in the cascade that leads to the formation of
fibrin, the main protein component of a blood clot. (See Fig. 12-21 in Chapter 12 for more
details on blood clotting.) • F
 inally, a careful comparison of artwork with its corre-
H 2O
bone resorption Process in which osteoclasts
break down bone and release minerals, result-
ing in a transfer of calcium from bone to blood.
Transmission of Nerve Impulses to Target Cells
When a nerve impulse reaches its target site—such as a muscle, other nerve cells, or a
sponding text was done to ensure that they are com-
tetany Continuous, forceful muscle contraction
gland—the impulse is transmitted across the synapse, the junction between the nerve and
pletely coordinated and consistent. The final result is
~

without relaxation.
its target cells. In many nerves, the arrival of the impulse at the target site causes calcium
ions from the extracellular medium to flow into the nerve. The rise in calcium ions in the
a striking visual program that holds readers’ attention
ADP 5
~ nerve triggers
An enzyme transfers synapticfrom
one phosphate vesicles
eachtoofrelease their store
the 3-carbon of neurotransmitters.
molecules to an The released neu-
rotransmitter
ADP, thereby producing thenofcarries
a total 2 ATP. the impulse across the synapse to the target cells (Fig. 14-20).
5
ATP
~ ~
and supports the goals of clarity, ease of comprehen-
Pyruvate 6 6 1
Nerve impulses,
The last step in glycolysis is the by opening of pyruvate. Generally, pyruvate
formation
Ca2+ channels, stimulate the
enters the mitochondria for further metabolism. A total
fusion of synaptic vesicles
Nerve
of 2 pyruvates are
impulse
sion, and critical thinking. The attractive layout and
design of this edition are clean, bright, and inviting.
formed from each containing
glucose that enters glycolysis.
neurotransmitters
with the cell membrane on the Ca2+
Key
nerve terminals. 1

Carbon Phosphate group

2
This leads to the release of a
Synaptic
vesicle
Presynaptic
terminal This creative presentation of the material is geared
toward engaging today’s visually oriented students.
ATP ADP neurotransmitter into the synapse.
~ ~ ATP ~ ADP Ca2+
channel Synapse
3 2
The neurotransmitter is carried
across the synapse to the
Figure 9-7 Glycolysis takes place in the cytosol portion of the cell. This process breaks glucosetarget
(a 6-carbon
cell. compound) into 2 units of a 3-carbon compound
called pyruvate. More details can be found in Appendix C.
Neurotransmitter Target
Figure 14-20 The release of neurotransmitters 3 cell
from nerve cells requires an influx of calcium
through specialized calcium channels. This
physiological function of calcium is vital for
normal functioning of the nervous system.

Illustrative Chapter Summary

New! An enhanced chapter summary reinforces
key concepts and promotes student comprehension
Chapter Summary
and retention. 4.1 The cell is the
basic structural unit of
the human body. Cells join
4.3 Chewing food breaks it into small
pieces and increases its surface area, which
together to make up tissues. The 4 1 Mouth and
enhances enzyme activity. Amylase produced by salivary glands
primary types of tissues are epithelial, salivary glands
digests a small amount of starch. Chewed food mixed with saliva is
connective, muscle, and nervous. called a bolus. When swallowing is initiated, the epiglottis covers the
Tissues unite to form organs, and trachea to prevent food from entering Parotid salivary gland
organs work together as an organ 2 Esophagus it. Peristalsis moves food down the Parotid duct

system. esophagus. There are 5 basic taste

sensations perceived by taste cells
5 Liver 3 Stomach on taste buds in the mouth, espe-
6 Gallbladder cially the tongue. Genetic variability
4 Pancreas
affects the ability to taste
Sublingual ducts
bitter compounds. The Submandibular duct
Sublingual salivary gland
7 Small
intestine 8 Large
intestine
sense of smell contrib-
Submandibular salivary gland
utes greatly to flavor
9 Rectum perceptions.
10 Anus

4.2 The GI tract includes the mouth, esophagus,

4.4 The lower esophageal sphincter
protects the esophagus from the backflow of
stomach, small intestine, and large intestine (colon, rectum, and anus). acidic stomach contents. When this sphincter does not work normally,
Sphincters along the GI tract control the flow of digesting food. The heartburn and GERD may
accessory organs (liver, gallbladder, and pancreas) are an important occur. Stomach cells produce Stomach
Esophagus
part of the digestive system. Movement through the GI tract is mainly gastric juice (HCl, pepsinogen,
through muscular contractions known as peristalsis. GI contents are mucus, and intrinsic factor). Pyloric sphincter
mixed with segmental contractions. Enzymes are specialized protein Pepsin (from pepsinogen)
molecules that speed up digestion by catalyzing chemical reactions. starts the digestion of protein.
Small
Most digestive enzymes are synthesized in the small intestine and Mixing of food and gastric intestine
pancreas. A lack of digestive enzymes can result in poor digestion, juice results in the production
3 opposing
poor absorption, malnutrition, and weight loss. of chyme, the liquid substance muscle layers
released in small amounts into
the small intestine. Stomach
Table 4-2 Overview of Digestion and Absorption GI Tract Functions

Organs

Mouth and salivary

glands
Digestive Functions

Prepare food for swallowing: chewing, moistening with saliva

Detect taste molecules
4.5 The small intestine has 3 sections: xv
Start digestion of starch with amylase enzyme duodenum, jejunum, and ileum. Most digestion
Esophagus Moves food to stomach by peristaltic waves initiated by swallowing occurs in the small
Stomach Secretes gastric juice containing acid and enzymes intestine. Secretions from
Connecting with
the Latest Updates
Global Updates and Changes
• Complete Dietary Guidelines update to include 2015–2020
recommendations.
• The entire tenth edition has been updated, refined, and
streamlined to enhance learning.
• New features throughout the tenth edition include Historical
Perspectives, Perspectives on the Future, and illustrative
end-of-chapter summaries.
Chapter 1, The Science of Nutrition
• New Perspective on the Future, “Nutritional Genomics,” added.
• “The Price of Food,” a new Global Perspective created.
• Genetics and nutrition is now a Clinical Perspective.
• New Historical Perspective, “War on Pellegra,” included.
• Updated statistics on leading causes of death.
• Fresh, new photos for visual engagement.
• Section introducing systematic reviews, including the Academy
of Nutrition and Dietetics’ Evidence Analysis Libraries and
Cochrane Collaboration, included.
Chapter 2, Tools of a Healthy Diet
• Complete Dietary Guidelines update to include 2015–2020
recommendations.
• Extensively revised the figure (figure 2.6) summarizing the
Dietary Guidelines to reflect the five overarching concepts of
the 2015–2020 Dietary Guidelines.
• Added a new figure to graphically illustrate the proportion of
Americans currently meeting dietary intake goals.
• Updated cover image of the Dietary Guidelines report.
• Perspective on the Future, “Updating the Nutrition Facts
Panel,” added.
• Portion size estimate photos enriched and expanded.
• Enhanced presentation on the origin and evolution of food
enrichment.
• Expert Perspective revised to showcase the menu labeling policies.
Chapter 3, The Food Supply
• Updated domestic and international food insecurity statistics
highlighting the worldwide burden of malnutrition and hunger.
• Section on organic foods and genetically modified foods updated.
• Expanded discussion of food additives, drawing attention to
inadequate safety testing of some food additives.
• Historical Perspective on features the early use of food
preservation compounds, such as sodium nitrate and
sodium nitrite.
• Emerging trends related to norovirus infections on cruise ships
included.
• Addition of the pharmaceutical compound botox, derived from
the foodborne illness bacterium Clostridum botulinum, linking
text concepts to novel applications.
xvi
• Latest CDC foodborne illness statistics included.
• New Take Action personalizing food safety practices and risks.
Chapter 4, Human Digestion and Absorption
• New Perspective on the Future featuring potential
relationships between gut microbiota and health conditions,
such as type 2 diabetes and obesity.
• Table added to summarize the functions of the organs of the
gastrointestinal system.
• Innovative new figure added, clearly illustrating the processes
of mixing, segmentation, and peristalsis.
• Condition of dry mouth, related to decreased saliva
production, added.
• Engaging Historical Perspective featuring Dr. William Castle’s
novel research method leading to the discovery of a substance
in gastric secretions required for absorption of vitamin B-12.
• New, enhanced photo clearly illustrating the structure of the
small intestine.
• Global Perspective on diarrhea in infants and children updated
with latest statistics.
• Discussion of relationships among gut microbiota and health
and disease expanded.
• Bristol Stool Scale, a tool for describing characteristics of
stools, added.
• New Take Action, which helps students investigate gluten
content of grains.
• New Take Action teaches students how dietary patterns may
contribute to digestive health.
• Expert Perspective from the Field updated to include new
terminology and statistics for gluten-related disorders.
Chapter 5, Carbohydrates
• Updated information on non-nutritive sweeteners highlighting
the sweetness level of alternatives compared to sucrose.
• Expanded figure on the structure of polysaccharides,
increasing the clarity of similarities and differences in
carbohydrate chemistry.
• Statistics on carbohydrate and sugar consumption revised.
• Updated Expert Perspective “Taxing Sugar-Sweetened
Beverages”.
• New figure comparing added sugar sources of the U.S.
population.
• Fiber consumption presentation enhanced with a figure
comparing fiber intake by nation.
• Revised figure clarifying the absorption of glucose in the small
intestine.
• Clinical Perspective “Diabetes Mellitus” enhanced with lab
values for diagnosis and medical nutrition therapy.
• Historical Perspective featuring the development of
techniques to better determine the molecular structure of
 vitamin B-12, vitamin D, and insulin by Dorothy Crowfoot
Hodgkin.
• Critical Thinking feature added to address city-mandated limit
on sweetened beverage consumption.
Chapter 6, Lipids
• Enhanced discussion of cholesterol sources.
• Restructured presentation of lipid transport.
• New Critical Thinking feature on fat and weight loss.
• New Case Study focusing on the links between eating
practices as a young adult and chronic disease risk in later
adulthood.
• Updated table on fat intake recommendations.
• New graph illustrating blood cholesterol trends in the U.S.
• Streamlined Expert Perspective “Omega-6 Fatty Acids: Harmful
or Healthful?” and new illustrative table.
• Revised image illustrating incorporation of triglycerides
into fat cells.
Chapter 7, Proteins
• Perspective on the Future “Timing Protein Intake” added.
• Streamlined figure depicting transamination and deamination.
• Clarified figure showing protein synthesis.
• Food protein allergies formatted as a Clinical Perspective.
• Latest research on meat intake and health incorporated.
Chapter 8, Alcohol
• Alcohol use statistics updated.
• New figure clearly illustrating the size of a standard drink.
• New figure demonstrating the relationship among blood
alcohol content, behaviors, feelings, and impairments.
• New figure illlustrating the J-shaped relation between alcohol
intake and health risks.
• Statistics on fetal alcohol spectrum disorders updated.
• New Take Action, helping students evaluate myths about
alcohol intake.
Chapter 9, Energy Metabolism
• New figure contrasting anabolic and catabolic reactions.
• Clarified figure demonstrating niacin’s and riboflavin’s roles in
energy metabolism.
• Improved figure showing aerobic carbohydrate metabolism.
• Addition of discussion and figure on the Cori cycle.
• New section on ATP recycling.
• Enhanced discussion of ATP production.
• Streamlined glycolysis figure.
• New anerobic glycolysis figure and updated beta-oxidation
figure.
• Figures restyled to enhance student understanding.
• New Study Questions added to promote learning.
Chapter 10, Energy Balance, Weight Control, and Eating
Disorders
• Latest map of obesity rates in the U.S.
• Perspective on the Future “Rethinking the Calories in a Pound
of Fat” added.
• Enhanced discussion of brown adipose tissue.
• Clarified presentation on short-term satiety control.
• New headings added to guide study of eating behavior regulation.
• Additional headings inserted to improve understanding of
types of fad diets.
• Eating disorders section overhauled and streamlined to reflect
latest diagnostic criteria (DSM-5).
Chapter 11, Nutrition, Exercise, and Sports
• Expanded section on warm-up and cool-down physical
exercise activities.
• Clarified figure illustrating energy sources for muscular activity.
• Enhanced figure illustrating ATP formation from the
macronutrients.
• Historical Perspective feature on oral rehydration added.
• Protein recommendations updated to reflect current
evidence-based literature.
Chapter 12, The Fat-Soluble Vitamins
• Latest data on antioxidant supplements from the Age-Related
Eye Disease (ARED) Study 2 Group incorporated.
• Updated dietary supplements section.
• Critical Thinking on vitamin A food sources added.
• Critical Thinking on carotenoid foods updated.
• Global Perspective on vitamin A deficiency revised with new
statistics added.
• Case study on supplement intake updated.
• Historical Perspective highlighting the work of Elmer
McCollum, the discovery of B vitamins and vitamin D added.
Chapter 13, The Water-Soluble Vitamins
• Water-soluble vitamin intakes, prominent food sources, and
the prevalence of inadequate intake statistics updated.
• New case study on vitamin deficiency incorporated.
• Historical Perspective about the work of Christjaan Eijkman to
discover the cure for beriberi added.
• Updated information on the pharmacological use of vitamin B-6.
• Ready-to-eat breakfast cereals providing 100% of the Daily
Value for folic acid included.
• New table summarizing causes of vitamin B-12 deficiency.
• Historical Perspective describing the work of Albert Szent-Gyorgyi
in identifying the oxidation and reduction functions of vitamin
C added.
• Carnitine and taurine discussion updated.
xvii
Chapter 14, Water and Major Minerals
• Enhanced information on the consumption of water and
sweetened beverages.
• Expanded discussion of dehydration and its causes.
• New table summarizing the factors influencing mineral
bioavailability.
• Latest statistics on major mineral intakes, prominent food
sources, and the prevalence of inadequate intake included.
• New table summarizing recommendations for dietary sodium
intake.
• New figure displaying sources of dietary sodium in the U.S. diet.
• Updated table summarizing the effect of lifestyle modification
on blood pressure lowering.
• New, detailed clinical case, helping students describe the
effects of diet and physical activity on blood pressure and
make recommendations for improvement.
• New recommendations from the U.S. Preventive Services for
the routine use of calcium supplements included.
• New figure illustrating the regulation of serum calcium
included.
Chapter 15, Trace Minerals
• New Global Perspective on the e-Library of Evidence for
Nutrition Actions identifing a credible source for accessing
evidenced-based information related to nutrition interventions
across the globe.
• New figure to illustrate food sources of iron and overall iron
absorption incorporated.
• Case study on iron-deficiency anemia added to help enhance
student integration of knowledge about food sources of iron
intake, clinical symptoms, and related biochemical data.
• Statistics about the fluoridation of the water supply systems
updated.
• Clinical Perspective “Nutrients, Diet, and Cancer” updated to
reflect latest data.
• Statistics for iron deficiency revised.
• Information on iodine deficiency and access to iodized salt
worldwide updated.
xviii
Chapter 16, Nutritional Aspects of Pregnancy and Breastfeeding
• Perspective on the Future “Fetal Origins of Disease” added.
• Historical Perspective “The First 10 Minutes of Life”
incorporated.
• Fresh, new photos, enhancing visual engagement.
• Effects of advances in reproductive technology on multiple
births and nutrient needs introduced.
• Definition of “term” deliveries incorporated.
• Critical role of maternal weight on pregnancy outcome now
featured in its own section.
• New headings, highlighting key aspects of the maternal food
supply on pregnancy outcome.
Chapter 17, Nutrition during the Growing Years
• Separate Clinical Perspectives focusing on potential nutrition-
related problems during infancy, childhood, and adolescence
created.
• Enhanced table describing the physical and eating skills of
young children.
• Images added to table describing food-related skills of
preschoolers to enhance understanding of child development.
• New Healthy Eating Daily Plan for Preschoolers figure
included.
• Global Perspective “Autism” expanded to include latest
nutrition-related findings.
• FDA ban on bisphenol A in baby bottles and sippy cups
addressed.
• Parent responsibilities for child and teen nutrition table
restyled to promote better comprehension.
Chapter 18, Nutrition during the Adult Years
• Updated and enhanced table summarizing popular herbal
remedies, nutrient supplements, and hormones.
• Expanded use of photos to reinforce key concepts.
• Enhanced discussion of the compression of morbidity figure.
• Exercise recommendations for older adults updated and
expanded.
• Warning signs of Alzheimer disease updated to latest criteria.
 Connections That
Suit Your Needs
Logical Organization, Flexible Sequencing
This new edition addresses the curricular realities of today’s college coursework by organizing and consolidating the content
into 5 main parts and 18 chapters. This organization presents the core content in a thorough yet manageable fashion. To give
instructors even greater flexibility in tailoring reading assignments to course requirements and cross-referencing lectures to the
book, each major section in the chapters is numbered. If, for example, an instructor plans to address only part of a chapter on a
certain day, he or she can direct students to focus on just those sections.

Assessment and Evaluation of Learning

One of our primary goals as nutrition educators is to ensure that students leave our courses with a meaningful understanding
of the nutrition principles and concepts they need to advance their education and improve their diets and health. Determining
how well we have met this goal requires assessment, on both the student and the instructor levels. To this end, we have built in
assessment tools that allow both students and instructors to measure their success:
• Student Learning Objectives at the beginning of each chapter
• Online test bank questions correlated to individual Student Learning Objectives
• Knowledge Check questions after each major section
• Study Questions at the end of each chapter
• Critical Thinking questions in the margins

Customize your course materials to your learning outcomes!

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Tap into other rights-secured third-party sources as well. Then, arrange the content in a way that makes the most sense for your
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tion! Choose the best format for your course: color print, black-and-white
print, or eBook. The eBook is now even viewable on an iPad®! And when
you are done, you will receive a free PDF review copy in just minutes!

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xix
Acknowledgments
We offer a hearty and profound thank you to the many individuals who have supported and guided us along the way.
To our loved ones: Without your patience, understanding, assistance, and encouragement, this work would not have been
possible.
To our wonderful students—past, present, and future: The lessons you have taught us over the years have enlightened
us and sustained our desire to provide newer, better opportunities to help you successfully launch your careers and promote
healthful lifelong living.
To our amazing team at McGraw-Hill Education. Brand Managers, Marija Magner and Amy Reed and Product Developer
Darlene Schueller—we thank you most of all for your confidence in us! We deeply appreciate your endless encouragement and
patience as you expertly shepherded us along the way. A special thanks to Vice President, General Manager, Products & Markets
Marty Lange, Managing Director Michael Hackett, and Marketing Manager Kristine Rellihan and the entire marketing team.
Sincere thanks to Content Project Manager MaryJane Lampe for keeping production on track, Designer Matt Backhaus, and Copy
Editor Debra DeBord for her meticulous attention to detail. We also thank Content Licensing Specialists Lorraine Buczek and Lori
Hancock, Photo Researcher Mary Reeg, and the many talented illustrators and photographers for their expert assistance.
To Your Health!
Carol Byrd-Bredbenner
Gaile Moe
Jacqueline Berning
Danita Kelley

Thank You, Reviewers and Symposium Participants

To our conscientious, dedicated expert reviewers and instructors: Thank you for sharing your insightful and constructive comments with us.
We truly appreciate the time you committed to reviewing this book and discussing your thoughts and goals for this course. We especially
appreciate the assistance provided by Angie Tagtow, Cynthia Kupper, Stephanie Atkinson, Maureen Story, Penny Kris-Etherton, Wahida
Karmally, Robert P. Heaney, Judith Rodriguez, Clare Hasler-Lewis, Kelly Brownell, Margo Wootan, and Judi Adams, those who shared their
expertise in compiling the Expert Perspective from the Field features. Your suggestions and contributions clearly reflect dedication to excel-
lence in teaching and student learning and are invaluable to this edition.

List of Reviewers
Sheila Barrett Caryn Coffman
Northern Illinois University Cuesta College
Renee Barrile Mary Dean Coleman-Kelly
UMass Lowell The Pennsylvania State University
Cynthia Blanton Ilko G. Iliev
Idaho State University Southern University at Shreveport
Angelina Boyce Karen Israel
Hillsborough Community College Anne Arundel Community College
Kurt Campbell Mark Knauss
Northern Oklahoma College Georgia Highlands College
Gale Carey Allen Knehans
University of New Hampshire University of Oklahoma Health Sciences Center

xx
Robert Lee
Central Michigan University
Symposium Participants
Laurie Allen
Makuba Lihono
University of North Carolina at Greensboro
University of Arkansas at Pine Bluff
Hawley C. Almstedt
Mary Katherine Lockwood
Loyola Marymount University
University of New Hampshire
Alex Kojo Anderson
Doug Mashek
University of Georgia
University of Minnesota
Catherine M. Berry
Debra Mason
University of Wisconsin–Eau Claire
Mt. Hood Community College
Jackie Buell
Mary P. Miles
Ohio State University
Montana State University
Melanie Tracy Burns
Judith Myhand
Eastern Illinois University
Louisiana State University
Thomas W. Castonguay
Lisa Nicholson
University of Maryland
California Polytechnic State University–San Luis Obispo
Prithiva Chanmugam, Emeritus
Ryan Paruch
Louisiana State University
Tulsa Community College
Mary Dean Coleman-Kelly
Eleanor B. Pella
The Pennsylvania State University
Harrisburg Area Community College
Mount St. Mary’s University Janet Colson
Middle Tennessee State University
Christian Roberts
UCLA Maggi Dorsett
Butte College
Daniel H. Rowlson
Oakland Community College Sara Bachman Ducey
Montgomery College
Amy Schmidt
Edinboro University of Pennsylvania Julia Erbacher
Salt Lake Community College
Karla Shelnutt
University of Florida Eugene J. Fenster
Metropolitan Community College–Longview
Melissa M. Shock
University of Central Arkansas Katie Ferraro
University of California, San Francisco
Bernice G. Spurlock
Hinds Community College William A. Forsythe
East Carolina University
Chris Wendtland
Monroe Community College Lisa Gurule
Central New Mexico Community College
Najat Yahia
Central Michigan University Donna Handley
University of Rhode Island

xxi
 Stacy Hastey Millicent Owens
Connors State College College of the Sequoias
Beverly W. Henry Gloria Payne
Northern Illinois University Middle Tennessee State University
Clarie B. Hollenbeck Robin Polokoff
San Jose State University Cal State University East Bay
Donna Huisenga Diablo Valley College
Illinois Central College Las Positas College

Jasminka Ilich-Ernst Joan E. Quinn

Florida State University Northern Illinois University

Jean Jackson Wanda Ragland

Bluegrass Community and Technical College Macomb Community College

Thunder Jalili Maureen Reidenauer

University of Utah Camden County College

Janine Jensen Ruth A. Reilly

Tulsa Community College University of New Hampshire

Demaree L. Johnson B. Burgin Ross

Dixie State University University of North Carolina–Greensboro

Rachel Jones Lisa A. Sheldon

University of Utah Greenfield Community College

Shanil Juma Dana Sherman

Texas Woman’s University Ozarks Technical Community College

Colleen Kvaska Ilse Silva-Krott

Fullerton College Upper Iowa University

Linda Johnston Lolkus Carole Sloan

Indiana University–Purdue University Fort Wayne Henry Ford Community College

Anne B. Marietta Marsha Spence

Southeast Missouri State University The University of Tennessee

Suresh T. Mathews Priya Venkatesan

Auburn University Pasadena City College

Molly M. Michelman Ann Volk

University of Nevada, Las Vegas Antelope Valley College

Allison Miner Heidi Wengreen

Prince George’s Community College Utah State University

Mithia Mukutmoni Najat Yahia

Sierra College Central Michigan University

Kimberly B. Myers
East Carolina University

xxii
 Contents
Meet the Author Team vi
Preface vii
2 TOOLS OF A HEALTHY DIET 38
2.1 Dietary Reference Intakes (DRIs) 40
Estimated Average Requirements (EARs) 40
Part 1 Nutrition Basics Recommended Dietary Allowances (RDAs) 41
Adequate Intakes (AIs) 42
Tolerable Upper Intake Levels (Upper
Levels, or ULs) 42
1 THE SCIENCE OF NUTRITION 2 Estimated Energy Requirements (EERs) 42
Acceptable Macronutrient Distribution
1.1 Nutrition Overview 4
Ranges (AMDRs) 43
Nutrients 4
Appropriate Uses of the DRIs 43
Phytochemicals and Zoochemicals 8
Putting the DRIs into Action to Determine
Expert Perspective from the Field: Functional Foods 9
the Nutrient Density of Foods 44
  1.2 Energy Sources and uses 10
2.2 Daily Values (DVs) 45
  1.3 The North American diet 12
Reference Daily Intakes (RDIs) 45
What Influences Our Food Choices? 13
Daily Reference Values (DRVs) 45
Take Action: Why You Eat What You Do 14
Putting the Daily Values into Action on
Global Perspective: The Price of Food 15
Nutrition Facts Panels 47
  1.4 Nutritional Health Status 16
Take Action: Applying the Nutrition Facts Label to
Health Objectives for the U.S. for the Year
Your Daily Food Choices 52
2020 16
Global Perspective: Front-of-Package Nutrition
Assessing Nutritional Status 17
Labeling 53
Limitations of Nutritional Assessment 18
2.3 Nutrient Composition of Foods 53
Importance of Being Concerned about
Putting Nutrient Databases into Action to
Nutritional Status 19
Determine Energy Density and Dietary
Getting Nutrition-Related Advice:
Intake 54
The Nutrition Care Process 19
Expert Perspective from the Field: Menu Labeling:
Clinical Perspective: Genetics and Nutrition 21
How Many Calories Are in That? 55
Take Action: Create Your Family Tree for
2.4 Dietary Guidelines for Americans 56
Health-Related Concerns 24
Putting the Dietary Guidelines into Action 58
  1.5 Using Scientific Research to Determine
Take Action: Are You Putting the Dietary
Nutrient Needs 24
Guidelines into Practice? 60
Making Observations and
2.5 MyPlate 60
Generating Hypotheses 25
Putting MyPlate into Action 61
Laboratory Animal
Rating Your Current Diet 66
Experiments 27
Take Action: Does Your Diet Meet MyPlate
Human Experiments 27
Recommendations? 67
  1.6 Evaluating Nutrition Claims and
Chapter Summary 68
Products 31
Study Questions 70
Buying Nutrition-Related
References 71
Products 31
Chapter Summary 33
Study Questions 35
References 37

xxiii
3 THE FOOD SUPPLY 72 4 HUMAN DIGESTION AND ABSORPTION 116
3.1 Food Availability and Access 74 4.1 Organization of the Human Body 118
Health Consequences of Malnutrition and 4.2 Digestive System Overview 122
Food Insecurity 74 Anatomy of the GI Tract 123
Food Insecurity in the U.S. 75 GI Motility: Mixing and Propulsion 124
Programs to Increase Food Security in the Digestive Enzymes and other Secretions 124
U.S. 76 4.3 Moving through the GI Tract: Mouth and
Food Insecurity and Malnutrition in the Esophagus 126
Developing World 78 Taste and Smell 126
3.2 Food Production 79 Swallowing 127
Organic Foods 79 4.4 Moving through the GI Tract: Stomach 128
Biotechnology—Genetically Modified Foods 80 4.5 Moving through the GI Tract: Small Intestine
3.3 Food Preservation and Processing 83 and Accessory Organs 130
Food Irradiation 84 Liver, Gallbladder, and Pancreas 131
Food Additives 84 Gastrointestinal Hormones: A Key to
3.4 Food and Water Safety 87 Orchestrating Digestion 132
Foodborne Illness Overview 87 Absorption in the Small Intestine 133
Take Action: A Closer Look at Food Additives 88 Global Perspective: Diarrhea in Infants and
Microbial Pathogens 89 Children 135
Water Safety 98 4.6 Moving Nutrients around the Body: Circulatory
Preventing Foodborne and Waterborne Systems 136
Illnesses 99 Cardiovascular System 137
3.5 Enviromental Contaminants in Foods 100 Lymphatic System 137
Lead 100 4.7 Moving through the GI Tract: Large Intestine 137
Take Action: Check Your Food Safety Skills 102 Gut Microbiota 138
Dioxins 103 Absorption of Water and Electrolytes 139
Clinical Perspective: Foodborne Illness Can Be Elimination of Feces 139
Deadly 104 4.8 When Digestive Processes Go Awry 140
Mercury 105 Heartburn and Gastroesophageal Reflux
Polychlorinated Biphenyls (PCBs) 105 Disease 140
Pesticides and Antibiotics 105 Ulcers 140
Global Perspective: Traveler’s Diarrhea 106 Gallstones 142
Expert Perspective from the Field: Organic Foods Food Intolerances 142
and Local Food Systems 109 Intestinal Gas 142
Chapter Summary 110 Constipation 143
Study Questions 112 Take Action: Investigate Flours and Grains
References 114 for Gluten Content 144
Expert Perspective from the Field: Gluten-related
Disorders: Celiac Disease and Non-celiac Gluten
Sensitivity 145
Diarrhea 146
Irritable Bowel Syndrome 146
Inflammatory Bowel Disease 147
Hemorrhoids 147
Take Action: Are You Eating for a Healthy
Digestive System? 148
Chapter Summary 149
Study Questions 151
References 152

xxiv
Part 2 Energy-Yielding 6.2 Food Sources of Triglycerides 196
Hidden Fats 198
Nutrients and Alcohol Fat Replacements 198
Take Action: Is Your Diet High in Saturated and
Trans Fat? 199
5 CARBOHYDRATES 154 6.3 Functions of Triglycerides 200
5.1 Structures of Carbohydrates 156 Provide Energy 200
Monosaccharides: Glucose, Fructose, Galactose, Provide Compact Energy Storage 200
Sugar Alcohols, and Pentoses 156 Insulate and Protect the Body 200
Disaccharides: Maltose, Sucrose, and Aid Fat-Soluble Vitamin Absorption and
Lactose 158 Transport 201
Oligosaccharides: Raffinose and Essential Fatty Acid Functions 201
Stachyose 159 6.4 Phospholipids 202
Polysaccharides: Starch, Glycogen, and Phospholipid Functions 202
Fiber 159 Sources of Phospholipids 203
5.2 Carbohydrates in Foods 162 6.5 Sterols 204
Starch 163 Sterol Functions 204
Fiber 163 Sources of Sterols 204
Nutritive Sweeteners 163 6.6 Recommended Fat Intakes 205
Non-Nutritive (Alternative) Sweeteners 165 Mediterranean Diet 206
Take Action: Choose the Sandwich with the Most Essential Fatty Acid Needs 206
Fiber 167 Our Fat Intake 206
5.3 Recommended Intake of Carbohydrates 167 6.7 Fat Digestion and Absorption 207
Our Carbohydrate Intake 168 Digestion 207
Take Action: Estimate Your Fiber Intake 171 Absorption 208
5.4 Functions of Carbohydrates in the Body 171 6.8 Transporting Lipids in the Blood 210
Digestible Carbohydrates 171 Transporting Dietary Lipids Utilizes
Indigestible Carbohydrates 172 Chylomicrons 210
5.5 Carbohydrate Digestion and Absorption 174 Transporting Lipids Mostly Made by
Digestion 174 the Body Utilizes Very-Low-Density
Absorption 175 Lipoproteins 212
Expert Perspective from the Field: Taxing LDL Removal from the Blood 213
Sugar-Sweetened Beverages 176 HDL’s Role in Removing Blood LDL 213
5.6 Health Concerns Related to Carbohydrate
Intake 177
Very-High-Fiber Diets 177
High Sugar Diets 177
Lactose Intolerance 178
Glucose Intolerance 178
Clinical Perspective: Diabetes Mellitus 179
Glycemic Index and Glycemic Load 184
Chapter Summary 186
Study Questions 188
References 189

6 LIPIDS 190
6.1 Triglycerides 192
Structure 192
Naming Fatty Acids 194
Essential Fatty Acids 195

xxv
 6.9 Health Concerns Related to Fat Intake 214 Transporting Nutrients 245
High Polyunsaturated Fat Intake 214 Forming Glucose 245
Excessive Omega-3 Fatty Acid Intake 214 Expert Perspective from the Field: Nutrition and
Imbalances in Omega-3 and Omega-6 Fatty Immunity 246
Acids 214 Providing Energy 247
Intake of Rancid Fats 214 7.7 Health Concerns Related to
Expert Perspective from the Field: Omega-6 Fatty Protein Intake 247
Acids: Harmful or Healthful? 215 Protein-Energy Malnutrition 247
Clinical Perspective: Cardiovascular Disease High-Protein Diets 249
(CVD) 216 Clinical Perspective: Food Protien Allergies 250
Diets High in Trans Fat 218 Global Perspective: How Big Is your Foodprint? 251
Diets High in Total Fat 219 7.8 Vegetarian Diets 252
Take Action: What Is Take Action: Protein and the Vegan 254
Your 10-Year Risk of Special Concerns for Infants and Children 255
Cardiovascular Chapter Summary 256
Disease? 220 Study Questions 258
Chapter Summary 222 References 259
Study Questions 224
References 225 8 ALCOHOL 260

7 PROTEINS 226 8.1 Sources of Alcohol 262

Production of Alcoholic Beverages 262
7.1 Structure of 8.2 Alcohol Absorption and Metabolism 264
Proteins 228 Alcohol Metabolism: 3 pathways 264
Amino Acids 228 8.3 Alcohol Consumption 267
Synthesis of Non- Take Action: Alcohol and Driving 269
essential Amino 8.4 Health Effects of Alcohol 269
Acids 229 Guidance for Using Alcohol Safely 269
Amino Acid Composition: Potential Benefits of Alcohol Intake 270
Complete and Incomplete Proteins 230 Risks of Excessive Alcohol Intake 270
7.2 Synthesis of Proteins 231 Effects of Alcohol Abuse on Nutritional
Transcription and Translation of Genetic Status 272
Information 231 Alcohol Consumption during Pregnancy and
Protein Organization 233 Breastfeeding 274
Denaturation of Proteins 234 Global Perspective: Alcohol Intake around the
Adaptation of Protein Synthesis to Changing World 275
Conditions 234 8.5 Alcohol Use Disorders: Alcohol Abuse and
7.3 Sources of Protein 234 Alcoholism 275
Evaluation of Food Protein Quality 235 Genetic Influences 276
7.4 Nitrogen Balance 238 Effect of Gender 276
Recommended Intakes of Protein 238 Age of Onset of Drinking 276
Take Action: Meeting Protein Needs When Dieting Ethnicity and Alcohol Abuse 277
to Lose Weight 240 Mental Health and Alcohol Abuse 277
7.5 Protein Digestion and Absorption 240 Clinical Perspective: Diagnosis and Treatment of
7.6 Functions of Proteins 242 Alcoholism 278
Producing Vital Body Structures 243 Take Action: Do You Know Why These are
Maintaining Fluid Balance 243 Alcohol Myths? 279
Contributing to Acid-Base Balance 244 Chapter Summary 280
Forming Hormones, Enzymes, and Study Questions 282
Neurotransmitters 245 References 283
Contributing to Immune Function 245

xxvi
Part 3 Metabolism and Chapter Summary 313
Study Questions 315
Energy Balance References 316

10 ENERGY BALANCE, WEIGHT CONTROL,

9 ENERGY METABOLISM 284
AND EATING DISORDERS 318
9.1 Metabolism: Chemical Reactions in the
10.1 Energy Balance 320
Body 286
Energy Intake 321
Converting Food into Energy 286
Energy Expenditure 322
Oxidation-Reduction Reactions: Key
10.2 Measuring Energy Expenditure 324
Processes in Energy Metabolism 288
10.3 Eating Behavior Regulation 326
9.2 ATP Production from Carbohydrates 289
10.4 Estimating Body Weight and Composition 328
Glycolysis 290
Body Mass Index 328
Transition Reaction: Synthesis of
Measuring Body Fat Content 328
Acetyl-CoA 290
Assessing Body Fat Distribution 330
Citric Acid Cycle 292
10.5 Factors Affecting Body Weight and
Electron Transport Chain 292
Composition 332
The Importance of Oxygen 293
Role of Genetics 332
Anaerobic Metabolism 294
Role of Environment 333
9.3 ATP Production from Fats 296
Genetic and Environmental Synergy 334
ATP Production from Fatty Acids 296
Diseases and Disorders 334
Carbohydrate Aids Fat Metabolism 298
10.6 Treatment of Overweight and Obesity 335
Ketones: By-products of Fat
Control of Energy Intake 337
Catabolism 298
Regular Physical Activity 337
Ketosis in Diabetes 298
Control of Problem Behaviors 339
Ketosis in Semistarvation or Fasting 298
Expert Perspective from the Field: Tailoring a
9.4 Protein Metabolism 300
Healthy Eating Plan to Fit Your Lifestyle 341
Gluconeogenesis: Producing Glucose
Weight-Loss Maintenance 342
from Glucogenic Amino Acids and
10.7  Fad Diets 342
Other Compounds 301
Clinical Perspective: Professional Help for
Gluconeogenesis from Typical Fatty
Weight Control 346
Acids Is Not Possible 301
Take Action: Changing for the Better 348
Disposal of Excess Amino
10.8  Eating Disorders 350
Groups from Amino Acid
Prevalence and Susceptibility 350
Metabolism 301
Anorexia Nervosa 351
Global Perspective: Cancer Cell
Bulimia Nervosa 354
Metabolism 302
Binge-Purge Cycle 355
9.5 Alcohol Metabolism 303
Binge Eating Disorder 357
9.6 Regulation of Energy Metabolism 304
Eating Disorders Not Otherwise Specified
The Liver 306
(EDNOS) 358
ATP Concentrations 306
Other Related Conditions 358
Enzymes, Hormones, Vitamins, and
Prevention of Eating Disorders 358
Minerals 306
Take Action: Assessing Risk of Developing an
9.7 Fasting and Feasting 307
Eating Disorder 359
Fasting 307
Chapter Summary 360
Feasting 308
Study Questions 362
Take Action: Weight Loss and Metabolism 310
References 363
Clinical Perspective: Inborn Errors of
Metabolism 311
Take Action: Newborn Screening in Your
State 312

xxvii
11 NUTRITION, EXERCISE, AND 11.6 Fluid Needs for Active Individuals 389
Fluid Intake and Replacement Strategies 391
SPORTS 364 Water Intoxication 391
Sports Drinks 392
11.1 Benefits of Fitness 366
11.7 Food and Fluid Intake before, during, and after
11.2 Characteristics of a Good Fitness Program 367
Exercise 392
Mode 367
Pre-Exercise Meal 392
Duration 367
Fueling during Exercise 393
Frequency 367
Recovery Meals 394
Intensity 367
Global Perspective: Gene Doping and the Wide
Progression 369
World of Sports 395
Consistency 369
11.8 Ergogenic Aids to Enhance Athletic
Variety 369
Performance 395
Achievement and Maintenance of
Chapter Summary 398
Fitness 369
Study Questions 400
11.3 Energy Sources for Muscle Use 371
References 401
ATP: Immediately Usable Energy 371
Phosphocreatine: Initial Resupply of
Muscle ATP 371
Take Action: How Physically Fit Are You? 372 Part 4 Vitamins and Minerals
Carbohydrate: Major Fuel for Short-Term,
High-Intensity, and Medium-Term
Exercise 375 12 THE FAT-SOLUBLE VITAMINS 402
Fat: Main Fuel for Prolonged, Low Intensity
Exercise 378 12.1 Vitamins: Essential Dietary Components 404
Protein: A Minor Fuel Source during Absorption of Vitamins 404
Exercise 379 Malabsorption of Vitamins 404
Fuel Use and VO2max 380 Transport of Vitamins 405
11.4 The Body’s Response to Physical Activity 381 Storage of Vitamins in the Body 405
Specialized Functions of Skeletal Muscle Vitamin Toxicity 406
Fiber Types 381 12.2 Vitamin A 406
Adaptation of Muscles and Body Physiology Vitamin A in Foods 407
to Exercise 381 Vitamin A Needs 408
11.5 Power Food: Dietary Advice for Athletes 382 Absorption, Transport, Storage, and
Energy Needs 382 Excretion of Vitamin A 409
Carbohydrate Needs 383 Functions of Vitamin A (Retinoids) 410
Fat Needs 386 Carotenoid Functions 411
Protein Needs 386 Vitamin A Deficiency Diseases 412
Take Action: Meeting the Protein Needs of an Vitamin A Toxicity 413
Athlete: A Case Study 387 Global Perspective: Vitamin A Deficiency 415
Vitamin and Mineral Needs 388 12.3 Vitamin D 416
Vitamin D2 in Foods 416
Vitamin D3 Formation in the Skin 416
Vitamin D Needs 417
Absorption, Transport, Storage, and
Excretion of Vitamin D 417
Functions of Vitamin D 419
Vitamin D Deficiency Diseases 420
Vitamin D Toxicity 421

xxviii
 12.4 Vitamin E 422 Niacin Deficiency 452
Vitamin E in Foods 422 Pharmacological Use of Niacin 453
Vitamin E Needs 422 13.5 Pantothenic Acid 454
Absorption, Transport, Storage, and Pantothenic Acid in Foods 454
Excretion of Vitamin E 423 Pantothenic Acid Needs and Upper
Functions of Vitamin E 423 Level 454
Vitamin E Deficiency 425 Absorption, Transport, Storage, and
Vitamin E Toxicity 425 Excretion of Pantothenic Acid 454
12.5 Vitamin K 425 Functions of Pantothenic Acid 455
Vitamin K Sources 426 Pantothenic Acid Deficiency 455
Vitamin K Needs 426 13.6 Biotin 456
Absorption, Transport, Storage, and Sources of Biotin: Food and Microbial
Excretion of Vitamin K 426 Synthesis 456
Functions of Vitamin K 426 Biotin Needs and Upper Level 456
Vitamin K Deficiency 427 Absorption, Transport, Storage, and
Take Action: Does Your Fat-Soluble Vitamin Intake Excretion of Biotin 457
Add Up? 428 Functions of Biotin 457
Vitamin K Toxicity 428 Biotin Deficiency 457
12.6 Dietary Supplements: Healthful or Harmful? 430 13.7 Vitamin B-6 458
Take Action: A Closer Look at Supplements 432 Vitamin B-6 in Foods 458
Chapter Summary 433 Vitamin B-6 Needs and Upper Level 458
Study Questions 435 Absorption, Transport, Storage, and
References 436 Excretion of Vitamin B-6 459
Functions of Vitamin B-6 459
Vitamin B-6 Deficiency 460
13 THE WATER-SOLUBLE VITAMINS 438 Pharmacological Use of Vitamin B-6 460
13.8 Folate 461
13.1 Water-Soluble Vitamin Overview 440 Folate in Foods 461
Coenzymes: A Common Role of Dietary Folate Equivalents 462
B-Vitamins 441 Folate Needs 462
Enrichment and Fortifi cation of Grains 442 Upper Level for Folate 462
13.2 Thiamin 443 Absorption, Transport, Storage, and
Thiamin in Foods 444 Excretion of Folate 462
Thiamin Needs and Upper Level 444 Functions of Folate 463
Absorption, Transport, Storage, and Folate Deficiency 464
Excretion of Thiamin 445 Clinical Perspective: Neural Tube Defects 466
Functions of Thiamin 445 13.9 Vitamin B-12 467
Thiamin Deficiency 446 Vitamin B-12 in Foods 467
13.3 Riboflavin 447 Vitamin B-12 Needs and Upper Level 468
Riboflavin in Foods 447 Absorption, Transport, Storage, and
Riboflavin Needs and Upper Level 447 Excretion of Vitamin B-12 468
Absorption, Transport, Storage, and Functions of Vitamin B-12 469
Excretion of Riboflavin 448 Vitamin B-12 Deficiency 469
Functions of Riboflavin 448 13.10 Choline 471
Riboflavin Deficiency 449 Choline in Foods 471
13.4 Niacin 449 Choline Needs and Upper Level 471
Niacin in Foods 450 Absorption, Transport, Storage, and
Niacin Needs and Upper Level 451 Excretion of Choline 472
Absorption, Transport, Storage, and Functions of Choline 472
Excretion of Niacin 451 Take Action: B-vitamin Supplements 473
Functions of Niacin 451 Choline Deficiency 473

xxix
 13.11 Vitamin C 474
Vitamin C in Foods 474
Vitamin C Needs 475
Upper Level for Vitamin C 475
Absorption, Transport, Storage, and
Excretion of Vitamin C 475
Functions of Vitamin C 475
Vitamin C Deficiency 477
Vitamin C Intake above the RDA 479
13.12 Vitamin-like compounds 480
Carnitine 480
Taurine 480
Take Action: Spotting Fraudulent Claims for
Vitamins and Vitamin-like Substances 481
Chapter Summary 482
Study Questions 484
References 486
14 WATER AND MAJOR MINERALS 488
14.1 Water 490
Water in the Body: Intracellular and
Extracellular Fluids 490
Functions of Water 493
Water in Beverages and Foods 494
Water Needs 496
Regulation of Water Balance 497
Global Perspective: Water for Everyone 501
14.2 Overview of Minerals 501
Food Sources of Minerals 502
Absorption and Bioavailability of
Minerals 502
Transport and Storage of Minerals 504
Excretion of Minerals 504
Functions of Minerals 504
Mineral Deficiencies 504
Mineral Toxicity 504
14.3 Sodium (Na) 505
Sodium in Foods 505
Sodium Needs 506
Absorption, Transport, Storage, and
Excretion of Sodium 507
Functions of Sodium 507
Sodium Deficiency 507
Excess Sodium and Upper Level 508
14.4 Potassium (K) 509
Potassium in Foods 509
Potassium Needs 510
Absorption, Transport, Storage, and
Excretion of Potassium 510
Functions of Potassium 510
xxx
Potassium Deficiency 510
Excess Potassium and Upper Level 511
14.5 Chloride (CI) 511
Chloride in Foods 511
Chloride Needs 511
Absorption, Transport, Storage, and
Excretion of Chloride 512
Functions of Chloride 512
Chloride Deficiency 512
Upper Level for Chloride 512
Clinical Perspective: Hypertension and
Nutrition 513
14.6 Calcium (Ca) 516
Calcium in Foods 516
Calcium Needs 517
Calcium Supplements 518
Calcium Absorption, Transport, Storage,
Regulation, and Excretion 519
Functions of Calcium 519
Take Action: Estimate Your Calcium Intake 523
Clinical Perspective: Osteoporosis 524
Take Action: Bone Health 527
Potential Health Benefits of Calcium 527
Upper Level for Calcium 527
14.7 Phosphorus (P) 528
Phosphorus in Foods 528
Phosphorus Needs 528
Absorption, Transport, Storage, and
Excretion of Phosphorus 528
Functions of Phosphorus 529
Phosphorus Deficiency 529
Toxicity and Upper Level for
Phosphorus 529
14.8 Magnesium (Mg) 529
Magnesium in Foods 529
Magnesium Needs 530
Absorption, Transport, Storage, and
Excretion of Magnesium 530
Functions of Magnesium 531
Magnesium Deficiency 531
Upper Level for Magnesium 532
14.9 Sulfur (S) 532
Chapter Summary 534
Study Questions 536
References 538
15 TRACE MINERALS 540
15.1 Iron (Fe) 542
Iron in Foods 542
Iron Needs 542
Absorption, Transport, Storage, and
Excretion of Iron 543
Functions of Iron 545
Iron Deficiency 547
Iron Overload and Toxicity 548
15.2 Zinc (Zn) 549
Zinc in Foods 549
Dietary Needs for Zinc 550
Absorption, Transport, Storage, and
Excretion of Zinc 550
Functions of Zinc 551
Zinc Deficiency 551
Zinc Toxicity 551
Take Action: Iron and Zinc Intake in a Sample
Vegan Diet 552
15.3 Copper (Cu) 552
Copper in Foods 552
Dietary Needs for Copper 552
Absorption, Transport, Storage, and
Excretion of Copper 553
Functions of Copper 553
Copper Deficiency 554
Copper Toxicity 554
15.4 Manganese (Mn) 554
Manganese in Foods 554
Dietary Needs for Manganese 555
Absorption, Transport, Storage, and
Excretion of Manganese 555
Functions of Manganese 555
Manganese Deficiency and Toxicity 555
15.5 Iodine (I) 556
Iodine in Foods 556
Dietary Needs for Iodine 557
Absorption, Transport, Storage, and
Excretion of Iodine 557
Functions of Iodine 557
Iodine Deficiency Disorders (IDD) 557
Iodine Toxicity 558
15.6 Selenium (Se) 560
Selenium in Foods 560
Dietary Needs for Selenium 561
Absorption, Transport, Storage, and
Excretion of Selenium 561
Functions of Selenium 561
Selenium Deficiency 562
Selenium Toxicity 562
15.7 Chromium (Cr) 563
Chromium in Foods 563
Dietary Needs for Chromium 563
Absorption, Transport, Storage, and
Excretion of Chromium 563
Functions of Chromium 563
Chromium Deficiency and Toxicity 563
15.8 Fluoride (F) 564
Fluoride in Foods 564
Dietary Needs for Fluoride 564
Absorption, Transport, Storage, and
Excretion of Fluoride 564
Functions of Fluoride 564
Fluoride Deficiency and Toxicity 565
Take Action: Is Your Local Water Supply
Fluoridated? 567
15.9 Molybdenum (Mo) and Ultratrace Minerals 567
Global Perspective: The e-Library of Evidence for
Nutrition Actions 568
Clinical Perspective: Nutrients, Diet, and
Cancer 569
Chapter Summary 572
Study Questions 574
References 575
Part 5 Nutrition Applications
in the Life Cycle
16 NUTRITIONAL ASPECTS OF PREGNANCY
AND BREASTFEEDING 576
16.1 Pregnancy 578
Prenatal Developmental Stages: Conception,
Zygotic, Embryonic, and Fetal 579
Nourishing the Zygote, Embryo, and
Fetus 583
16.2 Nutritient Needs of Pregnant Women 584
Energy Needs 585
Nutrients Needed for Building New
Cells 585
Nutrients Needed for Bone and Tooth
Development 587
Expert Perspective from the Field: Grains and Folic
Acid Fortification 588
Pregnant Women Do Not Have an Instinctive
Drive to Consume More Nutrients 588
xxxi
 16.3 Diet and Exercise Plan for Pregnancy 589
Prenatal Vitamin and Mineral
Supplements 591
Physical Activity during Pregnancy 591
Global Perspective: Pregnancy and
Malnutrition 592
16.4 Maternal Weight and Pregnancy
Outcome 593
Maternal Prepregnancy Weight 593
Maternal Weight Gain 593
Pattern of Maternal Weight Gain 594
16.5 Nutrition-Related Factors Affecting
Pregnancy Outcome 595
Young Maternal Age 596
Maternal Eating Patterns 596
Maternal Health 596
Maternal Sociocultural Factors 598
Maternal Food Supply 598
Maternal Lifestyle 600
Take Action: Healthy Diets for Pregnant
Women 601
Clinical Perspective: Nutrition-Related
Physiological Changes of Concern during
Pregnancy 602
16.6 Lactation 604
Milk Production 604
16.7 Nutrient Needs of Breastfeeding Women 606
Maternal Nutritional Status 606
Food Choices during Lactation 607
16.8 Factors Affecting Lactation 608
Maternal Weight 608
Maternal Age 608
Maternal Eating Patterns 608
Maternal and Infant Health 608
Sociocultural Factors 609
Maternal Food Supply 610
Maternal Lifestyle Choices 610
Take Action: Investigating Breastfeeding 611
Chapter Summary 612
Study Questions 614
References 615
17 NUTRITION DURING THE GROWING
YEARS 616
17.1 Growing Up 618
Height and Weight 618
Body Composition 619
Body Organs and Systems 619
xxxii
17.2 Physical Growth 620
Tracking Growth 620
Using Growth Chart Information 622
17.3 Nutrient Needs 623
Global Perspective: Autism 624
Energy 624
Protein 624
Fat 625
Carbohydrate 625
Water 625
Vitamins and Minerals 626
17.4 Feeding Babies: Human Milk and
Formula 628
Nutritional Qualities of Human Milk 628
Nutritional Qualities of Infant Formula 629
Comparing Human Milk and Infant
Formula 630
Feeding Technique 631
Preparing Bottles 632
17.5 Feeding Babies: Adding Solid Foods 634
Deciding When to Introduce Solid
Foods 634
Rate for Introducing Solid Foods 636
Sequence for Introducing Solid Foods 636
Weaning from the Breast or Bottle 638
Learning to Self-Feed 638
Clinical Perspective: Potential Nutrition-Related
Problems of Infancy 639
17.6 Children as Eaters 640
Appetites 641
When, What, and How Much to Serve 642
Food Preferences 643
Mealtime Challenges 644
Take Action: Getting Young Bill to Eat 645
Clinical Perspective: Potential Nutrition-Related
Problems of Childhood 646
17.7 Teenage Eating Patterns 648
Factors Affecting Teens’ Food Choices 648
Helping Teens Eat More Nutritious
Foods 649
Take Action: Evaluating a Teen Lunch 650
Clinical Perspective: Potential Nutrition-Related
Problems of the Adolescence 651
Chapter Summary 652
Study Questions 654
References 655
18 NUTRITION DURING THE Appendices
A Human Physiology: A Tool for Understanding
ADULT YEARS 656 Nutrition A-1
B Chemistry: A Tool for Understanding
18.1 Physical and Physiological Changes during
Nutrition A-25
Adulthood 658
C Detailed Depictions of Glycolysis, Citric
Usual and Successful Aging 660
Acid Cycle, Electron Transport Chain,
Factors Affecting the Rate of Aging 660
Classes of Eicosanoids, and Homocysteine
Take Action: Stop the Clock! Are You Aging
Metabolism A-48
Healthfully? 662
D Dietary Advice for Canadians A-54
18.2 Nutrient Needs during Adulthood 663
E The Food Lists for Diabetes: A Helpful Menu
Defining Nutrient Needs 664
Planning Tool A-66
18.3 Factors Influencing Food Intake and Nutrient
F Fatty Acids, Including Omega-3 Fatty Acids,
Needs 668
in Foods A-80
Physical and Physiological Factors 668
G Metropolitan Life Insurance Company Height-
Psychosocial Factors 676
Weight Table and Determination of Frame
Economic Factors 677
Size A-82
18.4 Nutrition Assistance Programs 678
H English-Metric Conversions and Nutrition
18.5 Nutrition-Related Health Issues of the Adult
Calculations A-85
Years 679
I Caffeine Content of Beverages, Foods, and
Alcohol Use 680
Over-the-Counter Drugs A-90
Slowed Restoration of Homeostasis 680
J Estimated Average Requirements (EARs) for
Alzheimer Disease 680
Nutrients A-92
Arthritis 681
K CDC Growth Charts A-94
Take Action: Helping Older Adults Eat Better 682
L Sources of Nutrition Information A-103
Clinical Perspective: Complementary Health
M Dietary Intake and Energy Expenditure
Approaches 683
Assessment A-106
Chapter Summary 687
N Food Composition Table A-115
Study Questions 689
Glossary Terms G-1
References 690
Photo Credits C-1
Index I-1

xxxiii
A nutritious diet is key to good health and longevity.
To learn more, carefully study this text and visit
nutrition.gov.
 PART 1 Nutrition Basics

Learning Objectives
1
After studying this chapter, you will be able to
The Science
of Nutrition

Chapter Outline
1.1 Nutrition Overview

1. Define the terms nutrition, carbohydrates, proteins, lipids (fats and oils), Expert Perspective from the Field:
vitamins, minerals, water, and calories. Functional Foods
2. Use the physiological fuel values of energy-yielding nutrients to determine 1.2 Energy Sources and Uses
the total energy content (calories) in a food or diet.
1.3 The North American Diet
3. Describe the major characteristics of the North American diet and the food
behaviors that often need improvement. Global Perspective: The Price of Food
4. Describe the factors that affect our food choices. 1.4 Nutritional Health Status
5. Discuss the components and limitations of nutritional assessment. Clinical Perspective: Genetics and Nutrition
6. List the attributes of lifestyles that are consistent with the Healthy People 2020 1.5 Using Scientific Research to
goals and those that contribute to the leading causes of death in North America. Determine Nutrient Needs
7. Describe the role of genetics in the development of nutrition-related diseases.
1.6 Evaluating Nutrition Claims
8. Explain how the scientific method is used in developing hypotheses and and Products
theories in the field of nutrition.
9. Identify reliable sources of nutrition information.

IN OUR LIFETIMES, WE WILL eat about 60 tons of food served at 70,000 meals and countless snacks. Research over
the last 50 years has shown that the foods we eat have a profound impact on our health and longevity. A healthy diet—especially
one rich in fruits and vegetables—coupled with frequent exercise can prevent and treat many age-related diseases.1 In contrast,
eating a poor diet and getting too little exercise are risk factors for many common life-threatening chronic diseases, such as
cardiovascular (heart) disease, diabetes, and certain forms of cancer.2,3 Another diet-related problem, drinking too much alcohol,
can impair nutritional status and is associated with liver disease, some forms of cancer, accidents, and suicides. As you can see in
Figure 1-1, diet plays a role in the development of most of the leading causes of death in the U.S. The combination of poor diet and
too little physical activity is indirectly the second leading cause of death—obesity (smoking is the first).4
We live longer than our ancestors did, so preventing age-related diseases is more important now than ever before. Today, many
people want to know more about how nutritious dietary choices can bring the goal of a long, healthy life within reach.5 They
may wonder what the best dietary choices are, how nutrients contribute to health, or if multivitamin and mineral supplements
are needed. How can people know if they are eating too much saturated fat, trans fat, or cholesterol? Why are carbohydrates
important? Is it possible to get too much protein?

3
3
 4 PART 1 Nutrition Basics
Figure 1-1 Leading causes of death in the
U.S. The major health problems in North
America are largely caused by a poor diet,
excessive energy intake, and not enough
physical activity.
From Centers for Disease Control and Prevention,
National Vital Statistics Report. Canadian statistics
are quite similar.
Bold terms in the book are defined in the
Glossary. Bold terms also are defined in the text
and/or chapter margin when first presented.
Diseases of the heart*†‡
Cancer*†‡
Cerebrovascular disease (stroke)*‡#
Chronic obstructive lung disease
24% and allied conditions‡
23%
Accidents and adverse effects†
Diabetes*
Influenza and pneumonia
5%
Alzheimer disease*
25% Kidney disease*‡
6%
Blood-borne infections
5%
3% Chronic liver disease†
2% 3% 2% All other causes
1% 1%
* Causes of death in which diet plays a part
† Causes of death in which excessive alcohol consumption plays a part
‡ Causes of death in which tobacco use plays a part
# Diseases of the heart and cerebrovascular disease are included in the more global term cardiovascular disease.
Is the food supply safe to eat? Would a vegetarian diet lead to better health? This book,
beginning with this chapter, will help you build the nutrition knowledge base needed to
answer these questions (and many more!) and apply this knowledge to safeguard your
health, as well as the health of others.
As you begin your study of nutrition, keep in mind that this field of study draws
­heavily on chemistry, biology, and other sciences. For the greatest understanding of nutri-
tion principles, you may want to review human physiology (Appendix A), basic chemistry
concepts (Appendix B), and the metric system (Appendix H).
1.1 Nutrition Overview
The American Medical Association defines nutrition as the “science of food; the nutrients
and the substances therein; their action, interaction, and balance in relation to health and
disease; and the process by which the organism (e.g., human body) ingests, digests, absorbs,
transports, utilizes, and excretes food substances.” Food provides the nutrients needed to
fuel, build, and maintain all body cells.
Nutrients
You probably are already familiar with the terms carbohydrates, lipids (fats and oils),
­proteins, vitamins, and minerals (Table 1-1). These, plus water, make up the 6 classes of
nutrients in food. Nutrients are substances essential for health that the body cannot make or
that it makes in quantities too small to support health.
To be considered an essential nutrient, a substance must have these characteristics:
• It has a specific biological function.
• Removing it from the diet leads to a decline in human biological function, such as the
normal functions of the blood cells or nervous system.
• Returning the omitted substance to the diet before permanent damage occurs restores to
normal those aspects of human biological function impaired by its absence.
 CHAPTER 1 The Science of Nutrition 5

Table 1-1 Essential Nutrients in the Human Diet*

Energy-Yielding Nutrients
Carbohydrate Lipids (Fats and Oils) Protein (Amino Acids)
Glucose (or a carbohydrate Linoleic acid (omega-6) Histidine Lysine Threonine
that yields glucose) a-Linolenic acid (omega-3) Isoleucine Methionine Tryptophan
Leucine Phenylalanine Valine
Non-Energy-Yielding Nutrients
Vitamins Minerals
Some
Questionable
Water-Soluble Fat-Soluble Major Trace Minerals Water
Thiamin A Calcium Chromium Arsenic Water
Riboflavin D Chloride Copper Boron
Niacin E Magnesium Fluoride Nickel
Pantothenic acid K Phosphorus Iodide Silicon
Biotin Potassium Iron Vanadium
B-6 Sodium Manganese
B-12 Sulfur Molybdenum
Folate Selenium
C Zinc
*This table includes nutrients that the current Dietary Reference Intakes and related publications list for humans. There is some disagree­ment about whether the questionable minerals and certain other minerals not listed in the
table are essential. Fiber could be added to the list of essential substances, but it is not a nutrient (see Chapter 5). The vitamin-like compound choline plays essential roles in the body but is not listed under the vitamin category
at this time. Alcohol is a source of energy, but it is not an essential nutrient.

Nutrients can be assigned to 3 functional categories (Table 1-2):

1. Those that primarily provide energy (typically expressed in kilocalories [kcal])
2. Those that are important for growth and development (and later maintenance)
3. Those that regulate body processes and keep body functions running smoothly
Some overlap exists among these groupings. The energy-yielding nutrients and water make
up a major portion of most foods.6
Because carbohydrates, proteins, lipids, and water are needed in large amounts, they
are called macronutrients. In contrast, vitamins and minerals are needed in such small
amounts in the diet that they are called micronutrients. Let’s now look more closely at the
classes of nutrients.

Table 1-2 Functional Categories of Nutrients

Promote Growth
Provide Energy and Development Regulate Body Processes
Most carbohydrates Proteins Proteins
Proteins Lipids Some lipids
Most lipids (fats and oils) Some vitamins Some vitamins Alcoholic beverages are rich in energy (calories),
Some minerals Some minerals but alcohol is not a nutrient.

Water Water
 6 PART 1 Nutrition Basics

Carbohydrates
Carbohydrates are composed mainly of the elements carbon, hydrogen, and oxygen. Fruits,
vegetables, grains, beans, and sugars are the primary dietary sources of carbohydrate.
The main types of carbohydrates are simple and complex. Small carbohydrate ­structures
are called sugars or simple carbohydrates—table sugar (sucrose) and blood sugar
­(glucose) are examples. Some sugars, such as glucose, can chemically bond together to
form large carbohydrates, called polysaccharides or complex carbohydrates (Fig. 1-2).
Examples of complex carbohydrates include the starch in grains and the glycogen stored
in our muscles. Fiber, another type of complex carbohydrate, forms the structure of plants.
Glucose, which comes from simple carbohydrates and starch, is a major source of
energy in most cells. It and most other carbohydrates provide an average of 4 calories per
gram (kcal/g).7 (Fiber provides little energy because it cannot be broken down by digestive
processes.) When too little carbohydrate is eaten to supply sufficient glucose, the body is
forced to make glucose from proteins. (Chapter 5 focuses on carbohydrates.)

Lipids
Like carbohydrates, lipids (e.g., fats, oils, and cholesterol) are compounds composed mostly
of the elements carbon, hydrogen, and oxygen (Fig. 1-3). Note that the term fats refers to
lipids that are solid at room temperature, whereas oils are those that are l­iquid at room tem-
perature. Lipids yield more energy per gram than carbohydrates—on average, 9 calories per

Simple Carbohydrates Complex Carbohydrates

Many foods are rich sources of the nutrients

we recognize today as essential for health.

Sugar Starch
Readily usable form of carbohydrates Storage form of carbohydrate in foods
Fiber
Indigestible carbohydrate that forms structure
of plant cell walls

The simple sugars are represented by the

macronutrient Nutrient needed in gram
quantities in the diet. yellow hexagons (glucose),

micronutrient Nutrient needed in milligram or blue triangles (fructose), The yellow hexagons represent the glucose
microgram quantities in the diet. molecules that make up starch and fiber.
and red circles (galactose). As you'll see in Chapter 5, starch and fiber
element Substance that cannot be ­separated differ in the way the glucose molecules are
linked together.
into simpler substances by chemical processes.
Common elements in nutrition include carbon,
oxygen, hydrogen, nitrogen, c­ alcium, phosphorus,
and iron. Figure 1-2 Two views of carbohydrates—dietary and chemical.
 CHAPTER 1 The Science of Nutrition 7

gram. (See Chapter 9 for details concerning the reason for the high energy yield of lipids.)
Lipids
Lipids are insoluble in water but can dissolve in certain organic solvents (e.g., ether and
benzene).
The lipid type called a triglyceride is the major form of fat in foods and a key
energy source for the body. Triglycerides are also the major form of energy stored in the
body. They are composed of 3 fatty acids attached to a glycerol molecule. Fatty acids
are long chains of carbon flanked by hydrogen with an acid group attached to the end
­opposite glycerol.
Most lipids can be separated into 2 basic types—­saturated and unsaturated—based on
the chemical structure of their dominant fatty acids. This difference helps determine whether
a lipid is solid or liquid at room temperature, as well as its effect on health. Although almost
all foods contain a variety of saturated and unsaturated fatty acids, plant oils tend to contain
mostly unsaturated fatty acids, which make them liquid at room temperature. Many animal
fats are rich in saturated fatty acids, which make them solid at room temperature. Unsatu- Triglyceride
rated fats tend to be healthier than saturated fats—saturated fat raises blood cholesterol,
Fatty acid
which can clog arteries and eventually lead to cardiovascular disease.
Two specific unsaturated fatty acids—linoleic acid and alpha-linolenic acid—
are essential nutrients. They must be supplied by our diets. These essential fatty acids
have many roles, including being structural components of cell membranes and help- Glycerol
ing regulate blood pressure and nerve transmissions. A few tablespoons of vegetable
oil daily and eating fish at least twice weekly supply sufficient amounts of essential
fatty acids.7
Some foods also contain trans fatty acids—unsaturated fats that have been pro-
cessed to change their structure from the more typical cis form to the trans form (see
Chapter 6). These are found primarily in deep-fried foods (e.g., doughnuts and french
fries), baked snack foods (e.g., cookies and crackers), and solid fats (e.g., stick margarine The black, white, and red circles represent
and shortening). Large amounts of trans fats in the diet pose health risks, so, like saturated carbon, hydrogen, and oxygen atoms,
respectively, in the triglyceride molecule.
fat, their intake should be minimized.7 (Chapter 6 focuses on lipids.)

Proteins Figure 1-3 Dietary and chemical views

Proteins, like carbohydrates and fats, are composed of the elements carbon, oxygen,
and hydrogen (Fig. 1-4). Proteins also contain another element—nitrogen. Pro-
teins are the main structural material in the body. For example, they are a major part
of bone and muscle; they also are important components in blood, cell membranes,
enzymes, and immune factors.7 Proteins can provide energy for the body—on aver-
age, 4 calories per gram; however, the body typically uses little protein to meet its daily
energy needs.
Proteins form when amino acids bond together. Twenty common amino acids are
found in food; 9 of these are essential nutrients for adults, and 1 additional amino acid is
essential for infants. (Chapter 7 focuses on proteins.)

Vitamins atom Smallest unit of an element that still has

Vitamins have a wide variety of chemical structures and can contain the elements carbon, all the properties of the element. An atom con-
hydrogen, nitrogen, oxygen, phosphorus, sulfur, and others. The main function of vitamins tains protons, neutrons, and electrons.
is to enable many chemical reactions to occur in the body. Some of these reactions help
compound Atoms of 2 or more elements
release the energy trapped in carbohydrates, lipids, and proteins. Vitamins themselves pro-
bonded together in specific proportions.
vide no usable energy for the body.
The 13 vitamins are divided into 2 groups. Fat-soluble vitamins (A, D, E, and K) dis- molecule Atoms linked (bonded) together; the
solve in fat. Vitamin C and the B-vitamins (thiamin, riboflavin, niacin, vitamin B-6, panto- smallest part of a compound that still has all
thenic acid, biotin, folate, and vitamin B-12) are water-soluble vitamins. The vitamin groups the properties of the compound.
often act quite differently. For example, cooking is more likely to destroy water-soluble
enzyme Compound that speeds the rate
vitamins than fat-soluble vitamins. Water-soluble vitamins are excreted from the body much
of a chemical process but is not altered by the
more readily than fat-soluble vitamins. As a result, fat-soluble vitamins, especially vitamin A,
process. Almost all enzymes are proteins.
are much more likely to accumulate in excessive amounts in the body, which then can cause
toxicity. (Vitamins are the focus of Chapters 12 and 13.) chemical reaction Interaction between
2 chemicals that changes both chemicals.
 8 PART 1 Nutrition Basics
Proteins
Hemoglobin
(protein found in red blood cells)
Amino acids (protein building blocks) are
used to build body proteins like this one.
Figure 1-4 Dietary and chemical views
of proteins.
organic compound Substance that contains
carbon atoms bonded to hydrogen atoms in the
chemical structure.
inorganic substance Substance lacking
c­ arbon atoms bonded to hydrogen atoms in
the chemical structure.
metabolism Chemical processes in the body
that provide energy in useful forms and sustain
vital activities.
phytochemicals Physiologically active
c­ ompounds found in plants that may provide
health benefits.
zoochemicals Physiologically active
c­ ompounds found in foods of animal origin
that may provide health benefits.
Minerals
The nutrients discussed so far are all complex organic compounds, whereas minerals
are structurally very simple, inorganic substances. The chemical structure of an organic
­compound contains carbon atoms bonded to hydrogen atoms, whereas an inorganic
­substance generally does not. In this case, the term organic is not related to the farming
practices that produce organic foods (these are described in Chapter 3).
Minerals typically function in the body as groups of one or more of the same atoms
(e.g., sodium or potassium) or as parts of mineral combinations, such as the calcium- and
phosphorus-containing compound called hydroxyapatite, found in bones. Because they are
elements, minerals are not destroyed during cooking. (However, they can leak into cooking
water and get discarded if that water is not consumed.) Minerals yield no energy for the
body but are required for normal body function. For instance, minerals play key roles in the
nervous system, the skeletal system, and water balance.
Minerals are divided into 2 groups: major minerals and trace minerals. Major minerals
are needed daily in gram amounts. Sodium, potassium, chloride, calcium, and phosphorus
are examples of major minerals. Trace minerals are those that we need in amounts of less
than 100 mg daily. Examples of trace minerals are iron, zinc, copper, and selenium. (Minerals
are the focus of Chapters 14 and 15.)
Water
Water is the sixth class of nutrients. Like minerals, water also is inorganic. Although some-
times overlooked as a nutrient, water is the nutrient needed in the largest quantity. Water
(H2O) has numerous vital functions in the body. It acts as a solvent and lubricant and is a
medium for transporting nutrients to cells. It also helps regulate body temperature. Bever-
ages, as well as many foods, supply water. The body even makes some water as a by-product
of metabolism. (Water is examined in detail in Chapter 14.)
Phytochemicals and Zoochemicals
Phytochemicals (plant components in fruits, vegetables, legumes, and whole grains)
and zoochemicals (components in animals) are physiologically active compounds.
They are not considered essential nutrients in the diet. Still, many of these sub­stances
­provide significant health benefits.8 For instance, numerous studies show reduced ­cancer
A tomato contains the phytochemical lycopene; thus, it can be called a functional food.
 CHAPTER 1 The Science of Nutrition 9

xpert Perspective from the Field

Functional Foods
Foods rich in phytochemicals (chemicals from plants) and
zoochemicals (chemicals from foods of animal origin) are Functional Food Categories8
sometimes referred to as functional foods. A functional food
Conventional Foods:
provides health benefits beyond those supplied by the traditional
Unmodified Whole Foods
nutrients it contains—the food offers additional components
that may decrease disease risk and/or promote optimal health. Fruits Spices Dairy products
According to Dr. Clare Hasler-Lewis,* functional foods fall into Vegetables Nuts Fish
four categories.8 Herbs
The phytochemicals and zoochemicals that are present Modified Foods: Fortified, Enriched,
naturally in unmodified whole foods like fruits and vegetables or Enhanced Foods
are thought to provide many health benefits (see Table
1-3). Foods modified by adding nutrients, phytochemicals, Calcium-fortified orange juice
zoochemicals, or herbs (see Chapter 18) also may provide Omega-3-enriched bread
health benefits. For instance, orange juice fortified with calcium Breakfast bars enhanced with ginkgo biloba
Cheese made with plant sterols
may help prevent osteoporosis. Medical foods are designed to
help enhance the management of health conditions. An example Medical Foods: Food, Formula, or Supplement
is phenylalanine-restricted formula fed to infants born with the Used under Medical Supervision to Manage
inborn error of metabolism condition called phenylketonuria a Health Condition
(PKU) (see Chapter 9). This formula helps them develop
Phenylalanine-free formulas for phenylketonuria
normally. Dr. Hasler indicated that the array of modified foods, (PKU)
medical foods, and special dietary use foods is expanding Limbrel® for osteoarthritis
rapidly. An important trend in the food industry is the addition Axona® for Alzheimer disease
of nutrients, phytochemicals, and other components in hopes of VSL#3® for ulcerative colitis
boosting the healthfulness of the food supply.
Special Dietary Use Foods:
*Clare M. Hasler-Lewis, Ph.D., MBA, is an international authority on Foods That Help Meet a Special
functional foods. She is the founding executive director of the Robert Dietary Need
Mondavi Institute for Wine and Food Science at the University of
California, Davis, and serves as the university’s primary liaison to the Infant formula for infants
wine and food industries. Dr. Hasler also was the founding director of Lactose-free foods for lactose intolerance
the Functional Foods for Health Program at the University of Illinois. Sugar-free foods for weight loss
Gluten-free foods for celiac disease

risk among people who regularly ­consume fruits and vegetables. Re­searchers surmise
that some phytochemicals in fruits and vegetables block the d­ evelopment of ­cancer (see
­Chapter 15).9,10
Some phytochemicals and zoochemicals also have been linked to a reduced risk of To learn more about bioactive compounds
cardiovascular disease. It will likely take many years for scientists to unravel the impor- in foods, visit www.sigma-aldrich.com/­life
tant effects of the many different phytochemicals and zoochemicals in foods. Multivitamin -science/nutrition-research/learning-center/
and mineral supplements currently contain few or none of these beneficial chemicals. Thus, bioactive-nutrient-explorer.html.
nutrition and health experts suggest that a diet rich in fruits, vegetables, legumes, and whole-
grain breads and cereals is the most reliable way to obtain the potential benefits of phyto-
chemicals.11 In addition, foods of animal origin, such as fatty fish, can provide the beneficial
zoo­chemical omega-3 fatty acids (see Chapter 6), and fermented dairy products provide
probiotics (see ­Chapter 4). Table 1-3 lists some phytochemicals and zoochemicals under
study, with their common food sources.
 10 PART 1 Nutrition Basics
ion Atom with an unequal number of ­electrons
(negative charges) and protons (positive
charges). Negative ions have more electrons
than protons; positive ions have more protons
than electrons.
Table 1-3 Examples of Phytochemicals and Zoochemicals under Study
Phytochemicals Food Sources
Allyl sulfides/organosulfides Garlic, onions, leeks
Saponins Garlic, onions, licorice, legumes
Carotenoids (e.g., lycopene) Orange, red, and yellow fruits and vegetables; egg yolks
Monoterpenes Oranges, lemons, grapefruit
Capsaicin Chili peppers
Lignans Flaxseed, berries, whole grains
Indoles Cruciferous vegetables (broccoli, cabbage, kale)
Isothiocyanates Cruciferous vegetables, especially broccoli
Phytosterols Soybeans, other legumes, cucumbers, other fruits and vegetables
Flavonoids Citrus fruit, onions, apples, grapes, red wine, tea, chocolate,
tomatoes
Isoflavones Soybeans, other legumes
Catechins Tea
Ellagic acid Strawberries, raspberries, grapes, apples, bananas, nuts
Anthocyanosides Red, blue, and purple plants (eggplant, blueberries)
Fructooligosaccharides Onions, bananas, oranges (small amounts)
Stilbenoids (e.g., resveratrol) Blueberries, grapes, peanuts, red wine
Zoochemicals
Sphingolipids Meat, dairy products
Conjugated linoleic acid Meat, cheese
Knowledge Check
1. What are the 6 classes of nutrients?
2. What characteristics do the macronutrients share?
3. How are vitamins categorized?
4. How are minerals different from carbohydrates, lipids, protein, and vitamins?
5. What are phytochemicals and zoochemicals?
1.2 Energy Sources and Uses
Humans obtain the energy needed to perform body functions and do work from carbohy-
drates, fats, and proteins. Alcohol is also a source of energy, supplying about 7 calories per
gram. As mentioned previously, it is not considered a nutrient, however, because alcohol has
no required function. After digesting and absorbing energy-producing nutrients, the body
transforms the energy trapped in carbohydrate, protein, fat, and alcohol into other forms of
energy in order to do the following:
• Build new compounds
• Move muscles
• Transmit nerve impulses
• Balance ions within cells
 CHAPTER 1 The Science of Nutrition 11

Figure 1-5 Use the nutrient

HONEY WHEAT BREAD values on the Nutrition Facts
Nutrition Facts label to calculate the energy
content of a food. Based on
Serving Size 1 slice (36g) Servings Per Container 19
carbohydrate, fat, and protein
Amount Per Serving content, a serving of this food
Calories 80 Calories from Fat 10 (honey wheat bread) contains
% Daily Value* % Daily Value* 81 kcal ([15 3 4] [1 3 9] ­
Total Fat 1g 2% Total Carbohydrate 15g 5% [3 3 4] 5 81). The label lists
80 because Nutrition Facts
Saturated Fat 0g 0% Dietary Fiber 2g 8%
labels round values.
Trans Fat less than 1g **
Cholesterol 0mg 0% Sugars less than 1g
Sodium 200mg 8% Protein 3g
Vitamin A 0% Vitamin C 0% Calcium 0% Iron 4%

(See Chapter 4 for more on digestion and absorption. Chapter 9 describes how energy is Physiological fuel values.
released from chemical bonds and then used by body cells to support the processes just Carbohydrate
described.) 4 kcal per gram
Calorie is often the term used to express the amount of energy in foods. Technically,
a calorie is the amount of heat energy it takes to raise the temperature of 1 gram of water Protein
1 degree Celsius (1°C). Because a calorie is such a tiny measure of heat, food energy is 4 kcal per gram
more accurately expressed in terms of the kilocalorie (kcal), which equals 1000 calories.
(If the c in calories is capitalized, this also signifies kilocalories.) A kilocalorie (kcal) is Energy Alcohol
the amount of heat energy it takes to raise the temperature of 1000 g (1 liter) of water 1°C. sources 7 kcal
for body per gram
In everyday usage, the word calorie (without a capital c) also is used to mean kilocalorie.
functions
Thus, the term calorie and its abbreviation, kcal, are used throughout this book. Any values
given on food labels in calories are actually in kilocalories (Fig. 1-5).
The calories in food can be measured using a bomb calorimeter (see Chapter 10). Or
they can be estimated by multiplying the amount of carbohydrates, proteins, fats, and alco-
hol in a food by their physiological fuel values. The physiological fuel values are 4, 9, 4, Fat
and 7 for carbohydrate, fat, protein, and alcohol, respectively. These values are adjusted to 9 kcal
account for the extent to which foods can be digested and substances (e.g., waxes and fibers) per gram
that humans cannot digest. Thus, they should be considered estimates.
Physiological fuel values can be used to determine the calories in food. Consider
these foods:
1 Large Hamburger The word calorie typically is used to mean
Carbohydrate 39 grams 3 4 5 156 kcal kilocalorie; thus, this book uses the term calorie
and its abbreviation, kcal.
Fat 32 grams 3 9 5 288 kcal
Many scientific journals express energy
Protein 30 grams 3 4 5 120 kcal content of food as kilojoules (kJ), rather than
Alcohol   0 grams 3 7 5    0 kcal kilocalories. A mass of 1 gram moving at a
velocity of 1 meter/second possesses the energy
Total 564 kcal
of 1 joule (J); 1000 J 5 1 kJ. Heat and work are
2 forms of energy; thus, measurements expressed
8-ounce Pina Colada
in terms of kilocalories (a heat measure) are
Carbohydrate 57 grams 3 4 5 228 kcal interchangeable with measurements expressed
Fat   5 grams 3 9 5 45 kcal in terms of kilojoules (a work measure):
1 kcal 5 4.18 kJ.
Protein   1 gram 3 4 5    4 kcal
Alcohol 23 grams 3 7 5 161 kcal
Total                     438 kcal
kilocalorie (kcal) Heat energy needed to
raise the temperature of 1000 grams of water
1 degree Celsius.
 12 PART 1 Nutrition Basics

These values also can be used to determine the portion of total energy intake that
c­arbohydrate, fat, protein, and alcohol provide to your diet. Assume that one day you
­consume 283 g of carbohydrates, 60 g of fat, 75 g of protein, and 9 g of a­ lcohol. This
consumption yields a total of 2035 kcal ([283 3 4] 1 [60 3 9] 1 [75 3 4] 1 [9 3 7]
5 2035). The percentage of your total energy intake derived from each nutrient can then be
determined:
% of energy intake as carbohydrate 5 (283 3 4) / 2035 5 0.56 3 100 5 56%
% of energy intake as fat 5 (60 3 9) / 2035 5 0.27 3 100 5 27%
% of energy intake as protein 5 (75 3 4) / 2035 5 0.15 3 100 5 15%
% of energy intake as alcohol 5 (9 3 7) / 2035 5 0.03 3 100 5 3%

Knowledge Check
1. What does the term calorie mean?
2. How do calories, kilocalories, and kilojoules differ?
3. How many calories are in a food that has 8 g carbohydrate, 2 g alcohol,
4 g fat, and 2 g protein?

1.3 The North American Diet

Increasing vegetable intake, such as a daily
salad, is one strategy to boost intake of
important nutrients.
Large surveys are conducted in the U.S. and Canada to determine what people are eating. The
U.S. government uses the National Health and Nutrition Examination Survey (NHANES)
administered by the U.S. Department of Health and Human Services. In Canada, this infor-
mation is gathered by Health Canada in conjunction with Agriculture and Agrifood Canada.
Results from these surveys and others show that North American adults consume, on aver-
age, 16% of their energy intake as proteins, 50% as carbohydrates, and 33% as fats. These
percentages are estimates and vary slightly from year to year and to some extent from person
to person. Although these percentages fall within a healthy range12 (see Chapter 2), many
people are eating more than they need to maintain a healthy weight.12,13
Animal sources, such as meat, seafood, dairy products, and eggs, supply about
two-thirds of the protein intake for most North Americans; plant sources provide only
about a third. In many other parts of the world, it is just the opposite: plant proteins—
from rice, beans, corn, and other vegetables—dominate protein intake. About half the
carbohydrates in North American diets comes from simple carbohydrates (sugars);
the other half comes from starches (e.g., pastas, breads, and potatoes). Most North
­Americans need to reduce their sugar intake and increase their intake of starch and
fiber. Because approximately 60% of dietary fat comes from animal sources and
only 40% from plant sources, many North Americans are consuming far more
saturated fat and cholesterol than is recommended.
These surveys also indicate that most of us could improve our diets by
focusing on rich food sources of vitamin A, vitamin E, iron, potassium,
and calcium and by reducing sodium intake. Nutrient intake varies in
some demographic groups, which means these individuals need to pay
special ­attention to certain nutrients. For example, older adults often
get too little vitamin D, and women of childbearing years frequently
have inadequate iron intake.
In terms of food, many North Americans could improve their
­nutrient intake by moderating intake of sugared soft drinks and fatty
foods and eating more fruits, vegetables, whole-grain breads, and
reduced-fat dairy products. Vitamin and mineral supplements also can
help meet nutrient needs but, as you’ll see in Chapter 12, they cannot fully
make up for a poor diet in all respects.14
Another random document with
no related content on Scribd:
Plummer, Mr., i., 209
Plague, the, iii., 203
Polani, Dr., i., 352
Poujolat et Boutés, MM., ii., 150; iii., 132
Pretyman, Dr., iii., 166
Prickly Heat, ii., 285
Prince of Wales, (George IV.) ii., 99, 382
Princess Elizabeth, ii., 102, ter.
Princes, the, iii., 268
Prudoe, Lord, iii., 38, 203, 215
Puckler Muskau, Prince, i., 139; iii., 4, 37, 89, 127, 142, 170, 255,
313

Queen Victoria, ii., 228, 232, 259, 277; iii., 239

Rashéyah, iii., 274, 316

Reading aloud, iii., 128
Reasons for statesmen’s actions, ii., 29
Reichstadt, Duke of, i., 206
Religion, iii., 312
Revolutions, i., 280; ii., 168; iii., 299
Revolution in Mount Lebanon, i., 347
Rewisky, Count, iii., 183
Reynaud, Mr., ii., 356
Rice, ii., 52
Richmond, Duke of, ii., 28, 64, 94, 95
Rich, Mr.
Rings, nose, ii., 200
Risk Allah
Roberts, Mr., iii., 82
Robinson, three years’ residence, iii., 204
Romney, Lord, ii., 24, 381
Rugged Paths, i., 210
Rûm, village
Russell, Lady Wm., i., 27
Russian spy, iii., 266
Rutland, Duchess of, ii., 52, 108

Saady, maid servant, ii., 327, 344; iii., 160

Salàmy Effendi
Salisbury, Lady, ii., 105
Saunders, Admiral, iii., 178
Scenes at Mar Elias, ii., 315
Scott, Capt., i., 235
Scott, Dr. John, dedication &c., i., 59
Scott, Walter, ii., 173; iii., 172
Selim Koblàn, character of, iii., 59
Serpent, iii., 292
Serpent at Tarsûs, ii., 360
Servants, English, ii., 70; iii., 161
Servants, men, i., 24; ii., 30
Servants, Syrian, i., 290; ii., 148, 309
Servants’ Wages, ii., 122
Servants, women, i., 26; ii., 136; iii., 161, 364
Sentimentality, i., 294
Sevenoaks Common, i., 384; ii., 23
Sevigné, Madame, iii., 116
Shadwell, Col., ii., 23
Shakspeare, i., 300
Shemmaûny, iii., 219
Sheridan, ii., 58
Sherỳf Pasha, iii., 67, 75
Sheykh Beshỳr, ii., 357
Sheykh Ibrahim, iii., 242
Sheykh Mohammed Nasýb, iii., 173
Shibly el Arriàn, iii., 318
Shifts, what made of, ii., 269
Ship plundered by Greeks, i., 40
Sidmouth, Viscount, i., 216
Silver spoon stolen, ii., 272
Singers in Syria, iii., 206
Slaves, i., 226, 288, 364
Sligo, Lord
Smith, Newman, i., 63
Smith, Sir Sydney, ii., 292
Spetchingly, Mem. of a Peeress, iii., 171
Spies, iii., 78, 297
Spit in the face, iii., 52
Stammering, ii., 108
Stanhope, Charles, ii., 85; iii., 165
Stanhope, Countess, ii., 14
Stanhope, Earl, i., 296; ii., 15; iii., 165
Stanhope, James Hamilton, i., 10; ii., 85; iii., 165
Stanhope, Lady H., takes to her bed, ii., 43, 48;
her complexion, ii., 16, 166;
her opinion of women, i., 376; iii., 262;
gives away money, ii., 240, 244;
has boys in her service, iii., 195;
her estimate of herself, iii., 121;
foretells revolutions, ii., 168; iii., 265;
her personal cleanliness, i., 148;
her hatred of women, i., 166;
takes no man’s arm, i., 81;
never shakes hands, iii., 143;
is able to command an army, ii., 32;
her pension, iii., 48, 99;
furious with her maids, ii., 276;
flogging, i., 294; ii., 136; iii., 46, 51, 242;
her veracity, ii., 324;
her freedom of speech, i., 135; ii., 37; iii., 262;
the sublimity of her language, i., 135;
her fearlessness, i., 106; ii., 366; iii., 270;
refuses Mrs. M’s. company, ii., 246;
men of her time, ii., 105; iii., 128;
is neglected, ii., 211; iii., 194;
Dr. M.’s trembling legs, iii., 144;
like a Delphic priestess, ii., 175;
like Gray’s Agrippina, iii., 217;
drinks brandy, ii., 270, 276;
her severity, i., 299;
seated in an alcove, iii., 4;
has a tooth drawn, ii., 44;
her jealousy of the queen, ii., 221;
her house in Montague Square, iii., 192;
what she gave to her brother James, ii., 88;
shape of her skull, iii., 294;
will live by rules of grandeur, ii., 275;
appearance of her tongue, ii., 237;
her dislike to Swiss governesses, i., 321;
frequent in eating, ii., 48;
ever just to others, iii., 121;
her advice excellent, ii., 167, 208; iii., 120;
open to flattery, iii., 217;
“qui faisoit la pluie et le beautemps,” ii., 371;
praised by an Imàm, iii., 30;
her property, ii., 88;
is taken for a man, ii., 145;
the divine right of kings, ii., 365;
her conversational powers, i., 135;
the Emir Beshỳr annoys her, i., 55,;
her feet free from smell
her deliberate affronts, ii., 217;
her establishment, i., 272;
 resolved never to return to England;
her end in blood, ii., 340; iii., 321;
her munificence, ii., 238, 244;
wishes to be buried like a dog, ii., 339;
would destroy books, iii., 52;
wields the mace, iii., 56;
persons she wrote to, iii., 62;
her school for girls, iii., 64;
signs papers for Mr. Pitt, iii., 171;
smokes, iii., 188;
rejects eulogistic verses on herself, iii., 216;
physicks everybody, iii., 242;
refuses Duke Maximilian’s portrait, iii., 254;
insists on Dr. Meryon’s leaving her, iii., 255, 298;
advises him where to settle, iii., 256;
Duc de Bordeaux to kiss her stirrups, iii., 287;
walls up her gateway, iii., 298, 319;
disliked Mr. Canning, i., 315;
her influence over people, i., 92;
her debts, i., 339
Stanhope, Lady Lucy, ii., preface
Stars, peoples, ii., 251, 262, 364
Stewart, Lord, i., 187
Stowe, ii., 57
Strangers sent away, ii., 160
Strangways, Mr., ii., 369
Stratford de Redcliffe, Lord, ii., 290
Stuart, the Misses
Sugden, Sir Edw., ii., 281
Suicide, uncommon, ii., 129
Sulyman, son of Skender, iii., 35
Sunflower Family, i., 384, Mr. M. L.
Sussex, Duke of, i., 187; ii., 104; iii., 268
Syria, climate of, i., 187; iii., 253
Sturt, Bridget

Taat-el-Dyn, i., 163

Tamarisk Pavilion, ii., 43
Tattenbach, Count, iii., 102, 110
Taylor, Colonel Thomas, iii., 277
Taylor, Thomas, i., 18, 31
Temple, Earl, i., 277
Thanet, Lord, ii., 22
Thé, Madlle. du, ii., 262
Thief lurking, iii., 292
Things clean and unclean, i., 148
Thurlow, Lord
Tickell, Mr., ii., 10, 75
Tobacco, smoking, iii., 188
Tongue, unclean, i., 28
Tooke, Horne, i., 374; ii., 31
Townsend, Mr., ii. FN[8]
Traveller, unknown, iii., 82
Travellers, why sent away, ii., 160
Tread on a toe, ii., 212
Tristram, the hermit, iii., 130
Tumblers, iii., 245
Turk, a real, i., 60
Turk, striking a, iii., 217
Turner, Mr. Wm., ii., 37
Tutors marry ladies of quality, iii., 81
Tutungi, Michael, ii., 320, 325; iii., 79
Twiss, Lady Stanhope’s maid, iii., 160
Tyr el Hakem, iii., 111

Urquhart, David, i., 245

Valentia, Viscount
Vansittart, Mr.
Verity, Dr., ii., 32
Verses on Mrs. Moore, iii., 216
Vincent, Lord St., iii., 138
Vices of the aristocracy, iii., 181
Volney, Mons., ii., 153
Voyage from Leghorn, i., 39

Wales, Prince of, (George IV.), i., 313; ii., 99, 101, 104
Wales, Princess of, i., 308
Wallace, Mr.
Walling up the gateway, iii., 319
Walmer Castle, ii., 66, 75, 214
Ward, Mr., iii., 189
Warren, Dr., ii., 34
Way, Mr., i., 137, 147
Wellesly, Lord, ii., 297
Wellington, Duke of, ii., 82, 293, 364
Wellington, the negro, iii., 254, 257, 277
Wiberforce, Mr., ii., 22
Wilbraham, clerk of the kitchen, ii., 247
Williams, Lady H. S.’s maid, i., 20, 70, 154, 158, 212; ii., 255
Wilsenheim, Count, letter to, iii., 309, 314
Wilson, Mr., Lord Chatham’s tutor, ii., 247
Witchcraft, i., 141
Woman spy, iii., 78
Women, Lady H. S.’s opinion of, i., 166, 376
World, the, heartless, iii., 194
Wraxhall, Sir Nathaniel, iii., 290, 293
Wynnes, the

Yanta, village, iii., 293, 297

York, Duke of, i., 23; ii., 105
Yorke, Captain, 4th Earl Hardwicke, i., 362; ii., 135, 373; iii., 181
Young men of Lady H. S.’s time, iii., 128

Zahly, village, iii., 286

Zeyneb, her shape, i., 288; iii., 51
Zezefûn, iii., 242
Zoave, Capt., Robert, i., 247
London: F. Shoberl, Printer, 37, Dean Street, Soho.
 Transcriber’s Note:
This book was written in a period when many words had not
become standardized in their spelling. Words may have multiple
spelling variations or inconsistent hyphenation in the text. These
have been left unchanged unless indicated below. Obsolete and
alternative spellings were left unchanged.
Footnotes were renumbered sequentially and were moved to the
end of the chapter. Obvious printing errors, such as backwards,
reversed, upside down, or partially printed letters and punctuation
were corrected. Final stops missing at the end of sentences and
abbreviations were added. Duplicate words and letters at line
endings or page breaks were removed. Quote marks, accents and
parentheses were adjusted to standard usage.
In the index, there are numerous entries without corresponding
volume or page numbers. There are additional entries with volume
and page numbers that do not match the book.
The following were changed:

Hamâdy to Hamâady
Damacus to Damascus
entaining to entertaining
unconcious to unconscious
Feeky to Freeky and page number from 288 to 259
added dropped comma: at 6d., a loaf
replaced hyphen with space: hind legs, corn market

Added missing volume and page numbers to index entries:

Abu Ghosh, i., 263

 Advice, iii., 271
Cheshire Gentleman, iii., 166
Cœle-Syria iii., 57, FN[32]
Flies on horses’ tails, ii., 35
Footmen’s Nosegays, iii., 128
Letters to Mr. Speaker Abercrombie, ii., 223, 239, 272;
Liverpool, Lady, ii., 76, 95, 96
Loustaunau Capt., iii., 306
Malmesbury, Lord, i., FN[43], FN[65], FN[66], FN[67], FN[68],
162, 270; ii., 26, FN[3], FN[32]; iii., FN[20]
Meryon, his salary, ii., 2;
Prickly Heat, ii., 285
Richmond, Duke of, ii., 28, 64, 94, 95
Servants’ Wages, ii., 122
Sevigné, Madame, iii., 116
Sheykh Ibrahim, iii., 242
Temple, Earl, i., 277
Townsend, Mr., ii. FN[8]

The only mention of Signor Catafago is in the Index so references

are not found on the page numbers listed. Also, page number 324
for Signor Baldassare Matteir does not exist in any of the three
volumes.
 *** END OF THE PROJECT GUTENBERG EBOOK MEMOIRS OF
THE LADY HESTER STANHOPE, AS RELATED BY HERSELF IN
CONVERSATIONS WITH HER PHYSICIAN, VOL. 3 (OF 3) ***

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