Nutritional Sciences: From Fundamentals to Food, Fourth Edition
By Michelle McGuire and Kathy A Beerman
Contents:
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? 211
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