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brief contents

10 Achieving and Maintaining a Healthful Body Weight 342

in depth 10.5 Obesity 372

11 Nutrition and Physical Fitness: Keys to good health 380

in depth 11.5 Disorders Related to Body Image, Eating, and Exercise  413

12 Food Safety and Technology: Protecting our food 424

in depth 12.5  The Safety and Effectiveness of  Dietary Supplements  454

13 Food Equity, Sustainability, and Quality: The challenge of “good food” 460

in depth 13.5  Malnutrition  480

14 Nutrition Through the Life Cycle: Pregnancy and the first year of life 486

in depth 14.5  The Fetal Environment  524

15 Nutrition Through the Life Cycle: Childhood to late adulthood 528

in depth 15.5  Searching for the Fountain  of Youth  562

Appendices A-1 References R-1 Answers AN-1 Glossary GL-1 Index IN-1 Credits CR-1

1 Nutrition: Linking food and health 2

in depth 1.5 New Frontiers in Nutrition and Health 29

2 Designing a Healthful Diet 36 in depth 2.5  Healthful Eating Patterns  59

3 The Human Body: Are we really what we eat? 64

in depth 3.5 Disorders Related to Specific Foods  93

4 Carbohydrates: Plant-derived energy nutrients 98

in depth 4.5   Diabetes  130

5 Fats: Essential energy-supplying nutrients 138

in depth 5.5  Cardiovascular Disease  167

6 Proteins: Crucial components of all body tissues 178

in depth 6.5 Vitamins and Minerals: Micronutrients with  Macro Powers  211

7 Nutrients Essential to Fluid and Electrolyte Balance 222

in depth 7.5  Alcohol  249

8 Nutrients Essential to Key Body Functions 260

in depth 8.5  Cancer  292

9 Nutrients Essential to Healthy Tissues 300

in depth 9.5  Osteoporosis  334

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Helping Students See Nutrition Concepts Come Alive in Their Daily Lives

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Nutrition Concepts Applied to Students’ Daily Lives

NEW! In Depth Chapters Obesity, Malnutrition, and Healthful Eating Patterns are three new mini-chapters that focus on topics such as the health and societal problems surrounding undernourishment; the effectiveness of lifestyle changes, medications, dietary supplements, and surgery in obesity treatment; and the components and principles of a healthful eating pattern.

NEW! Chapter 13: Food Equity, Sustainability, and Quality: The Challenge of “Good” Food Focuses on current issues of food quality and availability that directly affect today’s students. Topics include the disparities in availability of high-quality, nourishing food thought to contribute to the poverty-obesity paradox, unsafe working conditions in many U.S. farms and factories, and more.

NEW! Focus Figures 6 new Focus Figures on topics such as nutrition and human disease, the scientific method, the new nutrition facts panel, and more; and 8 new Meal Focus Figures have been added that graphically depict the differences in sets of meals, such as a comparison of nutrient density or a comparison of two high- carbohydrate meals, to engage students with relevant and practical information, and much more.

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Help Students Master Tough Concepts of the Course

NEW! Learning Outcomes Approach New approach creates a clear learning path for students with numbered learning outcomes at the beginning of each chapter that are then tied to each major chapter section, helping students navigate each chapter and measure their progress against specific learning goals; this approach also helps instructors assess the key information and skills students are meant to take away from each chapter.

NEW! Study Plans Study Plans conclude each chapter, tying the chapter learning outcomes to the review questions and math review questions, and also includes the test yourself t/f answers and web links.

NEW! Table of Contents Organization To better streamline the coverage of the micronutrients, four former chapters (7-10 in the 4e) now become three (7-9 in the 5e) to help students better comprehend the role of vitamins and minerals in fluid and electrolyte balance (Ch. 7); key body functions (energy metabolism, antioxidant functions, and vision) (Ch. 8); and healthy body tissues (collagen, blood, and bone) (Ch. 9).

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BEFOrE CLASS Mobile Media and Reading Assignments Ensure Students Come to Class Prepared

Continuous Learning Before, During, and After Class

Pre-Lecture Reading Quizzes are easy to customize and assign

NEW! Interactive eText 2.0 gives students access to the text whenever they can access the internet. eText features include:

• Now available on smartphones and tablets

• Seamlessly integrated videos and other rich media

• Accessible (screen-reader ready) • Configurable reading settings, including

resizable type and night reading mode • Instructor and student note-taking,

highlighting, bookmarking, and search • Also available for offline use via Pearson’s

eText 2.0 app

NEW! Reading Questions ensure that students complete the assigned reading before class and stay on track with reading assignments. Reading Questions are 100% mobile ready and can be completed by students on mobile devices.

UPDATED! Dynamic Study Modules help students study effectively by continuously assessing student performance and providing practice in areas where students struggle the most. Each Dynamic Study Module, accessed by computer, smartphone or tablet, promotes fast learning and long-term retention.

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AFTEr CLASS MasteringNutrition Delivers Automatically Graded Nutrition Activities

Learning Catalytics, a “bring your own device” student engagement, assessment, and classroom intelligence system, allows students to use their smartphone, tablet, or laptop to respond to questions in class.

DUrING CLASS Engage students with Learning Catalytics

with MasteringNutrition™

UPDATED! Nutrition Animations explain big picture concepts that help students learn the hardest topics in nutrition. These animations, complete with a new design and compatible with Mastering and mobile devices, help students master tough topics and address students’ common misconceptions, using assessment and wrong-answer feedback.

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AFTEr CLASS Easy-to-Assign, Customize, Media-Rich, and Automatically Graded Assignments.

Continuous Learning Before, During, and After Class

NEW! Study Plan items tie all end-of- chapter material to specific numbered Learning Outcomes and Mastering assets. Assignable study plan items contain at least one multiple choice question per Learning Outcome and wrong-answer feedback.

NEW! ABC News Videos bring nutrition to life and spark discussion with up-to-date hot topics from 2012 to 2016 that occur in the nutrition field. Multiple-choice questions provide wrong-answer feedback to redirect students to the correct answer.

ExPANDED! Focus Figure Coaching Activities better guide students through key nutrition concepts with interactive mini-lessons.

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with MasteringNutrition™

Math Coaching Activities provide hands-on practice of important nutrition- related calculations to help students understand and apply the material. Questions include wrong-answer feedback.

UPDATED! Nutritools Build-A-Meal Coaching Activities have been updated and allow students to combine and experiment with different food options and learn firsthand how to build healthier meals. The Build a Meal, Build a Pizza, Build A Salad, and Build A Sandwich tools have been carefully rethought to improve the user experience, making them easier to use and are now HTML5 compatible for mobile devices.

Single sign-on to MyDietAnalysis allows students to complete a diet assignment. Students keep track of their food intake and exercise and enter the information to create a variety of reports. A mobile version gives students 24/7 access via their smartphones to easily track food, drink, and activity on the go. MyDietAnalysis Case Study Activities with quizzing provide students with hands-on diet analysis practice that can also be automatically graded.

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Teaching Resources ■■ Instructor Resource and Support Manual in

Microsoft Word and PDF formats ■■ Teaching with Student Learning Outcomes ■■ Teaching with Web 2.0 ■■ Learning Catalytics: Getting Started ■■ Getting Started with MasteringNutrition

Student Supplements ■■ Eat Right! ■■ Live Right! ■■ Food Composition Table

resources for YOU, the Instructor

MasteringNutrition™ provides you with everything you need to prep for your course and deliver a dynamic lecture, in one convenient place. Resources include:

Media Assets for Each Chapter ■■ ABC News Lecture Launcher videos ■■ Nutrition Animations ■■ PowerPoint Lecture Outlines ■■ PowerPoint clicker questions and Jeopardy-style

quiz show questions ■■ Files for all illustrations and tables and selected

photos from the text

Test Bank ■■ Test Bank in Microsoft, Word, PDF, and RTF

formats ■■ Computerized Test Bank, which includes all

the questions from the printed test bank in a format that allows you to easily and intuitively build exams and quizzes.

Measuring Student Learning Outcomes? All of the MasteringNutrition assignable content is tagged to book content and to Bloom’s Taxonomy. You also have the ability to add your own learning outcomes, helping you track student performance against your learning outcomes. You can view class performance against the specified learning outcomes and share those results quickly and easily by exporting to a spreadsheet.

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Janice Thompson, PhD, FACSM University of Birmingham

Melinda Manore, PhD, RD, CSSD, FACSM Oregon State University

Nutrition An Applied Approach F I F T H E D I T I O N

330 Hudson Street, NY NY 10013

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Courseware Portfolio Manager: Michelle Yglecias Content Producer: Deepti Agarwal Managing Producer: Nancy Tabor Courseware Director, Content Development: Barbara Yien Development Editor: Laura Bonazzoli Art Development Editor: Jay McElroy Courseware Editorial Assistant: Nicole Constantine Rich Media Content Producer: Timothy Hainley, Lucinda Bingham Mastering Content Developer, Science: Lorna Perkins Full-Service Vendor: SPi Global Copyeditor: Alyson Platt Art Coordinator: Rebecca Marshall, Lachina Publishing Services Design Manager: Mark Ong Interior Designer: Preston Thomas Cover Designer: Preston Thomas Photographer: Renn Valo, CDV LLC Rights & Permissions Project Manager: Matt Perry, Cenveo Publishing Services Rights & Permissions Management: Ben Ferrini Photo Researcher: Danny Meldung, Photo Affairs, Inc. Manufacturing Buyer: Stacey Weinberger, LSC Communications Executive Product Marketing Manager: Neena Bali Senior Field Marketing Manager: Mary Salzman

Cover Photo Credit: portishead1/gettyimages

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved. Printed in the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms and the appropriate contacts within the Pearson Education Global Rights & Permissions department, please visit www.pearsoned.com/permissions/.

Acknowledgements of third party content appear on pages CR-1 to CR-3, which constitutes an extension of this copyright page.

PEARSON, ALWAYS LEARNING and MasteringHealth are exclusive trademarks in the U.S. and/or other countries owned by Pearson Education, Inc. or its affiliates.

Unless otherwise indicated herein, any third-party trademarks that may appear in this work are the property of their respective owners and any references to third-party trademarks, logos or other trade dress are for demonstrative or descriptive purposes only. Such references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the owner and Pearson Education, Inc. or its affiliates, authors, licensees or distributors.

Library of Congress Cataloging-in-Publication Data Names: Thompson, Janice, author. | Manore, Melinda, author. Title: An applied approach / Janice Thompson, Ph.D., FACSM, University of Birmingham, Melinda Manore, Ph.D., RD, CSSD, FACSM, Oregon State University. Description: Fifth edition. | New York, NY : Pearson, 2017. Identifiers: LCCN 2016037778 | ISBN 0134516230 Subjects: LCSH: Nutrition. Classification: LCC QP141 .T467 2017 | DDC 612.3–dc23 LC record available at https://lccn.loc.gov/2016037778

1 16

ISBN 10: 0-13-451623-0; ISBN 13: 978-0-13-451623-3 (Student edition) ISBN 10: 0-13-460828-3; ISBN 13: 978-0-13-460828-0 (Instructor’s Review Copy)www.pearsonhighered.com

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This book is dedicated to my family, friends, and colleagues—you provide constant support, encouragement, and unconditional love. It is also dedicated to my students and the communities with which I work—you continue to inspire me, challenge me, and teach me.

This book is dedicated to my parents, for their consistent love, prayers, support, and encouragement. You helped me believe in myself.

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v

Janice Thompson, PhD, FACSM University of Birmingham, UK

Janice Thompson earned a doctorate in exercise physiology and nutrition at Arizona State University. She is currently professor of public health nutrition and exercise at the University of Birmingham, UK, in the School of Sport and Exercise Sciences. Her research focuses on designing and assessing the impact of nutrition and physi- cal activity interventions to reduce the risks for obesity, cardiovascular disease, and type 2 diabetes in high-risk populations. She also teaches nutrition and research methods courses and mentors graduate research students. Janice is a Fellow of the American College of Sports Medicine (ACSM), a member of the Scientific Committee of the European College of Sports Science, and a member of the American Society for Nutrition (ASN), the British Association of Sport and Exercise Science (BASES), and the Nutrition Society. Janice won an undergraduate teaching award while at the University of North Carolina, Charlotte, a Community Engagement Award while at the University of Bristol, and the ACSM Citation Award for her contributions to research, education, and service to the exercise sciences. In addition to The Science of Nutrition, Janice coauthored the Pearson textbooks Nutrition: An Applied Approach and Nutri- tion for Life with Melinda Manore. Janice loves hiking, yoga, traveling, and cooking and eating delicious food. She likes almost every vegetable except fennel and believes chocolate should be listed as a food group.

Melinda Manore, PhD, RD, CSSD, FACSM Oregon State University

Melinda Manore earned a doctorate in human nutrition with minors in exercise physi- ology and health at Oregon State University (OSU). She is the past chair of the OSU Department of Nutrition and Food Management and is currently a professor of nutri- tion. Prior to OSU, she was a professor at Arizona State University. Melinda’s area of expertise is nutrition and exercise, particularly the role of diet and exercise in health and prevention of chronic disease, exercise performance, and energy balance. She has a special focus on the energy and nutritional needs of active women and girls across the life cycle. Melinda is an active member of the Academy of Nutrition and Dietetics (AND) and the American College of Sports Medicine (ACSM). She is the past chair of the AND Research Dietetic Practice Group; served on the AND Obesity Steering Com- mittee; and is an active member of the Sports, Cardiovascular, and Wellness Nutri- tion Practice Group. She is a fellow of ACSM, has served as vice president and on the Board of Trustees, and received the ACSM Citation Award for her contributions to research, education, and service to the exercise sciences. Melinda is also a member of the American Society of Nutrition (ASN) and the Obesity Society. She is the past chair of the U.S. Department of Agriculture (USDA) Nutrition and Health Committee for Pro- gram Guidance and Planning and currently is chair of the USDA, ACSM, AND Expert Panel Meeting, Energy Balance at the Crossroads: Translating Science into Action. She serves on the editorial board of numerous research journals and has won awards for excellence in research and teaching. Melinda also coauthored the Pearson textbooks Nutrition: An Applied Approach and Nutrition for Life with Janice Thompson. Melinda is an avid walker, hiker, and former runner who loves to garden, cook, and eat great food. She is also an amateur birder.

about the authors

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vii

Why We Wrote This Book Nutrition gets a lot of press. Go online or pick up a magazine and you’ll read the lat- est debate over which weight-loss diet is best; turn on the TV or stream a video and you’ll hear a celebrity describe how she lost 50 pounds without exercising; scan the headlines or read some blogs and you’ll come upon the latest “super foods” and the politics surrounding the creation of new, enhanced “designer” foods. How can you evaluate these sources of nutrition information and find out whether the advice they provide is reliable? How do you navigate through seemingly endless recommenda- tions and arrive at a way of eating that’s right for you—one that supports your physi- cal activity, allows you to maintain a healthful weight, and helps you avoid chronic diseases?

Nutrition: An Applied Approach began with our conviction that students and instructors would both benefit from an accurate and clear textbook that links nutri- ents to their functional benefits. As authors and instructors, we know that students have a natural interest in their bodies, their health, their weight, and their success in sports and other activities. By demonstrating how nutrition relates to these interests, this text empowers students to reach their personal health and fitness goals. Through- out the text, material is presented in a lively narrative that continually links the facts to students’ circumstances, lifestyles, and goals. Information on current events and research keeps the inquisitive spark alive, illustrating that nutrition is truly a “living” science, and a source of considerable debate. The content of Nutrition: An Applied Approach is appropriate for non-nutrition majors, but also includes information that will challenge students who have a more advanced understanding of chemistry and math. We present the “science side” in a contemporary narrative style that’s easy to read and understand, with engaging features that reduce students’ apprehensions and encourage them to apply the material to their lives. Also, because this book is not a derivative of a major text, the writing and the figures are cohesive and always level appropriate.

As teachers, we are familiar with the myriad challenges of presenting nutrition information in the classroom, and we have included the most comprehensive ancil- lary package available to assist instructors in successfully meeting these challenges. We hope to contribute to the excitement of teaching and learning about nutrition—a subject that affects all of us, and a subject so important and relevant that correct and timely information can make the difference between health and disease.

New to the Fifth Edition Retaining its hallmark applied approach, the new fifth edition takes personal nutrition concepts a step further with dynamic new features that help students realize that they think about their nutrition daily. The most noteworthy changes include:

NEW! Focus Figures (two new) in Chapter 1, one focusing on nutrition and human disease, the other on the six groups of nutrients found in food. NEW! Meal Focus Figures (four new) graphically depict the differences in sets of meals, such as a comparison of nutrient density or a comparison of two high- carbohydrate meals, to engage students with useful information. UPDATED! Nutrition Facts Panel and Dietary Guidelines for Americans offer the latest nutritional guidelines (Chapter 2). NEW! Chapter 13: Food Equity, Sustainability, and Quality: The Challenge of “Good” Food focuses on current issues of food quality and availability that directly affect today’s students. Topics include the disparities in availability of high-quality,

Welcome to Nutrition: An Applied Approach, Fifth Edition!

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viii | New to the Fifth Edition

nourishing food thought to contribute to the poverty-obesity paradox, unsafe working conditions in many U.S. farms and factories, and more. NEW! In Depth Chapters: Obesity, Malnutrition, and Healthful Eating Patterns, these three new mini-chapters focus on topics such as the health and societal problems surrounding undernourishment; the effectiveness of lifestyle changes, medications, dietary supplements, and surgery in obesity treatment; and the com- ponents and principles of a healthful eating pattern. NEW! ABC News Videos bring nutrition to life and spark discussion with up-to- date hot topics from 2012 to 2016. MasteringNutrition activities tied to the videos include multiple-choice questions that provide wrong-answer feedback to redirect students to the correct answer.

To help students master tough concepts of the course, updates include:

NEW! Table of Contents organization to better streamline the coverage of the micronutrients where four former chapters [7 to 10 in the 4th edition] now become three [7 to 9 in the 5th edition] to reduce duplicate coverage and help students better comprehend the role of vitamins and minerals in fluid and elec- trolyte balance (Chapter 7); key body functions (energy metabolism, antioxidant functions, and vision) (Chapter 8); and healthy body tissues (collagen, blood, and bone) (Chapter 9). NEW! Learning Outcomes approach creates a clear learning path for students with numbered learning outcomes at the beginning of each chapter that are then tied to each major chapter section, helping students navigate each chapter and measure their progress against specific learning goals, and helping instructors assess the key information and skills students are meant to take away from each chapter. NEW! Study Plans conclude each chapter, tying the chapter learning outcomes to the review questions and math review questions, and also includes the Test Your- self true/false answers and Web Links. NEW! Offline access to the eText anytime with eText 2.0. Complete with embed- ded ABC News videos and animation, eText 2.0 is mobile friendly and ADA accessible.

Now available on smartphones and tablets. Seamlessly integrated videos. Accessible (screen-reader ready). Configurable reading settings, including sizable type and night reading mode. Instructor and student note taking, highlighting, bookmarking, and search.

This fifth edition of Nutrition: An Applied Approach also features the Mastering- Nutrition™ online homework, tutorial, and assessment system, which delivers self- paced tutorials and activities that provide individualized coaching, a focus on course objectives, and tools enabling instructors to respond individually to each student’s progress. The proven Mastering system provides instructors with customizable, easy- to-assign, automatically graded assessments that motivate students to learn outside of class and arrive prepared for lecture.

The Visual Walkthrough located at the front of this text provides an overview of these and other important features in the fifth edition. For specific changes to each chapter, see the following.

Chapter 1 Nutrition: Linking Food and Health Restructured headings throughout the chapter to improve organization and flow of the chapter. Expanded narrative text on wellness and the role that a healthy diet plays in pro- moting wellness. Revised Figure 1.1 (previously titled “Components of Wellness”) to figure illustrat- ing how a nutritious diet contributes to wellness in numerous ways. Deleted the Nutrition Myth or Fact and incorporated discussion of pellagra into the narrative text. Deleted the Hot Topic on spam and incorporated it into the narrative text.

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New to the Fifth Edition | ix

New Focus Figure 1.2 on the relationship between nutrition and human disease, which consolidated the previous Figures 1.2 to 1.4. New Focus Figure 1.3 on the six groups of nutrients found in foods, which consoli- dated the previous Figures 1.6 to 1.8, and added in new information and graphics on vitamins and minerals. Deleted previous Table 1.4 on AMDRs, as this information is provided in Focus Figure 1.4. New Focus Figure 1.5 on the scientific method—improves upon previous figure. Added new narrative text for epidemiological studies, prevalence, and incidence. New Figure 1.6 on types of research studies—combines narrative and decorative photos. New end-of-chapter Nutrition Debate on “Conflict of Interest”; included a new Critical Thinking Question that requires students to conduct research into the topic.

In Depth 1.5 New Frontiers in Nutrition and Health Slightly expanded the discussion of epigenetics and added a new figure illustrating the effect of epigenetic factors on gene expression. Deleted the Hot Topic on PB&J.

Chapter 2 Designing a Healthful Diet Restructured chapter headings and subheadings to improve organization, flow, and readability. Revised the chapter opener Test Yourself questions. Included new Meals Focus Figure (now Figure 2.1) illustrating the concept of nutrient density, which is now discussed as one of the characteristics of a health- ful diet. Expanded narrative on nutrient density to include an example of the NuVal system in supermarkets. Complete rewrite of section on “What’s Behind Our Food Choices?” which moved here from the former In Depth 2.5. Updated section on food labels, and included updated and enhanced figures on food labels (now Figure 2.3) and the Nutrition Facts panel (now Focus Figure 2.4). Deleted the previous Figure 2.3 (Health Claims Report Card) as it was repetitive and not particularly helpful. Updated section on Dietary Guidelines for Americans to include the latest 2015– 2020 DGAs. Deleted previous Table 2.3 (Ways to Incorporate the Dietary Guide- lines for Americans into your Daily Life) as it was outdated and inconsistent with the new DGAs. Moved the discussion and figure of the Mediterranean-style eating pattern and the Exchange System to the new In Depth on Healthful Eating Patterns, and tightened up the section on “Ethnic Variations and Other Eating Plans.” Added in a new section on “Get Some High-Tech Help” in designing a healthful diet. Expanded the section “Can Eating Out Be Part of a Healthful Diet?” to include recent evidence related to nutrition labeling on menus, and whether this has changed the menu choices of Americans when eating out. Deleted the Nutrition Label Activity on “How Realistic Are the Serving Sizes Listed on Food Labels?” as it was repetitive and did not add any additional information to what is already included in the narrative and figures. Revised the Nutrition Debate on “Nutrition Advice from the U.S. Government: Is Anyone Listening?”

In Depth 2.5 Healthful Eating Patterns This is an entirely new In Depth, teaching students the components and principles of a healthful eating pattern as recommended by the 2015–2020 Dietary Guidelines for Americans, and providing some examples, such as the Mediterranean diet.

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x | New to the Fifth Edition

Chapter 3 The Human Body: Are We Really What We Eat?

Reorganized opening section to improve text-art integration. Split discussion of gastrointestinal anatomy and physiology so that the journey of food through the GI tract is discussed in its own A-section, followed by an A- section covering the accessory organs and special features. Deleted the Hot Topic on GI simulators. Added discussion and a figure of the four mechanisms by which nutrients are absorbed across enterocytes. Expanded discussion and added figure of peristalsis and segmentation.

In Depth 3.5 Disorders Related to Specific Foods Tightened narrative on food allergies. Added discussion of non-celiac gluten sensitivity.

Chapter 4 Carbohydrates: Plant-Derived Energy Nutrients Incorporated the information on health properties of various forms of sugars into the chapter narrative (previously in Nutrition Myth or Fact box). Expanded information on types of soluble fibers. Added more detail on how fructose is metabolized differently from glucose, and the impact of these differences on insulin release, satiety, and associations with obesity. Incorporated information on hypoglycemia into the narrative (previously included in a Hot Topic). Updated the recommendations on added sugars based on the new 2015–2020 Dietary Guidelines for Americans in the narrative and Table 4.1. Added information on Advantame, a new artificial sweetener. Fully revised the section on the role artificial sweeteners play in weight management. Updated the end-of-chapter Nutrition Debate on whether added sugars are the cause of the obesity epidemic. Revised Figure 4.1 to more clearly show the results that occur from the chemical reactions that take place in photosynthesis. Enhanced Figure 4.11 on the glycemic index to include a graph showing the surge in blood glucose with high versus low glycemic index foods, along with the glyce- mic index values for specific foods. Added new Meals Focus Figure 4.16 comparing the food and fiber content of two diets, one high in fiber-rich carbohydrates and one high in refined carbohydrates.

In Depth 4.5 Diabetes Added historical information on the discovery of the role of insulin in diabetes. Added a figure identifying and allowing comparison of lab values for normal blood glucose, prediabetes, and diabetes for the FPG, OGT, and A1C tests. Expanded the information on lifestyle changes (including dietary strategies and smoking cessation) to reduce the risk for type 2 diabetes.

Chapter 5 Fats: Essential Energy-Supplying Nutrients Reorganized opening pages of the chapter: The first main section now provides an overview of the three main types of lipids. The second main section discusses triglycerides in detail. Updated the discussion of trans fatty acids to cover the recent FDA ruling to elimi- nate partially hydrogenated oils (PHOs) from the food supply by 2018. Updated all content to reflect the 2015–2020 Dietary Guidelines. Updated Figure 5.11 on micelle transport.

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New to the Fifth Edition | xi

Added a new Meals Focus Figure comparing a day’s meals high and low in satu- rated fat. Deleted Table 5.2. Expanded recommendations for consuming beneficial fats. Emphasized the role of a diet high in added sugars in cardiovascular disease. Replaced the Nutrition Debate on fat blockers with a new debate on the contro- versy about the role of saturated fats in cardiovascular disease.

In Depth 5.5 Cardiovascular Disease Updated throughout, including and especially on role of different types of dietary fats and blood lipids in CVD. Replaced calculation matrix (former Figure 4) with a link to a web-based risk assessment, replacing the lab data on blood lipids with a table from the NHLBI. Modestly expanded the information on medications for CVD.

Chapter 6 Proteins: Crucial Components of All Body Tissues

Revised chapter introduction to make it more pertinent to the target audience. Revised Figure 6.6 to include exclusively red blood cells. Expanded section on nitrogen balance to include a discussion of the limitations of the method. Deleted previous Table 6.2 (protein needs) to reflect most up-to-date evidence that is now discussed in the text. Updated section on protein needs, including new evidence that protein needs of many groups may be higher than the RDA. Streamlined and updated the section on potential harmful effects of high protein intakes. Added a Nutrition Label Activity on assessing your protein intake. Expanded the information on vegan diets, including more information on health benefits as compared to vegetarian diets. Included a new Meal Focus Figure comparing a day’s meals that are comprised of nutrient-dense protein sources to meals that are less nutrient dense (Figure 6.13). Included a new figure comparing the protein content of a vegan meal with a meat- based meal (Figure 6.15). Deleted section on “Disorders Related to Genetic Abnormalities.” Replaced the Nutrition Debate with a more current topic, “Are Current Protein Recommendations High Enough?”

In Depth 6.5 Vitamins and Minerals: Micronutrients with Macro Powers

Added information on ultra-trace minerals. Added QuickTips on retaining vitamins in foods.

Chapter 7 Nutrients Essential to Fluid and Electrolyte Balance

Added a new figure on fluid balance. Expanded the description of the regulation of fluid balance. Updated information on the dangers of energy drinks. Changed feature box on bottled water to a Nutrition Label Activity. Added a Nutrition Debate on controversy related to current sodium intake guidelines.

In Depth 7.5 Alcohol Added a new figure showing caloric content of popular alcoholic drinks. Added a new figure describing levels of impairment related to blood alcohol concentration.

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xii | New to the Fifth Edition

Chapter 8 Nutrients Essential to Key Body Functions This chapter combines the content from Chapters 8 and 10 of the fourth edition that focuses on the role of micronutrients in supporting three key body functions, namely, energy metabolism, antioxidant function, and vision. The micronutrients covered here are: for energy metabolism, the B-vitamins, choline, iodine, chro- mium, manganese, and sulphur; for antioxidant function, vitamin E, vitamin C’s antioxidant role, selenium, and the antioxidant functions of the carotenoids; and for vision, vitamin A. To maintain a chapter of reasonable length, content has been condensed modestly throughout. The chapter includes a Focus Figure on vision, two QuickTips features, a Nutri- Case, several Nutrition Online links, and a Nutrition Debate on the importance of deriving antioxidants from foods and not supplements.

In Depth 8.5 Cancer Expanded the description of cancer progression (Initiation, Promotion, and Progression). Updated the discussion and debate around the potential contribution of “bad luck” to causing cancer. Added in information on how exercise can reduce risks for various forms of cancer. Updated information on the role of tanning beds in increasing the risk for skin cancer. Updated information on the role of phytochemicals in cancer prevention.

Chapter 9 Nutrients Essential to Healthy Tissues This chapter combines the content from Chapters 8, 9, and 10 of the fourth edi- tion that focuses on the role of micronutrients in supporting connective tissues; namely, blood, the collagen component of connective tissues, and bone. The micronutrients covered here are: for blood, the trace minerals iron, zinc, and cop- per, and vitamins B6, folate, B12, and K; for collagen synthesis, vitamin C; and for bone, calcium, phosphorus, magnesium, fluoride, and vitamins D and K. To maintain a chapter of reasonable length, content has been condensed modestly throughout. The chapter includes a new figure on the role of vitamin C in collagen synthesis; a new Focus Figure on regulation of blood calcium; a You Do the Math on calculat- ing iron intake; three QuickTips features, a Nutri-Case, several Nutrition Online links, and a Nutrition Debate on the surge in vitamin D deficiency.

In Depth 9.5 Osteoporosis Updated opening story on bone health to discuss mother-daughter with osteoporo- sis and osteopenia. Expanded information on the role of calcium and vitamin D supplements in pro- moting bone health. Included a more age-appropriate figure for kyphosis (now Figure 3). Added a new figure on the reduction in bone density with age (now Figure 4). Updated research on the impact of caffeine on risk for fractures. Tightened up section on nutritional influences on osteoporosis risk, and updated information on the role of protein in promoting bone health. Updated the research into whether calcium and vitamin D supplementation can prevent osteoporosis. Included new information addressing the latest controversy on whether exercise can strengthen bone and reduce risk for fractures. Added new information on pharmaceutical treatments for osteoporosis. Discussed the controversy on whether taking calcium supplements increases the risk for myocardial infarction.

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New to the Fifth Edition | xiii

Chapter 10 Achieving and Maintaining a Healthful Body Weight

Reorganized chapter headings and content to improve flow and clarity. Deleted three figures to update and reduce clutter: (a) variations in lean body mass (previously Figure 11.7); (b) the goal-setting card (previously 11.9); and (c) graph of childhood obesity rates (previously 11.11). Replaced the previous Figure 11.8 with a new Meal Focus Figure (now Figure 10.7). Incorporated updated information on whether being overweight is associated with decreased risks for premature mortality and various chronic diseases. Added two new sections on the factors that influence body weight: (a) the protein leverage hypothesis; and (b) the drifty gene hypothesis. Integrated the information on sociocultural factors affecting food choice and body weight to reduce repetition. Expanded information on non-exercise activity thermogenesis (NEAT), and added as a boldface term and margin definition. Moved all information on obesity (why it is harmful, why it occurs, and how it is treated) into In Depth 11.5. Condensed the narrative on the effect of macronutrient composition of the diet on weight loss to reduce repetition. Included a discussion of mindful eating in the section on behavioral modification. Updated the Nutrition Debate on high-carbohydrate, moderate-fat diets, and included a discussion of the effects of the Paleo diet on weight loss.

In Depth 10.5 Obesity Extracted, updated, and expanded information that had been in the weight chap- ter in the fourth edition. Included new information on the pro-inflammatory role of adipokines and the relationship between abdominal obesity, metabolic syndrome, and cardiometabolic risk. To support this discussion, we altered Figure 1, which depicts abdominal obesity and its inflammatory effects. Added a new Focus Figure 2 and accompanying discussion on the more than 100 variables that directly or indirectly influence energy balance and body weight. Expanded the discussion of how people in the National Weight Control Registry succeed in losing weight and keeping it off. Added more information on prescription weight-loss medications, on weight-loss dietary supplements, and on the risks and benefits of bariatric surgery.

Chapter 11 Nutrition and Physical Fitness: Keys to Good Health

Incorporated the discussion of the inactivity levels of Americans into the section on “How Can You Improve Your Fitness?” Added in a link to the President’s Challenge Adult Fitness Test to the end-of- chapter Web Links. Incorporated the latest information on the roles of lactic acid as a key fuel source into the section, “The Breakdown of Carbohydrates Provides Energy for Both Brief and Long-Term Exercise.” Revised Figure 11.9 (illustration of use of carbohydrate and fat across levels of exercise intensity) to include an additional bar graph illustrating the absolute amount of kcal from fat and carbohydrate that are expended during exercise of low and moderate intensity. Added in new information and references related to intrinsic and extrinsic motiva- tion to be active and high intensity interval training (HIIT). Incorporated the latest sports nutrition guidance for macronutrient, micronutri- ent, and fluid replacement that was recently published in the 2016 ACSM Position Stand on Nutrition and Exercise Performance. Included a new Meal Focus Figure (Figure 11.10) illustrating examples of one day of high-carbohydrate meals differing in total energy content.

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xiv | New to the Fifth Edition

Incorporated updated section on ergogenic aids into the chapter narrative. Updated the Nutrition Debate on “How Much Physical Activity Is Enough?”

In Depth 11.5 Disorders Related to Body Image, Eating, and Exercise

Expanded the information on body image, explaining how it can affect eating and exercise patterns, as well as physical and mental health. Included a discrete discussion of excessive exercise (also called exercise addiction or exercise dependence). Included a discrete narrative discussion of body dysmorphic disorder and the sub- type called muscle dysmorphia. Included information about relative energy deficiency in sports (RED-S), which encompasses numerous health problems associated with inadequate energy con- sumption to meet the energy needs of active men and women. The female athlete triad is one form of RED-S. Removed discussion of talking to a friend about disordered eating.

Chapter 12 Food Safety and Technology: Protecting Our Food

Replaced Fight Bac! Logo with the food safety logo from the USDA’s Foodsafety.gov. Added information on the Hazard Analysis Critical Control Point (HACCP) system. Identified percentages of foodborne illness outbreaks by setting (restaurants, homes, etc.). Added a QuickTips for food safety for packed lunches. Expanded narrative on benefits and concerns of GM foods, placing the entire dis- cussion in the narrative section instead of covering part in narrative and part in the Nutrition Debate. Expanded the discussion of persistent organic pollutants, including types and health concerns. Briefly explained how food animals become reservoirs for antibiotic-resistant pathogens. Changed the Nutrition Debate topic to question organic foods: are they worth the cost?

In Depth 12.5 The Safety and Effectiveness of Dietary Supplements

Throughout, emphasized safety concerns with dietary supplements. Tightened the structure of the chapter to eliminate repetition. Completely rewrote the table on herbal supplements.

Chapter 13 Food Equity, Sustainability, and Quality: The Challenge of “Good Food” This is an entirely new chapter for the fifth edition. It covers global and domestic food insecurity, inequities in farm, food service, and food retail labor, the role of the food industry in limiting food diversity and influencing our food choices, sustainability (use of natural resources and emission of greenhouse gases and other forms of pollu- tion) and aspects of the food movement such as local food, fair trade, and others.

In Depth 13.5 Malnutrition This is a new In Depth. It covers severe acute malnutrition (SAM), micronutrient deficiencies, the nutrition paradox in countries transitioning out of poverty, and the poverty– obesity paradox, emphasizing hypotheses attempting to explain why it occurs.

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Chapter 14 Nutrition Through the Life Cycle: Pregnancy and the First Year of Life

Expanded the discussion of the roles of mothers’ and fathers’ preconception health and pregnancy outcomes. Updated guidelines to reflect 2015–2020 Dietary Guidelines for Americans. New figure on foods at risk for bacterial contamination. Added discussion on ”older” mothers. Added Meal Focus Figure comparing nonpregnant and lactating diets. Added discussion of Cronobacter contamination of infant formula. New Nutrition Debate on new approaches to preventing pediatric food allergies.

In Depth 14.5 The Fetal Environment Updated research throughout, especially on the effects of maternal obesity on offspring.

Chapter 15 Nutrition Through the Life Cycle: Childhood to Late Adulthood

Expanded information on the federal School Breakfast and School Lunch Pro- grams, as well as in-class breakfasts, replacing the former Nutrition Myth or Fact box on breakfast. Added discussion of Class 2 and Class 3 obesity in pediatric populations, and of the health effects of pediatric obesity. Expanded the discussion on the family’s role in the prevention and management of pediatric obesity. Replaced the Tufts University plate for older adults with a plate based on the USDA MyPlate. Expanded the discussion on nutrition/medication interactions for older adults. Updated information on federal food programs for older adults.

In Depth 15.5 Searching for the Fountain of Youth Updated all research throughout, especially in the discussion on Calorie restriction and other dietary approaches, “anti-aging” supplements, and the CDC’s guidelines for healthy lifestyle and chronic disease prevention.

Teaching and Learning Package Available with Nutrition: An Applied Approach, Fifth Edition, is a comprehensive set of ancillary materials designed to enhance learning and to facilitate teaching.

Instructor Supplements MasteringNutrition with Pearson eText 2.0 and MyDietAnalysis MasteringNutrition is an online homework, tutorial, and assessment product designed to improve results by helping students quickly master concepts. Stu- dents will benefit from self-paced tutorials that feature immediate wrong answer feedback and hints that emulate the office-hour experience to help keep them on track. With a wide range of interactive, engaging, and assignable activities, stu- dents will be encouraged to actively learn and retain tough course concepts:

Before class, assign adaptive Dynamic Study Modules and reading assignments from the eText with Reading Quizzes to ensure that students come prepared to class, having done the reading.

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xvi | New to the Fifth Edition

During class, Learning Catalytics, a “bring your own device” student engagement, assessment and classroom intelligence system, allows students to use their smartphone, tablet, or laptop to respond to questions in class. With Learning Catalytics, you can assess students in real time using open- ended question formats to uncover student misconceptions and adjust lectures accordingly. After class assign, an array of assignments such as Focus Figure Coaching Activities, ABC News Videos, Nutrition Animations, Nutri-Tool Activities, and much more. Students receive wrong-answer feedback personalized to their answers, which will help them get back on track. MyDietAnalysis is available as a single sign-on to MasteringNutrition. Devel- oped by the nutrition database experts at ESHA Research, Inc., and tailored for use in college nutrition courses, MyDietAnalysis provides an accurate, reliable, and easy-to-use program for students’ diet analysis needs. Featured is a data- base of nearly 20,000 foods and multiple reports.

For more information on MasteringNutrition, please visit www.masteringhealthand nutrition.com

ABC News Nutrition and Wellness Lecture Launcher Videos. Twenty-seven brand-new brief videos help instructors stimulate critical discussion in the class- room. Videos are provided already linked within PowerPoint lectures and are available separately in large-screen format with optional closed captioning through MasteringNutrition. Instructor Resource and Support Manual. Easier to use than a typical instructor’s manual, this key guide provides a step-by-step visual walk-through of all the resources available to you for preparing your lectures. Also included are tips and strategies for new instructors, sample syllabi, and suggestions for integrating MasteringNutrition into your classroom activities and homework assignments. Test Bank. The Test Bank incorporates Bloom’s Taxonomy, or the Higher Order of Learning, to help instructors create exams that encourage students to think analytically and critically, rather than simply to regurgitate information. Great Ideas! Active Ways to Teach Nutrition. This manual provides ideas for classroom activities related to specific nutrition topics, as well as suggestions for activities that can be adapted to various topics and class sizes.

Student Supplements MasteringNutrition Student Study Area also provides students with self-study material like access to the eText 2.0, practice quizzes, flashcards, videos, MP3s, and much more to help them get the best grade in your course at their own pace. Dynamic Study Modules in MasteringNutrition assess students’ performance and activity in real time. They use data and analytics that personalize content to target students’ particular strengths and weaknesses. And, because we know students are always on the go, Dynamic Study Modules can be accessed from any computer, tablet, or smartphone. MyDietAnalysis (www.mydietanalysis.com). Powered by ESHA Research, Inc., MyDietAnalysis features a database of nearly 20,000 foods and multiple reports. It allows students to track their diet and activity using up to three profiles and to generate and submit reports electronically. Eat Right! Healthy Eating in College and Beyond. This handy, full-color booklet provides students with practical guidelines, tips, shopper’s guides, and recipes that turn healthy eating principles into blueprints for action. Topics include healthy eating in the cafeteria, dorm room, and fast-food restaurants; planning meals on a budget; weight management; vegetarian alternatives; and how alcohol affects health. Food Composition Table available via PDF and posted in the MasteringNutrition Study Area for students to access easily.

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Nutri-case: You Play the Expert! | xvii

nutri-case | YOU PlaY THE ExPErT! Our Nutri-Case scenarios enable students to evaluate the nutrition-related beliefs and behaviors of five people representing a range of backgrounds and nutritional chal- lenges. Take a moment to get acquainted with our Nutri-Case characters here.

THEO Hi, I’m Theo. let’s see, I’m 21, and my parents moved to the Midwest from Nigeria 11 years ago. I’m 6’8” tall and weigh in at 200 lbs. The first time I ever

played basketball, in middle school, I was hooked. I won lots of awards in high school and then got a full scholarship to the state univer-

sity, where I’m a junior studying political science. I decided to take a nutrition course because, last year, I had a hard time making it through the playing season, plus keeping up with my classes and homework. I want to have more energy, so I thought maybe I’m not eating right. anyway, I want to

figure out this food thing before basketball season starts again.

HaNNaH Hi, I’m Hannah. I’m 18 years old and in my first year at Valley Community College. I’m 5’6” and right now I weigh 171 lbs. I haven’t made up my mind yet about my

major. all I know for sure is that I don’t want to work in a hospital like my mom! I got good grades in high school, but I’m a little freaked out by college so far. There’s so much homework, plus one of my courses has a lab, plus I have to work part time because my mom doesn’t have the money to put me through school. . . . Sometimes I feel like I just can’t handle it all. and when I get stressed out, I eat. I’ve already gained 10 pounds and I haven’t even finished my first semester!

lIZ I’m liz, I’m 20, and I’m a dance major at the School for Performing arts. I’m 5’4” and currently weigh about 103 lbs. last year, two other dancers from my class

and I won a state championship and got to dance in the New Year’s Eve celebration at the governor’s mansion. This spring, I’m going to audition for the City Ballet, so I have to be in top condition. I wish I had time to take a nutrition course, but I’m too busy with dance classes, rehearsals, and teaching a dance class for kids. But it’s okay, because I get lots of tips from other dancers and from the Internet. like last week, I found a website especially for dancers that explained how to get rid of bloating

before an audition. I’m going to try it for my audition with the City Ballet!

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xviii | Nutri-case: You Play the Expert!

GUSTaVO Hello. My name is Gustavo. I’m 69 years young at the moment, but when I was

13 years old I came to the United States from Mexico with my parents and three sisters to pick crops in California. Now I manage a large vineyard. They ask me when I’m going to retire, but I can still work as hard as a man half my age. Health problems? None. Well, maybe my doctor tells

me my blood pressure is high, but that’s normal for my age! I guess what keeps me going is thinking about how my father died 6 months after he retired. He had colon cancer, but he never knew it until it was too late. anyway, I watch the nightly news and read the papers, so I keep up on what’s good for me, “Eat less salt” and all that stuff. I’m doing great! I’m 5’5” tall and weigh 166 lbs.

JUDY I’m Judy, Hannah’s mother. I’m 38 years old and a nurse’s aide at Valley Hospital. I’m 5’5” and weigh 200 lbs. Back when Hannah was a baby, I dreamed of going to college so I could be a registered nurse. But then my ex and I split up, and

Hannah and me, we’ve been in survival mode ever since. I’m proud to have raised my daughter without any handouts, and I do good work, but the pay never goes far enough and it’s exhausting. I

guess that’s partly because I’m out of shape, and my blood sugar is high. Most nights I’m so tired at the end of my shift that I just pick up some fast food for supper. I know I should be making home-cooked meals, but like I said, I’m in survival mode.

Throughout this text, students will follow these five characters as they grapple with various nutrition-related challenges. As they do, the characters might remind students of themselves, or of people they may know. Our hope is that by applying the information learned in this course to their own circumstances, students will deepen their understanding of the importance of nutrition in achieving a healthful life.

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xix

It is always eye-opening to author a textbook and to realize that the work of so many people contributes to the final product. There are numerous people to thank, and we’d like to begin by extending our gratitude to our contributors. Our deepest gratitude and appreciation goes to Dr. Linda Vaughan of Arizona State University. Linda revised and updated the fluid and electrolyte balance chapter and the life cycle chapters. She also revised the In Depth features on alcohol, the fetal environment, and strategies to promote healthy aging. Our enduring thanks as well goes to the many contributors and colleagues who made important and lasting contributions to earlier editions of this text. We also extend our sincere thanks to the able reviewers who provided much important feedback and guidance for this revision. These reviewers help to ensure our content is up-to-date and that the presentation of this information meets the needs of instructors and students.

We would like to thank the fabulous staff at Pearson for their incredible sup- port and dedication to this book. Our Acquisitions Editor, Michelle Yglecias, has provided unwavering support and guidance throughout the entire process of writing and publishing this book. We could never have written this text without the exceptional skills of our Developmental Editor, Laura Bonazzoli, whom we have been fortunate enough to have had on board for multiple editions. In addi- tion to providing content guidance, Laura revised and updated the chapters on the human body, food safety, and food security, as well as the In Depth features on new frontiers in nutrition, disorders related to specific foods, dietary supple- ments, and malnutrition. Laura’s energy, enthusiasm, and creativity significantly enhanced the quality of this textbook. Deepti Agarwal, our Project Editor, kept us on course and sane with her humor, organizational skills, and excellent edi- torial instincts, and made revising this book a pleasure rather than a chore. We are also deeply indebted to Art Development Editor Jay McElroy for his work on the Focus Figures in this edition. Nicole Constantine, Editorial Assistant, pro- vided invaluable editorial and administrative support that we would have been lost without. Multiple talented players helped build this book in the production and design processes as well. Rebecca Marshall supervised the photo program, assisted by Matt Perry, who researched the important photo permissions. Pres- ton Thomas created both the beautiful interior design and our glorious cover, under the expert guidance of Mark Ong. We would also like to thank the pro- fessionals at SPi Global, especially our Project Manager Karen Berry, for their important contributions to this text. Our thanks as well to Laura Bonazzoli for her excellent work on developing and updating the comprehensive Test Bank.

We also can’t go without thanking the marketing and sales teams, espe- cially Neena Bali, Executive Marketing Manager, and Mary Salzman, Field Marketing Manager, who ensured that we directed our writing efforts to meet the needs of students and instructors. The team at Pearson is second to none, and their hard work and targeted efforts ensure that this book will get out to those who will benefit most from it.

We would also like to thank the many colleagues, friends, and family mem- bers who helped us along the way. Janice would like to thank her coauthor Melinda Manore, who has provided unwavering support and guidance through- out her career and is a wonderful life-long friend and colleague. She would also like to thank her family and friends, who have been so incredibly supportive throughout her career. They are always there to offer a sympathetic ear and

acknowledgments

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xx | Acknowledgments

endless encouragement, and lovingly tolerate the demands of juggling a full- time job and authoring multiple textbooks. She would also like to thank her students because they are the reason she loves her job so much. They provide critical feedback on her teaching approaches, and help her to understand the issues and challenges they face related to learning and application of knowledge.

Melinda would specifically like to thank her husband, Steve Carroll, for the patience and understanding he has shown through this process—once again. He has learned that there is always another chapter due! Melinda would also like to thank her family, friends, graduate students, and profes- sional colleagues for their support and listening ear throughout this whole process. They all helped make life a little easier during this incredibly busy time. Finally, she would like to thank Janice, a great friend and colleague, who makes working on the book fun and rewarding.

Janice Thompson

Melinda Manore

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xxi

Ann Marie Afflerbach University of North Texas

April Graveman Marshalltown Community College

Christina Minges Miami University of Ohio

George Delahunty Goucher College

reviewers

Irving Smith Coppin State University

Lisa Murray Pierce College

Mallory Brown Eastern Kentucky University

Monica Esquivel University of Hawaii—Manoa

Theresa Martin College of San Mateo

Zhenhua Liu University of Massachusetts— Amherst

focus group participants

Priscilla Connors University of North Texas

Emily Shupe Western Illinois University

Donna Louie University of Colorado, Boulder

Elizabeth Sussman California State University, Northridge

Lisa Kenyon Wright State University

Joanne Tippin Shasta College

Pei-Yang Liu University of Akron

Elisabeth De Jonge George Mason University

Sherry Stewart Navarro College

Linda Friend Wake Technical Community College

Joann Burnett Indiana University, Purdue

Julia Rieck Indiana University, Purdue

Heidi Wengreen Utah State University

Serah Theuri University of Southern Indiana

Sherry Fletcher Palm Beach Community College

Lisa Herzig California State University, Fresno

Nancy Hunt Lipscomb University

Betty Joynes Camden County Community College

Erika Ireland California State University, Fresno

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xxii

10 Achieving and Maintaining a Healthful Body Weight 342

in depth 10.5 Obesity 372

11 Nutrition and Physical Fitness: Keys to good health 380

in depth 11.5 Disorders related to Body Image, Eating, and Exercise  413

12 Food Safety and Technology: Protecting our food 424

in depth 12.5 The Safety and Effectiveness of Dietary Supplements 454

13 Food Equity, Sustainability, and Quality: The challenge of “good food” 460

in depth 13.5 Malnutrition 480

14 Nutrition Through the Life Cycle: Pregnancy and the first year of life 486

in depth 14.5 The Fetal Environment 524

15 Nutrition Through the Life Cycle: Childhood to late adulthood 528

in depth 15.5 Searching for the Fountain of Youth  562

Appendices A-1 References R-1 Answers AN-1 Glossary GL-1 Index IN-1 Credits CR-1

1 Nutrition: Linking food and health 2

in depth 1.5 New Frontiers in Nutrition and Health 29

2 Designing a Healthful Diet 36 in depth 2.5 Healthful Eating Patterns 59

3 The Human Body: Are we really what we eat? 64

in depth 3.5 Disorders related to Specific Foods  93

4 Carbohydrates: Plant-derived energy nutrients 98

in depth 4.5 Diabetes 130

5 Fats: Essential energy-supplying nutrients 138

in depth 5.5 Cardiovascular Disease 167

6 Proteins: Crucial components of all body tissues 178

in depth 6.5 Vitamins and Minerals: Micronutrients with Macro Powers  211

7 Nutrients Essential to Fluid and Electrolyte Balance 222

in depth 7.5 alcohol 249

8 Nutrients Essential to Key Body Functions 260

in depth 8.5 Cancer 292

9 Nutrients Essential to Healthy Tissues 300

in depth 9.5 Osteoporosis 334

brief contents

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xxiii

1 Nutrition: Linking food and health 2 What is nutrition? 4 How does nutrition support health? 5

a Nutritious Diet Contributes to Wellness 5

a Nutritious Diet reduces the risk for Disease 5

What are nutrients? 8 Macronutrients Provide Energy 8

you do the math Calculating the Energy Contribution of Carbohydrates, Fats, and Proteins 10

Micronutrients assist in the regulation of Body Functions 11

Water Supports all Body Functions 12

How much of each nutrient do most people need? 12 How do nutrition scientists evaluate claims? 15

The Scientific Method Enables researchers to Test a Hypothesis 15

repetition of research Is required to Develop Theories 17

Why do nutrition scientists use different types of research? 18

animal Studies Can Inform Human Studies 18

Epidemiological Studies Explore Patterns Within Populations 18

Clinical Trials Examine Cause and Effect 19

How can you use your knowledge of research to evaluate nutrition claims? 20

Watch for Conflict of Interest and Bias 21

Evaluate a Website’s Credibility 22

nutri-case LIZ 23

Which sources of nutrition advice are trustworthy? 23

Trustworthy Experts are Educated and Credentialed 23

Government agencies are Usually Trustworthy 24

Professional Organizations Provide reliable Nutrition Information 25

nutrition debate Conflict of Interest: Should Scientists and Industry Collaborate in Research? 26

contents

xxiii

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xxiv | Contents

1.5 New Frontiers in Nutrition and Health 29 How does our diet affect our genes? 30

The Foods We Eat Can Influence Gene Expression 30

Nutrigenomics Studies Food-Gene Interactions 31

Nutrigenomics Could lead to Personalized Nutrition 31

How does our diet affect our microbiome? 32 a Healthy Microbiome Promotes a Healthy Body 32

Probiotics and Prebiotics Nourish the Microbiome 32

How do phytochemicals enhance our health? 33

nutri-case HANNAH 33

2 Designing a Healthful Diet 36 What is a healthful diet? 38

a Healthful Diet Is adequate 38

a Healthful Diet Is Moderate 38

a Healthful Diet Is Nutrient-Dense 38

a Healthful Diet Is Balanced 38

a Healthful Diet Is Varied 40

What’s behind our food choices? 40 Sensory Data Influence Food Choices 40

Sociocultural Cues and Emotions Influence Food Choices 41

learning Influences Food Choices 41

How can reading food labels help you improve your diet? 42

Five Components Must Be Included on Food labels 42

Use the Nutrition Facts Panel to Evaluate and Compare Foods 43

Food labels Can Display a Variety of Claims 43

nutri-case GUSTAVO 47

How do the Dietary Guidelines for Americans promote a healthful diet? 47 How can the USDA Food Patterns help you design a healthful diet? 48

log Onto MyPlate 48

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Contents | xxv

limit Empty Calories 49

Watch Your Serving Sizes 50

Consider Ethnic Variations and Other Eating Plans 50

Get Some High-Tech Help 51 you do the math How Much Exercise Is Needed to Combat Increasing Food

Portion Sizes? 52

Can eating out be part of a healthful diet? 53 avoid large Portions 53

Use Nutrition Information 54 nutrition debate Nutrition Advice from the U.S. Government:

Is Anyone Listening? 56

2.5 Healthful Eating Patterns 59 What is a healthful eating pattern? 60

nutri-case JUDY 60

What are some healthful eating patterns? 61 a Mediterranean-Style Eating Pattern Is Healthful 61

The Exchange System Can Help You Follow a Healthful Eating Pattern 62

The Healthy Eating Plate and Power Plate are also Healthful Eating Patterns 62

Include regular Physical activity 63

3 The Human Body: Are we really what we eat? 64 How do food molecules build body structure? 66

atoms Bond to Form Molecules 66

Molecules Join to Form Cells 66

Why do we feel the urge to eat? 68 The Hypothalamus regulates Hunger 68

Nerve Cells in the Gastrointestinal System Signal the Hypothalamus 69

Hormones Send Chemical Messages to the Hypothalamus 69

The amount and Type of Food Play a role 70

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xxvi | Contents

How does food travel through the gastrointestinal tract? 70

Digestion Begins in the Mouth 72

The Esophagus Transports Food from the Pharynx into the Stomach 73

The Stomach Mixes, Digests, and Stores Food 74 you do the math Negative Logarithms and the pH Scale 76

Most Digestion and absorption Occur in the Small Intestine 77

The large Intestine Stores Food Waste Until It Is Excreted 77

What else contributes to gastrointestinal function? 79 The Gallbladder and Pancreas aid in Digestion 79

a Specialized lining Boosts absorption in the Small Intestine 80

Four Types of absorption Occur in the Small Intestine 80

Blood and lymph Transport Nutrients 80

The liver regulates Blood Nutrients 82

The GI Flora Perform Several Beneficial Functions 83

The Neuromuscular System regulates the activities of the GI Tract 83

What disorders are related to digestion, absorption, and elimination? 85

Heartburn and Gastroesophageal reflux Disease (GErD) are Caused by reflux of Gastric Juice 85

an Ulcer Is an area of Erosion in the GI Tract 86

Some Disorders affect Intestinal Function 87

nutri-case THEO 88

Cancer Can Develop in any Gastrointestinal Organ 89 nutrition debate H. pylori: Could the Same Germ Make Us Sick

and Keep Us Well? 90

3.5 Disorders Related to Specific Foods 93 What are food intolerances? 94 What are food allergies? 94 nutrition label activity Recognizing Common Allergens in Foods 95

Is celiac disease the same as gluten sensitivity? 96 Celiac Disease Is an Inherited Immune Disease 96

nutri-case LIZ 96

Nonceliac Gluten Sensitivity Is the Subject of research 97

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4 Carbohydrates: Plant-derived energy nutrients 98 What are carbohydrates? 100

Simple Carbohydrates Include Monosaccharides and Disaccharides 100

Polysaccharides are Complex Carbohydrates 102

Why do we need carbohydrates? 104 Carbohydrates Provide Energy for Daily activities and Exercise 104

Carbohydrates Spare Protein and Prevent Ketoacidosis 105

Fiber Helps Us Stay Healthy 105

How does the body process carbohydrates? 107 Digestion Breaks Down Most Carbohydrates into Monosaccharides 107

The liver Converts Most Nonglucose Monosaccharides into Glucose 107

Fiber Is Excreted from the large Intestine 109

How does the body regulate blood glucose levels? 110 Insulin and Glucagon regulate Blood Glucose levels 110

Fructose Does Not Stimulate Insulin release 110

Other Hormones Increase Blood Glucose levels 112

The Glycemic Index Shows How Foods affect Our Blood Glucose level 112

How much total carbohydrate and added sugar should you eat? 114

The recommended Dietary allowance for Total Carbohydrate reflects Glucose Use by the Brain 114

Most americans Eat Too Much added Sugar 114

Sugars are Blamed for Many Health Problems 115

How much fiber do you need, and what are the best sources? 118

Whole Grains are Excellent Sources of Fiber 118

Other Good Sources of Fiber are Vegetables, Fruits, Nuts, and Seeds 119

nutrition label activity Recognizing Carbohydrates on the Label 120

What’s the story on alternative sweeteners? 123 limited Use of alternative Sweeteners Is Not Harmful 124

The Effect of alternative Sweeteners on Body Weight Is Unclear 125

nutri-case HANNAH 126

nutrition debate Are Added Sugars the Cause of the Obesity Epidemic? 127

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4.5 Diabetes 130 What is diabetes? 131 How is diabetes classified? 132

In Type 1 Diabetes, the Body Does Not Produce Enough Insulin 132

In Type 2 Diabetes, Cells Become less responsive to Insulin 132

Three Blood Tests are Used to Diagnose Diabetes 134

How can you reduce your risk for type 2 diabetes? 134 Some Diabetes risk Factors are Modifiable 135

lifestyle Changes Can reduce Your risk 135

Dietary Counseling Can Help People living with Diabetes 136

nutri-case JUDY 136

Prescription Medications or Surgery May Be advised 136

5 Fats: Essential energy-supplying nutrients 138 What are fats? 140

Triglycerides are the Most Common Food-Based Fat 140

Phospholipids Combine lipids with Phosphate 141

Sterols Have a ring Structure 141

Why are some triglycerides better than others? 142 Fatty acid Chain length affects Digestion and absorption 142

level of Hydrogen Saturation Influences Health Effects 142

Carbon Bonding Influences Shape 143

Trans Fatty acids are Especially Harmful 144

Essential Fatty acids Have Unique Health Benefits 145

Why do we need fats? 147 Fats Provide Energy 147

Fats Enable the Transport of Fat-Soluble Vitamins 149

Fats Help Maintain Cell Function 149

Body Fat Provides Protection 149

Dietary Fats Contribute to the Flavor, Texture, and Satiety of Foods 149

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How does the body process fats? 150 The Gallbladder, liver, and Pancreas assist in Fat Digestion 150

absorption of Fat Occurs Primarily in the Small Intestine 150

Fat Is Stored in adipose Tissues for later Use 153

How much fat should you eat? 154 recognize the Fat in Foods 154

Decipher label Claims 154 nutrition label activity How Much Fat Is in This Food? 155

nutri-case LIZ 156

Keep Your Fat Intake Within the aMDr 156

aim for a Balance of the Essential Fatty acids 156

reduce Your Intake of Saturated Fats 157

avoid Trans Fatty acids 158

What about Dietary Cholesterol? 158

Select Beneficial Fats 160

Watch Out When You’re Eating Out 162

Be aware of Fat replacers 163

Fat Blockers Contribute Minimally to Weight loss 163 nutrition debate Are Saturated Fats Bad or Benign? 164

5.5 Cardiovascular Disease 167 What is cardiovascular disease? 168

atherosclerosis Is Narrowing of arteries 168

Hypertension Increases the risk for Heart attack and Stroke 170

What factors influence the risk for cardiovascular disease? 170

Many CVD risk Factors are Within Your Control 170

Blood lipids Play a Significant role in Cardiovascular Disease 171

You Can Estimate Your risk for Cardiovascular Disease 174

How can you reduce your risk for cardiovascular disease? 174

Take Steps to Improve Your Blood lipid levels 174

Take Steps to Manage Your Blood Pressure 175

nutri-case GUSTAVO 177

Prescription Medications Can Improve Blood lipids and Blood Pressure 177

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6 Proteins: Crucial Components of All Body Tissues 178 What are proteins? 180

The Building Blocks of Proteins are amino acids 180

Nine amino acids are Essential 180

How are proteins made? 181 amino acids Bond to Form a Variety of Peptides 182

Genes regulate amino acid Binding 182

Protein Turnover Involves Synthesis and Degradation 184

Protein Organization Determines Function 184

Protein Denaturation affects Shape and Function 185

Protein Synthesis Can Be limited by Missing amino acids 186

Protein Synthesis Can Be Enhanced by Mutual Supplementation 186

Why do we need proteins? 187 Proteins Contribute to Cell Growth, repair,

and Maintenance 187

Proteins act as Enzymes and Hormones 188

Proteins Help Maintain Fluid and Electrolyte Balance 188

Proteins Help Maintain acid–Base Balance 188

Proteins Help Maintain a Strong Immune System 189

Proteins Serve as an Energy Source 190

Proteins assist in the Transport and Storage of Nutrients 190

Proteins are Critical to Nerve Function, Blood Clotting, and Wound Healing 191

How does the body process proteins? 191 Stomach acids and Enzymes Break Proteins into Short

Polypeptides 191

Enzymes in the Small Intestine Break Polypeptides into Single amino acids 191

Protein Digestibility affects Protein Quality 193

How much protein should you eat? 193 Nitrogen Balance Is a Method Used to Determine

Protein Needs 193 you do the math Calculating Your Protein Needs 195

recommended Dietary allowance for Protein 195

Most americans Meet or Exceed the rDa for Protein 196

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Protein Sources Include Much More Than Meat! 196 nutrition label activity How Much Protein Do You Eat? 199

The Health Effects of High Protein Intake are Unclear 199

Protein Deficiency Can result in Severe Illness and Death 201

Can a vegetarian diet provide adequate protein? 203 There are Many Types of Vegetarian Diets 203

People Choose Vegetarianism for Many Different reasons 204

a Vegetarian Diet Can Present Some Challenges 206

MyPlate Can Help You Plan a Vegetarian Diet 207

nutri-case THEO 207

nutrition debate Are Current Protein Recommendations High Enough? 208

6.5 Vitamins and Minerals: Micronutrients with Macro Powers 211 How were the micronutrients discovered? 212 How are vitamins classified? 212

Fat-Soluble Vitamins 212

Water-Soluble Vitamins 212

Same Vitamin, Different Names and Forms 213

How are minerals classified? 214 Major Minerals 214

Trace and Ultra-Trace Minerals 216

Same Mineral, Different Forms 218

How do our bodies use micronutrients? 218 What We Eat Differs from What We absorb 218

What We Eat Differs from What Our Cells Use 218

What are some controversies in micronutrient research? 218

are Supplements Healthful Sources of Micronutrients? 220

Can Micronutrients Prevent or Treat Chronic Disease? 220

nutri-case LIZ 220

Do More Essential Micronutrients Exist? 221

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7 Nutrients Essential to Fluid and Electrolyte Balance 222 What is body fluid? 224

Body Fluid Is the liquid Portion of Our Cells and Tissues 224

Body Fluid Is Composed of Water and Electrolytes 225

Why do we need water and electrolytes? 226 Water Performs Functions Critical to life 226

Electrolytes Support Many Body Functions 227

How does the body maintain fluid balance? 230 The Hypothalamus regulates Thirst 230

We Gain Fluids Through Intake and Metabolism 231

We lose Fluids Through Urine, Sweat, Evaporation, Exhalation, and Feces 232

How much water should you drink? 233 Our requirements for Water are Individualized 233

Tap Water Is as Healthful as Bottled Water 233

all Beverages are Not Created Equal 234 nutrition label activity Is Bottled Water Better Than Tap? 235

How do four major minerals contribute to fluid balance? 237

Sodium Is a Positively Charged Extracellular Electrolyte 238

Potassium Is a Positively Charged Intracellular Electrolyte 240

Chloride Is a Negatively Charged Extracellular Electrolyte 242

Phosphorus Is a Negatively Charged Intracellular Electrolyte 242

What disorders are related to fluid and electrolyte balance? 243

Dehydration Develops as Fluid loss Exceeds Fluid Intake 243

Water Intoxication Can Be Fatal 244

Heat Illnesses are linked to Dehydration 244

nutri-case GUSTAVO 245

nutrition debate Low Sodium Diets: Fit for All or Just a Few? 246

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7.5 Alcohol 249 What happens to alcohol in the body? 250 What do we know about moderate drinking? 251

Moderate Drinking Has Certain Health Benefits 251

Moderate Drinking Is associated with Certain risks 251

What do we know about alcohol use disorders? 252 alcohol Use Disorders Include abuse and Dependence 252

alcohol Use Disorders Have Toxic Effects 253

nutri-case THEO 254

Should you be concerned about your alcohol intake? 257 How can you talk to someone about an alcohol use disorder? 258

8 Nutrients Essential to Key Body Functions 260 How does the body regulate energy metabolism? 262 How do the B-vitamins function in energy metabolism? 264

Thiamin Supports Carbohydrate and amino acid Metabolism 264

riboflavin Supports the Metabolism of Carbohydrates and Fats 265

Niacin Supports Metabolism, DNa replication, and Cell Differentiation 266

Vitamin B6 Is a Coenzyme for Over 100 Enzymes 267

The Most Basic Cellular Functions require Folate 269

Vitamin B12 Participates in amino acid and Homocysteine Metabolism 270

Pantothenic acid and Biotin are required for all Energy Pathways 272

nutri-case JUDY 273

How do choline and four minerals function in energy metabolism? 273

Choline Is a Vitamin-like Nutrient 273

Iodine Is required for the Synthesis of Thyroid Hormones 273

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Chromium Is Important in Carbohydrate Metabolism 274

Manganese assists in Energy Metabolism and Bone Health 274

Sulfur Is a Component of Thiamin, Biotin, and Two amino acids 275

What are antioxidants, and how do they protect our cells? 275

Oxidation Is a Chemical reaction in Which atoms lose Electrons 275

Oxidation Sometimes results in the Formation of Free radicals 276

Free radicals Can Destabilize Other Molecules and Damage Our Cells 276

antioxidants Work by Stabilizing Free radicals or Opposing Oxidation 277

What nutrients and phytochemicals function as antioxidants? 278

Vitamin E Is a Key antioxidant 278

Vitamin C Is a Water-Soluble antioxidant 280

Selenium Is a Key antioxidant Mineral 280

Manganese, Copper, Iron, and Zinc assist in antioxidant Function 281

Carotenoids like Beta-Carotene Have antioxidant Properties 281

What is the role of vitamin A in vision and other functions? 283

There are Several Forms of Vitamin a 284

Vitamin a Is Essential to Sight 284

Vitamin a Supports Cell Differentiation, reproduction, and Bone Growth 284

avoid Excessive Intake of Vitamin a 286

Vitamin a Derivatives are Effective in Treating acne 287 nutrition debate Antioxidants: From Foods or Supplements? 289

8.5 Cancer 292 What is cancer and how does it arise? 293 What factors influence cancer risk? 293

Nonmodifiable Factors Play a role 293

Many risk Factors are Modifiable 295

How is cancer diagnosed and treated? 296 Can cancer be prevented? 297

Check 297

Quit 297

Move 297

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Nourish 298

antioxidants Play a role in Preventing Cancer 298

nutri-case GUSTAVO 299

9 Nutrients Essential to Healthy Tissues 300 How do three trace minerals help maintain healthy blood? 302

Iron Is a Component of the Oxygen-Carrying Proteins in Blood and Muscle 303

you do the math Calculating Daily Iron Intake 305

Zinc Contributes to Hemoglobin 307

Copper Is Critical for Iron Transport 308

How do four vitamins promote healthy blood? 310 Vitamin B6, Folate, and Vitamin B12 are required for the Healthy

Development of red Blood Cells 310

Vitamin K Supports Blood Clotting 311

How does vitamin C help maintain healthy collagen? 312

Vitamin C Is required for the Synthesis of Collagen 312

Vitamin C Has Many Other roles in the Body 313

The rDa for Vitamin C Is Easily Obtained 313

What are the components and activities of healthy bone? 315

The Composition of Bone Provides Strength and Flexibility 315

The Constant activity of Bone Tissue Promotes Bone Health 316

Bone Density Is assessed with a Dxa Test 317

How do four minerals help maintain healthy bone? 318

Calcium Is the Major Mineral Component of Bone 318

Phosphorus Combines with Calcium in Hydroxyapatite Crystals 323

Magnesium Is a Component of Bone and Helps regulate Bone Status 323

Fluoride Is Found in Teeth and Bones 324

How do two fat-soluble vitamins support healthy bone? 326

Vitamin D regulates Calcium 326

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nutri-case THEO 330

Vitamin K assists in remodeling of Bone 330 nutrition debate Vitamin D Deficiency: Why the Surge, and What Can

Be Done? 331

9.5 Osteoporosis 334 What is osteoporosis? 335 What influences osteoporosis risk? 335

aging Increases Osteoporosis risk 336

Gender and Genetics affect Osteoporosis risk 336

Tobacco, alcohol, and Caffeine Influence Osteoporosis risk 337

Nutritional Factors Influence Osteoporosis risk 338

regular Physical activity reduces Osteoporosis risk 338

How is osteoporosis treated? 339 Can osteoporosis be prevented? 340

Some People Might Benefit from Supplements 340

nutri-case GUSTAVO 340

Physical activity and Other lifestyle Choices Can Help 341

10 Achieving and Maintaining a Healthful Body Weight 342 What is a healthful body weight? 344 How can you evaluate your body weight? 344

Determine Your Body Mass Index 344 you do the math Calculating Your Body Mass Index 346

Measure Your Body Composition 347

assess Your Fat Distribution Patterns 347

How does energy balance influence body weight? 349 Energy Intake Is the Kilocalories We Consume Each Day 351

Energy Expenditure Includes More Than Just Physical activity 351

you do the math Calculating BMR and Total Daily Energy Needs 354

research Suggests limitations of the Energy Balance Equation 355

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What factors influence body weight? 355 Genes May Influence Body Weight in Different Ways 355

Metabolic Factors Influence Weight loss and Gain 357

Physiologic Factors Influence Body Weight 357

Sociocultural Factors affect Food Choices and Body Weight 358

How can you lose weight safely and keep it off? 360

nutri-case HANNAH 361

avoid Fad Diets 361

Many Diets Focus on Macronutrient Composition 362

If You Design Your Own Diet Plan, Include the Three Strategies 362

What if you need to gain weight? 367 For Safe and Effective Weight Gain, Choose Nutrient-Dense Foods 367

amino acid and Protein Supplements Do Not Increase Muscle Mass 368 nutrition debate High-Carbohydrate, Moderate-Fat Diets—Have They

Been Oversold? 369

10.5 Obesity 372 Why is obesity harmful? 373 Why does obesity occur? 374 How is obesity treated? 376

Obesity Does respond to Diet and Exercise 376

Weight loss Can Be Enhanced with Prescription Medications 376

Many Supplements Used for Weight loss Contain Stimulants 377

Surgery Can Be Used to Treat Morbid Obesity 377

11 Nutrition and Physical Fitness: Keys to good health 380 What are the benefits of physical activity? 382

Physical activity Increases Our Fitness 382

Physical activity reduces Our risk for Chronic Diseases 383

How can you improve your fitness? 384 assess Your Current level of Fitness 384

Identify Your Personal Fitness Goals 384

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Make Your Program Varied, Consistent, and Fun! 385

appropriately Overload Your Body 386

Include a Warm-Up and a Cool-Down Period 388 you do the math Calculating Your Maximal and Training Heart

Rate Range 389

Keep It Simple, Take It Slow 389

What fuels our activities? 391 The aTP-CP Energy System Uses Creatine Phosphate

to regenerate aTP 391

The Breakdown of Carbohydrates Provides Energy for Both Brief and long-Term Exercise 391

aerobic Breakdown of Fats Supports Exercise of low Intensity and long Duration 394

amino acids are Not Major Sources of Fuel During Exercise 396

How does physical activity affect energy and macronutrient needs? 396

Vigorous Exercise Increases Energy Needs 397

Carbohydrate Needs Increase for Many active People 399

nutri-case JUDY 400

Moderate Fat Consumption Is Enough to Support Most activities 402

Many athletes Have Increased Protein Needs 403

How does physical activity affect fluid and micronutrient needs? 403

Dehydration and Heat-related Illnesses 403

Guidelines for Proper Fluid replacement 404

Inadequate Micronutrient Intake Can Diminish Health and Performance 405

Are ergogenic aids necessary for active people? 407 Many Ergogenic aids are Said to Build Muscle Mass and Strength 407

Some Ergogenic aids are Said to Optimize Fuel Use 408 nutrition debate How Much Physical Activity Is Enough? 410

11.5 Disorders Related to Body Image, Eating, and Exercise 413 What is body image, and how does it influence health? 414

Body Image Influences Eating Behaviors 414

Body Image Influences Exercise Behaviors 414

Body Dysmorphic Disorder Is a Psychiatric Diagnosis 415

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What factors contribute to disorders related to body image, eating, and exercise? 416

Influence of Genetic Factors 416

Influence of Family 416

Influence of Media 416

Influence of Social and Cultural Values 417

Comorbidity with Other Psychological Disorders 417

What psychiatric eating disorders are recognized? 417

anorexia Nervosa 417

Bulimia Nervosa 418

Binge-Eating Disorder 420

What syndromes of disordered eating are recognized? 420

Night-Eating Syndrome 420

The Female athlete Triad 421

nutri-case LIZ 422

How are eating disorders treated? 422

12 Food Safety and Technology: Protecting our food 424 What is foodborne illness and why is it a critical concern? 426

Ingestion of Contaminants Prompts acute Illness 426

reducing Foodborne Illness Is a Challenge 426

What causes most foodborne illness? 429 Several Types of Microorganisms Contaminate Foods 429

Some Foodborne Illness Is Due to Toxins 431

Certain Conditions Help Microorganisms Multiply in Foods 433

nutri-case THEO 433

How can you prevent foodborne illness? 434 Clean: Wash Your Hands and Kitchen Surfaces Often 434

Separate: Don’t Cross-Contaminate 434

Chill: Store Foods in the refrigerator or Freezer 435

Cook: Heat Foods Thoroughly 437

Protect Yourself from Toxins in Foods 437

Be Choosy When Eating Out—Close to Home or Far away 438

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How is food spoilage prevented? 440 What are food additives, and are they safe? 441

Food additives Include Nutrients and Preservatives 441

Other Food additives Include Flavorings, Colorings, and Texturizers 442

are Food additives Safe? 442

How is genetic modification used in food production, and is it safe? 443

Genetic Modification Includes Selective Breeding and recombinant DNa Technology 443

Genetic Modification Has Many Benefits 444

Genetic Modification Poses Certain risks 444

Should GM Foods Be labeled? 445

How do residues harm our food supply? 446 Persistent Organic Pollutants Can Cause Illness 446

Pesticides Protect against Crop losses—But at a Cost 448

Growth Hormones and antibiotics are Used in animals 449

Organic Farming Promotes Ecological Balance 449 nutrition debate Organic Foods: Are They Worth the Cost? 451

12.5 The Safety and Effectiveness of Dietary Supplements 454 How are dietary supplements regulated? 455 Are there special precautions for herbs? 456 Should you take a dietary supplement? 457

nutri-case THEO 459

13 Food Equity, Sustainability, and Quality: The challenge of “good food” 460 How prevalent is food insecurity? 462

about 795 Million People Worldwide are Hungry 462

Over 17 Million american Households are Food Insecure 463

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Why don’t all people have access to nourishing food? 463

nutri-case JUDY 464

acute Food Shortages are Often Caused by Weather Events and Wars 464

The Major Cause of Chronic Hunger Is Unequal Distribution of Food 464

Overpopulation Contributes to Chronic Food Shortages 465

local Conditions Can Contribute to Chronic Hunger 465

Climate Change Threatens Global Food Security 466

Is our food equitably produced and sold? 467 Farm labor Is Dangerous and Poorly Paid 467

Food retail and Service Work Maintains the “Working Poor” 467

How does industrial agriculture affect the security, sustainability, and diversity of our food supply? 468

Industrial agriculture Has Increased Food Security but Threatens Our Environment 468

Monopolization of agriculture reduces Food Diversity 469

The Food Industry Influences america’s Diet 470

What initiatives are addressing the challenges of “good” food? 471

Many International Initiatives Increase access to Nourishing Food 471

National and local Programs Help Nourish americans 471

Sustainable agriculture reduces Environmental Impact and Increases Food Diversity 472

Corporate and Philanthropic Initiatives are Promoting “Good” Food 473

How can you promote “good” food? 474 Support Food Security 474

Purchase Fair Trade Goods 474

Choose Foods That are Healthful for You and the Environment 475 nutrition debate Meat Consumption and Climate Change: Tofu to the

Rescue? 477

13.5 Malnutrition 480 What problems are linked to undernourishment? 481

low Energy Intake Promotes Wasting, Stunting, and Mortality 481

Micronutrient Deficiencies lead to Preventable Diseases 481

Undernourishment Promotes Socioeconomic Problems 482

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nutri-case LIZ 483

How could limited access to good food promote obesity? 483

a Nutrition Paradox Is Evident in Transitioning Populations 483

Physical and Socioeconomic Factors May Promote Obesity among the Poor 484

14 Nutrition Through the Life Cycle: Pregnancy and the first year of life 486 How does a healthful diet support conception and gestation? 488

a Healthful Diet Is Critical Before Conception 488

a Healthful Diet Supports Embryonic and Fetal Development 488

appropriate Maternal Weight Gain Supports a Healthy Birth Weight 492

What are a pregnant woman’s nutrient needs? 494 Macronutrients Provide Energy and Build Tissues 494

Micronutrients Support Increased Energy Needs and Tissue Growth 495

Fluid Needs of Pregnant Women Increase 498

What are some common nutrition-related concerns of pregnancy? 499

Morning Sickness, Cravings, and GI Discomfort are Common 499

Serious Disorders Include Diabetes, Hypertension, and Foodborne Illness 500

nutri-case JUDY 501

Maternal age Can affect Pregnancy 502

a Careful Vegetarian Diet and regular Exercise are Safe During Pregnancy 502

Many Substances Can Harm the Embryo or Fetus 504

How does nutrition support lactation? 505 lactation Is Maintained by Hormones and Infant Suckling 505

Breastfeeding Woman Have High Nutrient Needs 506

What are some advantages and challenges of breastfeeding? 509

Breast Milk Is Nutritionally Superior to Infant Formula 509

Breastfeeding Has Many Other Benefits for the Infant and Mother 510

Physical and Social Concerns Can Make Breastfeeding Challenging 511

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Contents | xliii

What are an infant’s nutrient needs? 513 Nutrition Fuels Infant Growth and activity 513

Infants Have Unique Nutrient Needs 514

Infant Formula Is a Nutritious alternative to Breast Milk 516 nutrition label activity Reading Infant Food Labels 517

What are some common nutrition-related concerns of infancy? 518

Infants Begin to Need Solid Foods at about 6 Months of age 518

Some Foods and Beverages are Not Safe for Infants 519

Several Nutrition-related Disorders are Concerns for Infants 519 nutrition debate Preventing Food Allergies in Infants: Allergen Avoidance,

or Introduction? 521

14.5 The Fetal Environment 524 How does fetal adaptation to famine affect adult health? 525 How do other nutritional imbalances in utero affect adult health? 525

nutri-case HANNAH 526

15 Nutrition Through the Life Cycle: Childhood to late adulthood 528 What are the nutritional needs and concerns of toddlerhood? 530

Body Size and activity Increase Toddlers’ Nutrient Needs 530 you do the math Is This Menu Good for a Toddler? 532

Encourage Nutritious Food Choices with Toddlers 533

Vegan Diets May Not Be Healthful for Toddlers 534

What are the nutritional needs and concerns of childhood? 535

Growth and Development Increase Children’s Nutrient Needs 535

Encourage Nutritious Food Choices with Children 538

School attendance Influences Children’s Nutrition 538

Childhood Brings Unique Nutrition-related Concerns 539

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What are the nutritional needs and concerns of adolescence? 541

Puberty Triggers Dramatic Growth and Maturation 541

rapid Growth Increases an adolescent’s Nutrient Needs 541

Encourage Nutritious Food Choices with adolescents 543

appearance and Substance Use are Key Concerns of adolescence 543

nutri-case LIZ 546

Why is pediatric obesity harmful, and what can be done? 546

Obesity Impairs Children’s Health 546

Encourage Healthful Eating Patterns 547

Encourage Physical activity 548

What characterizes aging? 549 americans are Getting Older 549

Characteristic Physiologic Changes accompany aging 550

What are the nutritional needs and concerns of older adults? 551

Some Nutrient recommendations Increase or Decrease with aging 551

Older adults Have Many Unique Nutrition-related Concerns 555 nutrition debate Physical Activity in Older Adulthood: What Amounts, Types,

and Intensities Are Appropriate? 559

15.5 Searching for the Fountain of Youth 562 Does calorie restriction increase life span? 563

Calorie restriction May reduce Production of Free radicals 563

Calorie restriction Presents Significant Challenges 564

alternatives to Calorie restriction Show Similar Benefits 564

Can supplements slow aging? 565

nutri-case GUSTAVO 565

Are your actions today promoting a longer, healthier life? 566

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Contents | xlv

Appendices A 2015–2020 Dietary Guidelines, Dietary Reference Intakes, and Dietary

Guidelines Recommendations A-3 B Calculations and Conversions B-1 C Foods Containing Caffeine C-1 D U.S. Exchange Lists for Meal Planning D-1 E Stature-for-Age Charts E-1 F The USDA Food Guide Evolution F-1

References R-1 Answers AN-1 Glossary GL-1 Index IN-1 Credits CR-1

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2

test yourself 1. T F A Calorie is a measure of the amount of

fat in a food.

2. T F Proteins are not the primary source of energy for our body.

3. T F The Recommended Dietary Allowance is the maximum amount of a vitamin or other food component that people should consume to support normal body functions.

Test Yourself answers are located in the Study Plan at the end of this chapter.

M01_THOM6233_05_SE_C01.indd 2 11/4/16 3:00 PM

Go online for chapter quizzes, pre-tests, interactive activities, and more!

1 Nutrition Linking food and health Miguel hadn’t expected college life to make him feel so tired. After classes, he just wanted to go back to his dorm and sleep. Scott, his roommate, had little sympathy. “It’s all that junk food you eat!” he insisted. “Let’s go down to the organic market for some real food.” Miguel dragged himself to the market with Scott. They bought fresh vegetables and fish, and were heading to the checkout when they noticed a woman in a white lab coat promoting a variety of “energy-boosting” supplements. Miguel was intrigued and told her that he had been feeling tired lately. She nodded sympathetically. “You look pale. I’d recommend taking an iron supplement.” She handed him a bottle of tablets. “This one is easy to absorb, and it’s on special this week.” Miguel bought the supplement and began taking it that night. A week later, he didn’t feel any better, so he visited the campus health clinic. The physician there ran some tests and told him that his thyroid gland wasn’t function- ing properly. She prescribed a medication and congratulated Miguel for catching the problem early. “If you had waited,” she said, “you could have become seriously ill.” Miguel asked if he should continue taking his iron supplement. The doctor looked puzzled. “Where did you get the idea that you needed an iron supplement?”

Like Miguel, you’ve probably been offered nutrition-related advice from well-meaning friends and self-professed “experts.” Perhaps you found the advice helpful, or maybe, as in Miguel’s case, it turned out to be all wrong. Where can you go for reli- able advice about nutrition? What exactly is nutrition, and how does what we eat influence our health? In this chapter, we’ll begin to answer these questions.

learning outcomes After studying this chapter you should be able to:

1 Define the term nutrition and describe its evolution as a science, p. 4.

2 Explain how nutrition supports health, pp. 5–6.

3 Identify the six classes of nutrients essential for health, pp. 8–12.

4 Distinguish among six groups of Dietary Reference Intakes for nutrients, pp. 12–15.

5 Describe the steps of the scientific method, pp. 15–18.

6 Discuss the design and primary goals of three basic types of nutrition research, pp. 18–20.

7 Explain how to discern the truth or fallacy of nutrition- related claims, pp. 20–23.

8 List several professionals, government agencies, and organizations that are trustworthy sources of nutrition information, pp. 23–25.

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4 | Chapter 1 Nutrition: Linking food and health

What is nutrition? Although many people think that food and nutrition mean the same thing, they don’t. Food refers to the plants and animals we consume. It provides the chemicals our body need to maintain life and support growth and health. Nutrition, in contrast, is the sci- ence that studies food and how food nourishes our body and influences our health. It encompasses how we consume, digest, absorb, and store the chemicals in food, and how these chemicals affect our body. Nutrition also involves studying the factors that influence our eating patterns, making recommendations about the amount we should eat of each type of food, attempting to maintain food safety, and addressing issues related to the global food supply. You can think of nutrition, then, as the science that encompasses everything about food.

When compared with other scientific disciplines such as chemistry, biology, and physics, nutrition is a relative newcomer. Although food production has played a defining role in the evolution of the human species, an appreciation of the importance of nutrition to our health has developed only within the past 400 years. Early research in nutrition focused on making the link between dietary deficiencies and illness. For instance, in the mid-1700s, it was discovered that regular consumption of citrus fruits could prevent a potentially fatal disease called scurvy. But two centuries would pass before a deficiency of vitamin C was identified as the precise culprit. Another early discovery in nutrition is related to pellagra, a disease characterized by a skin rash, diarrhea, and mental impairment. In the early 20th century it afflicted more than 50,000 people each year, and in about 10% of the cases it resulted in death. Originally thought to be an infectious disease, experiments conducted by Dr. Joseph Goldberger and colleagues found that pellagra could be effectively treated by changing the diet of those affected from one that was predominantly corn-based to one that included a variety of nutritious foods. Although Goldberger could not identify the precise com- ponent in the new diet that cured pellagra, he eventually found an inexpensive and widely available substance, brewer’s yeast, that when added to the diet prevented or reversed the disease. Shortly after Goldberger’s death in 1937, scientists identified the component that is deficient in the diet of pellagra patients: a vitamin called niacin, which is plentiful in brewer’s yeast.

Nutrition research continued to focus on identifying and preventing deficiency diseases through the first half of the 20th century. Then, as the higher standard of living after World War II led to an improvement in the American diet, nutrition research began pursuing a new objective: supporting health and preventing and treating chronic diseases—that is, diseases that come on slowly and can persist for years, often despite treatment. Chronic diseases of particular interest to nutrition researchers include obesity, cardiovascular disease, type 2 diabetes, and various cancers. This new research has raised as many questions as it has answered, and we still have a great deal to learn about the relationship between nutrition and chronic disease.

In recent decades, advances in technology have contributed to the emergence of several exciting new areas of nutrition research. For example, reflecting our growing understanding of genetics, nutrigenomics seeks to uncover links between our genes, our environment, and our diet. The In Depth following this chapter describes this and other new frontiers in nutrition research and health.

food The plants and animals we consume. nutrition The science that studies food and how food nourishes our body and influences our health. chronic diseases Diseases that come on slowly and can persist for years, often despite treatment.

↑  Nutrition is the science that studies all aspects of food and its influence on our body and health.

LO 1 Define the term nutrition and describe its evolution as a science.

recap Food refers to the plants and animals we consume, whereas nutrition is the scientific study of food and how food affects our body and our health. An appreciation of the importance of nutrition to our health has developed only within the past 400 years. Early research in nutrition focused on making the link between dietary deficiencies and illness. Contemporary nutrition research typi- cally studies the influence of nutrition on chronic disease.

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How does nutrition support health? | 5

How does nutrition support health? Think about it: If you eat three meals a day, by this time next year, you’ll have had more than a thousand chances to influence your body’s makeup! As you’ll learn in this text, you really are what you eat: the substances you take into your body are broken down and reassembled into your brain cells, bones, muscles—all of your tis- sues and organs. The foods you eat also provide your body with the energy it needs to function properly. These are just two of the ways that proper nutrition supports your health. Let’s look at two more.

A Nutritious Diet Contributes to Wellness Wellness can be defined in many ways. Traditionally defined as simply the absence of disease, wellness is now considered an active process we work on every day. Consuming a nutritious diet contributes to wellness in a variety of ways, including by providing the energy and functional chemicals that help us to perform activi- ties of daily living, support our ability to concentrate and perform mental tasks, and boost our ability to ward off infections (FIguRE 1.1).

In this book, we focus on two critical aspects of physical health: nutrition and physical activity. The two are so closely related that you can think of them as two sides of the same coin: our overall state of nutrition is influenced by how much energy we expend doing daily activities, and our level of physical activity has a major impact on how we use the food we eat. We can perform more strenuous activities for longer periods when we eat a nutritious diet, whereas an inadequate or excessive food intake can make us lethargic. A poor diet, inadequate or excessive physical activity, or a combination of these also can lead to serious health problems. Finally, several studies have suggested that healthful nutrition and regular physical activity can increase feelings of well-being and reduce feelings of anxiety and depression. In other words, whole- some food and physical activity just plain feel good!

Because of its importance to the wellness of all Americans, nutri- tion has been included in the national health promotion and disease prevention plan of the United States. Called Healthy People, the plan is revised every decade. Healthy People 2020, launched in January 2010, identifies a set of goals and objectives (as an agenda) that we hope to reach as a nation by the year 2020.1 This agenda was devel- oped by a team of experts from a variety of federal agencies under the direction of the Department of Health and Human Services.

The four overarching goals of Healthy People are to “1) attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; 2) achieve health equity, eliminate disparities, and improve the health of all groups; 3) create social and physical environments that promote good health for all; and 4) promote quality of life, healthy development, and healthy behaviors across all life stages.” These overarching goals are supported by hundreds of specific goals, including many related to nutrition. Others address physical activity and the problems of overweight and obesity, which are, of course, influenced by nutrition. TAbLE 1.1 identifies some objectives related to weight, nutrition, and physical activity from Healthy People 2020.

A Nutritious Diet Reduces the Risk for Disease Nutrition appears to play a role—from a direct cause to a mild influence—in the development of many diseases (FOCus FIguRE 1.2). As we noted, poor nutrition is a direct cause of deficiency diseases, such as scurvy and pellagra. Early nutrition

LO 2 Explain how nutrition supports health.

wellness A multidimensional, active process by which people make choices that enhance their lives.

↑  FIguRE 1.1 Consuming a nutritious diet contrib- utes to our wellness in numerous ways.

Supports our ability to perform activities of daily living

Enhances our ability to concentrate and perform mental tasks

Strengthens our ability to fight infections by maintaining our immune system

Provides opportunities for social interactions through shared cooking and eating experiences

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6 | Chapter 1 Nutrition: Linking food and health

research focused on identifying the missing vitamin or other food substance behind such diseases and on developing guidelines for intake levels that are high enough to prevent them. Over the years, nutrition scientists successfully lobbied for the fortifi- cation of foods with the substances of greatest concern. These measures, along with a more abundant and reliable food supply, have almost completely wiped out the majority of nutritional deficiency diseases in developed countries. However, they are still major problems in many developing nations.

In addition to causing disease directly, poor nutrition can have a subtle influ- ence on our health. For instance, it can contribute to the development of brittle bones (a disease called osteoporosis) as well as to the progression of some forms of cancer. These associations are considered mild; however, poor nutri- tion is also strongly associated with three chronic diseases—heart disease, stroke, and diabetes—which are among the top 10 causes of death in the United States (see Focus Figure 1.2).

It probably won’t surprise you to learn that the primary link between poor nutri- tion and early death is obesity. Fundamentally, obesity is a consequence of eating more Calories than are expended. At the same time, obesity is a well-established risk factor for heart disease, stroke, and the most common form of diabetes. Unfor- tunately, the prevalence of obesity has dramatically increased throughout the United States during the past 30 years (see Focus Figure 1.2). Throughout this text, we will discuss in detail how nutrition and physical activity affect the development of obesity.

recap Nutrition is an important component of wellness and is strongly associated with physical activity and body weight. Healthy People 2020 is a health promotion and disease prevention plan for the United States. One goal of a healthful diet is to prevent deficiency diseases, such as scurvy and pella- gra; a second goal is to lower the risk for chronic diseases, including heart disease, stroke, and the most common form of diabetes, all of which are linked to obesity.

TAbLE 1.1 Weight, Nutrition, and Physical Activity Objectives from Healthy People 2020

Topic Objective Number and Description

Weight status NWS-8. Increase the proportion of adults who are at a healthy weight from 30.8% to 33.9%. NWS-9. Reduce the proportion of adults who are obese from 34.0% to 30.6%. NWS-10.2. Reduce the proportion of children aged 6 to 11 years who are considered obese from 17.4% to 15.7%.

Food and nutrient composition

NWS-14. Increase the contribution of fruits to the diets of the population aged 2 years and older. NWS-15. Increase the variety and contribution of vegetables to the diets of the population aged 2 years and older.

Physical activity PA–1. Reduce the proportion of adults who engage in no leisure-time physical activity from 36.2% to 32.6%. PA–2.1. Increase the proportion of adults who engage in aerobic physical activity of at least moderate intensity for at least 150 minutes per week, or 75 minutes per week of vigorous intensity, or an equivalent combination from 43.5% to 47.9%. PA–2.3. Increase the proportion of adults who perform muscle-strengthening activities on 2 or more days of the week from 21.9% to 24.1%.

Data adapted from: Healthy People 2020 (U.S. Department of Health and Human Services).

Want to see how the prevalence of obesity differs across various ethnic groups

in the United States? Go to www .cdc.gov and enter “obesity data trend maps” into the search bar.

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focus figure 1.2 The Relationship between Nutrition and Human Disease

Diseases of the heart

Cancer

Chronic respiratory disease

Unintentional injuries

Stroke

Alzheimer’s disease

Diabetes mellitus

Influenza and pneumonia

Inflammatory kidney disease

Suicide

0 100 200 300 400 500 600

Number of deaths (in thousands)

700

20101994

No Data <10% 10%–14% 15%–19%

20%–24% ≥30%25%–29%

15%–20% 20%–25%

25%–30% 30%–35% ≥35%

Obesity, which increases the risk for diseases of the heart, stroke, and diabetes, surged between 1994 and 2010, the last year during which there was a significant increase in rates.

Graphics and data from: “Prevalence of Self-Reported Obesity among U.S. Adults” and “Percent of Obese (BMI=30) in U.S. Adults: 1994” (Centers for Disease Control and Prevention).

Source: Graphics from Centers for Disease Control and Prevention, Obesity Prevalence Maps 1985 to 2010.

Nutrition also plays a minor role in some diseases, such as certain types of cancer, some joint diseases such as osteoarthritis, and a disease called osteoporosis, which can cause loss of bone mass, as shown here.

Some diseases are the direct result of a nutritional deficiency or toxicity. The disease shown here, pellagra, is caused by a deficiency of a vitamin called niacin.

Some diseases have a strong nutritional component. These include diseases of the heart, stroke, and diabetes, all of which are among the top causes of death in the United States, as shown in this graph. Data from: “Deaths: Preliminary Data for 2011” (U.S. Department of Health and Human Services).

611

585

131

149

129

76

85

57

47

41

Bone loss from osteoporosis

Normal bone

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8 | Chapter 1 Nutrition: Linking food and health

What are nutrients? We enjoy eating food because of its taste, its smell, and the pleasure and comfort it gives us. However, we rarely stop to think about what our food actually contains. Foods are composed of many chemical substances, some of which are not useful to the body and others of which are critical to our growth and function. These latter chemicals are referred to as nutrients. The six groups of nutrients found in foods are (FOCus FIguRE 1.3):

carbohydrates fats and oils (two types of lipids) proteins vitamins minerals water

The term organic is commonly used to describe foods that are grown with little or no use of synthetic chemicals. But when scientists describe individual nutrients as organic, they mean that these nutrients contain both carbon and hydrogen, funda- mental units of matter that are common to all living organisms. Carbohydrates, lipids, proteins, and vitamins are organic. Minerals and water are inorganic. Organic and inorganic nutrients are equally important for sustaining life but differ in their struc- tures, functions, and basic chemistry. You will learn more about these nutrients in subsequent chapters; a brief review is provided here.

Macronutrients Provide Energy Carbohydrates, fats, and proteins are the only nutrients that provide energy. By this we mean that our body breaks down these nutrients and reassembles their compo- nents into a fuel that supports physical activity and basic functioning. Although tak- ing a multivitamin might be beneficial in other ways, it will not provide you with the energy for a 20-minute session on the stair-climber! The energy-yielding nutrients are also referred to as macronutrients. Macro means “large,” and our body need relatively large amounts of these nutrients to support normal function and health.

Energy Is Measured in Kilocalories The energy in foods is measured in units called kilocalories (kcal). A kilocalorie is the amount of heat required to raise the temperature of 1 kilogram (about 2.2 pounds) of

water by 1 degree Celsius. We can say that the energy found in 1 gram of carbohydrate is equal to 4 kcal.

Kilo- is a prefix used in the metric system to indicate 1,000 (think of kilometer). Technically, 1 kilocalorie is equal to 1,000 calories. A kilocalo- rie is also sometimes referred to as a large calorie or as a Calorie, written with a capital C. Because they’re designed for the public, nutrition labels typically use the term calories to indicate kilocalories. Thus, if the wrapper on an ice cream bar states that it contains 150 calories, it actually contains 150 kilocalories.

In this textbook, we use the term energy when referring to the gen- eral concept of energy intake or energy expenditure. We use the term kilocalories (kcal) when discussing units of energy. We use the term Calories with a capital “C” when presenting information about foods and food labels.

Both carbohydrates and proteins provide 4 kcal per gram, alcohol provides 7 kcal per gram, and fats provide 9 kcal per gram. Thus, for every gram of fat we consume, we obtain more than twice the energy derived from a gram of carbohydrate or protein. Refer to the You Do the Math box on page 10 to learn how to calculate the energy contribution of carbohydrates, fats, and proteins in a given food.

LO 3 Identify the six classes of nutrients essential for health.

nutrients Chemicals found in foods that are critical to human growth and function.

organic A substance or nutrient that contains the elements carbon and hydrogen.

inorganic A substance or nutrient that does not contain carbon and hydrogen.

macronutrients Nutrients that our body need in relatively large amounts to support normal function and health. Carbohydrates, fats, and proteins are energy-yielding macronutrients.

↑  Carbohydrates are the primary source of fuel for our body, particularly for our brain.

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9

focus figure 1.3 The six groups of Nutrients Found in Foods

Vitamins

Carbohydrates

Proteins

Minerals

Functions: Primary energy source for the body Composed of: Chains of carbon, hydrogen, and oxygen Best Food Sources: Whole grains, vegetables, fruits

Functions: Support tissue growth, repair, and maintenance Composed of: Amino acids made up of carbon, hydrogen, oxygen, and nitrogen Best Food Sources: Meats, dairy products, seeds, nuts, legumes

Functions: Assist with release of macronutrients; critical to building and maintaining bone, muscle, and blood; support immune function and vision Composed of: Fat-soluble and water-soluble compounds Best Food Sources: Fruits, vegetables, dairy products, meats

Functions: Assist with fluid regulation and energy production; maintain health of blood and bones; rid body of harmful by-products of metabolism Composed of: Single elements such as sodium, potassium, calcium, or iron Best Food Sources: Fruits, vegetables, dairy products, meats

Functions: Ensures proper fluid balance; assists in regulation of nerve impulses, body temperature, and muscle contractions Composed of: Hydrogen and oxygen Best Food Sources: Water, juices, soups, fruits, vegetables

Functions: Important source of energy at rest and during low- intensity exercise Composed of: Carbon, hydrogen, and oxygen Best Food Sources: Vegetable oils, butter, and dairy products

Fats and oils

Water

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10 | Chapter 1 Nutrition: Linking food and health

The energy in food is used for everything from maintaining normal body functions—such as breathing, digesting food, and repairing damaged tissues and organs—to enabling you to perform physical activity and even to read this text. So how much energy is produced from the foods you eat?

To answer this question, you need to know the follow- ing information:

Carbohydrates should make up the largest percentage of your nutrient intake, about 45–65%; they provide 4 kcal of energy per gram of carbohydrate consumed.

Proteins also provide 4 kcal of energy per gram; they should be limited to 10–35% of your daily energy intake.

Fats provide the most energy, 9 kcal per gram; they should make up 20–35% of your total energy intake.

In order to figure out whether you’re taking in the appropriate percentages of carbohydrates, fats, and pro- teins, you will need to use a little math.

1. Let’s say you have completed a personal diet analysis, and you consume 2,500 kcal per day. You consume 300 g of carbohydrates, 90 g of fat, and 123 g of protein.

2. To calculate your percentage of total energy that comes from carbohydrate, you must do two things:

a. Multiply your total grams of carbohydrate by the energy value for carbohydrate.

300 g of carbohydrate * 4 kcal/g = 1,200 kcal of carbohydrate consumed

b. Take the kcal of carbohydrate consumed, divide this by the total kcal consumed, and multiply by 100. This will give you the percentage of the total energy you consume that comes from carbohydrate.

(1,200 kcal/2,500 kcal) * 100 = 48% of total energy comes from carbohydrate

3. To calculate your percentage of total energy that comes from fat, you follow the same steps but incor- porate the energy value for fat:

a. 90 g of fat * 9 kcal/g = 810 kcal of fat b. (810 kcal/2,500 kcal) * 100 = 32.4% of total

energy comes from fat

Now try these steps to calculate the percentage of the total energy you consume that comes from protein.

Also, have you ever heard that alcohol provides “empty Calories”? Alcohol contributes 7 kcal per gram. You can calculate the percentage of kcal from alcohol in your daily diet, but remember that it is not considered an energy nutrient.

These calculations will be very useful throughout this course as you learn more about how to design a health- ful diet and how to read labels to help you meet your nutritional goals. Later in this book you will learn how to estimate your unique energy needs.

Carbohydrates Are a Primary Fuel source Carbohydrates are the primary source of fuel for our body, particularly for our brain and during physical exercise (see Focus Figure 1.3). Carbo- refers to carbon, and hydrate refers to water. You may remember that water is made up of hydrogen and oxygen. Thus, carbohydrates are composed of chains of carbon, hydrogen, and oxygen.

Carbohydrates are found in a wide variety of foods, including rice, wheat, and other grains, as well as vegetables and fruits. Carbohydrates are also found in legumes (foods that include lentils, beans, and peas), seeds, nuts, and milk and other dairy products. (Carbohydrates and their role in health are the subject of Chapter 4.)

Fats Provide Energy and Other Essential Nutrients Fats are another important source of energy for our body (see Focus Figure 1.3). They are a type of lipids, a diverse group of organic substances that are insoluble in water. Like carbohydrates, fats are composed of carbon, hydrogen, and oxygen; however, they contain proportionally much less oxygen and water than carbohydrates do. This quality allows them to pack together tightly, which explains why they yield more energy per gram than either carbohydrates or proteins.

carbohydrates The primary fuel source for our body, particularly for our brain and for physical exercise.