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

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

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

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

Kathryn Pinna
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Nutrition for Health and Health Care, © 2020, 2017, 2014 Cengage Learning, Inc.
Seventh Edition
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Linda Kelly DeBruyne, Kathryn Pinna
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Printed in the United States of America

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Students
Features of this Text
Access Everything You Need

in One Place
Empower Students to Reach

their Potential
xviii Preface
Control Your Course— Ancillaries
and Your Content ●●
A test bank is available through Cengage Learning
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that allows instructors to author, edit, and manage test
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Preface xix
Acknowledgments
xx
Overview of Nutrition
and Health
Chapter Sections and Learning Objectives (LOs)
1.1 Food Choices

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Healthy People
malnutrition: any condition caused by

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

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

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

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

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

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

2015–2020

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Another random document with
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The Project Gutenberg eBook of Au bon soleil
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you are located before using this eBook.
Title: Au bon soleil
Author: Paul Arène
Release date: January 4, 2024 [eBook #72618]
Language: French
Original publication: Paris: G. Charpentier, 1881
Credits: Véronique Le Bris, Laurent Vogel and the Online Distributed

Proofreading Team at https://www.pgdp.net (This file was
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*** START OF THE PROJECT GUTENBERG EBOOK AU BON

SOLEIL ***
PAUL ARÈNE
AU BON SOLEIL
PARIS
G. CHARPENTIER, ÉDITEUR
13, RUE DE GRENELLE-SAINT-GERMAIN, 13
1881
Tous droits réservés.
OUVRAGES DU MÊME AUTEUR
PUBLIÉS DANS LA BIBLIOTHÈQUE-CHARPENTIER

à 3 fr. 50 le volume.
LA GUEUSE PARFUMÉE
Jean des Figues. — Le Tor d’Entrays. — Le clos des âmes. — La

mort de Pan. — Le canot des six Capitaines. 1 vol.
DANS LA COLLECTION IN-8 DES VOLUMES ILLUSTRÉS
Broché 8 fr. — Riche reliure en toile tranches dorées 12 fr. — Reliure

d’amateur avec coins, tête dorée, 15 fr.
LA VRAIE TENTATION DU GRAND SAINT ANTOINE
Contes de Noël, avec illustrations de Vollon, Bastien-Lepage,

Léonce Petit, Jean d’Alheim, Sahib, Scott, Rochegrosse, Forain,
Sutter, G. Bigot, Chevalier.
CONTES PROVENÇAUX
LA MORT DE CARMENTRAN.
A l’époque dont nous parlons, le chemin de fer entre Marseille et

Gap, marqué de petits points sur les cartes routières, n’existait
pourtant qu’en projet. La vallée de la Durance ne voyait pas, quatre
fois par jour et la durée d’une seconde à chaque fois, les deux trains
montants et les deux descendants jeter sur ses champs et ses
roches, plus silencieux, plus solitaires après cela, le bruit d’un
tourbillon et l’ombre d’une fumée. Mais, en revanche, la route
nationale, maintenant déserte, résonnait dès le matin sous les
équipages des rouliers, ce n’étaient que jurons et claquements de
fouets, longs attelages de mulets portant le filet frangé, en ficelle
blanche, et le collier à la provençale, cornu, pointu, revêtu de peau
de chien teinte en bleu, égayé de nombreux grelots et de deux
anneaux de verre où passent les guides ; ce n’étaient que carrioles
haut chargées, roulant et tanguant comme un vaisseau à trois ponts,
avec le brancan plus petit qui suit dans un sillage de poussière ; et
tous les soirs, aux auberges échelonnées : la Bégude, la Mounine,
les Trois Rois, d’interminables repas à pleines tablées faisaient
courir les servantes et flamber les fourneaux.
On achève de dîner au « Logis de la grosse Hôtesse » qui est
l’endroit où les rouliers descendent dans la petite ville mi-provençale,
mais déjà montagnarde de Saint-Domnin. Dîner de gens fatigués, et
qu’on prolonge coudes sur table en trempant le traditionnel biscuit
de Veynes dans un dernier verre de vin. Quelques-uns des convives
s’endorment, le nez dans leurs bras croisés, d’autres proposent
d’aller prendre le gloria, n’importe où. A ce moment un homme entre,
l’air fort et doux, il porte sur l’épaule des outils de tailleur de pierre.
— Bonsoir à tous, et la compagnie !
— Tiens, Lenthéric ! comment va, Lenthéric ? Vous prendrez bien
avec nous un verre de vin et un biscuit.
— Ce serait volontiers, mais la femme m’attend. Je passais, en
revenant de la carrière, pour savoir si le cousin n’est pas arrivé.
— Perdigal ? Nous l’avons laissé à Manosque avec un
chargement de faïence d’Apt…
— … Et son carmentran ?
— Naturellement, puisque nous sommes en carnaval. Un
carmentran superbe, haut de huit pieds, doré comme un soleil, et qui
a dans le corps un demi-quintal de paille. Perdigal le trimballe depuis
huit jours à l’avant de sa charrette et compte le brûler ici.
— Alors, Perdigal pourrait arriver cette nuit ou demain ?
— Après demain plutôt, juste pour le mercredi des cendres. Et
maintenant le verre est versé à l’amitié.
Le tailleur de pierres sorti. — Quel grand Saint-Joseph ! s’écria

un petit bonhomme chafouin et roux. Mais le vieux roulier qui avait
versé à boire, l’interrompant :
— Tu dis, Pierre-Antoine…?
— Je dis qu’il fait mauvais pour les gavots se marier avec des
Provençales, et que si Lenthéric veut savoir quand arrivera le
cousin, il n’a qu’à le demander à sa femme.
— Tu as la langue longue, Pierre-Antoine.
— Et pas la vue courte, maître Arnaud ! c’est ce qui m’a permis à
mon dernier voyage, de distinguer de loin deux charrettes arrêtées
sur le bord de la route et quelqu’un qui ressemble à Perdigal entrer
avec une femme dans un bastidon que vous savez, le premier à
gauche après le pont du Jabron, entre la chaussée et la rivière.
— Le bastidon de Lenthéric ?
— Je ne sais pas si le bastidon est à Lenthéric, mais, sûrement la
femme est sienne.
— Alors, dit le vieux roulier en se levant, que Perdigal et la belle
se cachent. Lenthéric, par métier, aime la poudre, on le connaît
aussi bon chasseur que bon carrier.
Le petit homme roux ne mentait point ; bientôt l’événement

prouva que Lenthéric avait eu tort d’aller chercher femme en
Provence.
Voici comment le mariage s’était fait :
Deux ans auparavant, MM. Damase frères, possesseurs à
Jouques (Bouches-du-Rhône) d’un moulin à papier monté encore
d’après l’ancien système, avaient eu besoin de remplacer deux
énormes cuves de pierre émiettées en faisant la pâte sous l’effort
continu des lourds pilons. La roche du pays étant trop tendre, ils
chargèrent Perdigal, qui faisait les voyages à la montagne, de leur
procurer deux blocs de la grosseur voulue en pierre froide de Saint-
Domnin, beau calcaire à grains serrés, dur comme l’acier, et qui,
sous le ciseau, prend le poli du marbre vert. Perdigal et Lenthéric se
connaissaient ; Lenthéric avait une carrière à Champ-Brencous, au-
dessus de Saint-Domnin, et, dans sa carrière, une veine pleine d’où
l’on pouvait, si l’on voulait, extraire des blocs plus gros que des
maisons. L’affaire s’arrangea donc à merveille :
— Je repasserai dans trois semaines, dit Perdigal.
— Tu peux, répondit Lenthéric.
Trois semaines après, jour pour jour, les blocs étaient prêts. Un
travail de Romain ! Il avait fallu, pour les isoler, peiner de l’aube à la
nuit, faire jouer le pic et la poudre, tout en s’aidant des fissures
naturelles bourrées d’humus, où les racines des buis et des
lavandes prolongeaient leurs longs filaments, fissures que Lenthéric
avait étudiées et dont il sut profiter en maître ouvrier.
Tout Saint-Domnin voulut admirer ces blocs.
Les bonnes gens en calculaient le poids, s’étonnant qu’un seul
homme pût venir à bout de deux pareils morceaux ; le principal du
collège affirmait qu’à les voir se détacher ainsi, en haut du plateau,
sur l’horizon, vous auriez dit des pierres druidiques.
Quant à la question de savoir s’il valait mieux les creuser sur
place ou simplement les dégrossir pour achever le travail à Jouques,
MM. Damase frères s’en rapportaient à Lenthéric. Lenthéric s’arrêta
à cette dernière solution comme plus prudente : un bloc brut ne
craint rien, tandis que pour une pierre travaillée, avec le peu de
soins des charretiers et des manœuvres, un accident est toujours à
craindre. Peut-être aussi Lenthéric voyait-il avec plaisir une occasion
d’aller faire un tour en Provence. Pour les Provençaux de la
Provence montagnarde, la vraie Provence, celle du chêne-vert et de
l’olivier, des tambourins et des belles filles, apparaît comme une
sorte de terre sacrée. Les enfants tout petits en rêvent, et quiconque
y a passé un an ou deux rapporte de là-bas les douces façons de
parler qu’il gardera toute sa vie.
Lenthéric ne connaissait du monde que sa carrière, étroit plateau

battu par les vents, et Saint-Domnin si noir dans ses noires murailles
au fond du cirque des rochers blancs que remplit d’un bruit éternel le
cours torrentueux de la Durance. Aussi ce voyage de trois jours avec
Perdigal, le long des routes, derrière le haquet gémissant sous le
poids des blocs enchaînés ; la nouveauté du pays, le ciel plus clair,
l’air plus limpide au sortir des gorges ; sans compter les repas du
soir, les chansons, la joie des rouliers partagée ; ce grand coup de
soleil dans une existence monotone, tout cela le rajeunissait, le
grisait.
Le troisième jour, comme le soir tombait, Perdigal, prenant par le
milieu son manche de fouet en bois tressé, montra du bout un petit
village à mi-coteau et, derrière, une maison longue et basse, percée
de cent fenêtres, qui se cachait dans la verdure :
— Jouques, dit-il, là-bas, c’est la fabrique.
Et, rejetant son fouet sur son cou, il prit le cordeau pour faire
enfiler à l’attelage l’entrée d’une avenue de peupliers.
— Bonjour, Perdigal, cria une voix fraîche.
— Eh ! bonjour, cousine.
— Quelles pierres, bou diou ! deux jolis diamants de gavot.
— N’en dis pas de mal, voici l’orfèvre.
Voyant Lenthéric apparaître, la jeune fille se sauva.
— Nous sommes un peu cousins, son père qui était ouvrier s’est
noyé, il y a longtemps, quand elle était toute petite, en levant
l’écluse. Ces messieurs l’ont gardée. Maintenant, elle plie du papier
à la fabrique.
— Elle est gaie comme un chardonneret, ta cousine, dit
Lenthéric.
— On l’appelle Vivette, ajouta Perdigal.
Le travail pouvait durer un bon mois.

On descendit les blocs devant la papeterie au bord d’un pré que
la chute de la grande roue arrose, et, dès le lendemain, Lenthéric les
attaquait. L’endroit est joli, un sycomore y fait ombre, et Vivette,
toujours en course, trouvait moyen vingt fois par jour de s’arrêter,
regardant les éclats de pierre qui volaient sous le ciseau de
Lenthéric.
— Prenez garde à vos yeux, misé Vivette, car leur faire mal serait
grand dommage !
— Ah ! vraiment ? « grand dommage » ? répondait Vivette, en
imitant le parler montagnard. L’accent du gavot la faisait rire, mais
ses compliments lui allaient au cœur.
Cependant, à mesure que les cuves avançaient, Lenthéric

songea qu’il lui faudrait bientôt repartir. Il allait parfois vers le milieu
du jour, s’étendre, seul, au bas du pré ; et là, dans la fraîcheur de
l’herbe, tandis que sans s’effaroucher du bruit sourd des marteaux,
du frémissement de la machine et du remous des eaux grondantes,
les oiseaux chantaient sur les arbres, voyant de loin Vivette
apparaître à une fenêtre du séchoir et sourire, tête retournée, il se
représentait sa carrière de Champ-Brencous, son travail toujours
solitaire, se disant qu’à recommencer pareille vie il se trouverait
malheureux. Puis une idée lui vint : pourquoi ne pas emmener
Vivette ? Vivette, de sa présence, éclairerait tout. Vivette n’avait pas
vingt ans, c’est vrai ; mais lui en avait à peine quarante. Vivette était
pauvre, orpheline ; mais lui possédait du bien pour deux : une
maison, une vigne, un champ, sans compter son état. Droit comme
un montagnard et pressé d’ailleurs par le temps, il s’ouvrit un jour du
projet à MM. Damase qui l’approuvèrent ; Vivette ne refusa point, et
la noce fut célébrée à la fabrique, Perdigal étant garçon d’honneur,
le jour même de la pose des deux grandes cuves.
Vivette se trouva, comme on dit, tout de suite chez elle à Saint-
Domnin. Elle avait sa maison, n’était plus ouvrière, mais artisane, et
Lenthéric si bon, si amoureux avec cela, qu’il fallait bien, de gré ou
de force, être heureuse de son bonheur. Puis elle eut grand succès
avec son parler clair et ses jolies façons provençales. Tout le monde
en raffola : ce ne fut trois semaines durant que visites, dîners,
commérages et grandes parties de bastidon, entre amis et voisins,
d’où l’on revient à la nuit tombante, en chantant.
Le triste Champ-Brencous lui-même plaisait à Vivette. Tous les
jours, sur les onze heures, elle partait de la ville, portant le déjeuner
de Lenthéric dans un panier. Elle montait le chemin de Saint-Jean,
entre le cimetière neuf et la citadelle, et puis suivait le long plateau
rocheux, crête de colline découronnée par les exploitations, et d’où
pierre à pierre tout Saint-Domnin est sorti. Des blocs entassés, des
trous béants, des écroulements de pierrailles et, de loin en loin, une
plaque de gazon ras, étoilée suivant la saison de chardons à fleurs
violettes, ou de petits œillets amoureux du vent et des cimes. Tout
au bout, en pleine montagne boisée, était la carrière, avec un demi-
arpent de vigne pris sur le bois, un jardinet fait de terres rapportées,
et une maisonnette flanquée de sa cave et de sa citerne, que
Lenthéric avait bâtie à ses moments perdus. Sur la cave on lisait : —
Pour moi ! — sur la citerne : — Pour les amis ! — plaisanterie qui
faisait rire sans tromper personne, Lenthéric n’étant point ivrogne ni
capable surtout de refuser un verre de vin à qui que ce soit. Vivette
arrivée, on déjeunait là, en tête à tête, sur un fragment de roc éclaté,
et c’était charmant ainsi dans la bonne odeur des genets et des buis,
où se mêlait parfois l’odeur de poudre d’un coup de mine.
Hélas ! après un an ce charme de nouveauté s’envola. Saint-

Domnin, Champ-Brencous semblèrent tristes à Vivette ; et
maintenant, soit qu’elle allât à la carrière, soit qu’elle en revint, il lui
arrivait souvent de s’arrêter et de regarder là-bas si, au fin bout de la
vallée, suivant le cours de la Durance qui luisait çà et là, dans les
graviers, en chapelets de petits lacs, elle pourrait apercevoir ce doux
pays de Jouques, le village, la papeterie. Mais là-bas, au fin bout,
une montagne barrait la vallée. Vraie porte de prison, que cette
montagne !
Le bon Lenthéric, lui, ne s’apercevait de rien. Il continuait son
double métier de carrier et de tailleur de pierres, gai toujours et se
donnant volontiers une après-midi de congé quand le travail ne
pressait pas trop, pour aller tuer dans les ravins pierreux de la colline
quelque lièvre nourri de thym ou quelque savoureuse perdrix rouge.
Mais que le travail pressât ou pas, que la chasse fût ouverte ou
non, lièvres et perdrix n’avaient qu’à se tenir sur leur garde à chaque
passage du cousin Perdigal.
Le cousin passait une fois par mois, quelquefois deux, tantôt un
jour et tantôt l’autre, selon ses chargements.
De tous les rouliers de Provence et de Dauphiné, ce grand
garçon blondin était bien celui qui portait le plus gaillardement la
blouse bleue et la ceinture rouge. Bon comme le pain, franc comme
l’or, très fin cependant, on l’aimait. Le dernier couché pour gouverner
ses bêtes, le premier debout au matin sous les voûtes noires des
écuries, pour surveiller le garçon bégayant, aux yeux ensommeillés,
qui marche d’un pas de somnambule, somnambule, holà ! très lucide
dès qu’il s’agit de faire sauter la moitié d’une botte de foin ou la
totalité d’un picotin d’avoine, Perdigal faisait son métier en habile
homme, parcourant du haut en bas les quatre départements,
descendant les fruits, les peaux d’agneau et de chevreau, les
amandes-pistaches de la montagne, et remontant les épiceries de
Marseille, les gros vins du Var, l’ail et l’oignon en longues liasses, les
melons de Cavaillon, les oranges, les artichauts, les cardes, les
aubergines, et les tomates rouges déjà comme un corail quand
celles de Saint-Domnin verdissaient à peine. Avec cela, joyeux
compagnon, beau danseur, bon lutteur, incomparable aux cartes et
aux boules, sans pareil pour conter des contes salés et chanter la
chanson grivoise : « un flambeau », comme il s’appelait.
Ce diable de Perdigal avait chaque jour des inventions nouvelles.
Tant que durait l’été, il amusait tout le pays avec d’énormes
chapeaux en alfa tressée, hauts comme un minaret, larges comme
une plate-forme, qu’un de ses amis, cuisinier à bord, lui rapportait
d’Algérie. L’hiver, c’était un carmentran, mannequin énorme, attaché
dès le premier jour de carnaval sur le devant de la carriole, promené
ainsi trois semaines durant à travers villages et bourgs, jugé enfin et
brûlé selon les formes, le mercredi des cendres, à l’endroit où l’on se
trouvait, au hasard de l’itinéraire.
— S’il pouvait, cette année, le brûler chez nous ! disaient les gens
tout le long de la route.
Et c’est pour cela qu’au nom de Perdigal la reconnaissance
publique avait ajouté le sobriquet glorieux de Carmentran.
Allant ainsi de Marseille aux montagnes, toujours en fête,
toujours prêt à raconter devant les gavots ébahis ses plaisirs de là-
bas et ses aventures amoureuses, Perdigal, ou Carmentran si vous
voulez, semblait apporter du bout de la route blanche, par delà les
collines pelées, à cette triste ville de Saint-Domnin, quelque chose
de l’éblouissement de la Babylone provençale. Brouhaha du Cours
Belzunce et du vieux port, gaz des trottoirs, cafés illuminés, théâtres,
buvettes à marins, ruelles mystérieuses, tout cela, il le promenait
avec lui. Aussi était-il secrètement envié, tout simple roulier qu’il fût,
des aspirants surnuméraires qui vont et viennent deux par deux,
d’un air très pressé, sur la grande place de la ville, espérant tromper
par ces marches forcées les agitations de leur cœur ; les servantes
d’auberge lui réservaient leurs sourires les plus larges ; et c’est de lui
encore que rêvaient les petites artisanes sur le pas des portes, en
taquinant du bout des doigts la chaîne d’argent de leurs ciseaux.
Mais Carmentran ne s’en faisait pas plus fier pour cela, et portait
gaiement, en vrai bon garçon qu’il était, le fardeau de son renom
diabolique.
Devant la femme de son ami, par exemple, le Don Juan devenait

timide. Il est vrai de dire qu’après deux ans on eût avec peine
reconnu la jeune fille à qui la souple langue provençale avait trouvé,
vivant portrait, ce diminutif de Vivette. Vivette ? non ! mais
Geneviève, la belle Geneviève comme les gens commençaient à
l’appeler.
Florissante beauté que voilait un peu de tristesse, la belle
Geneviève s’égayait pourtant aux retours périodiques de Perdigal.
C’était alors une éclaircie, comme si les nuages s’ouvraient pour
laisser voir là-bas le village sur son coteau, la fabrique, et les années
de jeunesse en plein soleil.
Un soir que Perdigal et Geneviève revenaient de la carrière, par
le plateau, côte à côte, sans rien se dire, mais leurs pensées
intérieures allant côte à côte comme eux :
— Hélas ! si j’avais su ! soupira Geneviève.
— Si nous avions su ! répondit Perdigal.
Puis ils se turent, ayant entendu sonner dans les pierrailles les
souliers ferrés de Lenthéric.
A partir de ce moment, sans que rien de plus se fût passé,
Perdigal multiplia ses voyages. Pour lui comme pour Geneviève il
n’y avait désormais d’heureux jours que les rares jours passés
ensemble. Marseille vainement promettait ses joies ; vainement,
pour l’attarder, les chambrières prodiguaient leurs œillades, leur rire
à belles dents et les reculs effarouchés qui montrent le pli du cou et
font saillir le corsage :
— Je suis pressé, mesdemoiselles, on m’attend à Saint-Domnin !
Mais qu’elle lui paraissait longue maintenant cette route qu’il
parcourait si gaillardement jadis !
Une fois, Perdigal resta deux mois sans paraître : l’héritage d’un
oncle, puis un voyage indispensable dans le Bas-Languedoc, pour
des vins. Alors Geneviève fut si triste que Lenthéric lui-même s’en
aperçut.
— Écoute, Vivette, c’est de ton pays que tu t’ennuies. D’un autre
côté, voici longtemps que MM. Damase m’ont fait promettre d’aller
là-bas, pour une commande. Si tu veux, nous nous embarquerons
demain dans la voiture et nous resterons à Jouques quatre ou cinq
jours.
Après les cinq jours, on voulut retenir Vivette.
— Qu’elle reste, dit Lenthéric ; cela m’amusera, une semaine ou
deux, de faire mon manger moi-même comme quand j’étais garçon.
Et il repartit gaiement. Pauvre Lenthéric !
Le soir même, au soleil tombant, Vivette alla s’asseoir dans

l’allée de peupliers, à l’endroit où le chemin tourne ; et là, se
souvenant de la rencontre d’il y a deux ans, quand Perdigal et
Lenthéric avaient amené les pierres, il lui sembla revivre sa vie et la
revivre avec Perdigal.
— C’est tout comme alors ! disait-elle.
En effet, tout comme alors, un bruit de grelots retentit sous les
arbres, et une charrette parut balançant dans la nuit qui commençait
sa grosse lanterne en toile blanche.
— Perdigal !
— Vivette !
Pendant ce temps, songeant à Vivette, le brave Lenthéric
cheminait sur la route de Saint-Domnin.
Telle est, comme les gens la racontent, l’histoire de la faute de
Vivette avec Perdigal.
Ce train durait depuis six mois déjà le jour où le bon Lenthéric

entra dans la salle à manger du « Logis de la grosse Hôtesse » pour
demander aux rouliers quand arriverait le cousin.
— Si le cousin arrive cette nuit, dit Lenthéric à sa femme, il
viendra nous réveiller de grand matin, et j’aurai le temps, avant
déjeuner, d’aller lui cueillir son lièvre.
Mais le matin, Perdigal n’étant pas venu le réveiller, Lenthéric
monta à sa carrière.
Sur les onze heures, comme toujours, Vivette apporta la soupe à
Lenthéric ; seulement elle ne voulut pas déjeuner :
— Je mangerai à la maison ; j’ai laissé un cuveau de linge en
train de couler, et il ne faut pas que le lessif froidisse.
Lenthéric déjeuna tout seul, puis il se remit tranquillement à
marteler une dalle mince et sonore qui chantait sous le marteau
comme une cloche, et remplissait de ses sons clairs la carrière et la
maisonnette. Cette dalle était destinée à recouvrir la tombe d’un
riche bourgeois de Saint-Domnin. Lenthéric commença donc à
graver dessus un beau CY GIT en lettres gothiques ; et il était là, tout
à l’ouvrage, en train de pousser par petits coups sa fine pointe dans
la seconde branche du T, quand des cris joyeux retentirent.
Une bande de galopins, ébouriffés à l’ordinaire et tout essoufflés
d’avoir couru, venaient de s’arrêter à la vue du tailleur de pierre. Ils
avaient des livres et des cartables.
— Bien le bonjour, monsieur Lenthéric ! si cela ne vous faisait
rien, nous voudrions traverser votre vigne.
— Traverser ma vigne, et pourquoi ?
— Nous sortions de l’école et nous avons dit d’aller attendre
votre cousin au Grand-Portail.
— Perdigal ! Il arrive donc ?
— Aujourd’hui à six heures, avec un chargement de faïence
d’Apt. La publication en a été faite par le crieur… Même qu’il a sur
sa charrette son carmentran qu’on doit brûler… Alors comme c’est
par ici le plus court…
Le prétendu « plus court » allongeait bien d’une demi-lieue ; mais
soit répugnance à traverser la ville sous l’œil sévère des parents,
soit goût instinctif des écoliers pour les endroits sauvages et les
promenades non frayées, ils avaient choisi ce chemin-là.
— Allons, passez, mauvaise graine !
Et tandis que la bande, prenant la pente, se poussait
bruyamment vers le Grand-Portail, Lenthéric, d’un coup d’œil, ayant
inspecté la route déserte jusqu’à l’horizon entre sa double rangée de
cailloux en tas et de bornes kilométrique, se dit : — Le cousin, à ce
que je vois, ne sera pas ici avant cinq bons quarts d’heure ; j’ai donc
tout le temps de tuer mon lièvre.
Quand Lenthéric eut tué son lièvre, il calcula que Perdigal ne

pouvait tarder, et s’assit au bord de la route, résolu de l’attendre en
fumant une pipe. Il songeait à la joie de Perdigal lorsqu’il verrait le
lièvre, à la surprise de Vivette. Puis il réfléchit que Vivette ne lui avait
pas annoncé l’arrivée de Perdigal, et cela l’étonna un peu. Mais
comme Lenthéric était un homme sans fiel ni malice, qu’il respectait
sa femme et qu’il savait Perdigal son ami, il laissa de côté cette idée
et se mit à rêver d’autre chose.
Au bout d’un moment, des claquements de fouet, le
frémissement lent de cent grelots et le tic-tac régulier des grandes
roues battant sur l’essieu annoncèrent l’arrivée des charrettes.
Perdigal marchait un peu en arrière, près de la seconde ; à l’avant
de la première, qui était presque vide, un énorme mannequin, ficelé
le long d’une perche, se dandinait.
Lenthéric allait se montrer, quand il aperçut une femme assise
dans le petit hamac de sparterie que les rouliers installent sur le côté
de leurs voitures pour s’y reposer un peu, en dépit des règlements,
quand ils sont las et qu’il n’y a pas de gendarmes en vue.
— Diable de Perdigal, pensa Lenthéric, toujours le même !
Et, ne voulant pas déranger Perdigal dans ses amourettes, il
résolut de laisser les charrettes filer.
Mais les charrettes s’arrêtaient. En cet endroit, la route fait un

coude et l’on ne risque pas d’y être aperçu. La femme sauta sur le
chemin :
— Tiens, Vivette, la clef que tu oublies.
Lenthéric qui avait reconnu Vivette, reconnut aussi la clef du
bastidon qu’il avait à quelques kilomètres de là, et où il renfermait, à
la récolte, les amandes-pistaches d’un petit champ et les raisins d’un
bout de vigne.
Ce fut comme un éclair, il devina tout.
— Sauve-toi, Vivette, quelqu’un ! murmura soudain Perdigal,
devenu tout pâle.
Et Vivette s’étant sauvée, Perdigal se retourna, les bras croisés,
du côte de Lenthéric. Il ne le voyait pas, mais il le devinait, ayant
entendu le craquement d’un fusil qu’on arme, ayant aperçu le bout
du canon qui s’abaissait entre les branches.
— Tire, Lenthéric !
Lenthéric, aveuglé, tira.
— Tu m’as tué ! dit Perdigal en portant à sa poitrine ses deux
mains qui s’ensanglantèrent.
Subitement, toute la colère de Lenthéric était tombée… Il avait,

comme dans un rêve, couché Perdigal sur la charrette, et lui faisait
boire l’eau-de-vie de sa gourde :
— Un ami ! est-ce Dieu possible ? un ami ! soupirait-il, sans trop
savoir ce que cela voulait dire, et si c’était à lui-même, à sa main
trop prompte, ou bien à la trahison de Perdigal que le reproche
s’adressait.
Au bout d’un moment, Perdigal ouvrit les yeux. Sa première
parole fût :
— Et Vivette ?…
A ce nom, Lenthéric sentit son sang bouillir ; mais, voyant la mort
sur le front de Perdigal, il jugea le crime assez puni et dit à voix
basse :
— Je pardonne.
— A tous deux ?
— A tous deux !
Perdigal mit sa main dans la main de Lenthéric.
— Lenthéric, un dernier service : tu vas ouvrir le caisson de la
carriole et me donner le pistolet qui est derrière la musette.
Lenthéric hésitait ne comprenant pas.
— Donne vite, je suis pressé !
Cette fois Lenthéric obéit, mais Perdigal lui rendit l’arme en
disant :
— Tire en l’air, toi ; je n’ai plus la force.
Lenthéric tira en l’air.
— Maintenant, place-moi le pistolet entre les doigts… comme
ça… bien ! fit Perdigal dont la voix s’affaiblissait ; comprends-tu,

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Nutrition for Health and Health Care 7th

Edition Edition Linda Kelly Debruyne -

Nutrition for Health and Health Care (MindTap Course

(eBook PDF) Nutrition for Health and Health Care 7th

Health Psychology: An Introduction to Behavior and

Health Psychology: An Introduction to Behavior and

(eBook PDF) The Sociology of Health, Illness, and

Promoting Health: The Primary Health Care Approach 7th

(eBook PDF) Health Policy: Application for Nurses and

(eBook PDF) Delivering Health Care in America 7th

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

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

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

Tolerable Upper Intake Levels (UL) for Minerals

Linda Kelly DeBruyne

Product Assistant: Lauren R. Monz

Intellectual Property Project Manager:

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

Text Researcher: Sriranjani Ravi,

Printed in the United States of America

National Health Goals 11 Monosaccharides 68

Digestion in the Mouth 45

Finding the Fats in Foods 108 Genetics and Weight 174

Nutrition in Practice Fad Diets 195

Protein Deficiency 132 Chapter 8

Health Risks of Underweight 161 Water Balance 238

Nutrition Prior to Pregnancy 272

Nutrition in Practice Encouraging Successful Nutrition in Practice Hunger and Community

Care Planning 404

Drug Effects on Food Intake 416 Dry Mouth 490

Oral Supplements 434 Chapter 18

Candidates for Parenteral Nutrition 448 Fat Malabsorption 519

Symptoms of Diabetes Mellitus 566 Causes of Acute Kidney Injury 630

Consequences of Atherosclerosis 597 Prevention of HIV Infection 665

Changes for This Edition Chapter 7

acid regurgitation, heartburn, bloating, pernicious

specialized nutrition support oral nutrition

MindTap: Empower Your

Features of this Text

Access Everything You Need

Empower Students to Reach

You Need Them

1.1 Food Choices

1.2 The Nutrients

1.3 Nutrient Recommendations

1.4 National Nutrition Surveys

1.6 Food Labels

1.7 Nutrition in Practice: Finding the Truth about Nutrition

1.1 Food Choices

2 CHAPTER 1 Overview of Nutrition and Health

Ethnic Heritage and Regional Cuisines

ethnic diets Photo 1-1

halal Ethnic meals and family gatherings

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

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

Availability, Convenience, and Economy

4 CHAPTER 1 Overview of Nutrition and Health

Nutrition is only one of the many factors

1.7 Nutrition in Practice: Finding the Truth about Nutrition

FIGURE 1-3 Inaccurate versus Accurate View of Nutrient Intakes

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

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

TABLE 1-7 Estimated Daily kCalorie