Nutritional Sciences: From Fundamentals to Food, 4th Edition PDF by Michelle McGuire, Kathy A Beerman


Nutritional Sciences: From Fundamentals to Food, Fourth Edition

By Michelle McGuire, Kathy A. Beerman

Nutritional Sciences: From Fundamentals to Food, Fourth Edition


Chapter 1 The Science of Nutrition 3

Everybody Has a Story Choosing Nutrition as a Career Path 4

What Do We Mean by “Nutrition”? 5

Nutrients Support All We Do 5 • Foods Contain Nutrients

and Nonnutrients 6 • Organic Nutrients Are Different

From Organic Foods 7 • Phytochemicals, Zoonutrients, and Functional Foods 7

Focus On Food Understanding What Is Meant by “Organic Foods” 8

What Are the Major Nutrient Classes? 9

Carbohydrates Are Vital For Energy and Regulatory

Roles 9 • Proteins Make Up Muscles and Are Important

for Energy and Regulation 9 • Lipids Do More Than

Provide Energy 10 • Water Is The Essence of Life

Itself 10 • Vitamins Regulate Reactions and Promote

Growth and Development 10 • Minerals Provide Structure and Assist with Regulation 10

How Do Foods Provide Energy? 11

Energy In Food Is Measured In Units Called Calories 11

How Is Nutrition Research Conducted? 13

Step 1: The Observation Must Be Accurate 13 •

Step 2: A Hypothesis Makes Sense of An

Observation 14 • Step 3: Data Are Collected To Test The

Hypothesis 16 • Intervention Studies Test for Causality 17

Are All Nutrition Claims Believable? 21

Determine The Source of The Information 21 •

Credibility of The Researchers Is Important 22 • Who

Paid For The Research? 22 • Evaluate The Experimental

Design 22 • Do Public Health Organizations Concur? 22

Nutrition and Health: What Is the Connection? 23

Public Health Agencies Assess The Health of The

Nation 23 • Mortality and Morbidity Rates Measure

Death and Illness Over Time 23 • Life Expectancy Has

Increased Dramatically 24 • Diseases Are Either Infectious

or Noninfectious 25 • Chronic Diseases Are The Leading

Causes of Death 26 • Risk Factors Do Not Necessarily

Cause Diseases 26 • Understanding Nutrition Is More

Important Than Ever 27

Focus On Diet and Health Industrialization, Population

Growth, and the Nutrition Transition 28

Chapter 2 Nutritional Assessment and Dietary Planning 31

Everybody Has a Story Nutrient Deficiencies—Primary or Secondary? 32

What Is The Meaning of “Nutritional Status”? 33

Primary and Secondary Malnutrition Can Lead To Poor

Nutritional Status 33 • Adequate Nutrient Intake Can Be

Different Among Individuals 34

How Is Nutritional Status Assessed? 35

Anthropometry: Body Measurements Provide Information

Concerning Nutritional Status 35 • Laboratory Tests

Are Important Biochemical Indicators of Nutritional

Status 36 • Clinical Evaluations Assess Signs and

Symptoms of Disease 36 • Analysis of Your Diet Can Also

Be Helpful 37 • Food Composition Tables and Dietary

Analysis Software Are Important Tools 38

How Much of a Nutrient Is Adequate? 39

Dietary Reference Intakes (DRIs) Provide Reference

Standards 39 • DRI Values Depend on Many

Factors 41 • Estimated Average Requirements (EARs)

Reflect a Population’s Average Need 42 • Recommended

Dietary Allowances (RDAs) Are Recommended Intake Goals

For Individuals 43 • Adequate Intake (AI) Levels Were

Set When Data Were Lacking For EARs 44 • Tolerable

Upper Intake Levels (ULs) Reflect Safe Maximal

Intakes 44 • Chronic Disease Risk Reduction Intakes

(CDRRs) 45 • Energy Intake Can Also Be Evaluated 46

How Can You Easily Assess and Plan Your Diet? 48

Food Guidance Systems Have Been Part of Dietary Planning For Decades 48

2020 Dietary Guidelines for Americans: Our Current

Recommendations 50

2020 Dietary Guidelines For Americans 50

Food Matters Working Toward the Goal: Maximizing

Nutrient Intake by Increasing Fruit and Vegetable Intake 55

Nutrients of Public Health Concern 55 • Healthy

Eating Patterns 56 • MyPlate lllustrates How To Put

Recommendations Into Practice 56 • Healthy People 2030

Outlines Our Nation’s Goals For Healthy Living 57

Focus On Diet and Health Are Legumes Protein Foods or

Vegetables? 58

How Can You Use Food Labels to Plan a Healthy Diet? 59

Understanding Nutrition Facts Labels 60

Focus On Food What Makes a Food Kosher? 61

Focus On Food The Buy Fresh Buy Local Campaign 64

Nutrient Content Claims, Structure/Function Claims, and Health Claims 65

Can You Put These Concepts into Action? 66

Step 1: Set the Stage and Set Your Goals 67 • Step 2:

Assess Your Nutritional Status 67 • Step 3: Set The Table

To Meet Your Goals 67 • Step 4: Compare Your Plan With

Your Assessment: Did You Succeed? 68 • There Is No Time Like The Present 68

Chapter 3 Chemical, Biological, and Physiological Aspects of Nutrition 71

Everybody Has a Story Living with Gastroparesis 72

How Does Chemistry Apply to the Study of Nutrition? 73

Atoms Are Fundamental Units of Matter That Make up the

World Around Us 74 • Chemical Bonds Enable Atoms

to Form Millions of Different Molecules 75 • Complex

Molecules Are Vital to Cell Function 76 • Acid–Base

Chemistry Is Important to the Study of Nutrition 77

How Do Biological Molecules Form Cells, Tissues,

Organs, and Organ Systems? 78

Substances Cross Cell Membranes By Passive and Active

Transport 78 • Cell Organelles Carry Out Specialized

Functions Critical for Life 80 • Groups of Cells Make Up

Tissues, Tissues Make Up Organs, and Organs Make Up Organ Systems 81

How Does the Digestive System Break Down Food

into Absorbable Components? 83

The GI Tract Has Four Tissue Layers that Contribute to the Process of Digestion 85

How Do Gastrointestinal Motility and Secretions Facilitate Digestion? 86

Gastrointestinal (GI) Motility Mixes and Propels Food

in the GI Tract 87 • Gastrointestinal (GI) Secretions Aid

Digestion and Protect the GI Tract 87 • Neural and

Hormonal Signals Regulate Gastrointestinal Motility and Secretions 89

How Does the Gastrointestinal Tract Coordinate

Functions to Optimize Digestion and Nutrient Absorption? 90

Digestion Begins in the Mouth With Chewing and Mixing Food 91

Focus On Clinical Applications A Loss of Smell Can Spell Trouble 93

The Esophagus Delivers Food to the

Stomach 94 • Functions of the Stomach Include Storage,

Release of Gastric Secretions, and Mixing 95

Focus On Clinical Applications Gastroesophageal Reflux Disease 96

The Small Intestine Is the Primary Site of Chemical Digestion

and Nutrient Absorption 100

What Is the Role of the Large Intestine? 105

Focus On Clinical Applications Understanding Celiac Disease 106

The Large Intestine Aids in the Elimination of Solid Waste

Products 106 • Fluids and Electrolytes Are Absorbed

and Reabsorbed in the Large Intestine 107 • Microbial

Action in the Large Intestine Breaks down Undigested Food

Residue 108

Focus On Clinical Applications Irritable Bowel Syndrome

and Inflammatory Bowel Disease 109

The Large Intestine Stores and Eliminates Solid Waste

Products from the Body 110

Focus On Clinical Applications The Fecal Microbiome:

Building a Healthy Community 111

How Does the Body Circulate Nutrients and Eliminate

Cellular Waste Products? 112

Nutrients Absorbed from the Small Intestine Are Circulated

to the Liver 113 • The Cardiovascular System Circulates

Nutrients, Oxygen, and Other Substances 113 •

The Lymphatic System Transports Fat-Soluble Nutrients

Away from the GI Tract 115 • The Kidneys Play an

Important Role in Excreting Cellular Waste Products 115

Focus On Clinical Applications What Urine Says About

Your Health 117

Chapter 4 Carbohydrates 119

Everybody Has a Story Getting The Diagnosis 120

What Are Simple Carbohydrates? 121

Monosaccharides Are Single Sugar Molecules 122

Focus On Diet and Health Fructose and Nonalcoholic Fatty

Liver Disease 124

Disaccharides Consist of Two Monosaccharides 124

What Are Complex Carbohydrates? 127

Oligosaccharides Are Components of Cell Membranes 127

Polysaccharides Differ in the Types and Arrangements

of Sugar Molecules 127

Focus On Food Are Nonsugar Sweeteners Beneficial

to Health? 128

How Are Carbohydrates Digested, Absorbed,

and Circulated in the Body? 136

Starch Digestion Begins in the Mouth 136 • Disaccharides

Are Digested in the Small Intestine 138 •

Monosaccharides Are Readily Absorbed from the Small

Intestine 139

Focus On the Process of Science The Evolutionary History

of Lactose Tolerance 140

Monosaccharides Have Several Functions in the Body 142

How Do Hormones Regulate Blood Glucose and Energy

Storage? 142

The Hormones Insulin and Glucagon Are Produced by

the Pancreas 143 • Insulin Lowers Blood Glucose and

Promotes Energy Storage 143 • Glucagon Helps Increase

Blood Glucose 146 • Fight-or-Flight Response Provides an

Immediate Energy Source 148 • Ketones Are the Body’s

Alternative Energy Source 148

How Much Carbohydrate Do We Require? 148

Dietary Reference Intakes for Carbohydrates 150

Food Matters Working Toward the Goal: Focus

on Reducing Added Sugars 151

Making the Right Food Choices 151

Nutrition Matters Nutrition and Diabetes 152

What Is Diabetes? 152

The Discovery of Insulin 152 • Diabetes Is Classified by Its

Underlying Cause 152

What Is Type 1 Diabetes? 153

Type 1 Diabetes Is Caused by a Lack of Insulin

Production 153 • Metabolic Disturbances Result from

Type 1 Diabetes 154 • Type 1 Diabetes Requires

Exogenous Insulin 155

What Is Type 2 Diabetes? 157

Type 2 Diabetes Is Caused by Insulin Resistance 157 •

Genetic and Lifestyle Factors Increase the Risk of

Developing Type 2 Diabetes 159 • Signs and Symptoms

of Type 2 Diabetes Are Often Ignored 159 • Managing

Type 2 Diabetes Can Help Prevent Long-Term

Complications 160 • Lifestyle Practices Can Influence Risk

of Developing Type 2 Diabetes 161

What Are Secondary Diabetes and Gestational

Diabetes? 161

Some Pregnant Women Develop Gestational Diabetes 161

Focus On the Process of Science The Story of the Akimel

O’odham 162

Managing Diabetes Today Can Help Prevent Health

Problems Tomorrow 163

Chapter 5 Protein 167

Everybody Has a Story Living with Peanut

Allergy 168

What Are Proteins? 169

Amino Acids Are the Building Blocks of

Proteins 169 • Amino Acids Are Classified As Essential,

Nonessential, or Conditionally Essential 170

Are All Food Proteins Equal? 171

Complete and Incomplete Proteins 171 • Protein

Complementation 172 • Protein Quality 172

Focus On Food Genetically Modified Organisms (GMOs)

and Protein Quality 173

How Are Proteins Made? 173

Step 1: Cell Signaling Initiates Protein Synthesis 174 •

Step 2: Transcription Transfers Genetic Information to

mRNA 175 • Step 3: Translation Produces a New Peptide

Chain 175

How Do Proteins Get Their Shapes? 175

Primary Structure Dictates a Protein’s Basic

Identity 176

Focus On Clinical Applications Sickle Cell Anemia and

CRISPR-Cas9 177

Secondary Structure Folds and Twists a

Peptide Chain 177 • Tertiary Structure Adds

Complexity 178 • Some Proteins Have Quaternary

Structure and Prosthetic Groups 179 • Denaturing Agents

Alter a Protein’s Shape and Function 179

Genetics, Epigenetics, Nutrition,

and Nutrigenomics 180

Genetic Alterations: Mutations and Polymorphisms 181 •

Experts Believe That Nutrition May Be Related to

Epigenetics 182 • The Human Genome Project Has

Opened the Door to Nutrigenomics 182

Focus On the Process of Science Personalized Nutrition

Based on Genetic Makeup 183

How Are Dietary Proteins Digested, Absorbed, and

Circulated? 183

Protein Digestion Begins in the Stomach 183 • Protein

Digestion Continues in the Small Intestine 184 • Amino

Acids Are Absorbed in the Small Intestine and Circulated in

the Blood 185

What Are the Major Functions of Proteins and Amino

Acids in the Body? 186

Proteins Provide Structure 187 • Enzymes Are Proteins

That Catalyze Chemical Reactions 188 • Muscle Proteins

Facilitate Movement 188 • Some Proteins Provide a

Transport Service 188 • Hormones and Cell-Signaling

Proteins Are Critical Communicators 188 • Proteins Protect

the Body 189 • Fluid Balance Is Regulated in Part by

Proteins 189 • Proteins Help Regulate pH 189 • Proteins

Are Sources of Glucose and Energy (ATP) 190 • Amino

Acids Serve Many Additional Purposes 191

Protein Turnover, Urea Excretion, and Nitrogen

Balance 192

Protein Turnover Helps Maintain an Adequate Supply

of Amino Acids 192 • Nitrogen Is Excreted As

Urea 192 • What Is Nitrogen Balance? 192

How Much Protein Do You Need? 193

Dietary Reference Intakes (DRIs) for Amino Acids 193 •

Dietary Reference Intakes (DRIs) for Proteins 194 •

Experts Debate Whether Athletes Need More

Protein 195 • Additional Recommendations for Protein

Intake 195

Focus On Sports Nutrition Do Protein and Amino Acid

Supplements Enhance Athletic Performance? 196

Food Matters Working Toward the Goal: Obtaining

Sufficient Protein While Minimizing Fats 197

Vegetarian Diets: Healthier Than Other Dietary

Patterns? 197

There Are Several Forms of Vegetarianism 197 •

Vegetarian Diets Sometimes Require Thoughtful

Choices 198

What Are the Consequences of Protein Deficiency? 199

Protein Deficiency Is Most Common In Early

Life 199 • Protein Deficiency In Adults 200

Protein Excess: Is There Cause for Concern? 200

Red Meat And Processed Meat: Related to Increased Risk for

Cancer? 201

Nutrition Matters Food Safety 202

What Causes Foodborne Illness? 202

Foodborne Illnesses Are Caused by Infectious and

Noninfectious Agents 202 • Different Strains of a

Microorganism Are Called Serotypes 202 •

Some Organisms Make Toxins Before We Eat

Them 204 • Some Organisms Make Enteric (Intestinal)

Toxins After We Eat Them 205 • Some Organisms Invade

Intestinal Cells 206 • Protozoa And Worms Are Types Of

Parasites 206 • Prions Are Inert, Nonliving Proteins That

May Be Infectious 207

How Can Noninfectious Substances Cause Foodborne

Illness? 208

Algae Toxins Can Make Some Fish and Shellfish

Poisonous 208 • Some Pesticides, Herbicides,

Antibiotics, And Hormones Are Dangerous 209 • Food

Allergies And Sensitivities Can Also Cause Foodborne

Illness 209 • Generally Recognized As Safe

(GRAS) 210 • New Food Safety Concerns Are Always

Emerging 210

How Do Food Manufacturers Prevent Contamination?


Careful Food-Handling Techniques Help Keep Food

Safe 211 • Proper Food Production, Preservation, And

Packaging Can Prevent Illness 211

What Steps Can You Take to Reduce Foodborne

Illness? 213

Check Consumer Advisory Bulletins 213 • The FightBAC!®

Campaign Provides Basic Food Safety Advice 214 • Be

Especially Careful When Eating Out 215

What About Avoiding Foodborne Illness While Traveling

or Camping? 215

Drink Only Purified or Treated Water 215 • Avoid Or

Carefully Wash Fresh Fruit And Vegetables 215 • Traveling

In Areas With Variant Creutzfelt-Jakob Disease 215

What Are Some Emerging Issues of Food

Biosecurity? 216

Regarding COVID-19 And Foodborne Illness 216

Chapter 6 Lipids 219

Everybody Has a Story Gallbladder Surgery—When Things

Do Not Go Smoothly 220

What Are Lipids? 221

Fats and Oils Are Types of Lipids 221 • Fatty Acids Are the

Most Common Type of Lipid 221 • Fatty Acids Are Named

for Their Structures 225

Focus On Diet and Health Global Elimination of Trans Fatty

Acids 226

Which Fatty Acids Do We Need, and Where Do They

Come From? 228

There Are Two Essential Fatty Acids: Linoleic Acid and

Linolenic Acid 228 • Some Fatty Acids Are Conditionally

Essential 230 • Dietary Sources of Different Types of Fatty

Acids 230

Focus On Life Cycle Nutrition Optimal Lipid Nutrition

during Infancy 231

Mono-, Di-, and Triglycerides: What’s the

Difference? 232

Triglycerides Play Many Roles in the Body 232

What Are Phospholipids and Sterols? 234

Phospholipids Are Considered “Amphipathic” 234 •

Phospholipids Are Critical for Cell Membranes and Lipid

Transport 235 • Sterols and Sterol Esters Are Lipids with

Ring Structures 236

How Are Dietary Lipids Digested? 239

Digestion of Triglycerides Requires Bile and Lipases 239

Focus On Clinical Applications Gallbladder Disease and

Gallstones 242

Digestion of Phospholipids and Cholesteryl Esters Also

Requires Pancreatic Enzymes 243

How Are Dietary Lipids Absorbed and Circulated in the

Body? 243

Dietary Lipids Are Absorbed in the Small Intestine 243 •

Dietary Lipids Are Circulated Away from the Small Intestine

in Two Ways 244

Additional Transport of Lipids Throughout the Body

Requires Additional Lipoproteins 246

What Is the Relationship Between Lipid Intake and

Health? 248

Lipid Intake, Obesity, and Cardiovascular Disease 248 •

The Relationship Between Dietary Lipids and Cancer Is

Unclear 249

What Are the Dietary Recommendations for

Lipids? 249

Consume Adequate Amounts of the Essential Fatty

Acids 249

Focus On the Process of Science The Long and Winding

Road of Shifting Lipid Recommendations 250

Pay Special Attention to the Long-Chain Omega-3 Fatty

Acids 251 • Dietary Guidelines for Americans and

American Heart Association Recommend Limiting Saturated

Fatty Acid Consumption 251 • Trans Fatty Acids

Should Be Minimized 251 • Guidelines for Total Lipid

Consumption 251

Food Matters Working Toward the Goal: Getting the Right

Lipids in Your Diet 252

Nutrition Matters Nutrition and Cardiovascular

Health 254

How Does Cardiovascular Disease Develop? 254

Atherosclerosis Can Lead to Cardiovascular Disease 254 •

Heart Disease Is a Type of Cardiovascular Disease 256 •

Stroke Is Another Form of Cardiovascular Disease 257

What Are the Risk Factors for Cardiovascular

Disease? 258

Nonmodifiable Risk Factors 258 • Modifiable Risk

Factors 258

How Does Dietary Intake Influence Cardiovascular

Risk? 260

Hypertension Can Be Partially Controlled with Diet 260 •

Controlling Blood Lipid Levels with Diet 261 • Other

Dietary Factors and Patterns Are Associated with Lower

Risk 262 • Heart-Healthy Dietary Patterns 262

What Are the General Nutrition Guidelines for Healthy

Hearts? 264

Be Mindful of Energy Intake and Macronutrient

Balance 264 • Vitamins and Minerals Also Matter for

Dietary Prevention of Cardiovascular Disease 264

Chapter 7 Energy Metabolism 267

Everybody Has a Story The Importance of Newborn

Screening 268

What Is Energy Metabolism? 269

Metabolic Pathways Consist of Linked Chemical

Reactions 269 • Metabolic Pathways Can Be Catabolic

or Anabolic 271 • Biochemical Reactions Require

Enzymes 271 • Energy Metabolism Is Influenced by ATP

Levels 274

What Is the Role of ATP in Energy Metabolism? 275

High-Energy Bonds Enable ATP to Store and Release

Energy 275 • ATP Is Synthesized by Substrate

Phosphorylation and by Oxidative Phosphorylation 276

How Do Catabolic Pathways Release Stored

Energy? 278

Catabolic Pathways Metabolize Glucose for

Energy 278 • Catabolic Pathways Can Metabolize Protein

for Energy 284 • Triglycerides Are an Important Source of

Energy 285

How Do Anabolic Pathways Contribute to Energy

Metabolism? 289

Glycogenesis Generates Glycogen from Glucose 289 •

Lipogenesis Forms Fatty Acids and Triglycerides 289 •

Gluconeogenesis Forms Glucose from Noncarbohydrate

Sources 290 • Ketogenesis Plays an Important Role during

Times of Limited Glucose Availability 291

Focus On Diet and Health Ketogenic Diets and Seizure

Disorders 293

How Is Energy Metabolism Influenced by Feeding and

Fasting? 293

The Fed State Favors Energy Storage 294 • Cells

Rely on Stored Energy during the Postabsorptive

State 294 • Energy Stores Decline during the Fasting

State 296

Focus On Diet and Health Chronic Caloric Restriction and

Longevity 297

The Body Conserves Energy Stores during the State of

Prolonged Starvation 297 • Versatile Solutions Help the

Body Meet Its Energy Needs 298

Focus On the Process of Science Keys Starvation

Experiment 299

Nutrition Matters Alcohol, Health, and Disease 300

What Is Alcohol and How Is It Produced? 300

Alcohol Is Produced by Fermentation 300 • Several Factors

Influence the Rate of Alcohol Absorption 301 • Alcohol

Circulates and Accumulates in the Blood 302 • Alcohol

Affects the Central Nervous System 303 • Defining Safe

Levels of Alcohol Consumption 303

How Is Alcohol Metabolized? 304

The Alcohol Dehydrogenase (ADH) Pathway Metabolizes

the Majority of Alcohol 305 • The Microsomal

Ethanol-Oxidizing System (MEOS) Can Also Metabolize

Alcohol 306 • Alcohol Metabolism and Liver Disease 306

What Other Health Consequences Are Associated with

Chronic Alcohol Consumption? 307

Alcohol and Nutritional Status 308 • Alcohol and

Cardiovascular Disease 310 • Alcohol and Brain

Function 311 • Alcohol and Cancer 312 • Alcohol and

Pancreatitis 312

How Does Alcohol Abuse Contribute to Individual and

Societal Problems? 312

Alcohol Use on College Campuses 313 • Recommendations

for Responsible Alcohol Use 313

Chapter 8 Energy Balance and Body Weight Regulation 319

Everybody Has a Story The Decision to Have Gastric

Bypass Surgery 320

What Is Energy Balance? 321

Energy Balance Affects Body Weight 321

What Determines Energy Intake? 324

Hunger and Satiety Are Physiological Influences on Energy

Intake 324

Focus On Clinical Applications Bariatric Surgery 328

Appetite and Food Aversions Can Also Affect Energy

Intake 329

What Determines Energy Expenditure? 330

Basal Metabolism Accounts for Most of TEE 330

Focus On Food Food Cravings, Food Aversions, and Food

Addictions 331

Physical Activity Is the Second-Largest Component of

TEE 333 • Thermic Effect of Food (TEF ) Is a Minor

Component of TEE 334 • Methods of Assessing Total

Energy Expenditure (TEE) 334 • Direct and Indirect

Calorimetry Used to Estimate TEE 334 • Stable Isotopes

Can Be Used to Estimate TEE 335 • TEE Can Be

Estimated Using Mathematical Formulas 335

How Are Body Weight and Body Composition

Assessed? 335

Being Overweight Means Having Excess Weight; Being

Obese Means Having Excess Fat 336 • Tables Are a Guide

to Assessing Body Weight 336 • Clinicians Use Several

Techniques to Assess Body Composition 337 • Body Fat

Distribution Affects Health 340

How Do Behavior, Environment, and Genetics

Contribute to Obesity? 342

Demographic Trends Impact Obesity Rates 342

Focus On the Process of Science The Gastrointestinal (GI)

Tract Microbiome, Undernutrition, and Obesity: Is There a

Connection? 344

Sedentary Lifestyles Contribute to Weight Gain 345

Can Genetics Influence Body Weight? 346

Twin Studies Help Scientists Understand Role of Genetics in

Obesity Risk 347 • Discovery of the “Obesity Genes” in

Mice Provided a Genetic Model of Obesity 347

How Does the Body Regulate Energy Balance and Body

Weight? 348

Adjusting Energy Intake and Energy Expenditure Maintains

Energy Balance 349 • Hormonal Influences on Body

Weight 350

What Are the Best Approaches to Weight Loss? 352

Healthy Eating to Promote Overall Health 352

Food Matters Working Toward the Goal: Maintaining

a Healthy Body Weight by Balancing Caloric Intake with

Energy Expenditure 353

Components of a Healthy Eating Plan 354

Focus On Food Eating More and Weighing Less 356

Does Macronutrient Distribution Matter? 357

High-Carbohydrate, Low-Fat Weight Loss Diets 357 •

Low-Carbohydrate Weight-Loss Diets 358 • Intermittent

Fasting vs. Continuous Energy Restriction 360

Nutrition Matters Disordered Eating 362

How Do Eating Disorders Differ from Disordered

Eating? 362

People with Anorexia Nervosa Pursue Excessive

Thinness 363 • People with Bulimia Nervosa Binge and

Purge 366 • Binge Eating Disorder Is a Distinct Disordered

Eating Pattern 368 • Most Eating Disorders Are Classified

as Other Specified Feeding or Eating Disorder 368

Are There Other Disordered Eating Behaviors? 369

Some Food-Related Disturbances Involve Nocturnal

Eating 369 • Food Neophobia: Avoidance of Trying New

Foods 370 • Muscle Dysmorphia: Preoccupation with

Muscularity 370

What Causes Eating Disorders? 371

Sociocultural Factors 371 • Family Dynamics 372 •

Personality Traits, Sexual Orientation, and Emotional Factors

Can Trigger Eating Disorders 373 • Biological and Genetic

Factors May Also Play a Role in Eating Disorders 373

Are Athletes at Increased Risk for Eating

Disorders? 374

Athletics May Foster Eating Disorders in Some

People 374 • The Female Athlete Triad 374

How Can Eating Disorders Be Prevented and

Treated? 375

Prevention Programs Must Promote a Healthy Body

Image 376 • Treatment Strategies Must Focus on

Psychological Issues 376

Chapter 9 Physical Activity and Health 379

Everybody Has a Story From Couch to Ironman™ 380

What Are the Health Benefits of Physical Activity? 381

Physical Activity Improves Health and Physical

Fitness 381 • Components of Physical

Fitness 383 • ACSM Exercise Recommendations for

Healthy Adults 385

How Does Physical Activity Impact Energy

Metabolism? 388

ATP Can Be Generated By Aerobic and Anaerobic

Respiration 388

Focus On Sports Nutrition Do Creatine Supplements

Enhance Athletic Performance? 392

What Physiologic Adaptations Occur in Response to

Athletic Training? 395

Both Strength and Endurance Training Improve Athletic

Performance 395 • Some Athletes Use “Performance-

Enhancing” Aids 397

How Does Physical Activity Influence Dietary

Requirements? 397

Energy Requirements to Support Physical

Activity 397 • Recommendations for Macronutrient

Intake are Similar for Physically Active and Sedentary

Individuals 402

Focus On Sports Nutrition Glycogen Supercompensation

and Athletic Performance 403

An Adequate Diet is Likely to Satisfy Micronutrient

Requirements 404 • Exercise Increases the Need for Fluid

and Electrolytes 406 • Nutrition Plays an Important Role in

Post-Exercise Recovery 407

Chapter 10 Water-Soluble Vitamins, Choline, and Carnitine 411

Everybody Has a Story Gracefully Facing the Challenges of

Neural Tube Defects 412

The Water-Soluble Vitamins: A Primer 413

Water-Soluble Vitamins Tend to Have Similar

Properties 413 • Water-Soluble Vitamins Function

in Diverse Ways 413 • Some Vitamins Have Several

Names 415 • Some Foods Are “Enriched” or “Fortified”

With Micronutrients 416 • Water-Soluble Vitamins Can Be

Destroyed by Cooking and Improper Storage 418

Thiamin (Vitamin B1)—Needed for Production of Acetyl

Coenzyme A 418

Whole Grains, Pork, and Fish Are Rich in Thiamin 418 •

“Antithiamin Factors” Decrease Thiamin Bioavailability 419

Food Matters Working Toward the Goal: Consuming

Whole-Grain Foods to Optimize Your Intake of Water-

Soluble Vitamins 420

Thiamin Is Critical for ATP Production 420 • Thiamin

Deficiency Results in Beriberi 421 • Recommended

Intakes of Thiamin 422

Riboflavin (Vitamin B2)—Coenzyme Required for

Reduction–Oxidation Reactions 422

Meat and Dairy Products Are Rich Sources of

Riboflavin 422 • Riboflavin Assists in Reduction–

Oxidation (Redox) Reactions 423 • Riboflavin Deficiency

Causes Ariboflavinosis 423 • Recommended Intakes of

Riboflavin 423

Niacin (Vitamin B3)—Required for Energy

Metabolism 424

Meat and Mushrooms Are Good Sources of

Niacin 424 • Niacin Is Involved in Reduction–Oxidation

(Redox) Reactions 426 • Niacin Deficiency Results in

Pellagra 426 • Recommended Intakes of Niacin 427

Pantothenic Acid (Vitamin B5)—A Component of

Coenzyme A 427

Pantothenic Acid Is Found in Most Plant and Animal

Foods 427 • Pantothenic Acid Is Needed for ATP

Production and Fatty Acid Synthesis 427 • Recommended

Intakes for Pantothenic Acid 428

Vitamin B6—Critical for Metabolism of Amino

Acids 428

Chickpeas, Tuna, and Liver Are Rich in Vitamin B6

428 • Vitamin B6 Is Needed for Making Nonessential Amino

Acids and Gluconeogenesis 429 • Vitamin B6 Deficiency

Causes Microcytic Hypochromic Anemia 430 • Too Much

Vitamin B6 Can Be Toxic 430 • Recommended Intakes of

Vitamin B6 431

Biotin (Vitamin B7)—Coenzyme for Carboxylation

Reactions 431

Nuts, Mushrooms, and Eggs Are Rich in Biotin 431 • Biotin

Adds Bicarbonate (HCO3

-) Subunits in Carboxylation

Reactions 431 • Recommended Intakes for Biotin 432

Folate—Required for Methylation Reactions 433

Green Leafy Vegetables Are Rich Sources of Folate 433

Focus On Diet and Health The Complex Association

Among B Vitamins, the GI Microbiome, and Health 434

Folate Facilitates Single-Carbon Transfers 435 • Folate

Deficiency Causes Megaloblastic Macrocytic

Anemia 437 • Recommended Intakes of Folate 438

Vitamin B12 (Cobalamin)—Vitamin Made Only by

Microorganisms 438

Only Microorganisms Produce Vitamin B12 438 • Vitamin B12 Is

Involved in ATP and Methionine Production 439 • Vitamin B12

Deficiency Causes Pernicious Anemia 439 • Recommended

Intakes For Vitamin B12 440

Vitamin C (Ascorbic Acid)—Critical Antioxidant 440

Many Fruits and Vegetables Are Rich Sources of

Vitamin C 441 • Vitamin C Is a Potent Antioxidant 441 •

Vitamin C Is Important for Immune Function 443 • Vitamin

C Deficiency Causes Scurvy 444 • Recommended Intakes

for Vitamin C 444

Choline—An Important Component of Cell

Membranes 444

Eggs Are Rich Sources of Dietary Choline 444 • Choline

Deficiency 445

Carnitine—Needed for Intracellular Fatty Acid

Transport 446

Carnitine Carries Fatty Acids Across Membranes 446

Summary of the Water-Soluble Vitamins and Use of

Supplements 446

Dietary Supplements Can Contain Many Substances 447

Chapter 11 Fat-Soluble Vitamins 451

Everybody Has a Story Living Successfully with Factor V

Leiden Thrombophilia 452

What Makes the Fat-Soluble Vitamins Unique? 453

Each Fat-Soluble Vitamin Has Several Names 454

Vitamin A and the Carotenoids—Needed for Eyesight

and Much More 454

Vitamin A and Provitamin A Carotenoids Are Found in

Diverse Plant and Animal Foods 455 • Absorption

of Vitamin A and the Carotenoids Requires Adequate

Lipids 456 • Vitamin A Is Critical for Vision, Growth, and

Reproduction 457 • Nonprovitamin A Carotenoids Are

Potent Antioxidants 460 • Vitamin A Deficiency Causes

Vitamin A Deficiency Disorder (VADD) 461 • Vitamin A

Toxicity Causes Hypervitaminosis A 462 • Recommended

Intakes for Vitamin A and the Carotenoids 462

Focus On Diet and Health Vitamin A and International

Child Health 463

Vitamin D—The “Sunshine Vitamin” 464

Vitamin D Is Found Naturally in Only a Few

Foods 464 • Vitamin D Is Also Made in the

Skin 464 • Dietary Vitamin D Absorption and

Vitamin D Activation 466 • Vitamin D Regulates

Calcium Homeostasis, Gene Expression, and Cell

Differentiation 466

Focus On Diet and Health Vitamin D—Needed for More

Than Just Healthy Bones 469

Vitamin D Deficiency May Be Relatively Common 469

Recommended Intakes and Vitamin D Toxicity 470

Vitamin E—Antioxidant That Protects Biological

Membranes 471

Vitamin E Is Abundant in Oils, Nuts, and Seeds 471 •

Vitamin E Is a Potent Antioxidant 472 • Vitamin E Deficiency

Causes Hemolytic Anemia 473 • Recommended Intakes for

Vitamin E 473

Vitamin K—Critical for Coagulation 474

Vitamin K Is Found Naturally in Dark Greens, Fish, and

Legumes 474 • Vitamin K Is Involved in Blood Clotting

Cascade 475 • Vitamin K Deficiency Can Cause

Severe Bleeding 476

Fat-Soluble Vitamins: Summary and Overall

Recommendations 476

Focus On Clinical Applications Nutrient–Drug Interactions

and Vitamin K 477

Food Matters Working Toward the Goal: Increasing Fat-

Soluble Vitamin Intake via Fruits and Vegetables 478

Nutrition Matters Nutrition and Cancer 479

How Does Cancer Develop? 479

Cancer Develops in a Multistep Manner 480

How Is Cancer Detected and Treated? 481

Routine Cancer Screening Is Recommended 481 • There

Are Many Treatment Options for Cancer 482 • Cancer and

Its Treatments Can Influence Nutritional Status 482

What Other Factors Are Related to Risk of Cancer? 483

Biological Factors Are Related to Cancer Risk 483 • Lifestyle

and Environmental Factors Impact Cancer Risk 485

Can Optimal Nutrition Help Prevent Cancer? 486

Recommendation #1: Maintain a Healthy Body

Weight 487 • Recommendation #2: Be Physically

Active 488 • Recommendation #3: Eat a Diet

Rich in Whole Grains, Vegetables, Fruit, and

Beans 489 • Recommendation #4: Limit Consumption

of “Fast Foods” and Other Processed Foods High in

Fat, Starches, or Sugars 490 • Recommendation #5:

Limit Intake of Red Meat and Processed

Meat 490 • Recommendation #6: Limit Consumption

of Sugar-Sweetened Drinks 491 • Recommendation #7:

Limit Alcohol 491 • Recommendation #8: Choose Foods

Over Supplements 491 • Special Recommendation #1:

Women Should Breastfeed Their Infants 491 • Special

Recommendation #2: Cancer Survivors Should Follow the

Same Recommendations 491

Diet and Cancer: What Is in the Future? 492

Chapter 12 The Major Minerals and Water 495

Everybody Has a Story Cicely’s Challenge with Bone

Health 496

What Are Minerals? 497

Common Characteristics of Major Minerals 498

Calcium—The Body’s Most Abundant Mineral 499

Dietary and Supplemental Sources of Calcium 499

Food Matters Working Toward the Goal: Increasing

Calcium and Potassium Intakes by Consuming Low-Fat

Dairy Foods 500

Calcium Homeostasis Is Complex 501 • Structional

Functions of Calcium 502 • Regulatory Functions of

Calcium 503

Focus On Food Dairy Consumption and Chronic Disease

Prevention 504

Calcium Deficiency Also Affects Nerve and Muscle

Function 504 • Calcium Toxicity Can Cause Kidney Stones

and Calcification of Soft Tissues 504 • Recommended

Intakes for Calcium 505

Phosphorus—A Component of Biological

Membranes 505

Phosphorus Is Abundant in Protein-Rich

Foods 505 • Regulation of Blood Phosphorus Levels

Is Similar to That of Calcium 506 • Additional Roles for

Phosphorus 506 • Phosphorus Deficiency Is Rare; Toxicity

Causes Mineralization of Soft Tissues 507

Magnesium—Needed for Building Bones and Stabilizing

Enzymes 507

Beans, Nuts, and Seeds Are Excellent Sources of

Magnesium 507 • Blood Levels of Magnesium

Are Regulated by the Small Intestine and

Kidneys 508 • Magnesium Is Important for Bones

and Stabilizes Anions 508 • Magnesium Deficiency

and Toxicity Are Rare 508 • Recommended Intakes for

Magnesium 508

Sodium and Chloride—Regulators of Fluid Balance 509

Sodium and Chloride Contents of Foods Are Readily

Available 509 • Sodium Absorption Is Enhanced

by Glucose 509 • Blood Sodium Levels Are

Carefully Regulated 511 • Sodium and Chloride

Are Important Ions 512 • Sodium and Chloride

Deficiencies Can Occur During Illness and Physical

Exertion 512 • Overconsumption of Sodium Increases

Blood Pressure in Some People 512 • Recommended

Intakes for Sodium and Chloride 513

Potassium—An Important Intracellular Cation 514

Potassium Is Found in a Variety of Fruits, Vegetables, Dairy

Products, and Meat 514 • Potassium Is the Body’s Major

Intracellular Cation 514 • Potassium Deficiency and

Toxicity 515

Water—The Essence of Life 516

Distribution of Water in the Body 516 • Fluid (Water)

Balance Is Shifted by Movement of Ions 517 • Water Is

Essential for Life 518

Focus On Clinical Applications Ions, Fluid Balance, and

Cystic Fibrosis 519

Water Insufficiency Causes Dehydration 520 •

Recommendations for Water Intake 522

Focus On Diet and Health Coffee, Caffeine, and

Health 523

How Are the Functions and Food Sources of the Major

Minerals Related? 525

Nutrition Matters Nutrition and Bone Health 526

Do Bones Continue to Develop and Grow Throughout

Life? 526

Bone Tissue is Complex and Living 526 • Bones Contain

Osteoblasts, Osteoclasts, and Osteocytes 527

What Causes Osteoporosis? 528

There Are Two Types of Osteoporosis 529 • Osteoporosis

Can Seriously Affect Health and Well-Being 530 •

Biological and Lifestyle Factors Increase Risk for

Osteoporosis 530

Are You at Risk? 532

For Most People, Screening Should Begin at Age

65–70 Years 532 • Osteoporosis Can Be Treated with

Medications 532 • Optimal Nutrition Is Critical for Bone

Health 533

Chapter 13 The Trace Minerals 537

Everybody Has a Story Living Life as an “Iron Man” 538

What Do the Trace Minerals Have in Common? 539

Regulation of Trace Minerals in The Body 539 • Trace

Minerals Act as Cofactors and Prosthetic Groups and Provide

Structure to Tissues 539

Iron—Transporter of Oxygen 540

Iron Is in Both Plant- and Animal-Derived

Foods 540 • Many Factors Influence Iron

Bioavailability 541 • Iron Absorption Is Tightly

Regulated 542 • Iron Is a Component of Heme

and Nonheme Proteins 544 • Iron Deficiency Causes

Anemia and Much More 546 • Iron Toxicity Can Be

Fatal 548 • Recommended Intakes for Iron 548

Focus On Clinical Applications Sustainable Solutions to a

Challenging Health Problem: Iron Deficiency Anemia 549

Copper—Cofactor in Redox Reactions 550

Organ Meats Are Excellent Sources of Copper 550

Food Matters Working Toward the Goal: Increasing Trace

Mineral Intake via Nuts and Seeds 561

Excess Copper Is Eliminated in Bile 561 • Copper

Is Involved in Reduction–Oxidation (Redox)

Reactions 551 • Copper Deficiency and Toxicity Are

Rare 552

Iodine (Iodide)—An Essential Component of the Thyroid

Hormones 552

Marine Foods Supply Iodine Naturally 552 • Goitrogens

Inhibit Iodine Utilization 553 • Iodine Is a Component of

Thyroid Hormones 553

Focus On the Process of Science Iodine Deficiency

and Iodination of Salt 554

Iodine Deficiency Causes Cretinism and Goiter

555 • Recommended Intakes for Iodine 555

Selenium—A Mineral with Antioxidant Functions 556

Nuts, Seafood, and Meats Are Rich in

Selenium 556 • Selenium Is Incorporated into

Selenoproteins 556 • Selenium Is an Important

Antioxidant 557 • Selenium Deficiency and Toxicity:

Keshan Disease and Selenosis 557

Chromium—Implicated in Glucose Homeostasis 557

Chromium Content of Foods Depends on Chromium

Content of Soil 557 • Chromium May Be Involved

in Glucose Homeostasis 558 • Chromium Deficiency

and Toxicity Are Rare 558 • Recommended Intakes for

Chromium 558

Manganese—Important for Gluconeogenesis and Bone

Formation 558

Plant Foods Are the Best Sources of

Manganese 559 • Severe Manganese Deficiency Causes

Weak Bones and Slow Growth 559

Molybdenum—Required in Exceedingly Small

Quantities 559

Legumes, Nuts, and Grains Provide

Molybdenum 559 • Molybdenum Deficiency Is Rare 559

Zinc—Involved in RNA Synthesis and Gene

Expression 560

Zinc Is Found in Shellfish, Organ Meats, and Dairy

Foods 560 • Zinc Absorption Is Regulated Similarly to

Iron 561 • Zinc Is Involved in RNA Synthesis and Gene

Expression 561 • Vegetarians May Need Additional Zinc 561

Fluoride—Nonessential Mineral That Strengthens Bones and Teeth 562

Many Communities Fluoridate Their Water 562 • Fluoride

Strengthens Bones and Teeth 562 • Fluoride Toxicity Results in Fluorosis 562

Are There Other Important Trace Minerals? 563

Integration of Functions and Food Sources 563

Chapter 14 Life Cycle Nutrition 567

Everybody Has a Story Learning how to feed an infant with a cleft palate 568

What Physiological Changes Take Place During the Human Life Cycle? 568

Growth and Development Take Place at Various Times

During the Life Cycle 568 • Nutrient Requirements Can

Change for Each Stage of the Life Cycle 571

What Are the Major Stages of Prenatal Development? 571

Prenatal Development Is Divided into Embryonic and

Fetal Periods 572 • Gestational Age Is Important to Assess 575

What Are the Recommendations for a Healthy Pregnancy? 577

Recommended Weight Gain Depends on BMI 577

Focus On the Process of Science Developmental Origins

of Health and Disease 578

Maternal Nutrient and Energy Requirements Change

During Pregnancy 579 • Maternal Smoking Is

Harmful to the Fetus 583 • Staying Healthy During

Pregnancy 584 • Pregnancy-Related Health Concerns 584

Food Matters Working Toward the Goal: Selecting Foods during Pregnancy 585

Why Is Breastfeeding Recommended During Infancy? 585

Lactation Is the Process of Milk Production 587 • Milk

Production Is a Matter of Supply and

Demand 589 • Human Milk Is Beneficial for Babies 589

Focus On Science feature The Human Milk Microbiome 590

Lactation Influences Maternal Energy and Nutrient

Requirements 591 • Breastfeeding Is Beneficial for Mothers 592

What Are the Nutritional Needs of Infants? 592

Infant Growth Is Assessed using Growth

Charts 592 • Developmental Stages Provide the Basis for

Recommended Infant Feeding Practices 593 • Nutrient

Supplementation Recommendations Are Based

on Whether the Infant Is Breastfed or Formula

Fed 597 • Complementary Foods Can Be Introduced

Around 6 Months of Age 598

What Are the Nutritional Needs of Toddlers and Young Children? 600

Growth and Development Influence Nutritional Needs of

Toddlers and Young Children 601 • Feeding Behaviors in Children 601

Focus On Diet and Health Children Who Are Overweight: A Growing Concern 603

Recommended Energy and Nutrient Intakes for Toddlers and

Young Children 604 • Dietary Guidelines for Toddlers and Young Children 606

How Do Nutritional Requirements Change During Adolescence? 606

Growth and Development during Adolescence 607 •

Nutritional Concerns and Recommendations during Adolescence 608

How Do Age-Related Changes in Adults Influence

Nutrient and Energy Requirements? 610

Adulthood Is Characterized by Physical

Maturity 610 • There Are Many Theories as to Why We

Age 611 • Nutritional Issues of Adults 612

Focus On Clinical Applications Antioxidants and Eye

Health in Older Adults 613

Assessing Nutritional Risk in Older Adults 617

Nutrition Matters Food Security, Hunger, and Malnutrition 619

What Is Food Security? 619

Prevalence of Food Insecurity in the United

States 620 • Poverty is the Underlying Factor Associated with Food Insecurity 621

What Are the Consequences of Food Insecurity? 623

Organizations that Provide Food-Based Assistance in the

United States 624 • Other Food Security Strategies 627

What Causes Worldwide Hunger and Malnutrition? 628

Many Factors Contribute to Global Food Insecurity 629

What Are the Long-Term Impacts of Food Insecurity on Global Health? 631

Consequences of Global Malnutrition 631

What Are Potential Solutions for Global Food Insecurity and Malnutrition? 633

Global Efforts Helping to Alleviate Food Insecurity and Malnutrition 633 • Taking Action Against Hunger can

Make a Difference 634

Appendices A-1

A Aids to Calculations A-2

B Estimated Energy Requirement (EER) Calculations and Physical Activity Values (PA) A-4

C Summary of the 2020–2025 Dietary Guidelines for Americans A-6

D Dietary Reference Intakes (DRIs) A-7

Commonly Used Weights, Measures, and Metric

Conversion Factors A-12

References R-1

Glossary G-1

Index I-1

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