▪ Connect Insight® generates easy-to-read reports on individual students, the class as a whole, and on specific assignments.
▪ The Connect Insight dashboard delivers data on performance, study behavior, and effort. Instructors can quickly identify students who struggle and focus on material that the class has yet to master.
▪ Connect automatically grades assignments and quizzes, providing easy-to-read reports on individual and class performance.
More students earn As and Bs when they use Connect.
Trusted Service and Support
▪ Connect integrates with your LMS to provide single sign-on and automatic syncing of grades. Integration with Blackboard®, D2L®, and Canvas also provides automatic syncing of the course calendar and assignment-level linking.
▪ Connect offers comprehensive service, support, and training throughout every phase of your implementation.
▪ If you’re looking for some guidance on how to use Connect, or want to learn tips and tricks from super users, you can find tutorials as you work. Our Digital Faculty Consultants and Student Ambassadors offer insight into how to achieve the results you want with Connect.
Connecting Instructors and Students to Additional Digital Resources
Saves students and instructors time while improving performance
McGraw-Hill Campus integrates all of your digital products from McGraw-Hill Education with your school’s Learning Management System for quick and easy access to best-in-class content and learning tools.
Dietary Analysis Tool
NutritionCalc Plus is a powerful dietary analysis tool featuring more than 30,000 foods from the ESHA Research nutrient database, which is comprised of data from the latest USDA Standard Reference database, manufacturer’s data, restaurant data, and data from literature sources. NutritionCalc Plus allows users to track food and activities, and then analyze their choices with a robust selection of intuitive reports. The interface was updated to accommodate ADA requirements and modern mobile experience native to today’s students. This tool is provided complimentary in Connect with Perspectives in Nutrition.
Presentation Tools allow you to customize your lectures
Enhanced Lecture Presentations Contain lecture outlines, art, photos, and tables. Fully customizable, adapted for ADA compliance, complete, and ready to use—these presentations will streamline your work and let you spend less time preparing for lecture!
Editable Art Fully editable (labels and leaders) line art from the text
Animations Over 50 animations bring key concepts to life, available for instructors and students.
Digital Lecture Capture
Tegrity® is a fully automated lecture capture solution used in traditional, hybrid, “flipped classes” and online courses to record lessons, lectures, and skills.
Connecting Students to Today’s Nutrition
Our Intended Audience
This textbook was developed for students pursuing nutrition and health science careers as well as those wanting a better understanding of how nutrition affects their lives. Because this course often attracts students from a broad range of majors, we have been careful to include examples and explanations that are relevant to them and to include sufficient scientific background to make the science accessible to them. The appendices help students who wish to learn more or need assistance with the science involved in human physiology, chemistry, and metabolism.
To better bridge the span of differing science backgrounds and to enhance student interest and achievement of course objectives, we organized the presentation of the material within chapters to flow seamlessly from concrete to abstract learning. In chapters focusing on nutrients, for example, concrete concepts, such as food sources of the nutrients and recommended intakes, are introduced early in the chapter to create a framework for more abstract concepts, such as functions, digestion, and absorption.
Accurate, Current Science That Engages Students
The eleventh edition continues the tradition of presenting scientific content that is reliable, accurate, and up-to-date. This edition incorporates coverage of recent nutrition research, as well as the recent updates to consumer guidelines and tools—Dietary Guidelines for Americans, MyPlate, Healthy People 2020, and the new Nutrition Facts panel. It also retains the in-depth coverage students need to fully understand and appreciate the role of nutrition in overall health and to build the scientific knowledge base needed to pursue health-related careers or simply live healthier lives. To enhance these strengths and promote greater comprehension, new research findings and peer-reviewed references are incorporated and artwork is enhanced to further complement the discussions. The presentation of complex concepts was scrutinized to increase clarity through the use of clear, streamlined, precise, and student-friendly language. Timely and intriguing examples, illustrative analogies, clinical insights, culinary perspectives, historical notes, future perspectives, and thoughtprovoking photos make the text enjoyable and interesting to students and instructors alike.
Allergies, including food allergies, involve responses of the immune system designed to eliminate foreign proteins (antigens). Food allergy responses occur when the body mistakenly reacts to a food as though it were a harmful invader. In some people, certain food components, typically proteins (called allergens), cause hypersensitivity reactions and trigger this response. These allergens stimulate white blood cells to produce antibodies (mostly, the immunoglobulin IgE) that bind to antigens and cause the symptoms associated with an allergic reaction.15
Fortunately, most allergic reactions are mild, such as a runny nose, sneezing, itching skin, hives, or digestive upset (indigestion, nausea, vomiting, diarrhea). For those who are severely allergic, exposure to the allergenic food may cause a generalized, life-threatening reaction involving all body systems (known as anaphylaxis or anaphylactic shock).
Anaphylaxis causes decreased blood pressure and respiratory distress so severe that the person cannot breathe—death will occur
without immediate medical help. In the U.S., allergic reactions result in 200,000 emergency room visits and 150 to 200 deaths per year.
The protein in any food can trigger an allergic reaction. However, 8 foods account for 90% of all food allergies: peanuts, tree nuts (e.g., walnuts and cashews), milk, eggs, fish, shellfish, soy, and wheat (Fig. 7-16). Other foods frequently identified as causing allergic reactions are meat and meat products, fruits, and cheese.
The only way to prevent allergic reactions is to avoid foods known to trigger reactions. Carefully reading food labels and asking questions when eating out are essential, perhaps life-saving, steps for those with food allergies.15 In addition, individuals preparing foods at home or in restaurants need to know their menu ingredients and take steps to ensure that foods that cause an allergic reaction in a person do not come in contact with the food to be served to that individual. Even trace amounts of an allergen can cause a reaction.
To prevent cross-contact, anything that will be used to prepare an allergen-free meal (e.g.,
Food Protein Allergies
Connecting with a Personal Focus
Applying Nutrition on a Personal Level
A key objective in nearly all introductory courses is for students to apply their new knowledge of nutrition to their own lives. Practical applications clearly linked to nutritional science concepts are woven throughout each chapter to help students apply their knowledge to improving and maintaining their own health and that of others for whom they are responsible, such as future patients or offspring.
• Take Action features in each chapter allow students to examine their own diets and health issues.
• Updated case studies showcase realistic scenarios and thoughtprovoking questions.
• New discussion of the Nutrition Facts panel outlines the innovative changes to this important consumer tool.
Applying Nutrition to Career and More
5.4 Functions of Carbohydrates in the Body
The EPA requires that the public be notified if water contamination is a danger to public health. For instance, nitrate con tamination from fertilizer runoff is particularly dangerous to infants because it prevents oxy gen from circulating in the body. As related earlier, Cryptosporidium can contaminate water supplies (it is not affected by nor mal chlorination procedures). Boiling tap water for a minimum of 1 minute is the best way to kill Cryptosporidium Alternatively, individuals can purchase a water filter that screens out this parasite. Even though the U.S. has one of the cleanest water supplies in the world, illnesses from contaminated drinking water do occur. The CDC monitors water-related outbreaks, which average about 30 per year.63 Water safety experts note that these data likely underestimate the true number of illnesses caused by contaminated water.
Digestible Carbohydrates
The digestible and indigestible carbohydrates in our diets have vital functions in our bodies.3,8 These diverse functions are critical to normal metabolism and overall health.
• Expert Perspectives from the Field features examine cutting-edge topics and demonstrate how emerging, and sometimes controversial, research results affect nutrition knowledge and practice.
• Clinical Perspectives highlight the role of nutrition in the prevention and treatment of disease. These topics will be especially interesting to students planning careers in dietetics or health-related fields.
Most of the digestible carbohydrates in our diets are broken down to glucose. As glucose, they provide a primary source of energy, spare protein from use as an energy source, and prevent ketosis.
Providing Energy
• Global Perspectives discuss concepts related to critical health and nutrition issues around the world. These timely features also aim to engage students with thought-provoking challenges.
Preventing Foodborne and Waterborne Illnesses Safe food and water supplies require a “farm-to-fork” approach. All those who grow our food, along with processors, distributors, and consumers, are responsible for food and water safety.64 Several government agencies regulate and coordinate these efforts, monitor food and water, conduct research, enforce wholesomeness and quality standards and laws, and educate consumers (Table 3-8). To do their part, consumers need to know how to handle food safely at home. In
• Historical Perspectives heighten awareness of critical discoveries and events that have affected our understanding of nutritional science.
plete the Take Action:
The main function of glucose is to act as a source of energy for body cells. In fact, red blood cells and cells of the central nervous system derive almost all their energy from glucose. Glucose also fuels muscle cells and other body cells, although many of these cells rely on fatty acids to meet energy needs, especially during rest and light activity. Recall that glucose provides 4 kcal of energy per gram.
• Perspective on the Future features address emerging trends affecting nutrition science and practice.
Sparing Protein from Use as an Energy Source
• Culinary Perspectives focus on interesting food trends and their impact on health.
The amino acids that make up dietary protein are used to build body tissues and to perform other vital functions only when carbohydrate intake provides enough glucose for energy
• Each major heading in the chapters is numbered and cross-referenced to the end-of-chapter summary and study questions to make it easy to locate and prioritize important concepts.
CHAPTER 3 The Food Supply 99
of their diets. In fact, on average, 13% of the sugars. Daily intake is about 335 kcal for men 360 kcal of added sugars per day. beverages to which sugar has been added during added sugar are soft drinks, cakes, cookies, Although sugars supply calories, they usually more nutritious foods. Children and adolescents sugar and empty calories. Dietary surveys indian excess of sugar-sweetened beverages and both of which are essential for bone health. compromise bone development and health. risk of weight gain and obesity. Recent evsugars, particularly sugar-sweetened beverages, adults. The “supersizing” trend noted in food concern. For example, in the 1950s, a typical a 20-ounce bottle is a typical serving. This sugar to the diet. Drinking 1 bottle per day for to 18-pound (7.75 to 8.25 kg) weight gain. also supplies extra energy, which promotes more low fat and fat-free snack products, these added sugar in order to produce a dessert with product often is a high calorie food that equals or fat food product it was designed to replace. (especially fructose) have been associated with condisease—namely, increased blood levels of levels of HDL-cholesterol. Studies also increased consumption of sugar-sweetened bev2 diabetes and Metabolic Syndrome.25 To conclude that increased sugar intake is a risk Metabolic Syndrome. However, it is a good suggested in MyPlate (see Chapter 2).
Discovering the molecular layout of biologically important molecules is critical to understanding their function and treating disease. The biochemist and crystallographer Dorothy Crowfoot Hodgkin developed new X-ray techniques that permitted her to determine the structure of over 100 molecules, including insulin, vitamin B-12, vitamin D, and penicillin. Her work with insulin improved treatment of diabetes. Knowing the structure of vitamin B-12 advanced our knowledge of its role in blood health. Learn more about this Nobel Prize winner at www.nobelprize.org/nobel_prizes/ chemistry/laureates/1964/hodgkin-bio.html
Perspective on the Future
hands, workspace, pans, utensils, plates) should be washed thoroughly before preparing the allergen-free meal. Unlike foodborne illness pathogens, such as bacteria and viruses, cooking an allergenic food often does not render its allergens harmless.16
The prevalence of food allergies has increased in the last 20 years.15,16 Although difficult to estimate, it appears that approximately 5 to 8% of children and 2 to 4% of adults have food allergies.15,16 It is unclear why some people develop allergies and what steps might help decrease the risk of developing food allergies. Most research indicates that maternal dietary restrictions do not play a significant role in preventing food allergies in their children.15 After the child is born, the following steps may help prevent food allergies.9 These guidelines are especially important for families with a history of any type of allergy.
The common wisdom that eating 3500 kcal less than you need will result in the loss of 1 pound has come under great scrutiny. Weight loss research models based on thermodynamics, mathematics, physics, and chemistry indicate many more than 3500 calories may be stored in a pound of body fat. Researchers are working to build and validate more accurate weight loss prediction models.57 Learn more at www.pbrc.edu/research-and-faculty/ calculators/weight-loss-predictor
thinned peanut butter, eggs, milk). If an allergy is diagnosed, children must avoid the problematic foods. For children not at high risk for food allergies, when they are able to tolerate some solid foods (between 4 and 6 months of age), introducing small amounts of potentially allergenic foods may help prevent allergies.17
Many young children with food allergies outgrow them.15,18 Thus, parents should not assume that the allergy will be long-lasting. Allergies to certain foods (e.g., milk, egg, soy, wheat) are more likely to be outgrown than are allergies to other foods (e.g., peanuts, tree nuts, fish, and shellfish).15 Those with allergies may be tested by physicians periodically to determine whether they have outgrown the allergy. If
Perspective from the Field
Spot-reducing by using diet and physical activity is not possible. “Problem” local fat deposits can be reduced in size, however, using lipectomy (surgical removal of fat). This procedure carries some risks and is
Would like to manage weight and healthy food choices in college
Enjoy eating ethnic foods and making them a part of a normal diet
Enjoy eating more vegetables and whole grains compared to animal
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Foodborne illness often means a few hours or even a few days of discomfort and then the illness resolves on its own. In some cases, though, foodborne illness causes more serious medical problems, which can have lifelong effects. High-risk populations—infants and young children, the elderly, pregnant women and their fetuses, and those with impaired immune systems—have the greatest risk of serious complications like these:
These diets teach students how to make better food choices for health and weight management.
These plans and diets help focus on international foods and eating patterns.
These diets encourage consumers to consume more fruits, vegetables, and whole grains to help with weight loss and
How Big Is Your Foo Print? Growing evidence indicates that what we eat may affect not only
take 10,000 steps/day—typically, we take half that many or less.
Food allergies and food intolerances are not the same. Food allergies cause an immune response as a result of exposure to certain food components, typically proteins. In contrast, food intolerances (see Chapter 4) are caused by an individual’s inability to digest certain food components, usually due to low amounts of specific enzymes. Generally, larger amounts of an offending food are required to produce the symptoms of food intolerance than to trigger allergic symptoms. Food allergies tend to be far more life threatening than food intolerances.
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The American Academy of Allergy and Immunology has a toll-free number (800822-2762) to answer questions about food allergies and help direct people to specialists who treat allergy problems. Free information on food allergies is available by contacting Food Allergy Research & Education at www .foodallergy.org
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Better Digestion by The American Dietetic Association, Leslie Bonci, RD
∙ The College Student’s Guide to Eating Well on Campus by Ann Litt, MS, RD
∙Mediterranean Diet & Pyramid
∙Latino Diet & Pyramid
∙African Diet & Pyramid
∙Asian Diet & Pyramid All at www.oldwayspt.org/
• Hemolytic uremic syndrome (HUS). Most cases of HUS are caused by the toxin produced by Escherichia coli 0157:H7. The toxin attacks red blood cells, causing them to break apart (called hemolysis), and the kidneys, causing waste products to build up (called uremia). Early symptoms of HUS include bloody diarrhea, vomiting, sleepiness, and low urine output. In the worst cases, the toxin damages multiple organs,
Listeriosis Listeria monocytogenes bacteria cause listeriosis, a rare but serious disease. Listeriosis begins with muscle aches, fever, and nausea. It can spread to the nervous system, causing severe headache, stiff neck, loss of balance, and confusion. Pregnant women and their fetuses are particularly vulnerable—listeriosis can cause miscarriage, premature delivery, infection in the fetus, and fetal death. During pregnancy, women are 20 times more likely to develop the disease. The elderly also are susceptible. A 2008 outbreak in Canada from contaminated deli meats resulted in 29 deaths; almost all of them were elderly individuals. About 1 in 5 persons with listeriosis will die from the infection.
∙ Volumetrics Weight-Control Plan by Barbara Rolls, PhD, RD
∙ The Whole Grain Diet Miracle by Lisa Hark, PhD, RD
• Guillain-Barré syndrome (GBS). Campylobacter jejuni is a cause of this rare nervous system disorder. In GBS, peripheral nerves (those that connect the spinal cord and brain to the rest of the body) are
months, and about 30% of those with GBS do not fully recover, experiencing lifelong pain, weakness, and/or paralysis. Reactive arthritis. Foodborne illness caused by Salmonella, Shigella, Campylobacter, and others can cause reactive arthritis. This condition usually develops 2 to 6 weeks after the initial infection and causes inflammation throughout the body, but especially in the joints and eyes. Pain and swelling of the knees, ankles, and feet are common. Inflammation of the urinary tract and blistering of the palms of the hands and soles of the feet also are common. Genetic factors play an important role in determining who develops the disease. Most people with reactive arthritis require medical treatment and will recover after 2 to 6 months, but about 20% experience mild arthritis for a much longer time.
can be continued throughout life. There example, walking vigorously 3 miles tivities of lighter intensity are less likely
tooth decay.
CHAPTER 10 Energy Balance, Weight Control, and
Making Visual Connections
12-3 Food sources of vitamin A.
to MyPlate food groups, used for oils and pink is used for that do not fit easily into food
(e.g., candy, salty snacks).
Publishing /Alamy RF
ChooseMyPlate.gov, U.S. Department of
Adult women RDA = 700
Dynamic, Accurate Artwork
Margarine, 2 tbsp
Beef liver, 3 oz
More than 1000 drawings, photographs, and tables in the text were critically analyzed to identify how each could be enhanced and refined to help students more easily master complex scientific concepts.
Cheddar cheese, 3 oz
Fat-free milk, 1 cup
2.4
Water (70 to 90% of total) Alcohol (80% of total) Bile
• Many illustrations were updated or replaced to inspire student inquiry and comprehension and to promote interest and retention of information.
Sweet potato, 1⁄2 cup
Carrots, 1⁄2 cup
Kale, 1⁄2 cup
Broccoli, 1⁄2 cup
Spinach, 1⁄2 cup
Romaine lettuce, 1⁄2 cup
Vitamin K and biotin (synthesized by microorganisms in the large intestine) Gases Water (10 to 30% of total)
• Many illustrations were redesigned to use brighter colors and a more attractive, contemporary style. Others were fine-tuned to make them clearer and easier to follow. Navigational aids show where a function occurs and put it in perspective of the whole body.
• Coordinated color schemes and drawing styles keep presentations consistent and strengthen the educational value of the artwork. Color-coding and directional arrows in figures make it easier to follow events and reinforce interrelationships.
Acorn squash, 1⁄2 cup
Apricot, 1⁄2 cup
Mango, 1⁄2 cup
Figure 4-17 Nutrient absorption relies on 4 major absorptive processes. 1 Passive diffusion (in green) is diffusion of nutrients across the absorptive cell membranes.
Peach, 1⁄2 cup
Dietary Guidelines for Americans 2015–2020
and several proteases (to digest protein). Pancreatic en zymes break large macronutrient molecules into smaller subunits.
2 Facilitated diffusion (in blue) uses a carrier protein to move nutrients down a concentration gradient. 3 Active absorption (in red) involves a carrier protein as well as energy to move nutrients (against a concentration gradient) into absorptive cells.
Gastrointestinal Hormones: A Key to Orchestrating Digestion
4 Phagocytosis and pinocytosis (in gray and orange) are forms of active transport in which the absorptive cell membrane forms an invagination that engulfs a nutrient to bring it into the cell.
The diets of many people in the U.S. and Canada are too high in calories, fat, saturated fat, trans fat, cholesterol, sugar, salt, and alcohol.17 Many consume insufficient amounts of whole grains, fruits, and vegetables. These dietary patterns put many of us at risk of major chronic “killer” diseases, such as cardiovascular disease and cancer. In response to concerns about the prevalence of these killer disease patterns, every 5 years since 1980, the U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services (DHHS) have published the Dietary Guidelines for Americans (Dietary Guidelines, for short).
The Dietary Guidelines are the foundation of the U.S. government’s nutrition policy and education. They reflect what scientific experts believe is the most accurate and up-to-date scientific knowledge about nutritious diets, physical activity, and related healthy lifestyle choices.
The Dietary Guidelines are designed to meet nutrient needs while reducing the risk of obesity, hypertension, cardiovascular disease, type 2 diabetes, osteoporosis, alcoholism, and foodborne illness. The Dietary Guidelines also guide government nutrition programs, research, food labeling, and nutrition education and promotion. For example, the Dietary Guidelines provide
RE was based on the assumption that carotenoids made a greater contribution to vitamin A needs than is now known to be the case. Nutrient databases may contain this older RE standard because it will take some time to update these resources.
The remarkable work of the digestive system requires the careful regulation and coordination of several processes, including the production and release of hormones throughout the length of the GI tract. Five hormones, part of the endocrine system, play key roles in this regulation: gastrin, secretin, cholecystokinin (CCK), somatostatin, insulinotropic peptide (Table 4-4). To illustrate their functions, let’s follow a turkey sandwich through the digestive system:
and dietary supplements may be useful sources of 1 or more nutrients that otherwise might be consumed in less than recommended amounts. These practices are especially important for people whose typical food choices lead to a diet that cannot meet nutrient recommendations such as for calcium. However, dietary supplements are not a substitute for a healthful diet.
Figure 4-15 The common bile duct from the liver and gallbladder and the pancreatic duct join together at the hepatopancreatic sphincter to deliver bile, pancreatic enzymes, and bicarbonate to
The Dietary Guidelines for Americans 2015–2020 have 5 key recommendations intended to help people age 2 and older, as well as special population groups (e.g., older adults), achieve healthy eating patterns. The key recommendations have interconnected relationships; thus, all need to be implemented to achieve the best health.
To compare the older RE or IU standards with current RAE recommendations, assume that, for any preformed vitamin A in a food or added to food, 1 RE (3.3 IU) = 1 RAE. There is no easy way to convert RE or IU units to RAE units for foods that naturally contain provitamin A carotenoids. A general rule of thumb is to divide the older values for foods containing carotenoids by 2, and then do the conversion from RE to IU to RAE, as shown in Table 12-1. There also is no easy way to do this calculation for food containing a mixture of preformed vitamin A and carotenoids. Generally speaking, these foods contain less vitamin A than the RE or IU values suggest.
Individuals should aim to meet their
Vitamin A Needs
1. As you eat a turkey sandwich (or even just think about it), gastrin is produced by cells in the stomach. Gastrin signals other stomach cells to release HCl and pepsinogen (for protein digestion). After thorough mixing, the turkey sandwich, now liquid chyme, is released in small amounts into the small intestine.
As chyme is gradually released from the stomach into the small intestine, gastrin production slows and the small intestine secretes secretin and CCK. Both hormones trigger the release of enzyme- and bicarbonate-containing pancreatic juices that digest carbohydrate, fat, and protein and reduce the acidity of the intestinal contents. Fat in the small intestine (from the mayonnaise and the turkey) further stimulates the secretion of CCK by the small intestine. CCK promotes contraction of the gallbladder, which releases the stored bile that aids fat digestion. Relaxation of the hepatopancreatic sphincter allows bile and pancreatic juices to flow into the small intestine. CCK also slows GI motility to give digestive enzymes from the small intestine and pancreas
The RDA for vitamin A is 900 μg Retinol Activity Equivalents (RAE) per day for adult men and 700 μg RAE per day for adult women.2 At this intake, adequate body stores of vitamin A are maintained in healthy adults. The Daily Value used on food packages and supplements is 900 μg. At present, there is no DRI for beta-carotene or any of the other provitamin A carotenoids.1 The average intakes of adult men and women in North America currently meet DRI guidelines for vitamin A. Thus, vitamin A is no longer a mandatory nutrient to include on food and supplement labels.
Elise is a 20-year-old college sophomore. Over the last few months, she has been experiencing regular bouts of esophageal burning, pain, and a sour taste in the back of her mouth. This usually happens after a large lunch or dinner. Elise often takes an over-the-counter antacid to relieve these unpleasant symptoms. However, the symptoms have worsened and Elise has decided to visit the university health center. The nurse practitioner at the center tells Elise it is good she came in for a checkup because she suspects Elise is experiencing heartburn and acid indigestion, but she might also be experiencing gastroesophageal reflux disease (GERD). What types of lifestyle and dietary changes may help reduce or prevent heartburn and GERD? What types of medications are especially helpful in treating this problem?
• In many figures, process descriptions appear in the body of the figure. This pairing of the action and an explanation walks students step-by-step through the process and increases the teaching effectiveness of these figures.
• Intriguing chapter opening photos pique students’ curiosity by featuring seemingly unrelated topics that draw connections between the photo and nutrition.
4
• Finally, a careful comparison of artwork with its corresponding text was done to ensure that they are completely coordinated and consistent. The final result is a striking visual program that holds readers’ attention and supports the goals of clarity, ease of comprehension, and critical thinking. The attractive layout and design of this edition are clean, bright, and inviting. This creative presentation of the material is geared toward engaging today’s visually oriented students.
Illustrative Chapter Summary
The visual chapter summary continues to reinforce key concepts and promote student engagement and comprehension.
4.2
Sphincters along the GI tract control the flow of its contents. The accessory organs (liver, gallbladder, and pancreas) are an important part of the digestive system. Movement through the GI tract is mainly through muscular contractions known as peristalsis. GI contents are mixed with segmental contractions. Enzymes are specialized protein molecules that speed up digestion by catalyzing chemical reactions. Most digestive enzymes are synthesized in the small intestine and pancreas. A lack of digestive enzymes can result in poor digestion, poor absorption, malnutrition, and weight loss.
4.3 Chewing food breaks it into small pieces and increases its surface area, which enhances enzyme activity. Amylase produced by salivary glands digests a small amount of starch. Chewed food mixed with saliva is called a bolus. When swallowing is initiated, the epiglottis covers the trachea to prevent food from entering it. Peristalsis moves food down the esophagus. There are 5 basic taste sensations perceived by taste cells on taste buds in the mouth, especially the tongue. Genetic variability affects the ability to taste bitter compounds. The sense of smell contributes greatly to flavor perceptions.
4.4 The lower esophageal sphincter protects the esophagus from the backflow of acidic stomach contents. When this sphincter does not work normally, heartburn and GERD may occur. Stomach cells produce gastric juice (HCl, pepsinogen, mucus, and intrinsic factor). The hormone ghrelin triggers hunger and eating. Pepsin (from pepsinogen) starts the digestion of protein. Mixing of food and gastric juice results in the production of chyme, the liquid substance released in small amounts into the small intestine.
4.5 The small intestine has 3 sections: duodenum, jejunum, and ileum. Most digestion occurs in the small intestine.
Connecting with the Latest Updates
Global Updates and Changes
΅ The entire eleventh edition has been updated, refined, and streamlined to enhance learning.
΅ Complete Nutrition Facts panel updated to include latest regulations
΅ Incorporation of new Daily Values in charts demonstrating nutrient content
΅ New Culinary Perspective feature throughout the eleventh edition
΅ All Dietary Reference Intakes (RDA, AI, UL, EAR, and AMDR) grouped into 1 appendix for quick and easy access
Chapter 1, The Science of Nutrition
΅ Updated statistics on leading causes of death
΅ Fresh, new photos for visual engagement
΅ Section introducing how to navigate scientific journal articles to enhance student self-confidence in using these materials
΅ New FDA guidance to the dietary supplement industry introduced
Chapter 2, Tools of a Healthy Diet
΅ Complete Nutrition Facts panel updated to include latest regulations
΅ Application of Dietary Reference Intakes (DRIs) to federal nutrition programs incorporated
΅ Extensive revision of Table 2-2 to include the newly released Daily Value (DV) updates
΅ All images of the Nutrition Facts panel replaced to show the new format
΅ Updated coverage of the new restaurant menu labeling regulations
΅ Figure summarizing the Dietary Guidelines for Americans (Figure 2-6) refined to facilitate reading ease and comprehension.
΅ Incorporated most recent updates to MyPlate that were made based on the Dietary Guidelines for Americans 2015–2020
΅ Added latest guidance on added sugar maximums (Table 2-6)
Chapter 3, The Food Supply
΅ Updated domestic and international food insecurity statistics highlighting the worldwide burden of malnutrition and hunger
΅ Enhanced discussion on food deserts
΅ Addition of the effects of the Syrian civil war on food insecurity
΅ New discussion of the impact of food waste on global food insecurity
΅ Expanded discussion of the nutritional benefits of foods grown using conventional vs. organic farming practices
΅ Extensive revision of discussion of biotechnology, genetically modified foods and animals, production methods (such as gene editing), regulations, and safety
΅ New example of how intentional food additives are used in typically consumed foods
΅ Enhanced discussion of safety concerns associated with incidental additives, such as arsenic, pesticide residues, and BPA
΅ Latest CDC foodborne illness statistics included
΅ Updates to foodborne illness food sources, symptoms, and transmission incorporated into key chapter tables (Tables 3-4, 3-5, 3-6, and 3-7)
΅ Fully updated discussion of prions
΅ Discussion of water contamination in Flint, Michigan, added
΅ Overhauled discussion of lead poisoning
΅ New section on arsenic in the food supply and the contributions of rice
΅ Extensive revision of discussion of polychlorinated biphenyls (PCBs) in the food supply
΅ New table (Table 3-9) summarizing guidelines to help children and pregnant and breastfeeding women limit mercury in the diet
΅ New Expert Perspective from the Field on sustainability in university food service
Chapter 4, Human Digestion and Absorption
΅ Enhanced discussion on taste perception, super tasters, and PROP
΅ Added explanation of the functions of the stomach during digestion and incorporated it into Table 4-4 as a regulatory hormone of the GI tract
΅ Incorporated role of ghrelin in regulation of food intake
΅ Update of the Global Perspective to include latest global data on child death from diarrhea
΅ Extensive revision of gut microbiota section to incorporate the latest discoveries in this rapidly changing area of scientific study
΅ Discussion of probiotics and prebiotics expanded
΅ New Culinary Perspective featuring fermented foods
΅ Low FODMAP diet introduced
΅ New section on nonalcoholic fatty liver disease exploring this increasingly common disorder
Chapter 5, Carbohydrates
΅ New photo of stevia added
΅ Take Action revised to increase student engagement
΅ Statistics on carbohydrate and sugar consumption revised
΅ Figures updated to show the newest Nutrition Facts panels
΅ Role of whole grains in reducing obesity risk, enhancing blood glucose control, and reducing cholesterol absorption added
΅ Extensive revision of Figure 5-17 to enhance student understanding of blood glucose regulation
Chapter 6, Lipids
΅ Triglyceride section headers refined to increase clarity
΅ Enhanced labeling of type and health effects of fatty acids (Table 6-1)
΅ Refined figure of adipose cell importing triglycerides
΅ Streamlined discussion body fat’s role in insulating the body
΅ Updated saturated fat intakes to Institute of Medicine recommendations
΅ Discussion of saturated fat intake revised to reflect recent research findings and expert guidance
΅ Figure 6-17 caption refined to promoting increased comprehension of differences in lipoprotein structure and composition
Chapter 7, Proteins
΅ New discussion on pulses as a key component of vegetarian diets and as sustainable crops
΅ Enhanced image of normal and sickle red blood cells
΅ New Knowledge Check items for sources of protein
΅ Refined fluid balance depiction (Figure 7-14) to enhance clarity
΅ Latest statistics on protein-energy malnutrition incorporated
΅ Revised food allergy prevention discussion to reflect the latest guidance
΅ Updated Global Perspective to reflect most current population projections
Chapter 8, Alcohol
΅ Alcohol standard sizes updated to use alcoholic drink equivalents
΅ Addition of equation demonstrating calculation of alcohol drink equivalents
΅ Terminology updated to use DSM-5 recommendations of “alcohol use disorder”
΅ Alcohol consumption trends and statistics updated
΅ New Culinary Perspective explores cooking with alcohol and alcohol burn-off and retention by food preparation method
΅ Newly available powdered alcohol described
΅ New section on college and underage drinking included
΅ Extensive revision of table on the impact of harmful and underage college drinking (Table 8-4)
΅ Dangers of combining alcohol and caffeine added
΅ Updated cirrhosis section to reflect newest research
΅ New table summarizing DSM-5 diagnostic criteria for an alcohol use disorder added
΅ Enhanced discussion of ethnicity and alcohol abuse
΅ New section on economic costs of alcohol abuse included
΅ Streamlined Clinical Perspective to focus on treatment of alcohol use disorders
΅ Improved labeling of figure showing carnitine shuttling fatty acids into mitochondria (Figure 9-12)
΅ New figure illustrating the J-shaped relation between alcohol intake and health risks
΅ Statistics on fetal alcohol spectrum disorders updated
Chapter 9, Energy Metabolism
΅ Improved clarity of image explaining ATP structure (Figure 9-3)
΅ Refined image depicting ATP storing and yielding energy (Figure 9-4)
΅ Revised Knowledge Check items to promote learning
΅ Refined visual summary of the liver’s role in metabolism (Figure 9-21)
Chapter 10, Energy Balance, Weight Control, and Eating Disorders
΅ Most up-to-date map of obesity rates in the U.S.
΅ Latest statistics on high fructose corn syrup consumption added
΅ Addition of sleep deprivation as a factor influencing hunger feelings
΅ Newest fad diets incorporated into Table 10-7
΅ New headings added to guide study of eating behavior regulation
΅ Newest statistics on prevalence and susceptibility of disordered eating
΅ Eating disorders section enhanced to describe types of anorexia nervosa
΅ Section on binge eating disorder added
΅ Other Specified Feeding and Eating Disorders updated and expanded to reflect latest diagnostic criteria (DSM-5)
Chapter 11, Nutrition, Exercise, and Sports
΅ Section added on Relative Energy Deficiency in Sport (REDS)
΅ Updated procedures for cooling the body when heat exhaustion occurs
΅ Latest recommendations for use of sports drinks incorporated
Chapter 12, The Fat-Soluble Vitamins
΅ Updated food sources of vitamin A (Figure 12-3) to reflect latest Daily Values
΅ Nutrition Facts labeling changes for vitamin A incorporated
΅ Links noted between beta-carotene and alpha-carotene’s role in breast cancer risk reduction from the European Prospective Investigation into Cancer (EPIC) and Nurses’ Health Study discussed
΅ Expanded discussion on possible links between betacarotene, lycopene, and lutein and cardiovascular disease risk reduction
΅ New data on vitamin A deficiency in Global Perspective
΅ Newest Daily Values incorporated into food sources of vitamin D (Figure 12-11)
΅ Streamlined discussion of vitamin D needs, toxicity, and concerns
΅ Latest Daily Values for vitamin E included in food sources (Figure 12-16)
΅ Discussion of latest vitamin E research related to cancer added
΅ Vitamin K food sources revised to reflect newest Daily Values (Figure 12-20)
΅ Case Study updated to reflect newly released Daily Values
Chapter 13, The Water-Soluble Vitamins
΅ Water-soluble vitamin intakes, prominent food sources, and the prevalence of inadequate intake statistics updated
΅ Updated food sources of selenium to include newest Daily Value (Figure 15-17)
΅ Latest fluoridated water statistics for the U.S. added (Figure 15-20)
΅ Enhanced Take Action focusing on fluoridation
΅ Refined Clinical Perspective on nutrients, diet, and cancer to reflect newest research and recommendations
΅ Latest statistics on cancer deaths incorporated (Figure 15-21)
Chapter 16, Nutritional Aspects of Pregnancy and Breastfeeding
΅ Expert Perspective from the Field updated to include fortification of masa corn meal
΅ Updated pregnancy and malnutrition statistics
΅ Smoking during pregnancy and breastfeeding expanded to include nicotine from cigarettes, electronic cigarettes, and patches
΅ Dietary intake of breastfeeding women with regard to potential allergens updated
΅ Added advice from the CDC for breastfeeding by women with HIV
Chapter 17, Nutrition during the Growing Years
΅ Updated guidance on cholesterol screening for children
΅ New section on potassium needs during the growing years
΅ New breastfeeding statistics added
΅ Updated table describing advantages to infants provided by human milk (Table 17-2)
΅ Expanded discussion of physical abilities indicating infants’ readiness for solid foods
΅ Complete overhaul of Figure 17-5 describing the latest infant feeding guidelines from the American Academy of Pediatrics
΅ American Academy of Pediatrics whole diet approach and children’s diet incorporated
΅ Added American Academy of Pediatrics guidelines for parents of toddlers
΅ New school wellness policy legislation reviewed
΅ Hyperactivity section updated
Chapter 18, Nutrition during the Adult Years
΅ Updated statistics and figure (Figure 18-1) summarizing life expectancy
΅ Table summarizing current hypotheses about the causes of aging (Table 18-1) updated and enhanced
΅ Potassium as a nutrient of concern for adults added
΅ Role of increased protein intake as potential strategy for reducing risk of sarcopenia introduced
΅ Current chronic disease prevalence rates incorporated
΅ Revised Clinical Perspective to reflect newest categorization of complementary and alternative health approaches
΅ Streamlined table summarizing popular herbal remedies (Table 18-6)
Acknowledgments
We offer a hearty and profound thank you to the many individuals who have supported and guided us along the way.
To our loved ones: Without your patience, understanding, assistance, and encouragement, this work would not have been possible.
To our wonderful students—past, present, and future: The lessons you have taught us over the years have enlightened us and sustained our desire to provide newer, better opportunities to help you successfully launch your careers and promote healthful lifelong living. Thank you in particular to the students who have used SmartBook®, as your feedback was instrumental in the revisions for this edition.
To our amazing team at McGraw-Hill Education: Senior Portfolio Manager Marija Magner and Senior Product Developer Michelle Flomenhoft—we thank you most of all for your confidence in us! We deeply appreciate your endless encouragement and patience as you expertly shepherded us along the way. A special thanks to Vice President, Portfolio and Learning Content Mike Ryan, Managing Director Thomas Timp, Marketing Manager Valerie Kramer and the entire marketing team. Sincere thanks to Content Project Managers Sandy Wille and Jessica Portz for keeping production on track, Designer Tara McDermott, and Copy Editor Debra DeBord for her meticulous attention to detail. We also thank Content Licensing Specialist Shawntel Schmitt, and the many talented illustrators and photographers for their expert assistance.
To our conscientious, dedicated expert reviewers and instructors: Thank you for sharing your insightful and constructive comments with us. We truly appreciate the time you committed to reviewing this book and discussing your thoughts and goals for this course. We especially appreciate the assistance provided by Stephanie Atkinson, Kelly Brownell, Clare M. Hasler-Lewis, Penny Kris-Etherton, Cynthia Kupper, Judith Rodriguez, Kristi Theisen, and Margo G. Wootan, those who shared their expertise in compiling the Expert Perspective from the Field features. Your suggestions and contributions clearly reflect dedication to excellence in teaching and student learning and are invaluable to this edition.
To Your Health!
Carol Byrd-Bredbenner
Gaile Moe
Jacqueline Berning
Danita Kelley
Meet the Author Team iv Preface v
Part 1 Nutrition
Fundamentals 3
1 THE SCIENCE OF NUTRITION 3
1.1 Nutrition Overview 4
Nutrients 4
Phytochemicals and Zoochemicals 8
Expert Perspective from the Field: Functional Foods 9
1.2 Energy Sources and Uses 10
1.3 The North American Diet 12
What Influences Our Food Choices? 13
Take Action: Why You Eat What You Do 14
Global Perspective: The Price of Food 15
1.4 Nutritional Health Status 16
Health Objectives for the U.S. for the Year 2020 16
Assessing Nutritional Status 17
Limitations of Nutritional Assessment 18
Importance of Being Concerned about Nutritional Status 19
Getting Nutrition-Related Advice: The Nutrition Care Process 19
Clinical Perspective: Genetics and Nutrition 21
Take Action: Create Your Family Tree for Health-Related Concerns 24
1.5 Using Scientific Research to Determine Nutrient Needs 24
Making Observations and Generating Hypotheses 25
Laboratory Animal Experiments Human Experiments 27
1.6 Evaluating Nutrition Claims and Products 31
Buying Nutrition-Related Products 31
Chapter Summary 33
Study Questions 35
References 37
2 TOOLS OF A HEALTHY DIET 39
2.1
Dietary Reference Intakes (DRIs) 40
Estimated Average Requirements (EARs) 40
Recommended Dietary Allowances (RDAs) 41
Adequate Intakes (AIs) 42
Tolerable Upper Intake Levels (Upper Levels, or ULs) 42
Estimated Energy Requirements (EERs) 42
Acceptable Macronutrient Distribution Ranges (AMDRs) 43
Appropriate Uses of the DRIs 43
Putting the DRIs into Action to Determine the Nutrient Density of Foods 44
2.2 Daily Values (DVs) 45
Reference Daily Intakes (RDIs) 45
Daily Reference Values (DRVs) 45
Putting the Daily Values into Action on Nutrition Facts Panels 47
Take Action: Applying the Nutrition Facts Label to Your Daily Food Choices 52
Global Perspective: Front-of-Package Nutrition Labeling 53
2.3 Nutrient Composition of Foods 53
Putting Nutrient Databases into Action to Determine Energy Density and Dietary Intake 54
Expert Perspective from the Field: Menu Labeling: How Many Calories Are in That? 55
2.4 Dietary Guidelines for Americans 2015–2020 56
Putting the Dietary Guidelines into Action 58
Take Action: Are You Putting the Dietary Guidelines into Practice? 60
2.5 MyPlate 60
Putting MyPlate into Action 61
Rating Your Current Diet 66
Take Action: Does Your Diet Meet MyPlate Recommendations? 67
Chapter Summary 68
Study Questions 70
References 71
THE FOOD SUPPLY 73
3.1
Food Availability and Access 74
Health Consequences of Malnutrition and Food Insecurity 74
Food Insecurity in the U.S. 75
Programs to Increase Food Security in the U.S. 76
Food Insecurity and Malnutrition in the World’s Developing Regions 78
3.2 Food Production 79
Organic Foods 79
Biotechnology—Genetically Modified Foods 80
3.3 Food Preservation and Processing 84
Food Irradiation 84
Food Additives 84
3.4
Food and Water Safety 87
Foodborne Illness Overview 87
Take Action: A Closer Look at Food Additives 88
Microbial Pathogens 89
Water Safety 98
Preventing Foodborne and Waterborne Illnesses 99
Clinical Perspective: Foodborne Illness Can Be Deadly 101
Take Action: Check Your Food Safety Skills 102
3.5 Environmental Contaminants in Foods 103
Lead 103
Arsenic 104
Dioxins and Polychlorinated Biphenyls (PCBs) 104
Mercury 104
Pesticides and Antibiotics 104
Global Perspective: Traveler’s Diarrhea 106
Expert Perspective from the Field: Sustainability in University Food Service 109
Chapter Summary 110
Study Questions 112
References 114
4
HUMAN DIGESTION AND ABSORPTION 117
4.1 Organization of the Human Body 118
4.2 Digestive System Overview 122
Anatomy of the GI Tract 123
GI Motility: Mixing and Propulsion 124
Digestive Enzymes and Other Secretions 124
4.3 Moving through the GI Tract: Mouth and Esophagus 126
Taste and Smell 126
Swallowing 127
4.4 Moving through the GI Tract: Stomach 128
4.5 Moving through the GI Tract: Small
Intestine and Accessory Organs 130
Liver, Gallbladder, and Pancreas 131
Gastrointestinal Hormones: A Key to Orchestrating Digestion 132
Absorption in the Small Intestine 133
Global Perspective: Diarrhea in Infants and Children 135
4.6 Moving Nutrients around the Body:
Circulatory Systems 136
Cardiovascular System 137
Lymphatic System 137
4.7 Moving through the GI Tract: Large Intestine 137
Gut Microbiota 138
Culinary Perspective: Fermented Foods 140
Absorption of Water and Electrolytes 140
Elimination of Feces 141
4.8 When Digestive Processes Go Awry 141
Heartburn and Gastroesophageal Reflux Disease 141
Ulcers 142
Nonalcoholic Fatty Liver Disease 143
Gallstones 144
Food Intolerances 144
Intestinal Gas 144
Constipation 145
Diarrhea 146
Clinical Perspective 147
Irritable Bowel Syndrome 147
Take Action: Investigate Flours and Grains for Gluten Content 147
Expert Perspective from the Field: Glutenrelated Disorders: Celiac Disease and Nonceliac Gluten Sensitivity 148
Inflammatory Bowel Disease 149
Hemorrhoids 149
Take Action: Are You Eating for a Healthy Digestive System? 150
Chapter Summary 151
Study Questions 153
References 154
Part 2 Energy-Yielding
Nutrients and Alcohol 157
5 CARBOHYDRATES 157
5.1 Structures of Carbohydrates 158
Monosaccharides: Glucose, Fructose, Galactose, Sugar Alcohols, and Pentoses 158
Disaccharides: Maltose, Sucrose, and Lactose 160
Oligosaccharides: Raffinose and Stachyose 161
Polysaccharides: Starch, Glycogen, and Fiber 161
5.2 Carbohydrates in Foods 164
Starch 165
Fiber 165
Nutritive Sweeteners 165
Non-nutritive (Alternative) Sweeteners 167
Take Action: Choosing a Sandwich 169
5.3 Recommended Intake of Carbohydrates 169
Our Carbohydrate Intake 170
Take Action: Estimate Your Fiber Intake 173
5.4 Functions of Carbohydrates in the Body 173
Digestible Carbohydrates 173
Indigestible Carbohydrates 174
5.5 Carbohydrate Digestion and Absorption 176
Digestion 176
Absorption 177
Expert Perspective from the Field: Taxing Sugar-Sweetened Beverages 178
5.6 Health Concerns Related to Carbohydrate Intake 179
Very-High-Fiber Diets 179
High Sugar Diets 179
Lactose Intolerance 180
Glucose Intolerance 180
Clinical Perspective: Diabetes Mellitus 183
Glycemic Index and Glycemic Load 186
Chapter Summary 188
Study Questions 190
References 191
6 LIPIDS 193
6.1 Triglycerides 194
Structure 194
Naming Fatty Acids 196
Essential Fatty Acids 197
6.2 Food Sources of Triglycerides 198
Hidden Fats 200
Fat Replacements 200
Take Action: Is Your Diet High in Saturated and Trans Fat? 201
6.3 Functions of Triglycerides 202
Provide Energy 202
Provide Compact Energy Storage 202
Insulate and Protect the Body 202
Aid Fat-Soluble Vitamin Absorption and Transport 203
1. Define the terms nutrition, carbohydrates, proteins, lipids (fats and oils), vitamins, minerals, water, and calories
2. Use the physiological fuel values of energy-yielding nutrients to determine the total energy content (calories) in a food or diet.
3. Describe the major characteristics of the North American diet and the food behaviors that often need improvement.
4. Describe the factors that affect our food choices.
5. Discuss the components and limitations of nutritional assessment.
6. List the attributes of lifestyles that are consistent with Healthy People 2020 goals and those that contribute to the leading causes of death in North America.
7. Describe the role of genetics in the development of nutrition-related diseases.
8. Explain how the scientific method is used in developing hypotheses and theories in the field of nutrition.
9. Identify reliable sources of nutrition information.
Chapter Outline
1.1 Nutrition Overview
Expert Perspective from the Field: Functional Foods
1.2 Energy Sources and Uses
1.3 The North American Diet
Global Perspective: The Price of Food
1.4 Nutritional Health Status
Clinical Perspective: Genetics and Nutrition
1.5 Using Scientific Research to Determine Nutrient Needs
1.6 Evaluating Nutrition Claims and Products
IN OUR LIFETIMES, WE WILL eat about 60 tons of food served at 70,000 meals and countless snacks. Research over the last 50 years has shown that the foods we eat have a profound impact on our health and longevity.
A healthy diet—especially one rich in fruits and vegetables—coupled with frequent exercise can prevent and treat many age-related diseases. 1 In contrast, eating a poor diet and getting too little exercise are risk factors for many common lifethreatening, chronic diseases, such as cardiovascular (heart) disease, diabetes, and certain forms of cancer. 2,3 Another diet-related problem, drinking too much alcohol, can impair nutritional status and is associated with liver disease, some forms of cancer, accidents, and suicides. As you can see in Figure 1-1, diet plays a role in the development of most of the leading causes of death in the U.S. The combination of poor diet and too little physical activity contributes to well over half of these deaths. 3,4
We live longer than our ancestors did, so preventing age-related diseases is more important now than ever before. Today, many people want to know more about how nutritious dietary choices can bring the goal of a long, healthy life within reach.5 They may wonder what the best dietary choices are, how nutrients contribute to health, or if multivitamin and mineral supplements are needed. How can people know if they are eating too much saturated fat, trans fat, or cholesterol? Why are carbohydrates important? Is it possible to get too much protein?
