Wardlaw contemporary nutrition a funcional approach 5th smith 1

Wardlaw’s Contemporary Nutrition: A Functional Approach is organized somewhat differently than the traditional nutrition textbook as seen in the contents of Contemporary Nutrition sho

Contemporary NUTRITION

Wardlaw’s

A Functional Approach

Fifth Edition

smi06605_FM_i-xxvii.indd ii 11/24/16 07:06 PM

WARDLAW’S CONTEMPORARY NUTRITION: A FUNCTIONAL APPROACH,

FIFTH EDITION

Published by McGraw-Hill Education, 2 Penn Plaza, New York, NY 10121 Copyright © 2018 by

McGraw-Hill Education All rights reserved Printed in the United States of America Previous

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1 2 3 4 5 6 7 8 9 LMN 21 20 19 18 17

ISBN 978-1-259-70660-8

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Library of Congress Cataloging-in-Publication Data

Names: Wardlaw, Gordon M | Smith, Anne M., 1955 | Collene, Angela.

Title: Wardlaw’s contemporary nutrition : a functional approach.

Other titles: Contemporary nutrition : a functional approach

Description: Fifth edition / Anne M Smith Ph.D., R.D.N., L.D.,

Department of Human Sciences, College of Education and Human Ecology,

The Ohio State University, Angela L Collene M.S., R.D.N., L.D | New York, NY :

McGraw-Hill Education, [2018] | Includes index.

Identifiers: LCCN 2016042223 | ISBN 9781259706608 (alk paper)

Subjects: LCSH: Nutrition.

Classification: LCC QP141 W377 2018 | DDC 613.2—dc23 LC record available at

https://lccn.loc.gov/2016042223

The Internet addresses listed in the text were accurate at the time of publication The inclusion of a

website does not indicate an endorsement by the authors or Hill Education, and

McGraw-Hill Education does not guarantee the accuracy of the information presented at these sites.

mheducation.com/highered

Brief Contents

Breakfast: ©Corbis/Punchstock; bowl of cereal: ©Medioimages/Photodisc/Getty Images; citrus fruit: ©Creatas/PunchStock; woman hitting volleyball: ©Purestock/SuperStock; pregnant woman: ©Getty Images

to change! Do carbohydrates cause weight gain? Do I need to limit saturated fat? Should we eat foods that contain gluten or not? Second, there are so many choices Did you know that the average supermarket carries about 40,000 food and beverage products? The manufacturers of all those products are vying for your attention, but typically, the most aggressively marketed items are not the healthiest How can you identify a healthy product? Third, as a nation, we eat many of our meals and snacks away from home When we eat foods that someone else has prepared for us, we surrender control over what is in our food, where the food came from, and how much of it goes on our plates Undoubtedly, you are interested in what you should be eating and how the food you eat affects you.

accurately convey changing and seemingly conflicting messages to all kinds of students Our students commonly have misconceptions about nutrition, and many have a limited background in biology or chemistry We teach complex scientific concepts at a level that will enable you to apply the material to your own life.

Functional Approach We are very excited to introduce you to our newest

author, Dr. Colleen Spees! Like our other authors, she is a Registered Dietitian Nutritionist, which means she will help you to translate nutrition science into practical advice At The Ohio State University, Dr Spees is a valued expert on cancer, nutritional genomics, and food security We are thrilled that she brings her unique perspective and contemporary ideas to our team.

As in previous editions, we have written this book to help you make informed choices about the food you eat We will take you through explanations of the nutrients in food and their relationship to health but will also make you aware

of the multitude of other factors that drive food choices To guide you, we refer

to many reputable research studies, books, policies, and websites throughout the book With this information at your fingertips, you will be well equipped to make your own informed choices about what and how much to eat There is much to learn, so let’s get started!

Anne Smith Angela Collene Colleen Spees

Contemporary NUTRITION

The Ohio State University

Colleen K Spees Ph.D., M.Ed., R.D.N., L.D., FAND

Division of Medical Dietetics and Health Sciences,

College of Medicine The Ohio State University

ANNE M SMITH, Ph.D., R.D.N., L.D., is an associate professor emeritus at The Ohio State

University She was the recipient of the 1995 Outstanding Teacher Award from the College

of Human Ecology, the 2008 Outstanding Dietetic Educator Award from the Ohio Dietetic Association, the 2006 Outstanding Faculty Member Award from the Department of Human Nutrition, and the 2011 Distinguished Service Award from the College of Education and Human Ecology for her commitment to undergraduate education in nutrition Dr Smith’s research in the area of vitamin and mineral metabolism has appeared in prominent nutrition journals, and she was awarded the 1996 Research Award from the Ohio Agricultural Research and Development Center She is a member of the American Society for Nutrition and the Academy of Nutrition and Dietetics

ANGELA L COLLENE, M.S., R.D.N., L.D., began her career at her alma mater, The

Ohio State University, as a research dietitian for studies related to diabetes and aging Other professional experiences include community nutrition lecturing and counseling, owner of a personal chef business, and many diverse and rewarding science writing and editing projects

Her interests include novel approaches to glycemic control, weight management, and—quite predictably for the mother of three little girls—maternal and child nutrition Mrs Collene currently teaches nutrition at The Ohio State University and Ohio Northern University

She is a member of the Academy of Nutrition and Dietetics

COLLEEN K SPEES, Ph.D., M.Ed., R.D.N., L.D., FAND is an academic instructor and

researcher at The Ohio State University College of Medicine She earned her Doctorate in Health Sciences at Ohio State with a research focus on Nutritional Genomics and Cancer and her Master’s degree in Exercise Science and Health Promotion from Vanderbilt University

Her primary focus of teaching and research involves interventions aimed at providing optimal nutrition for vulnerable populations (http://go.osu.edu/hope) In addition to teaching nutrition at The Ohio State University and Columbus State Community College, Dr Spees also developed and teaches a graduate level Nutritional Genomics course She is the recipient

of several national awards from the Academy of Nutrition and Dietetics, including the 2016 Distinguished Practice Award; 2015 Award for Excellence in Oncology Nutrition Research;

2015 Outstanding Dietetic Educator Award; 2013 Nutrition Informatics Video Challenge Teaching Award; 2009 Top Innovator in Education Teaching Award; and has been a Content Expert and Reviewer for the Nutritional Genomics & Food Security Academy Position Papers

Dr Spees is also a recognized Fellow of the Academy of Nutrition and Dietetics

About the Authors

Monty Soungpradith; © Open

Image Studio

© RALPHOTOSTUDIO

Special Acknowledgements

It is because of the tireless efforts of a cohesive team of talented professionals that we can bring you the fifth edition of

top-notch staff at McGraw-Hill Education We are grateful to Marija Magner, our Brand Manager, for her strategic ship and vast knowledge of the higher education market We value the efforts of our Marketing Manager, Jessica Cannavo, who connects instructors across the nation with our work and brings us constructive feedback from the field We thank our award-winning Product Developer, Darlene Schueller, who coordinated the editorial team with her keen eye for detail, strong work ethic, and organizational expertise We are grateful to our Content Project Managers, April Southwood and Jane Mohr, and their staff for the careful coordination of the numerous production efforts needed to create the very appeal-ing and accurate fifth edition We appreciate the meticulous work of our copyeditor, Carey Lange; proofreaders, David Staloch and Gina Delaney; our content licensing specialists, Lorraine Buczek and Lori Slattery; and photo editors, Lori Hancock and Mary Reeg We thank our designer, Tara McDermott, who ensured that every aspect of our work is visually appealing—not just on the printed page, but also in a variety of digital formats Finally, we are indebted to our colleagues, friends, and families for their constant encouragement, honest feedback, and shared passion for the science of nutrition

leader-In the preparation of each edition, we have been guided by the collective wisdom of reviewers who are excellent teachers They represent experience in community colleges, liberal arts colleges, institutions, and universities We have followed their recommendations, while remaining true to our overriding goal of writing a readable, student-centered text. 

Also with this edition, we are very pleased to have been able to incorporate real student data points and input, derived from thousands of our LearnSmart users, to help guide our revision LearnSmart heat maps provided a quick visual snap-shot of usage of portions of the text and the relative difficulty students experienced in mastering the content With these data, we were able to hone not only our text content but also the LearnSmart probes

Acknowledgements

With the fifth edition of Wardlaw’s Contemporary Nutrition: A Functional Approach, we remember its founding author,

Gordon M Wardlaw We are saddened that he lost his battle with cancer on January 19, 2014 He was a brilliant example of a man who acted decisively, followed his dreams, and created a legacy of learning

Dr Wardlaw had a passion for the science of nutrition and the research that supports it With his clear teaching style and

no-nonsense nutrition advice, he demonstrated an exceptional ability to translate scientific principles into practical knowledge both inside and outside the classroom This skill is what made his book truly “contemporary.” He was tireless when it came to stay-ing current and relevant to a changing world Each edition benefited from his genuine interest in responding to feedback from

students, colleagues, and instructors He retired from teaching and writing in 2005 to pursue another passion—building his

dream home in California There, in a home he built with his own two hands, he spent the last years of his life with his family and friends

It has been a privilege for all of us to join Dr Wardlaw as coauthors of this textbook For Anne Smith, he was an extraordinary colleague, mentor, and friend, who patiently taught her every step of the textbook writing process, beginning with the sixth

edition of Contemporary Nutrition Angela Collene was blessed to have been one of his graduate students at The Ohio State

University, when she first began to assist with revisions to his books Colleen Spees was a student in Dr Wardlaw’s first tion class at The Ohio State University and now holds his previous tenure-track position Like so many other students, col-

nutri-leagues, and friends, we remember Dr.  Wardlaw as a source of vast knowledge, good humor, and inspiration The best way

we know to honor our dear friend and mentor is to carry on his legacy of outstanding textbooks in introductory nutrition

Wardlaw’s Contemporary Nutrition: A Functional Approach will continue to evolve and reflect current trends and

break-throughs in nutrition science, but Dr Wardlaw’s fingerprints will remain on every page

smi06605_FM_i-xxvii.indd viii 11/26/16 10:53 AM

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auto-matically graded All Connect content is created by the authors,

so it is pedagogical, instructional, and at the appropriate level

Interactive questions using high-quality art from the textbook and

animations and videos from a variety of sources take you way

beyond multiple choice Assignable features from the book, such

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Your Plate, increase student engagement and understanding.

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traditional, hybrid, “flipped classes,” and online courses to record lessons, lectures, and skills.

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the ESHA database of well over 30,000 foods NutritionCalc Plus

allows your students to track their food and activity, and then

analyze their choices with a robust selection of reports This tool

is provided complimentary in Connect with Wardlaw’s

Contempo-rary Nutrition: A Functional Approach.

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Understanding Our Audience

We have written Wardlaw’s Contemporary Nutrition: A Functional Approach assuming that our students have a limited background

in college-level biology, chemistry, or physiology We have been careful to include the essential science foundation needed

to adequately comprehend certain topics in nutrition, such

as protein synthesis in Chapter 6 The science in this text has been presented in a simple, straightforward manner so that undergraduate students can master the material and apply it to their own lives The Concept Maps and detailed, annotated figures bring complex topics into view for students from any major.

Why the Functional Approach?

Wardlaw’s Contemporary Nutrition: A Functional Approach is

organized somewhat differently than the traditional nutrition

textbook (as seen in the contents of Contemporary Nutrition

shown on the right) in that Part Three presents information on

vitamins, minerals, and water using “a functional approach.”

Instead of describing these nutrients in their traditional categories

(e.g., water-soluble vitamins), we discuss them in groups based

on their roles in fluid and electrolyte balance, body defenses,

bone health, energy metabolism, blood health, and brain health

This format enables students to understand how these nutrients

interact in food and in our bodies to support key functions that

1 Nutrition, Food Choices, and Health 3

2 Designing a Healthy Dietary Pattern 37

3 The Human Body: A Nutrition Perspective 77

4 Carbohydrates 119

5 Lipids 159

6 Proteins 201

7 Energy Balance and Weight Control 233

8 Overview of Micronutrients and Phytochemicals 275

9 Fluid and Electrolyte Balance 303

10 Nutrients Involved in Body Defenses 333

11 Nutrients Involved in Bone Health 377

12 Micronutrient Function in Energy Metabolism 415

13 Nutrients That Support Blood and Brain Health 443

14 Nutrition: Fitness and Sports 475

15 Eating Disorders 513

16 Undernutrition Throughout the World 545

17 Safety of Our Food Supply 581

18 Nutrition During Pregnancy and Breastfeeding 621

19 Nutrition from Infancy Through Adolescence 663

20 Nutrition During Adulthood 707

Brief Contents

Wardlaw’s Contemporary Nutrition:

Constipation, difficult or infrequent evacuation of the bowels, is

commonly reported by adults Slow movement of fecal rial through the large intestine causes constipation More fluid is absorbed during the extended time the feces stay in the large intestine, so the feces become dry and hard.

mate-Constipation can result when people regularly ignore their normal bowel reflexes for long periods People may ignore nor- mal urges when it is inconvenient to interrupt occupational or social activities Muscle spasms of an irritated large intestine can also slow the movement of feces and contribute to constipation Calcium or iron supplements, and medications such as antacids, can also cause constipation.

How do you know if you have a peptic ulcer? Some people experience no symptoms at all, but most notice stomach pain about 2 hours after eating Stomach acid acting on a meal irritates the ulcer after most of the meal has moved from the site of the ulcer Other symptoms may include weight loss, lack of appetite, nausea and vomiting, or bloating Vomiting blood or what looks like coffee grounds and the appearance of black, tarry stools are signs

of bleeding in the GI tract Any evidence of GI bleeding warrants immediate medical attention.

The two chief culprits of peptic ulcer disease are infection of the stomach by the acid-resistant bacteria, Helicobacter pylori (H. pylori), and heavy use of medications that impair mucus produc- tion by the stomach Conditions that cause excessive stomach acid production also play a role In addition, cigarette smoking is known

to cause ulcers, increase ulcer complications such as bleeding, and lead to ulcer treatment failure.

H pylori bacteria is found in more than 80% of patients with stomach and duodenal ulcers The bacteria is common but results

in ulcer disease in only 10% to 15% of those infected Although the mechanism by which H pylori causes ulcers is not well under- stood, treatment of the infection with antibiotics heals the ulcers and prevents their recurrence Two Australian physicians were awarded the Nobel Prize in 2005 “for their discovery of the bac- terium H. pylori and its role in gastritis and peptic ulcer disease.”

Nonsteroidal anti-inflammatory drugs (NSAIDs) are

medica-tions for painful inflammatory condimedica-tions such as arthritis rin, ibuprofen, and naproxen are the most commonly used types

Aspi-NSAIDs reduce the mucus secreted by the stomach Newer ications, called “Cox-2 inhibitors” (e.g., celecoxib [Celebrex®]), have been used as a replacement for NSAIDs because they are less likely to cause stomach ulcers They do offer some advan- tages over NSAIDs, but they may not be totally safe for some people, especially those with a history of cardiovascular disease

med-or strokes.

The primary risk associated with an ulcer is the possibility that

it will erode entirely through the stomach or intestinal wall The GI contents could then spill into the body cavities, causing a massive infection In addition, an ulcer may damage a blood vessel, leading

to substantial blood loss For these reasons, it is important to never ignore the early warning signs of ulcer development, which include

a persistent gnawing or burning near the stomach that may occur immediately following a meal or awaken you at night.

Today, a combination approach is used for ulcer therapy ple infected with H pylori are given antibiotics and stomach acid- blocking medications (see Medicine Cabinet) There is a 90% cure rate for H pylori infections in the first week of this treatment Recur- rence is unlikely if the infection is cured, but an incomplete cure almost certainly leads to repeated ulcer formation (see Further Reading 14).

Peo-Are dietary changes effective for prevention or treatment of peptic ulcers? Many people think that eating spicy or acidic foods can cause ulcers Contrary to popular belief, these foods do not cause ulcers However, once an ulcer has developed, these foods may irritate damaged tissues Thus, for some people, avoidance of spicy or acidic foods may help to relieve symptoms.

In the past, milk and cream were thought to help cure ulcers

Clinicians now know that milk and cream are two of the worst foods for a person with ulcers because the calcium in these foods stimulates acid secretion and actually inhibits ulcer healing.

NSAIDs Nonsteroidal anti-inflammatory drugs; include aspirin, fen (Advil®), and naproxen (Aleve®).

ibupro-constipation A condition characterized by infrequent bowel movements.

Proton pump inhibitors (PPIs) are medications that inhibit the

ability of gastric cells to secrete hydrogen ions (i.e., protons) Low doses of this class of medications may be available with- out a prescription Because stomach acid is important for the absorption of vitamin B-12, prolonged use of PPIs could impair vitamin B-12 status.

acid-producing cells in the stomach.

▼ Regular physical activity complements a healthy diet Whether it is all at once or in segments throughout the day, incorporate

30 to 60 minutes or more of such activity into your daily routine.  © Monkey Business Image/AGE fotostock

Dear RDN: I am interested in making positive changes to my eating pattern to reach a healthy

weight and feel better How can I find a qualified nutrition expert who will give me personalized nutrition advice?

You have already made a big step toward better nutrition by taking this nutrition course! The information in this textbook is written by authors who are all qualified nutrition experts, namely registered dietitian nutritionists (RDN) The textbook and your instructor will provide a solid foun- dation in nutrition, but be aware that some people call themselves “nutritionists” without qualified training in nutrition The best approach to finding answers about your personal nutritional state is

to consult your primary care provider, registered dietitian (RD), or registered dietitian nutritionist (RDN) The RD/RDN has been certified by the Commission on Dietetic Registration of the Acad-

emy of Nutrition and Dietetics (AND) after completing rigorous classroom and clinical training in nutrition The RD/RDN must also complete continuing education The RD credential was recently updated to RDN to better reflect the scope of practice of dietitians. While both titles signify the same credential, we will use RDN when referring to dietitians in this book.

You can begin your search for a local RDN by asking your primary care provider or calling your health insurance company for a referral You can also find an RDN by using the AND national referral service, called Find a Registered Dietitian Nutritionist This service links consumers with qualified nutrition practitioners who provide reliable, objective nutrition information Visit the website, www.eatright.org, and click on “Find an Expert.” (In Canada, visit the Dietitians of Canada website, www.dietitians.ca, and click on “Find a Dietitian.”) Enter your ZIP code or state to display the providers in your area Select additional specialties that may apply to your specific needs The website will display a list of providers. A professional with the RD or RDN credential after his or her name is a qualified nutrition expert who is trained to help you separate facts from fads, and optimize your health with better food choices You can trust an RDN to translate the latest scien- tific findings into easy-to-understand nutrition information that you can sink your teeth into.

I hope this answer was helpful. We will use this feature, “Ask the RDN,” in every chapter to answer questions about topics that may seem to have conflicting viewpoints.

Your nutrition expert,

Anne M Smith, PhD, RDN, LD (author)

registered dietitian (RD) A person who has completed a baccalaureate degree program approved by the Accreditation Council for Education in Nutrition and Dietetics (ACEND), performed at least

1200 hours of supervised professional practice, passed a registration examina- tion, and complies with continuing educa- tion requirements.

registered dietitian nutritionist (RDN) The RDN is the updated credential formerly abbreviated RD. The credential was updated to better reflect the scope

of practice of the dietitian and to align with the new name of the professional organization for dietitians, the Academy

of Nutrition and Dietetics.

Who’s the Expert?

Fur-The report, F as in Fat: How Obesity Threatens America’s Future 2013 (see Further

Reading 19), shares evidence that since 2005 the rate of increase in obesity has been ing This is good news If the incidence of obesity continued to grow at recent rates, the effects on the health and wealth of our nation would be catastrophic by the year 2030

are obese,* by state, 2013.

Source: CDC, Prevalence of Self-Reported Obesity

Among U.S Adults by State and Territory, BRFSS,

2013.

*Body mass index (BMI) > 30, or about 30 pounds

overweight for a 5′9″ person, based on

self-reported weight and height.

AZ NM

AK

HI

GU PR

ND MN

MI WI IA MO

IL IN OH

PA NY ME

AR

SD NE KS OK TX

KY WV VA NC SC GA

TN LA

MS AL

VT NH MA RI CT NJ

MD DE CO

FL DC

a hypothesis that the prevalence of obesity in youth and adults would also have remained stable between 2003 and 2012 The purpose of this study was to analyze trends in childhood and adult obesity between 2003 and 2012 The analyses were based on measurements of weight and height in 9120 participants from the 2011—2012 National Health and Nutrition Examination Survey (NHANES) Childhood obesity was defined as a body mass index (BMI) at or above the 95th percentile of the CDC BMI- for-age growth charts in children and adolescents aged 2 to 19 years In adults, obesity was defined as a BMI greater than or equal to 30 Trends in obesity prevalence were analyzed across five periods (2003—2004, 2005—2006, 2007—2008, 2009—2010, and 2011—2012) Overall, the results of this study indicate no significant change for obesity from 2003—2004 through 2011—2012 in 2- to 19-year-olds or adults Results for prevalence of obesity in 2011—2012 were 16.9% in youth and 34.9% in adults There was a significant decrease in obesity from 13.9% to 8.4% among 2- to 5-year-olds and

a significant increase in obesity from 31.5% to 38.1% among women aged 60 years and older Based on these results, the authors of this study conclude that, while not increasing overall, the prevalence of obesity remains high in youth and adults, and thus should continue to be under surveillance.

Source: Ogden CL and others: Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association 311:806, 2014 (see Further Reading 16).

Newsworthy Nutrition, a feature in each chapter, highlights the use of the scientific method in recently published research studies that relate to the chapter topics In addition, assignable questions

in Connect take learning a step further by asking students to read primary literature and apply what they have learned.

Featuring the Latest Guidelines and Research

Nutrition is a dynamic field A vast quantity of research constantly reshapes our knowledge of nutritional science The fifth edition has been carefully updated to reflect current scientific under- standing, as well as the latest health and nutrition guidelines For everyday diet planning, students will learn about the 2015–2020 Dietary Guidelines for Americans, MyPlate, and Healthy People

2020 In discussions about specific nutrition concerns, the most recent data and recommendations from the Academy of Nutrition and Dietetics, American Heart Association, American Diabetes Association, Institute of Medicine, and American Psychological Association have been included in this edition.

Ask the RDN is a new feature in every chapter to answer questions about topics that may seem to have conflicting viewpoints. The Registered Dietitian Nutritionist is a qualified nutrition expert who is trained to help you separate facts from fads, and optimize your health with better food choices This feature will highlight the ability of the RDN to translate the latest scientific findings into easy-to-understand nutrition information.

The Medicine Cabinet feature presents information on common medications used to treat diseases that have a nutrition connection These features highlight the ways medications can affect nutritional status, as well as ways food and nutrients can affect how medications work.

Applying Nutrition on a

Personal Level

Throughout the fifth edition, we reinforce the fact that each

per-son responds differently to nutrients To further convey the

impor-tance of applying nutrition to their personal lives, we include many

examples of people and situations that resonate with college

students We also stress the importance of learning to intelligently

sort through the seemingly endless range of nutrition messages

to recognize reliable information and to sensibly apply it to their

own lives Our goal is to provide students the tools they need to

eat healthfully and make informed nutrition decisions after they

complete the class Many of these features can be assigned and

graded through Connect to help students learn and apply the

information and engage with the text.

Challenging Students

to Think Critically

The pages of Wardlaw’s Contemporary

Nutrition: A Functional Approach

contain numerous opportunities for

stu-dents to learn more about themselves

and their diet and to use their new

knowledge of nutrition to improve their

health These pedagogical elements

include Critical Thinking, Ask the RDN,

Case Studies, Nutrition and Your Health,

What Would You Choose?, and

News-worthy Nutrition Many of the

thought-provoking topics highlighted in these

features are expanded upon in the

online resources found in Connect.

Connecting with a

smi06605_ch02_036-075.indd 75 09/28/16 12:44 PM

Does Your Diet Compare to MyPlate?

Using your food-intake record from Chapter 1, place each food item in the appropriate group of the accompanying MyPlate Food Composition Table Supplement for serving sizes) Many of your food choices may contribute to more than one group

values, add the number of servings consumed in each group Finally, compare your total in each food group with the mended number of servings shown in Table 2-5 or obtained from the ChooseMyPlate.gov website Enter a minus sign (−) if your total falls below the recommendation or a plus sign (+) if it equals or exceeds the recommendation.

recom-Indicate the number of servings from MyPlate that each food yields:

Rate Your Plate

75

Food or Beverage Amount Eaten Grains Vegetables Fruits Dairy Protein

Group totals Recommended servings Shortages/overages in numbers of servings

Confirming pages

159

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What Would You Choose?

Several of your friends are getting together for a cookout, and you have volunteered to be the grill master Hamburgers will be the main “protein” portion of your meal ( Remember the size of that group on MyPlate?) You have heard that eating red meat is bad for your heart Is all red meat bad for your heart? In the meat section of the grocery store, you see several varieties of ground beef Which of the following types of ground beef would you choose for heart health?

Humans need very little fat in their diet to maintain health

In fact, the body’s need for the essential fatty acids can be met by daily consumption of only about 2 to 4 tablespoons of plant oil incorporated into foods and consumption of fatty fish such as salmon or tuna at least twice weekly The Food and Nutrition Board suggests that fat intake can be as high as 35%

of calories consumed for an adult Some experts suggest that

an intake as high as 40% of calories is appropriate as long

as the predominant type of fat is a healthy one, such as olive oil After learning more about lipids—fats, oils, and related compounds— in this chapter, you can decide for yourself how much fat you want to consume.

Let us look at lipids in detail—their forms, functions, metabolism, and food sources This chapter will also discuss the link between various lipids and the major “killer” disease

in North America: cardiovascular disease, which involves the heart, including the coronary arteries (coronary heart disease) and other arteries in the body.

5.7 Explain the recommendations for fat intake

5.8 Characterize the symptoms of cardiovascular disease and

highlight some known risk factors.

One of the biggest contributors to weight gain for college dents is consuming several hundred calories per day in the form cola contains about 140 kcal A 12-ounce can of regular beer has

stu-current weight or by increasing your physical activity For an adult

in weight loss of about 25 pounds over a year’s time As weight

will be required to lose additional weight.

Although many students skip it, breakfast is the most important

meal of the day Starting the day off with a serving of lean protein

(e.g., an egg, Canadian bacon, or protein shake), a fortified

whole-grain breakfast cereal, skim milk, and a serving of fruit puts you on

Andy is like many other college students He grew up on a quick bowl of cereal and

milk for breakfast and a hamburger, French fries, and cola for lunch, either in the school

cafeteria or at a local fast-food restaurant At dinner, he generally avoided eating any

of his salad or vegetables, and by 9:00 P.M he was deep into bags of chips and

cook-ies Andy has taken most of these habits to college He prefers coffee for breakfast

and possibly a chocolate bar Lunch is still mainly a hamburger, French fries, and cola,

but pizza and tacos now alternate more frequently than when he was in high school

One thing Andy really likes about the restaurants surrounding campus is that, for a few

cents more, he can make his hamburger a double or get extra cheese and pepperoni

on his pizza This helps him stretch his food dollar; searching out large-portion value meals for lunch and dinner now has become

part of a typical day.

Provide some dietary advice for Andy Start with his positive habits and then provide some constructive criticism, based on what you now know.

Answer the following questions, and check your responses at the end of this chapter As you make suggestions for Andy, think about your favorite food choices, why they are your favorites, and whether these are positive choices.

1 Start with Andy’s positive habits: What healthy choices are being made when Andy eats at local restaurants?

2 Now provide some constructive criticism:

a What are some of the negative aspects of items available at fast-food restaurants?

b Why is ordering the “value meals” a dangerous habit?

c What healthier substitutions could he make at each meal?

d List some healthier choices he could make at fast-food restaurants on campus.

Typical College Student

C A S E S T U D Y

© Image 100/Corbis

▲ Research (see Further Reading 18) has shown that gourmet coffee

bever-ages, such as lattes and cappuccinos, can increase calorie consumption by

about 200 kcal per day.  © BananaStock/PunchStock

⊲ Five Simple Tips to Avert Weight Gain

• Eat breakfast Rev up your metabolism with a protein source

such as an egg or low-fat yogurt, at least one serving of whole

• Plan ahead Eat a balanced meal or snack every 3 to 4 hours.

• Limit liquid calories Drink water instead of high-calorie soft

drinks, fruit juice, alcohol, or coffee; if you drink alcohol, limit it to

1 or 2 drinks per day.

• Stock the fridge Keep a stash of low-calorie, nutritious snacks

such as pretzels, light microwave popcorn, and fruit (fresh, canned, or dried).

• Exercise regularly Find a friend to work out with you Experts

recommend 30 minutes of moderate exercise at least 5 days a week.

Confirming pages

189

Cardiovascular disease is the major killer of North Americans It ically involves the coronary arteries and, thus, frequently the term coronary heart disease (CHD) or coronary artery disease (CAD) is used Each year, about 610,000 people die of coronary heart dis- ease in the United States About 735,000 people in the United

typ-10 years behind men in developing the disease Still, it eventually heart disease alone is $108.9 billion each year, which includes the costs of health care services, medications, and lost productivity.

Development of Cardiovascular Disease

The symptoms of cardiovascular disease develop over many years autopsies of young adults under 20 years of age have shown that many of them had atherosclerotic plaque in their arteries (Fig 5-17)

This finding indicates that plaque buildup can begin in childhood and continue throughout life, although it usually goes undetected for some time (see Further Reading 11).

The typical forms of cardiovascular disease—coronary heart disease and strokes—are associated with inadequate blood cir- culation in the heart and brain related to buildup of this plaque

oxygen and nutrients When blood flow via the coronary arteries surrounding the heart is interrupted, the heart muscle can be dam- aged A heart attack, or myocardial infarction, may result (review

Fig 5-17) This may cause the heart to beat irregularly or to stop

About 25% of people do not survive their first heart attack If blood brain dies, causing a cerebrovascular accident, or stroke.

A heart attack can strike with the sudden force of a mer, with pain radiating up the neck or down the arm It can sneak

sledgeham-up at night, masquerading as indigestion, with slight pain or sure in the chest Crushing chest pain is a more common symptom subtle in women that death occurs before she or the health pro- fessional realizes that a heart attack is taking place If there is any

pres-5.8 Nutrition and Your Health

Lipids and Cardiovascular Disease

© Foodcollection

plaque A cholesterol-rich substance deposited in the blood vessels;

it contains various white blood cells, smooth muscle cells, various proteins, cholesterol and other lipids, and eventually calcium.

myocardial infarction Death of part of the heart muscle Also termed

Attractive, Accurate Artwork

Illustrations, photographs, and tables in the text were

created to help students more easily master complex

scientific concepts.

• Many illustrations were updated or replaced to inspire

student inquiry and comprehension and to promote

interest and retention of information Many were also

redesigned to use brighter colors and a more attractive,

contemporary style.

• In many figures, color-coding and directional arrows

make it easier to follow events and reinforce

interrela-tionships Process descriptions appear in the body of

the figures This pairing of the action and an explanation

walks students step-by-step through the process and

increases teaching effectiveness.

The final result is a striking visual program that holds

readers’ attention and supports the goals of clarity, ease

of  comprehension, and critical thinking The attractive

layout and design of this edition are clean, bright, and

inviting This creative presentation of the material is

geared toward engaging today’s visually oriented

60 0 0 190 97 17 89 83 72

Food Item

and Amount

Whole Grain Total ® cereal, 1 cup

Tortellini with cheese filling, ¹⁄² cup

Brown rice, cooked, ¹⁄² cup

Red peppers, raw, 1 cup

Brussels sprouts, cooked, 1 cup

Spinach, raw, 2 cups

Strawberries, 1 cup

Orange, 1 medium

Grapefruit juice, canned, 1 cup

% RDA for Adult Males (90 milligrams)

119% 111% 96%

FIGURE 10-11 Food sources of vitamin C (a) The fill of the background color (none, 1/3, 2/3, or completely covered) within each food group

on MyPlate indicates the average nutrient density for vitamin C in that group (b) The bar graph shows the vitamin C content of several foods compared to the RDA for adult males and females Overall, fruits and vegetables are the richest sources of vitamin C Foods in the dairy and protein groups (not shown) are poor sources of vitamin C.

Source: Nutrition data from USDA National Nutrient Database for Standard Reference, Release 26.

(a) (b)

Linoleic acid

Omega-6 Family

Alpha-linolenic acid

Omega-3 Family

Eicosapentaenoic acid (EPA)

Docosahexaenoic acid (DHA)

Arachidonic acid Essential fatty acids

∙ Section 1.6, “What Is the Current State of the North can Diet and Health?” has been updated extensively to reflect recent changes in obesity trends Figure 1-7 showing the percentage of adults who were obese in 2013, as well as other obesity statistics, has been updated The most recent report,

Ameri-F as in Ameri-Fat: How Obesity Threatens America’s Ameri-Future 2013,

is discussed The Newsworthy Nutrition feature has been

updated to “No change in obesity prevalence in youth or adults between 2003 and 2012,” summarizing research pub-

lished in the Journal of the American Medical Association in

2014 (Further Reading 16)

∙ Further Readings have been updated with three new articles and all Further Readings are now linked to the end of chapter list in the digital text

Chapter 2: Designing a Healthy Dietary Pattern

∙ Significant changes in Chapter 2 revolve around the newly released 2015–2020 Dietary Guidelines for Americans In Section 2.2, the entire subsection, “Dietary Guidelines—The Basis for Menu Planning” has been revised To help students understand the political issues surrounding the Guidelines,

we have included a discussion of the process used to establish them The five foundational guidelines of the 2015–2020 Dietary Guidelines are outlined and Key Recommendations are illustrated in Figure 2-2

∙ Section 2.2 also highlights the Guidelines’ new emphasis on

“Healthy Eating Patterns” with the following new subsections:

Shifting to Healthy Eating Patterns; Importance of Calorie Balance Within Healthy Eating Patterns; Food Components to Include in Your Healthy Eating Pattern; and Food Components

to Limit in Your Healthy Eating Pattern The new Figure 2-3, Comparing current eating patterns in the United States to the Dietary Guidelines, is directly from the Guidelines report. 

∙ Section 2.3, MyPlate—A Menu-Planning Tool, has been updated to reflect the new Dietary Guidelines and includes

the new Ask the RDN feature, which answers the question of

how to follow the Mediterranean Diet eating plan

∙ A new box on Diet and Nutrition Apps has been added to Section 2.7 and includes a link to the Academy of Nutrition and Dietetics’ science-based reviews of the most popular diet and nutrition apps for phones and tablets

Chapter 3: The Human Body: A Nutrition Perspective

∙ Figure 3-10 has been updated to illustrate the location of the pharynx

∙ In Section 3.9, the Newsworthy Nutrition feature has been

updated to present recent research on the effects of probiotics

on bowel regularity

Global Changes

∙ To help our readers locate cross-references in the text, we

have added section numbers when referring to other chapters/

sections of text This will be especially helpful when using

the digital text because these references are hot links that will

take you right to that section!

∙ Throughout this new edition we have replaced the term “diet”

in most cases with the term “eating pattern” or “dietary

pat-tern.” This reflects the emphasis on “healthy eating patterns”

in the new 2015–2020 Dietary Guidelines for Americans

∙ In addition, we have replaced the term “calorie” with

“kilocalo-rie” when referring to specific energy amounts For example,

the Concept Check for Section 1.4 now reads: What are the

energy (kilocalorie) values for each of the “energy nutrients”?

∙ Images of the Nutrition Facts Label have been updated to the

newly approved format

∙ One of the most noticeable changes in this new edition is the

inclusion of the new feature, “Ask the RDN (Registered

Dieti-tian Nutritionist)” in every chapter We have used this feature

to address questions we frequently hear students asking about

food and nutrition topics covered in the popular media We use

the “Ask the RDN” in Chapter 1 to set the stage, answering the

most important question “How can I find a qualified nutrition

expert who will give me personalized nutrition advice?” The

feature is answered and signed by one of the authors, who are

all Registered Dietitian Nutritionists! Along these same lines,

we have emphasized RDNs as the nutrition experts and integral

part of the health care team throughout the text

∙ The last section of each chapter, Nutrition and Your Health, is

now a numbered section (e.g., Section 1.8 in Chapter 1) for easier

navigating especially within the digital components of the text

∙ As we discuss healthy eating patterns throughout the text, you

will notice more emphasis on the problems of

overconsump-tion of added sugars and less emphasis on problems from the

consumption of dietary cholesterol

Chapter-by-Chapter Revisions

Chapter 1: Nutrition, Food Choices, and Health

∙ Section 1.1 has been updated with the latest statistics on

fast-food restaurant advertising to children as well as a discussion

of the increase in marketing of fast food via mobile devices

and social media

∙ Figure 1-3 now illustrates the 10 leading causes of death in

the United States as reported by the Centers for Disease

Con-trol and Prevention in August 2015 (see Further Reading 15)

∙ The ingredient list on the Nutrition Facts panel shown in

Figure 1-4 has been updated to reflect the inclusion of only

whole wheat flour

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∙ In Section 5.6, we have added a new subsection on the role

of lipids in regulating body processes Information about eicosanoids, which had previously existed elsewhere in the chapter, is now presented in this section

∙ Table 5-5 has been updated with the latest Diet and Lifestyle Recommendations from the American Heart Association, which were released in 2013

∙ A new subheading within Section 5.7 summarizes the advice

of public health authorities on fish consumption Also, a new subsection discusses dietary patterns that promote cardiovas-cular health

∙ In Section 5.7 we have included a new Ask the RDN feature

about the health benefits of coconut oil

Chapter 6: Proteins

∙ The steady drop in U.S meat and poultry consumption is highlighted in Section 6.3 with new statistics from 2014 and contrasted with the significant increase in dairy production and consumption in China and India

∙  The new protein intake recommendations from the 2015–2020 Dietary Guidelines are outlined in Section 6.6, including the shifts recommended to increase variety in protein food choices and to make more nutrient-dense choices Section 6.6 also includes a discussion of current research showing that a more equal distribution of protein at each meal is important in maintaining body composition and bone health and in regulating glucose

∙ The association between the consumption of high levels of red and processed meat and the increased risk of colorectal cancer, including the findings of the 2015 report of the World Health Organization, is discussed in more detail in Section 6.7

∙ Section 6.7 also includes a discussion of the Paleo Diet  in

the form of an answer to the Ask the RDN question: Is the

Paleo Diet  a healthy way to include a good amount of quality protein into my eating plan?

∙ The graphic of “The New American Plate” in Section 6.9 has been replaced with a new photo published by the American Institute for Cancer Research

∙ Section 6.9 also includes a new Newsworthy Nutrition,

Vegetarian Dietary Patterns Decrease Risk of Colorectal Cancers, based on research published in 2015

Chapter 7: Energy Balance and Weight Control

∙ The CDC obesity prevalence and trends have been updated throughout to reflect the most current data

∙ The components of a healthy body weight have been revised throughout the chapter to emphasize the importance of dietary patterns and positive lifestyle behaviors in successful weight management and align with the 2015–2020 Dietary Guidelines for Americans

∙ Non-HDL cholesterol has been added as a risk factor for nutrition-related chronic disease in Section 7.3

∙ Evidence-based updates for Health Problems Associated with Excess Body Fat have been revised in Table 7-2

∙ Section 3.11 has been updated with current terminology and

the latest statistics on the relationships between nutrition and

genetics Readers will find an expanded and updated

collec-tion of web resources for further informacollec-tion on genetics

∙ The Nutrition and Your Health feature in Section 3.12 includes

updated information on treatments for irritable bowel

syn-drome The new Ask the RDN feature explores the question of

whether a gluten-free diet is an effective weight-loss method

∙ In the Rate Your Plate activity, we now provide a link to an

interactive tool to generate a medical family tree

Chapter 4: Carbohydrates

∙ In Section 4.3, the idea of consuming fruits and vegetables

as juice is discussed as an answer to the Ask the RDN

question, Is juicing healthier than eating whole fruits or

vegetables?

∙ What Are FODMAPs? is a new information box in Section 4.4

and explains this group of fermentable carbohydrates and lists

several websites that provide practical information on foods to

avoid and foods to include when restricting FODMAPs

∙ Section 4.6 provides a list of the new 2015–2020 Dietary

Guidelines’ recommendations for carbohydrate intake as part

of a healthy eating pattern

∙ Also featured in Section 4.6 is a new Newsworthy Nutrition,

“Americans are decreasing consumption of sugar-sweetened

beverages,” based on research published in 2013

∙ The CDC National Diabetes Statistics Report, 2014, as well

as the Position of the Academy of Nutrition and Dietetics:

Health implications of dietary fiber, 2015, have been updated

in the Further Readings

Chapter 5: Lipids

∙ On the whole, Chapter 5 has been reorganized to improve

flow of information Some figures and text content have been

moved so that all of the information on food sources of lipids

appears in Section 5.3 and all of the recommendations for fat

intake appear in Section 5.7

∙ Throughout the chapter, to reflect updated advice from the

2015–2020 Dietary Guidelines and the American Heart

Asso-ciation’s Diet and Lifestyle Recommendations, we emphasize

that the quality of fat in the diet is just as important as the

total amount of fat in the diet In addition, we have removed

any outdated recommendations about specific limits for

dietary cholesterol intake

∙ Section 5.1 has been expanded to introduce students to some

of the core terminology in the chapter

∙ Figure 5-3 has been revised to more accurately represent the

relationships among key omega-3 and omega-6 fatty acids

Likewise, the Lipids Concept Map, now in Section 5.2, has

been simplified to show how the various forms of lipids are

related to each other

∙ In Section 5.3, we point out that partially hydrogenated oils

are no longer generally recognized as safe for use in food

products

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xviii Connecting with the Latest Updates

∙ Sections have been renamed throughout Section 8.3 to reflect current research New titles include Body Defenses, Bone Health, and Blood and Brain Health

∙ The new Ask the RDN in Section 8.3 features the Raw Food

Plant Diet

∙ The Top 5 Dietary Supplements has been updated from 2012

to 2014 data in Section 8.5

∙ A new Newsworthy News feature has been updated with a

2015 study documenting increased emergency department visits for dietary supplement users

∙ The Chapter Summary reflects updates throughout and now includes functional foods In addition, a new study question

on phytochemicals has been added

∙ Further Readings have been updated to include three new articles

Chapter 9: Fluid and Electrolyte Balance

∙ Newly redesigned food source figures in this chapter (Figs. 9-14 and 9-15 for sodium and potassium) and throughout the text include both the nutrient density for the nutrients for foods in each food group on MyPlate and a bar graph showing the nutrient content of several foods from each food group compared to the AI for adult males and females

∙ The discussion of bottled water has been expanded in Section 9.2 with new statistics for the consumption of bottled water in 2014, as well as a link to the Natural Resources Defense Council website where students can read more about bottled water

∙ Questions about limiting the amount of salt in the diet are

answered in the new Ask the RDN feature in Section 9.6, which concludes with a new Newsworthy Nutrition, No

Evidence for Extreme Sodium Restrictions for Older Adults, based on research published in 2015

∙ Several updates have been made to Section 9.9 on Minerals and Hypertension The importance of balancing sodium and potassium to control blood pressure is highlighted in a new

Newsworthy Nutrition, and medications used to lower blood

pressure are now outlined in the Medicine Cabinet feature

We recommend the DASH diet and point out that it was named the best overall eating plan for the sixth year in a row

on the U.S News & World Report’s 2016 Best Diets list.

∙ What the Dietitian Chose includes updates on the class action

lawsuits filed by a number of U.S consumers against the Coca-Cola® Bottling Company for false marketing of its popular vitaminwater® brand

∙ There are six new Further Readings.

Chapter 10: Nutrients Involved in Body Defenses

∙ In this edition, discussions of nutrients that function as oxidants and nutrients that support immunity have been com-bined into one revised chapter that focuses on body defenses

anti-New pedagogical elements reflect this reorganization of content

∙ Information on the DEXA-specific software that was

devel-oped to assess visceral body fat distribution has now been

added in Section 7.3

∙ Revisions aligning with the 2015–2020 Dietary Guidelines

for Americans have been made to Table 7-3 to describe

factors that encourage excess body fat stores and obesity

∙ The weight-loss triad, Figure 7-17, has been updated to

emphasize the interrelated components of successful weight

loss

∙ The Biggest Loser Eating Plan has been added in the new Ask

the RDN feature in Section 7.5

∙ The Newsworthy Nutrition article in Section 7.6 has been

updated to a 2015 publication documenting the link between a

plant-based dietary pattern and healthy body weight

∙ Table 7-5 has been condensed to include most popular

physi-cal activities and estimated physi-calorie costs associated with each

activity

∙ The Section 7.8 title has been altered (Behavioral Strategies

for Weight Management) to emphasize the importance of

modifiable lifestyle behaviors in successful weight

manage-ment and control

∙ Section 7.8 has also been updated throughout to reflect

2015–2020 DGA updates and recommended shifts in dietary

patterns to promote a healthy lifestyle The DGA Strategies

for Action with guiding principles and societal efforts help to

combat obesity

∙ The title for Table 7-6 has been updated to Behavioral Tactics

for Weight Loss

∙ Updates to weight-loss medications, recommendations, and

contraindications have been made in Section 7.9

∙ Information on intermittent fasting has been added to

Section 7.9 as a strategy for obesity treatment

∙ Figure 7-20 has been condensed to reflect the most current

bariatric procedures along with updated patient selection

criteria

∙ The Summary of Popular Diet Approaches to Weight Control

has been condensed and updated in Table 7-7

∙ Further Readings have been updated with three new

references

Chapter 8: Overview of Micronutrients

and Phytochemicals

∙ The chapter title now includes phytochemicals and reflects that

this information has been moved and updated in this chapter

∙ A newly redesigned Figure 8-1 has been revised to reflect the

key micronutrients contributing to bodily functions

through-out the functional chapters

∙ Summary Tables 8-1 through 8-4 have been updated to

enhance readability and quickly summarize pertinent

informa-tion on the funcinforma-tions, requirements, food sources, deficiency,

and toxicity of vitamins and minerals detailed throughout the

functional chapters

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Chapter 12: Micronutrient Function in Energy Metabolism

∙ In Section 12.8, the term iodine is now used instead of iodide to be consistent with Dietary Reference Intakes The link between mild iodine deficiency during pregnancy and decreased IQ in offspring is discussed based on recent stud-ies published in 2013 To further explore this topic, a new

Newsworthy Nutrition feature presents research published in

2015 on marginal iodine status among women of childbearing years in the United States

∙ Tips that will help boost metabolism, burn more calories, and reduce extra body fat are listed in Section 12.10 in the answer

to the Ask the RDN question “Are there things I can do that

will increase my metabolism and help prevent my weight from creeping up?” 

∙ There are three new Further Readings

Chapter 13: Nutrients That Support Blood and Brain Health

∙ In the fifth edition, we have incorporated state-of-the-science research about the role of nutrition in brain health into Chapter 13. The chapter title has been updated to “Nutrients That Support Blood and Brain Health.” The first part of the chapter now reviews the roles of vitamin K, folate, vitamin B-12, iron, and copper in synthesizing and maintaining the

health of red blood cells A new Nutrition and Your Health

feature in Section 13.7 reviews the functions of nutrients in brain health Content on the roles of nutrients and probiotics

in immune health has been moved to Chapter 10

∙ What Would You Choose? was revised to focus on the

recent WHO report linking red meat consumption with cancer

∙ The title of Section 13.2 has been updated to “Hemostasis and Vitamin K” to reflect revisions related to blood loss and vitamin K

∙ Figure 13-5 has been updated to include arrows highlighting the importance of prothrombin activator in the conversion from prothrombin to thrombin

∙ Information regarding parental refusal of vitamin K supplementation by parents has been added to Section 13.2 (also see Further Reading 18)

∙ The new Ask the RDN features reviews Peter D’Adamo’s book Eat Right for Your Type (4 Blood Types, 4 Diets):

The Individualized Diet Solution to Staying Healthy, Living Longer & Achieving Your Ideal Weight.

∙ In Section 13.3, a more detailed explanation of the functions

of folate covers its roles in neurotransmission, depression, and cancer protection

∙ Section 13.7 contains new information on Brain Health: Food for Thought. This novel addition details nutrients related to the formation of brain tissue, fuel for the brain, the nervous system, and brain health protection The section also cov-ers the latest research on the ways in which nutritional status during gestation and infancy, childhood, adolescence, and

∙ Section 10.1 now presents an overview of the immune

system and the immune response Table 10-1 summarizes the

nutrients that support immune function

∙ Whereas they existed in separate chapters in the fourth

edition of Contemporary Nutrition: A Functional Approach,

vitamin A and carotenoids are now discussed in tandem in

Section 10.3

∙ Throughout the chapters on micronutrients, we have made the

presentation of vitamins and minerals consistent to include

subsections on functions, deficiency, dietary requirements,

and toxicity (if applicable) Section 10.5 on vitamin E was

one that we revised to ensure this consistent navigation of

content

∙ Formerly a Nutrition and Your Health feature, emerging

evidence on the importance of probiotics for immune health

is now presented in Section 10.9

∙ Section 10.10 on Nutrition and Cancer contains updated

statistics and a revised discussion of the progression of

can-cer The link between excess body fat and cancer is explored

in further detail In the discussion of cancer prevention, we

have emphasized the importance of overall dietary patterns

and whole foods rather than individual nutrients

Chapter 11: Nutrients Involved in Bone Health

∙ Table 11-1, Biological Factors Associated with Bone Status,

has been expanded to include estrogen

∙ Section 11.2, Factors That Influence Bone Health, has been

reorganized and includes an update on the debate over the

impact of protein intake and acid load on bone health A

criti-cal review of this topic published in 2014 has been added to

the Further Readings

∙ A discussion of the effect of coffee and colas on bone health

has been added to Section 11.3 in the answer to the Ask the

RDN question, “Could the caffeine in these drinks be

damag-ing my bones and leaddamag-ing to osteoporosis?”

∙ The functions of vitamin D are now presented in two

subsec-tions: (1) Blood Calcium Regulation; and (2) Gene

Expres-sion and Cell Growth Figure 11-8 is a new illustration

depicting how vitamin D regulates blood calcium

∙ In Section 11.9, we have included updated 2014 prevalence

statistics from the National Osteoporosis Foundation (see

Further Reading 17), as well as a simplified Figure 11-16

depicting the relationship between peak bone mass and the

ulti-mate risk of developing osteoporosis and related bone fractures

∙ You will find more current information on the increasing

sales of nondairy milk beverages and on the availability of

new products such as cashew milk in Section 11.11 Cashew

milk is now listed in Table 11-6, which also has updated

values on the nutrient content of nondairy milk beverages

A new bulleted list, Dairy-Free Shopping Guide: Things to

Consider, is also available in Section 11.11

∙ The Further Readings have been updated with five new

articles

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Chapter 16: Undernutrition Throughout the World

∙ Targets and progress towards the eight United Nations Millennium Development Goals (MDGs) have been updated throughout the chapter and highlighted in Table 16-1

∙ Statistics on both domestic and global poverty and hunger from the FAO and U.S Census Bureau have been updated with 2015 data. 

∙ The prevalence of hunger, nutrient-deficiency diseases, and related health outcomes have also been updated to reflect the current literature. 

∙ Updates of the characteristics of users and impact of the erally subsidized nutrition programs, including SNAP, WIC, and Senior Nutrition Services that supply food for people in the United States, has been updated in Section 16.2

∙ Section 16.3 now includes expanded information available related to the nutritional impact of war and political unrest

in the Middle East and specific to refugees, those internally displaced, or those seeking political or religious asylum

∙ A section on the Global Hunger Index (GHI), a tool designed

to measure and track hunger worldwide, is discussed in Section 16.3 Climate change, the green revolution, and sustainable agriculture and their impact are also expanded in this section

∙ The 17 United Nations Sustainable Development Goals, a blueprint for global health, have been updated in the text and Figure 16-5 added. 

∙ Updates of the positive impact of global efforts to combat HIV/AIDS has been added. 

∙ The Non-GMO Project initiative promoting GMO food ing has been added. 

∙ The Ask the RDN features the non-GMO diet.

∙ A 2014 global analysis on GMO crops and pesticide exposure

is included in the text and as a Further Reading

∙ Undernutrition throughout all life stages (pregnancy through older adults) has been updated to reflect current prevalence and associated health outcomes

∙ The Further Readings include eight new references

Chapter 17: Safety of Our Food Supply

∙ In Section 17.1, many recent examples of foodborne illness outbreaks have been added throughout the text and in Table 17-1

∙ Table 17-2, which summarizes the agencies responsible for monitoring the food supply in the United States, has been streamlined to improve readability

∙ The discussion of overuse of antibiotics in animal feeds in Section 17-1 has been revised and expanded

∙ In Section 17-2, ultra-high temperature (UHT) processing has been added to the discussion of food preservation methods

∙ A new Figure 17-2 illustrates the settings of Norovirus outbreaks in the United States

adulthood may affect cognition, learning abilities, behavior,

migraines, depression, and neurodegenerative diseases. The

MIND Diet, a dietary intervention that shows promising

results for protecting the brain against cognitive decline, is

detailed in Section 13.7 and supported by Further Reading 11

∙ Seventeen new Further Readings have been added to reinforce

the new concepts in this chapter

Chapter 14: Nutrition: Fitness and Sports

∙ Sports nutrition advice throughout the chapter has been

updated to align with the revised joint position statement

on nutrition and athletic performance from the Academy

of Nutrition and Dietetics, Dietitians of Canada, and the

American College of Sports Medicine, released in March 2016

∙ Figure 14-5 illustrates the general concept of energy storage

in the chemical bonds of ATP

∙ Throughout the chapter, especially in Table 14-5 and

Table 14-9, references to sports nutrition products have

been updated to reflect the current market

∙ In Section 14.4, the discussion of the controversial topic of

protein needs of athletes, including the amount and timing of

protein intake, has been updated with the latest research

∙ The Newsworthy Nutrition feature now focuses on research on

a link between sports drinks and weight gain among

adoles-cents and young adults

∙ Section 14.6 has been updated with the latest statistics and

data on commonly used ergogenic aids

∙ The Further Readings have been updated with 10 new

resources on sports nutrition

Chapter 15: Eating Disorders

∙ In Section 15.2, we have added information about the two

subtypes of anorexia nervosa: restricting type and

binge-eating/purging type This information reinforces the point that

a person with an eating disorder exists on a spectrum of

disor-dered eating behaviors and may migrate from one disorder to

another

∙ The discussion of physical effects of anorexia nervosa has

been updated and expanded

∙ In Section 15.3, a new Newsworthy Nutrition feature looks at

the relationship between bulimia nervosa and binge drinking

or substance abuse

∙ Section 15.4 has been updated with information on

lisdexam-fetamine, the first drug to be approved for treatment of

binge-eating disorder

∙ A new Ask the RDN feature in Section 15.4 describes the

science behind intermittent fasting, but cautions readers that

this weight-loss method can be a gateway to disordered eating

behavior

∙ In Section 15.5, the various types of subthreshold eating

disorders are explained in greater detail

∙ Sixteen new articles have been incorporated into the listing of

Further Readings

xx Connecting with the Latest Updates

∙ In Section 19.4, the content on vegetarian diet planning for children has been expanded and revised.

∙ A new Ask the RDN feature explores the connections between

nutrition and autism

∙ In Section 19.5, we have included information from the

2016 WHO Report of the Commission on Ending Childhood Obesity

∙ In Section 19.7, information pertaining to food allergies and intolerances has been updated with new statistics and termi-

nology to reflect current medical literature A new thy Nutrition feature explains the ramifications of the LEAP study for children at risk of peanut allergies

∙ Fifteen new resources have been added to the Further Readings

Chapter 20: Nutrition During Adulthood

∙ Some of the content related to brain health (e.g., depression, Alzheimer’s disease) has been moved from this chapter to

the new Nutrition and Your Health feature in Section 13.7

Because of this reorganization, we have combined the two sections that discussed physiological and psychosocial changes that affect nutritional status Now, Section 20.3 is called “Factors Related to Nutritional Status of Adults.”

∙ In Section 20.1, a new Newsworthy Nutrition feature

high-lights research on the relationship between animal protein intake and mortality

∙ In Section 20.2, nutrition recommendations for the adult years have been updated to reflect the 2015–2020 Dietary Guidelines for Americans In this section, we also present the latest research on protein needs of older adults

∙ Figure 20-3 has been updated to match the most recent sion of the Nutrition Screening Initiative’s Nutrition Checklist for Older Adults, which utilizes the DETERMINE mnemonic ∙ Table 20-2 has been revised and expanded to provide more comprehensive array of strategies to cope with the physiologi-cal changes of aging

∙ In Section 20.3, we have expanded our discussion of tional strategies to cope with arthritis To further expand upon

nutri-this topic, the new Ask the RDN feature reviews the potential

benefits of an anti-inflammatory diet

∙ Table 20-3 has been updated with the latest research on popular herbal remedies used by American adults Referrals

to some current and relevant online resources pertaining to complementary and alternative medicine are provided

∙ In Section 20.4, we have included the recent MyPlate for Older Adults from Tufts University Information related to the use of community nutrition services by older Americans has been updated

∙ The Ask the RDN feature weighs the pros and cons of “clean”

eating

∙ To match the layout of other sections, we have added

Table 17-7 to summarize natural substances in foods that

can cause foodborne illness

∙ Table 17-8 has been revised to include a greater variety of

common sources of caffeine

∙ Table 17-9 now includes bisphenol A

∙ A new margin note in Section 17.6 highlights the ongoing

public health crisis that surfaced when high levels of lead

were detected in the drinking water in Flint, Michigan

∙ In Section 17.6, we have included information about USDA’s

Pesticide Data Program

∙ Table 17-10 has been updated with the Environmental

Working Group’s 2015 Dirty Dozen  and Clean Fifteen

∙ We have included the latest evidence on organic food

produc-tion in Secproduc-tion 17.7

∙ Ten new resources have been added to the Further Readings

Chapter 18: Nutrition During Pregnancy and Breastfeeding

∙ The content about nutrition and fertility in Section 18.1 has

been organized under the headings, “Hormonal Balance,”

“Key Nutrients,” and “Alcohol.”

∙ Ask the RDN reviews The Fertility Diet.

∙ Section 18.3 now includes updated statistics about low

birth-weight, preterm birth, teenage pregnancy, and prenatal care

∙ In several places throughout the chapter, we point out some

useful online resources to plan healthy dietary patterns during

pregnancy

∙ Section 18.4 has been revised to reflect the most recent

rec-ommendations of the 2015–2020 Dietary Guidelines and the

American Heart Association We also reiterate the importance

of adequate hydration during exercise

∙ In Section 18.5, we have expanded our discussion of a healthy

dietary pattern during pregnancy to offer advice on food

choices within each food group

∙ A new margin note in Section 18.7 summarizes the

strik-ing results of a 2016 analysis of the economic benefits of

breastfeeding

∙ The listing of Further Readings now includes 13 updated

resources

Chapter 19: Nutrition from Infancy Through Adolescence

∙ In Table 19-2, the descriptions of infant nutrition products

have been updated to reflect the current market

∙ In Section 19.3, the paragraph on safe preparation and storage

of infant formula has been expanded and updated

Informa-tion about BPA in baby bottles has been revised

∙ A new Table 19-4 presents typical formula intake by infants

across a range of ages

∙ Updated information about kilocalories, sodium, and added

sugars from the 2015–2020 Dietary Guidelines for Americans

Connecting with the Latest Updates xxi

∙ Chapter 20: Low animal protein intake is associated with a major reduction in mortality.

∙ Revised What Would You Choose integrated concept

ques-tion, Chapter 13: Reducing red meat intake

Instructor Resources Updates

∙ PowerPoint slides updates to include:

∙ What Would You Choose from text

∙ NEW Case Studies from each chapter

∙ Accessibility updates ∙ Updated Teaching Strategies include a variety of classroom discussion topics and activities for student learning With this edition, we have included many new ideas that make use of digital resources and social media to engage millennial learn-ers This “buffet” of teaching strategies will provide options that are adaptable for face-to-face, hybrid, or online learning environments

∙ “Dietary Analysis Assignment” available as a Word document

∙ In Section 20.5, we have incorporated new research about

alcohol intake and cancer risk Recommendations regarding

alcohol use now reflect the 2015–2020 Dietary Guidelines for

Americans

∙ Eleven recent resources have been added to the Further

Readings

List of Key Digital Updates*

2015–2020 Dietary Guidelines for Americans updates across

Question Bank, Test Bank, and LearnSmart/SmartBook

Connect Question Banks Updates

∙ Addition of case studies for every chapter as assignable content

∙ Addition of dietary analysis assignment (from Appendix C) as

assignable content

∙ NEW Newsworthy Nutrition integrated concept questions

from text

∙ Chapter 1: No change in obesity prevalence in youth or

adults between 2003 and 2012

∙ Chapter 3: Probiotics provide relief from constipation

∙ Chapter 4: Americans are decreasing consumption of

sugar-sweetened beverages

∙ Chapter 7: Plant-based dietary pattern promotes healthy

body weight

∙ Chapter 8: Increased emergency department visits for

dietary supplement users

∙ Chapter 9: No evidence for extreme sodium restrictions

for older adults/sodium, but step up potassium to control

blood pressure

*One of the many benefits of digital tools is the ability for live/

real-time improvements to benefit the modern students’ learning

This list is updated at the time it was first available for purchase;

there may be more anytime after

xxii Connecting with the Latest Updates

2.7 Evaluating Nutrition Information 63

2.8 Nutrition and Your Health: Food Labels and Diet Planning 65 Case Study: Using the Nutrition Facts Label to Make Food Choices 71

Chapter 3 The Human Body: A Nutrition Perspective 77

3.1 Nutrition’s Role in Human Physiology 783.2 The Cell: Structure, Function, and Metabolism 783.3 Body Systems 81

3.4 Cardiovascular System and Lymphatic System 843.5 Urinary System 87

3.7 Endocrine System 89

3.9 Digestive System 913.10 Nutrient Storage Capabilities 1013.11 Nutrition and Genetics 102

3.12 Nutrition and Your Health: Common Problems with Digestion 106 Case Study: Gastroesophageal Reflux Disease 108

Chapter 1 Nutrition, Food Choices, and Health 3

1.1 Why Do You Choose the Food You Eat? 4

1.2 How Is Nutrition Connected to Good Health? 8

1.3 What Are the Classes and Sources of Nutrients? 10

1.4 What Math Concepts Will Aid Your Study of Nutrition? 14

1.5 How Do We Know What We Know About Nutrition? 17

1.6 What Is the Current State of the North American Diet and Health? 19

1.7 What Can You Expect from Good Nutrition and a Healthy Lifestyle? 24

1.8 Nutrition and Your Health: Eating Well in College 27

Case Study: Typical College Student 28

Chapter 2 Designing a Healthy Dietary Pattern 37

2.1 A Food Philosophy That Works 38

2.2 Dietary and Physical Activity Guidelines 43

2.4 States of Nutritional Health 56

2.5 Measuring Your Nutritional State 58

2.6 Specific Nutrient Standards and Recommendations 60

4.4 Making Carbohydrates Available for Body Use 134

Part Two: Energy Nutrients and Energy Balance

Case Study: Problems with Milk Intake 136

4.5 Putting Carbohydrates to Work in the Body 1384.6 Carbohydrate Needs 142

4.7 Nutrition and Your Health: Diabetes—When Blood Glucose Regulation Fails 147

Breakfast: ©Corbis/Punchstock; oriental woman: ©BloomImage RF/Getty Images; salad, pizza: ©Getty Images/Jonelle Weaver; bowl of cereal: ©Medioimages/Photodisc/Getty Images; salmon: ©Ingram Publishing/SuperStock; beans/rice: ©Digital Vision/age footstock; picnic basket: ©Ingram Publishing

xxiv Contents

Chapter 5 Lipids 159

5.1 Lipids: Common Properties 160

5.2 Lipids: Triglycerides, Phospholipids, and Sterols 160

5.3 Fats and Oils in Foods 165

5.4 Making Lipids Available for Body Use 173

5.5 Carrying Lipids in the Bloodstream 176

5.6 Roles of Lipids in the Body 179

5.7 Recommendations for Fat Intake 183

Case Study: Planning a Heart-Healthy Diet 188

5.8 Nutrition and Your Health: Lipids and Cardiovascular Disease 189

Chapter 6 Proteins 201

6.1 Amino Acids—Building Blocks of Proteins 202

6.2 Protein Synthesis and Organization 204

6.3 Protein in Foods 206

6.4 Protein Digestion and Absorption 210

6.5 Putting Proteins to Work in the Body 212

Case Study: Planning a Vegetarian Dietary pattern 227

Chapter 7 Energy Balance and Weight Control 233

7.2 Determination of Energy Use by the Body 2397.3 Assessing Healthy Body Weight 2417.4 Why Some People Are Obese—Nature Versus Nurture 2467.5 Treatment of Overweight and Obesity 249

7.6 Control of Calorie Intake Is Essential for Weight Management 2527.7 Regular Physical Activity Promotes Weight Loss and Maintenance of a Healthy Weight 254

7.8 Behavioral Strategies for Weight Management 2567.9 Professional Help for Weight Loss 259

7.10 Treatment of Underweight 263

7.11 Nutrition and Your Health: Popular Diets—Cause for Concern 265 Case Study: Choosing a Weight-Loss Program 268

9.6 Sodium 3169.7 Potassium 3199.8 Chloride 321

9.9 Nutrition and Your Health: Minerals and Hypertension 323 Case Study: Focus On The Positive 326

Chapter 10 Nutrients Involved in Body Defenses 333

10.1 Defending the Body Against Pathogens 33410.2 Protecting the Body from Oxidative Damage 33710.3 Vitamin A (Retinoids) and Carotenoids 34010.4 Vitamin C (Ascorbic Acid) 346

10.5 Vitamin E (Tocopherols) 34810.6 Selenium 351

Case Study: Choosing a Dietary Supplement 353

10.7 Zinc 354

Part Three: Vitamins, Minerals, and Water

Chapter 8 Overview of Micronutrients and

Phytochemicals 275

8.1 Vitamins: Vital Dietary Components 276

8.2 Minerals: Essential Elements for Health 282

Case Study: Getting the Most Nutrition from Your Food 288

8.3 The Functional Roles of Micronutrients 288

8.4 Phytochemicals 291

8.5 Nutrition and Your Health: Dietary Supplements—Who Needs

Them? 293

Chapter 9 Fluid and Electrolyte Balance 303

9.1 Water: Essential to Human Life 304

9.2 The Water Balancing Act 306

9.3 Electrolytes Regulate Fluid Balance 312

9.4 Electrolytes Are Essential for Nerve Impulse Transmission 313

9.5 Electrolytes Maintain Acid-Base Balance 314

Citrus fruit: ©Creatas/PunchStock; boy getting water: ©Photodisc/Getty Images RF; bowl of fruit: ©Lew Robertson, Brand Xpictures/Getty Images; variety of cheeses:

©Imagestate Media (John Foxx)/Imagestate; girl eating bowl of cereal: ©BananaStock/Punchstock; plate of food: ©FoodCollection

Contents xxv

10.8 Antioxidant Phytochemicals 356

10.9 Probiotics and the Immune System 360

10.10 Nutrition and Your Health:Nutrition and Cancer 366

Chapter 11 Nutrients Involved in Bone Health 377

Case Study: Worried About Grandma 403

11.10 Bone Health Assessment 404

11.11 Nutrition and Your Health: Bone Health Without Dairy 406

Chapter 12 Micronutrient Function in Energy

12.9 Chromium 42912.10 Other Trace Minerals Involved in Energy Metabolism 430

12.11 Nutrition and Your Health: Choline: The Newest Vitamin? 434

Chapter 13 Nutrients That Support Blood and Brain Health 443

13.1 Blood Cell Synthesis 44413.2 Hemostasis and Vitamin K 44713.3 Folate (Vitamin B-9) 45013.4 Vitamin B-12 (Cobalamin or Cyanocobalamin) 45413.5 Iron 457

13.6 Copper 461

Case Study: Anemia 463 13.7 Nutrition and Your Health: Brain Health:

Food for Thought 464

Chapter 14 Nutrition: Fitness and Sports 475

14.1 An Introduction to Physical Fitness 476

14.2 Achieving and Maintaining Physical Fitness 477

14.3 Energy Sources for Exercising Muscles 481

14.4 Tailoring Nutrient Recommendations for Athletes 486

14.5 Specialized Advice for Endurance, Strength, and Power Athletes 497

Case Study: Planning a Training Diet 504

14.6 Nutrition and Your Health: Ergogenic Aids and Athletic

Performance 505

Chapter 15 Eating Disorders 513

15.1 From Ordered to Disordered Eating Habits 514

15.2 Anorexia Nervosa 517

Part Four: Nutrition: Beyond the Nutrients

Case Study: Eating Disorders—Steps to Recovery 522

15.3 Bulimia Nervosa 52315.4 Binge-Eating Disorder 52815.5 Other Eating Disorders 53215.6 Additional Disordered Eating Patterns 53315.7 Prevention of Eating Disorders 535

15.8 Nutrition and Your Health: Eating Disorder Reflections 537

Chapter 16 Undernutrition Throughout the World 545

16.1 World Hunger: A Crisis of Nutrition Security 54616.2 Undernutrition in the United States 55316.3 Undernutrition in the Developing World 558

Woman hitting volleyball: ©Purestock/SuperStock; girl sneaking cake from refrigerator: ©BananaStock/PunchStock; bowls with rice: ©Nicholas Pitt/Digital Vision/Getty Images RF; bag of apples: ©Lifesize/Getty Images

xxvi Contents

16.4 Reducing Undernutrition in the  Developing World 565

16.5 Nutrition and Your Health: Undernutrition at Critical Life Stages 572

Case Study: Undernutrition During Childhood 574

Chapter 17 Safety of Our Food Supply 581

17.1 Food Safety: Setting the Stage 582

17.2 Food Preservation—Past, Present, and Future 586

17.3 Foodborne Illness Caused by Microorganisms 58717.4 Food Additives 593

17.5 Natural Substances in Foods That Can Cause Illness 59817.6 Environmental Contaminants in Food 601

17.7 Food Production Choices 606

17.8 Nutrition and Your Health: Preventing Foodborne Illness 611 Case Study: Preventing Foodbourne Illness at Gatherings 615

Chapter 20 Nutrition During Adulthood 707

20.1 The Graying of North America 70820.2 Nutrient Needs During Adulthood 71320.3 Factors Related to Nutritional Status of Adults 71820.4 Ensuring a Healthful Diet for the Adult Years 728

Case Study: Dietary Assistance for an Older Adult 731 20.5 Nutrition and Your Health: Nutrition Implications of Alcohol Consumption 732

Appendix A Daily Values Used on Food Labels A-1Appendix B Diabetes Menu-Planning Tools A-2Appendix C Dietary Assessment A-14

Appendix D Chemical Structures Important in Nutrition A-21

Appendix E Sources of Nutrition Information A-26Appendix F English-Metric Conversions and Metric Units A-29

Appendix G DRI Tables A-30Glossary G-1

Index I-1

Part Five: Nutrition: A Focus on Life Stages

Chapter 18 Nutrition During Pregnancy and

Breastfeeding 621

18.1 Nutrition and Fertility 622

18.2 Prenatal Growth and Development 625

18.3 Success in Pregnancy 628

18.4 Increased Nutrient Needs to Support Pregnancy 632

Case Study: Eating for Two 638

18.5 Eating Pattern for Pregnant Women 639

18.6 Physiological Changes of Concern During Pregnancy 641

18.7 Breastfeeding 644

18.8 Nutrition and Your Health: Preventing Birth Defects 652

Chapter 19 Nutrition from Infancy Through

Adolescence 663

19.1 Assessing Growth 664

19.2 Infant Nutritional Needs 667

19.3 Guidelines for Infant Feeding 672

Case Study: Undernutrition during infancy 679

19.4 Toddlers and Preschool Children: Nutrition Concerns 680

19.5 School-Age Children: Nutrition Concerns 688

19.6 Teenage Years: Nutrition Concerns 693

19.7 Nutrition and Your Health: Food Allergies and Intolerances 698

Pregnant woman: ©Getty Images; boy and girl eating: ©BananaStock/PunchStock; woman and mother hugging: ©Digital Vision/PunchStock

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1.2 Identify diet and lifestyle factors that contribute to the 15 leading causes of death in North America.

1.3 Define the terms nutrition, carbohydrate, protein, lipid (fat), alco-hol, vitamin, mineral, water, phytochemical, kilocalorie (kcal),

and fiber.

1.4 Determine the total calories (kcal) of a food or diet using the weight and calorie content of the energy-yielding nutrients,

con-vert English to metric units, and calculate percentages, such as percent of calories from fat in a diet.

Chapter 1 is designed to allow you to:

1.1 Describe how our food choices are affected by the flavor, texture, and appearance of food; routines and habits; early

experiences and customs; advertising; nutrition and health

concerns; restaurants; social changes; economics; and

physiological processes affected by meal size and

composition.

Student Learning Outcomes

© Corbis/Punchstock

What Would You Choose?

We begin each chapter with this activity to get you

think-ing We ask you to make a choice that is right for you using

the concepts discussed in the chapter At the end of each

chapter, we provide the logic behind what a dietitian would

recommend

project Unfortunately, your Psychology 101 class meets at

you decide to sleep those extra 20 minutes it would take to

sit down and enjoy breakfast at the dining hall What’s your

best time-saving breakfast option? What factors may hold

you back from making the correct choice?

a Skip breakfast but plan to consume a few extra calories

at lunch and dinner.

b Eat a low-fat granola bar and iced coffee from the

vending machines in your dorm.

c Eat a quick bowl of Wheaties™ with a banana and low-fat

milk along with a yogurt, all from your dorm room “pantry.”

d Pick up a ham, egg, and cheese bagel.

Think about your choice as you read Chapter 1, then see

What the Dietitian Chose at the end of the chapter. 

Unfortunately, this healthy lifestyle is not always easy to follow When it comes to “nutrition,” it is clear that some of our diets are out of balance with our metabolism, physiology, and physical activity level

We begin this chapter with some questions What influences your daily food choices? How important are factors such as taste, appearance, convenience, or cost? Is nutrition one of the factors you consider? Are your food choices influencing your quality of life and long-term health? By making optimal dietary choices, we can bring the goal of a long, healthy life within reach This is the primary theme of this chapter and throughout this book

The ultimate goal of this book is to help you find the best path to good nutrition The information presented is based on emerging science that is translated into everyday actions that improve health After completion of your nutrition course, you should understand the knowledge behind the food choices you make and recommend to others We call this achievement of making food choices that are right for you “nutrition literacy.”

1.5 Understand the scientific method as it is used in forming hypoth-eses and theories in the field of nutrition, including the

determi-nation of nutrient needs.

1.6 List the major characteristics of the North American diet, the food habits that often need improvement, and the key “Nutrition

and Weight Status” objectives of the Healthy People 2020

4 Contemporary Nutrition: A Functional Approach

1.1 Why Do You Choose the Food You Eat?

In your lifetime, you will eat about 70,000 meals and 60 tons of food Many factors—some internal, some external—influence our food choices This chapter begins with a discussion

of these factors and ends with a conversation specifically about eating well as a college student In between, we examine the powerful effect of dietary habits in determining overall health and take a close look at the general classes of nutrients—as well as the calories—

supplied by the food we eat We also discuss the major characteristics of the North American diet, the food habits that often need improvement, and the key “Nutrition and Weight Status”

objectives in the Healthy People 2020 report A review of the scientific process behind

nutrition recommendations is also included, along with an introduction to our “Newsworthy Nutrition” feature that you will see throughout the book

Understanding what drives us to eat and what affects food choice will help you understand the complexity of factors that influence eating, especially the effects of our routines and food advertising (Fig 1-1) You can then appreciate why foods may have different meanings to dif-ferent people and thus why food habits and preferences of others may differ from yours

WHAT INFLUENCES YOUR FOOD CHOICES?

Food means so much more to us than nourishment—it reflects much of what we think about ourselves The Bureau of Labor Statistics estimated that in 2013, Americans spent the equivalent

of 19 days eating and drinking If we live to be 80 years old, that will add up to 4.1 years of ing and drinking Overall, our daily food choices stem from a complicated mix of biological and social influences (see Fig 1-1) Let’s examine some of the key reasons we choose what we eat

eat-FIGURE 1-1 ⊲ Food choices are

affected by many factors Which have the

greatest impact on your food choices? 

© BananaStock/PunchStock

Food flavor, texture, and appearance preferences

Psychological needs

Food customs and culture

Social network

of family and friends

Lifestyle

Food cost Food availability

Social needs

Health and nutrition concerns, knowledge, and beliefs

Food marketing

Routines and habits

Education, occupation, and income

Chapter 1: Nutrition, Food Choices, and Health 5

choices Creating more flavorful foods that are both healthy and profitable is a major focus

of the food industry The challenge is to match the “taste” of the foods we prefer with the

best nutrition and health characteristics The good news is that chefs and “food bloggers” are

dedicating themselves to promoting nutritious food that is also delicious, resulting in food

that is good for us starting to taste better

on our food choices Many food customs, including ethnic diet patterns, begin as we are

introduced to foods during childhood Parents can lay a strong foundation knowing that

early exposure to food choices during infancy, toddler, and preschool years is important

in influencing later health behaviors Developing healthy patterns during childhood will

go a long way to ensure healthy preferences and choices when we are teenagers and

adults

convenience strongly influence choices Most of us eat from a core group of foods with

about 100 basic items accounting for 75% of our total food intake Recent surveys indicate

that the most commonly purchased foods in America are milk (about 23 gallons per person

yearly), ready-to-eat cereal, bottled water (about 34 gallons per year), soft drinks (nearly

41 gallons per year), and bread (about 53 pounds per year) It is no surprise that milk and

cereal are both on the top-five list because many Americans eat them together as their daily

breakfast Bread is also on the list because it is typically consumed at every meal in

America, making it one of the most common forms of grain eaten Bottled water has

become the drink of choice for most events, especially outdoor activities The

pop-ularity of carbonated soft drinks remains a concern because studies have found

an association between consumption of sugar-sweetened drinks and obesity in

children (see Chapter 19)

food interest of the consumer Consumers have more food choices than

ever and these choices are well advertised in newspapers and

maga-zines, on billboards, radio, television, and online The food

indus-try in the United States spends billions on advertising Some of

this advertising is helpful, as it promotes the importance of food

components such as calcium and fiber in our diets However,

the food industry also advertises highly sweetened cereals,

cookies, cakes, and soft drinks because they bring in the

greatest profits Researchers at Yale University found that

in 2012, fast-food restaurant chains spent $4.6 billion on

advertising, primarily television ads In recent years, most

fast-food restaurants increased their advertising to children

(Fig. 1-2), resulting in preschoolers viewing an average of

2.8 fast-food television ads, older children viewing 3.2 ads,

and teens viewing 4.8 ads every day This is of concern

because food advertising has been shown to have a definite

© Ingram Publishing

▲ Cereal and milk are two of the most monly purchased foods in America largely because they are eaten together for breakfast every day by many.  © Stockbyte/PunchStock

FIGURE 1-2 ▲ This chart shows the marketing expenditures used to promote food and beverages to children and teens in the United States

in  2009.

Source: Reading 9: Federal Trade Commission: A Review of Food Marketing to Children and Adolescents, Follow-Up Report, December 2012 www.ftc.gov/os/2012/12/121221food marketingreport.pdf

6 Contemporary Nutrition: A Functional Approach

effect on weight gain in children and adolescents In addition, marketing of fast food via mobile devices and social media has increased exponentially (see Further Reading 9) Recent studies indicate that the association between TV advertising of foods and drinks, and childhood obesity is especially prevalent in the United States (see Further Readings 3 and 10) Concern for the negative effect of advertising and marketing on the diets and health of children led the Council of Better Business Bureaus

to establish the Children’s Food and Beverage Advertising tiative, a self-regulatory program Participants are 17 of the largest food and beverage companies that represent about 80%

Ini-of child-directed television food advertising The Initiative is designed to shift the mix of foods advertised to children to encourage healthier dietary choices and healthy lifestyles (see Further Reading 11) Research also indicates that mass media influences the onset of eating disorders through its depiction

of extremely thin models as stereotypes of attractive bodies

Eating disorders will be introduced in Eating Well in College (Section 1.8) and discussed at length in Chapter 15

choices Restaurant food is often calorie dense, in large tions, and of poorer nutritional quality compared to foods made

por-at home Fast-food and pizza restaurant menus typically emphasize mepor-at, cheese, fried foods, and carbonated beverages In response to recent consumer demands, restaurants have placed healthier options on their menus and many are listing nutritional content there, as well Mandatory posting of the calorie content of restaurant items will go into effect soon as a result of the Affordable Care Act The law requires chain restaurants with 20 or more locations to post the calorie content of their offerings on menus or menu boards with other nutritional information available upon request The intent of the law is to provide consumers with clear and consistent nutrition information so that they can make informed and healthful choices Although many restaurants have already placed calorie information on their menus, the Food and Drug Administration (FDA) extended the date for which establishments must be compliant with the menu labeling rule to December 1, 2016

stem from a lifestyle that limits the amount of time spent in food preparation (see Further Reading 4) In the 2011 Academy of Nutrition and Dietetics Trends Survey, 62% of Ameri-can adults indicated that it took too much time to keep track of their diet (see Further Read-ing 2) Restaurants and supermarkets have responded to our demanding work schedules and long hours away from home by supplying prepared meals, microwavable entrees, and vari-ous quick-prep frozen products

indicates that after taste, cost is the number two reason why people choose the food they

do While the average American now spends less on food than in the past, young adults and those with higher incomes spend the most on food As income increases, so do meals eaten away from home and preferences for foods such as cookies, chocolate, cheese, and meat

Also keep in mind that as calorie intake increases, so does the food bill Tips for eating well

on a college student’s budget are discussed in Section 1.8

Last but not least, nutrition—or what we think of as “healthy foods”—also directs our

food purchases North Americans who tend to make health-related food choices are often well-educated, middle-class professionals These same people are generally health oriented, have active lifestyles, and focus on weight control The recent National Health Interview Survey showed that 74% of women in the study habitually or always read nutrition labels, whereas only 58% of men read labels on food products Label reading was associated with a lower body mass index (BMI, body weight relative to height), especially in women Women who read labels had a BMI of 1.48 points lower than women who did not read nutrition

C R I T I C A L T H I N K I N G

Can healthy choices be legislated? Public health authorities

would like to influence health behaviors by banning or

tax-ing unhealthy foods or tax-ingredients; however, industries and

many concerned citizens oppose the expanding reach of the

government This struggle gained national attention in the

summer of 2014 Mounting evidence for the link between

consumption of sugar-sweetened beverages and obesity

had prompted the proposal of a ban on the sale of sugary

drinks in containers larger than 16 ounces in some

establish-ments With the backing of then-mayor Michael Bloomberg,

this ban was approved by the New York City Board of Health

and would have taken effect in 2013 However, the

bever-age industry staunchly opposed the ban and the New York

Supreme Court invalidated the law In June 2014, the New York

Court of Appeals ruled that this ban overreached the health

department’s regulatory authority Whose responsibility is it to

determine which foods are good for you?

Chapter 1: Nutrition, Food Choices, and Health 7

C R I T I C A L T H I N K I N G

Sarah is majoring in nutrition and is well aware of the impor- tance of a healthy diet She has recently been analyzing her diet and is confused She notices that she eats a great deal of high-fat foods, such as peanut butter, cheese, chips, ice cream, and chocolate, and few fruits, vegetables, and whole grains

She also has become hooked on her daily cappuccino with lots of whipped cream What three fac- tors may be influencing Sarah’s food choices? What advice would you give her on how to have her diet match her needs?

labels This translates to a difference of 8.6 pounds for a woman of average height (see

Fur-ther Reading 14)

WHY ARE YOU SO HUNGRY?

Two drives, hunger and appetite, influence our desire to eat These drives differ dramatically

Hunger is primarily our physical, biological drive to eat and is controlled by internal body

mechanisms For example, as foods are digested and absorbed by the stomach and small

intes-tine, these organs send signals to the liver and brain telling us to reduce further food intake

Appetite, our primarily psychological drive to eat, is affected by many of the external

food choice mechanisms we discussed in the last section, such as environmental and

psycho-logical factors and social cues and customs (see Fig 1-1) Appetite can be triggered simply

by seeing a tempting dessert or smelling popcorn at the movie theater Fulfilling either or

both drives by eating sufficient food normally brings a state of satiety, a feeling of

satisfac-tion that temporarily halts our desire to continue eating

A region of the brain helps regulate satiety The feeding center and the satiety center

work in opposite ways, like a tug-of-war, to promote adequate availability of nutrients at

all times For example, when we haven’t eaten for a while, stimulation of the feeding center

signals us to eat As we eat, the nutrient content in the blood rises, and the satiety center is

stimulated This is why we no longer have a strong desire to seek food after a meal

Admit-tedly, this concept of a tug-of-war between the feeding and satiety centers is an

oversimpli-fication of a complex process The various feeding and satiety messages from body cells to

the brain do not single-handedly determine what we eat We often eat because food comforts

us (see Further Reading 20) Almost everyone has encountered a mouthwatering dessert and

devoured it, even on a full stomach It smells, tastes, and looks good We might eat because

it is the right time of day, we are celebrating, or we are seeking emotional comfort to

over-come the blues After a meal, memories of pleasant tastes and feelings reinforce appetite If

stress or depression sends you to the refrigerator, you are mostly seeking comfort, not food

calories Appetite may not be a physical process, but it does influence food intake We will

discuss more about this mechanism, including the effect of meal size and composition on

satiety, in Chapter 7 on energy balance and weight control

PUTTING OUR FOOD CHOICES INTO PERSPECTIVE

The next time you pick up a candy bar or reach for a second helping at a meal, remember

the internal and external influences on eating behavior You should now understand that

daily food consumption is a complicated mix of biological and social influences Body

cells, nutrients in the blood, hormones, brain chemicals, and our social and family customs

all influence food choices When food is abundant, appetite—not hunger—most likely

trig-gers eating Satiety associated with consuming a meal may reside primarily in our

psy-chological frame of mind Also, because satiety regulation is not perfect, body weight can

fluctuate We become accustomed to a certain amount of food at a meal Providing less

than that amount leaves us wanting more One way to use this observation for weight-loss

purposes is to train your eye to expect less food by slowly decreasing serving sizes to more

appropriate amounts Your appetite then readjusts as you expect less food Keep track of

what triggers your eating for a few days Is it primarily hunger or appetite? The Rate Your

Plate activity in this chapter also asks you to keep track of what influences your food intake

satiety A state in which there is no longer

a desire to eat; a feeling of satisfaction.

1 What are the factors that influence our food choices?

2 How do hunger and appetite differ in the way they influence our desire to eat?

3 What factors influence satiety?

8 Contemporary Nutrition: A Functional Approach

WHAT IS NUTRITION?

Nutrition is the science that links foods to health and disease It includes the processes

by which the human organism ingests, digests, absorbs, transports, and excretes food substances

NUTRIENTS COME FROM FOOD

What is the difference between food and nutrients? Food provides the energy (in the form

of calories) as well as the materials needed to build and maintain all body cells Nutrients are the substances obtained from food that are vital for growth and maintenance of a healthy

body throughout life For a substance to be considered an essential nutrient, three

charac-teristics are needed:

∙ First, at least one specific biological function of the nutrient must be identified in the body

∙ Second, omission of the nutrient from the diet must lead to a decline in certain cal functions, such as production of blood cells

∙ Third, replacing the omitted nutrient in the diet before permanent damage occurs will restore those normal biological functions

WHY STUDY NUTRITION?

We all may feel like nutrition experts because we all eat several times a day Nutrition edge can be confusing, however, and seem like a moving target Recommendations may seem to differ depending on their source, and there are so many choices when shopping for food or eating out We just learned that nutrition is only one of many factors that influence our eating habits There is a lot to learn, and we know that you are interested in what you should be eating and how the food you eat affects you Studying nutrition will help you erase any misconceptions you have about food and nutrition and make informed choices about the foods you eat and their relationship to health

knowl-Nutrition is a lifestyle factor that is a key to developing and maintaining an optimal state

of health for you A poor diet and a sedentary lifestyle are known to be risk factors for life-threatening chronic diseases such as cardiovascular (heart) disease, hypertension,

diabetes, and some forms of cancer (Table 1-1) Together, these and related disorders

account for two-thirds of all deaths in North America (Fig 1-3) (see Further Reading 15)

Not meeting nutrient needs in younger years makes us more likely to suffer health

con-sequences, such as bone fractures from the disease osteoporosis, in later years At the

same time, taking too much of a nutrient—such as a vitamin A supplement—can be ful Another dietary problem, drinking too much alcohol, is associated with many health problems

harm-U.S government scientists have calculated that a poor diet combined with a lack of ficient physical activity contributes to hundreds of thousands of fatal cases of cardiovascular

suf-essential nutrient In nutritional terms,

a substance that, when left out of a diet,

leads to signs of poor health The body

either cannot produce this nutrient or

cannot produce enough of it to meet its

needs If added back to a diet before

permanent damage occurs, the affected

aspects of health are restored.

nutrients Chemical substances in food

that contribute to health, many of which

are essential parts of a diet Nutrients

nourish us by providing calories to fulfill

energy needs, materials for building body

parts, and factors to regulate necessary

chemical processes in the body.

chronic Long-standing, developing over

time When referring to disease, this term

indicates that the disease process, once

developed, is slow and lasting A good

example is cardiovascular disease.

risk factors A term used frequently when

discussing the factors contributing to the

development of a disease A risk factor is

an aspect of our lives, such as heredity,

lifestyle choices (e.g., smoking), or

nutri-tional habits.

▲ Many foods are rich sources of nutrients. 

© Pixtal/AGE Fotostock

cardiovascular disease A general term

that refers to any disease of the heart and

circulatory system This disease is

gener-ally characterized by the deposition of

fatty material in the blood vessels

(hard-ening of the arteries), which in turn can

lead to organ damage and death Also

termed coronary heart disease (CHD), as

the vessels of the heart are the primary

sites of the disease.

Chapter 1: Nutrition, Food Choices, and Health 9

diabetes A group of diseases ized by high blood glucose Type 1 diabe- tes involves insufficient or no release of the hormone insulin by the pancreas and therefore requires daily insulin therapy Type 2 diabetes results from either insuf- ficient release of insulin or general inabil- ity of insulin to act on certain body cells, such as muscle cells Persons with type 2 diabetes may or may not require insulin therapy.

character-osteoporosis The presence of a induced fracture or a T-score of −2.5 or lower The bones are porous and fragile due to low mineral density.

stress-cancer A condition characterized by uncontrolled growth of abnormal cells.

hypertension A condition in which blood pressure remains persistently elevated Obesity, inactivity, alcohol intake, excess salt intake, and genetics may each con- tribute to the problem.

FIGURE 1-3 ▲ Ten leading causes of death in the United States

Source: Centers for Disease Control and Prevention, National Vital Statistics Report, Deaths: Leading Causes for 2012,

August 31, 2015 (see Further Reading 15 ) Canadian statistics are quite similar.

*Causes of death in which diet plays a part.

Cancer*Chronic lower respiratory disease

Stroke * Accidents Alzheimer’s disease * Diabetes mellitus*Kidney disease*Pneumonia/Influenza

Suicide

*Many bold terms are also defined in the page margins within each chapter and in the glossary at the end of this book.

Cancer A condition characterized by uncontrolled growth of abnormal cells.

Cardiovascular

(heart) disease A general term that refers to any disease of the heart and circulatory system This disease is generally characterized by the deposition of fatty material in

the blood vessels (hardening of the arteries), which in turn can lead to organ damage and death Also termed coronary heart disease (CHD), as the ves- sels of the heart are the primary sites of the disease.

Cholesterol A waxy lipid found in all body cells; it has a structure containing multiple

chemical rings Cholesterol is found only in foods of animal origin.

Chronic Long-standing, developing over time When referring to disease, this term

indicates that the disease process, once developed, is slow and lasting A good example is cardiovascular disease.

Diabetes A group of diseases characterized by high blood glucose Type 1 diabetes

involves insufficient or no release of the hormone insulin by the pancreas and therefore requires daily insulin therapy Type 2 diabetes results from either insufficient release of insulin or general inability of insulin to act on certain body cells, such as muscle cells Persons with type 2 diabetes may or may not require insulin therapy.

Hypertension A condition in which blood pressure remains persistently elevated Obesity,

inactivity, alcohol intake, excess salt intake, and genetics may each ute to the problem.

contrib-Kilocalorie

(kcal) Unit that describes the energy content of food Specifically, a kilocalorie (kcal) is the heat energy needed to raise the temperature of 1000 grams

(1 liter) of water 1 degree Celsius Although kcal refers to a 1000-calorie unit of measurement, it is commonly referred to as calories on food labels

Kilocalories is the technically correct term for the energy content of a food,

so we will use it in this book.

Obesity A condition characterized by excess body fat.

Osteoporosis Decreased bone mass related to the effects of aging (including estrogen

loss during menopause in women), genetic background, and poor diet.

Risk factor A term used frequently when discussing the factors contributing to the

development of a disease A risk factor is an aspect of our lives, such as heredity, lifestyle choices (e.g., smoking), or nutritional habits.

TABLE 1-1 ■ Glossary Terms to Aid Your Introduction to Nutrition*

glucose A six-carbon sugar that exists in

a ring form; found as such in blood, and

in table sugar bound to fructose; also known as dextrose, it is one of the simple sugars.

10 Contemporary Nutrition: A Functional Approach

disease, cancer, and diabetes each year among adults in the United States Thus, the nation of poor diet and too little physical activity may be the second leading cause of death

combi-in the United States In addition, obesity, which the American Medical Association recently

declared as a disease, is considered the second leading cause of preventable death in North America (smoking is the first) When they occur together, obesity and smoking cause even more health problems Obesity and chronic diseases are often preventable An important key

to good health and more health care savings is to realize that the cost of prevention, usually when we are children and young adults, is a small fraction of the cost of treating these dis-eases when we are older

The good news is that the increased interest in health, fitness, and nutrition shown

by Americans has been associated with long-term decreasing trends for heart disease,

cancer, and stroke (three of the leading causes of death) Mortality from heart

dis-ease, the leading cause of death, has been declining steadily since 1980 As you gain understanding about your nutritional habits and increase your knowledge about optimal nutrition, you will have the opportunity to dramatically reduce your risk for many com-mon health problems Recent research has shown that a healthy diet along with other healthy lifestyle factors can protect women from sudden cardiac death A healthy diet was defined as one with a high proportion of vegetables, fruits, nuts, omega-3 fats, and fish (see Further Reading 6) For additional help, the U.S federal government provides two websites that contain links to many sources of health and nutrition information (www.healthfinder.gov and www.nutrition.gov) Other useful sites are www.webmd

com and www.eatright.org

obesity Disorder involving excessive

body fat that increases the risk of health

problems.

water The universal solvent;

chemi-cally, H 2 O The body is composed of

about 60% water Water (fluid) needs are

about 9 (women) or 13 (men) cups per

day; needs are greater if one exercises

heavily.

vitamins An essential organic

(carbon-containing) compound needed in small

amounts in the diet to help regulate and

support chemical reactions and

pro-cesses in the body.

lipids A compound containing much

carbon and hydrogen, little oxygen, and

sometimes other atoms Lipids do not

dis-solve in water and include fats, oils, and

cholesterol.

minerals Element used in the body to

promote chemical reactions and to form

body structures.

proteins Food and body compounds

made of more than 100 amino acids;

pro-teins contain carbon, hydrogen, oxygen,

nitrogen, and sometimes other atoms in

a specific configuration Proteins contain

the form of nitrogen most easily used by

the human body.

kilocalorie (kcal) Heat energy needed to

raise the temperature of 1000 grams (1 L)

of water 1 degree Celsius

carbohydrates A compound containing

carbon, hydrogen, and oxygen atoms

Most are known as sugars, starches, and

fibers.

stroke A decrease or loss in blood flow

to the brain that results from a blood clot

or other change in arteries in the brain

This in turn causes the death of brain

tissue Also called a cerebrovascular

accident.

1 How do we define nutrition?

2 What are the three leading causes of death in which diet plays a part?

CONCEPT CHECK 1.2

✓

1.3 What Are the Classes and Sources

of Nutrients?

To begin the study of nutrition, let’s start with an overview of the six classes of nutrients

You are probably already familiar with the terms carbohydrates, lipids (fats and oils),

proteins, vitamins, and minerals These nutrients, plus water, make up the six classes of

nutrients found in food

Nutrients can then be assigned to three functional categories: (1) those that primarily

pro-vide us with calories to meet energy needs (expressed in kilocalories [kcal]); (2) those

impor-tant for growth, development, and maintenance; and (3) those that act to keep body functions running smoothly Some function overlap exists among these categories (Table 1-2) The

Nutrient Classes That Provide Energy Nutrient Classes That Promote Growth, Development, and Maintenance Nutrient Classes That Regulate Body Processes

TABLE 1-2 ■ Major Functions of the Various Classes of Nutrients

Chapter 1: Nutrition, Food Choices, and Health 11

energy-yielding nutrients (carbohydrates, lipids, and protein) along with water are needed

in relatively large amounts, so they are called macronutrients Vitamins and minerals are

needed in such small amounts in the diet that they are called micronutrients.

CARBOHYDRATES

Chemically, carbohydrates can exist in foods as simple sugars and complex carbohydrates

Simple sugars, frequently referred to as sugars, are relatively small molecules These

sug-ars are found naturally in fruits, vegetables, and dairy products Table sugar, known as

sucrose, is an example of a simple sugar that is added to many foods we eat Glucose, also

known as blood sugar or dextrose, is an example of a simple sugar in your blood Complex

carbohydrates are formed when many simple sugars are joined together For example,

plants store carbohydrates in the form of starch, a complex carbohydrate made up of

hun-dreds of glucose units Breads, cereals, grains, and starchy vegetables are the main sources

of complex carbohydrates

During digestion, complex carbohydrates are broken down into single sugar molecules

(such as glucose) and absorbed via cells lining the small intestine into the bloodstream (see

Chapter 3 for more on digestion and absorption) However, the bonds between the sugar

molecules in certain complex carbohydrates, called fiber, cannot be broken down by human

digestive processes Fiber passes through the small intestine undigested to provide bulk for

the stool (feces) formed in the large intestine (colon)

Aside from enjoying their taste, we need sugars and other carbohydrates in our diets

primarily to help satisfy the calorie needs of our body cells Carbohydrates provide a major

source of calories for the body, on average 4 kcal per gram Glucose, a simple sugar that the

body can derive from most carbohydrates, is a major source of calories for most cells When

insufficient carbohydrate is consumed, the body is forced to make glucose from proteins—

not a healthy change Chapter 4 focuses on carbohydrates

LIPIDS

Lipids (mostly fats and oils) in the foods we eat also provide energy Lipids yield more

calories per gram than do carbohydrates—on the average, 9 kcal per gram—because of

dif-ferences in their chemical composition They are also the main form for energy storage in

the body

Lipids dissolve in certain chemical solvents (e.g., ether and benzene) but not in water

In this book, the more familiar terms fats and oils will generally be used, rather than lipids

Generally, fats are lipids that are solid at room temperature, and oils are lipids that are liquid

at room temperature We obtain fats and oils from animal and plant sources Animal fats,

such as butter or lard, are solid at room temperature Plant oils, such as corn or olive oil, tend

to be liquid at room temperature To promote heart health, most people would benefit from

using more plant oils in place of solid fats (see Chapter 5)

Certain fats are essential nutrients that must come from our diet These key fats that the

body cannot produce, called essential fatty acids, perform several important functions in the

body: they help regulate blood pressure and play a role in the synthesis and repair of vital

cell parts However, we need only about 4 tablespoons of a common plant oil (such as canola

or soybean oil) each day to supply these essential fatty acids A serving of fatty fish, such

as salmon or tuna, at least twice a week is another healthy source of fats The unique fatty

acids in these fish complement the healthy aspects of common vegetable oils This will be

explained in greater detail in Chapter 5, which focuses on lipids

PROTEINS

Proteins are the main structural material in the body For example, proteins constitute a

major part of bone and muscle; they are also important components in blood, body cells,

enzymes, and immune factors Proteins can also provide calories for the body—on average,

4 kcal per gram Typically, however, the body uses little protein for the purpose of meeting

micronutrient A nutrient needed in ligram or microgram quantities in a diet.

mil-macronutrient A nutrient needed in gram quantities in a diet.

starch A carbohydrate made of multiple units of glucose attached together in a form the body can digest; also known as complex carbohydrate.

complex carbohydrate Carbohydrate composed of many monosaccharide molecules Examples include glycogen, starch, and fiber.

simple sugar Monosaccharide or charide in the diet.

disac-fiber Substances in plant foods not digested in the human stomach or small intestine These add bulk to feces Fiber naturally found in foods is also called dietary fiber.

cells The structural basis of plant and mal organization In animals it is bounded

ani-by a cell membrane Cells have the ability

to take up compounds from and excrete compounds into their surroundings.

bonds A linkage between two atoms formed by the sharing of electrons, or attractions.

▲ Salmon is a fatty fish that is a healthy source of essential fatty acids. © FoodCollection

enzymes A compound that speeds up the rate of a chemical reaction but is not altered by the reaction Almost all enzymes are proteins (some are made

of genetic material). 

12 Contemporary Nutrition: A Functional Approach

daily calorie needs Proteins are formed when amino acids are bonded together Some of

these are essential nutrients

Protein in our diet comes from animal and plant sources The animal products meat, poultry, fish, dairy products, and eggs are significant sources of protein in most diets Beans, grains, and some vegetables are good plant protein sources and are important to include in vegetarian diets

Most North Americans eat up to two times as much protein as the body needs to tain health This amount of extra protein in the diet reflects the standard of living and the dietary habits of most North Americans It is generally not harmful for healthy persons with

main-no evidence of heart or kidney disease, diabetes, or family history of colon cancer or kidney stones The excess is used for calorie needs and carbohydrate production but ultimately can

be converted to and stored as fat Chapter 6 focuses on proteins

VITAMINS

The main function of vitamins is to enable many chemical reactions to occur in the body

Some of these reactions help release the energy trapped in carbohydrates, lipids, and teins Remember, however, that vitamins themselves contain no usable calories for the body

pro-The 13 vitamins are divided into two groups: four are fat-soluble because they dissolve in fat (vitamins A, D, E, and K); nine are water-soluble because they dissolve in water (the B

vitamins and vitamin C) The two groups of vitamins have different sources, functions, and characteristics Water-soluble vitamins are found mainly in fruits and vegetables, whereas dairy products, nuts, seeds, oils, and breakfast cereals are good sources of fat-soluble vita-mins Cooking destroys water-soluble vitamins much more readily than it does fat-soluble vitamins Water-soluble vitamins are also excreted from the body much more readily than are fat-soluble vitamins Thus, the fat-soluble vitamins, especially vitamin A, have the abil-ity to accumulate in excessive amounts in the body, which then can lead to toxicity Vitamins are discussed in Chapters 8 through 13

MINERALS

Minerals are structurally simple, inorganic substances that do not contain carbon atoms

Minerals such as sodium and potassium typically function independently in the body, whereas minerals such as calcium and phosphorus combine to function in tissue, such as bone Because

of their simple structure, minerals are not destroyed during cooking, but they can still be lost if they dissolve in the water used for cooking and that water is then discarded Minerals are criti-cal players in nervous system functioning, water balance, structural (e.g., skeletal) systems, and many other cellular processes but produce no calories as such for the body

The 16 or more essential minerals required in the diet for good health are divided into

two groups: major minerals and trace minerals because dietary needs and concentrations

in the body vary enormously If daily needs are less than 100 milligrams, the mineral is classified as a trace mineral; otherwise, it is a major mineral Minerals that function based

on their electrical charge when dissolved in water are also called electrolytes; these include

sodium, potassium, and chloride Many major minerals are found naturally in dairy products and fruits, whereas many trace minerals are found in meats, poultry, fish, and nuts Minerals are covered in Chapters 8 through 13

tempera-3000 grams or about 13 cups—of water and/or other fluids every day Women need closer to

2200 grams or about 9 cups per day Fluid needs vary widely, however, based on differences

amino acid The building block for

pro-teins containing a central carbon atom

with nitrogen and other atoms attached.

chemical reaction An interaction

between two chemicals that changes

inorganic Any substance lacking carbon

atoms bonded to hydrogen atoms in the

chemical structure.

atom Smallest combining unit of

an element, such as iron or calcium

Atoms consist of protons, neutrons,

and electrons.

electrolyte A mineral that separates into

positively or negatively charged ions in

water They are able to transmit an

electri-cal current.

trace mineral Vital to health, a mineral

that is required in the diet in amounts less

than 100 milligrams per day.

major mineral Vital to health, a mineral

that is required in the diet in amounts

greater than 100 milligrams per day.

solvent A liquid substance in which other

substances dissolve.

Chapter 1: Nutrition, Food Choices, and Health 13

in body mass and environmental conditions Because thirst is a late sign of dehydration,

urine color can be used as another measure of hydration status Urine color should be no

more yellow than lemonade

Water is not only available from the obvious sources, but it is also the major component

in some foods, such as many fruits and vegetables (e.g., lettuce, grapes, and melons) The

body even makes some water as a by-product of metabolism Water is examined in detail

in Chapter 9

OTHER IMPORTANT COMPONENTS IN FOOD

Another group of compounds in foods from plant sources, especially within the fruit and

vegetable groups, is what scientists call phytochemicals Although these plant components

are not considered essential nutrients in the diet, many of these substances provide

signifi-cant health benefits Considerable research attention is focused on various phytochemicals

in reducing the risk for certain diseases For example, evidence from animal and

labora-tory studies indicates that compounds in blueberries and strawberries prevent the growth of

certain cancer cells Although certain phytochemicals are now available as dietary

supple-ments, research suggests that their health benefits are best obtained through the consumption

of whole foods Foods with high phytochemical content are sometimes called “superfoods”

because of the health benefits they are thought to confer There is no legal definition of the

term superfood, however, and there is concern that it is being overused in marketing certain

foods Table 1-3 lists some noteworthy phytochemicals with their common food sources

Tips for boosting the phytochemical content of your diet will be discussed in Chapter 2

metabolism Chemical processes in the body by which energy is provided in use- ful forms and vital activities are sustained.

phytochemical A chemical found in plants Some phytochemicals may con- tribute to a reduced risk of cancer or cardiovascular disease in people who consume them regularly.

Orange, red, and yellow fruits and vegetables

Cruciferous vegetables (broccoli, cabbage, kale) Indoles

Cruciferous vegetables, especially broccoli Isothiocyanates

Soybeans, other legumes, cucumbers, other fruits and

Citrus fruit, onions, apples, grapes, red wine, tea,

Blueberries, strawberries, raspberries, grapes, apples,

Red, blue, and purple plants (blueberries, eggplant) Anthocyanosides

Onions, bananas, oranges (small amounts) Fructooligosaccharides

TABLE 1-3 Food Sources of Some Phytochemical Compounds Under Study

▲ Blueberries are sometimes considered

“superfoods” because they are rich in promoting phytochemicals.  © Lifesize/Getty Images