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Contents in Brief

Preface xxi CHAPteR 13

CHAPteR 1
Child and
Nutrition Basics 1 Preadolescent Nutrition 343
Conditions and Interventions
CHAPteR 2
CHAPteR 14
Preconception Nutrition 50
Adolescent Nutrition 361
CHAPteR 3
CHAPteR 15
Preconception Nutrition 70
Conditions and Interventions Adolescent Nutrition 386
Conditions and Interventions
CHAPteR 4
CHAPteR 16
Nutrition During Pregnancy 87
Adult Nutrition 407
CHAPteR 5
CHAPteR 17
Nutrition During Pregnancy 138
Conditions and Interventions Adult Nutrition 428
Conditions and Interventions
CHAPteR 6
CHAPteR 18
Nutrition During Lactation 164
Nutrition and Older Adults 454
CHAPteR 7
CHAPteR 19
Nutrition During Lactation 197
Conditions and Interventions Nutrition and Older Adults 486
Conditions and Interventions
CHAPteR 8
Infant Nutrition 226 Answers to Review Questions AR-1

CHAPteR 9
Appendix A
Infant Nutrition 252 Summary of Research of Effects of
Conditions and Interventions Exercise Activities on Health of Older
Adults A-1
CHAPteR 10
Toddler and 272 Appendix B
Preschooler Nutrition Measurement Abbreviations
and Equivalents A-3
CHAPteR 11
Toddler and 302 Appendix C
Preschooler Nutrition Body Mass Index (BMI) A-5
Conditions and Interventions References R-1
CHAPteR 12 Glossary G-1
Child and 318 Index I-1
Preadolescent Nutrition

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
Contents

Preface xix Nutrition Assessment 38

Community-Level Assessment 38
Individual-Level Nutrition Assessment 39
All chapters include Resources and References Dietary Assessment 39
Anthropometric Assessment 40
Biochemical Assessment 41
CHAPteR 1 Monitoring the Nation’s Nutritional Health 42
Nutrition Basics 1 Public Food and Nutrition Programs 42
WIC 43
Introduction 2
Nationwide Priorities for Improvements in Nutritional Health 43
Principles of the Science of Nutrition 2
U.S. Nutrition and Health Guidelines 43
Essential and Nonessential Nutrients 3
Dietary Guidelines for Americans 44
Dietary Intake Standards 3
Carbohydrates 4 MyPlate.gov 45
Protein 6 The USDA’s Food Groups 46
Fats (Lipids) 8
Vitamins 10 CHAPteR 2
Other Substances in Food 13
Minerals 13 Preconception Nutrition 50
Water 22
Introduction 51
Nutritional Labeling 34
Preconception Overview 51
Nutrition Facts Panel 35
2020 Nutrition Objectives for the Nation Related
Ingredient Label 35
to Preconception 51
Dietary Supplement Labeling 35
Herbal Remedies 36 Reproductive Physiology 52
Functional Foods 36 Female Reproductive System 52
Male Reproductive System 55
The Life-Course Approach to Nutrition
and Health 37 Nutrition and Fertility 56
Meeting Nutritional Needs Across the Life Cycle 37 Undernutrition and Fertility 56
Dietary Considerations Based on Ethnicity 38 Body Fat and Fertility 57
Dietary Considerations Based on Religion 38 Nutrient Status and Fertility 58

Nutrition Time Line

H. Armstrong Roberts/
ClassicStock/Alamy

1621 1734
First Thanksgiving Scurvy recognized
feast at Plymouth
colony 1702
First coffeehouse
Photodisc

in America opens
in Philadelphia
vi

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
 Contents vii

Nutrition During the Periconceptional Period 61 Phenylketonuria (PKU) 80

Periconceptional Folate Status 61 Maternal PKU 80
Periconceptional iron Status 63 Nutritional Management of PKU 81
Recommended Dietary Intake for Preconceptional Celiac Disease 81
Women 63 Nutritional Management of Celiac Disease 81
Influence of Contraceptives on Preconceptional
Nutrition Status 64 CHAPteR 4
Nutritional Side Effects of Hormonal Contraception 64
Nutrition During Pregnancy 87
Model Preconceptional Health and Nutrition Programs 64
Preconceptional Benefits of WIC 65 Introduction 88
Decreasing Iron Deficiency in Preconceptional The Status of Pregnancy Outcomes 88
Women in Indonesia 65 Infant Mortality 88
Preconception Care: Preparing for Pregnancy 65 Low Birthweight, Preterm Delivery, and Infant
The Nutrition Care Process 65 Mortality 90
The Nutrition Care Process Related to the Preconception Reducing Infant Mortality and Morbidity 90
Period 67 Physiology of Pregnancy 91
Maternal Physiology 91
Normal Physiological Changes During Pregnancy 92
CHAPteR 3 The Placenta 95
Preconception Nutrition 70 Embryonic and Fetal Growth and Development 97
Conditions and Interventions Critical Periods of Growth and Development 97
Fetal Body Composition 99
Introduction 71 Nutrition, Miscarriage, and Preterm Delivery 102
Premenstrual Syndrome 71 Developmental Programming of Later Disease Risk 103
Treatment of PMS 71 Pregnancy Weight Gain 104
Weight Status and Fertility 72 Pregnancy Weight Gain Recommendations 105
Obesity, Body Fat Distribution, and Fertility 72 Nutrition and the Course and Outcome
Weight Status and Fertility in Men 73 of Pregnancy 108
Weight Status and Fertility in Women 73 Famine and Pregnancy Outcome 108
Negative Energy Balance and Fertility 75 Energy and Nutrient Needs During Pregnancy 109
Anorexia Nervosa, Bulimia Nervosa, and Fertility 75 The Need for Energy 110
The Female Athlete Triad and Fertility 75 The Need for Protein 111
Diabetes Prior to Pregnancy 76 The Need for Fat 111
Nutritional Management of Diabetes Prior The Need for Vitamins and Minerals
to Pregnancy 76 During Pregnancy 113
Calcium 117
Polycystic Ovary Syndrome and Fertility 78 Bioactive Components of Food 121
Nutritional Management of PCOS 79 The Need for Water 122

Nutrition Time Line

John A. Rizzo/

Photodisc
Getty Images

1744 1747 1750 1762

Photodisc/

First record of ice cream Lind publishes Ojibway and Sandwich invented
in America at Maryland “Treatise on Sioux war over by the Earl of
colony Scurvy,” citrus control of wild Sandwich
identified as cure rice stands
C Squared Studios/
Photodisc/Getty
Images

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
 viii Contents

Factors Affecting Dietary Intake During Pregnancy
Effect of Taste and Smell Changes on Dietary Intake
During Pregnancy 122
Cultural Considerations 123
Healthful Diets for Pregnancy 123
Vegetarian Diets in Pregnancy 124
Dietary Supplements during Pregnancy 127
Multivitamin and Mineral Prenatal Supplements
Food Safety During Pregnancy 130
Mercury Contamination 130
Assessment of Nutritional Status During Pregnancy
Dietary Assessment During Pregnancy 130
Nutrition Biomarker Assessment 131
Exercise and Pregnancy Outcome 131
Exercise Recommendations for Pregnant Women
Common Health Problems During Pregnancy
Nausea and Vomiting 132
Heartburn 133
Constipation 133
Model Nutrition Programs for Risk Reduction
in Pregnancy 133
The Montreal Diet Dispensary 133
The WIC Program 134
CHAPteR 5
Nutrition During Pregnancy
Conditions and Interventions
Introduction 139
Obesity and Pregnancy 139
Obesity and Infant Outcomes 139
Hypertensive Disorders of Pregnancy 141
Hypertensive Disorders of Pregnancy, Oxidative Stress,
and Nutrition 141
Chronic Hypertension 141
Gestational Hypertension 142
Preeclampsia–Eclampsia 142
Nutritional Recommendations and Interventions
for Preeclampsia 145
122 Diabetes in Pregnancy 145
Gestational Diabetes 145
Type 2 Diabetes in Pregnancy 150
Type 1 Diabetes During Pregnancy 150
Nutritional Management of Type 1 Diabetes in Pregnancy 151
Multifetal Pregnancies 151
Background Information about Multiple Fetuses 152
127 Risks Associated with Multifetal Pregnancy 153
Nutrition and the Outcome of Multifetal Pregnancy 154
Dietary Intake in Twin Pregnancy 155
Nutritional Recommendations for Women with
130 Multifetal Pregnancy 156
HIV/AIDS During Pregnancy 157
Consequences of HIV/AIDS During Pregnancy 158
Nutritional Factors and HIV/AIDS During Pregnancy 158
132 Nutritional Management of Women with HIV/AIDS
During Pregnancy 158
132
Eating Disorders in Pregnancy 159
Consequences of Eating Disorders in Pregnancy 159
Treatment of Women with Eating Disorders
During Pregnancy 159
Nutritional Interventions for Women with
Eating Disorders 159
Fetal Alcohol Spectrum Disorders 159
Nutrition and Adolescent Pregnancy 161
Growth During Adolescent Pregnancy 161
Obesity, Excess Weight Gain, and Adolescent
138 Pregnancy 161
Nutritional Recommendations for Pregnant Adolescents 161
Evidence-Based Practice 162
CHAPteR 6
Nutrition During Lactation 164
Introduction 165
Lactation Physiology 165
Functional Units of the Mammary Gland 165
Mammary Gland Development 165
Lactogenesis 165
Hormonal Control of Lactation 166

Nutrition Time Line

1771 1774 1775 1816

Potato heralded Americans drink Lavoisier (“the father Protein and
© Stefano Bianchetti/CORBIS

as famine food more coffee in of the science of amino acids

protest over nutrition”) discovers identified
Britain’s tea tax the energy-producing followed by
property of food carbohydrates
and fats in the
mid 1800s

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
 Contents ix

Secretion of Milk 167 Maternal Diet 181

The Letdown Reflex 167 Nutrition Assessment of Breastfeeding Women 181
Energy and Nutrient Needs 181
Human Milk Composition 168 Maternal Energy Balance and Milk Composition 182
Colostrum 168 Weight Loss During Breastfeeding 182
Water 168 Exercise and Breastfeeding 183
Energy 168 Vitamin and Mineral Supplements 183
Lipids 168 Vitamin and Mineral Intakes 183
Protein 170 Functional Foods 183
Milk Carbohydrates 170 Fluids 184
Fat-Soluble Vitamins 170 Alternative Diets 184
Water-Soluble Vitamins 171 Infant Colic 184
Minerals in Human Milk 171
Taste of Human Milk 172 Public Food and Nutrition Programs 184
USDA WIC Program 184
Benefits of Breastfeeding 172
Breastfeeding Benefits for Mothers 172 Optimal Duration, Influential Factors, and U.S. Goals
Breastfeeding Benefits for Infants 172 for Breastfeeding 185
Benefits 174 Optimal Breastfeeding Duration 185
Factors Influencing Breastfeeding Initiation and Duration 185
Breast Milk Supply and Demand 174 Breastfeeding Goals for The United States 186
Can Women Make Enough Milk? 175
Does the Size of the Breast Limit a Woman’s Ability Breastfeeding Promotion, Facilitation, and Support 187
to Nurse Her Infant? 175 Role of the Health Care System in Supporting
Is Feeding Frequency Related to the Amount of Milk Breastfeeding 187
a Woman Can Make? 175 Prenatal Breastfeeding Education and Support 188
Pumping or Expressing Milk 175 Lactation Support in Hospitals and Birthing Centers 189
Can Women Breastfeed after Breast Reduction Lactation Support after Discharge 191
or Augmentation Surgery? 175 The Workplace 191
What Is the Effect of Silicone Breast Implants The Community 192
on Breastfeeding? 176 National Breastfeeding Policy 193

The Breastfeeding Process 215 Model Breastfeeding Promotion Programs 193

Preparing the Breast for Breastfeeding 176 WIC National Breastfeeding Promotion Project—Loving
Breastfeeding Positioning 176 Support Makes Breastfeeding Work 193
Presenting the Breast to the Suckling Infant 177 The Business Case for Breastfeeding 194
Wellstart International 194
The Breastfeeding Infant 177
Infant Reflexes 177
Mechanics of Breastfeeding 178
CHAPteR 7
Identifying Hunger and Satiety 178
Feeding Frequency 178 Nutrition During Lactation 197
Identifying Breastfeeding Malnutrition 178
Tooth Decay 181
Conditions and Interventions
Vitamin Supplements for Breastfeeding Infants 181 Introduction 198

Nutrition Time Line

1833 1871 1895

Beaumont’s Proteins, carbohydrates, First milk station
experiments on and fats determined providing children
© Bettmann/CORBIS

a wounded to be insufficient with uncontaminated

man’s stomach to support life; that milk opens in
© Bettmann/CORBIS

greatly expands there are other New York City

knowledge “essential” components
about digestion

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
 x Contents

Common Breastfeeding Conditions 198 Model Programs 222

Sore Nipples 198 Breastfeeding Promotion in Physicians’ Office
Flat or Inverted Nipples 198 Practices (BPPOP) 222
Letdown Failure 198 The Rush Mothers’ Milk Club 223
Hyperactive Letdown 199
Hyperlactation 199
Engorgement 199 CHAPteR 8
Plugged Duct 199
Mastitis 200 Infant Nutrition 226
Low Milk Supply 200 Introduction 227
Maternal Medications 202 Assessing Newborn Health 227
Herbal Remedies 204 Birthweight as an Outcome 227
Specific Herbs Used in the United States 206 Infant Mortality 227
Milk Thistle/Blessed Thistle 207 Combating Infant Mortality 228
Standard Newborn Growth Assessment 228
Alcohol and Other Drugs and Exposures 207
Alcohol 207 Infant Development 228
Nicotine (Smoking Cigarettes) 209 Motor Development 228
Marijuana 209 Critical Periods 229
Caffeine 210 Cognitive Development 229
Other Drugs of Abuse 210 Digestive System Development 230
Environmental Exposures 210 Parenting 231

Neonatal Jaundice and Kernicterus 211
Bilirubin Metabolism 212
Physiologic Versus Pathologic Newborn Jaundice 212
Hyperbilirubinemia and Breastfeeding 213
Prevention and Treatment for Severe Jaundice 215
Information for Parents 215
Breastfeeding Multiples 215
Infant Allergies 216
Food allergy (Hypersensitivity) 217
Food Intolerance 217
Late-Preterm Infants 217
Human Milk and Preterm Infants
Medical Contraindications to Breastfeeding
Breastfeeding and HIV Infection 220
Human Milk Collection and Storage
Milk Banking 221
Energy and Nutrient Needs 232
Energy Needs 232
Protein Needs 232
Fats 232
Metabolic Rate, Energy, Fats, and Protein—How Do
They All Tie Together? 233
Other Nutrients and Non-nutrients 233
Physical Growth Assessment 234
Interpretation of Growth Data 235
Feeding in Early Infancy 236
Breast Milk and Formula 236
Cow’s Milk During Infancy 236
Soy Protein–Based Formulas During Infancy 237
219
Development of Infant Feeding Skills 238
220
Introduction of Solid Foods 239
The Importance of Infant Feeding Position 240
221 Preparing for Drinking from a Cup 241
Food Texture and Development 242

Nutrition Time Line

1896 1906 1910 1912

Funk suggested
Jonelle Weaver/Photodisc/

Atwater Pure Food and Pasteurized

© Bettmann/CORBIS

publishes Drug Act passed by milk introduced scurvy, beriberi,

Proximate President Theodore and pellagra
Getty Images

Composition Roosevelt to protect caused by

of Food consumers against deficiency of
Materials contaminated foods “vitamines” in
the diet

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
 Contents xi

First Foods 242 Does Intrauterine Growth Predict Growth

Inappropriate and Unsafe Food Choices 242 Outside? 257
Water 243 Interpretation of Growth 260
How Much Food Is Enough for Infants? 243
Nutrition for Infants with Special Health Care
How Infants Learn Food Preferences 244
Needs 260
Nutrition Guidance 244 Nutrition Risks to Development 261
The Infant’s Home Environment 245
Severe Preterm Birth and Nutrition 262
Supplements for Infants 245
How Sick Babies Are Fed 262
Common Nutritional Problems and Concerns 245 What to Feed Preterm Infants 263
Failure to Thrive 245 Preterm Infants and Feeding 264
Nutrition Intervention for Failure to Thrive 246 Infants with Congenital Anomalies and Chronic
Colic 246 Illness 266
Iron-Deficiency Anemia 246 Infants with Genetic Disorders 266
Diarrhea and Constipation 247
Prevention of Baby-Bottle Caries and Ear Infections 247 Feeding Problems 269
Food Allergies and Intolerances 247
Nutrition Interventions 269
Lactose Intolerance 248
Nutrition Services 270
Cross-Cultural Considerations 248
Vegetarian Diets 249

Nutrition Intervention for Risk Reduction 249 CHAPteR 10

Model Program: Newborn Screening 249
CHAPteR 9
Infant Nutrition
Conditions and Interventions
Introduction 253
Infants at Risk 253
Families of Infants with Special Health Care Needs
Energy and Nutrient Needs
Energy Needs 254
Protein Requirements 255
Fats 255
Vitamins and Minerals 256
Growth 256
Growth in Preterm Infants
Toddler and Preschooler 272
Nutrition
Introduction 273
Definitions of the Life-Cycle Stage 273
252 Importance of Nutrition 273
Tracking Toddler and Preschooler Health 273
Healthy People 2020 273
254 Normal Growth and Development 273
Measuring Growth 274
254 The 2000 CDC Growth Charts 275
WHO Growth Standards 276
Common Problems with Measuring and Plotting
Growth Data 276
Physiological and Cognitive Development 276
Toddlers 276
257 Preschool-Age Children 278

Nutrition Time Line

1914 1916 1917

C Squared Studios/
Photodisc/Getty

Goldberger identifies the First dietary guidance First food groups

Images

cause of pellagra (niacin
deficiency) in poor
1913 children to be a missing
First vitamin component of the diet
discovered (vitamin A) rather than a germ as
others believed
material produced for
the public was released.
It was titled “Food for
Young Children.”
published, The Five Food
Groups: Milk and Meat;
Vegetables and Fruits;
Cereals; Fats
and Fat Foods; Sugars
and Sugary Foods

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
 xii Contents

Temperament Differences 281 Public Food and Nutrition Programs 299

Food Preference Development, Appetite, and Satiety 281 WIC 299
WIC’s Farmers’ Market Nutrition Program 300
Energy and Nutrient Needs 283
Head Start and Early Head Start 300
Energy Needs 283
Supplemental Nutrition Assistance Program
Protein 284
(formerly the Food Stamp Program) 300
Vitamins and Minerals 284
Common Nutrition Problems 284
Iron-Deficiency Anemia 284 CHAPteR 11
Dental Caries 285
Constipation 286 Toddler and Preschooler 302
Elevated Blood Lead Levels 286
Food Security 287
Nutrition
Food Safety 287 Conditions and Interventions
Prevention of Nutrition-Related Disorders 288 Introduction 303
Overweight and Obesity in Toddlers
Who Are Children with Special Health Care
and Preschoolers 288
Needs? 303
Assessment of Overweight and Obesity 288
Prevention of Overweight and Obesity 288 Nutrition Needs of Toddlers and Preschoolers
Treatment of Overweight and Obesity Expert Committee with Chronic Conditions 305
Recommendations 289
Dietary Guidelines for Americans 2010 290 Growth Assessment 306
Nutrition and Prevention of Cardiovascular Disease in
Feeding Problems 307
Toddlers and Preschoolers 290
Behavioral Feeding Problems 309
Vitamin and Mineral Supplements 292
Excessive Fluid Intake 309
Herbal Supplements 292
Feeding Problems and Food Safety 309
Dietary and Physical Activity Recommendations 292 Feeding Problems from Disabilities Involving
Dietary Guidelines for Americans 2010 293 Neuromuscular Control 309
MyPlate 293
Nutrition-Related Conditions 310
Recommendations for Intake of Iron, Fiber,
Failure to Thrive 310
Fat, and Calcium 293
Toddler Diarrhea and Celiac Disease 311
Fluids 296
Autism Spectrum Disorders 312
Recommended vs. Actual Food Intake 296
Muscle Coordination Problems and Cerebral Palsy 312
Cross-Cultural Considerations 297
Pulmonary Problems 313
Vegetarian Diets 297
Developmental Delay and Evaluations 314
Child Care Nutrition Standards 298
Physical Activity Recommendations 298 Food Allergies and Intolerance 315
Nutrition Intervention for Risk Reduction 299 Dietary Supplements and Herbal Remedies 315
Nutrition Assessment 299
Model Program 299 Sources of Nutrition Services 315

Nutrition Time Line

1921 1928
First fortified food produced: lodized American Society
GIPhotoStock/Getty Images

salt. It was needed to prevent for Nutritional

widespread iodine deficiency goiter Sciences and
1929
in many parts of the United States the Journal of Essential
Photodisc

Nutrition founded fatty acids

identified

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
 Contents xiii

CHAPteR 12 Recommended vs. Actual Food Intake 333

Child and Preadolescent
Nutrition
Introduction 319
Definitions of the Life Cycle Stage
Importance of Nutrition 319
Cross-Cultural Considerations 334
318 Vegetarian Diets 334
Physical Activity Recommendations 334
Recommendations vs. Actual Activity 334
319 Determinants of Physical Activity 335
Organized Sports 335

Tracking Child and Preadolescent Health 319 Nutrition Intervention for Risk Reduction 335
Healthy People 2010 319 Nutrition Education 336
Nutrition Integrity in Schools 336
Normal Growth and Development 319 Nutrition Assessment 337
The 2000 CDC Growth Charts 320 Model Programs 337
WHO Growth References 321
Public Food and Nutrition Programs 339
Physiological and Cognitive Development of The National School Lunch Program 339
School-Age Children 321 School Breakfast Program 339
Physiological Development 321 Summer Food Service Program 340
Cognitive Development 322 Team Nutrition 340
Development of Feeding Skills and
Eating Behaviors 322
Energy and Nutrient Needs of School-Age CHAPteR 13
Children 324
Energy Needs 324
Child and Preadolescent 343
Protein 325 Nutrition
Vitamins and Minerals 325
Conditions and Interventions
Common Nutrition Problems 325
Introduction 344
Iron Deficiency 325
Dental Caries 325 “Children Are Children First”—What Does
that Mean? 344
Prevention of Nutrition-Related Disorders in
Counting Children with Special Health Care Needs 344
School-Age Children 326
Overweight and Obesity in School-Age Children 326 Nutritional Requirements of Children with Special
Addressing the Problem of Pediatric Overweight Health Care Needs 345
and Obesity 328 Energy Needs 345
Nutrition and Prevention of Cardiovascular Disease Protein Needs 346
in School-Age Children 329 Other Nutrients 346
Dietary Supplements 331
Growth Assessment 346
Dietary Recommendations 330 Growth Interpretation in Children with Chronic
Recommendations for Intake of Iron, Fiber, Fat, Calcium, Conditions 347
Vitamin D, and Fluids 331 Body Composition and Growth 347

Nutrition Time Line

1930s 1937 1941

Vitamin C identified in 1932, Pellagra found to be First refined
followed by pantothenic acid due to a deficiency grain-enrichment
and riboflavin in 1933, and of niacin standards developed
vitamin K in 1934
Photodisc

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
 xiv Contents

Nutrition Recommendations 349 Promoting Healthy Eating and Physical Activity

Methods of Meeting Nutritional Requirements 350 Behaviors 381
Fluids 351 The Home Environment and Parental Involvement 381
School Programs 381
Eating and Feeding Problems in Children with Special
Community Involvement in Nutritionally Supportive
Health Care Needs 352
Environments 384
Specific Disorders 352
Dietary Supplements and Herbal Remedies 357
CHAPteR 15
Sources of Nutrition Services 357
Nutrition Intervention Model Program 359 Adolescent Nutrition 386
Conditions and Interventions
CHAPteR 14 Introduction 387
Adolescent Nutrition 361 Overweight and Obesity 387
Health Implications of Adolescent Overweight
Introduction 362
and Obesity 388
Nutritional Needs in a Time of Change 362
Assessment and Treatment of Adolescent Overweight
Normal Physical Growth and Development 362 and Obesity 388
Changes in Weight, Body Composition,
Supplement Use Among Adolescents 391
and Skeletal Mass 364
Vitamin/Mineral Supplements 391
Normal Psychosocial Development 365 Ergogenic Supplements Used by Teens 391
Health and Nutrition-Related Behaviors During Nutrition for Adolescent Athletes 392
Adolescence 366
Special Dietary Concerns Among Adolescents 394
Dietary Requirements, Intake and Adequacy Among Substance Use 394
Adolescents 369 Iron-Deficiency Anemia 395
Energy and Nutrient Requirements of Adolescents 369 Hypertension 396
Energy 369 Hyperlipidemia 396
Protein 371 Children and Adolescents with Chronic Health
Carbohydrates 371 Conditions 398
Dietary Fiber 371
Dieting, Disordered Eating, and Eating Disorders 398
Fat 372
Disordered Eating Behaviors and Eating Disorders 399
Calcium 372
Iron 372
Vitamin D 373 CHAPteR 16
Folate 374
Dietary Intake and Nutritional Adequacy 374 Adult Nutrition 407
Nutrition Screening, Assessment, and Intervention 375 Introduction 408
Nutrition Education and Counseling 376 Importance of Nutrition 408

Nutrition Time Line

1941 1946 1947

Photodisc/Getty Images

First Recommended National Vitamin B12

David Buffington/

Dietary Allowances (RDAs) School Lunch identified

AP Photo

announced by President Act passed

Franklin Roosevelt on radio

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
 Contents xv

Tracking Adult Nutritional Health and its CHAPteR 17

Determinants 409
Health Objectives for the Nation 409
Health Disparities Among Groups of Adults
Physiological Changes During the Adult Years 412
Body Composition Changes in Adults/ Lean Body Mass
and Adiposity 412
Continuum of Nutritional Health 412
States of Nutritional Health 413
Energy Recommendations 414
Age-Related Changes in Energy Expenditure 414
Estimating Energy Needs in Adults 414
Energy Adjustments for Weight Change 415
Energy Balance 416
Nutrient Recommendations 416
Macro and Micro Nutrient Recommendations
Risk Nutrients 416
Dietary Recommendations for Adults 418
Total Diet Approach 418
Beverage Intake Recommendations 420
Alcoholic Beverages 420
Water Intake Recommendations 420
Effects of Caffeine Intake on Water Need 421
Dietary Supplements and Functional Foods 421
The Eating Competence Model 422
Physical Activity Recommendations 423
Guidelines for Physical Activity 423
Promotion of Physical Activity 423
Physical Activity, Body Composition, and Metabolic
Change 424
Diet and Physical Activity 424
Nutrition Intervention for Risk Reduction
A Model Health-Promotion Program 425
Public Food and Nutrition Programs 426
Putting It All Together 427
Adult Nutrition 428
409 Conditions and Interventions
Introduction 429
Overweight and Obesity 429
Effects of Obesity 429
Etiology of Obesity 430
Screening and Assessment 430
Recommendation for Weight-Management Therapy 431
Nutrition Assessment 432
Nutrition Interventions for Weight Management 432
Weight Loss 432
Medical Nutrition Therapy for Weight Management 432
Cognitive Behavioral Therapy for Weight
Management 432
416 Physical Activity for Weight Management 434
The Challenge of Weight Maintenance 434
Pharmacotherapy for Weight Loss 434
Bariatric Surgery 434
Cardiovascular Disease 435
Prevalence of CVD 436
Etiology of Atherosclerosis 436
Physiological Effects of Atherosclerosis 437
Risk Factors for CVD 437
Screening and Assessment of CVD 437
Nutrition Interventions for CVD 437
Primary Prevention 437
Medical Nutrition Therapy for CVD 439
Pharmacotherapy of CVD 440
Metabolic Syndrome 440
Introduction 440
Prevalence of Metabolic Syndrome 441
424 Etiology of Metabolic Syndrome 441
Effects of Metabolic Syndrome 441
Screening and Assessment 441
Nutrition Interventions for Metabolic Syndrome 441

Nutrition Time Line

1953 1965 1966 1968

Double helix Food Stamp Act Child Nutrition First national nutrition
structure passed, Food Stamp Act adds school survey in United States
of DNA program established breakfast to the launched (the Ten
Photodisc

discovered National School State Nutrition

Lunch Program Survey)

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
 xvi Contents

Diabetes Mellitus 442 A Picture of the Aging Population: Vital

Prevalence of Diabetes 443
Disparities in the Prevalence of Diabetes 443
Etiology of Diabetes 443
Physiological Effects of Diabetes 443
Prevention of Diabetes Complications 443
Screening and Assessment 444
Nutrition Assessment 444
Interventions for Diabetes 444
Medical Nutrition Therapy for Diabetes 445
ADA Exchange Lists 445
Carbohydrate Counting 446
Self-Monitored Blood Glucose 446
Physical Activity in Diabetes Management 447
Pharmacological Therapy of Type 2 Diabetes 447
Herbal Remedies and Other Dietary Supplements 447
Cancer 447
Prevalence of Cancer 447
Physiological and Psychological Effects of Cancer 448
Etiology of Cancer 448
Risk Factors for Cancer 448
Screening and Assessment 448
Nutrition Interventions for Cancer 449
Alternative Medicine and Cancer Treatment 449
HIV Disease 450
Prevalence of HIV 450
Physiological Effects of HIV 450
Etiology of HIV 451
Assessment 451
Nutrition Interventions for HIV 451
CHAPteR 18
Nutrition and Older Adults
Introduction 455
What Counts as Old Depends on Who Is Counting
Food Matters: Nutrition Contributes to a Long
and Healthy Life 455
Statistics 456
Global Population Trends: Life Expectancy
and Life Span 456
Health Objectives for Older Adults 457
Theories of Aging 457
Programmed Aging 458
Wear-and-Tear Theories of Aging 458
Calorie Restriction to Increase Longevity 459
Physiological Changes 459
Body-Composition Changes 460
Changing Sensual Awareness: Taste and Smell,
Chewing and Swallowing, Appetite and Thirst 461
Nutritional Risk Factors 462
Dietary Recommendations for Older Adults 465
Nutrient Recommendations 469
Estimating Energy Needs 469
Nutrient Recommendations for Older Adults: Energy
Sources 470
Age-Associated Changes: Nutrients of Concern 473
Nutrient Supplements: When, Why, Who, What,
and How Much? 475
Dietary Supplements, Functional Foods,
and Complementary Medicine 477
Nutrient Recommendations: Using the Food Label 477
Cross-Cultural Considerations in Making Dietary
Recommendations 479
Food Safety Recommendations 479
Physical Activity Recommendations 480
Physical Activity Guidelines 480
Nutrition Policy and Intervention for Risk
454 Reduction 481
Nutrition Education 481
455 Community Food and Nutrition Programs 482
Store-to-Door: A Nongovernmental Service that
Supports Aging in Place 483

Nutrition Time Line

1970 1972 1977 1978

First Canadian national Special Supplemental Dietary Goals First Health
nutrition survey launched Food and Nutrition for the United Objectives
(Nutrition Canada Program for Women, States issued for the Nation
National Survey) Infants, and Children released
(WIC) established

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
 Contents xvii

Senior Nutrition Program: Promoting Socialization Prevalence 498

and Improved Nutrition 483 Etiology 498
The Promise of Prevention: Health Promotion 484 Effects of Osteoporosis 499
Nutritional Remedies 500
Other Issues Impacting Nutritional Remedies 501
CHAPteR 19
Oral Health 501
Nutrition and Older Adults 486 Gastrointestinal Diseases 502
Conditions and Interventions Gastroesophageal Reflux Disease (GERD) 502
Stomach Conditions Affect Nutrient Availability:
Introduction: The Importance of Nutrition 487
Vitamin B12 Malabsorption 503
Nutrition and Health 487 Constipation 504
Heart Disease 488 Inflammatory Diseases: Osteoarthritis 506
Prevalence 488 Definition and Prevalence 506
Risk Factors 488 Etiology 507
Nutritional Remedies for Cardiovascular Diseases 489 Effects of Osteoarthritis 507
Risk Factors 508
Stroke 490
Nutritional Remedies 508
Definition 490
Prevalence 490 Cognitive Impairment, Dementia and Alzheimer's
Etiology 491 Disease 508
Effects of Stroke 491 Definition 508
Risk Factors 491 Prevalence 509
Nutritional Remedies 491 Etiology of Cognitive Impairment 509
Effects of Cognitive Impairment 510
Hypertension 492
Nutrition Interventions for Cognitive Impairment 510
Definition 492
Prevalence 492 Polypharmacy: Prescription and Over-the-Counter
Etiology 492 Medications 510
Effects of Hypertension 492
Low Body Weight /Unintentional Weight Loss 512
Risk Factors 492
Definition 512
Nutritional Remedies 492
Etiology and Effects 513
Diabetes: Special Concerns for Older Adults 494 Nutrition Interventions 514
Effects of Diabetes 494
Dehydration 514
Nutritional Interventions 494
Definition 514
Obesity 495 Etiology 515
Definition 495 Effects of Dehydration 515
Prevalence 496 Nutritional Interventions 515
Etiology, Effects, and Risk Factors of Obesity 496 Rehydrate Slowly 516
Nutritional Remedies 497 Dehydration at End of Life 516
Osteoporosis 498 Bereavement 516
Definition 498 Addendum 516

Nutrition Time Line

1997 1998 2003 2009

RDAs Folic acid Sequencing of Obesity and
expanded fortification DNA in the human diabetes
to Dietary of refined genome completed. become
USDA

Reference grain Marks beginning global 2011

Jeff Greenberg/Alamy

Intakes products of new era of epidemics USDA introduces

(DRIs) begins research in the MyPlate icon and
nutrient–gene ChooseMyPlate.gov food
interactions and dietary guidance

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
xviii Contents

Answers to Review Questions AR-1 Appendix C

Appendix A Body Mass Index (BMI) A-5
Summary of Research of Effects References R-1
of Exercise Activities on Health
Glossary G-1
of Older Adults A-1
Index I-1
Appendix B
Measurement Abbreviations
and Equivalents A-3

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

Preface
It is our privilege to offer you the fifth edition of Nutrition
Through the Life Cycle. This text was initially developed,
and has been revised, to address the needs of instructors
teaching, and students taking, a two- to four-credit course
in life-cycle nutrition. It is written at a level that assumes
students have had an introductory nutrition course.
Overall, the text is intended to give instructors a tool they
can productively use to enhance their teaching efforts, and
to give students an engaging and rewarding educational
experience they will carry with them throughout their lives
and careers.
The authors of Nutrition Through the Life Cycle
represent a group of experts who are actively engaged in
clinical practice, teaching, and research related to nutrition
during specific phases of the life cycle. All of us remain
totally dedicated to the goals established for the text at
its conception: to make the text comprehensive, logically
organized, evidence-based, realistic, and relevant to the
needs of instructors and students.
Chapter 1 summarizes key elements of introductory
nutrition and gives students who need it a chance to
update or renew their knowledge. Students can “test” their
knowledge of many aspects of introductory nutrition by
answering the review questions listed at the end of the
chapter. Coverage of the life-cycle phases begins with pre-
conception nutrition and continues with each major phase
of the life cycle through adulthood and the special needs of
the elderly. Each of these 19 chapters was developed based
on a common organizational framework that includes
key nutrition concepts, prevalence statistics, physiological
principles, nutritional needs and recommendations, model
programs, case studies, and recommended practices.
To meet the knowledge needs of students with the vari-
ety of career goals represented in many life-cycle nutrition
courses, we include two chapters for each life-cycle phase.
The first chapter for each phase covers normal nutrition
topics, and the second covers nutrition-related conditions
and interventions. Every chapter focuses on scientifically
based information and employs up-to-date resources and
references. Each chapter begins with learning objectives
and ends with a list of key points and review questions.
Answers to the case studies and review questions,
and Internet resources that lead to reliable information on
topics presented in the chapters, are now located on the
web and can be accessed through www.cengagebrain.com.
Web addresses that lead to scientific consensus and other
reports coming out within a year or two are also listed.
Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
Chapter 1: Nutrition Basics xix
New to the Fifth Edition
Advances in knowledge about nutrition and health
through the life cycle are expanding at a remarkably
high rate. New research is taking our understanding of the
roles played by healthful diets, nutrients, gene variants and
nutrient–gene interactions, body fat, physical activity, and
dietary supplements to new levels. The continued escala-
tion of rates of overweight, obesity, and type 2 diabetes are
having broad effects on the incidence of disease throughout
the life cycle. New knowledge about nutrition and health
through the life cycle requires that we understand the ef-
fects of nutrients and body fat on hormonal activity, nutri-
ent triggers to gene expression, and the roles of nutrients in
the development and correction of chronic inflammation,
oxidative stress, and endothelial dysfunction. Recommen-
dations for dietary and nutrient supplement intake and for
physical activity in health and disease are changing due to
these understandings.
The practice of dietetics and nutrition is changing due
to the emerging emphasis on electronic medical records,
evidence-based health care services, and standardization of
care delivery. The American Academy of Food and Nutrition
is responding to these changes though the development and
implementation of nutrition care process standards. These
standards are intended to provide a systematic approach to
the delivery of nutrition care to patients and clients.
You will see these emerging areas of direct relevance
to nutrition and updated information about nutrition
incorporated throughout the fifth edition of Nutrition
Through the Life Cycle. It differs from the previous edition
in several important ways. We have:
created learning objectives relevant to each major
topic covered in the chapters;
expanded the number and types of review questions
listed at the end of the chapters;
inserted new photographs, tables, and figures to
enhance instruction and student understanding of
material presented; and
incorporated information from ChooseMyPlate,
the 2010 Dietary Guidelines, and the 2020 Health
Objectives for the Nation into this edition.
Chapter-by-Chapter Changes
In addition to the enhancements just listed for every
chapter, we have extensively revised and updated the text
based on the most current research. The following list
summarizes the major changes.
xix
 xx Preface
Chapter 1: Nutrition Basics
Expanded coverage of the effects of gene variants
and nutrient–gene interactions that influence health
and disease risk
Updated recommendations on EPA, DHA intake
and health
Incorporated 2010 Dietary Guidelines and
ChooseMyPlate recommendations into the content, as
well as the Healthy People 2020 nutrition objectives
Added a section related to the use of USDA’s
ChooseMyPlate interactive diet planning and evalua-
tion tools
Reorganized and re-focused content on healthy
diets, expanded coverage of the DASH Eating Plan
Added 20 review questions to the end of the chapter
Chapter 2: Preconception Nutrition
Extensively modified content on nutritional
implications of traditional contraceptives and a look
at proposed male hormonal contraceptives
Expanded coverage on the periconceptional period, in-
cluding effects of nutrient intake and nutritional status
during this period on fertility and pregnancy outcome
Added emphasis on gene variants and nutrient
utilization
Added content on culturally and ethnically based
differences in folate status, neural tube defect
prevalence, and availability and utilization of folic
acid–fortified foods
Replaced MyPyramid with ChooseMyPlate content on
healthy diets for women and men prior to conception
Expanded review questions from Chapters 12 to 29
Chapter 3: Preconception Nutrition: Conditions
and Interventions
New content on “Negative Energy Balance and
Fertility”
Major sections of content are reorganized within the
chapter
New illustrations appear
Content on medical nutrition therapy for various
conditions has been condensed
Content on herbal remedies is now incorporated
into chapter contents
Review questions expanded from
Chapters 12 to 24
Chapter 4: Nutrition During Pregnancy
Several major content sections are reorganized
within the chapter
Expanded coverage of food safety during pregnancy
Changes “Fetal Origins Hypothesis” to “Develop-
mental Origins” and added new examples of nutri-
tional triggers to later disease development
Replaced illustrations to reflect updated content and
recommendations
Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
Added content on the effects of the famine in China
(1959–61) on pregnancy outcome.
Added multiple examples of diet for pregnancy from
ChooseMyPlate.gov
Extensively revised content on postpartum weight
retention
Expanded review questions from Chapters 11 to 33
Chapter 5: Nutrition During Pregnancy: Conditions
and Interventions
Extensively revised content on gestational and
type 2 diabetes in pregnancy
Added content on newly identified gene variants and
their effect on nutrient metabolism and disease and
disorder risk during pregnancy
Redirected content on fetal alcohol spectrum to
fetal alcohol spectrum disorders and provided
new definitions and information about these
disorders
Added information about alcohol intake and its ef-
fects on pregnancy outcome
Added content on recently released nutrition
recommendations for pregnant women
with HIV/AIDS
Chapter 6: Nutrition During Lactation
Updated to reflect more current breastfeeding rates
and the progress in initiation that has been made
Added the composition of a human milk substitute
(formula) to the table along with human and cow’s
milk composition
Updated Mypyramid data to MyPlate data
Added a figure demonstrating the lay-back position
for nursing
Chapter 7: Nutrition During Lactation: Conditions
and Interventions
Mastitis incidence updated
Added caution regarding herbal galactogogues from
Academy of Breastfeeding Medicine
Added information on Domperidone’s orphan drug
status
Alcohol section updated to reflect current recom-
mendations on use during lactation
Smoking and lactation section updated
Caffeine section updated to include recommended
intake of coffee
Food allergy and intolerance section updated
to include recommendations from the National
Institute of Allergy and Infectious Diseases
American Academy of Pediatrics practice
recommendations on use of human milk for preterm
infants updated
2010 WHO recommendations on breastfeeding and
HIV included
Milk Banking statistics updated

Chapter 8: Infant Nutrition
Incorporated Nutrition Care process language
Introduced standardized language in nutrition
diagnosis for iron deficiency anemia in contrast to
medical diagnosis
Incorporating Healthy People 2020 objectives and
2010 Dietary Guidelines in text and in replaced and
expanded Table 8.1
New table about CDC and WHO growth charts
Incorporated Iron recommendations from the
AAP in text
Incorporated Vitamin D recommendations
Incorporated WHO growth standard
recommendation from CDC for <24 months
Incorporated 2010 AAP clinical report on iron and
iron deficiency recommendations for infants
Replaced Infant Exercise topic changed to
Environmental Recommendations
Infant mortality updated
Added NIH allergy guidelines for lactose and soy
formula
Updated Table 8.6, adding prebiotics and nucleo-
tides to formula
Chapter 9: Infant Nutrition: Conditions
and Interventions
Incorporated Nutrition Care process language
Explained the difference between medical diagnoses
and nutrition diagnoses in two chronic conditions:
Down syndrome and severe prematurity
Added text about probiotics and prebiotics in
preemies
Added text about US-ASPEN 2009 enteral nutrition
practice including milk banking
Added text about WHO growth charts, Fenton and
Olsen charts
Included text and references on near-term preemie
outcomes
Confirmed and updated Table 9.2 formula composition
New illustration showing the WHO growth chart
for an infant who has correction for prematurity
New illustration depicting how a boy with IUGR grows
over time as plotted on a standard WHO growth chart
Replaced VCFS with preferred term Chromosome
22q11.2
Updated terminology for fetal, infant and prenatal
deaths based on AAP 2011 report
Updated vital statistics, 2005 Dietary Guidelines
and 2010 Healthy People objectives
Added text to emphasize outcome research and cut
back on infant mortality
Chapter 10: Toddler and Preschooler Nutrition
Children’s health status data updated
Updated health objectives to Healthy People 2020
objectives
Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
Preface xxi
Revised overweight and obesity data to the
NHANES 2009-10 data
Updated data for common nutritional problems of
toddlers and preschoolers, including iron deficiency,
dental caries, abnormal blood lead levels, and food
insecurity
Dietary Guidelines for Americans updated
to 2010 version
Updated information found in Consumer Nutrition
Education tool from MyPlate.gov
Added recommendations from NHLBI expert
panel on evidence-based cardiovascular guidelines,
including the CHILD-1, CHILD-2-LDL, and
CHILD-2-TG diet patterns
Updated intake data to NHANES 2009–2010 data
Chapter 11: Toddler and Preschooler Nutrition:
Conditions and Interventions
Incorporated Nutrition Care process language
Based on the increased primary care developmental
screening related to autism spectrum disorders,
chapter has been updated with clarification of
education laws (IDEA and Part C), with two new
tables: Table 11.1 on Early Intervention Nutrition
Services for 3- to 5-year-old children (related to
expansion of education), Table 11.2 provides notes
for educational, medical, and nutrition problems for
one toddler and one preschooler
Added text about nutrition assessment and its
benefits in the growth section
Added text with example to emphasize medicine
and nutrition for home care of complexly
ill children
New Illustration 11.2 on WHO growth chart
Chapter 12: Child and Preadolescent Nutrition
Statistics on child and preadolescent health updated
Revised health objectives to Healthy People 2020
objectives
Updated overweight and obesity data to NHANES
2009–10 data
Added information about the NHLBI expert panel
recommendations on evidence-based cardiovascular
health guidelines
Updated intake data to NHANES 2009–10 data
Updated nutrition standards in the National School
Lunch and School Breakfast Programs to current
USDA standards
Chapter 13: Child and Preadolescent Nutrition:
Conditions and Interventions
Incorporated Nutrition Care process language
Updated text about Down syndrome growth charts
Added role of parent and child at home,
showing technology dependency in Nutrition
Recommendations
xxii Preface
Added text about growth hormone use and its im-
pact in growth assessment
Updated prevalence for each chronic condition
(e.g., diabetes)
Added prevalence of and information about celiac
disease to chronic conditions
Chapter 14: Adolescent Nutrition
Revised and rearranged content on eating behaviors
and dietary quality
Dietary adequacy information arranged to fit in
nutrition needs portion of the chapter
Updated common dietary behaviors and nutrient
concerns
National data on nutrient inadequacies revised
Chapter 15: Adolescent Nutrition: Conditions
and Interventions
Updated information on sports nutrition
(moved from Chapter 14)
New table showing recommendations for food and
beverages prior to sports events
Rearranged special needs nutrition section to fall
under the special dietary concerns information
New table showing recommendations for fluid
intake during strenuous physical activity
Chapter 16: Adult Nutrition
Chapter reorganized to flow from defining
nutritional needs of adults to dietary guidance and
interventions to meet needs
New information on the determinants of nutritional
health includes environmental factors
The continuum of nutritional health is now part of
physiological changes during the adult years
New section on Energy Recommendations better
organizes energy requirements and methods of
estimating energy expenditure
Added information about risk nutrients , including
how they are grouped by similar functions, and pre-
sented newest research about excesses or inadequacies
Updated information from the Dietary Guidelines
includes the Total Diet Approach
The Eating Competence Model is presented as a
contrast to the “prescriptive” Dietary Guidelines
New illustration showing the determinants and
overarching goals of Healthy People 2020
Chapter 17: Adult Nutrition: Conditions
and Interventions
New information about the three compartments for fat
storage, and expanded explanation of central adiposity
Included conclusions from recent systematic reviews
of evidence
Revised content and tables to reflect new
perspectives of Healthy People 2020
Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
Guidelines for management of diabetes reflect new
views regarding individualization of A1C goals for
those with longer duration of diabetes
Newest version of the ADA Exchange Lists for
diabetes meal planning
Content revised to reflect evolving recommendations
regarding the percentage of calories from
carbohydrates and fat
Information about chronic disease being a greater
concern in HIV included
Chapter 18: Nutrition and Older Adults
Graphics for the most recent food guidance tools
updated
Revised supplement guidance and dietary reference
intake information for vitamins and minerals
Updated tables on “What We Eat in America”
New table on poverty benchmarks among older adults
New vital health statistics, including longevity
around the world and Healthy People 2020
Chapter 19: Nutrition and Older Adults: Conditions
and Interventions
Reviewed and updated all text sections, integrating
new treatment effectiveness evidence
Included table addressing budgetary constraints that
affect food purchasing
Updated tables, including prevalence of chronic
disease, treatment of heart disease, and oral health
status of older adults
Included table of nutritional values of cereal grains,
including glycemic index
Instructor Resources
Updated for the fifth edition is a Power Lecture DVD-ROM
that contains Microsoft PowerPoint™ lecture presentations
with artwork, chapter outlines, classroom activities, lecture
launchers, Internet exercises, discussion questions, hyperlinks
to relevant websites, and case studies. The DVD-ROM also
includes a Test Bank, expanded and improved, that contains
multiple-choice, true/false, matching, and discussion exercises.
Acknowledgments
It takes the combined talents and efforts of authors, edi-
tors, assistants, and the publisher to develop a new edition
of a textbook and its instructional resources. The positive
attitude and efforts of Marni Rolfes, Developmental Edi-
tor, in the fifth edition are applauded by all of the authors.
We are fortunate to have Peggy Williams, Senior Acquisi-
tions Editor, heading up the team that supports the growth
and development of Nutrition Through the Life Cycle.
Reviewers
Many thanks to the following reviewers, whose careful
reading and thoughtful comments helped enormously in
shaping both earlier editions and this fifth edition.
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