Understanding Normal & Clinical Nutrition, Twelfth Edition
By Sharon Rady Rolfes, Kathryn Pinna and Ellie Whitney
Table of Contents:
Preface xvii
Acknowledgments xxii
Reviewers xxiii
Chapter 1
An Overview of Nutrition 2
1.1 Food Choices 3
1.2 The Nutrients 6
Nutrients in Foods and in the Body 6
The Energy-Yielding Nutrients: Carbohydrate, Fat, and Protein 7
The Vitamins 11
The Minerals 11
Water 11
1.3 The Science of Nutrition 12
Conducting Research 12
Analyzing Research Findings 15
Publishing Research 16
1.4 Dietary Reference Intakes 17
Establishing Nutrient Recommendations 17
Establishing Energy Recommendations 19
Using Nutrient Recommendations 20
Comparing Nutrient Recommendations 21
1.5 Nutrition Assessment 21
Nutrition Assessment of Individuals 22
Nutrition Assessment of Populations 23
1.6 Diet and Health 25
Chronic Diseases 25
Risk Factors for Chronic Diseases 25
Highlight 1 > Nutrition Information and Misinformation 28
Chapter 2
Planning a Healthy Diet 34
2.1 Principles and Guidelines 35
Diet-Planning Principles 35
Dietary Guidelines for Americans 38
2.2 Diet-Planning Guides 40
USDA Food Patterns 40
Food Lists 47
Putting the Plan into Action 47
From Guidelines to Groceries 49
2.3 Food Labels 53
The Ingredient List 54
Nutrition Facts Panel 54
Claims on Labels 57
Consumer Education 58
Highlight 2 > Vegetarian Diets 62
Chapter 3
Digestion, Absorption, and Transport 68
3.1 Digestion 69
Anatomy of the Digestive Tract 70
The Muscular Action of Digestion 72
The Secretions of Digestion 73
The Final Stage 74
3.2 Absorption 76
Anatomy of the Absorptive System 77
A Closer Look at the Intestinal Cells 77
3.3 The Circulatory Systems 79
The Vascular System 79
The Lymphatic System 81
3.4 The Health and Regulation of the GI Tract 82
Gastrointestinal Microbes 82
Gastrointestinal Hormones and Nerve Pathways 83
The System at Its Best 85
Highlight 3 > Common Digestive Problems 87
Chapter 4
The Carbohydrates: Sugars, Starches, and Fibers 94
4.1 The Chemist’s View of Carbohydrates 95
Monosaccharides 96
Disaccharides 97
Polysaccharides 98
4.2 Digestion and Absorption of Carbohydrates 101
Carbohydrate Digestion 101
Carbohydrate Absorption 103
Lactose Intolerance 103
4.3 Glucose in the Body 105
A Preview of Carbohydrate Metabolism 105
The Constancy of Blood Glucose 106
4.4 Health Effects and Recommended Intakes of Sugars 109
Health Effects of Sugars 110
Recommended Intakes of Sugars 113
Alternative Sweeteners 114
4.5 Health Effects and Recommended Intakes of Starch and Fibers 116
Health Effects of Starch and Fibers 116
Recommended Intakes of Starch and Fibers 118
From Guidelines to Groceries 120
Highlight 4 > Carbs, kCalories, and Controversies 124
Chapter 5
The Lipids: Triglycerides, Phospholipids,
and Sterols 128
5.1 The Chemist’s View of Fatty Acids and Triglycerides 129
Fatty Acids 130
Triglycerides 132
Characteristics of Solid Fats and Oils 133
5.2 The Chemist’s View of Phospholipids and Sterols 136
Phospholipids 136
Sterols 137
5.3 Digestion, Absorption, and Transport of Lipids 138
Lipid Digestion 138
Lipid Absorption 141
Lipid Transport 141
5.4 Lipids in the Body 144
Roles of Triglycerides 144
Essential Fatty Acids 145
A Preview of Lipid Metabolism 146
5.5 Health Effects and Recommended Intakes of Saturated Fats, Trans Fats, and Cholesterol 147
Health Effects of Saturated Fats, Trans Fats, and Cholesterol 147
Recommended Intakes of Saturated Fat, Trans Fat,
and Cholesterol 149
5.6 Health Effects and Recommended Intakes of
Monounsaturated and Polyunsaturated Fats 149
Health Effects of Monounsaturated and Polyunsaturated Fats 149
Recommended Intakes of Monounsaturated and
Polyunsaturated Fats 151
From Guidelines to Groceries 152
Highlight 5 > High-Fat Foods—Friend or Foe? 160
Chapter 6
Protein: Amino Acids 168
6.1 The Chemist’s View of Proteins 169
Amino Acids 169
Proteins 171
6.2 Digestion and Absorption of Proteins 172
Protein Digestion 172
Protein Absorption 174
6.3 Proteins in the Body 174
Protein Synthesis 174
Roles of Proteins 177
A Preview of Protein Metabolism 180
6.4 Protein in Foods 182
Protein Quality 183
Complementary Proteins 183
6.5 Health Effects and Recommended Intakes of Protein 184
Health Effects of Protein 184
Recommended Intakes of Protein 185
From Guidelines to Groceries 187
Read Food Labels 187
Protein and Amino Acid Supplements 187
Highlight 6 > Nutritional Genomics 190
Chapter 7
Energy Metabolism 196
7.1 Chemical Reactions in the Body 197
7.2 Breaking Down Nutrients for Energy 200
Glucose 202
Glycerol and Fatty Acids 206
Amino Acids 206
The Final Steps of Energy Metabolism 207
7.3 Feasting and Fasting 213
Feasting—Excess Energy 213
The Transition from Feasting to Fasting 214
Fasting—Inadequate Energy 214
Low-Carbohydrate Diets 217
Highlight 7 > Alcohol in the Body 219
Chapter 8
Energy Balance and Body Composition 230
8.1 Energy Balance 231
8.2 Energy In: The kCalories Foods Provide 232
Food Composition 232
Food Intake 233
8.3 Energy Out: The kCalories the Body Expends 235
Components of Energy Expenditure 236
Estimating Energy Requirements 239
8.4 Body Weight and Body Composition 240
Defining Healthy Body Weight 241
Body Fat and Its Distribution 243
8.5 Health Risks Associated with Body Weight and Body Fat 246
Health Risks of Underweight 247
Health Risks of Overweight and Obesity 247
Other Considerations 249
Highlight 8 > Eating Disorders 252
Chapter 9
Weight Management: Overweight, Obesity,
and Underweight 260
9.1 Overweight and Obesity 261
Fat Cell Development 262
Fat Cell Metabolism 262
Set-Point Theory 263
9.2 Causes of Overweight and Obesity 263
Genetics and Epigenetics 263
Environment 266
9.3 Problems of Overweight and Obesity 268
Health Risks 268
Perceptions and Prejudices 268
Dangerous Interventions 269
9.4 Aggressive Treatments for Obesity 270
Drugs 270
Surgery 270
Other Medical Procedures 272
9.5 Weight-Loss Strategies 272
Changes, Losses, and Goals 272
Eating Patterns 273
Physical Activity 276
Environmental Influences 279
Behavior and Attitude 280
Weight Maintenance 282
Prevention 283
Community Programs 283
9.6 Underweight 284
Problems of Underweight 284
Weight-Gain Strategies 284
Highlight 9 > The Latest and Greatest Weight-Loss
Diet—Again 289
Chapter 10
The Water-Soluble Vitamins: B Vitamins
and Vitamin C 292
10.1 The Vitamins—An Overview 293
10.2 The B Vitamins 296
Thiamin 297
Riboflavin 300
Niacin 301
Biotin 304
Pantothenic Acid 304
Vitamin B6 305
Folate 306
Vitamin B12 311
Choline 313
Nonvitamins 313
Interactions among the B Vitamins 313
10.3 Vitamin C 317
Vitamin C Roles 318
Vitamin C Recommendations 319
Vitamin C Deficiency 320
Vitamin C Toxicity 320
Vitamin C Food Sources 321
Highlight 10 > Vitamin and Mineral Supplements 325
Chapter 11
The Fat-Soluble Vitamins: A, D, E, and K 332
11.1 Vitamin A and Beta-Carotene 333
Roles in the Body 334
Vitamin A Deficiency 336
Vitamin A Toxicity 337
Vitamin A Recommendations 338
Vitamin A in Foods 338
11.2 Vitamin D 340
Roles in the Body 341
Vitamin D Deficiency 342
Vitamin D Toxicity 343
Vitamin D Recommendations and Sources 344
11.3 Vitamin E 346
Vitamin E as an Antioxidant 347
Vitamin E Deficiency 347
Vitamin E Toxicity 347
Vitamin E Recommendations 347
Vitamin E in Foods 348
11.4 Vitamin K 348
Roles in the Body 348
Vitamin K Deficiency 349
Vitamin K Toxicity 349
Vitamin K Recommendations and Sources 350
Highlight 11 > Antioxidant Nutrients in Disease Prevention 353
Chapter 12
Water and the Major Minerals 358
12.1 Water and the Body Fluids 359
Distribution and Movement of Body Fluids 360
Regulation of Fluid Balance 362
Fluid and Electrolyte Imbalance 363
Acid–Base Balance 364
Water Balance and Recommended Intakes 366
12.2 The Minerals— An Overview 369
12.3 The Major Minerals 370
Sodium 370
Chloride 373
Potassium 374
Calcium 375
Phosphorus 380
Magnesium 381
Sulfate 383
Highlight 12 > Osteoporosis and Calcium 386
Chapter 13
The Trace Minerals 392
13.1 The Trace Minerals—An Overview 393
13.2 The Trace Minerals 395
Iron 395
Zinc 404
Iodine 407
Selenium 409
Copper 410
Manganese 411
Fluoride 412
Chromium 413
Molybdenum 413
13.3 Contaminant Minerals 414
Highlight 13 > Phytochemicals and Functional Foods 417
Chapter 14
Life Cycle Nutrition: Pregnancy and Lactation 424
14.1 Nutrition prior to Pregnancy 425
14.2 Growth and Development during Pregnancy 426
Placental Development 426
Fetal Growth and Development 426
Critical Periods 428
14.3 Maternal Weight 431
Weight prior to Conception 431
Weight Gain during Pregnancy 432
Exercise during Pregnancy 434
14.4 Nutrition during Pregnancy 435
Energy and Nutrient Needs during Pregnancy 435
Common Nutrition-Related Concerns of Pregnancy 438
14.5 High-Risk Pregnancies 440
The Infant’s Birthweight 440
Malnutrition and Pregnancy 441
Food Assistance Programs 441
Maternal Health 442
The Mother’s Age 443
Practices Incompatible with Pregnancy 444
14.6 Nutrition during Lactation 447
Lactation: A Physiological Process 448
Breastfeeding: A Learned Behavior 448
Maternal Energy and Nutrient Needs during Lactation 449
Maternal Health 450
Practices Incompatible with Lactation 451
Highlight 14 > Fetal Alcohol Syndrome 455
Chapter 15
Life Cycle Nutrition: Infancy, Childhood,
and Adolescence 458
15.1 Nutrition during Infancy 459
Energy and Nutrient Needs 459
Breast Milk 461
Infant Formula 464
Special Needs of Preterm Infants 466
Introducing Cow’s Milk 466
Introducing First Foods 467
Mealtimes with Toddlers 470
15.2 Nutrition during Childhood 470
Energy and Nutrient Needs 471
Hunger and Malnutrition in Children 473
The Malnutrition-Lead Connection 475
Hyperactivity and “Hyper” Behavior 476
Food Allergy and Intolerance 477
Childhood Obesity 479
Mealtimes at Home 484
Nutrition at School 487
15.3 Nutrition during Adolescence 489
Growth and Development 489
Energy and Nutrient Needs 490
Food Choices and Health Habits 491
Highlight 15 > Childhood Obesity and the Early Development of Chronic Diseases 497
Chapter 16
Life Cycle Nutrition: Adulthood and the Later Years 502
16.1 Nutrition and Longevity 503
Observation of Older Adults 504
Manipulation of Diet 506
16.2 The Aging Process 508
Physiological Changes 508
Other Changes 510
16.3 Energy and Nutrient Needs of Older Adults 511
Water 512
Energy and Energy Nutrients 512
Vitamins and Minerals 513
Dietary Supplements 514
16.4 Nutrition-Related Concerns of Older Adults 515
Vision 515
Arthritis 516
The Aging Brain 516
Alcohol 519
16.5 Food Choices and Eating Habits of Older Adults 520
Malnutrition 521
Food Assistance Programs 521
Meals for Singles 522
Highlight 16 > Hunger and Community Nutrition 526
Chapter 17
Nutrition Care and Assessment 532
17.1 Nutrition in Health Care 533
Effects of Illness on Nutrition Status 533
Responsibility for Nutrition Care 533
Nutrition Screening 535
The Nutrition Care Process 536
17.2 Nutrition Assessment 539
Historical Information 539
Food Intake Data 540
Anthropometric Data 543
Biochemical Data 546
Physical Examination 548
Highlight 17 > Nutrition and Immunity 552
Chapter 18
Nutrition Intervention 558
18.1 Implementing Nutrition Care 559
Approaches to Nutrition Care 560
Documenting Nutrition Care 561
18.2 Energy Intakes in Hospital Patients 563
Indirect Calorimetry 563
Predictive Equations 563
18.3 Dietary Modifications 565
Modified Diets 565
Diet Progression 568
Alternative Feeding Routes 568
Nothing by Mouth (NPO) 569
18.4 Foodservice 570
Menu Planning 570
Food Selection 570
Food Safety 570
Improving Food Intake 570
Highlight 18 > Food Allergies 573
Chapter 19
Medications, Diet-Drug Interactions, and Herbal
Products 576
19.1 Medications in Disease Treatment 577
Medication Administration 578
Risks from Medications 578
Patients at High Risk of Adverse Effects 579
19.2 Diet-Drug Interactions 580
Drug Effects on Food Intake 580
Drug Effects on Nutrient Absorption 582
Dietary Effects on Drug Absorption 582
Drug Effects on Nutrient Metabolism 583
Dietary Effects on Drug Metabolism 583
Drug Effects on Nutrient Excretion 584
Dietary Effects on Drug Excretion 584
Diet-Drug Interactions and Toxicity 585
19.3 Herbal Products 586
Effectiveness and Safety of Herbal Products 586
Use of Herbal Products in Illness 588
Highlight 19 > Complementary and Alternative Medicine 591
Chapter 20
Enteral Nutrition Support 596
20.1 Oral Supplements 597
20.2 Tube Feedings in Medical Care 598
Candidates for Tube Feedings 598
Tube-Feeding Routes 598
20.3 Enteral Formulas 601
Types of Enteral Formulas 601
Formula Characteristics 602
Formula Selection 603
20.4 Administration of Tube Feedings 604
Safe Handling of Formula 605
Initiating and Advancing a Tube Feeding 606
Meeting Water Needs 608
Medication Delivery during Tube Feedings 609
Tube-Feeding Complications 610
Transition to Table Foods 611
Highlight 20 > Inborn Errors of Metabolism 615
Chapter 21
Parenteral Nutrition Support 620
21.1 Indications for Parenteral Nutrition 621
Peripheral Parenteral Nutrition 622
Total Parenteral Nutrition 622
21.2 Parenteral Solutions 624
Parenteral Nutrients 624
Solution Preparation 625
21.3 Administering Parenteral Nutrition 628
Insertion and Care of Intravenous Catheters 628
Administration of Parenteral Solutions 629
Discontinuing Parenteral Nutrition 629
Managing Metabolic Complications 630
21.4 Nutrition Support at Home 632
Candidates for Home Nutrition Support 632
Planning Home Nutrition Care 633
Quality-of-Life Issues 633
Highlight 21 > Ethical Issues in Nutrition Care 636
Chapter 22
Metabolic and Respiratory Stress 640
22.1 The Body’s Responses to Stress and Injury 641
Hormonal Responses to Stress 641
The Inflammatory Response 642
22.2 Nutrition Treatment of Acute Stress 644
Determining Nutritional Requirements 644
Approaches to Nutrition Care in Acute Stress 647
Patients with Burn Injuries 647
22.3 Respiratory Stress 649
Chronic Obstructive Pulmonary Disease 650
Respiratory Failure 652
Highlight 22 > Multiple Organ Dysfunction Syndrome 657
Chapter 23
Upper Gastrointestinal Disorders 660
23.1 Conditions Affecting the Esophagus 662
Dysphagia 662
Gastroesophageal Reflux Disease 665
23.2 Conditions Affecting the Stomach 667
Dyspepsia 668
Nausea and Vomiting 668
Gastroparesis 669
Gastritis 669
Peptic Ulcer Disease 669
23.3 Gastric Surgery 671
Gastrectomy 671
Bariatric Surgery 674
Highlight 23 > Oral Health and Chronic Illness 679
Chapter 24
Lower Gastrointestinal Disorders 682
24.1 Common Intestinal Problems 683
Constipation 683
Intestinal Gas 685
Diarrhea 686
24.2 Malabsorption 688
Fat Malabsorption 688
Bacterial Overgrowth 689
24.3 Conditions Affecting the Pancreas 691
Pancreatitis 691
Cystic Fibrosis 693
24.4 Conditions Affecting the Small Intestine 694
Celiac Disease 695
Inflammatory Bowel Diseases 696
Short Bowel Syndrome 699
24.5 Conditions Affecting the Large Intestine 702
Irritable Bowel Syndrome 702
Diverticular Disease of the Colon 703
Colostomies and Ileostomies 704
Highlight 24 > Probiotics and Intestinal Health 709
Chapter 25
Liver Disease and Gallstones 712
25.1 Fatty Liver and Hepatitis 714
Fatty Liver 714
Hepatitis 714
25.2 Cirrhosis 716
Consequences of Cirrhosis 717
Treatment of Cirrhosis 719
Nutrition Therapy for Cirrhosis 719
25.3 Liver Transplantation 723
25.4 Gallstone Disease 724
Types of Gallstones 724
Consequences of Gallstones 725
Risk Factors for Cholesterol Gallstones 725
Treatment of Gallstones 726
Highlight 25 > Anemia in Illness 730
Chapter 26
Diabetes Mellitus 734
26.1 Overview of Diabetes Mellitus 735
Symptoms of Diabetes Mellitus 735
Diagnosis of Diabetes Mellitus 736
Types of Diabetes Mellitus 737
Prevention of Type 2 Diabetes Mellitus 738
Acute Complications of Diabetes Mellitus 739
Chronic Complications of Diabetes Mellitus 741
26.2 Treatment of Diabetes Mellitus 742
Treatment Goals 743
Evaluating Diabetes Treatment 744
Nutrition Therapy: Dietary Recommendations 745
Nutrition Therapy: Meal-Planning Strategies 746
Insulin Therapy 747
Antidiabetic Drugs 752
Physical Exercise and Diabetes Management 753
Sick-Day Management 754
26.3 Diabetes Management in Pregnancy 755
Pregnancy in Type 1 or Type 2 Diabetes 755
Gestational Diabetes 755
Highlight 26 > The Metabolic Syndrome 759
Chapter 27
Cardiovascular Diseases 762
27.1 Atherosclerosis 763
Consequences of Atherosclerosis 764
Development of Atherosclerosis 764
Causes of Atherosclerosis 765
27.2 Coronary Heart Disease (CHD) 766
Symptoms of Coronary Heart Disease 767
Evaluating Risk for Coronary Heart Disease 767
Lifestyle Management to Reduce CHD Risk 768
Vitamin Supplementation and CHD Risk 772
Lifestyle Changes for Hypertriglyceridemia 774
Drug Therapies for CHD Prevention 775
Treatment of Heart Attack 775
27.3 Stroke 776
Stroke Prevention 777
Stroke Management 777
27.4 Hypertension 778
Factors That Influence Blood Pressure 778
Factors That Contribute to Hypertension 778
Treatment of Hypertension 780
27.5 Heart Failure 783
Consequences of Heart Failure 783
Medical Management of Heart Failure 783
Highlight 27 > Coping with Feeding Disabilities 788
Chapter 28
Kidney Diseases 792
28.1 Functions of the Kidneys 793
28.2 The Nephrotic Syndrome 794
Consequences of the Nephrotic Syndrome 795
Treatment of the Nephrotic Syndrome 795
28.3 Acute Kidney Injury 796
Causes of Acute Kidney Injury 796
Consequences of Acute Kidney Injury 798
Treatment of Acute Kidney Injury 798
28.4 Chronic Kidney Disease 800
Consequences of Chronic Kidney Disease 801
Treatment of Chronic Kidney Disease 802
Kidney Transplants 806
28.5 Kidney Stones 809
Formation of Kidney Stones 809
Consequences of Kidney Stones 810
Prevention and Treatment of Kidney Stones 810
Highlight 28 > Dialysis 815
Chapter 29
Cancer and HIV Infection 818
29.1 Cancer 819
How Cancer Develops 819
Nutrition and Cancer Risk 820
Consequences of Cancer 822
Treatments for Cancer 823
Nutrition Therapy for Cancer 826
29.2 HIV Infection 830
Prevention of HIV Infection 830
Consequences of HIV Infection 830
Treatments for HIV Infection 832
Nutrition Therapy for HIV Infection 834
Highlight 29 > Foodborne Illness 839
Appendix A
Cells, Hormones, and Nerves
Appendix B
Basic Chemistry Concepts
Appendi x C
Biochemical Structures and Pathways
Appendix D
Measures of Protein Quality
Appendix E
Nutrition Assessment: Supplemental Information
Appendix F
Estimated Energy Needs
Appendix G
Choose Your Foods: Food Lists for Diabetes and Weight
Management
Appendix H
Aids to Calculation
Appendix I
WHO Nutrition Recommendations
Appendix J
Healthy People 2020
Appendix K
Enteral Formulas
Glossary GL-0
Index IN-1
Inside Covers
Dietary Reference Intakes (DRI) A
Daily Values (DV) for Food Labels Y
Body Mass Index (BMI) Z