Understanding Normal and Clinical Nutrition, 8th Edition

Front Cover......Page 1
Title Page......Page 5
Copyright......Page 6
Brief Contents......Page 9
Contents......Page 11
Food Choices......Page 30
The Nutrients......Page 32
Nutrients in Foods and in the Body......Page 33
The Energy-Yielding Nutrients: Carbohydrate, Fat, and Protein......Page 34
The Minerals......Page 37
Conducting Research......Page 38
Analyzing Research Findings......Page 41
Publishing Research......Page 42
Establishing Nutrient Recommendations......Page 43
Using Nutrient Recommendations......Page 45
Comparing Nutrient Recommendations......Page 46
Nutrition Assessment of Individuals......Page 47
Nutrition Assessment of Populations......Page 49
Risk Factors for Chronic Diseases......Page 51
HIGHLIGHT 1 Nutrition Information and Misinformation—On the Net and in the News......Page 57
Diet-Planning Principles......Page 64
Dietary Guidelines for Americans......Page 66
USDA Food Guide......Page 68
Exchange Lists......Page 74
From Guidelines to Groceries......Page 75
Food Labels......Page 81
Nutrition Facts......Page 82
The Daily Values......Page 83
Nutrient Claims......Page 85
Structure-Function Claims......Page 86
Consumer Education......Page 87
HIGHLIGHT 2 Vegetarian Diets......Page 91
Digestion......Page 98
Anatomy of the Digestive Tract......Page 99
The Muscular Action of Digestion......Page 101
The Secretions of Digestion......Page 103
The Final Stage......Page 105
Anatomy of the Absorptive System......Page 107
A Closer Look at the Intestinal Cells......Page 108
The Vascular System......Page 110
The Lymphatic System......Page 111
Gastrointestinal Hormones and Nerve Pathways......Page 113
The System at Its Best......Page 115
HIGHLIGHT 3 Common Digestive Problems......Page 119
The Chemist’s View of Carbohydrates......Page 128
Monosaccharides......Page 129
Disaccharides......Page 130
Starches......Page 132
Fibers......Page 133
Digestion and Absorption of Carbohydrates......Page 134
Carbohydrate Absorption......Page 135
Lactose Intolerance......Page 137
Glucose in the Body......Page 138
A Preview of Carbohydrate Metabolism......Page 139
The Constancy of Blood Glucose......Page 140
Health Effects of Sugars......Page 144
Controversies Surrounding Sugars......Page 146
Recommended Intakes of Sugars......Page 148
Health Effects of Starch and Fibers......Page 149
Recommended Intakes of Starch and Fibers......Page 151
From Guidelines to Groceries......Page 152
HIGHLIGHT 4 Alternatives to Sugar......Page 159
The Chemist’s View of Fatty Acids and Triglycerides......Page 166
Fatty Acids......Page 167
Degree of Unsaturation Revisited......Page 169
Phospholipids......Page 172
Sterols......Page 173
Lipid Digestion......Page 174
Lipid Absorption......Page 176
Lipid Transport......Page 177
Roles of Triglycerides......Page 180
Essential Fatty Acids......Page 181
A Preview of Lipid Metabolism......Page 182
Health Effects of Lipids......Page 183
Recommended Intakes of Fat......Page 187
From Guidelines to Groceries......Page 188
HIGHLIGHT 5 High-Fat Foods—Friend or Foe?......Page 199
Amino Acids......Page 208
Proteins......Page 210
Protein Absorption......Page 212
Protein Synthesis......Page 214
Roles of Proteins......Page 216
A Preview of Protein Metabolism......Page 220
Protein Quality......Page 222
Protein-Energy Malnutrition......Page 223
Health Effects of Protein......Page 226
Recommended Intakes of Protein......Page 228
Protein and Amino Acid Supplements......Page 229
HIGHLIGHT 6 Nutritional Genomics......Page 234
CHAPTER 7 Metabolism: Transformations and Interactions......Page 240
Chemical Reactions in the Body......Page 241
Breaking Down Nutrients for Energy......Page 244
Glucose......Page 246
Glycerol and Fatty Acids......Page 249
Amino Acids......Page 251
Breaking Down Nutrients for Energy— In Summary......Page 253
The Final Steps of Catabolism......Page 254
Energy Balance......Page 257
Feasting—Excess Energy......Page 259
Fasting—Inadequate Energy......Page 260
HIGHLIGHT 7 Alcohol and Nutrition......Page 265
Energy Balance......Page 276
Food Composition......Page 277
Food Intake......Page 278
Energy Out: The kCalories the Body Expends......Page 280
Components of Energy Expenditure......Page 281
Estimating Energy Requirements......Page 283
Defining Healthy Body Weight......Page 285
Body Fat and Its Distribution......Page 287
Health Risks Associated with Body Weight and Body Fat......Page 290
HIGHLIGHT 8 Eating Disorders......Page 297
Overweight and Obesity......Page 308
Fat Cell Metabolism......Page 309
Causes of Overweight and Obesity......Page 310
Genetics......Page 311
Environment......Page 313
Health Risks......Page 315
Dangerous Interventions......Page 316
Surgery......Page 319
Weight-Loss Strategies......Page 321
Eating Plans......Page 322
Physical Activity......Page 326
Environmental Influences......Page 329
Behavior and Attitude......Page 330
Weight Maintenance......Page 332
Public Health Programs......Page 333
Weight-Gain Strategies......Page 334
HIGHLIGHT 9 The Latest and Greatest Weight-Loss Diet—Again......Page 342
The Vitamins—An Overview......Page 350
The B Vitamins—As Individuals......Page 353
Thiamin......Page 354
Riboflavin......Page 355
Niacin......Page 358
Biotin......Page 360
Pantothenic Acid......Page 362
Vitamin B6......Page 363
Folate......Page 365
Vitamin B12......Page 369
Non-B Vitamins......Page 372
The B Vitamins—In Concert......Page 373
B Vitamin Roles......Page 374
B Vitamin Deficiencies......Page 375
B Vitamin Food Sources......Page 376
Vitamin C......Page 377
Vitamin C Roles......Page 378
Vitamin C Recommendations......Page 379
Vitamin C Toxicity......Page 380
Vitamin C Food Sources......Page 381
HIGHLIGHT 1 0 Vitamin and Mineral Supplements......Page 387
Vitamin A and Beta-Carotene......Page 396
Roles in the Body......Page 397
Vitamin A Deficiency......Page 399
Vitamin A in Foods......Page 401
Roles in the Body......Page 404
Vitamin D Deficiency......Page 405
Vitamin D Recommendations and Sources......Page 406
Vitamin E......Page 408
Vitamin E Recommendations......Page 409
Vitamin K......Page 410
Vitamin K Deficiency......Page 411
The Fat-Soluble Vitamins— In Summary......Page 412
HIGHLIGHT 11 Antioxidant Nutrients in Disease Prevention......Page 417
Water and the Body Fluids......Page 424
Water Balance and Recommended Intakes......Page 425
Blood Volume and Blood Pressure......Page 428
Fluid and Electrolyte Balance......Page 429
Acid-Base Balance......Page 433
The Minerals—An Overview......Page 435
Sodium......Page 437
Chloride......Page 440
Potassium......Page 441
Calcium Roles in the Body......Page 443
Calcium Recommendations and Sources......Page 445
Calcium Deficiency......Page 448
Phosphorus......Page 449
Magnesium......Page 450
Sulfate......Page 452
HIGHLIGHT 12 Osteoporosis and Calcium......Page 458
The Trace Minerals—An Overview......Page 468
Iron Roles in the Body......Page 469
Iron Absorption and Metabolism......Page 470
Iron Deficiency......Page 472
Iron Toxicity......Page 474
Iron Recommendations and Sources......Page 476
Iron Contamination and Supplementation......Page 477
Zinc Absorption and Metabolism......Page 479
Zinc Deficiency......Page 480
Zinc Recommendations and Sources......Page 481
Iodine......Page 482
Selenium......Page 484
Copper......Page 485
Manganese......Page 486
Fluoride......Page 487
Chromium......Page 488
Other Trace Minerals......Page 489
Closing Thoughts on the Nutrients......Page 490
HIGHLIGHT 13 Phytochemicals and Functional Foods......Page 496
Nutrition prior to Pregnancy......Page 504
Fetal Growth and Development......Page 505
Critical Periods......Page 507
Maternal Weight......Page 510
Weight Gain during Pregnancy......Page 511
Exercise during Pregnancy......Page 513
Nutrition during Pregnancy......Page 514
Energy and Nutrient Needs during Pregnancy......Page 515
Common Nutrition-Related Concerns of Pregnancy......Page 519
The Infant’s Birthweight......Page 520
Malnutrition and Pregnancy......Page 521
Maternal Health......Page 522
The Mother’s Age......Page 524
Practices Incompatible with Pregnancy......Page 525
Nutrition during Lactation......Page 527
Lactation: A Physiological Process......Page 528
Maternal Energy and Nutrient Needs during Lactation......Page 529
Maternal Health......Page 531
Practices Incompatible with Lactation......Page 532
HIGHLIGHT 14 Fetal Alcohol Syndrome......Page 538
Energy and Nutrient Needs......Page 542
Breast Milk......Page 545
Infant Formula......Page 547
Introducing Cow’s Milk......Page 549
Introducing Solid Foods......Page 550
Mealtimes with Toddlers......Page 552
Energy and Nutrient Needs......Page 553
Hunger and Malnutrition in Children......Page 557
Hyperactivity and “Hyper” Behavior......Page 559
Food Allergy and Intolerance......Page 560
Childhood Obesity......Page 562
Mealtimes at Home......Page 566
Nutrition at School......Page 568
Growth and Development......Page 570
Energy and Nutrient Needs......Page 571
Food Choices and Health Habits......Page 572
Problems Adolescents Face......Page 573
HIGHLIGHT 15 Childhood Obesity and the Early Development of Chronic Diseases......Page 581
CHAPTER 16 Life Cycle Nutrition: Adulthood and the Later Years......Page 588
Nutrition and Longevity......Page 589
Observation of Older Adults......Page 590
Manipulation of Diet......Page 591
The Aging Process......Page 592
Physiological Changes......Page 593
Other Changes......Page 595
Energy and Energy Nutrients......Page 596
Vitamins and Minerals......Page 597
Nutrient Supplements......Page 598
Vision......Page 599
Arthritis......Page 600
The Aging Brain......Page 601
Food Choices and Eating Habits of Older Adults......Page 602
Food Assistance Programs......Page 603
Meals for Singles......Page 604
HIGHLIGHT 16 Hunger and Community Nutrition......Page 610
Effects of Illness on Nutrition Status......Page 616
Responsibility for Nutrition Care......Page 617
Nutrition Screening......Page 618
The Nutrition Care Process......Page 620
Historical Information......Page 622
Food Intake Data......Page 623
Anthropometric Data......Page 626
Biochemical Data......Page 628
Physical Examinations......Page 631
HIGHLIGHT 17 Nutrition and Immunity......Page 636
Documenting Nutrition Care......Page 642
Approaches to Nutrition Care......Page 644
Determining Energy Requirements......Page 646
Modified Diets......Page 648
Alternative Feeding Routes......Page 651
Nothing by Mouth (NPO)......Page 652
Food Selection......Page 653
Food Preparation and Delivery......Page 654
Improving Food Intake......Page 655
HIGHLIGHT 18 Foodborne Illnesses......Page 659
Medications in Disease Treatment......Page 668
Risks from Medications......Page 669
Patients at High Risk of Adverse Effects......Page 670
Effectiveness and Safety of Herbal Products......Page 671
Use of Herbal Products in Illness......Page 673
Drug Effects on Nutrient Absorption......Page 675
Drug Effects on Nutrient Metabolism......Page 677
Drug Effects on Nutrient Excretion......Page 678
Diet-Drug Interactions and Toxicity......Page 679
HIGHLIGHT 19 Anemia in Illness......Page 684
Enteral Formulas......Page 690
Types of Enteral Formulas......Page 691
Formula Characteristics......Page 692
Indications for Tube Feedings......Page 693
Feeding Routes......Page 694
Formula Selection......Page 696
Safe Handling......Page 698
Initiating and Progressing a Tube Feeding......Page 699
Tube Feeding Complications......Page 702
Transition to Table Foods......Page 703
HIGHLIGHT 20 Inborn Errors of Metabolism......Page 709
Indications for Parenteral Nutrition......Page 714
Parenteral Nutrients......Page 717
Solution Preparation......Page 718
Insertion and Care of Intravenous Catheters......Page 721
Discontinuing Intravenous Feedings......Page 723
Managing Metabolic Complications......Page 724
Candidates for Home Nutrition Support......Page 725
Planning Home Nutrition Care......Page 726
Quality-of-Life Issues......Page 727
HIGHLIGHT 21 Ethical Issues in Nutrition Care......Page 731
The Body’s Responses to Stress and Injury......Page 736
The Inflammatory Response......Page 737
Determining Nutritional Requirements......Page 739
Patients with Burn Injuries......Page 742
Chronic Obstructive Pulmonary Disease......Page 744
Respiratory Failure......Page 748
HIGHLIGHT 22 Multiple Organ Dysfunction Syndrome......Page 754
Dysphagia......Page 758
Gastroesophageal Reflux Disease......Page 761
Dyspepsia......Page 765
Gastritis......Page 766
Peptic Ulcer Disease......Page 767
Gastric Surgery......Page 768
Gastrectomy......Page 769
Bariatric Surgery......Page 772
HIGHLIGHT 23 Dental Health and Chronic Illness......Page 777
Constipation......Page 782
Diarrhea......Page 785
Fat Malabsorption......Page 787
Bacterial Overgrowth......Page 788
Conditions Affecting the Pancreas......Page 790
Pancreatitis......Page 791
Cystic Fibrosis......Page 792
Celiac Disease......Page 794
Inflammatory Bowel Diseases......Page 795
Short Bowel Syndrome......Page 798
Irritable Bowel Syndrome......Page 801
Diverticular Disease of the Colon......Page 803
Colostomies and Ileostomies......Page 804
HIGHLIGHT 24 Probiotics and Intestinal Health......Page 810
Fatty Liver and Hepatitis......Page 814
Fatty Liver......Page 815
Hepatitis......Page 816
Cirrhosis......Page 817
Consequences of Cirrhosis......Page 818
Treatment of Cirrhosis......Page 820
Medical Nutrition Therapy for Cirrhosis......Page 821
Liver Transplantation......Page 824
Types of Gallstones......Page 825
Consequences of Gallstones......Page 826
Treatment for Gallstones......Page 827
HIGHLIGHT 25 Food Allergies......Page 833
Overview of Diabetes Mellitus......Page 838
Diagnosis of Diabetes Mellitus......Page 839
Types of Diabetes Mellitus......Page 840
Acute Complications of Diabetes Mellitus......Page 842
Chronic Complications of Diabetes Mellitus......Page 844
Treatment Goals......Page 845
Evaluating Diabetes Treatment......Page 846
Body Weight Concerns......Page 847
Medical Nutrition Therapy: Nutrient Recommendations......Page 848
Medical Nutrition Therapy: Meal-Planning Strategies......Page 849
Insulin Therapy......Page 850
Physical Activity and Diabetes Management......Page 855
Diabetes Management in Pregnancy......Page 857
Gestational Diabetes......Page 858
HIGHLIGHT 26 The Metabolic Syndrome......Page 863
Atherosclerosis......Page 868
Development of Atherosclerosis......Page 869
Causes of Atherosclerosis......Page 870
Evaluating Risk for Coronary Heart Disease......Page 872
Therapeutic Lifestyle Changes for Lowering CHD Risk......Page 874
Lifestyle Changes for Hypertriglyceridemia......Page 879
Drug Therapies for CHD Prevention......Page 881
Treatment of Heart Attack......Page 882
Factors That Influence Blood Pressure......Page 883
Factors That Contribute to Hypertension......Page 884
Treatment of Hypertension......Page 885
Consequences of Heart Failure......Page 888
Medical Management of Heart Failure......Page 889
Stroke Prevention......Page 890
Stroke Management......Page 891
HIGHLIGHT 27 Feeding Disabilities......Page 895
Functions of the Kidneys......Page 900
The Nephrotic Syndrome......Page 901
Treatment of the Nephrotic Syndrome......Page 902
Consequences of Acute Renal Failure......Page 905
Treatment of Acute Renal Failure......Page 906
Chronic Kidney Disease......Page 907
Consequences of Chronic Kidney Disease......Page 908
Treatment of Chronic Kidney Disease......Page 909
Kidney Transplants......Page 913
Kidney Stones......Page 915
Consequences of Kidney Stones......Page 916
Prevention and Treatment of Kidney Stones......Page 918
HIGHLIGHT 28 Dialysis......Page 923
How Cancer Develops......Page 928
Nutrition and Cancer Risk......Page 930
Consequences of Cancer......Page 932
Treatments for Cancer......Page 933
Medical Nutrition Therapy for Cancer......Page 934
Consequences of HIV Infection......Page 938
Treatments for HIV Infection......Page 940
Medical Nutrition Therapy for HIV Infection......Page 942
HIGHLIGHT 29 Complementary and Alternative Medicine......Page 948
APPENDIX A Cells, Hormones, and Nerves......Page 955
APPENDIX B Basic Chemistry Concepts......Page 962
APPENDIX C Biochemical Structures and Pathways......Page 970
APPENDIX D Measures of Protein Quality......Page 987
APPENDIX E Nutrition Assessment: Supplemental Information......Page 990
APPENDIX F Physical Activity and Energy Requirements......Page 1000
APPENDIX G Exchange Lists for Diabetes......Page 1006
APPENDIX H Table of Food Composition......Page 1023
APPENDIX I WHO: Nutrition Recommendations Canada: Guidelines and Meal Planning......Page 1102
APPENDIX J Healthy People 2010......Page 1114
APPENDIX K Enteral Formulas......Page 1116
Glossary......Page 1120
Index......Page 1146
Aids To Calculation......Page 1189
Dietary Reference Intakes......Page 2
Daily Values For Food Labels......Page 1191
Body Mass Index (BMI)......Page 1192