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Nutrition and Diet Therapy SIXTH EDITION
Carroll A. Lutz, MA, RN Associate Professor Emerita Jackson College Jackson, Michigan
Erin E. Mazur, MSN, RN, FNP-BC Assistant Professor of Nursing Jackson College Jackson, Michigan
Nancy A. Litch, MS, RD Supervisory Dietitian VA Medical Center Ann Arbor, Michigan
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F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2015 by F. A. Davis Company Copyright © 1994, 1997, 2001, 2006, 2011 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Publisher, Nursing: Joanne Patzek DaCunha, RN, MSN Director of Content Development: Darlene D. Pedersen Content Project Manager: Elizabeth Hart, Christina Snyder Electronic Project Manager: Katherine Crowley Illustration and Design Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Lutz, Carroll A., author. Nutrition and diet therapy / Carroll A. Lutz, Erin Mazur, Nancy A. Litch. — Sixth edition. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8036-3718-4 I. Mazur, Erin, author. II. Litch, Nancy A., author III. Title. [DNLM: 1. Diet Therapy. 2. Diet. 3. Nutritional Physiological Phenomena. WB 400] RM217 613.2—dc23 2014003146 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036-3718-4/14 0 + $.25.
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Dedications To my coauthor of 22 years, Karen R. Przytulski, RD, an exceptional and steadfast colleague throughout the first five editions of this text, to Gail Ladwig, RCV, who recommended me to F. A. Davis company in 1989 and led me to Nancy in 2011, and to my nephew, Bob Weber, my trusted source of information and encouragement for all six editions. —Carroll A. Lutz
To Carroll, thank you for your guidance and wisdom throughout this process. To Jeff, Spencer, and Carter, thank you for your encouragement and patience; you are loved! —Erin E. Mazur
To Carroll, for your wealth of knowledge and experience, thank you for this opportunity. To Paul and Evan, thank you for your support and understanding. —Nancy A. Litch
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Preface The sixth edition of Nutrition and Diet Therapy is designed to provide the beginning student with knowledge of the fundamentals of nutrition related to the promotion and maintenance of optimal health. Practical applications and treatment of pathologies with nutritional components are stressed. In addition, basic scientific information is introduced to enable students to begin to understand nutritional issues reported in the mass media. The sequential introduction of material continues to be a unique feature of this text. The authors resist the temptation to introduce concepts and examples of applications before the underlying basic science and vocabulary have been covered. The sixth edition has been extensively updated with new information (the FODMAP diet) incorporating new illustrations and tables (a more detailed vitamin K-controlled diet). Increased attention is paid to feeding the hungry and global issues involving nutrition. Within the boundaries of a beginning course, enough specific information is included to enhance understanding of the “why” of nutritional care, not only the “what.” This book was written to meet the educational needs of nursing students, dietetic assistants, diet technicians, and others. Support materials for the student include case studies with examples of care plans, including referrals to other members of the health-care team, followed by Critical Thinking Questions designed to provoke imaginative thought and to foster discussion. Each chapter has review questions and clinical analysis study questions. Additional student study aids listed in this Preface are available online through DavisPlus. As researchers discover new and more effective treatments for nutrition-related disorders and health maintenance, the ability to think critically becomes increasingly important for professional growth and development. Students need not only to grasp the facts but also to apply the information in a clinical environment. This text has been developed to facilitate acquiring these skills. The text can be used to teach a complete course in nutrition or as a desk reference for practitioners. The student using this book needs no previous grounding in anatomy, physiology, or medical terminology. Subjects are fully supported by diagrams, illustrations, figures, and tables. Depending upon the curriculum, chapters may be omitted or presented in a different sequence. We recognize that this text contains an immense amount of data
and information. We hope this rich store of information permits instructors to adapt the text to the objectives of their courses while serving as a reference and directory for students, satisfying their curiosities or completing solo or group projects whether in preclinical or in clinical courses. The content of Nutrition and Diet Therapy, sixth edition, is organized into three units. Unit 1, The Role of Nutrients in the Human Body, covers basic information on nutrition as a science and how this information is applied to nutritional care. All the essential nutrients are covered, including definitions and descriptions of functions, effects of excesses and deficiencies, and food sources. Nutritional standards, including the Dietary Reference Intakes, are explained and incorporated into discussions of nutrients. Information on the use of food in the body and how the body maintains energy balance completes the unit. Unit 2, Family and Community Nutrition, provides an overview of topics such as nutrition throughout the life cycle covering pregnancy, lactation, infancy, childhood, adolescence, and adulthood. Lastly, issues in food management are addressed. Unit 3, Clinical Nutrition, focuses on the care of clients with pathologies caused by or causing nutritional impairments. General topics include nutrient delivery via oral, enteral, and parenteral routes, and interactions among foods, nutrients, medications, and supplements. Pathological conditions include diabetes mellitus and hypoglycemia, cardiovascular disease, renal disease, digestive diseases, and cancer. Other pertinent topics include weight control, nutrition in critical care and during stress, diet affecting inflammation and infections, and care of the client with a terminal illness. Special features are used throughout the text to facilitate the teaching and learning process. All of the chapters include the following: Boxes and Tables contain summaries, assessment tools, commonly prescribed diets used in medical nutrition therapy, and research findings. Clinical Applications stimulate the interest of the beginning student by showing how the information is pertinent to providing health care. Clinical Calculations isolate and explain many of the mathematical calculations that are used in nutritional science. vii
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viii
PREFACE
Dollars & Sense items focus on costs associated with commonly used foods and supplements. Occasionally, budget-sparing recipes are given to exemplify principles in the chapters. Genomic Gems highlight links between a person’s genetic makeup and utilization of nutrients and dietary substances. Illustrations reinforce important points in the text or graph statistical data for clarity. Flowcharts of physiological and pathological processes lead the student to an understanding of the relationship between nutrition and health. A Case Study with a proposed Care Plan allows the student to see how the nutrition principles described in the chapter are applied in a specific clinical situation. The case studies were written to incorporate elements that are likely to occur in practice. Teamwork following the care plan illustrates continuing care of a client by various members of the health-care team. Study Aids, Chapter Review Questions, and Clinical Analysis Questions help the student to focus on essential concepts. Answers to the Study Aids questions are printed in Appendix C. Critical Thinking Questions invite the student to think holistically with compassion and creativity. They can be used as a basis for class discussion. Appendices of Dietary Reference Intakes (Appendix A) and the Academy of Nutrition and Dietetics Exchange Lists for Diabetes (Appendix B) serve as readily available sources of information for students in class discussions or group assignments. A Glossary (Appendix D) of more than 1000 entries assists the reader to recall definitions of terms boldfaced in the text. The Bibliography (Appendix E) supports the text with data sources and introduces the student to the scientific literature.
In addition to the text resources, students can access online resources via DavisPlus: Student Study Questions are different from the inbook questions and provide the student with additional content review. All 360 questions are broken down by chapter, include a rationale, and have print and e-mail capabilities. Flash Cards developed from the book glossary provide students an online resource for key term review. Additional Web Resources are compiled in one place to provide the student easy access to nutrition content, including links to MyPlate resources, U.S. Department of Agriculture resources, and nutrition management tools. Electronic Updates will be added as new information becomes available. Updates will be posted under the link for “Content Updates.” Accompanying the text for instructors who adopt it for their classes are: An Instructors’ Guide with suggestions for course organization, classroom activities, and student assignments. PowerPoint Presentations for all the chapters of the book. These presentations provide a ready source of material to select for classroom use. An Electronic Test Bank containing an additional 200 questions, arranged by chapter. We believe that Nutrition and Diet Therapy, sixth edition, provides the clinical information necessary for a fuller understanding of the relationship between the knowledge about nutrition and diet and its clinical application. This text balances direct explanations of the underlying science with an introduction to the clinical responsibilities of the health-care professional.
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Reviewers Chanda D. Beaty, MSN, RN/NP
Cathleen E. Kunkler, MSN, RN, ONC, CNE
Nursing Instructor Upper Cape Regional Technical School Bourne, Massachusetts
Associate Professor, Nurse Education Corning Community College Corning, New York
Stephanie Bruce, MS, RN
Karen A. Lindale Potts, RN, BC, MSN, CDE
Assistant Professor Alverno College Milwaukee, Wisconsin
Nursing Director Delaware Skills Center Practical Nursing Course Wilmington, Delaware
Patricia Davis-Scott, MS, RN
Gayla Love, MSN Ed, BSN, RN, COI, CCM
Assistant Professor Cumberland University Lebanon, Tennessee
Program Administrator Southern Crescent Technical College Griffin, Georgia
Diane Dembicki, PhD, LMT, CYT
Jane Lucht, RN, MSM
Clinical Associate Professor and Director of MS Nutrition Program College of Nursing and Public Health Adelphi University Garden City, New York
Associate Professor Edgewood College Madison, Wisconsin
Holly Doogs, RN, MSN Nursing Faculty State Fair Community College Sedalia, Missouri
Cathleen Dowe, MSN, RN Adjunct Instructor Jefferson Community College Watertown, New York
MaryAnn Edelman, RN, MS, CNS Associate Professor Kingsborough Community College Brooklyn, New York
Tonia Grant, MSN, RN Assistant Professor Medgar Evers College—CUNY Brooklyn, New York
Anjeleigh L. Partridge, RN, MSN Nurse Educator and LPN Instructor Southern Crescent Technical College Griffin, Georgia
Sharon Todd, MSN NIS, BSN, ASN, RN Practical Nursing Instructor Southern Crescent Technical College Griffin, Georgia
Susan Wessel, RN, MSN Professor of Nursing Southwestern Illinois College Belleville, Illinois
Shawn White, MSN, BSN, RN Nurse Educator Southern Crescent Technical College Griffin, Georgia
Coleen Kumar, RN, MS Associate Professor/Deputy Chairperson Kingsborough Community College Brooklyn, New York ix
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Acknowledgments Writing a book, even a sixth edition, is a huge task, requiring the assistance of many people. Of particular note are the two new coauthors who accepted ownership of the project right from the beginning. All of our colleagues and family members contributed to this project, sometimes with information and critiques, sometimes by being supportive, sometimes just by leaving us alone to work. We thank all the organizations and publishers that gave permission for the use of their materials for this
and previous editions. Our editorial and production staff at F.A. Davis Company, including Joanne DaCunha, Elizabeth Hart, Christina Snyder, Katherine Margeson, and Bob Butler, shared their knowledge and expertise throughout joint project. Our developmental editor, Jennifer Schmidt, and production editors, Kelly Boutross and Chris Waller, kept us focused on our common goal of excellence. To all of them and the countless others who did not have to deal with us directly go our heartfelt thanks.
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Contents Preface vii Acknowledgments xi
Unit 1 The Role of Nutrients in the Human Body 1 1 2 3 4 5 6 7 8 9
Nutrition in Human Health
3
Carbohydrates 34 Fats
48
Protein 65 Energy Balance 84 Vitamins
97
Minerals
133
Water 173 Digestion, Absorption, Metabolism, and Excretion
197
Unit 2 Family and Community Nutrition 215 10 11
Life Cycle Nutrition: Pregnancy and Lactation 217 Life Cycle Nutrition: Infancy, Childhood, and Adolescence 238 xiii
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xiv
12 13
CONTENTS
Life Cycle Nutrition: The Mature Adult 269 Food Management
288
Unit 3 Clinical Nutrition 305 14 15
Nutrient Delivery
16 17 18 19 20 21 22 23 24
Weight Management
307
Interactions: Food and Nutrients Versus Medications and Supplements 330 364
Diet in Diabetes Mellitus and Hypoglycemia 386 Diet in Cardiovascular Disease 412 Diet in Renal Disease
436
Diet in Digestive Diseases 455 Diet and Cancer
496
Nutrition in Critical Care Diet in HIV and AIDS
516
532
Nutritional Care of the Terminally Ill
544
Appendices A B C D E
Dietary Reference Intakes for Individuals
Index
655
557
Academy of Nutrition and Dietetics Exchange Lists for Diabetes 563 Answers to Questions 576 Glossary
578
Bibliography
607
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1 The Role of Nutrients in the Human Body
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1 Nutrition in Human Health LEARNING OBJECTIVES After completing this chapter, the student should be able to: ■ ■ ■ ■ ■ ■ ■ ■ ■ ■
Describe the relationship between nutrition and health. Identify the six classes of nutrients, their functions, and their essentiality. Recognize the possible relationship of genetics to the adequacy of nutrition. Compare dietary intakes in the United States with the U.S. Department of Agriculture Dietary Guidelines. Discuss issues related to food insecurity on local and global levels. List and describe the steps in providing nutritional care. Explain the intended use of the Dietary Reference Intakes. Relate the underlying concept of the Exchange Lists to overall healthful eating. Give an example of a provider’s use of, and respect for, cultural beliefs having a favorable impact on a health outcome for a client. State the preferences and dietary restrictions of several cultural and religious groups.
F
ood is essential to life. Choosing food wisely can contribute to a healthy, satisfying life. This chapter introduces concepts and practices that underlie the nourishment of human beings as well as some barriers to achieving optimal nutrition. Information on the influence of culture on nutrition concludes the chapter.
The Language of Nutrition Nutrition is the science of food and its relationship to health. Nutrition involves the processes of taking in and utilizing nourishment. It includes natural and artificial feeding. According to the World Health Organization, health is the state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity. How nutrition influences human health is the subject of this textbook.
That food or its lack affects physical health is readily seen. For example, both motor and mental development are suboptimal in young children with iron deficiency anemia (Stoltzfus, 2011). On occasion, social well-being may be developed to the detriment of physical well-being as when social occasions are accompanied by foods that may not contribute to the best possible health. Certainly, human beings should take nourishment daily. What an individual chooses to eat may affect his or her health that day but also well into the future.
Disease Prevention The general prevention of disease is categorized on three levels: primary, secondary, and tertiary. Application of the principles of nutrition can contribute to prevention of disease on each of these levels. 3
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UNIT 1 ■ THE ROLE OF NUTRIENTS IN THE HUMAN BODY
Primary prevention is the implementation of practices that are likely to avert the occurrence of disease. Many nutritional changes have been promoted to thwart particular diseases, but most, with the exception of actual vitamin deficiency diseases, lack solid evidence of effectiveness. Excessive body weight is clearly related to heart disease, stroke, type 2 diabetes mellitus, some cancers, joint diseases, and some fertility disorders. The difficulty lies in motivating people to change behavior today for possible benefits in the perhaps distant future. Maintaining a healthy body weight is a primary prevention strategy. Secondary prevention is the institution of monitoring techniques to discover incipient diseases early enough to enhance the opportunity to control their effects. If a person’s risk for diabetes is found in the prediabetes stage by testing blood sugar levels, noninvasive treatments such as weight loss and diet modification can successfully derail or delay the development of the disease. Tertiary prevention is the use of treatment techniques after a disease has occurred to prevent complications or to promote maximum adaptation. For example, clients with various diseases that cause swallowing disorders can be helped to maintain nourishment and to avoid choking incidents with nutritional interventions (see Chapter 14).
Nutrients Historically, the science of nutrition has been based on the nutrients in food. Nutrients are the chemical substances supplied by food that the body needs for growth, maintenance, and repair.
Classes and Essentiality Nutrients are divided into six classes, each of which is discussed in subsequent chapters: 1. Carbohydrates (often abbreviated as CHO for carbon, hydrogen and oxygen; these elements are also those in lipids but an abbreviation is not used for lipids.) 2. Fats (lipids) 3. Proteins 4. Minerals 5. Vitamins 6. Water Nutrients are considered essential, nonessential, or conditionally essential, depending on whether the body can or cannot manufacture them. ■
An essential nutrient is one that the human body requires but cannot manufacture in sufficient amounts to meet bodily needs. Thus, essential
■
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nutrients must be supplied by foods in the diet. Vitamin C, vitamin A, and calcium are three of the more than 40 essential nutrients. Nonessential nutrients are not needed in the diet because the body can make them from other substances. For example, the amino acid alanine is a nonessential nutrient because the body can manufacture it from other raw materials. Conditionally essential nutrients are those that, under most circumstances, a healthy body can manufacture in sufficient quantities. In certain situations of physiological status or disease, the body cannot produce optimal amounts. The amino acid tyrosine is an example of a conditionally essential nutrient (see Chapter 4).
Functions All nutrients perform one or more of the following functions: 1. Serve as a source of energy or heat 2. Support the growth and maintenance of tissue 3. Aid in the regulation of basic body processes These three life-sustaining functions collectively are part of metabolism, the sum of all physical and chemical changes that take place in the body. Nutrients have specific metabolic functions and interact with one another to maintain the body. SOURCE OF ENERGY Energy is defined in the physical sciences as the capacity to do work. Energy exists in a variety of forms: electric, thermal (heat), chemical, mechanical, and others. All food enters the body as chemical energy. The body processes the chemical energy of food and converts it into other energy forms. For example, chemical energy is transformed into electric signals in nerves and into mechanical energy in muscles. Carbohydrates, fats, and proteins, the nutrients that supply energy, are referred to as the energy nutrients. The energy both in foods and in the body is measured in kilocalories, abbreviated kcal (see Glossary). Because energy cannot be seen, heard, or felt, it is one of the most difficult biological concepts to understand. For this reason, it warrants its own chapter (see Chapter 5). GROWTH AND MAINTENANCE OF TISSUES Some nutrients provide the raw materials for building body structures, and they participate in the continued growth and maintenance of necessary tissues. Water, proteins, fats, and minerals are the nutrient classes that contribute in a major way to building body structures.
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CHAPTER 1 ■ NUTRITION IN HUMAN HEALTH
REGULATION OF BODY PROCESSES Some nutrients control or regulate chemical processes in the body. For example, certain minerals and proteins help regulate how water is distributed in the body. Vitamins are necessary in the series of reactions involved in generating energy. Vitamins themselves are not energy sources, but if the body lacks a particular vitamin, it will not produce energy efficiently.
Functional Foods In addition to the nutrients listed above, foods contain other physiologically active substances from plant (phytochemical), animal, and microbial sources, some of which reputedly promote health. Phytochemicals identified thus far number in the tens of thousands, including 8000 polyphenolic compounds (Gropper and Smith, 2013). It is small wonder that pinning down the health effect of one component in a food is daunting. Therefore, the amount and quality of evidence for the usefulness of functional foods varies. Definitions of functional foods are equally varied by source and are not officially recognized as a food category by the U.S. Food and Drug Administration (FDA). One of the simplest definitions is as follows: Functional foods are foods or food ingredients that have additional health or physiological benefits over and above the normal nutritional value they provide (Nicoletti, 2012). The Academy of Nutrition and Dietetics (formerly the American Dietetic Association) categorizes functional foods as indicated in Table 1-1. Several examples of functional foods being studied appear in Table 1-2. Bear in mind that a given food may contain thousands of phytochemicals that differ under divergent cultivation and storage methods. The extent to which foods
TABLE 11
■
Functional Foods
CATEGORY
SELECTED EXAMPLES
Conventional foods (whole foods)
Blueberries Cranberry juice (see Chapter 21) Cruciferous vegetables: broccoli, cabbage, cauliflower, Brussels sprouts (see Chapter 21) Green tea Mushrooms Some nuts Oatmeal as part of heart healthy diet Tomatoes (see Chapter 21) Omega-3 fatty acids in eggs and margarines (For definition, see Chapter 6.) Oligosaccharides functioning as prebiotics (see Chapter 20)
Modified foods, fortified Synthesized food ingredients
Adapted from Crowe and Francis, 2013; Milner, Toner, and Davis, 2014.
TABLE 12
■
Selected Functional Foods, Bioactive Components, and Reported Health Benefits
FUNCTIONAL FOODS Apples, tea, onions Berries
BIOACTIVE COMPONENTS UNDER STUDY Flavonoids Polyphenols
Cruciferous vegetables (broccoli, cauliflower, cabbage)
Isothiocyanates
Green Tea
Polyphenols
Oats
Beta-glucan (soluble fiber) Resveratrol
Purple grape juice or red wine Soy products
5
Isoflavones
REPORTED HEALTH BENEFIT Prevention of cardiovascular disease Protection against cancer through abilities to counteract, reduce, and repair damage from oxidative stress and inflammation Reduction of prostate cancer risk
Inhibition of cancer initiation and blockage of cancer progression Reduction of blood cholesterol levels Reduction of heart disease risk by decreasing blood platelet aggregation Reduction in incidence of hormonerelated cancers
Sources: American Dietetic Association, 2009; Kanwar, Taskeen, Mohammad, Huo, et al, 2012; Li, Kong, Bao, Ahmad, et al, 2011; Liu, Mao, Cao, and Xie, 2012; Majewska-Wierzbicka and Czeczot, 2012; Othman, Moghadasian, and Jones, 2011; Seeram, 2008; Zhang, 2012.
may be labeled with a health claim is discussed in Chapter 15. Specific examples of functional foods with the best efficacy are provided as the subject matter dictates in other chapters.
Nutritional Genomics In April 2003, the Human Genome Project announced that the actual sequence of the human genetic code had been transcribed. In simple terms, the genetic code is the human body’s software instructions for manufacturing proteins (see Genomic Gem 1-1). It is now possible to cheaply and quickly sequence the parts of genes that encode amino acids of all 22,000 human genes (Brunner, 2012). A subfield of nutritional genomics, nutrigenetics, detects gene variants within an individual to identify environmental factors that trigger dysfunction or disease. Examples of gene variants conveying susceptibility for dysfunction include those for food allergies and celiac disease (Gropper and Smith, 2013). The trigger in food allergy is the offending food (see Chapter 11). In celiac disease, it is the gluten in wheat, rye, or barley (see Chapter 20). Another subfield of nutritional genomics is nutrigenomics, the study of the interaction between one’s diet and his or her genes, which can markedly influence digestion, absorption, and elimination as well as influence their sites of actions (Riscuta and Dumitrescu, 2010). A
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UNIT 1 ■ THE ROLE OF NUTRIENTS IN THE HUMAN BODY 70
Genomic Gem 1-1 Genetic Code as Software To visualize the relationships among the human body, genetic code, and diet, think of the body as a machine similar to a personal computer. Software provides directions to the computer; a person’s genetic code provides instructions to the body. Just as a personal computer cannot operate without software, the human body cannot operate without instructions from the genetic code. Think of data input by the operator as much like food that is taken in or eaten. For years, scientists have studied the effects of nutrients and phytochemicals on our body’s hardware, or structure. Only recently have researchers begun the study of nutrients and phytochemicals on the body’s software, or genetic code. Almost everyone has software on their computers that is never used. The human body also has instructions that are similarly never used. What causes a software program or gene in the human body to be turned on or expressed? Some scientists are beginning to understand that the activation is partly due to the food we eat or do not eat. The premise underlying nutrigenomics is that diet’s influence on health depends on an individual’s genetic makeup, thereby suggesting that not all individuals respond identically to a given diet. Thus, one person would be more susceptible to the negative effects of a suboptimal diet than another person would be. More research is needed to identify those who will benefit most from dietary change and those who might be placed at risk because of an adjustment (Riscuta and Dumitrescu, 2010).
possible application of nutrigenomics in a person susceptible to chronic inflammation is to ensure adequate omega-3 fatty acids intake (see Chapter 3) to reduce the expression of genes that encode for inflammatory cytokines (Gropper and Smith, 2013).
60 Male (154 pounds)
50
Female (128 pounds) 40 30 20 10 0
Water
Protein
Fat
Ash
CHO
FIGURE 11 Approximate body composition as a percent of body weight of a 25-year-old man weighing 154 pounds and woman weighing 128 pounds. Note that the typical woman has more fat and less protein than the man because of differences in muscle. The percentage of ash content is equal in both sexes. The human body has minimal carbohydrate content.
losing weight (see Chapter 16). When the body loses protein, it is losing muscle tissue, organ mass, the protein stored in body substances, or combinations thereof. Preservation of body protein is necessary for optimal health. A person’s body fat and protein content can be modified by food intake, exercise, or both. Exercise increases body protein content by increasing muscle. Eating too much food increases the fat content of the body because fat is stored for future use as energy. Excessive body fat, both in amount and location, has health consequences.
Food Choices Body Composition Nutrient intake can affect body composition, which in turn can affect health. The human body is composed of five types of substances: 1. 2. 3. 4. 5.
Water Protein Fat Ash (mineral content as in the skeleton) Carbohydrate
Figure 1-1 shows these substances as a percentage of body weight in young adults. Because of its increased muscle, the male body contains more protein than the female body. With age, body composition typically becomes higher in fat and lower in protein. Health-care providers are often concerned that their clients retain their muscle, particularly when
Often unconscious and automatic, more than 220 food decisions may be made daily with emotional cues, habit, and peer pressure playing major roles in food choices. A French study found that price was most often cited as the primary factor influencing food choice decisions followed by eating habits, and taste (Jacquier, Bonthoux, Baciu, and Ruffieux, 2012). Note the lack of attention to nutritional composition. Undoubtedly, the French are not unique in ranking nutritional composition tenth of the most frequently cited factors used in food choice decisions. Despite the complexity of food decisions, many governments worldwide have published well-researched, rational, and practical dietary and food guidelines. This text discusses only the U.S. recommendations, which are revised periodically to incorporate new research findings into advice promoting healthy dietary behaviors.
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CHAPTER 1 ■ NUTRITION IN HUMAN HEALTH
What We Should Eat Poor diet and physical inactivity are the most important factors producing the epidemic of overweight and obesity in this country that affects men, women, and children in all segments of society. Even in persons of normal weight, poor nutrition and physical inactivity are associated with heart disease, diabetes, thinning bones, and some forms of cancer. In addition, certain racial and ethnic groups have disproportionate rates of excessive body weight and associated chronic illnesses. Current dietary advice from the U.S. government attempts to remedy that unhealthy state of affairs. The Healthy People 2020 Web site has a section on Nutrition and Weight Status at www. healthypeople.gov/2020/topicsobjectives2020/overview. aspx?topicid=29.
Dietary Guidelines Every 5 years since 1980, the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS) have published Dietary Guidelines for Americans based on the latest scientific and medical information. Traditionally, the focus has been on healthy individuals aged 2 years and older. In 2010, the Guidelines were also aimed at those at risk for chronic disease to encourage proper dietary habits to promote health and reduce risk for major chronic diseases. These recommendations accommodate the
7
food preferences, cultural traditions, and economic resources of many diverse groups who live in the United States. The Guidelines are intended to evaluate several days’ intake of food, not to rate individual food items or a single meal or 1 day’s intake. Government policymakers, nutrition educators, and health providers are expected to use the advice to improve the health of the nation. For example, the Guidelines would be used to create menus for school lunch programs, nursing home residents, and prisoners. The Dietary Guidelines for Americans, 2010 also recognizes that in recent years, nearly 15% of American households have been unable to acquire adequate food to meet their needs. This dietary guidance can help them maximize the nutritional content of their meals. Many other Americans consume less than optimal intake of certain nutrients even though they have adequate resources for a healthy diet. Published materials encompass printed and electronic versions of Dietary Guidelines for Americans, and interactive Internet materials are available at www.choosemyplate.gov/printmaterials-ordering.html. Of note, the guidelines do not apply to individuals who have diseases or conditions that alter normal nutritional requirements. Clinical Application 1-1 summarizes the key recommendations for the general population and certain subsets of the population. Many of the terms may be unfamiliar but will become so in later chapters.
1-1
Clinical Application Key Recommendations of 2010 Dietary Guidelines BALANCING CALORIES TO MANAGE WEIGHT ■
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Prevent and/or reduce overweight and obesity through improved eating and physical activity behaviors. Control total calorie intake to manage body weight. For people who are overweight or obese, this will mean consuming fewer calories from foods and beverages. Increase physical activity and reduce time spent in sedentary behaviors. Maintain appropriate calorie balance during each stage of life— childhood, adolescence, adulthood, pregnancy, breastfeeding, and older age.
FOOD AND FOOD COMPONENTS TO REDUCE ■
Reduce daily sodium intake to less than 2300 milligrams (mg) and further reduce intake to 1500 mg among persons aged 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1500 mg
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recommendations applies to about half of the U.S. population, including children, and the majority of adults. Consume less than 10% of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids. Consume less than 300 mg per day of dietary cholesterol. Keep trans fatty acid consumption as low as possible by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils, and by limiting other solid fats. Reduce the intake of calories from solid fats and added sugars. Limit the consumption of foods that contain refined grains, especially refined grain foods that contain solid fats, added sugars, and sodium. If alcohol is consumed, it should be consumed in moderation—up to one drink per day for women and two drinks per day for men— and only by adults of legal drinking age. (Continued)
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1-1
Clinical Application—cont’d FOODS AND NUTRIENTS TO INCREASE
■
Individuals should meet the following recommendations as part of a healthy eating pattern while staying within their caloric needs. ■ ■
■
■
■
■
■
■ ■
Increase fruit and vegetable intake. Eat a variety of vegetables, especially dark-green and red and orange vegetables and beans and peas Consume at least half of all grains as whole grains. Increase whole grain intake by replacing refined grains with whole grains. Increase intake of fat-free or low-fat milk, and milk products, such as milk, yogurt, cheese, or fortified soy beverages. Choose a variety of protein foods, which include seafood, lean meat and poultry, eggs, beans and peas, soy products, and unsalted nuts and seeds. Increase the amount and variety of seafood consumed by choosing seafood in place of some meat and poultry. Replace protein foods that are higher in solid fats with choices that are lower in solid fats and calories and/or sources of oils. Use oils to replace solid fats where possible. Choose foods that provide more potassium, dietary fiber, calcium, and vitamin D, which are nutrients of concern in American diets. These foods include vegetables, fruits, whole grains, and milk and milk products.
RECOMMENDATIONS FOR SPECIFIC POPULATION GROUPS
Consume 400 micrograms (mcg) per day of synthetic folic acid (from fortified foods and/or supplements) in addition to food forms of folate from a varied diet.
Women who are pregnant or breastfeeding: ■
■
■
Consume 8 to 12 ounces of seafood per week from a variety of seafood sources. Because of their high methyl mercury content, limit white (albacore) tuna to 6 ounces per week, and do not eat the following four types of fish: tilefish, shark, swordfish, and king mackerel. If pregnant, take an iron supplement, as recommended by an obstetrician or other health-care provider.
Individuals aged 50 years and older: ■
Consume foods fortified with vitamin B12, such as fortified cereals, or dietary supplements.
BUILDING HEALTHY EATING PATTERNS ■
■
■
Select an eating pattern that meets nutrient needs over time at an appropriate calorie level. Account for all foods and beverages consumed and assess how they fit within a total healthy eating pattern. Follow food safety recommendations when preparing and eating foods to reduce the risk of foodborne illnesses.
Women capable of becoming pregnant: ■
Choose foods that supply heme iron, which is more readily absorbed by the body, additional iron sources, and enhancers of iron absorption such as vitamin C-rich foods.
SOURCE: Dietary Guidelines for Americans, 2010. www.cnpp.usda.gov/DietaryGuidelines.htm
MyPlate The latest educational food guidance system promoted by the USDA is called MyPlate, available online at www. choosemyplate.gov/print-materials-ordering/gettingstarted.html (Fig. 1-2). The intent of the MyPlate icon is to reduce risks for obesity, diabetes, cardiovascular disease, cancer, and other chronic diseases by helping consumers to eat correct proportions of healthy foods meal by meal. The interactive Web site offers sections for consumers and professionals, sample menus and recipes, tips for vegetarians, and many links to other resources. A page to personalize goals and record progress is located at www.choosemyplate.gov/SuperTracker.
What We Actually Eat The government periodically surveys food intake of the population to monitor progress toward meeting dietary goals. Information from two such investigations is discussed next.
FIGURE 12 The MyPlate icon shows relative proportions of five food groups to permit consumers to more easily visualize an ideal meal. The ChooseMyPlate.gov interactive Web site offers dietary assessment tools, nutrition education resources, and clear actionable information about how to make better food choices. (From U.S. Department of Agriculture, 2011, with permission.)
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The What We Eat in America Survey Each year, more than 5000 U.S. residents are interviewed about what they ate and drank for 24-hour periods on 2 nonconsecutive days. The data is part of the HHS National Health and Examination Survey (NHANES) that also includes physical examinations. Among the recent findings concerning foods consumed by Americans are the following: 1. Most people reported eating less than 2 ounces of whole grains per day compared with the 1.5 to 5 ounces recommended according to age and gender. 2. Grain-based desserts (cakes, cookies, pies, cobblers, sweet rolls, pastries, and doughnuts) accounted for a greater proportion of daily kilocalories than did any other food group. 3. Average intake of fluid milk in persons 9 years of age and older was about three-quarters of a cup compared with the recommended amount of 3 cups. Adolescents reporting milk consumption on a given day was 49% compared with 76% 30 years ago. 4. Snacks provided 32% of all daily kilocalories from solid fats and added sugars for women and 31% for men (Bliss, 2012). Thus, eating healthier foods to maintain a healthy weight is still an unachieved goal for most Americans. Much more information on this topic appears in Chapter 16.
State-Specific Trends in Fruit and Vegetable Consumption Reflecting the importance of fruit and vegetable intake to a healthy diet (encompassing one-half of the MyPlate graphic), the Centers for Disease Control (CDC) monitors dietary intake through a telephone survey. Results show that much behavior change will be needed to increase to 75% of the population those who consume two or more servings of fruit daily and to 50% those who consume three or more servings of vegetables daily. In the 2009 survey: 1. An estimated 32.5% of U.S. adults consumed fruit two or more times per day with the highest percentage in Washington, DC (40.2%) and the lowest in Oklahoma (18.1%). 2. Above average consumption of fruit was reported by women, adults over the age of 55 years, Black and Hispanic people, and college graduates. 3. An estimated 26.3% of adults consumed vegetables three or more times per day with the highest percentage in Tennessee (33.0%) and the lowest in South Dakota (19.6%). 4. Above average consumption of vegetables was reported by women; adults over the age of 45 years; White, non-Hispanic people; and individuals who
9
had attended or graduated from college (Centers for Disease Control, September 10, 2010).
Effectiveness of Policy Nutritional public policies have had a limited impact on consumer behavior probably because the mechanisms of food choice decisions are poorly understood. Decision-making not only involves rationality but also feelings, emotions, and memories (Jacquier et al, 2012). Analysis of the effectiveness of policy interventions in the European Union found that although diet quality had improved across countries, it still fell short of the World Health Organization dietary guidelines. This review divided interventions into measures providing information and those targeting the market environment. Information measures included 1. Reduced or banned unhealthy food advertisements— generally produced a weak positive effect on improving diets. 2. Public information campaigns—raised awareness of unhealthy eating but failed to translate the message into action. 3. Nutritional labeling—allowed for informed but not necessarily healthier choices. Interventions targeting the market environment included 1. Fiscal measures and 2. Nutrient, food, and diet standards. The last two are rarer and generally more effective than information measures, although admittedly more intrusive (Brambila-Macias, Shankar, Capacci Mazzocchi et al, 2011).
Unbalanced Nutrition Ingesting too much or too little of a nutrient can interfere with health and well-being. Each nutrient has a beneficial range of intake; an intake below or above that range is incompatible with optimal health.
Malnutrition Malnutrition (faulty nutrition) can be caused by inadequate or unbalanced intake of food or nutrients or to ineffective processing by the body due to malfunction or disease. The result in the body’s cells is an excess or deficiency of one or more nutrients that can lead to physical abnormalities and possibly mental dysfunction.
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Ideally, a person should consume a diet marked by balance, moderation, and variety. 1. Balance is displayed in the MyPlate icon that shows the proportions of foods in a meal. 2. Moderation is exemplified by judicious portion sizes such as are used on the Nutrition Facts labels found on many food items (see Chapter 13). 3. Variety is characterized by selection of many different foods rather than always eating one’s favorites or those easiest to prepare. If those three qualities of a good diet are consistently absent, health may suffer and recovery from illness may be prolonged. For instance, ambulatory adults who were at nutritional risk when admitted to the hospital had inpatient stays almost twice as long (13 versus 7 days) as those not at nutritional risk when admitted (Caccialanza, Klersy, Cereda, Cameletti et al, 2010). Malnutrition involving protein is addressed in Chapter 4. Vitamin and mineral deficiency diseases are found in Chapters 6 and 7. Effects of other nutritional imbalances are considered in other chapters as appropriate.
Food Insecurity Food insecurity is the limited or uncertain availability of nutritionally adequate and safe foods or doubtful ability to acquire food, whether some of the time or always. Food insecurity, often associated with poverty and low income, has important implications for the health and nutrition of individuals and nations.
In the United States The 2010 Dietary Guidelines for Americans acknowledged the extent of food insecurity in the country. One objective of the Guidelines was to assist residents with limited resources to maximize the nutritional content of their meals. EXTENT OF THE PROBLEM An estimated 14.5% (17.2 million) of American households were food insecure at some time during 2010. These households had difficulty at some time during the year providing enough food for all their members due to a lack of resources. Rates of food insecurity were higher than the national average for households with incomes near or below 185% of the federal poverty level, households
with children headed by single women or single men, and Black and Hispanic households. Food insecurity was more prevalent in households with children than those with no children. Elderly people living alone or with others had the least food insecurity of the households described. Food insecurity was also more common in large cities and rural areas than in the suburbs. Regionally, the prevalence of food insecurity was higher in the South and West than in the Midwest and Northeast. See Figure 1-3 to compare the percentage of the household groups categorized as food insecure. It is apparent that a household fits into several of the subgroups simultaneously. For instance, a single Hispanic mother living in the West below the federal poverty line is at risk on all those levels. The degree of compounded risk is not discernible from these statistics. FOOD COSTS AND RESOURCES In 2010, all U.S. households spent a median of $43.75 per week per person on food. Households with low food security and very low food security spent $34.00 per week per person (Coleman-Jensen, Nord, Andrews, and Carlson, 2011). Fifty-nine percent of the food-insecure households received assistance from one or more of the federal food and nutrition assistance programs during the
Northeast Midwest West South Hispanic Black White Solo elder Married w children Single fathers Single mothers < Poverty line U.S. Total 0
10
20
30
40
50
Very Low Low Total
FIGURE 13 Percentage of each of these household groups of the U.S. population experiencing very low food security, low food security, and the total of the two. Forty percent of the poor households and 35% of households headed by single mothers faced the most food insecurity according to the survey (data from Coleman-Jensen, Nord, Andrews, and Carlson, 2011).
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month before the survey (Coleman-Jensen et al, 2011). 1. The Supplemental Nutrition Assistance Program (SNAP, formerly the Food Stamp Program) provided benefits to 40.9% of food-insecure households while serving 46 million individuals overall in 2011 (Gunderson, 2014). 2. Children in 32.4% of the food-insecure households received free or reduced-price school lunches. In 2009, more than 31 million students participated in the National School Lunch Program with 16.3 million receiving free lunches (Gunderson, 2014). 3. Women and children in 13.6% of the food-insecure households received food vouchers from the Women, Infants, and Children’s program (WIC). Currently WIC serves 45% of all infants who are born in the United States (Gunderson, 2014). Despite that assistance, poor people’s food intake overall is concentrated in inexpensive, high-kilocalorie food of low nutritional quality. Low-cost, highkilocalorie foods containing added sugar and fat comprise almost 40% of the daily kilocalorie intake of people with low resources because their communities offer little else. The lack of full service supermarkets with fresh produce and low-fat dairy products led to the descriptor of food deserts for such neighborhoods. Redefining obesity more broadly as a food security problem rather than an individual choice problem may generate better solutions. Some communities have provided incentives for convenience stores to stock fresh produce. Farmers’ markets have opened in some localities. Large food retailers have opened stores in poor neighborhoods as the result of public-private partnerships (Center for School, Health, and Education, 2011). A model of a mobile market distribution system to serve in-need neighborhoods shows that, with relatively few resources, these residents’ access to healthy food could be increased (Widener, Metcalf, and Bar-Yam, 2012). On the other hand, availability of fast food and convenience outlets versus purveyors of healthier food does not independently explain weight gain over time in elementary school–age children (Lee, 2010). Greater supermarket availability was generally unrelated to diet quality and fruit and vegetable intake. Relationships between grocery store availability and diet outcomes were mixed, suggesting that access to food stores alone is insufficient to produce behavior change, which may require complementary or alternative strategies (Boone-Heinonen, Gordon-Larsen, Kiefe, Shikany, et al, 2011).
11
Worldwide If access to food was not dependent on income but on need, the food available globally would be sufficient to meet the needs of humankind. Economic disparities are evident in consumption patterns. The amount of animal protein foods consumed by the wealthiest 20% of the world’s population is fourfold that of the poorest 20% (Uauy, Hawkesworth, and Dangour, 2014). In 2011, an estimated 925 million people suffered chronic hunger. Almost all the world’s undernourished live in developing countries, with 578 million in Asia and the Pacific and 239 million in sub-Saharan Africa. (See the map at www.wfp.org/hunger/map.) Five of the top 10 cost-effective solutions for development focus on nutrition (World Food Program, 2011). Multiple organizations, both governmental and private, are working to feed the hungry (See Box 1-1). AGRICULTURAL INNOVATIONS TO COMBAT HUNGER At least half the world’s food-insecure people are poor, small farmers working marginal lands without modern productivity enhancements (Fanzo and Pronyk, 2011). Scientists are working to improve plants, animals, and food products. The goals are to discover sustainable changes to agricultural practices in developing countries and to increase the nourishment in the food raised. Plant genetics remains a key component of global food security. Millions of lives depend on the extent to which crop genetic improvement can keep pace with the growing global population, changing climate, and shrinking environmental resources (Ronald, 2011). Following are some examples of work being accomplished. Diversifying Crops. In Kenya, just 10 of 210 species of leafy vegetables were marketed at baseline. A project in Nairobi to educate farmers, to stimulate demand for the
Box 1-1 ■ Feeding the Famished Global food aid deliveries in 2010 totaled 5.4 million tons, twothirds of it delivered by the United Nations’ World Food Program. One ton of mixed commodities will feed about 1800 persons for one day (World Food Program, 2011). A new fully cooked food-aid product has been developed to be used as a supplemental food ration for delivery overseas for humanitarian feeding programs. Uncooked blends were subject to spoilage and tended to have uneven distribution of vitamins and minerals. The processing of this instant corn-soy blend uses high heat and high pressure to cook the mixture completely in less than two minutes; it is then milled to a powder to be added to potable water and eaten as porridge (Bliss, 2011).
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“other” vegetables, and to distribute the produce effectively was successful. Within 3 years, produce delivery to market swelled from 31 to 400 tons per month, and increased the incomes of the monitored farmers 2- to 20-fold (Fanzo and Pronyk, 2011). Controlling Plant and Animal Diseases. Mapping the human genome is not the only genetic breakthrough affecting nutrition. Both plants and animals are under investigation for their potential to minimize losses from diseases. Rice is the main dietary staple for more than half the world’s population. It is grown in 114 countries on six continents (Ronald, 2011). A Japanese variety was the first rice genome to be sequenced, thus permitting researchers to determine which genes control certain traits such as disease resistance. Just as microorganisms develop immunity to antibiotics given to humans, plant pathogens also evolve so that the plant needs multiple genes to confer resistance (Durham and Avant, 2011). Rice blast, caused by a fungus, affects the plants in all stages of development. Geneticists at the USDA Agricultural Research Service developed molecular markers to screen for resistance genes (Yao and Flores, 2010). See Chapter 7 for information about arsenic in rice. Corn has been genetically engineered to produce proteins from the soil bacterium Bacillus thuringiensis which kills some key caterpillar and beetle pests. Consequently, lower amounts of chemical insecticides are used, thus reducing costs while protecting the environment (Ronald, 2011). Scientists are looking for areas in the cattle genome that support tolerance to tickborne diseases. A particular breed of South African cattle has such tolerance but has other traits that keep it from becoming the most marketable steer. If the desirable genes can be discovered, breeders will have sound knowledge to use when selecting animals for reproduction. A second objective of the Agricultural Research Service in South Africa is to help select breeds of cattle best suited for dairy ranching. In this operation, cows and calves graze together during the day but the calves are separated from their mothers at night so that the cow can be milked in the morning for daily income for the farmer. The calves still receive enough milk to grow and stay healthy (O’Brien, 2011). Enhanced Nutritional Content. Only a small percentage of corn varieties have naturally high levels of carotenoids, precursors of vitamin A. Researchers have discovered two genes in corn linked to higher beta-carotene levels as well as a faster, less expensive method to screen corn plants for more genes to produce even higher levels of the nutrient. Ultimately, the levels of carotenoids in Africa’s corn could be at least tripled (O’Brien, 2010).
More than 250 million Africans rely on the starchy root crop cassava as their staple source of calories. A typical cassava-based diet, however, provides less than 30% of the minimum daily requirement for protein and only 10 to 20% of that for iron, zinc, and vitamin A. Efforts to develop genetically engineered cassava with increased amounts of those nutrients are underway. Additional goals are to increase shelf life, boost resistance viral disease, and reduce toxic cyanogenic glycosides (see Chapter 4) to safe levels (Sayre, Beeching, Cahoon, Egesi, et al, 2011). Progress toward the United Nations’ Millennium Development Goal of reducing the proportion of people who suffer from hunger by half between 1990 and 2015 has been mixed. Of the 117 countries analyzed by UNICEF, 63 are on track to meet the target. Of the 20 countries that made no progress toward the goal, most are in Africa (Fanzo and Pronyk, 2011). The scientific advance of incorporating genes from other plants and bacteria into the rice gene, creating Golden Rice by adding beta-carotene, had not reached the poor farmers who desperately need it 14 years after its invention. Despite the donation of the technology by its inventors to the poor of the world, political and regulatory burdens plagued its dissemination. Fears of harm have been discredited by the United Nations’ Food and Agriculture Organization. Academies of science throughout the world have declared genetic modification of plants to be no more hazardous to people or the environment than are conventional plant breeding techniques (Dubock, 2012). See Chapter 6 for information on vitamin A deficiency that Golden Rice promises to cure.
Nutritional Care Nutritional status refers to the body’s condition related to the intake and use of nutrients. All members of the health-care team have roles in the effective evaluation of a client’s nutritional status. See Team Work 1-1. Dietary status describes what a client has been eating. Although a client’s dietary status may be adequate, his or her nutritional status may be poor. An evaluation of a client’s dietary status can help to determine the reason for this poor nutritional status, or it may rule out poor diet as the source of the client’s problem. Providing nutrition care usually involves several health-care providers to conduct the four steps of the process: assessment, analysis/diagnosis, planning/ intervention, and monitoring/evaluation. Fictional case studies throughout this book integrate the steps to provide nutritional care for the described clients with commonly encountered problems.
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13
TEAM
TEAM
WORK 11 Health-Care Providers in Nutrition Delivery
WORK
A client’s health-care team may include more than 15 members. The following are the respective titles and responsibilities of the major members of the health-care team.
Medical assistants are responsible for taking vital signs and measuring a client’s height and weight. When this information is not available, a complete nutritional assessment is not possible.
Registered nurses (RNs) are often the first team members to interview a client, and they communicate important nutritional information such as a client’s response to food, including intake and tolerance, to other team members. In addition, they identify and refer clients at high nutritional risk to other team members, and they provide some nutritional information to clients.
Clinical pharmacists (RPhs) prepare, preserve, and compound medicines and parenteral nutrition preparations and dispense them according to the prescriptions of physicians. They function as valuable resources for all team members and may also counsel clients about food–drug and drug–drug interactions.
Licensed practical nurses/licensed vocational nurses (LPNs/LVNs), supervised by RNs, feed clients, monitor food consumption, measure intake and output, and record data. Registered dietitians (RDs) and physicians are responsible for meeting clients’ nutritional needs. Dietitians interpret the physician’s diet order in terms of clients’ food habits and food choices, calculate clients’ nutritional requirements, evaluate clients’ response to therapeutic diets, recommend the best route for nutrient administration, enteral or parenteral, and provide in-depth nutrition education and counseling to clients. Among team members, the registered dietitian usually has the most education and training in the nutritional sciences. Dietetic technicians (DTs) assist dietitians by taking nutrition histories and body measurements, reviewing records, and monitoring clients’ food intake. They are often responsible for screening clients for nutritional risk and referring clients at risk to the registered dietitian. Physicians are responsible for the diagnosis and treatment of medical conditions. They manage medical care, order laboratory tests, and prescribe medications and diets. Physicians are responsible for communicating the diagnosis and explaining treatment options to clients. Treatment options should always be presented to clients at the same time they are given bad news. Only the physician or the designee can order diagnostic tests, medications, and other treatments.
Assessment Initiation of nutrition assessment in a timely manner is a requirement of accrediting and licensing agencies. Two levels of methodology are commonly used to identify clients at nutritional risk. Institutions are likely to select
Speech pathologists diagnose and treat swallowing disorders along with other nonnutrition-related disorders. Diagnosis involves determining the type of dysphagia the client manifests (see Chapter 9). Treatment for swallowing disorders may include exercises, positions, and strategies such as changing food and liquid textures for easier and safer swallowing. Occupational therapists recommend strategies to assist clients with disabilities attain maximum functioning in activities of daily living; regarding nutrition, they may provide assistive feeding devices or help modify food preparation areas. Social workers assess the family support system and link clients with services to help with care; they also provide assistance with financial concerns related to health care and with obtaining appropriate levels of care. Other health-care personnel who may be involved in client care include medical technologists, nurse practitioners, and psychologists. Many health-care personnel have advanced training and certification in one specific area. For example, both RNs and RDs may elect to obtain Certified Diabetes Educator (CDE) certification. Identifying a problem but having insufficient resources to address it is more likely than having too much assistance from other team members. Many functions of health-care personnel overlap to avoid missing a client’s problem (see Dollars & Sense 1-1).
a screening technique expected to identify nutritional problems common in their clientele. Although no nutritional screening tool is considered the gold standard for identifying nutritional risk, a comparison of four such tools found that each identified such clients at risk. Moreover, those at nutritional risk indeed developed
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1-1 All health-care workers’ roles are interconnected. Often coworkers cannot function efficiently unless someone else has completed his or her assigned duties in a timely fashion. For example, the dietitian cannot accurately estimate a client’s nutritional needs without an accurate height. The physician is hesitant to order a tube feeding without the dietitian’s recommendations, and the pharmacist will not mix a solution without a client’s weight. Delays in obtaining such information can have a significant impact on the cost of health care.
from 48% to 280% more complications during hospitalization and had a 1.6-day to 2.2-day longer hospital stay than those not identified to be at nutritional risk (Velasco, Garcia, Rodriguez, Frias, et al, 2011). A nutritional screening should be brief enough that the information can be gathered quickly. The time to administer the tool may be extremely brief because if a key factor is found to be present, the screening is stopped, and the client is declared at nutritional risk and referred to a dietitian. More comprehensive than screening, a nutritional assessment is the second level of methodology. It is an evaluation of a client’s nutritional status (nutrient stores) based on a physical examination, anthropometric measurements, laboratory data, and food intake information. Many members of the health-care team are involved in a comprehensive nutritional assessment, including the physician, dietitian, nurse, social worker, and laboratory staff. Because it requires considerable resources, this second level of nutritional assessment is usually completed only in the cases of clients at high nutritional risk. For example, a surgeon may order a comprehensive nutritional assessment before surgery to determine whether the client could tolerate a procedure better after nutritional rehabilitation. Assessment involves an organized and systematic search for pertinent subjective (what the client reports) and objective (what the health-care provider measures) data. (See samples in Table 1-3.) Note the difference between a client’s reported height and weight as subjective data and the health-care provider’s measured height and weight as objective data. Sometimes they may be identical, but not always. A conscientious search for accurate data creates a sound foundation on which to build nutritional care.
Subjective Data Subjective data as they relate to nutrition include the client’s history from an interview, or questionnaire, or food diary. Information on of the five techniques listed
TABLE 13
■
Sample Subjective and Objective Nutritional Data
SUBJECTIVE
OBJECTIVE
Usual diet and fluid intake Number of meals per day Last meal: time, foods, beverages, and amounts Food and nutrient supplements Appetite Problems with digestion and/or elimination Allergies or food intolerances Usual alcohol consumption Chewing and swallowing problems Use of dentures Usual weight and recent changes Food Likes and Dislikes
Measured height and weight Edema, severity, location Skin turgor and/or dryness Condition of teeth and gums Hair quantity and quality Body fat measurements Complete blood count Serum albumin Serum electrolytes
in Table 1-4 may be used. Some of the advantages and disadvantages of each are listed in the table. Of special concern are the food frequency questionnaires, food records, and dietary recalls are based on self-reported data. Any of them can contain errors because of inadequate recall and serious underreporting of kilocalorie intake by obese people (Rasmussen, Winning, Savorani, Toft, et al, 2012). Neither reported dietary intake nor any other item of assessment data is suitable to use as the sole criterion of nutritional status.
Objective Data A physical examination can include general appearance, anthropomorphic measurements, and laboratory or other diagnostic tests. GENERAL APPEARANCE Well-nourished people generally look healthy and usually have an optimistic perspective. Table 1-5 compares the appearance of a well-nourished individual with that of an individual who is less well nourished. A person need not display all of the abnormal signs listed to be regarded as malnourished. ANTHROPOMETRIC DATA For clinical purposes, body size, weight, and proportions are determined by anthropometry, the science of measuring the body. Such measurements are used to determine growth, body composition, and nutritional status. The body’s energy and protein stores also can be derived from these measurements. Underwater weighing and dual-energy x-ray absorptiometry (DEXA) are considered the gold standards for body composition assessment (Wang, Lim, and Caballero, 2014).
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TABLE 14
■
15
Commonly Used Techniques to Obtain Food Intake Information
TECHNIQUE
ADVANTAGES
DISADVANTAGES
Can be used to screen many clients quickly. Requires a minimally trained interviewer.
Is not comprehensive. May overlook some clients who would benefit from nutritional care.
Questionnaire can be tailored to particular nutrients of interest (e.g., lactose, gluten). May assess food usage for any length of time: day, week, month, weekends versus weekdays, summer versus winter, etc. Initial client contact does not require a highly trained interviewer.
May require special resources (e.g., computerized database) to evaluate the information collected. Provides limited information on a client’s food behaviors such as shopping and preparation, meal spacing, length of usual mealtime, etc.
A motivated client will provide reasonably accurate information. Research shows some clients will change their food habits while keeping a food record; therefore, this technique works well when a behavior change is desired.
A less highly motivated client will “forget to keep” part or all of the food record or record questionable amounts. Thus, this technique could yield inaccurate data to determine a client’s actual dietary and/or nutritional status. May require special resources (e.g., a computerized database) to evaluate the information obtained. Requires a follow-up visit to review the evaluated food records. Analysis of data is time-consuming.
Technique is fairly simple. Interviewer should be trained not to ask leading questions.
Yields limited information. The previous 24 hours may not have been usual for the client. Typically, clients may not remember what they ate and the amounts they ate. Estimates of amounts are frequently inaccurate.
Technique is comprehensive. Requires a highly trained interviewer, usually a dietitian. An analysis of the results obtained can usually be provided on the same day the information is collected. Is a good technique for high-risk clients when information is needed to evaluate the need for nutritional support and the likelihood of dietary prescriptions being implemented.
Is highly dependent on the willingness of the client to reveal information to the interviewer. Client must be a good historian. Technique is time-consuming.
Comparison With the MyPlate Model
Health-care provider asks client what he or she eats and compares this reported food intake with MyPlate Model. Food Frequency Questionnaire
Health-care provider requests client fill out a questionnaire asking about usual food intake during specified times, such as, “What do you usually eat for breakfast?”
Food Records
Health-care provider asks client to record his or her food intake for a specified length of time (1, 3, or 7 days).
24-Hour Dietary Recall
Health-care provider asks client what he or she has eaten during the previous 24 hours.
Diet History
Health-care provider conducts an in-depth interview to obtain information about usual food intake, drug and medication usage, alcohol and tobacco use, financial and physical ability to obtain food, special dietary needs, food allergies and intolerances, weight history, cultural and religious preferences that may influence food selection, ability to chew and swallow foods, previous dietary instructions received, client knowledge about nutrition, and elimination patterns.
The collection of anthropometric data on height and weight—triceps skinfold, midarm circumference, abdominal circumference, waist measurements, and body density measures—is described briefly in the following sections. Other measurements may also be selected. Height and Weight. These are the most widely used anthropometric measurements, and their derivative, the body mass index is the most commonly used indirect indicator of obesity and body adiposity (Wang et al, 2014). Height may be measured in inches or centimeters. Adults and older children are measured standing with head erect; infants and young children are measured lying on a firm, flat surface. Weight may be recorded in pounds or kilograms. The agency policy regarding calibration of the scale should be followed. Each time the client is weighed, it should be on the same scale at the same time of the day, and the client should be wearing the same kind of clothing.
Triceps Skinfold. Because skin is typically only 0.5 to 2 millimeters thick, skinfolds can be used as a measure of underlying fat. For this site, the tissue over the triceps muscle in the back of the upper arm is measured with calibrated calipers (Gropper and Smith, 2013). The triceps skinfold measurement helps to differentiate between a person who is heavy because of muscle mass and one who is heavy because of excess fat. Dietitians usually take skinfold measurements, a skill requiring much practice. All measurements should be repeated two or three times with the average recorded as the skinfold value. A skilled provider may achieve accuracy within 5% (Gropper and Smith, 2013). Body areas other than the triceps can also be used to measure skinfolds. When measuring extremities, if U.S. survey data are the standard of comparison, the right side of the body is used. In the United Kingdom and some other locales, the left side is used (Gropper and Smith, 2013).
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16 TABLE 15
Demeanor Weight Hair Eyes Lips Tongue
Teeth
■
General Appearance as an Indicator of Nutritional Status
NORMAL
ABNORMAL
Alert, responsive Positive outlook Reasonable for build
Lethargic Negative attitude Underweight Overweight, obese Dull, sparse; easily, painlessly plucked Pale conjunctiva Redness, dryness Chapped, red, swollen Bright red, purple Swollen or shrunken Several longitudinal furrows Painful, mottled, or missing, dental caries Spongy, bleeding, receding Rashes, swelling Light or dark spots Dry, cracked Spoon shaped or ridged Spongy bases Muscle wasting Skeletal deformities Loss of balance
Glossy, full, firmly rooted Uniform color Bright, clear, shiny Smooth Deep red Slightly rough One longitudinal furrow Bright, painless
Skin
Pink, firm Clear, smooth, firm, slightly moist
Nails
Pink, firm
Mobility
Erect posture Good muscle tone Walks without pain or difficulty
Gums
Midarm Circumference. Because 50% of the body’s protein stores are located in muscle tissue, the circumference (the outside edge of a circle) of the midarm provides information about body protein stores. The upper arm is measured between the shoulder and the elbow. The midarm circumference measurement is easily obtained and can be used to monitor a client’s nutritional progress. Waist Measurements. A standard procedure should be used for waist measurements that are recorded in inches or centimeters according to agency procedure. In general, with the person standing, the waist is measured at the narrowest site. The tissue should not be compressed. Abdominal circumference or girth is also used to monitor growth of a fetus or of abnormal tissue within the abdomen. The measure is also valuable when an individual is accumulating fluid in the abdominal cavity, a condition called ascites. Body Density Measures. Muscle and fat tissue have different rates of metabolism. Therefore, the proportions of each in the body influence whether a person is overweight. These proportions can be determined by several techniques, including underwater weighing, dual-energy x-ray absorptiometry (DEXA), and bioelectrical impedance. Underwater weighing compares the person’s scale weight with his or her weight underwater. After correcting
for lung volume, the examiner calculates the proportion of body fat. Underwater weighing provides the most accurate assessment of the amount of fat in the body. It is not easily determined, however. Even in research studies, several measurements must be taken and averaged to obtain a value that minimizes error. Because the technique is cumbersome, time-consuming, and requires special equipment, its main use is in research. In DEXA, two x-ray beams are passed through the body. The amount of energy detected after the beams pass through the body varies with bone, fat, and muscle tissue, and the percentage of those tissues in the body can be calculated. The x-ray exposure is relatively low: 1 to 10% of that used for a chest x-ray (Gropper and Smith, 2013), and unlike bioelectrical impedance, discussed next, DEXA is not affected by the client’s hydration status (Moran, Lavado-Garcia, and Pedrera-Zamorano, 2011). In clinical practice, DEXA is used to measure bone mineral density as an indicator of conditions marked by bone loss, such as osteopenia and osteoporosis (see Chapter 7). A screening test to determine a person’s level of risk for those conditions can be conducted with an ultrasound bone densitometer that involves no radiation exposure. In the bioelectrical impedance test, electrodes on the extremities are stimulated with a small amount of electrical current, which is then measured at the exit electrodes. Muscle tissue, organs, and blood, rich in water and electrolytes, allow an electrical current to pass with greater ease than does denser fat tissue. The greater electrolyte content and conductivity of the body’s fat-free mass is compared with that of fat. Currents are not painful and usually are not felt because of the small amount of current used. Body composition is predicted from equations developed on specific populations and may not be valid for tests performed on other groups. The client’s fatfree mass is predicted, and his or her percentage of body fat is determined by comparing body weight with the predicted fat-free mass. The three measurements obtained are percentages of the following: 1. Body water 2. Lean body mass 3. Body fat Because bioelectrical impedance is based on total body water, any factors disturbing water balance may alter the results. Examples are diuretic use, excessive sweating, hemodialysis, premenstrual edema, and alcohol consumption within the 24 hours before the test. This technology is the basis for the bathroom scales that measure body fat. Because the feet are the only contact places for the current to enter and exit, the scales are limited to estimating the fat in the lower body (Buzzell and Pintauro, 2012).
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LABORATORY TESTS Laboratory tests analyze body fluids and excretions. These data include results from blood, urine, and stool tests. From these tests, much information can be obtained concerning what a person has eaten, what his or her body has stored, and how the body is using nutrients. Blood can be analyzed for glucose, protein, or fat content. Vitamin and mineral status can be determined directly by examining the blood or indirectly by examining enzymes related to the vitamin or mineral. Many experts doubt, however, that vitamin or mineral body stores can be accurately determined by blood samples. The uncertainty lies in whether the nutrient in the blood reflects body stores, a transport form of the nutrient, or the amount in one specific body compartment. Also circulating in the blood are metabolites that are formed in and by the body as it processes food and nutrients. An international project documented 84% of the human serum metabolites and electronically published a catalog of 4229 of them for the use of scientists. In the future, a person’s metabolic fingerprint might reliably evaluate his or her health and risk for certain diseases (Wood, 2012), fine-tuning presentday measures of cholesterol, for instance, which is an imperfect predictor of health or illness. Good clinical judgment must be used in selecting tests and interpreting results. Reliance on a single test or single reading is not recommended.
assessed at low cost, and has a strong association with body fat and health risks, it is regarded as the best choice of available measures of body fatness (Wang et al, 2014). Clinical Calculation 1-1 shows the calculations using metric and American measurements. Although not identical, the results are close when calculated without rounding until the final result at three decimal places. For an approximate value using whole numbers, see Table 16-2. Internet calculators can be found at www. nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm. and www.cdc.gov/healthyweight/assessing/bmi Having derived a value for BMI, what meaning does it have for one’s health? In general, the following classifications are used: ■ ■ ■ ■ ■
BMI of 18 or less: Underweight BMI of 19 to 24: Normal BMI of 25 to 29: Overweight BMI of 30 to 39: Obese BMI of 40 or greater: Morbidly obese
Those standards were developed using Caucasian subjects. Alternative cutoff points recommended for Southeast Asians and Asian Americans to optimize diabetes care are as follows: ■ ■ ■ ■ ■
BMI less than 18.5: Underweight BMI of 18.5 to 22.9: Normal BMI of 23 to 24.9: Overweight BMI of 25 to 29.9: Obese BMI of 30 or greater: Extremely obese (Mechanick, Marchetti, Apovian, Benchimol, et al, 2012).
Analysis/Diagnosis The health-care provider uses subjective data, objective data, or both to identify the level of the client’s wellness regarding nutrition. The client’s physical findings are compared with standard nutritional parameters. His or her dietary intake is compared with that recommended for his or her age and activity level.
17
1-1
Clinical Calculation Body Mass Index Consider a person 5 feet, 10 inches tall who weighs 170 pounds. To calculate this body mass index using metric measures: BMI = weight in kilograms/(height in meters)2
Physical Standards The data gathered for a client is compared with expected results for similar clients. Commonly used standards include body mass index and waist measurements. BODY MASS INDEX The BMI, also known as the Quetelet Index, is derived from weight and height and was designed to provide a measure of weight independent of height. Although the BMI has been used as an indicator of obesity, it fails to distinguish adipose tissue from muscle or water weight. For very athletic individuals, BMI charts may falsely indicate obesity when the major body mass is not fat but muscle. Because the BMI is noninvasive, easily
1. Convert 70 inches to meters: Divide 70 by 39.37 (inches/meter) = 1.778 meters 2. Convert pounds to kilograms: Divide 170 by 2.2 (pounds/kilogram) = 77.273 kg 3. Insert values into BMI formula: BMI = weight in kilograms/(height in meters)2 77.273/1.778 ⫻ 1.778 77.273/3.161 = 24.446 Using the same values in an alternative American measures formula: Weight in pounds ⫻ 705; Divide by height (in inches); divide result by height in inches 170 ⫻ 705 = 119,850/70 = 1712.143/70 = 24.459
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The minimum survivable body weight in humans is a BMI of approximately 13. The maximum survivable body weight is a BMI of about 150 (Going, Hingle, and Farr, 2014). WAIST CIRCUMFERENCE Waist circumferences of more than 40 inches in non– Asian American men and 35 inches in non–Asian American women are related to increased risks of diabetes and cardiovascular diseases. In Asian men the risks increase with a waist measurement of 36 inches; in Asian women, 32 inches. Although relatively insensitive as a measure of the fatness of the viscera, waist circumference is widely used as a surrogate for visceral adipose tissue. In combination with BMI, waist circumference predicts disease risk better than either measure alone (Going et al, 2014).
Dietary Intake A client’s reported or recorded food intake can be grouped according to the classifications in MyPlate or individual foods can be analyzed using a computerized diet analysis program. ANALYSIS BY FOOD GROUPS A simple method of comparing a client’s reported intake with that recommended for him or her is to focus on the food groups found in MyPlate. Online calculation is available at www.choosemyplate.gov/supertracker-tools/ supertracker.html. Omitting entire food groups raises serious concerns about the adequacy of dietary intake and merits further investigation. Remember the phrase “Garbage In, Garbage Out” pertaining to computer user fallibility; the same can be applied to dietary intake—errors are likely if amounts consumed are estimated rather than measured. ANALYSIS OF NUTRIENTS More detailed information can be obtained by examining foods for their component nutrients and comparing the client’s data to Dietary Reference Intakes (described later). This process can be performed manually or electronically. The USDA publishes National Nutrient Database for Standard Reference and updates it annually. It contains data on nearly 8000 food items and up to 146 food components. It serves as the foundation for most food composition databases in use such as those in ChooseMyPlate.gov, commercial weight-loss firms, and apps for mobile hand-held devices. The food industry, commercial businesses, government groups, research and academic institutions, and local schools and hospitals all use the information copyright-free,
provided as a public service (Bliss, 2012). Search for nutrient content of individual foods at http://ndb.nal. usda.gov. One user-friendly Web site with many nutrition management and calculation tools is found at http:// nutritiondata.self.com/. Owned by Condé Nast Publications and based on the USDA National Nutrient Database for Standard Reference, its goals are to provide accurate, comprehensive, accessible, and understandable nutrition analysis. Its tool to rank foods by highest or lowest concentrations of nutrients can be found at http://nutritiondata.self.com/ tools/nutrient-search. Whether analyzed manually or electronically, care must be taken when selecting food items. For example, selection of “orange juice concentrate” instead of “orange juice” will skew the analysis badly. Regardless of the process used, the data accumulated need correct interpretation. The only scientifically correct statement justified when intake falls short of recommended levels is that the intake for a given period does not meet whatever standard is being used as a measuring stick. It is inappropriate to base a judgment of nutritional or dietary status solely on one piece of information.
Planning/Intervention The next step in providing nutritional care is to plan a strategy that addresses identified problems to treat or strengths to reinforce. Depending on the availability of resources, the strategy often involves referral to a dietitian.
Prioritizing Problems To be successful in stimulating behavior change, the health-care provider and the client must prioritize the problems and select acceptable interventions. Making one or two changes may be easier for the client to sustain than overhauling the client’s entire diet. For that reason, selecting the interventions most likely to make a major difference in the client’s health status is important. Except for teaching basic nutritional information, a nurse is likely to refer the client to a dietitian when one is available, particularly if the nutritional problem is severe or complex. Nurses with advanced training in nutrition, such as Certified Diabetes Educators, may assume the responsibility for a client’s nutrition as part of comprehensive care. Referral to a dietitian has two functions: 1. Ensuring comprehensive care. 2. Increasing the client’s awareness of the need for and benefits of nutritional services.
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Using Dietary Reference Intakes To focus care more finely than the broad approach using food groups, a client’s dietary intake can be compared with Dietary Reference Intakes (DRIs). One of the categories retains an old title, Recommended Dietary Allowances (RDAs). For a brief history of the origin of the RDAs, see Box 1-2. When first introduced, the RDAs focused on preventing deficiency diseases. Recent research supports a role for certain nutrients in reducing the risk of chronic diseases. This information has been factored into the standards for North America since 1997. In addition to RDAs for vitamins and minerals, DRIs have been established for the macronutrients (carbohydrate, fat, and protein) and for water and electrolytes. The DRIs are composed of five nutrient-based reference values that can be used for assessing and planning diets for groups according to life stage and gender. The DRIs are intended to apply to the healthy general population and refer to average daily intakes for 1 or more weeks. The components of the DRIs are as follows: ■
■
■
Estimated Average Requirements (EARs): Intake that meets the estimated nutrient needs of 50% of the individuals in the defined group. EAR is used to set the RDA and to assess or plan the intake of groups. Recommended Dietary Allowances (RDAs): Intake that meets the needs of 97 to 98% of individuals in the defined group. RDA is intended for use as a goal for daily intake by individuals, not for assessing the adequacy of an individual’s nutrient intake. Adequate Intakes (AIs): Average observed or experimentally determined intake that appears sufficient to meet individuals in the stated group. AI is used if an EAR or RDA cannot be set because of lack of information.
■
■
19
Acceptable Macronutrient Distribution Range (AMDR): Percentage of kilocalories (see Chapter 5 for information on kilocalories) from carbohydrate, fat, and protein associated with reduced risk of chronic disease while still providing sufficient intake of essential nutrients. Only the AMDR for protein has been set with the certainty of the RDA (see Appendix A). Figure 1-4 illustrates a single meal that complies with the AMDR. Tolerable Upper Intake Levels (ULs): Highest average daily intake by an individual that is unlikely to pose risks of adverse health effects in 97 to 98% of individuals in the defined group. Ordinarily the UL refers to intake from food, fortified food, water, and supplements; exceptions are footnoted in the table in Appendix A. The UL is designed for the general population and may be exceeded under medical supervision in clients with special needs.
Because the RDAs and AIs represent the quantities of nutrients found in typical diets in the United States and Canada, caregivers must adjust their planning for clients who take supplements or follow unusual diets. Table 1-6 compares and gives examples of these components of the DRIs. The DRIs, except the EARs, are listed in Appendix A.
Implementation After assessment, diagnosis, and planning, the next step is implementation. It may take time and patience to select appropriate interventions for an individual client
Box 1-2 ■ The Birth of the RDAs In 1940, as the United States geared up for its inevitable entrance into World War II, concern was raised about the nutritional status of military recruits and of the population in general. On the basis of studies conducted in the 1930s, an estimated one-third of the populace was not well nourished. Although the quantity of food was sufficient, the number of nutrient deficiencies documented indicated that the quality was inadequate (Yates, 2006). The U.S. National Academy of Sciences convened the Food and Nutrition Board, which first met in November 1940. It proposed the first set of RDAs in April 1941 covering the nine nutrients known to be essential for human health at the time: protein; calcium; iron; vitamins A, C, and D; thiamin; riboflavin; and niacin. Kilocalories were listed in 1941 but had been delisted by 1989. To help to remedy nutritional deficiencies, during World War II, bread was subject to a war food order mandating enrichment with thiamin, niacin, and iron and eventually riboflavin (U.S. Food and Drug Administration, 2009; Yates, 2006).
FIGURE 14 A plate from a Chinese buffet shows an acceptable distribution of macronutrients; however, the Acceptable Macronutrient Distribution Range and all the Dietary Reference Intakes are recommendations for a week or longer.
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20 TABLE 16
■
Dietary Reference Intake (DRI) Components
DRI
PERCENTAGE OF HEALTHY POPULATION INCLUDED
EAR
50
RDA
97–98
AI
Unknown
UL
97–98
AMDR
Not specified
USE
EXAMPLES
Set RDAs Assess/plan for groups Goal for individual daily intake Goal for individuals Tentative goals for groups Monitor potential excesses Suggested allocation of kilocalories to optimize health
Not applicable to individuals 290 mcg of iodine for lactating women Vitamin K amounts for all ages Most nutrients for infants 45 mg of iron for all older than 14 years of age Protein should contribute 10%–35% of daily kilocalories for adults
AI, Adequate Intake; AMDR, Acceptable Macronutrient Distribution Range; EAR, Estimated Average Requirement; RDA, Recommended Dietary Allowance; UL, Tolerable Upper Intake Level.
or family. Eating wisely or unwisely involves choices every day, several times a day, that affect the budget as well as health (see Dollars & Sense 1-2). A given diet prescription may be implemented in various ways, but finding the approach a client will use faithfully is not only a challenge but also the key to success. Two food-based, as opposed to nutrient-based, interventions include (1) ChooseMyPlate and (2) Food Exchange Lists.
ChooseMyPlate Much assistance, including budget advice, tips for choosing healthy foods, menus, recipes, games and activities for children, as well as guidance for parents appear on this Web site. For clients who wish to use it, the USDA interactive Web site offers a personalized nutrition and physical activity plan that also permits tracking of a person’s progress at www.choosemyplate.gov/SuperTracker.
1-2 Choosing Snacks Wisely Veggies as snacks are not only healthier than salty munchies but also less costly and less kilocalorie dense. Item
Price
Serving Size
Kilocalories
Cost/Serving
Potato chips, national brand Baby cut carrots, store brand
$3.99/9.5 oz
1 oz, about 11 chips
160
$0.42
$1.69/lb
3 oz, about 13 carrots
35
$0.32
Food Exchange Lists For the person who desires more information about food choices besides “fill half your plate with fruits and vegetables,” the use of Food Exchange Lists offers the opportunity to combine nutrition education with dayto-day practice. Few foods contain just one nutrient; rather, most are combinations of nutrients. Originally the basis for medical nutrition therapy for people with diabetes, Food Exchange Lists sort foods into equivalent groups to allow swapping of foods within the group. The Food Exchange Lists are used to calculate a client’s food intake, to educate a client about nutrition and meal planning, and to counsel a client about food choices. The lists are often adapted for weight loss programs and are sometimes used on labels for prepared meals. UNDERSTANDING THE EXCHANGE LIST SYSTEM The system is composed of six exchange lists of foods grouped by nutrient composition. For example, corn is on the starch list because it is closer in composition to a slice of bread than to green beans. The six basic lists are: 1. Starch 2. Fruit 3. Milk in three groups: fat-free/low-fat, reduced-fat, and whole 4. Nonstarchy Vegetable 5. Meat and Meat Substitutes in four groups: lean, medium-fat, high-fat, and plant-based proteins 6. Fat in three groups: monounsaturated, polyunsaturated, and saturated Depending on the variety, cheese can be a lean, medium-fat, or high-fat meat exchange. Similarly, different cuts of pork can be a lean, medium-fat, or highfat meat exchange. For the complete lists, as well as combination foods that are counted in several lists, see Appendix B or the online resource at www.eatright.org/ search.aspx?search=Exchange%20lists. Table 1-7 identifies typical foods in each exchange list. In addition, some foods are considered “free” and are permitted in large amounts because they contain little energy (few kilocalories). Free foods are on a separate list. Some free foods have limitations on the amount to be consumed in a day or at one time. In addition, combination foods (soups, casseroles) and selected fast foods appear on separate lists. Table 1-8 displays the amount of carbohydrate, protein, fat, and kilocalories (energy) for one exchange on each list. As the table shows, one exchange on the fruit list is
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TABLE 17
■
FOOD ITEMS
Starch
Cereals, grains, pasta, dried beans, peas, lentils, starchy vegetables, bread, crackers Beef, pork, veal, poultry, fish, wild game, cheese, eggs, tofu, peanut butter Fresh, frozen, or unsweetened canned fruit; dried fruit; fruit juice Raw or cooked nonstarchy vegetables, vegetable juices Milk, yogurt, evaporated milk, powdered milk Avocado, margarine, butter, mayonnaise, nuts, seeds, oil, salad dressing, bacon, coconut, cream, sour cream, whipped cream, cream cheese, olives
Meat and Meat Substitutes Fruit Vegetable Milk Fat
A meal plan is a food guide that shows the number of choices or exchanges the client should eat at each meal or snack. Table 1-10 illustrates meal plans for two kilocalorie levels. The table also illustrates how the exchanges might be distributed among meals. In summary, exchange lists and meal plans:
Typical Foods in Each Exchange List
EXCHANGE LIST
21
■ ■ ■
Provide food choices that necessitate minimal calculation, Control the distribution of nutrients throughout the day, and Incorporate balance, variety, and moderation into special diets.
See the complete Exchange Lists in Appendix B (reprinted with permission of the American Dietetic Association, 2008) or access additional information at www.eatright.org/search.aspx?search=Exchange%20lists.
Evaluation and Documentation not equal to one exchange on the vegetable list. To use this method of meal planning correctly, clients must choose the correct number of items from each appropriate list. In this context, exchange means a defined quantity of food within a list that can be interchanged with other foods in the same list. Portion sizes in the lists for various items have been adjusted to make each exchange approximately equal. Table 1-9 shows items equal to one starch exchange. Clearly, 1 1/2 cup of puffed cereal would take longer to eat and be more filling than 1/3 cup of cooked rice.
After implementing a nutritional plan, the health-care provider and the client decide to what extent the objective has been met. If progress has been unsatisfactory, they explore the reasons, such as 1. 2. 3. 4.
Documentation of services provided is a basic requirement for all health-care providers. Nurses may use the Nursing Process; dietitians the Nutrition Care Process. The employing agency dictates the format for documentation. One system was designed for use by several disciplines. Employing such a universal format facilitates
USING THE EXCHANGE LISTS Exchange lists can be adapted for any prescribed kilocalorie, protein, fat, or carbohydrate level. A specific meal plan for a client should be given with the exchange lists.
TABLE 18
■
unrealistic expectations, insufficient time allotted, interventions not appropriate interventions incorrectly implemented or not implemented.
Energy Composition of the Six Exchange Lists
FOOD LIST
CARBOHYDRATE GRAMS
PROTEIN GRAMS
FAT GRAMS
KILOCALORIES
Starch Fruits Milk Fat-free (skim)/low- fat (1%) Reduced fat (2%) Whole Nonstarchy Vegetables Meat and meat substitutes Lean meat Medium fat meat High fat meat Plant-based protein Fats
15 15
0-3 —
0-1 —
80 60
12 12 12 5
8 8 8 2
0-3 5 8 —
100 120 160 25
— — — Varies —
7 7 7 7 —
0-3 4-7 8+ Varies 5
45 75 100 Varies 45
Source: Choose Your Foods: Exchange Lists for Diabetes, American Dietetic Association, 2008. Used with permission.
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22 TABLE 19
■
focus on problems that should assist the student to begin to think critically as well as to see the potential for comprehensive nutritional care.
Examples of One Starch Exchange 1 1/2 cups 1 /2 cup 1 slice 1 /2 cup
Puffed cereal Plain shredded wheat Bread, white, whole grain, rye Corn, whole kernel Green peas Sweet potato Rice, cooked
Impact of Culture on Nutrition
/3 cup
1
See the complete Exchange Lists in Appendix B (reprinted with permission of the American Dietetic Association, 2008) or access additional information at www.eatright.org/search.aspx?search= Exchange%20lists.
TABLE 110
■
1500- and 1800-kcal Meal Plan Using Exchanges for 1 Day 1500 KCAL
1800 KCAL
7 1 3 4 3 2 6
7 3 3 5 5 2 7
Starch Meat, lean Meat, medium Vegetable Fruit Milk, skim Fat
DISTRIBUTION OF EXCHANGES THROUGHOUT THE DAY 1500KCAL MEAL PLAN
Starch Meat, lean Meat, medium Vegetable Fruit Milk, skim Fat
BREAKFAST
LUNCH
2 0 0 0 1 1 2
2 1 0 2 1 0 2
DINNER 2 0 3 2 1 0 2
SNACK 1 0 0 0 0 1 0
Culture refers to all the socially transmitted behavior patterns (attitudes, beliefs, and customs) shared by most members of a particular group that guide their thoughts and actions. Although nation of origin, ethnic identity, and religious affiliation are prime examples of culture, other alliances such as colleges, corporations, professions, political parties, and service clubs also imbue people with values and behavioral norms. Health practices draw together people of similar habits, such as athletes or vegetarians. Thus, some aspects of culture are passed on from birth, but other aspects are voluntarily selected. All aspects of culture, including the family’s food ways, ethnicity, and religion, may influence an individual’s food choices. Figure 1-5 shows a multigenerational birthday party shaped in part by culture. Even among individuals of similar cultural heritage, differences exist. Dietary preferences, for example, differ among people of Hispanic descent from such diverse places as Cuba, Puerto Rico, and Mexico. Just because a person belongs to a certain ethnic or religious group does not mean that he or she has adopted its traditional lifestyle and practices. Caution is advised before replacing traditional food preparation techniques that have succeeded for generations; changes can sometimes foster disease. For example, botulism outbreaks were traced to substituting
communication among providers. An example is the system using SOAP notes. The letters stand for: S: Subjective data (explained earlier) O: Objective data (explained earlier) A: Analysis or diagnosis based on S and O data P: Plan of action or treatment Within an agency, the client’s problems may be numbered sequentially, and each SOAP note is numbered to correspond to a specific problem. In other systems, each encounter with the client is treated separately. The Teamwork Notes following the Case Studies in this text are written in the SOAP format even though that may not be the required documentation format in the clinical facilities used by students studying nutrition. SOAP notes have the advantage of simplicity and
FIGURE 15 Different cultures have their own ways to observe life’s milestones: births, birthdays, weddings, deaths. These children are sharing a birthday tradition with their 88-year-old great-grandmother.
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23
plastic bags for clay pots in preparing a Native American dish in Alaska and to swapping similar bags for waxed paper and wooden crates to ship smoked fish in Michigan. The plastic bags excluded air and permitted the botulism organism to produce its toxin. Another example is mad cow disease spreading widely after changes in feed production in England.
protein component. Compared with other diets, their kilocaloric intake is less, resulting in low BMIs. No single factor explains exceptionally long life. Centenarians escaped infant mortality, infectious diseases before antibiotics were available, and age-associated diseases through combinations of genes, environment, and chance that vary with culture and geography (Pignolo, 2010).
Relation to Longevity
Basic Terminology
Life expectancy is the prospect of a certain mean length of life at a specified age based on current mortality rates in the population being considered. In 2007, the disparities in life expectancy in the United States by gender and race were the smallest ever recorded (Centers for Disease Control, September 17, 2010). As shown in Figure 1-6, life expectancy at birth has risen for Whites and Blacks in the United States since 1970, but not equally for all. Certain groups display exceptional longevity that relates to nutrition. Although a single dietary pattern promoting longevity has not been recognized, kilocalorie restriction seems to play a role in persons surviving to the age of 100 years. Populations with an unusually high prevalence of centenarians all tended to be (or were) physically active, nonobese, and small in stature (Hausman, Fischer, and Johnson, 2011). Furthermore, in the United States, persons with slender or medium body builds at age 30 years had 2.6 times the chance of surviving to age 100 than did persons with “stout” body builds (Gavrilova and Gavrilov, 2010). Long-lived Okinawans ascribe to the dietary mantra of “eat until you are only 80% full.” They consume large amounts of fruits and vegetables with soy as the major
To provide sensitive health-care services to people different from oneself requires some introspection as to one’s own values and attitudes. Knowledge of a few terms from the study of culture will help to arrive at a level of self-understanding and perhaps increased respect for others.
QuickStats: Life Expectancy at Birth, by Race* and Sex United States 1970 - 2007 85
Ethnocentrism The belief that one’s own group’s view of the world is superior to that of others is ethnocentrism. Historically, the dominant cultural group in the United States has been White descendants of northern Europeans who are middle class and Protestant. As a result, our health-care system reflects the important values of this culture: ■ ■ ■ ■ ■
Education Work Punctuality Independence A future orientation
Health-care providers have tried, often unsuccessfully, to deliver this version of health care to clients without regard to the clients’ cultures. Hence, clients who failed to achieve goals imposed on them were labeled “noncompliant.” Clients unable to communicate in the dominant culture’s language were defined as having “altered communication.”
80
Acculturation 75 70 65 60 55
White female Black female White male Black male Overall
0 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2006
*Includes Hispanics and non-Hispanics.
FIGURE 16 Life expectancy at birth for U.S. Blacks and Whites, 1970 to 2007. Although all segments of the population gained some expected years of life, the ascent is steadier for Whites than for Blacks (Centers for Disease Control, September 17, 2010).
The process of adopting the values, attitudes, and behavior of another culture, acculturation, often encourages less desirable health behaviors than were previously practiced. For example, using preference for the Spanish language to signify less acculturation, the prevalence of breastfeeding by Hispanic women was significantly higher among less acculturated than among highly acculturated mothers. Those who were more acculturated, responding to the survey in English, were 12% less likely to initiate breastfeeding, 23% less likely to breastfeed for 10 weeks or more, and 30% less likely to report exclusive breastfeeding for 10 weeks or more than the less acculturated group (Ahluwalia, D’Angelo, Morrow, and McDonald, 2012).
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Another adverse effect of acculturation is the increase in various diseases in native populations. A major disease affecting widely scattered indigenous populations undergoing acculturation is type 2 diabetes mellitus. Before the 20th century, diabetes was virtually unknown among native people, but by 1987, most indigenous peoples had diabetes prevalence and mortality rates several times higher than comparable Caucasian populations (Ely, Zavaskis, and Wilson, 2011). The Pima Indians in Arizona currently have the highest recorded prevalence of diabetes in the world. On average, American Indian and Alaska Native adults are 2.6 times more likely to have diabetes than non-Hispanic Whites of similar age (Centers for Disease Control, 2011). Adopting the modern lifestyle, including dietary changes leading to obesity, is credited with contributing to the worsening the health status of native peoples. Acculturation can have positive as well as negative effects on dietary patterns. More than half the Chinese immigrants to Canada surveyed reported more awareness and knowledge of healthy foods, increased consumption of fruits and vegetables, and decreased deep fat frying of foods compared with their previous practices in China. Compared with more recently arrived immigrants, those who lived in Canada the longest however, reported consuming increased portion sizes, dining out more frequently, and using more convenience foods (Rosenmoller, Gasevic, Seidell, and Lear, 2011)
Culturally Competent Care Knowledge and acceptance of and respect for other cultures underpin culturally competent care, which is a willingness and ability to deliver culturally congruent and acceptable care to clients. Employing institutions can assist health-care providers by attending to demographic, cultural, and epidemiological characteristics of their service areas to plan for and implement services appropriate for the cultural and language needs of their clients (U.S. Department of Health and Human Services, 2007). Even though health-care providers cannot be experts on every cultural group they encounter, they can develop openness to learning the client’s perspective. The goal is a treatment plan that successfully blends the client’s cultural beliefs with the practices of modern medicine. Clients learn their attitudes about health, the causes of illness, and their abilities to control outcomes as part of their maturation within their cultures. Those with high self-efficacy will believe they can perform a given task or behavior and will be more amenable to nutritional prescriptions and change than someone with less faith in her or his abilities or a more fatalistic view of life. Clinical Application 1-2 illustrates the adaptation of diabetic teaching to Native American mythology and beliefs.
1-2
Clinical Application Using Ojibway Mythology in Diabetic Teaching A Toronto program capitalized on Ojibway mythology to provide diabetes self-care instruction. The program was organized at the request of Native Canadians and included day-long educational workshops conducted by an elder. All participants sat in a circle, which confers equal status on every individual and represents harmony with nature. The beginning focus was on Nanabush, a legendary teacher of the Ojibway who symbolizes moderation and balance. Traditional narratives show him conversing with Diabetes. The moral of the story is to learn about “Diabetes,” to live with him, and to control one’s life through spiritual strength. Workshop activities included exercise breaks and a buffet lunch that allowed participants to choose their meals. Practitioners learned that avoiding a rigid diet prescription would enhance the individual’s freedom, which was highly valued among the Ojibway (Hagey, 1984).
Food Preferences of Ethnic Groups Food items considered appropriate for human consumption vary widely by culture and reflect economic and geographic constraints. Rituals of preparation may be culturally determined, and allocation of food resources within a household may reflect the culture’s values. Ethnic identity is important in determining staple foods, meal structure, and traditional holiday feasts. Familiarity of cuisine may aid adaptation to unfamiliar circumstances. Among international postgraduate students in England, eating together was a popular leisure activity, with food of students’ home countries being the most popular menu items. Eating homecountry food offered emotional as well as physical sustenance (Brown, Edwards, and Hartwell, 2010). In addition, certain foods may be culturally endorsed treatments for disease. For example, many cultures espouse variations of the “hot–cold” systems described in the sections that follow on Hispanic Americans and Chinese Americans. Also, foods traditionally given to children when they are sick may bring comfort to ill adults as well. The following brief summaries describe traditional foods of four cultural groups and suggest possible applications for adapting nutritional needs to accommodate these preferences.
African Americans Traditional African American cuisine began with the necessity of making do with ingredients available to slaves. One-pot dinners serve to tenderize meat and flavor
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vegetables. These stews often contain pork and greens such as dandelion, turnip, and collards. Other foods often served are dried beans, sweet potatoes, rice, grits, cornbread, and specialty gravies (red-eye, sausage, or cream). Soul food signifies a shared heritage and loving preparation, not just favorite and familiar foods. African Americans who choose this type of food should be encouraged to use beans, rice, and sweet potatoes but to cook without a lot of fat, such as by
TABLE 111
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GROUP
GRAINS AND STARCHES
LATINO Mexican
Tortillas, corn products, potatoes, corn
Puerto Rican
Plantains (starchy vegetable that looks like a large banana), Puerto Rican bread (resembles Italian bread), rice, viands (starchy vegetable, the roots and tubers of which are peeled, boiled, and eaten as a side dish) Rice
Cuban
ITALIAN
SOUTHERN BLACK AMERICAN
ASIAN Southern Chinese
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steaming. Traditional foods can be prepared by baking, braising, broiling, or grilling instead of frying. Fatfree broths can be substituted for rich gravies.
Hispanic Americans The dietary pattern covered in this section is that of Mexican Americans. Table 1-11 lists characteristic foods consumed by Puerto Rican and Cuban people as
Characteristic Eating Patterns of Selected Cultural Groups FRUITS
Guava, canned peaches, pears, fruit cocktail
Pasta, yeast breads, starchy root vegetables
Cornbread, biscuits, white bread, butter beans, corn, sweet potatoes, grits, rice, white potatoes, yams Rice
MEATS AND MEAT SUBSTITUTES
MILK AND MILK SUBSTITUTES
Chili peppers, tomatoes, onions, beets, cabbage, pumpkins, string beans
Meat, poultry, eggs; pinto, calico, garbanzo beans
Cheese; milk seldom consumed
Beets, eggplant, carrots, green beans, onions
Legumes (especially red kidney beans), eggs, pork, chicken, cod, fish, pigeon, peas, garbanzo beans
Flan (custard); milk seldom consumed
Green peppers, onions, tomatoes
Black beans, pork, chicken, chorizo (a highly seasoned sausage) Spiced sausages, fish, tomato-based meat sauces
Milk seldom used
Catfish, pork, chicken, black-eyed peas, other dried beans and peas
Buttermilk, evaporated milk, ice cream (high incidence of lactose intolerance) Limited except for ice cream
VEGETABLES
Green peppers, onions, tomatoes
Melons, bananas, peaches
All
Kale, collards, mustard greens, okra, tomatoes, cabbage, summer squash Mushrooms, bean sprouts, Chinese greens, bok choy
Beef, pork, poultry, seafood
Cheese; milk seldom consumed (high incidence of lactose intolerance)
TO DECREASE FAT Encourage: ■ Salsa as dip or topping ■ Baked corn tortillas, especially stuffed with chicken to make tamales, tostados, or enchiladas ■ Rice with chicken or beans ■ Reduced-fat cheeses Discourage: ■ Fried tortillas ■ Sour cream and regular cheese as toppings ■ Refried beans that are cooked in lard ■ Deep-fried foods such as chimichangas
Encourage: Salad with no-fat dressing ■ Minestrone soup ■ Pasta with tomato or clam sauce ■ Grilled meat or seafood Discourage: ■ White sauces made with cream, butter, or cheese ■ Breaded and fried meats and vegetables ■ Sausages and other fatty meats such as prosciutto (salt cured, dry aged ham) Encourage: ■ Baked fish and chicken ■ Steamed vegetables ■ Fresh melon ■ Grilled foods Encourage: ■ Hot and sour soup; wonton soup ■ Steamed (not fried) dumplings ■
(continued)
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TABLE 111
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GROUP
GRAINS AND STARCHES
Characteristic Eating Patterns of Selected Cultural Groups (Continued) FRUITS
VEGETABLES
MEATS AND MEAT SUBSTITUTES
MILK AND MILK SUBSTITUTES
Northern Chinese
Wheat, millet seed used in noodles, bread, dumplings
Chinese greens, bamboo, alfalfa sprouts, bok choy
Beef, poultry, seafood, eggs, tofu, soybeans
None (high incidence of lactose intolerance among all Chinese)
Japanese
Rice, most other complex carbohydrates
All
Fish, beef, pork, eggs, poultry, shellfish, soybean products
None (high incidence of lactose intolerance)
Asian Indian
Rice, wheat, millet, barley, maize, ragi (Old World cereal grain)
Mangoes, bananas
Cabbage, cauliflower, onions, chilies, tomatoes, potatoes, green leafy vegetables, okra, green beans, root vegetables
Legumes, nuts (Many vegetarians depending upon region)
Yogurt, buttermilk, milk added to coffee and tea
EUROPEAN Middle Eastern
Pita bread, rice, couscous, bulgur wheat
Figs, peaches, dates
Grape leaves, tomatoes, peppers, olives, eggplant, onions, squash, fennel, okra, peas
Lamb, chicken, goat, legumes, fish, squid
Yogurt, feta cheese
Northern European
Dark breads, wheat breads, potatoes
All
All, especially onions, carrots, beans
Beef, pork, poultry, fish, shellfish, eggs, sausages
All cheese and milk products
NATIVE AMERICAN
Corn, wild oats and rice, Indian biscuits (Bannock bread)
Wild berries, choke cherries, black cherries, crab apples
Wild rhubarb, Indian celery, wild mushrooms and roots
Game, seafood, acorns, hazelnuts, pine nuts
Few used (high incidence of lactose intolerance)
TO DECREASE FAT Lightly stir-fried chicken or seafood ■ Steamed whole fish ■ Steamed vegetables and steamed rice Discourage: ■ Egg rolls ■ Crispy fried noodles ■ Fried rice ■ Deep-fried entrees ■ Spareribs ■ Tempura Encourage: ■ Broiled, poached, or steamed lean meats and poultry if nonvegetarian and religious practice permits ■ Steamed, stir fried, baked, or roasted vegetables ■ Olive oil, canola oil ■ Low-fat dairy products Discourage: ■ Deep fried breads and snacks ■ Coconut oil Encourage: ■ Baked or grilled lean meats and vegetables, legumes ■ Fresh fruit ■ Yogurt dressings Discourage: ■ Fried meats and fish, excess cheese, butter between layers of phyllo (pastry) ■ Sour cream Encourage: ■ Broiled, poached, or steamed lean meats ■ Wine- and tomato-based sauces ■ Consommé Discourage: ■ Creamed soups and sauces ■ Sausages ■ Whole milk and whole-milk products ■ Fried potatoes ■ Sour cream Encourage: ■ Game with visible fat removed ■ Broiled, poached, or steamed meats Discourage: ■ Excessive fish oil ■ Fried food ■ Lard in cooking ■
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well as other ethnic groups. The table also suggests means of decreasing fat intake. Corn is the staple crop of Mexico. Vegetables and meat are characteristically incorporated into a main dish and served with salsa. Foods are typically stewed or fried in oil or lard. Fruits are popular. Sweet foods, such as yeast pastries, are common in the traditional Mexican diet, and sugar is commonly added to foods. A health belief that may influence a Mexican American’s food choices is the hot–cold system. Illness and physiological conditions are categorized as “hot” or “cold.” Foods of the opposite category are eaten in an attempt to return balance to the body. Because these categories vary widely from region to region, it is best simply to ask clients what foods they would like to eat. The traditional Mexican diet can be adapted to the recommendations of the Dietary Guidelines with some changes in preparation. Beans can be boiled, for example, instead of refried; beef can be grilled instead of fried; diet drinks can be substituted for lemonade or soda. The starches and fruits that are part of the Mexican American diet can still be used. Despite being low in milk and milk products, the usual diet provides calcium from the long-established practice of treating corn with calcium carbonate before incorporating it into tortillas. In many areas of the United States, however, tortillas are made with flour, bypassing this traditional compensatory mechanism that increased calcium intake (Purnell, 2013).
Native Hawaiians Before the arrival of Westerners, native Hawaiians consumed a diet based on taro (a starch root similar to potato), sweet potatoes, breadfruit, fruit, greens, and seaweed. Fat content was approximately 10% of kilocalories. Foods were eaten raw or steamed. Adopting a Western diet has been detrimental to native Hawaiians’ health. Among all of the population groups in the United States, the prevalence of obesity among native Hawaiians is second only to that of the Pima Indians. Longevity is greater in Hawaii than in any other state, except among native Hawaiians, who have the shortest life span of the state’s ethnic groups. Native Hawaiians also have the highest mortality rates dues to cardiovascular disease compared with all ethnic groups in the United States (Fong, Braun, and Tsark, 2003; Shintani, Beckham, Tang, et al, 1999; Shintani, Hughes, Beckham, and O’Connor, 1991). An experimental diet was introduced to native Hawaiians to determine whether short-term dietary changes could alter their risk factors for cardiovascular disease. At the start, these individuals had an average BMI of 39.6. All of the food was provided in two onsite meals and take-home snacks. The evening meal included a cultural or health education session.
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During the 3-week experiment, the participants were encouraged to eat as much of the traditional Hawaiian foods as they wanted but limited amounts of fish and chicken. Participants’ average energy intake decreased 41%, and their serum cholesterol decreased 14% (Shintani, Hughes, et al, 1991). An average weight loss of 15.1 pounds was maintained for an average of 2.8 years of follow-up (Shintani, Beckham, et al, 1999). As detailed in later chapters, total fat and cholesterol intakes are linked to an increased risk of chronic disease. For these native Hawaiians, adopting an ancestral diet dramatically altered risk factors for diabetes mellitus and heart disease. Some of the program’s success was attributed to inspiring pride in their heritage, but another theory is presented in Genomic Gem 1-2.
Chinese Americans As is common of cultures throughout the world, Chinese cooking is based on the availability of foodstuffs. Wheat is produced in northern China, where noodles and dumplings are a major part of the cuisine, whereas rice grown in the south is the staple grain of that area. A common cooking technique involves cutting meats into bite-sized pieces in the kitchen. Experience with diseases resulting from poor sanitation led to avoidance of cold water and raw fruits and vegetables. Fruits and vegetables are cooked quickly to retain a crisp texture. Chinese medicine views sickness as an imbalance between yin and yang forces, a system that some compare to the parasympathetic and sympathetic nervous systems that control involuntary bodily functions. Certain illnesses, foods, and medicines are categorized as yin or yang. Yin, or cold, foods include pork, most vegetables, boiled foods, foods served cold, and white foods. Yang, or hot foods, include beef, chicken, eggs,
Genomic Gem 1-2 Ancestral Foods Much about the occurrence of diseases is still unknown, particularly why some populations seem to be more at risk than others and why certain dietary practices are more protective of some people than others. Perhaps the correct combination of genetic, cultural, and socioeconomic factors is needed to achieve the desired health benefit. If the metabolism of a group of people evolved to work optimally on an ancestral diet rather than with a modern diet, possibly the alleles that are associated with increased disease risk may be silenced in the presence of the more ancestral and traditional diet and lifestyle (Ordovas, Kaput, and Corella, 2007).
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fried foods, foods served hot, and red foods. Noodles and soft rice are neutral, neither yin nor yang. To maintain fluid intake, Chinese Americans prefer hot tea to ice water. Dairy products are rarely used. A caregiver interested in increasing a Chinese American’s calcium intake would probably achieve better results advocating green leafy vegetables or tofu rather than milk. Family members may cook food at home to provide the hospitalized client with hot or cold foods. Because yin and yang cover various categories of foods, cooking methods, and colors, the perceptive nurse or dietitian can suggest items or procedures that also fit the diet prescribed by Western medicine. Clinical Application 1-3 relates such a case.
Food Restrictions by Religious Customs Certain religious practices may promote healthy lifestyles. Among Thai persons with type 2 diabetes, higher scores for Buddhist values were significantly correlated with better medication self-care and better dietary self-care than among those with lower scores (Sowattanangoon, Kochabhakdi, and Petrie, 2008). Table 1-12 lists selected religious customs that affect food intake, but practices change with locale and over time. Individuals also vary in the extent to which they implement dietary restrictions.
TABLE 112
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Selected Religious Customs That Affect Food Intake
RELIGION
RESTRICTED FOODS AND BEVERAGES
Buddhism
1. All meat 1. Meat prohibited by some denominations on holy days such as Good Friday and Ash Wednesday 2. Alcoholic beverages by some denominations 1. Vegetarianism common 2. Regional avoidance of some meat, poultry, fish, eggs, and cheese 1. All pork and pork products 2. All meat must be slaughtered according to ritual letting of blood 3. Carnivorous animals, birds of prey, and land animals without external ears 4. Blood and blood byproducts 5. Alcohol and intoxicants 6. Shellfish (some shellfish by some members) 1. All pork and pork products 2. All fish without scales and fins 3. Dairy products should not be eaten at the same meal that contains meat and meat products 4. All meat must be slaughtered and prepared according to biblical ordinances; because blood is forbidden as food, meat must be drained thoroughly. 5. Bakery products and prepared food mixtures must be prepared under acceptable kosher standards 6. Leavened bread and cake are forbidden during Passover 1. All pork and pork products 2. Shellfish 3. All flesh foods (some members) 4. All dairy products and eggs (some members) 5. Blood 6. Highly spiced foods 7. Meat broths 8. All alcoholic beverages 9. Coffee and tea
Catholicism
Hinduism
Islam
Orthodox Judaism
Seventh-Day Adventist
1-3
Clinical Application Bridging Yin and Yang Beliefs and the Germ Theory of Disease A Chinese infant experienced repeated bouts of diarrhea. Several tests were performed, and changes were made in the child’s formula to no avail. Finally, a nurse made a home visit. She discovered several bottles of home-prepared formula on the windowsill, whereas others were in the refrigerator. The family lived in a New York City apartment without air-conditioning, and it was midsummer. When the nurse asked about the procedure used to store the formula, the mother stated that childbirth is regarded as a cold condition, so she should avoid cold. Her husband, therefore, removed the day’s bottles from the refrigerator before he left for work every morning so the bottles would be warm for the mother’s condition. The nurse explained that storing the formula at room temperature permitted bacteria to grow in it and that these organisms were causing the baby’s diarrhea. Together, the mother and nurse searched for another procedure to bridge the cultural belief and the germ theory of disease. The mother decided to don a coat, hat, and gloves before opening the refrigerator to retrieve each bottle at feeding time. The nurse wisely guided the mother to a solution that left the mother’s belief system intact, and the infant’s diarrhea was cured (Jackson, 1993).
Jewish Americans Orthodox Jews interpret dietary laws stringently. These are the three key characteristics of strict kosher food preparation: 1. Only designated animals may be eaten. 2. Some of those animals must be ritually slaughtered and dressed. 3. Dairy products and meats must not be eaten at the same meal. Separate cooking and serving utensils are used for dairy meals and meat meals. Fruits, vegetables, and starches need no special preparation and can be served with either meat or dairy meals. When a preplanned kosher meal is unavailable, a cottage cheese fruit plate is a good choice for an Orthodox Jew. The cottage cheese should be transferred to a paper plate with new disposable plastic utensils to
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avoid the possibility of the utensils having ever touched meat. If bread or crackers are served, labels must indicate that they contain no meat products.
Muslim Americans One of the key health-care accommodations reported as necessary by American Muslims is the provision of halal food, which is seen as health promoting and integral to healing (Padela, Gunter, Killawi, and Heisler, 2012). Islam
29
has a strict set of dietary prescriptions, including ritual slaughter of poultry, beef, and lamb to make the meat halal. Strict Muslims avoid pork and alcohol; some avoid shellfish (Purnell, 2013). Figure 1-7 illustrates the multiple factors impinging on food choice and physical activity decisions. Modifying one’s own eating behavior, much less assisting someone else to do so, entails much more than simply knowing which foods are recommended and which should be restricted.
• Belief Systems • Heritage • Religion • Priorities • Lifestyle • Body Image • Homes • Schools • Workplaces • Recreational Facilities • Foodservice and Retail Establishments • Other Community Settings
Social and Cultural Norms and Values Sectors of Influence Environmental Settings
• Demographic Factors (e.g., age, gender, socioeconomic status, race/ethnicity, disability status) • Psychosocial Factors • Knowledge and Skills • Gene-Environment Interactions • Other Personal Factors
• Government • Public Health and Health Care Systems • Agriculture • Marketing/Media • Community Design and Safety • Foundations and Funders • Industry – Food – Beverage – Physical Activity – Entertainment
Individual Factors
Food and Beverage Intake
Physical Activity
FIGURE 17 A Social-Ecological Framework for Nutrition and Physical Activity Decisions. Social and cultural norms and values, sectors of influence, environmental settings, and individual factors all contribute to decisions to eat, drink, and exercise. (Adapted from (1) Centers for Disease Control and Prevention. Division of Nutrition, Physical Activity, and Obesity. State Nutrition, Physical Activity and Obesity (NPAO) Program: Technical Assistance Manual. January 2008, page 36. Accessed April 21, 2010. www.cdc.gov/obesity/downloads/TA_Manual_1_31_08.pdf. (2) Institute of Medicine. Preventing Childhood Obesity: Health in the Balance, Washington (DC): The National Academies Press; 2005, page 85. (3) Story M, Kaphingst KM, Robinson-O’Brien R, Glanz K. Creating healthy food and eating environments: Policy and environmental approaches. Annu Rev Public Health 2008;29:253-272. Reprinted from Dietary Guidelines for Americans, 2010. 7th Edition, Figure 6-1, Washington, DC: U.S. Government Printing Office, December 2010 with permission. www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf )
Keystones ■ ■
Health is a state of complete physical, mental, and social well-being, not just the absence of disease or infirmity. Optimal health is not possible with an inferior diet. The six classes of nutrients are carbohydrates, fats (lipids), proteins, vitamins, minerals, and water. Nutrients provide fuel, support tissue growth and maintenance, and regulate body processes. Essential nutrients are those that must be supplied by the diet or artificially because the body cannot manufacture sufficient amounts for health. (Continued)
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Keystones—cont’d ■
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New genetic knowledge offers the potential to personalize nutrition prescriptions to avoid interactions between one’s diet and his or her genes, which can adversely affect the body’s use of nutrients. According to the USDA Dietary Guidelines, most people do not consume enough whole grains, milk, or fruit and ingest too many solid fats and added sugars in grain-based desserts and snacks. Food insecurity in the United States, affecting certain demographic groups, is addressed with information measures and market strategies with a mixed record of success. Globally, food assistance and improved agricultural techniques have helped many countries, but hunger is still widespread in Africa. Nutritional care begins with assessment followed by analysis, planning, implementation, and evaluation. Assessment compiles subjective and objective data that are then analyzed to identify strengths and weaknesses. Planning with the client is essential to maximize the possibility of effective implementation and a favorable evaluation. The Dietary Reference Intakes (DRIs) encompass five nutrient-based reference values that can be used for assessing and planning diets for groups according to life stage and gender. The DRIs are intended to apply to the healthy general population and refer to average daily intakes for 1 or more weeks, not to judge adequacy of an individual’s intake that necessitates a broader prospective. Exchange lists categorize foods by specific amounts according to similar nutrient composition, which permit substituting within the category and may be used to teach a client about healthful eating by illustrating that all foods are not equally desirable or satisfying choices. It is possible to achieve modern medicine’s goal of minimizing bacterial proliferation in baby formula while maintaining a client’s hot–cold cultural belief, as was done in accommodating a Chinese mother’s need for protection from cold following childbirth with winter clothing when opening the refrigerator. Milk is likely not favored in cultural groups with a high prevalence of lactose intolerance, including African Americans, Asians, Italians, Latinos, and Native Americans. Religious convictions may restrict all meat for persons practicing Buddhism; pork for those practicing Islamic tenets, strict Judaism, and Seventh Day Adventist beliefs; as well as beef, pork, and fowl for Hindu adherents.
CASE STUDY
1-1
A student in a beginning nutrition course is showing a friend the textbook. “You could help me improve my diet,” the friend says. “I know I am not eating right.” At the time, the friend was eating a chocolate bar. She described herself as 18 years old and sedentary. The student asks the friend to list what she had eaten during the past 24 hours. From the friend’s list, the student gathers the following data: Breakfast: 8 ounces of reconstituted frozen orange juice, 2 cups of black coffee Lunch: 6 ounces of low-fat fruit yogurt and 6 square graham crackers Midafternoon snack: Mr. Goodbar, 1.2 ounces Dinner: 1 medium baked pork chop, lean only eaten, 2 cups of green salad, 2 tablespoons reduced-calorie French dressing, 12 ounces of diet Coke
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CASE STUDY (Continued) Opening a profile on ChooseMyPlate.gov, and inserting the friend’s height and weight (5 ft 4 in., 163 lbs), the student finds her friend’s BMI is 28.0 (overweight) and her 1-day intake compares with the recommended 1800 kilocalorie intake as follows:
Oils Milk Meat and beans Vegetables Fruits Grains Discretionary kilocalorie allowance
Friend’s Intake
ChooseMyPlate
3 tsp 3 ⁄4 cup 4 oz 1 cup 1 cup 1 1⁄2 oz 327
5 tsp 3 cups 5 oz 21⁄2 cups 11⁄2 cups 6 oz 161
In this situation, the student probably would not formalize a nutritional care plan for the friend, but the following plan illustrates the thought process involved in developing a care plan for this case.
CARE PLAN Subjective Data Expressed need for instruction in healthy diet. Twenty-four hour recall shows less than the recommended ChooseMyPlate intake for all food groups but excessive discretionary kilocalories. Overweight from reported height and weight Objective Data Observed eating a chocolate bar at 3 P.M. Analysis Self-reported need to improve nutrition Plan DESIRED OUTCOMES EVALUATION CRITERIA
ACTIONS/INTERVENTIONS
RATIONALE
Friend will keep a food record for 3 days.
Instruct friend to list everything she eats or drinks for 3 days. Lend friend textbook to read.
Food record will gather facts about the friend’s food intake to use as an instructional tool. Providing literature uses expert opinion to reinforce student’s teaching. Reading and seeing illustrations elicits active participation and employs senses other than hearing. Setting follow-up visit just after food record is completed will maintain the friend’s interest. Modeling desirable behavior is a technique to encourage change.
Friend will read the section on ChooseMyPlate in student’s textbook by this evening.
Friend will meet with student in 4 days to compare food record to ChooseMyPlate profile and design a plan of action.
Meet with friend in 4 days to sort and analyze food record data. Provide apples at meeting to model healthy snack food.
After 4 days, the two friends met in the college library to access ChooseMyPlate on the Internet. The friend says she has not been keeping the requested food diary. “I’m hopeless. I’ll never be able to change,” she moans. They sat outdoors and ate the apples that the nutrition student provided, but her friend washed hers down with another Mr. Goodbar. At that point, thinking her friend required more professional help than her friendship could provide, the student recommended the free clinic run by the college’s nursing department. They walked to the clinic together so the friend could make an appointment.
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TEAM
TEAM
WORK 12 Clinic’s Notes
WORK
The following Clinic’s Notes are representative of the documentation found in a client’s medical record.
Requesting assistance with diet planning. Shared dietary recall from last week. Not inclined to keep food diary. Denies chronic illness. Has attempted weight control on her own with little success due to splurging on sweets. Recognizes need for lifestyle changes as well as dietary improvement. Unsure of social support for lifestyle changes. Objective: Ht 5 ft; 4 in. Wt 163 lbs. BMI 28.0. VS WNL (vital signs within normal limits) Subjective:
Overweight due to unbalanced diet and sedentary lifestyle. Plan: Instruct in basic nutrition. Suggest private use of ChooseMyPlate.gov site to track diet and activity. Recommend participation in daily walking group that meets in the Physical Education Department to achieve 150 minutes of physical activity weekly along with the possibility of social support from fellow walkers. Follow-up visit in 1 week. Analysis:
Critical Thinking Questions 1. The 24-hour dietary recall in Case Study 1-1 tallies just 987 of the 1800 kilocalories recommended for the individual, yet she has been unsuccessful with weight control. What possible factors might explain the discrepancy?
3. You have a friend or relative who displays food intake similar to that described in Case Study 1-1. You care deeply for this person. How might you approach the subject of healthy eating if the person does not ask for assistance?
2. When the nutrition student met with the friend after 4 days, what other options might have been chosen instead of referral to the nursing clinic?
Chapter Review 1. Which of the following is an energy nutrient? a. Phytochemicals b. Vitamins c. Minerals d. Carbohydrates 2. Which of the following techniques is used to estimate the body’s protein stores? a. Weighing the person under water b. Measuring midarm circumference c. Calculating the body mass index d. Determining triceps skinfolds 3. Which of the following is true of the traditional Chinese yin and yang health belief system? a. A cold, or yin, condition is balanced by consuming hot, or yang, foods. b. A hot condition is flushed with large quantities of cold water. c. Rice is considered magical and is consumed at every meal. d. Yang, or hot, foods include only foods served hot.
4. Which of the following adheres to strict kosher regulations? a. Avoiding cheese and cheese products b. Eating only certain cuts of pork c. Keeping separate utensils and dishes for meat and dairy meals d. Serving lobster, clams, and shrimp only on festive occasions 5. Intake that meets the needs of 97 to 98% of individuals in a defined group is called a. Acceptable macronutrient distribution range b. Adequate intakes c. Estimated average requirements d. Recommended dietary allowances
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Clinical Analysis 1. Ms. G has just been diagnosed with type 2 diabetes. She is a Native American who has left her reservation for employment in town. Which of the following actions by the nurse shows respect for Ms. G’s culture? a. Instructing her to increase her intake of vegetables b. Telling her to lose weight and avoid alcohol and fast-food restaurants c. Giving Ms. G an instruction sheet based on the Food Exchange Lists d. Asking Ms. G how she “sees” or perceives diabetes in her life 2. Mr. P is a 65-year-old man, recently widowed, whose physician is recommending weight loss. Mr. P has had little experience with grocery shopping or cooking. Which of the following systems for instructing Mr. P would the nurse select to offer the best chance of success? a. A computerized diet analysis program b. ChooseMyPlate c. Exchange lists d. The RDA/AI tables
3. Ms. E attended a community health fair where she entered her recalled intake for the previous 24 hours into a computer for analysis. On the basis of the printout she was given, she now thinks she should begin taking vitamin and mineral supplements. A friend who is a nurse correctly bases her advice on the following: a. A 1-day diet recall offers inadequate data on which to base supplementation. b. A hand recalculation should be done to verify the accuracy of the computer printout. c. The RDAs on which computer programs are based are intended for only the 50% of the population who are obsessed with health. d. Undoubtedly, the operators of the computer at the fair had a product to sell: “Let the buyer beware.”
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2 Carbohydrates
LEARNING OBJECTIVES After completing this chapter, the student should be able to: ■ Describe the types of carbohydrates, identify food sources of each, and indicate their functions in the body. ■ List the major functions of carbohydrates and methods through which the body stores them. ■ Discuss dietary fiber and list its functions; identify dietary food sources. ■ Describe the relationship between carbohydrates and dental health. ■ List the carbohydrate content (in grams) of each appropriate exchange list. ■ Discuss dietary recommendations related to fiber, added sugar, and total carbohydrate intake.
C
arbohydrates, fats, and proteins all meet the body’s basic energy needs. Carbohydrates are the major source of energy because they break down rapidly and are readily available for use. This chapter defines basic terminology related to carbohydrates and discusses the body’s use of carbohydrates and the way carbohydrates relate to the other energy nutrients. Green plants manufacture carbohydrates during a complex process called photosynthesis. In this process, carbon dioxide from the air and water from the soil are transformed into sugars and starches. Sunlight and the green pigment chlorophyll are necessary for this conversion. All the food we eat is a product of photosynthesis. If this process did not occur, the whole food chain would collapse, and life would cease. Figure 2-1 illustrates this process. On the basis of their chemical structure, carbohydrates are divided into two major groups: sugars and starches. Sugars have a simple structure; starches are more complex. Therefore, sugars are often called 34
simple carbohydrates, and starches are called complex carbohydrates.
Composition of Carbohydrates Understanding the composition of carbohydrates involves understanding three structures: molecule, element, and atom: 1. A molecule is the smallest quantity into which a substance may be divided without loss of its characteristics. For example, the formula for water is H2O. If the hydrogen atoms are pulled from the oxygen atom, the resulting products are hydrogen and oxygen, which bear no resemblance to water. Molecules are made of elements. In the case of water, H2O, the elements are hydrogen and oxygen. 2. An element is a substance that cannot be separated into simpler parts by ordinary means. 3. An atom is the smallest particle of an element that retains its physical characteristics.
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Sunlight
Carbon Dioxide Enters the Plant
Oxygen Released
Carbohydrate Produced
6H2O + 6CO2
= C6H12O6 + 6O2
water + carbon dioxide
= carbohydrate + oxygen
FIGURE 21 Photosynthesis is a vital process that transforms carbon dioxide and water into carbohydrates.
Basic Terminology Carbohydrates are composed of the elements carbon, hydrogen, and oxygen. The ratio of hydrogen to oxygen is the same as that for water: two parts of hydrogen to one part of oxygen. The simplest carbohydrates have the formula C6H12O6. Carbohydrates are frequently abbreviated CHO. Simple carbohydrates (sugars) include monosaccharides and disaccharides (mono- means one, di- means two, and -saccharide means sweet). Starches are called polysaccharides.
Simple Carbohydrates Simple carbohydrates are of two types: monosaccharides and disaccharides. 1. A monosaccharide contains one molecule of C6H12O6. 2. A disaccharide is composed of two molecules of C6H12O6 joined together (minus one unit of H2O). When the body joins two monosaccharide molecules, a molecule of water is released in the process.
Monosaccharides Monosaccharides are the building blocks of all other carbohydrates. The three monosaccharides of importance in human nutrition are glucose, fructose, and galactose. Note the -ose ending in the name of each of these sugars. All monosaccharides and disaccharides end with the letters -ose.
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Glucose The monosaccharide glucose in the body is commonly called blood sugar. It is the major form of sugar in the blood. Normal fasting blood sugar (FBS) is 70 to 100 milligrams per 100 milliliters of serum or plasma. Impaired fasting glucose (IFG) is 100 to 125 milligrams per 100 milliliters of serum or plasma (www.care.diabetesjournal.org). Regardless of the form of sugar consumed, the body readily converts it to glucose. Another name for glucose is dextrose (abbreviated D). Clients in health-care facilities often receive intravenous feedings. Intravenous simply means within or into a vein. The most common intravenous feeding is D5W (5% dextrose in water), used primarily to deliver fluids to the client.
Fructose Fructose is found in fruits and honey. It is the sweetest of all the monosaccharides. Fructose is used extensively in soft drinks, canned foods, and various other processed foods. High-fructose corn syrup (HFCS) is very sweet because the cornstarch has been treated with an enzyme that converts some of the naturally present glucose to the sweeter fructose. The human body readily converts fructose to glucose. HFCS has become increasingly controversial in its use by the food industry. A possible link has been identified with HFCS consumption and diabetes. Countries using HFCS in their foods have a 20% higher prevalence of diabetes than those that do not use it. It is estimated that in the United States, 55 lb per person of HFCS are ingested annually. Many countries, including Australia, China, Denmark, France, Italy, Sweden, and the United Kingdom, have a per capita consumption of approximately 1 lb annually (Goran, 2012).
Galactose The monosaccharide galactose comes mainly from the breakdown of the milk sugar lactose. Yogurt and unaged cheese may contain free galactose. It is the least sweet of all the monosaccharides. The body converts galactose into glucose after ingestion.
Disaccharides When two monosaccharides are linked, a disaccharide is formed. The three important disaccharides are: 1. Sucrose 2. Lactose 3. Maltose
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UNIT 1 ■ THE ROLE OF NUTRIENTS IN THE HUMAN BODY
2-1
Sucrose The most prevalent disaccharide, sucrose, is ordinary white table sugar made commercially from sugar beets and sugar cane. Brown, granulated, and powdered sugars are all forms of sucrose. Sucrose is also found in molasses, maple syrup, fruits, and vegetables. The two monosaccharides joined to form sucrose are glucose and fructose. See Box 2-1 for more information on sugar in the U.S. diet. Clinical Calculation 2-1 provides information on converting grams of sugar into teaspoons of sugar.
Lactose Because lactose occurs naturally only in milk, it is commonly referred to as milk sugar. Lactose is the least sweet of the disaccharides. The two monosaccharides that make up lactose are glucose and galactose.
Clinical Calculation Converting Grams of Sugar Into Teaspoons of Sugar An added sugar intake of 60 grams does not mean much to average American consumers because most Americans are not familiar with the metric system. Food labels use the metric system to list the nutritional content of a product. To enhance understanding of label reading, let us convert grams of sugar into teaspoons. One teaspoon of sugar contains 4 grams of CHO. Therefore, 60 grams of sugar is equal to 15 teaspoons. Distinguished from the natural sugars such as lactose in milk and fructose in fruits, added sugars are those incorporated into foods and beverages during production. Major sources of added sugar include the following: ■ ■ ■
Candy Soft drinks Fruit drinks “Energy” and sports drinks Grain-based desserts such as cookies, cakes, and pastries
Maltose
■
Maltose is a double sugar that occurs primarily during starch digestion. The disaccharide maltose is produced when the body breaks starches into simpler units. Smaller amounts of this disaccharide are present in malt, malt products, beer, some infant formulas, and sprouting seeds. Maltose consists of two units of glucose.
In the 2010 Dietary Guidelines, the U.S. Department of Agriculture estimates that most Americans consume a diet of 16% added sugars. This contributes to a diet high in calories and low in nutrients.
Sugar in Foods The amount of sugar that is in a food product can be found on its label. The total amount of sugar in grams can be found on the Nutrition Facts portion of the label.
Box 2-1 ■ Added Sugar in the U.S. Diet Added sugars contribute to dental caries, reduce the intake of essential micronutrients when sugar in the diet displaces more nutritious items such as milk, and may lead to an increased incidence of cognitive impairment in the elderly. The increased consumption of added sugars is linked to a decreased intake of essential micronutrients and an increase in body weight. Data from the National Health and Nutrition Examination Survey, 2005–2010, indicate that children and adolescents obtain approximately 16% of their total kilocalories from added sugars, and adults 13% (Ervin, 2013). What is an appropriate amount of added sugar in a healthful diet? According to the American Heart Association, no more than 100 kilocalories for women and 150 kilocalories for men should consist of added sugars per day (Academy of Nutrition and Dietetics, 2012). Currently, the largest contributor of added sugar in the diet is sweetened carbonated beverages and other sweetened beverages, which provide 37% of added sugars (Bachman, 2008). The second largest contributor is table sugar and candy at 16.1% (U.S. Department of Agriculture, 2005).
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Sugar is both present naturally in foods and added to foods. For example, fruits contain fructose, and fructose can be added to soft drinks to enhance sweetness. The federal government regulates the use of terms such as sugar free, reduced sugar, less sugar for food products that have added sugar. Terms such as these can be located anywhere on the package’s label. Table 2-1 lists the standards, or definitions, for legally defined label descriptors.
Sugar Alcohols Some food products contain sugar alcohols. Sugar alcohols have various names, such as sugar replacers, polyols, nutritive sweeteners, and bulk sweeteners.
TABLE 21
■
Approved Definitions for Food Label Terms
TERM
STANDARD
Sugar-free
Contains less than one-half gram of sugars per serving At least 25% less sugar or sugars per serving than a standard serving size of a traditional food No sugars added during processing or packing, including ingredients that contain sugar, such as juice or dry fruit May not be used as a claim on a food label
Reduced sugar or less sugar No added sugar or without added sugar Low sugar From Food and Drug Administration (2009).
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Lactitol, maltitol, isomalt, sorbitol, xylitol, and mannitol are all sugar alcohols and currently are approved for use in the United States. Sugar alcohols are commonly used on a onefor-one replacement basis for sugars in recipes. For example, 1 cup of sugar would be replaced with 1 cup of isomalt in a recipe. Sugar alcohols add not only sweetness but also bulk to recipes. Sugar alcohols have the following characteristics: ■ ■ ■ ■
Generally do not promote tooth decay Commonly have a cooling effect on the tongue Are slowly and incompletely absorbed from the intestine into the blood May have a laxative effect for some people if consumed in excess
Nonnutrative Sweeteners
monosaccharides and disaccharides. The three types of complex carbohydrates of nutritional importance are starch, glycogen, and fiber. Table 2-3 summarizes the composition of carbohydrates.
Starch Starch, the major source of carbohydrate in the diet, is found primarily in grains, starchy vegetables, and legumes and in foods made from grains—cereals, breads, and pasta. Box 2-2 lists the many kinds of TABLE 23
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Composition of Carbohydrates
Elements
Molecule Monosaccharide (simple)
Nonnutrative sweeteners (NNS) are sugar substitutes, providing intense sweetness. Unlike sugar replacers, NNS do not add bulk or volume to a food product; they add only sweetness. They are 150 to 500 times as sweet as sugar and are mostly artificial, or synthetic. There are seven NNS approved for use in the United States, the most common of which are shown in Table 2-2 (Academy of Nutrition and Dietetics, 2012).
Disaccharide (simple) Polysaccharide (complex)
Legumes include these dried peas and beans: ■ ■ ■ ■
Chemically complex carbohydrates are called polysaccharides. Poly- means many, and polysaccharides consist of many molecules of C6H12O6 joined and many molecules of water released in the process. Polysaccharides can be composed of various numbers of
TABLE 22
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C (carbon) H (hydrogen) O (oxygen) C6H12O6 One unit of C6H12O6 Two units of C6H12O6 minus one unit of H2O Many units of C6H12O6 minus many units of H2O
Box 2-2 ■ Legumes
■
Complex Carbohydrates
37
■ ■ ■ ■ ■
Black beans Pinto beans Kidney beans Navy beans Soybeans Black-eyed peas Split peas Yellow peas Chick peas (garbanzo) Lentils
Nonnutritive Sweeteners
ARTIFICIAL SWEETENER
TRADE NAME
COMMENTS
Aspartame
Nutrasweet
Saccharin
Equal Sweet’N Low Sugar Twin
Sucralose
Splenda Stevia
Used in sweetened products such as puddings, gelatins, frozen desserts, yogurt, hot cocoa mixes, powdered soft drinks, carbonated beverages, teas, breath mints, chewing gums, some vitamins, and cold preparations. Also used as a tabletop sweetener. Reviewed by such regulatory agencies as the Centers for Disease Control and Food and Drug Administration and found to be safe. Should not be used by individuals with a rare genetic disease called phenylketonuria (www.aspartame.org). Artificial sweetener. Carbonated beverages, toothpaste, cold remedies, dietetic puddings, cakes, cookies. Saccharin was banned in Canada in 1977. The U.S. Food and Drug Administration also proposed a ban on saccharin, but Congress passed a moratorium on the ban. Although high doses of saccharin were shown to cause bladder cancer in male rats, numerous human studies have shown no association between saccharin and cancer at human levels of consumption. The only noncaloric sweetener made from sugar. Approved for use by the Food and Drug Administration. Only the forms listed have been granted approval by the FDA, not whole stevia leaves (which are sold as dietary supplements).
Rebaudioside A & stevioside purified from Stevia leaves Adapted from Academy of Nutrition and Dietetics, 2012.
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UNIT 1 ■ THE ROLE OF NUTRIENTS IN THE HUMAN BODY
legumes available. Strictly speaking, all starches yield simple sugars on digestion; starchy foods are mostly low in fat and high in carbohydrates, and some starchy foods have the advantage of containing much fiber.
Glycogen Glycogen represents the body’s carbohydrate stores. Glucose is stored in liver and muscle tissue as the polysaccharide glycogen. Glycogen is crucial to the function of the human body. During intense physical activity, the body utilizes blood glucose for energy. When blood glucose is depleted, muscle glycogen is broken down to provide immediate fuel in the form of glucose. Glycogen is built up and stored in muscle and the liver when blood glucose levels are high after infusion from the diet. Liver glycogen helps sustain blood glucose levels during sleep. The typical human body has an available store of glucose in the form of glycogen for about 1 day’s energy needs. Because the body’s ability to store carbohydrates in the form of glycogen is limited, an adequate intake of dietary carbohydrates is essential. When glycogen is stored, water is also stored. Each glycogen molecule attracts many molecules of water because of the way the elements are arranged. When glycogen stores are completely filled, the average person weighs about 4 lb more than when glycogen stores are empty.
Dietary Fiber Dietary fiber refers to foods, mostly from plants, that the human body cannot break down to digest and that is eliminated in intestinal waste. Sometimes called roughage or bulk, fiber adds almost no fuel or energy value to the diet, but it does add volume. Bulk fills the stomach, and most experts believe a full stomach contributes to a feeling of satiety, so further eating ceases. The recommended daily adequate intake (AI) for fiber is based on 14 grams of fiber per 1000 kcalories consumed or: ■ ■
Men: 38 grams Women: 25 grams
In the United States, the average person consumes less than the recommended amount of dietary fiber, and few people consume the recommended levels. Research has indicated the average fiber intake for U.S. adults is only 15 grams per day (American Diabetes Association Position Paper, 2008). Whole grains are an excellent source of dietary fiber. Dollars & Sense 2-1 provides a recipe for an economical, easy-to-prepare vegetable soup.
2-1 Vegetable Soup Plan your meals around whole grains. Start with wholewheat pasta, precooked brown rice, and beans (kidney, chick peas, white, etc.) and add other ingredients (leftover meats, seafood, quinoa, tofu, etc.) as your budget allows. Pack several containers, freezing some as desired, of this economical, easy-to-fix lunch or dinner for those super busy times. 16-ounce can beans (any kind—kidney, chick peas, white, etc.), drained 2 15-ounce cans tomatoes, stewed, low sodium 28 ounces vegetable broth, low sodium 16 ounces vegetables, mixed, frozen (any kind—plain, no sauce) 1 cup whole-wheat pasta, quinoa, pre-cooked brown rice (frozen or packaged) 1 /2 cup onion, chopped 1 teaspoon olive oil 2 cloves garlic, to taste (optional) dash pepper, to taste (optional) dash cayenne pepper or red pepper flakes, to taste (optional) 1. Sauté onion in olive oil for approximately 5 minutes or until slightly soft. 2. Combine all ingredients, except the whole-wheat pasta or pre-cooked brown rice. 3. Bring to a boil. 4. Add whole-wheat pasta or pre-cooked brown rice (along with optional ingredients, if desired) to the pot and simmer, covered, for approximately 10 minutes or until the pasta (if using) and/or vegetables are tender. Makes approximately 6 servings.
Eating too much fiber can cause problems. Much evidence suggests that eating more than 50 grams of fiber a day can interfere with mineral absorption, which can lead to conditions such as anemia and osteoporosis. Healthy people should achieve a desirable fiber intake by consuming fiber-rich fruits, vegetables, legumes, and whole-grain cereals, which also provide minerals, vitamins, and phytochemicals, instead of adding fiber concentrates (such as psyllium) to their diet. Fiber is classified as either soluble or insoluble. Solubility is the ability of one substance to dissolve in another. For example, oil does not dissolve in water, so oil is insoluble in water. Insoluble fiber does not dissolve in water, whereas soluble fiber does. Soluble fiber and insoluble fiber react differently in the body and are needed for different reasons.
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Soluble Fiber Sources of soluble fibers include beans, oatmeal, barley, broccoli, and citrus fruits; oat bran is a particularly good source of soluble fiber. Soluble fibers dissolve in water and thicken to form gels. The reported health benefits of soluble fibers include reduced cholesterol levels, regulated blood sugar levels, and weight loss (by helping dieters control their appetites).
Insoluble Fiber Examples of sources of insoluble fibers include the woody or structural parts of plants, such as fruit and vegetable skins, and the outer coating (bran) of wheat kernels. Insoluble fibers have been reported to promote regularity of bowel movements and reduce the risk of diverticular disease and some forms of cancer. The mechanism of these effects for insoluble fiber is due to decreased intestinal transit time and decreased intestinal pressure. Table 2-4 lists the food sources of each type of fiber and their reported health benefits.
Functions of Carbohydrates Carbohydrates play the following roles in the body: ■ ■ ■ ■
Provide fuel Spare body protein Help prevent ketosis Enhance learning and memory processes
Provide Fuel Carbohydrates, fats, and proteins provide the body’s energy needs. Energy is the capacity to do work. To understand the concept of energy, think of the human TABLE 24
Solubility Food sources
Benefit
■
Foods and Reported Benefits of Fiber
INSOLUBLE FIBER
SOLUBLE FIBER
Does not dissolve in water Wheat bran Corn bran Vegetables Nuts Fruit skins Some dry beans* Promotes regularity May help reduce risk of some forms of cancer May reduce risk of diverticular disease
Dissolves in water Oatmeal Oat bran, barley Some fruits such as apples, oranges Broccoli Some dry beans* May help reduce cholesterol levels May assist in regulating blood sugar levels May promote weight loss by increasing satiety†
*Current laboratory methods to assay soluble fiber content of individual foods are imprecise. This is the subject of much research. †Satiety is defined as the sensation of fullness after eating.
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body as a machine. Just as gasoline is a car’s fuel, so carbohydrates, proteins, and fats are the human machine’s fuel. Without fuel, a car powered by gas ceases to operate. Without fuel sources over an extended time, the human machine dies from starvation. Just as a person cannot efficiently substitute something other than gasoline to fuel a car with a gasoline engine, a person cannot efficiently substitute something other than carbohydrate, protein, and fat for fuel in the human body. Carbohydrate is a primary source of fuel for all cells in the body. The brain is a carbohydrate-dependent organ and must have an uninterrupted, ongoing source. The Recommended Dietary Allowance for carbohydrate is 130 g/d for adults and children based on the minimum amount of glucose used by the brain. The diet should be composed of 45% to 65% carbohydrates (Academy of Nutrition and Dietetics, 2012).
Spare Body Protein When too few carbohydrates are eaten, the body suffers. A continuous supply of glucose is required for all cells to function, particularly those of the central nervous system. Body glycogen stores are limited, and after they are depleted, the body can convert protein to glucose. The body will break down internal protein stores (muscle tissue) before fat stores if carbohydrate intake is inadequate. An adequate supply of dietary carbohydrates spares body protein stores from being partially converted into glucose and allows protein to be used for growth and repair of body tissue. This principle has important ramifications, which are discussed throughout the text.
Help Prevent Ketosis A balanced intake of energy nutrients is vital. If carbohydrate intake is too low, the body will break down both stored fat and internal protein to meet its fuel needs. The body cannot handle the excessive breakdown of stored fat because the body lacks the necessary equipment. As a result, partially broken-down fats accumulate in the blood in the form of ketones, and the person is said to be in a state of ketosis. Survival is possible on a very low carbohydrate diet, but good health is not. Fatigue, nausea, and lack of appetite are some of the undesirable consequences of ketosis. Coma and death have occurred in severe cases. The presence of ketosis is easily determined by testing for the presence of acetone or diacetic acid in the urine. Acetone and diacetic acid are ketone bodies. One hundred thirty grams of carbohydrate each day is usually enough to prevent ketosis (National Institutes of Health, 2009).
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Enhance Learning and Memory Considerable evidence exists that blood glucose concentrations regulate neural and behavioral processes. Glucose enhances learning and memory in humans throughout the life cycle. Findings across many laboratories demonstrate that glucose consumed early in the morning facilitates specific forms of cognitive function, particularly verbal declaration memory (intentional memory for words and narratives). Children score higher on tests when they eat breakfast. Improvements include both enhanced memory and retrieval of information from long-term memory. Glucose enhanced cognitive function in elderly test subjects who had some mild age-related memory deficits (Korol, 2002). However, elevated blood glucose, as seen in individuals with impaired glucose tolerance, has an increased incidence for a decline in mental function (Valeo, 2009; Yaffe, 2004). There have been studies that indicate that diets high in carbohydrate increase the incidence of mild cognitive impairment or dementia in the elderly (Roberts, 2012).
Health and Carbohydrates The kinds of carbohydrates eaten are important to health. Epidemiological data support the association between a high intake of vegetables and fruits and low risk of chronic disease. Legumes are low in fat and are excellent sources of protein, dietary fat, micronutrients, and phytochemicals. Numerous studies have linked regular consumption of whole grains with a lower risk of certain cancers and heart disease. Many nutrition experts attribute these health benefits to the fiber contained in whole grains. Sugary foods also often displace other more nutritious foods in the diet. For example, carbonated beverages may be consumed instead of milk and fruit juices. The 2010 Dietary Guidelines for Americans recommends reducing the calories consumed from added sugars. The American Heart Association recommends that women should eat or drink no more than 100 calories/d from added sugars (25 grams or 6 teaspoons) and men 150 calories/d (38 grams or 10 teaspoons; Academy of Nutrition and Dietetics, 2012).
remain in storage without deterioration) may stretch to years. In Asia, where rice is a dietary staple, carbohydrates provide as much as 80% of the fuel in the diet. In the U.S. population as a whole, the largest source of added sugar is regular soft drinks, which accounts for one-third of intake (Academy of Nutrition and Dietetics, 2012). The USDA’s (2005) Continuing Survey of Food Intake by Individuals finds that: ■ ■ ■
■
U.S. adults averaged only one serving per day of whole grains. Two percent of adults consumed no whole grain. Consumption of milk has decreased by 16% since the late 1970s, whereas consumption of carbonated soft drinks has increased by 16%. Only 54% of individuals ate fruit on a given day.
The 2010 Dietary Guidelines for Americans recommendations include: ■ ■ ■
■ ■ ■
Reduction in the foods and drinks with added sugars or energy containing sweeteners. Drink few or no regular soda pop, sports drinks, and fruit drinks. Eat fewer grain-based or dairy-based desserts, other desserts, and candy or eat smaller portions less frequently. Drink water, fat-free milk, or 100% fruit juice instead of fruit-flavored drinks. Eat fruit for dessert. Use the Nutrition Facts label to choose breakfast cereals and other packaged foods with less sugar, and use the ingredients list to choose foods with little or no added sugars.
Dental Caries Several studies have shown a relationship between carbohydrate consumption and dental caries. Dental caries is the gradual decay of the teeth. A dental cavity is a hole in a tooth caused by dental caries. Dental caries results from the interaction of four factors: a genetically susceptible tooth, bacteria, carbohydrate, and time. All four must occur simultaneously for a cavity to form, as Figure 2-2 illustrates. Some people are more genetically susceptible to caries than other people, as Genomic Gem 2-1 discusses.
Consumption Patterns Most of the world’s population subsists primarily on carbohydrates. Foods rich in carbohydrates are easily grown in most climates, low in cost, and easily stored. Many carbohydrates do not require refrigeration or electricity, and their shelf life (the time a product can
Food Sources Carbohydrates fall into two general groups: sugars and starches. All starches contain fiber; however, all starches do not provide equal amounts of fiber.
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2-1 Genetically susceptible tooth
Bacteria
Clinical Application Nursing-Bottle Syndrome Nursing-bottle syndrome is a dental condition caused by the frequent and prolonged exposure of an infant’s or young child’s teeth to liquids containing sugars. Milk, formula, fruit juice, and other sweetened drinks can all cause rampant dental cavities. Typically, nursing-bottle syndrome occurs when a caretaker habitually puts a baby to bed with a bottle of milk, juice, or other sweetened liquid. During sleep, the flow of saliva decreases, which allows liquids from the nursing bottle to pool around the teeth, undiluted for extended periods. Parents need to be cautioned against this practice. The main ways to maintain oral health include these steps:
Caries
Time
Carbohydrate
FIGURE 22 Interactions necessary for dental cavity formation.
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■ ■ ■
Reduce consumption and especially frequency of food and drink containing sugar. Consume sugar only as part of a meal. Snacks and drinks should be sugar-free. Avoid frequent consumption of acidic drinks.
Genomic Gem 2-1 Caries Genetic susceptibility is an individual’s likelihood of developing a given trait as determined by heredity. We cannot control our genetic susceptibility for cavities, and bacteria are always present in our mouths and difficult to eliminate. However, we can control the length of time carbohydrate-containing foods are in our mouths and the kinds of carbohydrates we eat. Risk Factors for Cavity Formation Bacteria, carbohydrate-containing foods, and the length of time that teeth are exposed to sugars influence cavity formation. Bacteria normally present in the mouth interact with dietary carbohydrates and produce acids. The acids, not the sugar, cause decay. All types of sugars can promote cavity formation, including fructose, glucose, maltose, lactose, and sucrose. A strong relationship exists between the length of time sugars are present in the mouth and the development of caries. For example, sticky foods such as caramels and raisins, which adhere to the tooth surface for long periods, are more likely than other foods to lead to tooth decay in susceptible people. Sipping sweetened beverages continually throughout the day can lead to tooth decay. Eating Right to Prevent Cavities Certain foods may help counteract the effects of the acids produced by oral bacteria. Aged cheese (cheddar, Swiss, blue, Monterey jack, brie, gouda), as well as processed American cheese, may inhibit tooth decay. Cheese stimulates the production of saliva. Chewing fibrous foods such as apples or celery stimulates the production of generous amounts of saliva. Saliva helps clear the mouth of food and counteracts acid production. Because saliva production is increased during a meal, sugars eaten with a meal are less likely to cause decay than those eaten between meals.
Sugars Table sugar contains approximately 4 grams of carbohydrates per teaspoon. When determining a person’s sugar consumption, we consider not only the simple sugars such as honey, jam, and jelly but also the sugars present in carbonated beverages, ice cream, sherbet, cakes, pies, cookies, and donuts. Sugar alcohols contain on average about 2 grams of carbohydrate per teaspoon.
Starches Starches are complex carbohydrates and are important sources of fiber and other nutrients. Figure 2-3 illustrates a typical cereal grain. Its main parts are the germ, bran, and endosperm. Most of the nutrients in cereal are in the bran and germ. Whole grains are more nutritious than refined grains, in which nutrients are removed during the milling process. During the milling of grain, the germ and bran are removed from the grain kernel. White flour results from the milling of wheat and white rice from the milling of rice. Oat products are not normally milled. The nutritive value of cereal depends on the amount of bran and germ retained during the milling process. For this reason, the use of whole grains should be encouraged whenever possible. Examples of whole grains include the following: ■ ■ ■ ■
Cornbread made from whole ground cornmeal Ground cornmeal Cracked wheat bread Oatmeal and oatmeal bread
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UNIT 1 ■ THE ROLE OF NUTRIENTS IN THE HUMAN BODY
Endosperm
Bran
Exchange List Values
Germ
Exchange lists were introduced in Chapter 1. This section focuses on exchange lists that contain carbohydrates. Exchanges that include carbohydrates are the starch/bread, vegetable, fruit, and milk lists (Appendix B).
FIGURE 23 The most nutritious parts of wheat germ are the bran and endosperm, which are removed during the milling of grain.
■ ■ ■ ■ ■ ■
45 to 60 grams of carbohydrate at each meal is recommended as a starting point for managing diabetes (Diabetes.org). Eating too much of any of the energy nutrients can result in unhealthful weight gain and uncontrolled blood glucose. Perhaps no other concept is more important to understanding nutrition than healthful portion sizes.
Pumpernickel bread (when made from whole grain flours) Rye bread (when made from whole grain flours) Whole-wheat bread Breads made from bran Barley Graham crackers
MyPlate The USDA rolled out MyPlate in 2010 as a way to help consumers learn the messages of the 2010 Dietary Guidelines. The emphasis is on portion control, eating more fruits and vegetables (half the plate), drinking fewer sugary drinks, choosing low-fat dairy products, and ensuring that half of grain consumption (a quarter of the plate) is from whole grains (ChooseMyPlate.gov). See Figure 1-2 to review.
Carbohydrate Counting In health care, carbohydrate counting helps teach clients about the carbohydrate content of foods and healthful portion sizes, which helps manage blood glucose levels. A serving is not the amount commonly eaten but a defined amount of a particular food according to nutrition experts. One serving or exchange of milk, fruit, grain, cereal, bread, or starchy vegetable is considered to be 15 grams of carbohydrate (American Diabetes Association and American Dietetic Association, 2009). Eating
Starch/Bread Exchange List One American Diabetes Association (ADA) exchange of starch contains approximately 15 grams of carbohydrates. For example, each of the food items in Figure 2-4 is equal to one starch exchange. Some foods are higher in fiber than other foods. See Table 2-5.
Vegetable Exchange List Raw and cooked vegetables are also good sources of carbohydrates. Vegetables contain between 2 and 3 grams of fiber per serving. One vegetable exchange contains approximately 5 grams of carbohydrate. Onehalf cup of cooked vegetables or one cup of raw vegetables equals one vegetable exchange. Vegetables also contribute vitamins and minerals to the diet.
Fruit Exchange List Fruits are another source of carbohydrates. One ADA exchange of fruit contains approximately 15 grams of carbohydrates (Table 2-6). Many fruits are excellent sources of fiber and contain vitamins and minerals. Figure 2-5 illustrates one serving or exchange of fruit.
Milk Exchange List Milk, with its lactose content, is an important source of carbohydrates. One cup of milk contains 12 grams of carbohydrates. Skim, whole, and 2% milk all contain approximately the same amount of carbohydrates. Box 2-3 lists milk equivalents.
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FIGURE 24 Each of these foods is equal to one starch exchange and contains about 15 grams of carbohydrates (see Appendix B). TABLE 25
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Selected Starch Exchanges
Bran cereal* Cooked cereal Ready-to-eat, unsweetened cereal Sugar-frosted cereal Beans (cooked)* Corn, whole kernel Potato, baked Whole-wheat bread
/2 cup /2 cup 3 /4 cup 1 /2 cup 1 /2 cup 1 /2 cup 1 small (3 ounces) 1 slice (1 ounce) 1
General rule: 1/2 cup of cereal, grain, or pasta or 1 ounce of a bread product is equal to one starch exchange. *Higher in fiber.
TABLE 26
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Selected Fruit Exchanges
Apple (raw, 2 in. across) Banana (small) Blueberries* Grapefruit (medium) Orange (21/2 in. across) Orange juice Prunes (dried)* Raspberries* Strawberries (raw whole)* *Contains 3 grams or more of fiber.
Dietary Recommendations
1
1 (4 ounce) apple 1 (4 ounce) banana 3 /4 cup Half grapefruit 1 (61/2 ounce) orange 1 /2 cup 3 medium 1 cup 11/4 cup
The Food and Nutrition Board of the National Academy of Sciences, Institute of Medicine, issued dietary recommendations for carbohydrates in 2005. To meet the body’s daily energy and nutritional needs while minimizing risk for chronic disease, adults should get 45% to 65% of their calories from carbohydrates. The committee reasoned that because carbohydrates, fat, and protein all serve as energy sources and can substitute for one another to some extent to meet caloric needs, the recommended ranges for consuming energy nutrients should be useful and flexible for dietary planning, hence the wide 45% to 65% range. The ranges for children are similar to those for adults in respect to carbohydrates. The Recommended Dietary Allowance for children older than 1 year of age and most adults younger than 70 years of age is 130 grams of CHO/day. The RDA is 175 grams of CHO per day for pregnant women and 210 grams per day for lactating women. According to the 2010 Dietary Guidelines for Americans, no more than 6% of total calories eaten should comprise added sugars (Academy of Nutrition and Dietetics, 2012). This suggested maximum stems from evidence that people with diets high in added sugars have lower intakes of essential nutrients.
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UNIT 1 ■ THE ROLE OF NUTRIENTS IN THE HUMAN BODY
44
FIGURE 25 Each of these foods is equal to one fruit exchange (see Appendix B).
Box 2-3 ■ Milk Equivalents Each of the following is equal to one exchange. ■
Eight ounces of plain low-fat yogurt (with added nonfat milk solids)
/3 cup dry nonfat milk /2 cup evaporated milk 1 cup of buttermilk
■
1
■
1
■
Keystones ■ ■ ■ ■ ■ ■ ■
■
Carbohydrates are composed of sugars and starches. The average American’s intake of sugars is considered excessive, whereas the intake of starches is considered low. Many Americans would benefit from increasing their fiber intake through the consumption of more whole-grain starches, fruits, and vegetables. Dietary carbohydrates promote tooth decay in susceptible individuals. The American Diabetes Association exchange lists that contain carbohydrates are the starch, vegetable, fruit, and milk lists. Strong evidence exists that a minimum of 130 grams of carbohydrates per day is necessary for adequate brain and body function. When there is no or little carbohydrate in the diet and the body uses protein or fat as a fuel source, the body in effect cannibalizes itself for glucose. Muscle and organ mass is lost in the process. The RDA for CHO is 130 grams of carbohydrates a day. Pregnant and lactating women have a higher Recommended Dietary Allowance for CHO.
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CHAPTER 2 ■ CARBOHYDRATES
CASE STUDY
45
2-1
K. L. is a 19-year-old college student. He is interested in bodybuilding and spends much of his time on strength conditioning. He lifts weights or uses an elliptical machine daily. He is 6 feet tall and weighs 175 lb. For the past 3 weeks, he has been drinking a powdered protein supplement (that contains no carbohydrate) instead of eating the dorm food, which he states “isn’t any good anyway.” He also takes a high-stress vitamin and mineral tablet. He arrived at the clinic today with complaints of fatigue, nausea, a lack of appetite, lightheadedness, and memory loss. His urine tested positive for ketones. The client is willing to talk to a registered dietitian.
CARE PLAN Subjective Data The client has chosen not to eat any foods that contain carbohydrates for approximately 3 weeks. Objective Data Urine positive for ketones. Analysis Inadequate intake of CHO, related to erroneous ideas about healthy eating as evidenced by verbal statements that he has not been eating CHO-containing foods and by urine positive for ketones. Plan DESIRED OUTCOMES EVALUATION CRITERIA
ACTIONS/INTERVENTIONS
RATIONALE
Client will state one reason why he needs CHO by the end of the appointment.
Encourage client to consume foods from MyPlate, including milk, starches, fruits, and vegetables. Refer to the dietitian for instruction on normal nutrition and protein needs for athletes.
Explaining why carbohydrates are necessary in the diet may motivate the client to eat carbohydrates. Milk, vegetables, fruits, and starches are all good sources of CHO. The nurse may need to educate the client about dietary sources of carbohydrates.
Schedule the client for a return visit in 1 week. Client will keep a food record for the dietitian.
On next visit, ask client to demonstrate knowledge gained. (For example, “How many servings of starch, fruits, and vegetables do you need daily?”) Test the urine for ketones at the next visit.
TEAM
TEAM
WORK 21 Dietitian’s Note
WORK
The following Dietitian’s Notes are representative of the documentation found in a client’s medical record. Dietitian’s Notes
Client states he wants to be able to lift more weight. Food records for 4 days show an average daily intake of 18 meats, 12 fats, 1 starch, 1 fruit, and 1 vegetable, and 1 low-fat milk. Client states he has just recently added starch, fruit, and milk to his diet per nurse’s recommendation. Patient continues to complain of fatigue and constipation. He finds it difficult to concentrate and study.
Subjective:
Ketones in urine, weight 175 lb (81 kg) height: 6 ft Analysis: Ideal body weight 178 ± 10%; estimated protein needs 81–97 grams. Estimated kcal need based on 81 kg and 25–35 kcal/kg = 2025–2835. Food records show an approximate intake of 2111 kcal and 25% protein, 66% fat, and 8% carbohydrate. Inadequate carbohydrate intake related to food and nutrition– related knowledge deficit as evidenced by ketone smell on breath, complaints of fatigue and difficulty concentrating, and food records. Objective:
Continued
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UNIT 1 ■ THE ROLE OF NUTRIENTS IN THE HUMAN BODY
46
TEAM
TEAM
WORK 21 Dietitian’s Note—cont’d
WORK
Client appears open to learning and prefers written and oral instructions.
2.
Plan 1. Client
3. 4.
to substitute CHO kcal for fat kcal by eliminating bacon, olives, soy nuts, and fatty meats from diet.
Client agreed to try adding 3 cups low-fat milk, 4 vegetables, 3 fruits, and 6 whole grains to diet. Appointment scheduled for follow-up in 1 week. Copy of MyPlate given to client.
Critical Thinking Questions 1. At the client’s next visit, what would you do if the food records showed a recorded carbohydrate intake of only 30 grams for most days? What if the client said, “I don’t want to eat any more because I feel better”?
to increase his carbohydrate intake because “Sugar is a quick energy food”? 3. At the next client visit, what would you do if he made no changes to his diet?
2. At the next client visit, what would you do if the food records showed that the client ate only sugar
Chapter Review 1. Which of the following is a disaccharide? a. Glucose b. Lactose c. Fructose d. Galactose 2. A healthy adult needs ____ grams of fiber each day. a. 5 to 11 b. 12 to 20 c. 21 to 38 d. More than 50 3. Twelve grams of simple carbohydrate is equal to ____ teaspoon(s) of sugar. a. 1 b. 2 c. 3 d. 8
4. One slice of bread contains approximately ____ grams of carbohydrates. a. 5 b. 8 c. 10 d. 15 5. Which of the following may cause diarrhea? a. A medication that contains sorbitol b. A lack of dietary fiber c. A lack of exercise d. An insufficient fluid intake
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CHAPTER 2 ■ CARBOHYDRATES
47
Clinical Analysis 1. Ms. C is concerned about the dangers associated with the consumption of artificial sweeteners and wants to know if they are safe. As a health-care worker, it is appropriate for you to: a. Ignore Ms. C’s comments because you think she is overly concerned. b. Assure her that the government wouldn’t allow a food or herbal product to be sold if it was hazardous to her health. c. Explain to her that no food is guaranteed to be 100% safe, and it is best to avoid artificial sweeteners if she is not comfortable with these products. d. Refer her to the local health food store. 2. Mr. J claims he is trying to lose weight, and his urinalysis shows that his urine contains ketones (ketonuria). You should ask him: a. When he ate last b. How much milk, fruit, and starch he usually eats c. What else he usually eats d. All of the above
3. Mr. P complains of constipation. As his nurse, you would like to teach him to eat more insoluble fiber to help alleviate his discomfort. You should encourage the intake of: a. Wheat and corn bran, nuts, fruit skins, and dried beans b. Eggs, cheese, and chicken c. Milk, yogurt, and ice cream d. Oatmeal, barley, and broccoli
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3 Fats
LEARNING OBJECTIVES After completing this chapter, the student should be able to: ■ Identify how fats are classified and discuss their physical properties. ■ List the major functions of fats both in the diet and in the body. ■ Discuss the relationships to health of cholesterol, saturated fat, polyunsaturated fat, trans-fatty acids, and monounsaturated fat. ■ List three current recommendations of the Food and Nutrition Board of the National Research Council that pertain to fat.
T
his chapter presents an introduction to lipids for students without a chemistry background. Chapter 18 expands on this chapter and discusses clinical nutrition in more detail. The descriptive name for fats of all kinds, lipids, is used in clients’ medical records. Lipids include true fats and oils as well as related fatlike compounds such as lipoids and sterols. Fats are a major source of fuel for the body. Dietary fat is found in both animal and plant products. Animal fats, which consist of a larger content of saturated fats, tend to have a higher melting point and are solid at room temperature. Plantderived fats are normally in the form of oils, having a lower melting point and comprising more unsaturated fats than animal products. Lipids are insoluble in water and are greasy to the touch. When two insoluble substances are mixed together, such as vinegar and oil, they separate readily. You can shake the vinegar and oil combination repeatedly, but it will still separate after the agitation stops.
of oxygen to carbon and hydrogen is lower in fats. The basic structural unit of a true fat is one molecule of glycerol joined to one, two, or three fatty acid molecules. Glycerol is thus the backbone of a fat molecule. A fatty acid is composed of a chain of carbon atoms with hydrogen and a few oxygen atoms attached. The fatty acid chains joined to the glycerol molecule vary in length (depending on the number of carbon atoms present) and composition. The different taste, smell, and physical appearance of each fat results from the variety of fatty acids and their physical arrangement in the fat molecules. Beef fat tastes, smells, and looks different from that of chicken mostly because of the difference in fatty acid composition. All fats contain fatty acids. A fat can have from one to three fatty acids, and the number of fatty acids a fat contains has important implications for both diet and health.
Basic Terminology
Monoglycerides and Diglycerides
Lipids are composed of the elements carbon, hydrogen, and oxygen. These are the same three elements that make up carbohydrates, but the proportion 48
When a single fatty acid is joined to a glycerol molecule, the resulting fat is called a monoglyceride. When two fatty acids are joined to a glycerol molecule, the fat is called a diglyceride. The terms
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CHAPTER 3 ■ FATS
monoglyceride and diglyceride are commonly seen on food labels.
Triglycerides When three fatty acids are joined to a glycerol molecule, a triglyceride is formed. Most of the fat found in our diets and in the body is in the form of triglycerides. Excess triglycerides are stored in the specialized adipose cells that make up adipose tissue. The human body has a virtually unlimited capacity to store fat. Figure 3-1 illustrates the structure of monoglycerides, diglycerides, and triglycerides.
Length of Fatty Acid Chain Fatty acids vary in the length of their fatty acid chains: Each chain is determined by the number of carbon atoms present, which can vary from 2 to 24. The length of the chain determines how the body transports the fat in the body; fatty acid chains of short length (70 y
Females
9-13 y 14-18 y 19-30 y 31-50 y 51-70 y >70 y
Males
1-3 y 4-8 y
Infants
0-6 mo 7-12 mo
Infants
LIFE STAGE GROUP
Dietary Reference Intakes (DRIs): Tolerable Upper Intake Levels (ULs), Vitamins (Food and Nutrition Board, Institute of Medicine, National Academies)
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APPENDIX A ■ DIETARY REFERENCE INTAKES FOR INDIVIDUALS
561
ND ND ND
ND ND ND
ND ND ND ND ND ND
ND ND ND ND ND ND
ND ND
NDe ND
17 20 20
17 20 20
11 17 20 20 20 20
11 17 20 20 20 20
3 6
ND ND
3000 2500 2500
3000 2500 2500
3000 3000 2500 2500 2000 2000
3000 3000 2500 2500 2000 2000
2500 2500
1000 1500
ND ND ND
ND ND ND
ND ND ND ND ND ND
ND ND ND ND ND ND
ND ND
ND ND
8000 10,000 10,000
8000 10,000 10,000
5000 8000 10,000 10,000 10,000 10,000
5000 8000 10,000 10,000 10,000 10,000
1000 3000
ND ND
10 10 10
10 10 10
10 10 10 10 10 10
10 10 10 10 10 10
1.3 2.2
0.7 0.9
900 1100 1100
900 1100 1100
600 900 1100 1100 1100 1100
600 900 1100 1100 1100 1100
200 300
ND ND
45 45 45
45 45 45
40 45 45 45 45 45
40 45 45 45 45 45
40 40
40 40
350 350 350
350 350 350
350 350 350 350 350 350
350 350 350 350 350 350
65 110
ND ND
9 11 11
9 11 11
6 9 11 11 11 11
6 9 11 11 11 11
2 3
ND ND
1700 2000 2000
1700 2000 2000
1100 1700 2000 2000 2000 2000
1100 1700 2000 2000 2000 2000
300 600
ND ND
1.0 1.0 1.0
1.0 1.0 1.0
0.6 1.0 1.0 1.0 1.0 1.0
0.6 1.0 1.0 1.0 1.0 1.0
0.2 0.3
ND ND
4 4 4
3.5 3.5 3.5
4 4 4 4 4 3
4 4 4 4 4 3
3 3
ND ND
400 400 400
400 400 400
280 400 400 400 400 400
280 400 400 400 400 400
90 150
45 60
ND ND ND
ND ND ND
ND ND ND ND ND ND
ND ND ND ND ND ND
ND ND
ND ND
ND ND ND
ND ND ND
ND ND 1.8 1.8 1.8 1.8
ND ND 1.8 1.8 1.8 1.8
ND ND
ND ND
34 40 40
34 40 40
23 34 40 40 40 40
23 34 40 40 40 40
7 12
4 5
2.3 2.3 2.3
2.3 2.3 2.3
2.2 2.3 2.3 2.3 2.3 2.3
2.2 2.3 2.3 2.3 2.3 2.3
1.5 1.9
ND ND
3.6 3.6 3.6
3.6 3.6 3.6
3.4 3.6 3.6 3.6 3.6 3.6
3.4 3.6 3.6 3.6 3.6 3.6
2.3 2.9
ND ND
VANADIUM ZINC SODIUM CHLORIDE SILICONc (mg/d)d (mg/d) (g/d) (g/d)
Note: A Tolerable Upper Intake Level (UL) is the highest level of daily nutrient intake that is likely to pose no risk of adverse health effects to almost all individuals in the general population. Unless otherwise specified, the UL represents total intake from food, water, and supplements. Due to a lack of suitable data, ULs could not be established for chromium and silicon. In the absence of a UL, extra caution may be warranted in consuming levels above recommended intakes. Members of the general population should be advised not to routinely exceed the UL. The UL is not meant to apply to individuals who are treated with the nutrient under medical supervision or to individuals with predisposing conditions that modify their sensitivity to the nutrient. aAlthough the UL was not determined for arsenic, there is no justification for adding arsenic to food or supplements. bThe ULs for magnesium represent intake from a pharmacological agent only and do not include intake from food and water. cAlthough silicon has not been shown to cause adverse effects in humans, there is no justification for adding silicon to supplements. dAlthough vanadium in food has not been shown to cause adverse effects in humans, there is no justification for adding vanadium to food, and vanadium supplements should be used with caution. The UL is based on adverse effects in laboratory animals; these data could be used to set a UL for adults, but not children and adolescents. eND = Not determinable due to lack of data of adverse effects in this age group and concern with regard to lack of ability to handle excess amounts. Source of intake should be from food only to prevent high levels of intake. Sources: Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride (1997); Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998); Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000); Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001); Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005); and Dietary Reference Intakes for Calcium and Vitamin D (2011). These reports may be accessed at www.nap.edu. Copyrighted by the National Academy of Sciences, used with permission.
14–18 y 19–30 y 31–50 y
Lactation
14–18 y 19–30 y 31–50 y
Pregnancy
9–13 y 14–18 y 19–30 y 31–50 y 51–70 y >70 y
Females
9–13 y 14–18 y 19–30 y 31–50 y 51–70 y >70 y
Males
1–3 y 4–8 y
Children
0–6 mo 7–12 mo
ARSENICa
MAGNE MANGA MOLYB PHOS NESE DENUM NICKEL PHORUS SELENIUM BORON CALCIUM COPPER FLUORIDE IODINE IRON SIUM CHROMIUM (mcg/d) (mg/d) (mcg/d) (mg/d) (mg/d) (mcg/d) (mg/d (mg/d)b (mg/d) (mcg/d) (mg/d) (g/d)
562
Infants
LIFE STAGE GROUP
Dietary Reference Intakes (DRIs): Tolerable Upper Intake Levels (ULs), Elements (Food and Nutrition Board, Institute of Medicine, National Academies)
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APPENDIX A ■ DIETARY REFERENCE INTAKES FOR INDIVIDUALS
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APPENDIX B Academy of Nutrition and Dietetics Exchange Lists for Diabetes
Legend: * = More than 3 grams of dietary fiber per serving. † = Extra fat, or prepared with added fat (count as 1 starch + 1 fat). # = 480 milligrams or more of sodium per serving; 600 milligrams or more of sodium per serving for combination food main dishes/meals and fast food main dishes/meals.
Starch List Bread FOOD
SERVING SIZE
FOOD
Bagel, large (about 4 oz) †Biscuit, 2 1/2 in. across Bread *reduced calorie white, whole-grain, pumpernickel, rye, unfrosted raisin Chapatti, small, 6 in. across †Cornbread, 1 3/4-in. cube English muffin Hot dog bun or hamburger bun Naan, 8 × 2 in.
/4 (1 oz) 1
Pancake, 4 in. across, /4 in. thick Pita, 6 in. across Roll, plain, small †Stuffing, bread †Taco shell, 5 in. across Tortilla, corn, 6 in. across Tortilla, flour, 6 in. across Tortilla, flour, 10 in. across †Waffle, 4-in. square or 4 in. across
1 1 /2 1 (1 oz) 1 /3 cup 2 1 1 1 /3 tortilla 1
1
2 slices (1 1/2 oz) 1 slice (1 oz) 1 1 (1 1/2 oz) 1 /2 1 /2 (1 oz) 1 /4
SERVING SIZE 1
Cereals and Grains FOOD
SERVING SIZE
FOOD
SERVING SIZE
Barley, cooked Bran, dry *oat *wheat *Bulgar (cooked) Cereals *bran cooked (oats, oatmeal) puffed shredded wheat, plain sugar-coated unsweetened, ready-to-eat Couscous Granola low-fat †regular
1
/3 cup
Grits, cooked Kasha Millet, cooked Muesli Pasta, cooked Polenta, cooked Quinoa, cooked Rice, white or brown, cooked Tabbouleh (tabouli), prepared Wheat germ, dry Wild rice, cooked
1
/4 cup /2 cup 1 /2 cup 1 1
/2 cup /2 cup 1 1/2 cups 1 /2 cup 1 /2 cup 3 /4 cup 1 /3 cup 1 1
/2 cup /2 cup 1 /3 cup 1 /4 cup 1 /3 cup 1 /3 cup 1 /3 cup 1 /3 cup 1 /2 cup 3 tbsp 1 /2 cup 1
/4 cup /4 cup
1 1
563
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APPENDIX B ■ EXCHANGE LISTS FOR DIABETES
Starchy Vegetables FOOD
SERVING SIZE
FOOD
Cassava Corn on cob, large *Hominy, canned *Mixed vegetables with corn, peas, or pasta *Parsnips *Peas, green Plantain, ripe Potato baked with skin boiled, all kinds †mashed, with milk and fat French fried (oven-baked)
/3 cup /2 cup 1 /2 cob (5 oz) 3 /4 cup 1 cup 1 /2 cup 1 /2 cup 1 /3 cup
*Pumpkin, canned, no sugar added Spaghetti/pasta sauce *Squash, winter (acorn, butternut) *Succotash Yam, sweet potato, plain
1 1
SERVING SIZE 1 cup /2 cup 1 cup 1 /2 cup 1 /2 cup 1
/4 large (3 oz) /2 cup or 1/2 medium (3 oz) 1 /2 cup 1 cup (2 oz) 1 1
Crackers and Snacks FOOD
SERVING SIZE
FOOD
Animal crackers Crackers †round, butter type saltine type †sandwich style, cheese or peanut butter filling †whole-wheat regular *whole-wheat lower fat or crisp breads Graham cracker, 2 1/2 in. square Matzo Melba toast, about 2 × 4-in. piece Oyster crackers
8
Popcorn *†with butter *no fat added *lower fat Pretzels Rice cakes, 4 in. across Snack chips fat-free or baked (tortilla, potato), baked pita chips †regular (tortilla, potato)
6 6 3 2–5 (3/4 oz) 2–5 (3/4 oz) 3 3 /4 oz 4 pieces 20
SERVING SIZE 3 cups 3 cups 3 cups 3 /4 oz 2 15–20 (3/4 oz) 9–13 (3/4 oz)
Beans, Peas, and Lentils The choices on this list count as 1 starch + 1 lean meat. FOOD
SERVING SIZE
*Baked beans *Beans, cooked (black, garbanzo, kidney, lima, navy, pinto, white) *Lentils, cooked (brown, green, yellow)
1
/3 cup /2 cup
1
FOOD
SERVING SIZE
*Peas, cooked (black-eyed, split) *#Refried beans, canned
1
/2 cup /2 cup
1
/2 cup
1
Fruit List Fruit The weight listed includes skin, core, seeds, and rind. FOOD
SERVING SIZE
FOOD
SERVING SIZE
Apple, unpeeled, small Apples, dried Applesauce, unsweetened
1 (4 oz) 4 rings 1 /2 cup
Apricots canned dried *fresh
/2 cup 8 halves whole (5 1/2 oz) 1
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APPENDIX B ■ EXCHANGE LISTS FOR DIABETES
565
Fruit—cont’d FOOD
SERVING SIZE
Banana, extra small *Blackberries Blueberries Cantaloupe, small Cherries sweet, canned sweet, fresh Dates Dried fruits (blueberries, cherries, cranberries, mixed fruit, raisins) Figs dried *fresh Fruit cocktail Grapefruit large sections, canned Grapes, small Honeydew melon *Kiwi Mandarin oranges, canned
1 (4 oz) 3 /4 cup 3 /4 cup 1 /3 melon or 1 cup cubed (11 oz) 1 /2 cup 12 (3 oz) 3 2 tbsp
1 1/2 1 1/2 large or 2 medium (3 1/2 oz) 1 /2 cup /2 (11 oz) /4 cup 17 (3 oz) 1 slice or 1 cup cubed (10 oz) 1 (3 1/2 oz) 3 /4 cup 1 3
FOOD
SERVING SIZE
Mango, small Nectarine, small *Orange, small Papaya Peaches, canned fresh, medium Pears canned fresh, large Pineapple canned fresh Plums canned dried (prunes) small *Raspberries *Strawberries *Tangerines, small Watermelon
/2 fruit (5 1/2 oz) or 1/2 cup 1 (5 oz) 1 (6 1/2 oz) 1 /2 fruit or 1 cup cubed (8 oz) 1
/2 cup 1 (6 oz) 1
/2 cup /2 (4 oz)
1 1
/2 cup /4 cup
1 3
/2 cup 3 2 (5 oz) 1 cup 1 1/4 cup whole berries 2 (8 oz) 1 slice or 1 1/4 cups cubes (13 1/2 oz) 1
Fruit Juice FOOD
SERVING SIZE
Apple juice/cider Fruit juice blends, 100% juice Grape juice Grapefruit juice
1
/2 cup /3 cup 1 /3 cup 1 /2 cup 1
FOOD
SERVING SIZE
Orange juice Pineapple juice Prune juice
1
/2 cup /2 cup 1 /3 cup 1
Milk List Milk and Yogurts FOOD
SERVING SIZE
COUNT AS
1 cup
1 fat-free milk
1
/2 cup
1 fat-free milk
2
/3 cup (6 oz)
1 fat-free milk
1 cup
1 reduced-fat milk
2
/3 cup (6 oz)
1 reduced-fat milk
1 cup 1 /2 cup 1 cup (8 oz)
1 whole milk 1 whole milk 1 whole milk
Fat-free (skim) or low-fat (1%)
Milk, buttermilk, acidophilus milk, Lactaid® Evaporated milk Yogurt, plain or flavored with artificial sweetener Reduced-fat (2%)
Milk, acidophilus milk, kefir, Lactaid® Yogurt, plain Whole
Milk, buttermilk, goat’s milk Evaporated milk Yogurt, plain
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APPENDIX B ■ EXCHANGE LISTS FOR DIABETES
Dairy-Like Foods FOOD Chocolate milk fat-free whole Eggnog, whole milk Rice drink flavored, low-fat plain, fat-free Smoothies, flavored, regular Soy milk light regular, plain Yogurt and juice blends low-carbohydrate (less than 6 grams carbohydrate per serving) with fruit, low-fat
SERVING SIZE
COUNT AS
1 cup 1 cup 1 /2 cup
1 fat-free milk + 1 carbohydrate 1 whole milk + 1 carbohydrate 1 carbohydrate + 2 fats
1 cup 1 cup 10 oz
2 carbohydrates 1 carbohydrate 1 fat-free milk + 2 1/2 carbohydrates
1 cup 1 cup
1 carbohydrate + 1/2 fat 1 carbohydrate + 1 fat
1 cup 2 /3 cup (6 oz) 2 /3 cup (6 oz)
1 fat-free milk + 1 carbohydrate 1 /2 fat-free milk 1 fat-free milk + 1 carbohydrate
Nonstarchy Vegetable List In general, 1 nonstarchy vegetable choice is: 1 ■ /2 cup of cooked vegetables or vegetable juice ■ 1 cup of raw vegetables Amaranth or Chinese spinach *Carrots Artichoke Cauliflower Artichoke hearts Celery Asparagus *Chayote Baby corn Coleslaw, packaged, no dressing Bamboo shoots Cucumber Bean sprouts Daikon Beans (green, wax, Italian) Eggplant Beets Gourds (bitter, bottle, luffa, bitter melon) #Borscht Green onions or scallions Broccoli Greens (collard, kale, mustard, turnip) *Brussels sprouts Hearts of palm Cabbage (green, bok choy, Chinese) Jicama
Kohlrabi Leeks Mixed vegetables (without corn, peas, or pasta) Mung bean sprouts Mushrooms, all kinds, fresh Okra Onions Pea pods *Peppers (all varieties) Radishes Rutabaga #Sauerkraut
Soybean sprouts Spinach Squash (summer, crookneck, zucchini) Sugar snap peas *Swiss chard Tomato Tomatoes, canned #Tomato sauce #Tomato/vegetable juice Turnips Water chestnuts Yard-long beans
Meat and Meat Substitutes List Lean Meats and Meat Substitutes FOOD
SERVING SIZE
FOOD
SERVING SIZE
Beef: Select or Choice grades trimmed of fat: ground round, roast (chuck, rib, rump), round, sirloin, steak (cubed, flank, porterhouse, T-bone), tenderloin #Beef jerky Cheeses with 3 grams of fat or less per oz Cottage cheese Egg substitutes, plain Egg whites
1 oz
Fish, fresh or frozen, plain: catfish, cod, flounder, haddock, halibut, orange roughy, salmon, tilapia, trout, tuna #Fish, smoked: herring or salmon (lox) Game: buffalo, ostrich, rabbit, venison #Hot dog with 3 grams of fat or less per oz (8 dogs per 14 oz package) Note: May be high in carbohydrate.
1 oz
/2 oz 1 oz 1 /4 cup 1 /4 cup 2 1
1 oz 1 oz 1
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567
Lean Meats and Meat Substitutes—cont’d FOOD
SERVING SIZE
FOOD
SERVING SIZE
Lamb: chop, leg, or roast Organ meats: heart, kidney, liver Note: May be high in cholesterol. Oysters, fresh or frozen Pork, lean #Canadian bacon rib or loin chop/roast, ham, tenderloin Poultry, without skin: chicken, Cornish hen, domestic duck or goose (well-drained of fat), turkey Processed sandwich meats with 3 grams of fat or less per oz: chipped beef, deli thin-sliced meats, turkey ham, turkey kielbasa, turkey pastrami
1 oz 1 oz
Salmon, canned Sardines, canned #Sausage with 3 grams of fat or less per oz Shellfish: clams, crab, imitation shellfish, lobster, scallops, shrimp Tuna, canned in water or oil, drained Veal: loin chop, roast
1 oz 2 small 1 oz 1 oz
SERVING SIZE
6 medium 1 oz 1 oz 1 oz
1 oz 1 oz
1 oz
Medium-Fat Meat and Meat Substitutes FOOD
SERVING SIZE
FOOD
Beef: corned beef, ground beef, meatloaf, Prime grades trimmed of fat (prime rib), short ribs, tongue Cheeses with 4–7 grams of fat per oz: feta, mozzarella, pasteurized processed cheese spread, reduced-fat cheeses, string Egg Note: High in cholesterol, limit to 3 per week. Fish, any fried type
1 oz
Lamb: ground, rib roast Pork: cutlet, shoulder roast Poultry: chicken with skin; dove, pheasant, wild duck, or goose; fried chicken; ground turkey Ricotta cheese #Sausage with 4–7 grams of fat per oz Veal, cutlet (no breading)
1 oz
1 1 oz
1 oz 1 oz 1 oz 2 oz (1/4 cup) 1 oz 1 oz
High-Fat Meat and Meat Substitutes FOOD Bacon #pork #turkey
Cheese, regular: American, bleu, brie, cheddar, hard goat, Monterey jack, queso, and Swiss #†Hot dog: beef, pork, or combination (10 per 1 lb-sized package)
SERVING SIZE 2 slices (16 slices per lb or 1 oz each, before cooking) 3 slices (1/2 oz each before cooking) 1 oz each before cooking 1
FOOD
SERVING SIZE
#Hot dog: turkey or chicken
1
(10 per 1 lb package) Pork: ground, sausage, spareribs Processed sandwich meats with 8 grams of fat or more per oz: bologna, hard salami, pastrami #Sausage with 8 grams fat or more per oz: bratwurst, chorizo, Italian, knockwurst, Polish, smoked, summer
1 oz 1 oz 1 oz
Plant-Based Proteins FOOD “Bacon” strips, soy-based *Baked beans *Beans, cooked: black, garbanzo, kidney, lima, navy, pinto, white *“Beef” or “sausage” crumbles, soy-based “Chicken” nuggets, soy-based *Edamame Falafel (spiced chickpea and wheat patties)
SERVING SIZE
COUNT AS
3 strips /3 cup 1 /2 cup 2 oz 2 nuggets (1 1/2 oz) 1 /2 cup 3 patties (about 2 in. across)
1 medium-fat meat 1 starch + 1 lean meat 1 starch + 1 lean meat 1 /2 carbohydrate + 1 lean meat 1 /2 carbohydrate + 1 medium-fat meat
1
/2 carbohydrate + 1 lean meat 1 carbohydrate + 1 high-fat meat 1
(continued)
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APPENDIX B ■ EXCHANGE LISTS FOR DIABETES
Plant-Based Proteins—cont’d FOOD
SERVING SIZE
COUNT AS
Hot dog, soy-based *Hummus *Lentils, brown, green, or yellow *Meatless burger, soy-based *Meatless burger, vegetable- and starch-based Nut spreads: almond butter, cashew butter, peanut butter, soy nut butter *Peas, cooked: black-eyed and split peas *#Refried beans, canned “Sausage” patties, soy-based Soy nuts, unsalted Tempeh Tofu Tofu, light
1 (1 /2 oz) /3 cup 1 /2 cup 3 oz 1 patty (about 2 1/2 oz) 1 tbsp
1
/2 cup /2 cup 1 (1 1/2 oz) 3 /4 oz 3 /4 cup 4 oz (1/2 cup) 4 oz (1/2 cup)
1 starch + 1 lean meat 1 starch + 1 lean meat 1 medium-fat meat 1 /2 carbohydrate + 1 medium-fat meat 1 medium-fat meat 1 medium-fat meat 1 lean meat
/2 carbohydrate + 1 lean meat 1 carbohydrate + 1 high-fat meat 1 carbohydrate + 1 lean meat 1 /2 carbohydrate + 2 lean meats 1 carbohydrate + 2 lean meats
1
1
1 high-fat meat
1 1
Fat List Unsaturated Fats—Monounsaturated Fats FOOD
SERVING SIZE
FOOD
SERVING SIZE
Avocado, medium Nut butters (trans-fat–free): almond butter, cashew butter, peanut butter (smooth or crunchy) Nuts almonds Brazil cashews filberts (hazelnuts) macadamia
2 tbsp (1 oz) 1 1/2 tsp
mixed (50% peanuts) peanuts pecans pistachios Oil: canola, olive, peanut Olives black (ripe) green, stuffed
6 nuts 10 nuts 4 halves 16 nuts 1 tsp 8 large 10 large
6 nuts 2 nuts 6 nuts 5 nuts 3 nuts
Unsaturated Fats—Polyunsaturated Fats FOOD
SERVING SIZE
FOOD
SERVING SIZE
Margarine: lower-fat spread (30%–50% vegetable oil, trans-fat–free) Margarine: stick, tub (trans-fat–free), or squeeze (trans-fat–free) Mayonnaise reduced fat regular Mayonnaise-style salad dressing reduced fat regular Nuts pignola (pine nuts) walnuts, English Oil: corn, cottonseed, flaxseed, grape seed, safflower, soybean, sunflower
1 tbsp
Oil: made from soybean and canola oil—Enova Plant stanol esters light regular Salad dressing #reduced fat Note: May be high in carbohydrate. #regular Seeds flaxseed, whole pumpkin, sunflower sesame seeds Tahini or sesame paste
1 tsp
1 tsp
1 tbsp 1 tsp 1 tbsp 2 tsp 1 tbsp 4 halves 1 tsp
1 tbsp 2 tsp 2 tbsp 1 tbsp 1 tbsp 1 tbsp 1 tbsp 2 tsp
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APPENDIX B ■ EXCHANGE LISTS FOR DIABETES
569
Saturated Fats FOOD
SERVING SIZE
FOOD
SERVING SIZE
Bacon, cooked, regular or turkey Butter reduced fat stick whipped Butter blends made with oil reduced fat or light regular Chitterlings, boiled Coconut, sweetened, shredded Coconut milk light regular Cream half and half heavy
1 slice
light whipped whipped, pressurized Cream cheese reduced fat regular Lard Oil: coconut, palm, palm kernel Salt pork Shortening, solid Sour cream reduced fat or light regular
1 1/2 tbsp 2 tbsp 1 /4 cup
1 tbsp 1 tsp 2 tsp 1 tbsp 1 1/2 tsp 2 tbsp (1/2 oz) 2 tbsp /3 cup 1 1/2 tbsp 1
1 1/2 tbsp (3/4 oz) 1 tbsp (1/2 oz) 1 tsp 1 tsp 1 /4 oz 1 tsp 3 tbsp 2 tbsp
2 tbsp 1 tbsp
Free Foods List Most foods on this list should be limited to three servings (as listed here) per day. Spread out the servings throughout the day. Food and drink choices listed here without a serving size can be eaten whenever you like.
Low-Carbohydrate Foods FOOD
SERVING SIZE
FOOD
Cabbage, raw Candy, hard (regular or sugar-free) Carrots, cauliflower, or green beans, cooked Cranberries, sweetened with sugar substitute Cucumber, sliced Gelatin dessert, sugar-free unflavored
1
/2 cup 1 piece 1 /4 cup 1 /2 cup 1 /2 cup
Gum Jam or jelly, light or no sugar added Rhubarb, sweetened with sugar substitute Salad greens Sugar substitutes (artificial sweeteners) Syrup, sugar-free
SERVING SIZE 2 tsp /2 cup
1
2 tbsp
Modified-Fat Foods With Carbohydrate FOOD
SERVING SIZE
FOOD
Cream cheese, fat-free Creamers nondairy, liquid nondairy, powdered Margarine spread fat-free reduced fat Mayonnaise fat-free reduced fat
1 tbsp (1/2 oz)
Mayonnaise-style salad dressing fat-free reduced-fat Salad dressing fat-free or low fat fat-free, Italian Sour cream, fat-free or reduced-fat Whipped topping light or fat-free regular
1 tbsp 2 tsp 1 tbsp 1 tsp 1 tbsp 1 tsp
SERVING SIZE 1 tbsp 1 tsp 1 tbsp 2 tbsp 1 tbsp 2 tbsp 1 tbsp
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570
APPENDIX B ■ EXCHANGE LISTS FOR DIABETES
Condiments FOOD
SERVING SIZE
Barbecue sauce Catsup (ketchup) Honey mustard Horseradish Lemon juice Miso Mustard Parmesan cheese, freshly grated Pickle relish Pickles #dill sweet, bread and butter sweet, gherkin
2 tsp 1 tbsp 1 Tbsp
1 1/2 tsp
FOOD
SERVING SIZE
Salsa #Soy sauce, light or regular Sweet and sour sauce Sweet chili sauce Taco sauce Vinegar Yogurt, any type
/4 cup 1 tbsp 2 tsp 2 tsp 1 tbsp 1
2 tbsp
1 tbsp 1 tbsp 1 1/2 medium 2 slices 3 /4 oz
Drinks/Mixes The foods on this list without a serving size can be consumed in any moderate amount. #Bouillon, broth, consommé ■ ■ Bouillon or broth, low-sodium ■ Carbonated or mineral water ■ Club soda ■ Cocoa powder, unsweetened (1 tbsp) ■ Coffee, unsweetened or with sugar substitute
■ ■ ■ ■ ■ ■
Diet soft drinks, sugar-free Drink mixes, sugar-free Tea, unsweetened or with sugar substitute Tonic water, diet Water Water, flavored, carbohydrate-free
Seasonings Any food on this list can be consumed in any moderate amount. ■ Flavoring extracts (for example, vanilla, almond, peppermint) ■ Garlic ■ Herbs, fresh or dried ■ Nonstick cooking spray
■ ■ ■ ■ ■
Pimento Spices Hot pepper sauce Wine, used in cooking Worcestershire sauce
Combination Foods List Entrees FOOD
SERVING SIZE
COUNT AS
#Casserole type (tuna noodle, lasagna, spaghetti with meatballs, chili with beans, macaroni and cheese)
1 cup (8 oz)
#Stews (beef/other meats and vegetables)
1 cup (8 oz)
Tuna salad or chicken salad
1
2 carbohydrates + 2 medium-fat meats 1 carbohydrate + 1 medium-fat meat + 0–3 fats 1 /2 carbohydrate + 2 lean meats + 1 fat
/2 cup (31/2 oz)
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APPENDIX B ■ EXCHANGE LISTS FOR DIABETES
571
Frozen Meals/Entrees FOOD
SERVING SIZE
COUNT AS
#*Burrito (beef and bean) #Dinner-type meal
1 (5 oz) Generally 14–17 oz
#Entree or meal with less than 340 calories
About 8–11 oz
3 carbohydrates + 1 lean meat + 2 fats 3 carbohydrates + 3 medium-fat meats + 3 fats 2–3 carbohydrates + 1–2 lean meats
Pizza #cheese/vegetarian, thin crust #meat topping, thin crust
1
/4 of a 12-in. (4 1/2–5 oz) /4 of a 12-in. (5 oz)
2 carbohydrates + 2 medium-fat meats 2 carbohydrates + 2 medium-fat meats + 1 1/2 fats 3 carbohydrates + 1 lean meat + 1–2 fats 2 1/2 carbohydrates + 1 medium-fat meat + 3 fats
1
#Pocket sandwich
1 (4 1/2 oz) 1 (7 oz)
#Pot pie
Salads (Deli-Style) FOOD
SERVING SIZE
COUNT AS
Coleslaw Macaroni/pasta salad
1
/2 cup /2 cup
1 carbohydrate + 1 /2 fats 2 carbohydrates + 3 fats
1
1
FOOD
SERVING SIZE
COUNT AS
#Potato salad
1
/2 cup
1 1/2–2 carbohydrates + 1–2 fats
Soups FOOD
SERVING SIZE
COUNT AS
#Bean, lentil, or split pea
1 cup 1 cup (8 oz) 1 cup (8 oz) 6 oz prepared 8 oz prepared 1 cup 1 cup 1 cup 1 cup (8 oz) 1 cup (8 oz)
1 carbohydrate + 1 lean meat 1 carbohydrate + 1 lean meat + 1 1/2 fats 1 carbohydrate + 1 fat 1 carbohydrate 2 1/2 carbohydrates + 1 lean meat 1 /2 carbohydrate + 1 fat 2 carbohydrates + 2 fats 1 carbohydrate 1 carbohydrate 1 carbohydrate
#Chowder (made with milk) #Cream (made with water) #Instant #with beans or lentils #Miso soup #Ramen noodle
Rice (congee) #Tomato (made with water) #Vegetable beef, chicken noodle, or other broth type
Fast Foods List Breakfast Sandwiches FOOD
SERVING SIZE
COUNT AS
#Egg, cheese, meat, English muffin
1 sandwich 1 sandwich
2 carbohydrates + 2 medium-fat meats 2 carbohydrates + 2 high-fat meats + 3 1/2 fats
#Sausage biscuit sandwich
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572
APPENDIX B ■ EXCHANGE LISTS FOR DIABETES
Main Dishes/Entrees FOOD
SERVING SIZE
COUNT AS
*#Burrito (beef and beans)
1 (about 8 oz) 1 (about 5 oz) 1 (about 2 oz) 6 (about 31/2 oz) 1 (about 4 oz) 6 (5 oz)
3 carbohydrates + 3 medium-fat meats + 3 fats 1 carbohydrate + 4 medium-fat meats 2 medium-fat meats 1 carbohydrate + 2 medium-fat meats + 1 fat 1 /2 carbohydrate + 3 medium-fat meats + 1 1/2 fats 5 medium-fat meats + 1 1/2 fats
#Chicken breast, breaded and fried
Chicken drumstick, breaded and fried #Chicken nuggets #Chicken thigh, breaded and fried #Chicken wings, hot
Asian FOOD
SERVING SIZE
COUNT AS
#Beef/chicken/shrimp with vegetables in sauce
1 cup (about 5 oz) 1 (about 3 oz) 1 /2 cup 1 cup 1 cup
1 carbohydrate + 1 lean meat + 1 fat 1 carbohydrate + 1 lean meat + 1 fat 1 1/2 carbohydrates + 1 1/2 fats 3 carbohydrates + 3 medium-fat meats + 2 fats 2 carbohydrates + 1 fat
#Egg roll, meat
Fried rice, meatless #Meat and sweet sauce (orange chicken) *#Noodles and vegetables in sauce (chow mein, lo mein)
Pizza FOOD
SERVING SIZE
COUNT AS
Pizza #cheese, pepperoni, regular crust #cheese/vegetarian, thin crust
1
/8 of a 14-in. (about 4 oz) /4 of a 12-in. (about 6 oz)
21/2 carbohydrates + 1 medium-fat meat + 1 1/2 fats 21/2 carbohydrates + 2 medium-fat meats + 1 1/2 fats
FOOD
SERVING SIZE
COUNT AS
#Chicken sandwich, grilled
1 1 1
3 carbohydrates + 4 lean meats 3 1/2 carbohydrates + 3 medium-fat meats + 1 fat 2 1/2 carbohydrates + 2 medium-fat meats + 2 fats
1 1 1
2 1/2 carbohydrates + 4 medium-fat meats + 1 fat 2 carbohydrates + 1 medium-fat meat + 1 fat 1 carbohydrate + 1 high-fat meat + 1 fat
6-in. sub 6-in. sub 1 small
3 carbohydrates + 2 lean meats 3 1/2 carbohydrates + 2 medium-fat meats + 1 fat 1 carbohydrate + 1 medium-fat meat + 1 1/2 fats
1
Sandwiches
#Chicken sandwich, crispy
Fish sandwich with tartar sauce Hamburger #large with cheese regular #Hot dog with bun Submarine sandwich #less than 6 grams fat #regular Taco, hard or soft shell (meat and cheese)
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APPENDIX B ■ EXCHANGE LISTS FOR DIABETES
Salads FOOD
SERVING SIZE
COUNT AS
*#Salad, main dish (grilled chicken type, no dressing or croutons)
Salad Small (about 5 oz)
1 carbohydrate + 4 lean meats 1 vegetable
Salad, side (no dressing or cheese)
Sides/Appetizers FOOD
SERVING SIZE
COUNT AS
†French fries, restaurant
small medium large small (about 4 1/2 oz) 1 serving (about 3 oz)
3 carbohydrates + 3 fats 4 carbohydrates + 4 fats 5 carbohydrates + 6 fats 2 1/2 carbohydrates + 4 fats 2 1/2 carbohydrates + 3 fats
FOOD
SERVING SIZE
COUNT AS
Milkshake, any flavor Soft-serve ice cream cone
12 oz 1 small
6 carbohydrates + 2 fats 2 1/2 carbohydrates + 1 fat
style #Nachos with cheese #Onion rings
Desserts
Alcohol List ALCOHOLIC BEVERAGE Beer light (4.2%) regular (4.9%) Distilled spirits: vodka, rum, gin, whiskey 80 or 86 proof Liqueur, coffee (53 proof) Sake Wine dessert (sherry) dry, red or white (10%)
SERVING SIZE
COUNT AS
12 fl oz 12 fl oz 1 1/2 fl oz
1 alcohol equivalent + 1/2 carbohydrate 1 alcohol equivalent + 1 carbohydrate 1 alcohol equivalent
1 fl oz 1 fl oz
1
3 1/2 fl oz 5 fl oz
1 alcohol equivalent + 1 carbohydrate 1 alcohol equivalent
/2 alcohol equivalent + 1 carbohydrate /2 alcohol equivalent
1
Sweets, Desserts, and Other Carbohydrates List Beverages, Soda, and Energy/Sports Drinks FOOD Cranberry juice cocktail Energy drink Fruit drink or lemonade Hot chocolate regular sugar-free or light Soft drink (soda), regular Sports drink
SERVING SIZE
COUNT AS
1
/2 cup 1 can (8.3 oz) 1 cup (8 oz)
1 carbohydrate 2 carbohydrates 2 carbohydrates
1 envelope added to 8 oz water 1 envelope added to 8 oz water 1 can (12 oz) 1 cup (8 oz)
1 carbohydrate + 1 fat 1 carbohydrate 2 1/2 carbohydrates 1 carbohydrate
573
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APPENDIX B ■ EXCHANGE LISTS FOR DIABETES
Brownies, Cake, Cookies, Gelatin, Pie, and Pudding FOOD
SERVING SIZE
COUNT AS
Brownie, small, unfrosted
1 1/4 in. square, 7 /8 in. high (about 1 oz)
1 carbohydrate + 1 fat
1⁄
12 of cake (about 2 oz) 2-in. square (about 2 oz) 2-in. square (about 1 oz)
2 carbohydrates 2 carbohydrates + 1 fat 1 carbohydrate + 1 fat
2 cookies (21/4 in. across) 3 cookies 2 small (about 2⁄3 oz) 3 small or 1 large (3⁄4–1 oz) 5 cookies 1 small (about 1 3/4 oz) 1 /2 cup (31/2 oz) 1 /2 cup
1 carbohydrate + 2 fats 1 carbohydrate 1 carbohydrate + 1 fat 1 carbohydrate + 1–2 fats 1 carbohydrate + 1 fat 2 carbohydrates + 1–1 1/2 fats 3 carbohydrates + 1 fat 1 carbohydrate
/6 of 8-in. pie /8 of 8-in. pie
3 carbohydrates + 2 fats 1 1/2 carbohydrates +1 1/2 fats
/2 cup /2 cup
2 carbohydrates 1 carbohydrate
Cake angel food, unfrosted frosted unfrosted Cookies (chocolate chip) gingersnap sandwich, with crème filling sugar-free vanilla wafer Cupcake, frosted Fruit cobbler Gelatin, regular Pie commercially prepared fruit, 2 crusts pumpkin or custard Pudding regular (made with reduced-fat milk) sugar-free or sugar- and fat-free (made with fat-free milk)
1 1
1 1
Candy, Spreads, Sweets, Sweeteners, Syrups, and Toppings FOOD
SERVING SIZE
COUNT AS
Candy bar, chocolate/peanut Candy, hard Chocolate “kisses” Coffee creamer dry, flavored liquid, flavored Fruit snacks, chewy (pureed fruit concentrate) Fruit spreads, 100% fruit Honey Jam or jelly, regular Sugar Syrup chocolate light (pancake type) regular (pancake type)
2 “fun size” bars (1 oz) 3 pieces 5 pieces
11/2 carbohydrates + 1 1/2 fats 1 carbohydrate 1 carbohydrate + 1 fat
4 tsp 2 Tbsp 1 roll (3/4 oz) 1 1/2 tbsp 1 tbsp 1 tbsp 1 tbsp
1
2 tbsp 2 tbsp 1 tbsp
2 carbohydrates 1 carbohydrate 1 carbohydrate
FOOD
SERVING SIZE
COUNT AS
Barbeque sauce Cranberry sauce, jellied #Gravy, canned or bottled Salad dressing, fat-free, low-fat, cream-based Sweet and sour sauce
3 tbsp /4 cup 1 /2 cup 3 tbsp 3 tbsp
1 carbohydrate 1 1/2 carbohydrates 1 /2 carbohydrate + 1/2 fat 1 carbohydrate 1 carbohydrate
/2 carbohydrate + 1/2 fat 1 carbohydrate 1 carbohydrate 1 carbohydrate 1 carbohydrate 1 carbohydrate 1 carbohydrate
Condiments and Sauces
1
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APPENDIX B ■ EXCHANGE LISTS FOR DIABETES
Doughnuts, Muffins, Pastries, and Sweet Breads FOOD
SERVING SIZE
COUNT AS
Banana nut bread Doughnut cake, plain yeast type, glazed Muffin (4 oz) Sweet roll or Danish
1-in. slice (2 oz)
2 carbohydrates + 1 fat
1 medium (11/2 oz) 3 3/4 in. across (2 oz) 1 /4 muffin (1 oz) 1 (21/2 oz)
1 1/2 carbohydrates + 2 fats 2 carbohydrates + 2 fats 1 carbohydrate + 1/2 fat 2 1/2 carbohydrates + 2 fats
Frozen Bars, Frozen Desserts, Frozen Yogurt, and Ice Cream FOOD Frozen pops Fruit juice bars, frozen, 100% juice Ice cream fat-free light no sugar added regular Sherbet, sorbet Yogurt, frozen fat-free regular
SERVING SIZE
COUNT AS
1 1 bar (3 oz)
1
/2 cup /2 cup 1 /2 cup 1 /2 cup 1 /2 cup
1 1/2 carbohydrates 1 carbohydrate + 1 fat 1 carbohydrate + 1 fat 1 carbohydrate + 2 fats 2 carbohydrates
/3 cup /2 cup
1 carbohydrate 1 carbohydrate + 0–1 fat
1 1
1 1
/2 carbohydrate 1 carbohydrate
Granola Bars, Meal Replacement Bars/Shakes, and Trail Mix FOOD
SERVING SIZE
COUNT AS
Granola or snack bar, regular or low-fat Meal replacement bar Meal replacement bar Meal replacement shake, reduced calorie Trail mix candy/nut-based dried fruit-based
1 bar (1 oz) 1 bar (11/3 oz) 1 bar (2 oz) 1 can (10–11 oz)
1 1/2 carbohydrates 1 1/2 carbohydrates + 0–1 fat 2 carbohydrates + 1 fat 1 1/2 carbohydrates + 0–1 fat
1 oz 1 oz
1 carbohydrate + 2 fats 1 carbohydrate + 1 fat
Copyright ©2008 Academy of Nutrition and Dietetics. Adapted from Choose Your Foods: Exchange Lists for Diabetes. Copyright 2008, Academy of Nutrition and Dietetics. Used with permission.
575
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APPENDIX C Answers to Questions
Chapter 1. Nutrition in Human Health Chapter Review 1. d 2. b 3. a
4. c
5. d
Clinical Analysis 1. d 2. b 3. a
Chapter Review 1. d 2. a 3. c
4. b 5. b
Clinical Analysis 1. c 2. d 3. c
Chapter 2. Carbohydrates Chapter Review 1. b 2. c 3. c
Chapter 8. Water
4. d
5. a
Clinical Analysis 1. c 2. d 3. a
Chapter 9. Digestion, Absorption, Metabolism, and Excretion Chapter Review 1. d 2. a 3. c
4. b 5. b
Clinical Analysis 1. c 2. d 3. a
Chapter 3. Fats Chapter Review 1. c 2. b 3. c
4. b
5. c
Chapter Review 1. b 2. a 3. c
Clinical Analysis 1. d 2. a 3. c
4. b
5. d
Clinical Analysis 1. d 2. c 3. a
4. b 5. d
Clinical Analysis 1. d 2. d 3. b
4. a
5. b
576
Chapter 12. Life Cycle Nutrition: The Mature Adult 4. a
5. d
Clinical Analysis 1. b 2. b 3. c
Chapter Review 1. c 2. a 3. d
Chapter 7. Minerals
Clinical Analysis 1. a 2. b 3. d
5. d
Chapter 13. Food Management
Clinical Analysis 1. d 2. c 3. b
Chapter Review 1. b 2. c 3. a
4. b
Clinical Analysis 1. c 2. c 3. a
Chapter Review 1. b 2. d 3. b
Chapter 6. Vitamins Chapter Review 1. c 2. d 3. a
5. d
Chapter 11. Life Cycle Nutrition: Infancy, Childhood, and Adolescence Chapter Review 1. c 2. b 3. c
Chapter 5. Energy Balance Chapter Review 1. c 2. a 3. c
4. a
Clinical Analysis 1. c 2. b. 3. d
Chapter 4. Proteins Chapter Review 1. a 2. c 3. b
Chapter 10. Life Cycle Nutrition: Pregnancy and Lactation
4. c
5. d
Clinical Analysis 1. b 2. a 3. c
4. b 5. a
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APPENDIX C ■ ANSWERS TO QUESTIONS
Chapter 14. Nutrient Delivery Chapter Review 1. c 2. a 3. c
4. b 5. a
Clinical Analysis 1. c 2. c 3. a
4. d
5. a
Chapter 16. Weight Management Chapter Review 1. a 2. b 3. d 4. b
5. b
4. b
5. d
Chapter 21. Diet and Cancer Chapter Review 1. d 2. d 3. c
4. a
5. b
Chapter 22. Diet in Critical Care Chapter Review 1. c 2. c 3. b
4. d
5. c
Clinical Analysis 1. c 2. d 3. b
Clinical Analysis 1. a 2. b 3. c
Chapter 17. Diet in Diabetes Mellitus and Hypoglycemia Chapter Review 1. a 2. b 3. d 4. b
5. a
Clinical Analysis 1. c 2. a 3. b
Chapter 23. Diet in HIV And AIDS Chapter Review 1. b 2. d 3. a
4. c 5. d
Clinical Analysis 1. b 2. b 3. b
Chapter 24. Nutritional Care of The Terminally Ill
Chapter 18. Diet in Cardiovascular Disease 4. b
5. d
Clinical Analysis 1. b 2. d 3. c
Chapter 19. Diet in Renal Disease Chapter Review 1. b 2. b 3. d 4. a Clinical Analysis 1. c 2. b 3. a
Chapter Review 1. c 2. b 3. d
Clinical Analysis 1. c 2. b 3. a
Clinical Analysis 1. c 2. a 3. c
Chapter Review 1. a 2. c 3. d
Chapter 20. Diet in Digestive Diseases
Clinical Analysis 1. a 2. c 3. a
Chapter 15. Interactions: Food and Nutrients Versus Medications and Supplements Chapter Review 1. b 2. d 3. c
577
5. d
Chapter Review 1. c 2. c 3. a Clinical Analysis 1. d 2. a 3. b
4. d
5. b
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APPENDIX D
Glossary
This glossary contains commonly used terms as well as terms that appear in boldface in the book. Abdominal circumference (girth)—Distance around the trunk at the umbilicus. Abdominal obesity—Excess body fat located between the chest and pelvis. Abortifacient—Anything used to cause or induce an abortion. Absorption—The movement of the end products of digestion from the gastrointestinal tract into the blood and/or lymphatic system. Accreditation—Process by which a nongovernmental agency recognizes an institution for meeting established criteria of quality. Acculturation—Process of adopting the values, attitudes, and behaviors of another culture. Acetone—A ketone body found in urine, which can be due to the excessive breakdown of stored body fat. Acetyl CoA—Important intermediate byproduct in metabolism formed from the breakdown of glucose, fatty acids, and certain amino acids. Acetylcholine—A chemical necessary for the transmission of nervous impulses. Achalasia—Failure of the gastrointestinal muscle fibers to relax where one part joins another. Achlorhydria—Absence of free hydrochloric acid in the stomach. Acidosis—Condition that results when the pH of the blood falls below 7.35; may be caused by diarrhea, uremia, diabetes mellitus, respiratory depression, and certain drug therapies. Acquired immune deficiency syndrome (AIDS)— A disease complex caused by a virus that attacks the immune system and causes neurological disease and permits opportunistic infections and malignancies. Acrodermatitis enteropathica—Rare autosomal recessive disease that causes zinc deficiency through an unknown mechanism of absorptive failure; fatal if untreated. Acute illness—A sickness characterized by rapid onset, severe symptoms, and a short course. Acute renal failure—Condition that occurs suddenly, in which the kidneys are unable to perform essential functions; usually temporary. Adaptive thermogenesis—The adjustment in energy expenditure the body makes to a large increase or decrease in kilocalorie intake of several days’ duration.
578
Additive—A substance added to food to increase its flavor, shelf life, and/or characteristics such as texture, color, and aroma. Adequate Intake (AI)—The average observed or experimentally defined intake by a defined population or subgroup that appears to sustain a defined nutritional state; incorporates information on the reduction of disease risk; may be used as a goal for an individual’s nutrient intake if an EAR or RDA cannot be set. Adipose cells—Cells in the human body that store fat. Adipose tissue—Tissue containing masses of fat cells. Adolescence—Time from the onset of puberty until full growth is reached. ADP (adenosine diphosphate)—A substance present in all cells involved in energy metabolism. Energy is released when molecules of ATP, another compound in cells, release a phosphoric acid chain and become ADP. The opposite chemical reaction of adding the third phosphoric acid group to ADP requires much energy. Adrenal glands—Small organs on the superior surface of the kidneys that secrete many hormones, including epinephrine (adrenalin) and aldosterone. Advanced directive—A signed document in which the client has specified what type of medical care is desired should he or she lose the ability to make decisions. Aerobic exercise—Training methods such as running or swimming that require continuous inspired oxygen. Afferent—Proceeding toward a center, as arteries, veins, lymphatic vessels, and nerves. Afferent arteriole—Small blood vessel through which blood enters the glomerulus (functional unit of the kidney). Aflatoxin—A naturally occurring food contaminant produced by some strains of Aspergillus molds; found especially on peanuts and peanut products. AIDS dementia complex (ADC)—A central nervous system disorder caused by the human immunodeficiency virus. ALA—See Alpha-linolenic acid. Albumin—A plasma protein responsible for much of the colloidal osmotic pressure of the blood. Aldosterone—An adrenocorticoid hormone that increases sodium and water retention by the kidneys.
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APPENDIX D ■ GLOSSARY
Alimentary canal—The digestive tube extending from the mouth to the anus. Alkaline phosphatase—An enzyme found in highest concentration in the liver, biliary tract epithelium, and bones; enzyme levels are elevated in liver, bone, and biliary disease. Alkalosis—Condition that results when the pH of the blood rises above 7.45; may be caused by vomiting, nasogastric suctioning, or hyperventilation. Allele—One of two or more different genes containing specific inheritable characteristics that occupy corresponding positions (loci) on paired chromosomes; an individual possessing a pair of identical alleles, either dominant or recessive, is homozygous for this gene. Allergen—Substance that provokes an abnormal, individual hypersensitivity. Allergy—State of abnormal, individual hypersensitivity to a substance. Alopecia—Hair loss, especially of the head; baldness. Alpha-linolenic acid (ALA)—A polyunsaturated omega-3 fatty acid found in some plants. Alpha-tocopherol equivalent (␣-TE)—The measure of vitamin E; 1 milligram of alphatocopherol equivalent equals 1.5 International Units of natural alpha-tocopherol or 2.2 IU of synthetic vitamin. Amenorrhea—Absence of menstruation; normally occurs before puberty, after menopause, and during pregnancy and lactation. Amino acids—Organic compounds that are the building blocks of protein; also the end products of protein digestion. Amniotic fluid—Albuminous liquid that surrounds and protects the fetus throughout pregnancy. Amylase—A class of enzymes that splits starches— for example, salivary amylase, pancreatic amylase. Anabolic phase—The third and last phase of stress; characterized by the building up of body tissue and nutrient stores; also called recovery phase. Anabolism—The building up of body compounds or tissues by the synthesis of more complex substances from simpler ones; the constructive phase of metabolism. Anaerobic exercise—A form of physical activity such as weight lifting or sprinting that does not rely on continuous inspired oxygen. Anaphylaxis—Exaggerated, life-threatening hypersensitivity response to a previously encountered antigen; in severe cases, produces bronchospasm, vascular collapse, and shock. Anastomosis—The surgical connection between tubular structures. Anemia—Condition of less-than-normal values for red blood cells or hemoglobin, or both; result is decreased effectiveness in oxygen transport; causes
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may include inadequate iron intake, malabsorption, and chronic or acute blood loss. Anencephaly—Congenital absence of the brain; cerebral hemispheres missing or reduced to small masses; fatal within a few weeks. Angina pectoris—Severe pain and a sense of constriction about the heart caused by lack of oxygen to the heart muscle. Angiotensin II—End product of complex reaction in response to low blood pressure; effect is vasoconstriction and aldosterone secretion. Anion—An ion with a negative charge. Anorexia—Loss of appetite. Anorexia nervosa—A mental disorder characterized by a 25% loss of usual body weight, an intense fear of becoming obese, and self-starvation. Anorexia of aging—Loss of appetite in an elderly individual related to physiologic, social, psychological, or medical causes. Anorexigenic—Causing loss of appetite. Antagonist—A substance that counteracts the action of another substance. Anthropometric measurements—Physical measurements of the human body such as height, weight, and skinfold thickness; used to determine body composition and growth. Anthropometry—The science of measuring the human body. Antibody—A specific protein developed in the body in response to a substance that the body senses to be foreign. Anticholinergic—An agent that blocks parasympathetic nerve impulses, thereby causing dry mouth, blurred vision due to dilated pupils, and decreased gastrointestinal and bronchial secretions. Antidiuretic hormone (ADH)—Hormone formed in the hypothalamus and released from the posterior pituitary in response to blood that is too concentrated; effect is return of water to the bloodstream by the kidney. Antigen—Protein or oligosaccharide marker on surface of cells; body can detect foreign antigens on organisms, foods, and transplanted tissues. Anti-insulin antibodies (AIAs)—A protein found to be elevated in persons with insulin-dependent diabetes mellitus. Antineoplastic drug—A drug that combats tumors. Antioxidant—A substance that prevents or inhibits the uptake of oxygen; in the body, antioxidants prevent tissue damage; in foods, antioxidants prevent deterioration. Antiretroviral—Substance or drug that stops or suppresses the activity of retroviruses such as human immunodeficiency virus (HIV). Anuria—A total lack of urine output.
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Apoferritin—A protein found in intestinal mucosal cells which combines with iron to form ferritin; it is always found attached to iron in the body. Apolipoproteins—Protein components of lipoproteins that assist in regulating lipid metabolism; apo A, the primary high-density lipoprotein apoprotein, is inversely related to the risk for developing coronary artery disease. Appetite—A strong desire for food or for a pleasant sensation, based on previous experience, that causes one to seek food for the purpose of tasting and enjoying. Aquaporin—Water transport proteins, found in many cell membranes, that serve as water-selective channels and explain the speed at which water moves across cell membranes. Arachidonic acid—An omega-6 polyunsaturated fatty acid present in peanuts; precursor of prostaglandins. Ariboflavinosis—Condition arising from a deficiency of riboflavin in the diet. Aromatic amino acids—Phenylalanine, tryptophan, tyrosine; ratio to branched-chain amino acids altered in liver failure. Arrhythmia—Irregular heartbeat. Arteriosclerosis—Common arterial disorder characterized by thickening, hardening, and loss of elasticity of the arterial walls; also called “hardening of the arteries.” Arthritis—Inflammatory condition of the joints, usually accompanied by pain and swelling. Ascites—Accumulation of serous fluid in the peritoneal (abdominal) cavity. Ascorbic acid—Vitamin C; ascorbic literally means “without scurvy.” Ash—The residue that remains after an item is burned; usually refers to the mineral content of the human body. Aspartame—Artificial sweetener composed of aspartic acid and phenylalanine; 180 times sweeter than sucrose; brand names: Equal®, Nutrasweet®. Aspergillus—Genus of molds that produce aflatoxins. Aspiration—The state in which a substance has been drawn into the nose, throat, or lungs. Assessment—An organized procedure to gather pertinent facts. Astrocyte—A supporting cell of the central nervous system that contributes to the blood–brain barrier. Asymptomatic—Without symptoms. Ataxia—Defective muscular coordination, especially seen in voluntary movement attempts. Atherosclerosis—A form of arteriosclerosis characterized by the deposit of fatty material inside the arteries; major factor contributing to heart disease.
Atom—Smallest particle of an element that has all the properties of the element. An atom consists of the nucleus, which contains protons (positively charged particles), neutrons (particles with no electrical charge), and surrounding electrons (negatively charged particles). Atopy—Genetic predisposition to develop allergy primarily involving immunoglobulin E (IgE) antibodies; a child with two atopic parents has a 75% chance of similar symptoms; a child with one atopic parent has a 50% chance. ATP (adenosine triphosphate)—Compound in cells, especially muscle cells, that stores energy; when needed, enzymes break off one phosphoric acid group, which releases energy for muscle contraction. Atrophy—Decrease in size of a normally developed organ or tissue. Autoimmune disease—A disorder in which the body produces an immunologic response against itself. Autonomy—Achieving independence; the psychosocial developmental task of the toddler. Autosomal dominant gene—Dominant gene on any chromosome except X or Y; autosomal dominant inheritance: trait or disease transmitted from one parent even if the matching gene from the other parent is normal; example: familial hypercholesterolemia. Autosomal recessive inheritance—Non–sex-linked pattern of inheritance in which an affected gene must be received from both parents for the individual to be affected; examples: cystic fibrosis, phenylketonuria (PKU), galactosemia, sickle cell disease. Note that the chance of normal, carrier, or affected children is the same with every pregnancy. Having had an affected child does not mean the offspring of next three pregnancies will be normal or carriers (see Fig. 4-2). Avidin—Protein in raw egg white that inhibits the B vitamin biotin. Bacteria—Single-celled microorganisms that lack a true nucleus; may be either harmless to humans or disease producing. Bacteriostat—Agent that prevents bacteria from growing and multiplying but does not necessarily kill them. Balanced diet—A diet including sufficient foods from each of the major food groups daily; one containing all the essential nutrients in required amounts. Bariatric surgery—Surgery performed to treat and control obesity. Barium enema—Series of x-ray studies of the colon used to demonstrate the presence and location of
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polyps, tumors, diverticula, or positional abnormalities. The client is first administered an enema containing a radio-opaque substance (barium) that enhances visualization when the film is exposed. Barium swallow—The primary diagnostic tool for direct visualization of the swallowing mechanism is called the cookie swallow or modified barium swallow. During this procedure, the client consumes three items of different viscosities. Each item contains a contrast medium that allows all phases of the swallowing mechanism to be visualized in x-rays. A physician is always present during this procedure. Basal ganglia—Four masses of gray matter located in the cerebrum; contribute to the subconscious aspects of voluntary movement; inhibit tremors. Benign—Not recurrent or progressive; nonmalignant; benign tumor may be life threatening in crucial tissue such as the brain. Beriberi—Disease caused by deficiency of vitamin B1 (thiamin). Beta-carotene—Carotenoid with the greatest provitamin A activity. Beta-endorphin—Chemical released in the brain during exercise that produces a state of relaxation. Bicarbonate—Any salt containing the HCO3⫺ anion; blood bicarbonate is a measure of alkali (base) reserve of the body; bicarbonate of soda is sodium bicarbonate (NaHCO3). Bile—Yellow secretion of the liver that alkalinizes the intestine and breaks large fat globules into smaller ones to facilitate enzyme digestive action. Binge-eating disorder—Eating disorder in which the patient eats excess amounts of food and calories and does not purge. Binging—Eating to excess; eating from 5000 to 20,000 kilocalories per day. Bioavailability—The rate and extent to which an active drug or nutrient or metabolite enters the general circulation, permitting access to the site of action; measured by concentration of the drug in body fluids or by the magnitude of the pharmacologic response. Bioelectric impedance—Indirect measure of body fatness based on differences in electrical conductivity of fat, muscle, and bone. Biological value—Scoring system of how well food proteins can be converted into body protein; eggs are norm of 100% of nitrogen being retained. Biotin—B-complex vitamin widely available in foods. Bladder—A body organ, also called the urinary bladder, which receives urine from the kidneys and discharges it through the urethra. Blood–brain barrier—Specialized cells lining the brain capillaries that separate the brain from the circulatory system, thus protecting it from harmful substances.
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Blood pressure—Force exerted against the walls of blood vessels by the pumping action of the heart. Blood urea nitrogen (BUN)—The amount of nitrogen present in the blood as urea, often elevated in renal disorders; may be referred to as serum urea nitrogen (SUN). B-lymphocytes (B-cells)—White blood cells that protect against infection by inducing antibody production; see Humoral immunity. Body frame size—Designation of a person’s skeletal structure as small, medium, or large; used to determine healthy body weight (HBW). Body image—The mental image a person has of himself or herself. Body mass index (BMI)—Weight in kilograms divided by the square of height in meters; BMIs of 19 to 24 are considered normal. Body substance isolation—A situation in which all body fluids should be considered contaminated and treated as such by all health-care workers. Bolus—A mass of food that is ready to be swallowed or a single dose of feeding or medication. Bolus feeding—Giving a 4- to 6-hour volume of a tube feeding within a few minutes. Bomb calorimeter—A device used to measure the energy content of food. Botulism—An often fatal form of food intoxication caused by the ingestion of food containing poisonous toxins produced by the microorganism Clostridium botulinum. Bowman capsule—The cuplike top of an individual nephron; functions as a filter in the formation of urine. Branched-chain amino acids—Leucine, isoleucine, lysine, valine; sometimes used as therapy for hepatic coma. Buffer—A substance that can react to offset excess acid or excess alkali (base) in a solution; blood buffers include carbonic acid, bicarbonate, phosphates, and proteins, including hemoglobin. Bulimia—Excessive food intake followed by extreme methods, such as self-induced vomiting and the use of laxatives, to rid the body of the foods eaten. C-reactive protein (CRP)—An abnormal protein produced by the liver in response to acute inflammation that is strongly associated with future vascular events. Cachexia—State of malnutrition and wasting seen in chronic conditions such as cancer, AIDS, malaria, tuberculosis, and pituitary disease. Calcidiol—25-hydroxyvitamin D [25(OH)D]; inactive form of vitamin D produced in the liver; circulating half-life of 15 days; serum level is best indicator of vitamin D status, reflecting vitamin D
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(from sun, food, and dietary supplements but not vitamin D stored in body tissues). Calcification—Process in which tissue becomes hardened with calcium deposits; necessary for bone anabolism; pathological in vitamin D toxicity. Calcitonin—Hormone produced by the thyroid gland that slows the release of calcium from the bone when serum calcium levels are high. Calcitriol—1,25-dihydroxyvitamin D [1,25(OH)2D]; physiologically active form of vitamin D produced primarily in the kidney; circulating half-life of 15 hours; serum levels typically not decreased until severe deficiency because of regulation by parathyroid hormone. Calorie—A measurement unit of energy; unit equaling the amount of heat required to raise or lower the temperature of 1 gram of water 1° Celsius. Campylobacter—Flagellated, gram-negative bacteria; important cause of diarrheal illnesses. Candida albicans—Microscopic fungal organism normally present on skin and mucous membranes of healthy people; cause of thrush, vaginitis, opportunistic infections. Capillary—Minute vessel connecting arteriole and venule; vessel wall acts as semipermeable membrane to exchange substances between blood and lymph and interstitial fluid. Carbohydrate—Any of a group of organic compounds, including sugar, starch, and cellulose, which contains only carbon, oxygen, and hydrogen. Carbonic acid—Aqueous solution of carbon dioxide; carbon dioxide in solution or in blood is carbonic acid. Carcinogen—Any substance or agent that causes the development of or increases the risk of cancer. Carcinoma—A malignant neoplasm that occurs in epithelial tissue. Cardia—Upper orifice of the stomach connecting with the esophagus. Cardiac arrhythmia—Irregular heartbeat. Cardiac sphincter—Smooth muscle band at the lower end of the esophagus; prevents reflux of stomach contents. Cardiomyopathy—Disease of heart muscle; may be primary due to unknown cause or secondary to another cardiac disorder or systemic disease. Carotene—One of several yellow to red antioxidant pigments that are precursors to vitamin A. Carotenemia—Excess carotene in the blood, producing yellow skin but not discoloring the whites of the eyes. Carotenoid—Group of more than 500 red, orange, or yellow pigments found in fruits and vegetables, about 50 of which are precursors of vitamin A;
includes carotene, which is such a precursor, and lycopene, which is not. Casein—Principal protein in cow’s milk. Catabolism—The breaking down of body compounds or tissues into simpler substances; the destructive phase of metabolism. Catalyst—A substance that speeds up a chemical reaction without entering into or being changed by the reaction. Cataract—Clouding of the lens of the eye. Cation—An ion with a positive charge. Cecum—The first portion of the large intestine between the ileum and the ascending colon. Celiac disease (gluten-sensitive enteropathy)—An intolerance to dietary gluten, which damages the intestine and produces diarrhea and malabsorption. Cell—The smallest functional unit of structure in all plants and animals. Cellular immunity—Delayed immune response produced by T-lymphocytes, which mature in the thymus gland; examples of this type of response are rejection of transplanted organs and some autoimmune diseases. Central parenteral nutrition (CPN)—Parenteral nutrition delivered into a large-diameter vein, usually the superior vena cava adjacent to the right atrium. Cerebrovascular accident (CVA)—An abnormal condition in which the brain’s blood vessels are occluded by a thrombus, an embolus, or hemorrhage, resulting in damaged brain tissue; stroke. Cesarean delivery—Delivery of a baby through a surgical incision made into the mother’s abdomen and uterus. Chelating agent—A chemical compound that binds metallic ions into a ring structure, inactivating them; used to remove poisonous metals from the body. Chemical digestion—Digestive process that involves the splitting of complex molecules into simpler forms. Chemical reaction—The process of combining or breaking down substances to obtain different substances. Chlorophyll—The green plant pigment necessary for the manufacture of carbohydrates. Cholecalciferol—Vitamin D3, formed when the skin is exposed to sunlight; further processed by the liver and kidneys; may be reported as serum 25-hydroxy-cholecalciferol. Cholecystitis—Inflammation of the gallbladder. Cholecystokinin—A hormone secreted by the duodenum; stimulates contraction of the gallbladder (releases bile) and the secretion of pancreatic juice.
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Cholelithiasis—The presence of gallstones. Cholestasis—Blockage of the flow of bile due to liver disease or obstructions in the duct system. Cholesterol—A fatlike substance made in the human body and found in foods of animal origin; associated with an increased risk of heart disease. Choline—Vitamin-like organic compound recognized as an essential nutrient; required for normal carbohydrate and fat metabolism and involved in protein metabolism. Chronic illness—A sickness persisting for a long period that shows little change or a slow progression over time. Chronic obstructive pulmonary disease (COPD)— A group of chronic diseases with a common characteristic of chronic airflow obstruction. Chronic renal failure—An irreversible condition in which the kidneys cannot perform vital functions. Chvostek’s sign—Spasm of facial muscles following a tap over the facial nerve in front of the ear; indication of tetany. Chylomicron—A lipoprotein that carries triglycerides in the bloodstream after meals. Chyme—The mixture of partly digested food and digestive secretions found in the stomach and small intestine during digestion of a meal. Chymotrypsin—A protein-splitting enzyme produced by the pancreas; active in the intestine. Cirrhosis—Chronic disease of the liver in which functioning cells degenerate and are replaced by fibrosed connective tissue. Client-care conference—A meeting that includes all health-care team members and may include the client or a significant other to review and update the client’s nursing care plan. Clostridium botulinum—An anaerobic (grows without air) organism that produces a poisonous toxin; the cause of botulism. Clostridium perfringens—A bacterium that produces a poisonous toxin that causes a food intoxication; the symptoms are generally mild and of short duration and include intestinal disorders. Cobalamin—Vitamin B12; essential for proper blood formation. Coenzyme—A substance that combines with an enzyme to activate it. Cognitive—Of, relating to, or involving conscious mental activities such as thinking, understanding, learning, and remembering. Colectomy—Surgical removal of part or all of the colon. Collagen—Fibrous insoluble protein found in connective tissue. Collecting tubule—The last segment of the renal tubule; follows the distal convoluted tubule. Several nephrons usually share a single collecting tubule.
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Colloidal osmotic pressure (COP)—Pressure produced by plasma and cellular proteins. Colon—The large intestine from the end of the small intestine to the rectum. Colonic residue—Total solid material in the large intestine after digestion, including insoluble fiber, secretions, shed cells, and microorganisms. Fiber is the chief contributor to colonic residue and residual substance manageable by diet. Colostomy—Surgical procedure in which an opening to the large intestine is constructed on the abdomen. Comorbidity—A disease coexisting with the primary disease. Complementation—Principle of meal planning advocating combining plant foods within a meal so that it contains all the essential amino acids; now applied to daily intake rather than to single meals. Complement system—Series of about 25 proteins that work to “complement” the activity of antibodies in destroying bacteria; also helps to rid the body of antigen–antibody complexes; in carrying out these tasks, it induces an inflammatory response. Complete protein—A protein containing all essential amino acids that humans need; usually found in animal sources such as milk, meat, eggs, and fish. Complex carbohydrate—A carbohydrate composed of many molecules of C6H12O6 joined together; polysaccharide; includes starch, glycogen, and fiber. Compound—Two or more elements united chemically in specific proportions. Compound fat—Substance obtained when one of the fatty acids joined to the glycerol molecule is replaced by another molecule, such as a protein. Conditionally essential nutrient—Substance normally manufactured by the body; in certain situations, the body cannot manufacture an optimal amount. Consanguinous union—Marriage of blood relatives; usually meaning second cousins or closer; genetic influence in unions between more distant relatives likely to differ only slightly from that in the general population. Constipation—Decrease in a person’s normal frequency of defecation; stool is often hard, dry, or difficult to expel. Contamination iron—Iron that leaches from cookware into the food; in special circumstances, can become hazardous. Continuous ambulatory peritoneal dialysis (CAPD)—A form of self-dialysis in which the dialysate is allowed to remain in the abdominal cavity for 4 to 6 hours before replacement.
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Continuous feeding—Enteral feeding in which the formula drips slowly throughout the prescribed time span. Contraindication—Any circumstance under which treatment should not be given. Coronary heart disease (CHD)—Disease resulting from the decreased flow of blood through the coronary arteries to the heart muscle. Coronary occlusion—Blockage of one or more branches of the coronary arteries, which supply the heart muscle with oxygen and nutrients. Creatine—Nonprotein substance synthesized in the body from arginine, glycine, and methionine; combines with phosphate to form creatine phosphate, which is stored in muscle tissue as an energy source. Creatinine—Nonprotein nitrogenous end product of creatine metabolism; because creatinine is excreted by the kidneys, serum creatinine levels are used to detect and monitor renal disease and to estimate muscle protein reserves. Cretinism—A congenital condition resulting from a lack of thyroid secretions; characterized by a stunted and malformed body and arrested mental development. Crohn disease—Inflammatory disease appearing in any area of the bowel in which diseased areas can be found alternating with healthy tissue. Cross-contamination—The spreading of a diseaseproducing organism from one food, person, or object to another food, person, or object. Cruciferous—Belonging to a botanical mustard family; includes broccoli, Brussels sprouts, cabbage, cauliflower, kale, kohlrabi, and Swiss chard. Crystalluria—The presence of crystals in the urine; may be caused by the administration of sulfonamides. Culture—The learned, shared, and transmitted values, beliefs, and norms of a particular group that guides its thinking, decisions, and actions in patterned ways. Cyclical variation—A recurring series of events during a specified period. Cystic fibrosis—Hereditary disease often affecting the lungs and pancreas in which glandular secretions are abnormally thick. Cysteine—Sulfur-containing amino acid often lacking in legumes. Cystitis—Inflammation of the bladder. Cytochrome P450 enzymes—Group of genetically determined enzymes that help to metabolize fatsoluble vitamins, steroids, fatty acids, and other substances and to detoxify drugs and environmental pollutants. Example: CYP3A4 depicts family (3), subfamily (A), and number (4). Cytokine—One of more than 100 proteins mainly produced by white blood cells that function in inflammatory and specific immune responses.
Deamination—Metabolic process whereby nitrogen is removed from an amino acid. Deciliter (dL)—100 milliliters or 1/10 liter. Decubitus ulcer—A pressure sore on the lower back, such as a bedsore. Dehiscence—Separation of the edges of a surgical incision. Delusion—False belief that is firmly maintained despite obvious proof to the contrary. Dementia—The impairment of intellectual function that usually is progressive and interferes with normal social and occupational activities. Dental caries—The gradual decay and disintegration of the teeth; a dental cavity is a hole in a tooth caused by dental caries. Dental plaque—Colorless and transparent gummy mass of microorganisms that grows on the teeth, predisposing them to decay. Deoxyribonucleic acid (DNA)—the hereditary material in humans and almost all other organisms; protein substance in the cell nucleus that directs all the cell’s activities, including reproduction. Desired outcome—The behavioral or physical change in a client that indicates the achievement of a nursing goal. Development—Gradual process of changing from a simple to a more complex organism; involves psychosocial and physical changes, not only an increase in size. Dextrose—Another name for the simple sugar glucose. DHA—See Docosahexaenoic acid. Diabetes insipidus—Increased water intake and increased urine output resulting from inadequate secretion of antidiuretic hormone (ADH) by the posterior pituitary or by failure of the kidney tubules to respond to ADH; underlying causes can be tumor, surgery, trauma, infection, radiation injury, or congenital anomaly. Diabetes mellitus—Disease caused by insufficient insulin secretion by the pancreas or insulin resistance by body tissues causing excess glucose in the blood and deranged carbohydrate, fat, and protein metabolism. Diabetic neuropathy—Degeneration of peripheral nerves occurring in diabetes; possible causes are microscopic changes in blood vessels or metabolic defects in nerve tissue. Diacetic acid—A ketone body found in the urine; can be due to the excessive breakdown of stored body fat. Diagnostic—Relating to scientific and skillful methods to establish the cause and nature of a sick person’s illness.
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Dialysate—In renal failure, the fluid used to remove or deliver compounds or electrolytes that the failing kidney cannot excrete or retain in proper concentrations. Dialysis—The process of diffusing blood across a semipermeable membrane to remove toxic materials and to maintain fluid, electrolyte, and acid–base balances in cases of impaired kidney function or absence of the kidneys. Dialysis dementia—A neurological disturbance seen in clients who have been on dialysis for a number of years. Diastolic pressure—Pressure exerted against the arteries between heartbeats; the lower number of a blood pressure reading. Dietary fiber—Material in foods, mostly from plants, that the human body cannot break down or digest. Dietary recall, 24-hour—Description of what a person has eaten for the previous 24 hours. Dietary Reference Intake (DRI)—Four nutrientbased reference values that can be used for assessing and planning diets for the healthy general population; refer to average daily intakes for 1 or more weeks; include Estimated Average Requirements (EARs), Recommended Dietary Allowances (RDAs), Adequate Intakes (AIS), and Tolerable Upper Intake Levels (ULs). Dietary status—Description of what a person has been eating; his or her usual intake. Digestion—The process by which food is broken down mechanically and chemically in the gastrointestinal tract into forms simple enough for intestinal absorption. Diglyceride—Two fatty acids joined to a glycerol molecule. Dilutional hyponatremia—Low serum sodium due not to an absolute lack of sodium but to an excess of water. Diplopia—Double vision. Disaccharide—A simple sugar composed of two units of C6H12O6 joined together; examples include sucrose, lactose, and maltose. Disulfide linkage—Specific chemical bond joining amino acids; in hair, skin, and nails, holds amino acids in their distinct shapes. Diverticulitis—Inflammation of a diverticulum. Diverticulosis—Presence of one or more diverticula. Diverticulum—A sac or pouch in the walls of a tubular organ; pl., diverticula. DNA—See Deoxyribonucleic acid. Docosahexaenoic acid (DHA)—A polyunsaturated omega-3 fatty acid found in fish oils. Dopamine—Catecholamine synthesized by the adrenals; immediate precursor in the synthesis of norepinephrine.
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Double-blind—Technique of scientific investigation in which neither the investigator nor the subject knows what treatment, if any, the subject is receiving. Double bond—A type of chemical connection in which, for example, a fatty acid has two neighboring carbon atoms, each lacking one hydrogen atom. Drink—An alcoholic beverage; see Standard drink. Dual-energy x-ray absorptiometry (DEXA)— Diagnostic test using two x-ray beams to determine body composition; used to measure bone mineral density as an indicator of osteopenia and osteoporosis. Duct—A structural tube designed to allow secretions to move from one body part to another body part. Dumping syndrome—A condition in which the contents of the stomach empty too rapidly into the duodenum; mostly occurs in patients who have had gastric resections. Duodenum—The first part of the small intestine between the stomach and the jejunum. Durable power of attorney—A document in which the client gives another person power to make medical treatment and related personal care decisions for him or her. Dysgeusia—Abnormal taste. Dysphagia—Difficulty swallowing; component of many diseases from Alzheimer disease and other neurological disorders to tumors of the head and neck. Dysphoria—A speech disorder characterized by hoarseness. Dyspnea—Difficulty breathing. Eclampsia—An obstetrical emergency involving hypertension, proteinuria, and convulsions appearing after the twentieth week of pregnancy. Eczema—Skin inflammation, acute or chronic; caused by external (chemical irritation or microbial invasion) or internal (genetic or psychological) factors. Edema—The accumulation of excessive amounts of fluid in interstitial spaces. Edentulous—The state of having no teeth. Efferent—Directed away from a center; used to describe arteries, veins, lymphatic vessels, and nerves. Efferent arteriole—Small blood vessel by which blood leaves the nephron. Efficacy—Ability of a drug or treatment to achieve the desired effect. Eicosapentaenoic acid (EPA)—Omega-3 fatty acid found in fish oils. Electrocardiogram (ECG)—A graphic record produced by an electrocardiograph that shows the electrical activity of the heart.
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Electroencephalogram (EEG)—The record obtained from an electroencephalograph that shows the electrical activity of the brain. Electrolyte—An element or compound that when dissolved in water separates (dissociates) into ions that are capable of conducting an electrical current; acids, bases, and salts are common electrolytes. Element—A substance that cannot be separated into simpler parts by ordinary means. Elemental and semielemental formula—Formula that contains either totally or partially hydrolyzed nutrients. Embolus—A circulating mass of undissolved matter in a blood or lymphatic vessel; may be composed of tissues, fat globules, air bubbles, clumps of bacteria, or foreign bodies, including pieces of medical devices. Embryo—A developing infant in the prenatal period between the second and eighth weeks inclusive. Empty kilocalories—Refers to a food that contains kilocalories and almost no other nutrients. Emulsification—The physical breaking up of fat into tiny droplets. Emulsifier—A molecule that attracts both waterand fat-soluble molecules. Emulsion—One liquid evenly distributed in a second liquid with which it usually does not mix. Encephalopathy—Generalized brain dysfunction with varying degrees of impairment of speech, cognition, orientation, and arousal. Endemic—The constant presence of a disease or infectious agent within a given geographic area; the usual prevalence of a given disease within such an area. Endogenous—Produced within or caused by factors within the organism. Endoscope—A device consisting of a tube and an optical system for observing the inside of a hollow organ or cavity. Endothelium—Flat cells lining blood and lymphatic vessels, the heart, and various body cavities; produce compounds affecting vascular lumen and platelets. End-stage renal failure—A state in which the kidneys have lost most or all of their ability to maintain internal homeostasis and produce urine. Energy—The capacity to do work. Energy balance—A situation in which kilocaloric intake equals kilocaloric output. Energy expenditure—The amount of fuel the body uses for a specified period. Energy imbalance—Situation in which kilocalories eaten do not equal the number of kilocalories used for energy. Energy nutrients—The chemical substances in food that are able to supply fuel; refers collectively to carbohydrate, fat, and protein.
Enrichment—The addition of nutrients previously present in a food but removed during food processing or lost during storage. Enteral nutrition—Nutrition provided through the gastrointestinal tract via a tube, catheter, or stoma that delivers nutrients distal to the oral cavity. Enteric-coated—A type of drug preparation designed to dissolve in the intestine rather than in the stomach. Enteritis—Inflammation of the intestines, particularly the small intestine. Enzyme—Complex protein produced by living cells that acts as a catalyst. EPA—See Eicosapentaenoic acid. Epidemic—Affecting or tending to affect a disproportionately large number of individuals within a population, community, or region at the same time; excessively prevalent or widespread. Epilepsy—Disease marked by repetitive abnormal electrical discharges within the brain; signs and symptoms vary with type: partial, generalized, or unclassified. Epinephrine—Hormone of the adrenal gland; produces the fight-or-flight response. Epithelial tissue—A type of tissue that forms the outer layer of skin and lines body surfaces opening to the outside; functions include protection, absorption, and secretion. Ergocalciferol—Vitamin D2 formed by the action of sunlight on plants. Ergot poisoning—Poisoning resulting from excessive use of the drug ergot or from the ingestion of grain or grain products infected with the Claviceps purpurea fungus. Erikson, Erik—Psychologist who devised a theory of human development consisting of eight stages of life, each with a psychosocial developmental task to be mastered. Erosion—Destruction of the surface of a tissue, either on the external surface of the body or internally. Erythropoietin—Hormone released by the kidney to stimulate red blood cell production. Esophagostomy—A surgical opening in the esophagus. Esophagus—A muscular canal extending from the mouth to the stomach. Essential amino acid—One of the amino acids that cannot be manufactured by the human body; must be obtained from food or artificial feeding. Essential (primary) hypertension—Elevated blood pressure that develops without apparent cause. Essential nutrient—A substance found in food that must be present in the diet because the human body lacks the ability to manufacture it in sufficient amounts for optimal health.
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Estimated Average Requirement (EAR)—Intake that meets the estimated nutrient need of 50% of the individuals in a life-stage and gender group; used to set the RDA and to assess or plan the intake of groups. Ethanol—Grain alcohol; ounces of ethanol in beverages can be estimated with the conversion factors of 0.045 for beer, 0.121 for wine, and 0.409 for liquor. Ethnocentrism—Belief that one’s own culture and worldview is superior to anyone else’s. Etiology—The cause of a disease. Evaporative water loss—Insensible water loss through the skin. Exchange—A defined quantity of food on the Academy of Nutrition and Dietetics Exchange List for Diabetes (see Appendix B) or on another exchange list. Exchange List—A food guide used in clinical practice to aid in meal planning. Excretion—The elimination of waste products from the body in feces, urine, exhaled air, and perspiration. Exogenous—Outside the body. External muscle layer—Muscle layer of the alimentary canal. External water loss—Water lost to the outside of the body. Extracellular fluid—Fluid found between the cells and within the blood and lymph vessels. Extrinsic factor—Vitamin B12, necessary for proper red blood cell development. Failure to thrive (FTT)—Medical diagnosis for infants who fail to gain weight appropriately or who lose weight; also applied to elderly who lose ability to care for themselves. Fasting—The state of having had no food or fluid enterally or no parenteral nutrition. Fasting blood sugar (FBS)—Blood glucose measured in the fasting state; normal values are 70 to 100 mg per deciliter. Fat-free mass—Lean body mass plus nonfat components of adipose tissue. Fatty acid—Part of the structure of a fat. Fatty liver—Accumulation of lipids in the liver cells; may be reversible if the cause, of which there are many, is removed. Feedback cycle—Control system of many bodily functions involving the interaction between a stimulus and an effect; in positive feedback, the effect increases the stimulus as uterine contractions increasing oxytocin secretion; in negative feedback, the effect decreases the stimulus as blood levels of thyroid hormone decrease secretion of thyroidstimulating hormone.
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Ferric iron—Oxidized iron, which is less absorbable from the gastrointestinal tract than ferrous iron; + abbreviated Fe3 . Ferritin—An iron–phosphorus–protein complex formed in the intestinal mucosa by the union of ferric iron with apoferritin; the form in which iron is stored in the tissues, mainly in liver, spleen, and bone marrow cells. Ferrous iron—The more absorbable form of iron for + humans; abbreviated Fe2 . Fetal alcohol syndrome (FAS)—A condition characterized by mental and physical abnormalities in an infant caused by the mother’s consumption of alcohol during pregnancy. Fetus—The human child in utero from the third month until birth; also applicable to the later stages of gestation of other animals. Fiber, dietary—Material in foods, mostly from plants, that the human body cannot break down or digest. Fibrin—Insoluble protein formed from fibrinogen by the action of thrombin; forms the meshwork of a blood clot. Fibrinogen—Protein in blood essential to the clotting process; also called Factor I; see Fibrin. Filtration—The process of removing particles from a solution by allowing the liquid to pass through a membrane or other partial barrier. First-degree relatives—An individual’s parents, siblings, or children. First pass effect—Process whereby drugs are extensively metabolized by the small intestine or liver enzymes; result is that less drug reaches the systemic circulation. Flatus—Gas in the digestive tract, averaging 400 to 1200 milliliters per day. Flavonoids—Nonnutritive antioxidant compounds that occur naturally in certain foods such as onions, apples, tea, and red wine; inhibit oxidation of low-density lipoprotein in laboratory experiments. Flow phase—The second phase in the stress response; marked by pronounced hormonal changes. Fluorosis—Condition due to excessive prolonged intake of fluoride; tissues affected are teeth and bones. FODMAPs—Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols; carbohydrates that are known to cause symptoms in patients with IBS because of their poor absorption, osmotic activity, and rapid fermentation. Folate—B vitamin necessary for DNA formation and proper red blood cell formation; form occurring in foods and body tissues.
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Folic acid—B vitamin necessary for DNA formation and proper red blood cell formation; oxidized form used to fortify foods and in supplements. Food acceptance record—A checklist that indicates food items accepted or rejected by the client. Food allergy—Sensitivity to a food that does not cause a negative reaction in most people. Food faddism—An unusual pattern of food behavior enthusiastically adapted by its adherents. Food frequency—A usual food intake or a description of what an individual usually eats during a typical day. Food infection—Infection acquired through contact with food or water contaminated with diseaseproducing microorganisms. Food insecurity—Limited or uncertain availability of nutritionally adequate and safe foods; uncertain ability to acquire food either sometimes or always. Food intoxication—An illness caused by the consumption of a food in which bacteria have produced a poisonous toxin. Food quackery—The promotion for profit of a medical scheme or remedy that is unproven or known to be false. Food record—A diary of a person’s self-reported food intake. Fortification—Process of adding nutritive substances not naturally occurring in the given food to increase its nutritional value; for example, milk fortified with vitamins A and D. Free radicals—Atoms or molecules that have lost an electron and vigorously pursue its replacement; in doing so, free radicals can damage normal cell constituents. Fructose—A monosaccharide found in fruits and honey; a simple sugar. Functional disease—One for which anatomic abnormality is not apparent; opposite of organic disease. Functional foods—Foods or food components that have additional health or physiological benefits over and above the normal nutritional value they provide. Fundus—Larger part of a hollow organ; the part of the stomach above its attachment to the esophagus. Galactose—A monosaccharide derived mainly from the breakdown of the sugar in milk, lactose; a simple sugar. Galactosemia—Lack of an enzyme needed to metabolize galactose; absolute contraindication to breastfeeding. Gallbladder—A pear-shaped organ on the underside of the liver that concentrates and stores bile. Gastric bypass—A surgical procedure that routes food around the stomach.
Gastric lipase—An enzyme in the stomach that aids in the digestion of fats. Gastric residual volume (GRV)—The volume of unabsorbed enteral feeding in the stomach. Gastric stapling—A surgical procedure on the stomach to induce weight loss by reducing the size of the stomach; also known as gastroplasty. Gastrin—A hormone secreted by the gastric mucosa; stimulates the secretion of gastric juice. Gastritis—Inflammation of the stomach. Gastroesophageal reflux (acid-reflux disorder) (GERD)—Regurgitation of stomach contents into the esophagus. Gastroparesis—Partial paralysis of the stomach. Gastrostomy—A surgical opening in the stomach. Gene—Basic unit of heredity; linear segment of deoxyribonucleic acid (DNA) that occupies a specific location on a specific chromosome; provides the instructions for protein synthesis. Generativity—The seventh of Erikson’s developmental stages, in which the middle-aged adult guides the next generation. Generic name—The name given to a drug by its original developer; usually the same as the official name given to it by the Food and Drug Administration. Genetic code—Hereditary instructions for building proteins; analogous to software that dictates the processing of information by the computer. Genetic susceptibility—Likelihood of an individual developing a given trait as determined by heredity. Genomics—The study of an organism’s complete set of DNA; regarding nutrition, the study of how different foods may interact with specific genes to increase the risk of common chronic diseases. Genotype—Total of the hereditary information present in an organism whether or not expressed in the individual’s phenotype (see Phenotype). Geriatrics—Branch of medicine involved in the study and treatment of diseases of the elderly. Gestation—Time from fertilization of the ovum until birth; in humans, the length of gestation is usually 38 to 42 weeks. Gestational diabetes (GDM)—Hyperglycemia and altered carbohydrate, protein, and fat metabolism related to the increased physiological demands of pregnancy. Globin—The simple protein portion of hemoglobin. Glomerular filtrate—The fluid that has been passed through the glomerulus. Glomerular filtration rate (GFR)—An index of kidney function; the amount of filtrate formed each minute in all the nephrons of both kidneys. Glomerulonephritis—Inflammation of the glomeruli.
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Glomerulus—The network of capillaries inside the Bowman capsule. Glossitis—Inflammation of the tongue. Glucagon—A hormone secreted by the alpha cells of the pancreas; increases the concentration of glucose in the blood. Gluconeogenesis—The production of glucose from noncarbohydrate sources such as amino acids and glycerol. Glucose—A monosaccharide (simple sugar) commonly called the blood sugar; the same as dextrose. Glucose tolerance test—A test of blood and urine after the patient receives a concentrated dose of glucose; used to diagnose abnormalities of glucose metabolism. Gluteal-femoral obesity—Excess body fat centered around an individual’s buttocks, hips, and thighs. Gluten—A type of protein found in wheat, rye, and barley; may contaminate oats through processing. Gluten-sensitive enteropathy (celiac disease)—An intestinal disorder caused by an abnormal response following the consumption of gluten. Glycemic index—A measure of how much the blood glucose level increases following consumption of a particular food that contains a given amount of carbohydrate. Glycerol—The backbone of a fat molecule; pharmaceutical preparation is glycerin. Glycogen—The form in which carbohydrate is stored in liver and muscle. Glycogenolysis—The breakdown of glycogen. Glycosuria—Glucose in the urine. Glycosylated hemoglobin—Hemoglobin to which a glucose group is attached; in diabetes mellitus, if the blood glucose level has not been controlled over the previous 120 days, the glycosylated hemoglobin level is elevated. Goiter—Enlargement of the thyroid gland characterized by pronounced swelling in the neck. Goitrogens—Substances that block the absorption of iodine, thereby causing goiter; found in cabbage, rutabaga, and turnips, but only related to goiter in cassava. Gout—A hereditary metabolic disease that is a form of acute arthritis and is marked by inflammation of the joints. GRAS List—Food additives categorized by the U.S. Food and Drug Administration to be Generally Recognized As Safe. Growth—Progressive increase in size of a living thing that entails the synthesis of new protoplasm and multiplication of cells. Gut failure—Impaired absorption due to structural damage to the small intestine; symptoms include diarrhea, malabsorption, and unsuccessful absorption of oral food.
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Halal—Pertaining to food prepared and served according to Islamic dietary laws. Half-life—In drug therapy, time required by the body to metabolize or inactivate half the amount of a substance. Harris–Benedict equation—A formula commonly used to estimate resting energy expenditure in a stressed client. Health—The state of complete physical, mental, and social well-being, not just the absence of disease or infirmity. Healthy body weight (HBW)—Estimate of a weight suitable for an individual based on frame size and height and weight tables. Heart failure—Inability of heart to circulate blood sufficiently to meet body’s needs; peripheral edema is an early sign of right sided failure usually due to lung disease; difficulty breathing is an early sign of left sided failure usually a consequence of myocardial infarction. Hematocrit—Percentage of total blood volume that is red blood cells; normal levels are 40% to 54% for men, 37% to 47% for women. Hematuria—Blood in the urine. Heme—The iron-containing portion of the hemoglobin molecule. Heme iron—Iron bound to hemoglobin and myoglobin in meat, fish, and poultry; 10% to 30% of the iron in these foods is absorbed. Hemochromatosis—A genetic disease of iron metabolism in which iron accumulates in the tissues. Hemodialysis—A method for cleansing the blood of wastes by circulating blood through a machine that contains tubes made of synthetic semipermeable membranes. Hemoglobin—The iron-carrying pigment of the red blood cells; carries oxygen from the lungs to the tissues. Hemolysis—Rupture of red blood cells releasing hemoglobin into the plasma; causes include bacterial toxins, chemicals, inappropriate medications, vitamin E deficiency. Hemolytic anemia—An abnormal reduction in the number of red blood cells due to hemolysis. Hemosiderin—An iron oxide–protein compound derived from hemoglobin; a storage form of iron. Hemosiderosis—Condition resulting from excess deposits of hemosiderin, especially in the liver and spleen; caused by destruction of red blood cells, which occurs in diseases such as hemolytic anemia, pernicious anemia, and chronic infection. Heparin—A chemical, found naturally in many tissues, that inhibits blood clotting by preventing the conversion of prothrombin to thrombin; also given as an anticoagulant medication.
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Hepatic portal circulation—A subdivision of the vascular system in which blood from the digestive organs and spleen circulates through the liver before returning to the heart. Hepatitis—Inflammation of the liver, caused by viruses, drugs, alcohol, or toxic substances. Hepcidin—Hormone synthesized by the liver that regulates iron metabolism; released in response to high body iron levels to inhibit iron transport in the duodenum and to prevent release of stored iron. Heterozygous—Having dissimilar pairs of genes, one from each parent, for any hereditary characteristic; genes, one from each parent, governing a particular trait; the dominant gene will produce the given trait in the individual. Hiatal hernia—A protrusion of part of the stomach into the chest cavity. High-density lipoprotein (HDL)—A plasma protein that carries fat in the bloodstream to the tissues or to the liver to be excreted; elevated blood levels are associated with a decreased risk of heart disease. High-fructose corn syrup (HFCS)—Corn syrup that has been enzymatically processed to convert some of its glucose into fructose to produce a desired sweetness; principal sweetener used in processed foods and beverages because it costs less than sucrose. Hives (urticaria)—Sudden swelling and itching of skin or mucous membranes, often caused by allergies; if the respiratory tract is involved, may be life threatening. Homeostasis—Tendency toward balance in the internal environment of the body, achieved by automatic monitoring and regulating mechanisms. Homozygous—Having two identical genes, one from each parent, governing a particular trait; necessary condition to produce a disease caused by a recessive gene, such as sickle cell anemia. Hormone—A substance produced by cells of the body that is released into the bloodstream and carried to target sites to regulate the activity of other cells and organs. Human immunodeficiency virus (HIV)—The virus that causes AIDS. Humoral immunity—Development of antibodies to specific antigens by the B-lymphocytes, some of which retain the ability to recognize the antigen if it is encountered again; basis of immunizations. Humulin—Exact duplicate of human insulin manufactured by altering bacterial DNA. Hunger—The sensation resulting from a lack of food, characterized by dull or acute pain around the lower part of the chest; in global context, insufficient quantity of food where minimum kilocalorie intake is not met.
Hydrochloric acid (HCl)—Strong acid secreted by the stomach that aids in protein digestion. Hydrogenation—The process of adding hydrogen to a fat to make it more highly saturated. Hydrolysis—A chemical reaction that splits a substance into simpler compounds by the addition of water; in hydrolyzed infant formulas, whole proteins are split into smaller pieces. Hydrostatic pressure—The pressure created by the pumping action of the heart on the fluid in the blood vessels. Hyperbilirubinemia—Excessive bilirubin in the blood; bilirubin is produced by the breakdown of red blood cells. Hypercalcemia—A serum calcium level that is too high; in adults, more than 5.5 milliequivalents per liter. Hypercholesterolemia—Excessive cholesterol in the blood. Hyperemesis gravidarum—Severe nausea and vomiting persisting after the fourteenth week of pregnancy of unknown etiology. Hyperglycemia—An elevated level of glucose in the blood; fasting value above 110 milligrams per deciliter, depending on measuring technique used. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)—Life-threatening complication of NIDDM characterized by blood glucose levels greater than 600 milligrams per deciliter, absence of or slight ketosis, profound cellular dehydration, and electrolyte imbalances. Hyperkalemia—Excessive potassium in the blood; greater than 5.0 milliequivalents per liter of serum in adults. Hyperlipoproteinemia—A group of acquired and inherited disorders causing increased lipoproteins and lipids in the blood; also referred to as hyperlipidemia. Hypermetabolism—An abnormal increase in the rate at which fuel or kilocalories are burned. Hypernatremia—An excess of sodium in the blood; greater than 145 milliequivalents per liter of serum in adults. Hyperparathyroidism—Excessive secretion of parathyroid hormone, causing changes in the bones, kidney, and gastrointestinal tract. Hyperphosphatemia—Excessive amount of phosphates in the blood; in adults, greater than 4.7 milligrams per 100 milliliters of serum. Hypertension—Condition of elevated blood pressure; diagnosed if blood pressure is greater than 140/90 on three successive occasions or if person is receiving antihypertensive medication. Hypertensive disorders of pregnancy—Blood pressure greater than 140 mm Hg systolic or greater than 90 mm Hg diastolic occurring in pregnancy;
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subcategories are chronic hypertension, gestational hypertension, preeclampsia, and eclampsia. Hypertensive kidney disease—A condition in which vascular or glomerular lesions cause hypertension but not total renal failure. Hyperthyroidism—Oversecretion of thyroid hormones, which increases the metabolic rate above normal. Hypertonic—A solution that contains more particles and exerts more osmotic pressure than the plasma. Hypervitaminosis—Condition caused by excessive intake of vitamins. Hypocalcemia—A depressed level of calcium in the blood; less than 4.5 milliequivalents per liter of serum in adults. Hypoglycemia—A depressed level of glucose in the blood; less than 70 milligrams per deciliter. Hypokalemia—Potassium depletion in the circulating blood; less than 3.5 milliequivalents per liter of serum in adults. Hyponatremia—Too little sodium per volume of blood; less than 135 milliequivalents per liter of serum in adults. Hypophosphatemia—Too little phosphate per volume of blood; in adults, less than 2.4 milligrams per 100 milliliters of serum. Hypothalamus—A portion of the brain that helps to regulate water balance, thirst, body temperature, carbohydrate and fat metabolism, and sleep. Hypothyroidism—Undersecretion of thyroid hormones; reduces the metabolic rate. Hypotonic—A solution that contains fewer particles and exerts less osmotic pressure than the plasma does. Iatrogenic malnutrition—Excessive or deficit intake of one or more nutrients induced by the oversight or omissions of health-care workers. Ideal body weight—Person’s projected healthy weight based on height, frame, and gender; for information about MetLife’s development of the tables, see http://www.halls.md/ideal-weight/ met.htm. Identity—The fifth developmental task in Erikson’s theory, in which the adolescent decides on an appropriate role. Idiopathic—Without a recognizable cause. Ileocecal valve—The valve between the ileum and cecum. Ileostomy—Surgical procedure in which an opening to the small intestine (ileum) is constructed on the abdomen. Ileum—The lower portion of the small intestine. Immune—Produced by, involved in, or concerned with resistance or protection against a specified disease.
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Immune system—The organs in the body responsible for fighting off substances interpreted as foreign. Immunity—The state of being protected from a particular disease, especially an infectious disease. Immunoglobulin—Blood proteins with known antibody activity; five types of immunoglobulins have been identified: IgA, IgD, IgE, IgG, and IgM. Immunosuppressive agent—Medication that interferes with the body’s ability to fight infection. Impaired glucose tolerance (IGT)—A type of classification for hyperglycemia; for persons who have a glucose intolerance but do not meet the criteria for classification as having diabetes. Implantation—Embedding of the fertilized egg in the lining of the uterus 6 or 7 days after fertilization. Incidence—The frequency of occurrence of any event or condition over a given time and in relation to the population in which it occurs. Incomplete protein—Protein lacking one or more of the essential amino acids that humans need; found primarily in plant sources such as grains and vegetables; gelatin is an animal product but is an incomplete protein. Incubation period—The time it takes to show disease symptoms after exposure to the causative organism. Indication—A circumstance that indicates when a treatment should or can be used. Indoles—Compounds found in vegetables of the cruciferous family that activate enzymes to destroy carcinogens. Industry—The fourth stage of development in Erikson’s theory in which the school-age child learns to work effectively. Infant botulism—Neurological toxicity caused by ingestion of Clostridium botulinum spores from honey or soil-contaminated foods; infant’s intestinal tract flora cannot suppress the spores; also called intestinal botulism. Infection—Entry and development of parasites or entry and multiplication of microorganisms in the bodies of persons or animals; may or may not cause signs and symptoms. Inflammatory response—The metabolic response of the immune system to infection or injury. Initiation—The first step in the cell’s becoming cancerous, when physical forces, chemicals, or biologic agents permanently alter the cell’s DNA. Initiative—The third stage of development in Erikson’s theory in which the preschooler learns to set and achieve goals. Insensible water loss—Water that is lost invisibly through the lungs and skin. Insoluble—Incapable of being dissolved in a given substance.
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Insulin—Hormone secreted by the beta cells of the pancreas in response to an elevated blood glucose level. Insulin resistance—A disorder characterized by elevated levels of both glucose and insulin; thought to be related to a lack of insulin receptors. Intact feeding—A feeding consisting of nutrients that have not been predigested. Intact nutrients—Nutrients that have not been predigested. Integrity—The final stage of Erikson’s theory of psychosocial development, in which the older adult learns to look back on his or her life as worthwhile. Intermittent feeding—Giving a 4- to 6-hour volume of a tube feeding over 20 to 30 minutes. Intermittent peritoneal dialysis—Method of dialysis treatment in which the dialysate remains in a patient’s abdominal cavity for about 30 minutes and then drains from the body by gravity. International normalized ratio (INR)—measure of standardized prothrombin time; used to monitor anticoagulation effects of warfarin; normal individual = 1; therapeutic range for anticoagulation = 2 to 3, meaning client’s blood takes 2 to 3 times as long as normal to clot. International unit (IU)—Individually scaled measure of vitamins A, D, and E agreed to by a committee of scientists; also used for some hormones, enzymes, and biologicals such as vaccines. Interstitial fluid—Extracellular fluid located between the cells. Intimacy—The sixth stage of development in Erikson’s theory, in which the young adult builds reciprocal, caring relationships. Intracellular fluid—Fluid located within the cells. Intravascular fluid—Fluid found in the blood and lymph vessels. Intravenous—Through a vein. Intrinsic factor—Specific protein-binding factor secreted by the stomach, necessary for the absorption of vitamin B12. Invisible fat—Dietary fats that cannot be seen easily; hidden fats in foods such as baked goods, peanut butter, emulsified milk, and so forth. Ion—An atom or group of atoms carrying an electrical charge; an ion with a positive charge is called a cation; an ion with a negative charge is called an anion. Ionic bond—A chemical bond formed between atoms by the loss and gain of electrons. Iron deficiency—State of inadequate iron stores measured by laboratory tests such as serum ferritin and transferrin saturation; may progress to anemia when the person’s hemoglobin value drops.
Irrigation—Flushing a prescribed solution through a tube or cavity. Irritable bowel syndrome—Diarrhea or alternating constipation-diarrhea with no discernible organic cause. Islet cell antibody—A protein found to be elevated in a person with insulin-dependent diabetes mellitus. Islets of Langerhans—Clusters of cells in the pancreas including alpha, beta, and delta cells; alpha cells produce glucagon, beta cells produce insulin, and delta cells produce somatostatin. Isotonic—A solution that has the same osmotic pressure as blood plasma. Isotretinoin—Vitamin A metabolite used to treat severe acne, requiring strict contraceptive protocols in fertile women because the metabolite can cause birth defects. Jaundice—Yellowing of skin, whites of eyes, and mucous membranes due to excessive bilirubin in the blood; causes may be obstructed bile duct, liver disease, or hemolysis of red blood cells. Jejunoileal bypass—A surgical procedure that removes a portion of the small intestine, bypassing about 90% of it. Jejunostomy—A surgical opening into the jejunum. Jejunum—The second portion of the small intestine. Joule—A measurement of energy; amount of energy needed to raise the temperature of 1 gram of cool, dry air by 1.8°F (1.0°C). Kaposi sarcoma—A type of cancer often related to the immunocompromised state that accompanies AIDS; characterized by multiple areas of cell proliferation, initially in the skin and eventually in other body sites. Keshan disease—Deterioration of the heart due to selenium deficiency, but heart failure not reversible by supplementation; named for the province of Keshan, China; fatality rate as high as 80%; in mice, linked to a mutation of an avirulent virus to a virulent one producing myocardial disease; virulent strain then caused heart disease in mice not selenium-deficient. Keto acid—Amino acid residue left after deamination. Ketoacidosis—Acidosis due to an excess of ketone bodies. Ketone—Any of a class of organic compounds characterized by a carbonyl group attached to two carbon atoms; example: acetone, used in nail polish remover and paint remover. Ketone body—Any of the three compounds (acetoacetic acid, acetone, and B-hydroxybutyric acid) that are normal intermediates in lipid metabolism; accumulate in blood and urine in abnormal amounts in conditions of impaired metabolism.
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Ketonuria—The presence of ketone bodies in the urine. Ketosis—Accumulation of ketone bodies in the blood; result of incomplete metabolism of fatty acids, generally from carbohydrate deficiency or malfunctioning carbohydrate metabolism. Kilocaloric density—The kilocalories contained in a given volume of a food. Kilocalorie (Kcal)—A measurement unit of energy; the amount of heat required to raise 1 kilogram of water 1° Celsius; on food labels: Calorie. Kilocalorie:nitrogen ratio—A mathematical relationship expressed as the number of kilocalories per gram of nitrogen provided in a feeding. Kilojoule—A measurement unit of energy required to move a mass of one kilogram with an acceleration of one meter per second; one kilocalorie equals 4.184 kilojoules. Konzo—An irreversible paralytic disease of the lower extremities caused by consumption of inadequately processed cassava roots that contain cyanide along with a diet deficient in sulphur-based amino acids. Korsakoff psychosis—Amnesia, often seen in chronic alcoholism, caused by degeneration of the thalamus due to thiamin deficiency; characterized by loss of short-term memory and inability to learn new skills. Kosher—pertaining to food prepared and served according to Jewish dietary laws. Krebs cycle—A complicated series of reactions that results in the release of energy from carbohydrates, fats, and proteins, also known as the TCA (tricarboxylic acid) cycle. Kussmaul respirations—Pattern of rapid and deep breathing due to the body’s attempt to correct metabolic acidosis by eliminating carbon dioxide through the lungs. Kwashiorkor—Severe protein deficiency in child after weaning; symptoms include edema, pigmentation changes, impaired growth and development, and liver pathology. Lactalbumin—Simple soluble protein found in greater concentration in human breast milk than in cow’s milk; easily absorbed by the infant. Lactase—An intestinal enzyme that converts lactose into glucose and galactose. Lactational amenorrhea—Absence of menstrual cycle in a mother who is fully breastfeeding. Lacteal—The central lymph vessel in each villus. Lactose—A disaccharide found mainly in milk and milk products. Large intestine—The part of the alimentary canal that extends from the small intestine to the anus. LCAT deficiency—A lack of LCAT (lecithincholesterol acyltransferase), an enzyme that
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transports cholesterol from the tissues to the liver for removal from the body. Lean body mass—Also called fat-free mass; the weight of the body minus the fat content but including essential fats that are associated with the central nervous system, the viscera, the bone marrow, and cell membranes. Legumes—Plants that have nitrogen-fixing bacteria in their roots; a good alternative to meat as a protein source; examples are dried beans, lentils. Lesion—Area of diseased or injured tissue. Leukopenia—Abnormal decrease in the number of white blood corpuscles; usually below 5000 per cubic millimeter. Life expectancy—The probable number of years that persons of a given age may be expected to live. Limiting amino acid—Particular essential amino acid lacking or undersupplied in a food that classifies the food as an incomplete protein. Linoleic acid—An essential fatty acid. Lipectomy—Surgical removal of adipose tissue. Lipid—Any one of a group of fats or fat-like substances that are insoluble in water; includes true fats (fatty acids and glycerol), lipoids, and sterols. Lipoid—Substances resembling fats but containing groups other than glycerol and fatty acids that make up true fats; example: phospholipids. Lipolysis—The breakdown of adipose tissue for energy. Lipoprotein—Combination of a protein with lipid components such as cholesterol, phospholipids, and triglycerides. Lipoprotein lipase—An enzyme that breaks down chylomicrons. Liposuction—Surgical removal of adipose tissue through a vacuum hose. Listeriosis—Bacterial infection caused by Listeria monocytogenes that is particularly virulent for fetuses; transmitted from the mother to the fetus in utero or through the birth canal; outbreaks associated with raw or contaminated milk, soft cheeses, contaminated vegetables, and ready-to-eat meats; others at risk include the elderly, those with impaired immune systems, and farm workers. Liver—A digestive organ that aids in the metabolism of all the energy nutrients, screens toxic substances from the blood, manufactures blood proteins, and performs many other important functions. Locus, loci (pl.)—In genetics, the site of a gene on a chromosome. Loop of Henle—The segment of the renal tubule that follows the proximal convoluted tubule. Low birth weight (LBW)—Characterizing an infant that weighs less than 2500 g (5.5 lb) at birth. Low-density lipoprotein (LDL)—A plasma protein containing more cholesterol and triglycerides than
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protein; elevated blood levels are associated with increased risk of heart disease. Luminal effect—Drug-induced changes within the intestine that affect the absorption of nutrients and drugs without altering the intestine. Lycopene—A red pigmented carotenoid with powerful antioxidant functions but no provitamin A activity; found in tomatoes and various berries and fruits. Lymph—A body fluid collected from the interstitial fluid all over the body and returned to the bloodstream via the lymphatic vessels. Lymphatic system—All the structures involved in the transportation of lymph from the tissues to the bloodstream. Lysine—Amino acid often lacking in grains. Macrocytic anemia—Anemia in which the red blood cells are larger than normal; one characteristic of pernicious anemia also found in folic acid deficiency. Macrophage—Monocyte (see Fig. 8-13) that has left the circulation and settled in a tissue such as the spleen, lymph nodes, and tonsils; with neutrophils, major phagocytic cells of immune system. Major minerals—Those present in the body in quantities greater than 5 grams (approximately 1 teaspoonful); humans need at least 100 milligrams daily (approximately 1⁄50 teaspoonful); also called macrominerals. Malabsorption—Inadequate movement of digested food from the small intestine into the blood or lymphatic system. Malignant—Tumor that infiltrates surrounding tissue and spreads to distant sites of the body. Malnutrition—Poor nutrition; results when the body’s cells receive either an excess or a deficiency of one or more nutrients. Maltase—An intestinal enzyme that converts maltose into glucose. Maltose—A disaccharide produced when starches are broken down by the body into simpler units; two units of glucose joined together. Marasmus—Malnutrition due to a protein and kilocalorie deficit. Mastication—The process of chewing. Mechanical digestion—The digestive process that involves the physical breaking down of food into smaller pieces. Median—Statistical measure of central tendency; in a ranked set, value above which and below which are an equal number of values. Medical foods—Foods formulated to be consumed or administered enterally under the supervision of a physician intended for the specific dietary management of a disease or condition, which have distinctive nutritional requirements.
Medical Nutrition Therapy (MNT)—Provision of nutrient, dietary, and nutrition education based on a comprehensive nutritional assessment by a registered dietitian (RD); can offer cost-effective health benefits in disease management and medication optimization. Megadose—Dose providing 10 times or more of the recommended dietary allowance. Megaloblastic anemia—Anemia characterized by large immature red blood cells in the bloodstream that cannot carry oxygen properly; occurs in folic acid deficiency and pernicious anemia. Melatonin—Hormone produced from the amino acid tryptophan by the pineal gland in the brain; stimulates the onset and duration of sleep; used to treat sleep disorders and jet lag. Menaquinone—Vitamin K that is synthesized by intestinal bacteria; also called vitamin K2. Meninges—Three membranes covering the brain and spinal cord; from the outside named the dura, arachnoid, and pia maters. Meningocele—Congenital protrusion of the meninges through a defect in the skull or the spinal column. Meningoencephalocele—Protrusion of the brain and its coverings through a defect in the skull. Menkes disease—Metabolic defect blocking the absorption of copper in the gastrointestinal tract. Meta-analysis—Statistical procedure for combining data from a number of studies to analyze therapeutic effectiveness. Metabolic syndrome—Combination of atherosclerotic risk factors, including dyslipidemia, insulin resistance, obesity, and hypertension, that produces an increased risk for coronary artery disease. Metabolism—The sum of all physical and chemical changes that take place in the body; the two fundamental processes involved are anabolism and catabolism. Metabolite—Any product of metabolism; 4229 human serum metabolites commonly detected and quantified (with today’s technology) in the human serum metabolome have recently been cataloged for use by researchers. Metastasis—The “seeding” of cancer cells to distant sites of the body; spread via blood or lymph vessels or by spilling into a body cavity. Methionine—Sulfur-containing amino acid often lacking in legumes. Microalbuminuria—Small amounts of protein in the urine. Detected by a laboratory using methods more sensitive than traditional urinalysis. Microflora—Resident bacteria in the intestinal tract; functions include assisting in the development of the immune system and protecting the host from foreign microbes.
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Microgram—One-millionth of a gram or onethousandth of a milligram; abbreviated mcg. Micronize—To pulverize a substance into very tiny particles. Microvilli—Microscopic, hairlike rodlets (resembling bristles on a brush) covering the edge of each villus. Midarm circumference—Measure of the distance around the middle of the upper arm; used to assess body protein stores. Milk-alkali syndrome—Condition characterized by high blood calcium and a more alkaline urine that predisposes to the precipitation of calcium in the kidney; caused by ingestion of excessive absorbable alkali and milk; associated with the milk and cream and antacid treatment of peptic ulcers used years ago. Milliequivalent (mEq)—Unit of measure used for determining the concentration of electrolytes in solution; expressed as milliequivalents per liter. Milling—The process of grinding grain into flour. Milliosmole—Unit of measure for osmotic activity. Mineral—An inorganic element or compound occurring in nature; in the body, some minerals help regulate bodily functions and are essential to good health. Mixed malnutrition—The result of a deficiency or excess of more than one nutrient. Modified diet—A term used in health-care institutions to mean the food served to a client has been altered or changed from that served to clients on regular diets, usually by physician order. Modular supplement—A nutritional supplement that contains a limited number of nutrients, usually only one. Mold—Any of a group of parasitic or other organisms living on decaying matter; fungi. Molecule—The smallest quantity into which a substance may be divided without loss of its characteristics. Monoamine oxidase inhibitor (MAOI)—A class of drugs that may have critical interactions with foods. Monocyte—White blood cell (see Fig. 8-3) that circulates in the bloodstream for about 24 hours before settling into tissues to become a macrophage; with macrophages, provide a defense against foreign antigens. Monoglyceride—One fatty acid joined to a glycerol molecule. Monosaccharide—A simple sugar composed of one unit of C6H12O6; examples include glucose, fructose, and galactose. Monounsaturated fat—A lipid in which the majority of fatty acids contain one carbon-tocarbon double bond.
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Morbid obesity—BMI greater than 39. Morbidity—The state of being diseased; number of cases of disease in relation to population. Mortality—State of being subject to death; the death rate; number of deaths per unit of population. Motility—Power to move spontaneously. Mucosa—A mucous membrane that lines body cavities. Mucosal effect—Drug-induced changes within the intestine that affect the absorption of drugs or nutrients by damaging the tissues. Mucus—A thick fluid secreted by the mucous membranes and glands. Multiparous—Having borne more than one child. Mutation—Permanent transmissible change in a gene; natural mutation produces evolutionary change in organisms; induced mutation results from exposure to environmental influences such as physical forces, chemicals, or biologic agents. Mycotoxin—A substance produced by mold growing in food that can cause illness or death when ingested by humans or animals. Myelin sheath—Fatty covering surrounding the long appendages of some nerves; serves to increase the transmission speed of impulses. MyPlate—U.S. Department of Agriculture food guide using the visual cues of a divided plate and a glass to represent the proportions of healthy foods for consumers. Myocardial infarction (MI)—Area of dead heart muscle; usually the result of coronary occlusion. Myocardium—The heart muscle. Myoglobin—A protein located in muscle tissue that contains and stores oxygen. Myxedema—A condition that occurs in older children and adults, resulting from hypofunction of the thyroid gland characterized by a drying and thickening of the skin and slowing of physical and mental activity. Narcolepsy—A chronic condition consisting of recurrent attacks of drowsiness and sleep. Nasoduodenal tube (ND tube)—A tube inserted via the nose into the duodenum. Nasogastric tube (NG tube)—A tube inserted via the nose into the stomach. Nasojejunal tube (NJ tube)—A tube inserted via the nose into the jejunum. Necrotizing enterocolitis—A condition in premature infants in which intestinal cells die and fall off. Neonate—Infant from birth to age 28 days. Neoplasm—A new and abnormal formation of tissue (tumor) that grows at the expense of the healthy organism. Nephritis—General term for inflammation of the kidneys.
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Nephron—The structural and functional unit of the kidney. Nephropathy—A kidney disease characterized by inflammation and degenerative lesions. Nephrosclerosis—A hardening of the renal arteries; may be caused by arteriosclerosis of the kidney arteries. Nephrotic syndrome—The end result of a variety of diseases that cause the abnormal passage of plasma proteins into the urine. Neuropathy—Any disease of the nerves. Neural tube defects—A birth defect of the brain, spine, or spinal cord; includes spina bifida and anencephaly. NHANES—National Health and Nutrition Examination Survey, a nationally representative crosssectional survey of civilian noninstitutionalized population of the United States; conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics; the interview includes demographic, socioeconomic, dietary, and health-related questions; the examination component consists of medical, dental, and physiological measurements, as well as laboratory tests. Niacin—A B vitamin that functions as a coenzyme in the production of energy from glucose; obtained from meat or produced from the amino acid tryptophan, present in milk, eggs, and meat; also called nicotinic acid. Niacin equivalent (NE)—Measure of niacin activity; equal to 1 milligram of preformed niacin or 60 milligrams of tryptophan. Night blindness—Vision that is slow to adapt to dim light; caused by vitamin A deficiency or hereditary factors or, in the elderly, by poor circulation. Nitrogen—Colorless, odorless, tasteless gas forming about 80% of Earth’s air. Nitrogen balance—The difference between the amount of nitrogen ingested and that excreted each day; when intake is greater, a positive balance exists; when intake is less, a negative balance exists. Nitrogen-fixing bacteria—Organisms that absorb nitrogen from the air, which, upon the death of the bacteria, is released for legume plants to use in the anabolism of protein. Nomogram—A chart that shows a relationship between numerical values. Nonessential—In nutrition, refers to a chemical substance or nutrient the body normally can manufacture in sufficient amounts for health. Nonessential amino acid—Any amino acid that can normally be synthesized by the body in sufficient quantities. Nonheme iron—Iron that is not bound to hemoglobin or myoglobin; all the iron in plant sources.
Norwalk virus norovirus—A causative organism that is responsible for more than 50% of the reported cases of epidemic viral gastroenteropathy. The incubation period ranges from 18 to 72 hours, and the outbreaks are usually self-limiting; influenzalike intestinal symptoms last for 24 to 48 hours. NSAID—Nonsteroidal anti-inflammatory drug; examples: aspirin, ibuprofen, naproxen, as well as agents available by prescription. Nulliparous—Never having borne a child. Nursing action (intervention)—Specific care to be administered, including physical and psychological care, teaching, counseling, and referring. Nursing-bottle syndrome—A condition in which an infant has many dental caries caused by drinking milk or other sweet liquids during sleep. Nutraceutical—Food component used for medicinal purposes; Ex: vitamins, minerals, amino acids; regulated under Dietary Supplement Health Education Act of 1994 (see Chapter 15). Nutrient—Chemical substance supplied by food that the body needs for growth, maintenance, and/or repair. Nutrient density—The concentration of nutrients in a given volume of food compared with the food’s kilocalorie content. Nutrigenetics—Detection of gene variants within an individual to identify environmental factors that trigger dysfunction or disease; part of the initiation of food allergies and celiac disease. Nutrigenomics—Study of the interaction between one’s diet and his or her genes in order to alter susceptibilities to disease and responses to foods. Nutrition—Science of food and its relationship to health; processes of taking in and utilizing nourishment. Nutrition support service—A team service for clients on enteral and parenteral feedings that assesses, monitors, and counsels these clients. Nutritional assessment—The evaluation of a client’s nutritional status based on a physical examination, anthropometric measurements, laboratory data, and food intake information. Nutritional status—Condition of the body as it relates to the intake and use of nutrients. Obese—Body mass index (BMI) of 30 kg/m2 or more; muscular person may exceed BMI of 30 kg/m2 but not be obese. Obesity—Excessive amount of fat on the body; for women, a fat content greater than 30%; for men, a fat content greater than 25%. Obesogens—Chemical in the environment that may have an effect on obesity.
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Objective data—Findings verifiable by another through physical assessment or diagnostic tests, also termed signs. Obligatory excretion—Minimum amount of urine production necessary to keep waste products in solution, amounting to 400 to 600 milliliters per day. Oliguria—A decreased output of urine. Oncogene—Carcinogenic gene that stimulates excessive reproduction of the cell. Opportunistic infection—Infection caused by normally nonpathogenic organisms in a host with decreased resistance. Opsin—A protein that combines with vitamin A to form rhodopsin, a chemical in the retina necessary for vision. Optic nerve—The second cranial nerve, which transmits impulses for the sense of sight. Oral cavity—The cavity in the skull bounded by the mouth, palate, cheeks, and tongue. Oral rehydration solution—Oral fluid that prevents or treats dehydration. Organ—Somewhat independent body part having specific functions; examples: stomach, liver. Orthostatic hypotension—A drop in blood pressure producing dizziness, fainting, or blurred vision when arising from a lying or sitting position or when standing motionless in a fixed position. Osmolality—Measure of osmotic pressure exerted by the number of dissolved particles per weight of liquid; usually reported clinically as mOsm/kg. Osmolarity—Measure of osmotic pressure exerted by the number of dissolved particles per volume of liquid; usually reported clinically as mOsm/L. Osmosis—The movement of water across a semipermeable cell membrane from an area with fewer particles to one with more particles. Osmotic demyelinating disease—Brain pathology caused by too rapid correction of hyponatremia resulting in motor nerve dysfunction including quadriplegia; more common in malnourished and debilitated clients. Osmotic pressure—The pressure that develops when a concentrated solution is separated from a less-concentrated solution by a semipermeable membrane. Osteoarthritis—Progressive deterioration of the cartilage in the joints; risk factors are aging, obesity, occupational or athletic abuse of joints, and trauma. Osteoblasts—Bone cells that build bone. Osteocalcin—Vitamin K–dependent protein; second most abundant protein in bone but its function is not yet clearly defined. Osteoclasts—Bone cells that break down bone. Osteodystrophy—Defective bone formation. Osteomalacia—Adult form of rickets.
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Osteopenia—Bone mineral density 1 to 2.5 standard deviations below the mean of healthy young adults. Osteoporosis—Bone mineral density more than 2.5 standard deviations below the mean of young adults. Ostomy—A surgically formed opening to permit passage of urine or bowel contents to the outside. Overnutrition—The result of an excess of one or more nutrients in the diet. Overweight—Body mass index from 25 kg/m2 to 29.99 kg/m2. Ovum—The egg cell that, after fertilization by a sperm cell, develops into a new individual. Oxalates—Salts of oxalic acid found in some plant foods; bind with the calcium in the plant, making it unavailable to the body. Oxidation—The process in which a substance is combined with oxygen. Oxidative stress—Cellular damage caused by oxygen-derived free radical formation; potential damage can be decreased by antioxidants. Oxytocin—A hormone produced by the posterior pituitary gland in the brain; effects are uterine contractions and release of milk. Pancreas—An abdominal gland that secretes enzymes important in the digestion of carbohydrates, fats, and proteins; also secretes the hormones insulin and glucagon. Pancreatic lipase—An enzyme produced by the pancreas; used in fat digestion. Pancreatitis—Inflammation of the pancreas. Pantothenic acid—A B-complex vitamin found in almost all foods; deficiencies from lack of food have not been documented. Paralytic ileus—A temporary cessation of peristalsis that causes an intestinal obstruction. Paralytic shellfish poisoning—Disease caused by the consumption of poisonous clams, oysters, mussels, or scallops. Parasite—An organism that lives within, upon, or at the expense of a living host. Parathyroid hormone (PTH)—Hormone secreted by the parathyroid glands; regulates calcium and phosphorus metabolism in the body. Parenteral feeding—Administration of nutrients by a route other than the gastrointestinal tract, such as subcutaneously, intravenously, intramuscularly, or intradermally. Parenteral nutrition (PN)—Provision of nutrients through a vein (intravenously) into a large diameter vein. (see Chapter 14) Paresthesia—Abnormal or unpleasant sensation resulting from nerve injury; described as a feeling of numbness, prickliness, stinging, or burning.
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Parietal—Two bones that form the sides and roof of the skull; also two lobes of the cerebrum lying roughly under those bones. Parity—Condition of having carried a pregnancy to viability (20 weeks or 500-gram birth weight) regardless of whether resulted in a live birth; nulliparous—never carried a child to viability; multiparous—more than once. Parotid glands—One of the salivary glands of the mouth, located just below and in front of the ears; the mumps virus causes infectious parotitis. Pathogen—Any disease-producing agent, especially a virus, bacterium, fungus, or other microorganism. Pectin—Purified carbohydrate obtained from peel of citrus fruits or apple pulp; gels when cooked with sugar at correct pH to thicken jelly and jam; contained in mashed raw apple, applesauce, firm banana; recommended for diarrhea to contribute firmness to stools. Pellagra—Deficiency disease due to lack of niacin and tryptophan; characterized by the three Ds: dermatitis, diarrhea, and dementia. Pepsin—An enzyme secreted in the stomach that begins protein digestion. Pepsinogen—The antecedent of pepsin; activated by hydrochloric acid, a component of gastric juice. Peptidases—Enzymes that assist in the digestion of protein by reducing the smaller molecules to single amino acids. Peptide bond—Chemical bond that links two amino acids in a protein molecule. Percutaneously—Affected through the skin. Perforated ulcer—Condition in which an ulcer penetrates completely through the stomach or intestinal wall, spilling the organ’s contents into the peritoneal cavity. Perinatal—Period beginning after the 28th week of pregnancy and ending 28 days after birth. Periodontal disease—Disorder of the gingiva (gums) and the supporting structures of the teeth. Perioperative immunonutrition—Provision of nutritional support before, during, and after surgery using enteral preparations modified by the addition of specific nutrients, such as arginine, omega-3 fatty acids, and others, which have been shown to upregulate the immune response, to control inflammatory response, and to improve gut function after surgery. Peripheral parenteral nutrition (PPN)—An intravenous feeding via a vein away from the center of the body, usually in the hand or forearm. Peristalsis—A wavelike muscular movement that propels food along the alimentary canal. Peritoneal dialysis—Method of removing waste products from the blood by injecting the flushing solution into a client’s abdomen and using the
client’s peritoneum as the semipermeable membrane. Peritoneum—The membrane that covers the internal abdominal organs and lines the abdominal cavity. Peritonitis—Inflammation of the peritoneal cavity. Pernicious anemia—Inadequate red blood cell formation due to lack of intrinsic factor from the stomach, which is required for the absorption of vitamin B12; leads to neural deterioration. Pesticides—A chemical used to kill insects or rodents. Petechiae—Pinpoint, flat, round, red lesions caused by intradermal or submucosal hemorrhage. P-glycoprotein—Cell membrane pump influencing cellular uptake and release of chemicals; affects relative susceptibility or resistance of cells to drug therapy. pH—Potential of Hydrogen; a scale representing the relative acidity or alkalinity of a solution; a value of 7 is neutral, less than 7 is acidic, and greater than 7 is alkaline. Pharmacodynamics—Study of drugs and their actions on living organisms; the clinical effects of the drugs. Pharmacokinetics—The study of the action of drugs, emphasizing absorption time, duration of effect, distribution in the body, and method of excretion. Pharynx—Muscular passage between the oral cavity and the esophagus. Phenotype—Observable properties of an organism; blood type is completely inherited; other phenotypes can be altered by environmental agents. Phenylalanine—Essential amino acid, which is indigestible if a person lacks a particular enzyme. Accumulation of phenylalanine in the blood can lead to mental retardation. Phenylketonuria (PKU)—Hereditary disease caused by the body’s failure to convert phenylalanine to tyrosine because of a defective enzyme. Phlebotomy—Puncturing or surgical opening of a vein to withdraw blood. Phospholipid—Diglyceride containing phosphorus; primary lipid constituent of cell membranes; examples include lecithin and myelin. Photosynthesis—Process through which plants containing chlorophyll are able to manufacture carbohydrates from carbon dioxide and water using the sun’s energy. Phylloquinone—Vitamin K1, found in foods. Phytic acid—A substance found in grains that forms an insoluble complex with calcium; phytates. Phytochemicals—Nonnutritive food components that provide medical or health benefits including the prevention or treatment of a disease.
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Phytonadione—Synthetic, water-soluble pharmaceutical form of vitamin K1; can be administered orally or by injection. Pica—The craving to eat nonfood substances such as dirt and laundry starch. Pitting edema—Usually of the skin of the extremities; firm pressure by a finger produces an indentation that remains for 5 seconds. Placebo—Drug or treatment used as inactive control in a test of therapy; “placebo effect” attributed to positive response caused by subject’s expectations. Placenta—The organ in the uterus through which the unborn child exchanges carbon dioxide for oxygen and wastes for nourishment; lay term is afterbirth. Plant sterols—Compounds, structurally similar to cholesterol, that in prescribed amounts interfere with the absorption of cholesterol and thus lower low-density lipoprotein cholesterol levels; marketed as table spreads (butter substitutes) and salad dressings. Plaque—Accumulation of material; in lining of arteries, obstructs blood flow; on crowns of teeth, forerunner of dental caries and periodontal disease. Plasma—The liquid portion of the blood including the clotting elements. Plasma transferrin receptor—Measure of iron status; increases even in mild deficiency; unaffected by inflammation. Plumbism—Lead poisoning. Pneumocystis pneumonia—A type of lung infection frequently seen in AIDS patients; caused by the organism Pneumocystis jiroveci, formerly called Pneumocystis carinii. Polycythemia—Increase in red blood cells; may be physiologic due to demand for oxygen-carrying capacity or pathologic as in polycythemia vera, a chronic, life-shortening disorder of unknown etiology involving hematologic stem cells. Polydipsia—Excessive thirst. Polymer—A natural or synthetic substance formed by combining two or more molecules of the same substance. Polymorphism—Occurrence of more than one form in a life cycle; variation in alleles within a species. Polypeptide—A chain of amino acids linked by peptide bonds that form proteins. Polyphagia—Excessive appetite. Polypharmacy—Concurrent use of a large number of drugs, increasing risk of interactions; especially likely in client with many diseases treated by multiple health-care providers. Polysaccharide—Complex carbohydrates composed of many units of C6H12O6 joined together; examples important in nutrition include starch, glycogen, and fiber.
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Polyunsaturated fat—A fat in which the majority of fatty acids contain more than one carbon-tocarbon double bond; intake is associated with a decreased risk of heart disease. Polyuria—Excessive urination. Positive feedback cycle—Situation in which a condition provokes a response that worsens the condition; example: low blood pressure due to a failing heart stimulates the kidney to save sodium and water, increasing fluid retention that further overloads the failing heart. Postprandial—Following a meal. Potable water—Water that is safe for drinking, free of harmful substances. Potassium pump—Proteins located in cell membranes that provide an active transport mechanism to move potassium ions across a membrane to their area of greater concentration; moves potassium ions into the cells. Prebiotic—Nondigestible food ingredients that encourage the growth of favorable intestinal microorganisms. Precursor—A substance from which another substance is derived. Preeclampsia—Hypertension and proteinuria, appearing after the twentieth week of pregnancy. Preformed vitamin—A vitamin already in a complete state in ingested foods, as opposed to a provitamin, which requires conversion in the body to be in a complete state. Pressure ulcer—Tissue breakdown from external force impairing circulation. Prevalence—The number of cases of a disease or condition present in a specified population at a given time. Primary amenorrhea—Delay of menarche (initial menstrual period) until after age of 16 or absence of secondary sex characteristics after age 14. Primary malnutrition—A nutrient deficiency due to poor food choices or a lack of nutritious food to eat. Primary prevention—The implementation of practices that are likely to avert the occurrence of disease; nutrition example: maintaining a healthy body weight. Principle of complementarity—Combining incomplete-protein foods so that each supplies the amino acids lacking in the other. Prion—A proteinaceous infectious agent, extremely difficult to destroy; resistant to heat, pressure cooking, ultraviolet light, irradiation, bleach, formaldehyde, and weak acids; even autoclaving at 135° for 18 minutes does not eliminate infectivity. Probiotic—Live microbial food supplements that improve the microbial balance of the intestine, mainly by reinforcing the intestinal mucosal barrier against harmful agents.
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Prognosis—Probable outcome of an illness based on client’s condition and natural course of the disease. Promotion—The second step in a cell turning cancerous, through the action of environmental substances on the altered, initiated gene. Proportionality—A medical treatment is ethically mandatory to the extent that it is likely to confer greater benefits than burdens to the client. Prostaglandins—Long-chain, unsaturated fatty acids mostly synthesized in the body from arachidonic acid; have hormone-like effects. Protein—Nutrient necessary for building body tissue; composed of carbon, hydrogen, oxygen, and nitrogen (and sometimes with sulfur, phosphorus, or iron); amino acids represent the basic structure of proteins. Protein binding sites—Various sites in the body tissues to which drugs may become attached, rendering the drug temporarily inactive. Protein-calorie malnutrition (PCM)—Condition in which the person’s diet lacks both protein and kilocalories. Protein-energy malnutrition (PEM)—Condition in which the person’s diet lacks both protein and kilocalories. Also termed protein-calorie malnutrition (PCM). Proteinuria—Protein in the urine. Prothrombin—A protein essential to the bloodclotting process; manufactured by the liver using vitamin K. Protocol—A description of steps to be followed when performing a procedure or providing care for a particular condition. Proto-oncogene—Gene that in the normal cell stimulates growth and maintenance; when mutated, becomes an oncogene. Provitamin—Inactive substance that the body converts to an active vitamin. Provitamin A—Carotenoids that are precursors of vitamin A, the most powerful of which is beta-carotene. Proximal convoluted tubule—The first segment of the renal tubule. Psychology—The science of mental processes and their effects on behavior. Psychosis—Severe mental disturbance with personality derangement and loss of contact with reality. Psychosocial development—The maturing of an individual in relationships with others and within himself or herself. Ptyalin—A salivary enzyme that breaks down starch and glycogen to maltose and a small amount of glucose; also known as salivary amylase. Puberty—The period of life at which the physical ability to reproduce is attained.
Pulmonary—Concerning or involving the lungs. Pulmonary edema—The accumulation of fluid in the lungs. Pulse pressure—The difference between systolic and diastolic blood pressure; normally 30 to 40 mm Hg; narrows in insufficient fluid volume and widens in excessive fluid volume. Purging—The intentional clearing of food out of the human body by vomiting and/or using enemas, laxatives, and/or diuretics. Purines—One of the end products of the digestion of some nitrogen-containing compounds. Pyelonephritis—An inflammation of the central portion of the kidney. Pyloric sphincter—The sphincter muscle guarding the opening between the stomach and small intestine. Pyridoxine—Pharmaceutical name for vitamin B6. Pyruvate—An intermediate in the metabolism of energy nutrients. Quality assurance—A planned and systematic program for evaluating the quality and appropriateness of services rendered. Quetelet index—Body mass index. Radiologist—Physician with special training in diagnostic imaging and radiation treatments. Rancid—Having the rank smell and sour taste of stale fat or oil from decomposition. Rate—The speed or frequency of an event per unit of time. Rationale—Reason certain actions are likely to achieve a desired outcome; in nursing, ideally based on research indicating a nursing action was effective in similar circumstances. Rebound scurvy—Vitamin C deficiency produced in a person following cessation of megadosing due to a habitually lessened rate of absorption. Recessive trait—One that requires two recessive genes for the trait, one from each parent, for the trait to be expressed (to be manifested) in the individual. Recommended Dietary Allowance (RDA)—Intake that meets the needs of 97% to 98% of the individuals in a life stage and gender group; intended as a goal for daily intake by individuals, not for assessing adequacy of an individual’s nutrient intake. Rectum—The lower part of the large intestine. Refeeding—The reintroduction of kilocalories and nutrients into a patient either orally or parenterally. Refeeding syndrome—A detrimental state that results when a previously severely malnourished person is reintroduced to food and/or nutrients and kilocalories improperly.
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Regurgitate—To cause to flow backward, as with an infant “spitting up.” Relative risk—In epidemiological studies, the ratio of the frequency of a certain disorder in groups exposed and groups not exposed to a particular hereditary or environmental factor. Renal—Pertaining to the kidney. Renal corpuscle—Refers collectively to both Bowman’s capsule and the glomerulus. Renal exchange lists—A specialized type of exchange list for clients with kidney disease who require restriction of one or more of the following: protein, sodium, phosphorus, and potassium. Renal osteodystrophy—Defective bone development caused by phosphorus retention, a low or normal serum calcium level, and increased parathyroid activity. Renal pelvis—A structure inside the kidney that receives urine from the collecting tubules. Renal threshold—The blood glucose level at which glucose begins to spill into the urine. Renal tubule—The second major portion of the nephron; appears ropelike. Renin—An enzyme produced by the kidney that catalyzes the conversion of angiotensinogen to angiotensin I. Rennin—An enzyme that coagulates milk. Reservoir—Place that an infectious agent normally lives and multiplies so that it can be transmitted to a susceptible host. Residue—Trace amount of any substance in a product at the time of sale; substance remaining in the bowel after absorption. Respiration—The exchange of oxygen and carbon dioxide between a living organism and the environment. Respirator—A machine used to assist respiration. Respiratory acidosis—Blood pH less than 7.35 caused by pulmonary disease, characterized by a retention of carbon dioxide. Respiratory alkalosis—Blood pH greater than 7.45 caused by pulmonary disease, characterized by a loss of carbon dioxide. Resting energy expenditure (REE)—The amount of fuel the human body uses at rest for a specified period of time; often used interchangeably with basal metabolic rate (BMR). Retina—Inner lining of eyeball that contains lightsensitive nerve cells; corresponds to film in camera. Retinal—Form of vitamin A specifically required for vision. Retinoic acid syndrome—Characteristic fetal deformities, including small ears or no ears, abnormal or missing ear canals, brain malformation, and heart defects caused by excessive preformed vitamin A or isotretinoin.
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Retinoids—Group of structurally similar compounds possessing the biological activity of all-trans retinol including retinol, retinal, retinoic acid, retinyl ester, and synthetic analogues. Retinol—One of the active forms of preformed vitamin A. Retinol Activity Equivalent (RAE)—Measure of vitamin A activity that considers both preformed vitamin A (retinol) and its precursor (carotene); 1 RAE equals 3.3 international units from animal foods or 20 international units from the betacarotene in plant foods. Retinopathy—Any disorder of the retina. Retrolental fibroplasia (RLF)—A disease of the vessels of the retina present in premature infants; often caused by exposure to high postnatal oxygen concentration. Rhabdomyolysis—Breakdown of muscle fibers resulting in myoglobin in the bloodstream; some components are toxic to kidney and can cause kidney damage. Rhodopsin—Light-sensitive protein in the retina that contains vitamin A; also called visual purple. Riboflavin—Coenzyme in the metabolism of protein; also called vitamin B2. Ribonucleic acid (RNA)—Nucleic acid that controls protein synthesis in all living cells; HIV/RNA is the genetic material of human immunodeficiency virus. Rickets—Disease caused by a deficiency of vitamin D that affects the young during the period of skeletal growth, resulting in bones that are abnormally shaped and weak. Ritter syndrome—An inflammatory skin disease seen in newborns, characterized by pustules that fill with a straw-colored fluid and become encrusted. Rooting reflex—The infant’s natural response to a stroke on its cheek, which turns the head toward that side to nurse. Rotavirus—Most common cause of infectious enteritis in human infants; survives for long periods on hard surfaces, in contaminated water, and on hands. Roux-en-Y—A surgical connection between the distal end of the small bowel and another organ such as the stomach. Rugae—Folds of mucosa of organs such as the stomach. Salivary amylase—An enzyme that initiates the breakdown of starch in the mouth. Salivary glands—The glands that secrete saliva into the mouth. Salmonella—A genus of bacteria responsible for many cases of foodborne illness.
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Salmonellosis—A bacterial infection manifested by the sudden onset of headache, abdominal pain, diarrhea, nausea, and vomiting. Fever is almost always present. Contaminated food is the predominant method of transmission. Sarcoma—A malignant neoplasm that occurs in connective tissue such as muscle or bone. Satiety—The feeling after consuming food that enough has been eaten; the sensation of satisfaction. Saturated fat—A fat in which the majority of fatty acids contain no carbon-to-carbon double bonds. Scurvy—Disease due to deficiency of vitamin C marked by bleeding problems and, later, by bony skeleton changes. Seasonal variation—Refers to differences during spring, summer, fall, and winter. Sebaceous gland—Oil-secreting gland of the skin; most sebaceous glands have a hair follicle associated with them. Second-degree relative—A relative sharing one-quarter of an individual’s genes; examples: grandparent, grandchild, uncle, aunt, nephew, niece, half-sibling. Secondary diabetes—A World Health Organization classification for diabetes when the hyperglycemia occurs as a result of another disorder. Secondary hypertension—High blood pressure that develops as the result of another condition. Secondary malnutrition—A nutrient deficiency due to improper absorption and distribution of nutrients. Secondary prevention—Institution of monitoring techniques to discover incipient diseases early to enhance the opportunity to control their effects; nutrition example: testing blood glucose levels to diagnose prediabetes. Secretin—A hormone that stimulates the production of bile by the liver and the secretion of sodium bicarbonate juice by the pancreas. Self-efficacy—The extent to which a person believes he or she has the ability to perform a particular task or behavior. Self-monitoring of blood glucose (SMBG)—A procedure that persons with diabetes follow to test their own blood glucose levels. Sensible water loss—Visible water loss through perspiration, urine, and feces. Sensitivity—Characteristic of diagnostic test; the proportion of people correctly identified as having the condition in question; a score of 100% would indicate that all the affected persons were identified by the test. Sepsis—A condition in which disease-producing organisms are present in the blood. Sequelae—Conditions following and resulting from a disease; sequel.
Serosa—A serous membrane that covers internal organs and lines body cavities. Serotonin—A body chemical that assists the transmission of nerve impulses; it produces constriction of blood vessels and is thought to be related to sleep. Serum—The liquid portion of the blood minus the clotting elements. Serum transferrin—Globulin in the blood that binds and transports iron; level increases in early iron deficiency, before hemoglobin and hematocrit readings drop. Shelf life—The duration of time a product can remain in storage without deterioration. Shigella—Organisms causing intestinal disease; spread by fecal-oral transmission from a client or carrier via direct contact or indirectly by contaminated food. SIAD (syndrome of inappropriate antidiuresis)— Dilutional hyponatremia resulting from diverse pathologies (central nervous system disorders, certain lung diseases, some tumors, particular drugs). Formerly called syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Signs—See Objective data. Simple carbohydrate—Composed of one or two units of C6H12O6; includes the monosaccharides (glucose, fructose, and galactose) and the disaccharides (sucrose, lactose, and maltose). Simple fat—Lipids that consist of fatty acids or a simple filler such as a hydroxyl (OH) molecule joined to glycerol. Small for gestational age (SGA)—Infant weighing less at birth than considered normal for the calculated length of the pregnancy. Small intestine—The part of the alimentary canal between the stomach and the large intestine, where most absorption of nutrients occurs. Sodium pump—Proteins located in cell membranes that provide an active transport mechanism to move sodium ions across a membrane to their area of greater concentration; moves sodium ions out of the cells and water follows. Solubility—The ability of one substance to dissolve into another in solution. Soluble—Able to be dissolved. Solute—The substance that is dissolved in a solvent. Solvent—A liquid holding another substance in solution. Somatostatin—A hormone produced by the delta cells of the islets of Langerhans that inhibits both the release of insulin and the production of glucagon. Specific gravity—The weight of a substance compared to an equal volume of a standard substance; usual standard for liquids is water; its specific gravity set at 1.000.
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Specificity—Characteristic of diagnostic test; the proportion of people correctly identified as not having the condition in question; a score of 100% would indicate that all of the unaffected persons were identified by the test. Sphincter—A circular band of muscles that constricts a passage. Spina bifida—Congenital defect in spinal column whereby the vertebrae fail to close; clinical manifestations may or may not include protrusion of the meninges outside the spinal canal. Spore—A form assumed by some bacteria that is highly resistant to heat, drying, and chemicals. Sprue—Chronic form of malabsorption syndrome affecting the small intestine; subcategories: tropical and nontropical. Standard (polymeric) formula—An oral or enteral feeding that contains all the essential nutrients in a specified volume. Standard drink—0.5 oz. of alcohol found in 12 oz. of beer, 5 oz. of wine, or 1.5 oz. distilled spirits. Staphylococcus aureus—One of the most common species of bacteria, which produces a poisonous toxin. The main reservoir is nose and throat discharge. Food can act as a vehicle for transmission, so proper hand washing is an essential means of control. Starches—Polysaccharides; many units of C6H12O6 joined together; complex carbohydrates. Steatorrhea—The presence of greater than normal amounts of fat in the stool, producing foulsmelling, bulky excrement. Sterol—Substance related to fats and belonging to the lipoids; for example, cholesterol. Stimulus control—The identification of cues that precede a behavior and rearranging daily activities to avoid such cues. Stoma—A surgically created opening in the abdominal wall. Stomach—The portion of the alimentary canal between the esophagus and small intestine. Stomatitis—An inflammation of the mouth. Stress—Any threat to a person’s mental or physical well being. Stress factor—A number used to predict how much a client’s kilocalorie need has increased as a result of a disease state. Subcutaneously—Beneath the skin. Subdural hematoma—Collection of blood under the outermost membrane covering the brain and spinal cord; usually resulting from head injury. Subjective data—Experiences the client reports, also termed symptoms. Submucosa—Structural layer of the alimentary canal below the mucosa; contains tissues and blood vessels.
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Sucrase—An enzyme in the intestinal mucosa that splits sucrose into glucose and fructose. Sucrose—A disaccharide; one unit of glucose and one unit of fructose joined together; ordinary white table sugar. Superior vena cava—One of the largest diameter veins in the human body; used to deliver parenteral nutrition. Supplemental Feeding Program for Women, Infants, and Children (WIC)—Federal program providing nutrition education and supplemental food to low-income pregnant or breastfeeding women and children up to 5 years of age. Symptoms—See Subjective data. System—An organized grouping of related structures or parts. Systolic pressure—Pressure exerted against the arteries when the heart contracts; the upper number of the blood pressure reading. Tapeworm—A parasitic intestinal worm that is acquired by humans through the ingestion of raw seafood or undercooked beef or pork. Tardive dyskinesia—Neurological syndrome involving involuntary, slow, rhythmic, movements often seen in the mouth and tongue; side effect of psychotropic drugs, especially phenothiazines. Target heart rate—Seventy percent of maximum heart rate (number of heartbeats per minute); a person’s target heart rate can be objectively determined by a stress test. Individuals can estimate their target heart rate by subtracting their age from 220 and multiplying the difference by 70%. A person’s target heart rate is the rate at which the pulse should be maintained for at least 20 minutes during aerobic exercise. Telomerase—enzyme that helps repair cell damage that occurs to the end of the DNA molecule during each cycle of cell division; cancer cells have telomerases that allow infinite repair to the DNA strands, contributing to their immortality. Teratogenic—Capable of causing abnormal development of the embryo; results in a malformed fetus. Term infant—One born between the beginning of the 38th week through the 42nd week of gestation. Tertiary prevention—Use of treatment techniques after a disease has occurred to prevent complications or to promote maximum adaptation; nutrition example: interventions to treat swallowing disorders to maintain nourishment and avoid choking incidents. Tetany—Muscle contractions, especially of the wrists and ankles, resulting from low levels of ionized calcium in the blood; causes include parathyroid deficiency, vitamin D deficiency, and alkalosis.
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Therapeutic index—Maximum tolerated dose of a drug divided by the minimum curative dose; a narrow index indicates greater potential for adverse side effects. Thermic effect of exercise (TEE)—The number of kilocalories used above resting energy expenditure as a result of physical activity. Thermic effect of foods (diet-induced thermogenesis, specific-dynamic action)—The energy cost to extract and utilize the kilocalories and nutrients in foods; the heat produced after eating a meal. Thiamin—Coenzyme in the metabolism of carbohydrates and fats; vitamin B1. Thiaminase—An enzyme in raw fish that destroys thiamin. Third-space losses—Sequestering of fluid in body cavities such as the chest and abdomen; in the abdominal cavity, it produces ascites. Thoracic—Pertaining to the chest, or thorax. Threonine—Essential amino acid often lacking in grains. Thrombus—A blood clot that obstructs a blood vessel; obstruction of a vessel of the brain or heart is among the most serious effects. Thrush—An infection caused by the organism Candida albicans; characterized by the formation of white patches and ulcers in the mouth and throat. Thymus—Gland in the chest, above and in front of the heart, that contributes to the immune response, including the maturation of T-lymphocytes. Thyroid-stimulating hormone (TSH)—A hormone secreted by the pituitary gland that stimulates the thyroid gland to secrete thyroxine and triiodothyronine; thyrotropin. Thyrotropin-releasing factor (TRF)—Stimulates the secretion of thyroid-stimulating hormone; produced in the hypothalamus. Thyroxine (T4)—A hormone secreted by the thyroid gland; increases the rate of metabolism and energy production. Tissue—A group or collection of similar cells and their similar intercellular substance that acts together in the performance of a particular function. T-lymphocytes (T-cells)—White blood cells that recognize and fight foreign cells such as cancer; thymic lymphocytes. Tolerable Upper Intake Level (UL)—Highest average daily intake by an individual that is unlikely to pose risks of adverse health effects in 97% to 98% of individuals in specified life-stage and gender group; ordinarily refers to intake from food, fortified food, water, and supplements. Tolerance level—The highest dose at which a residue causes no ill effects in laboratory animals.
Toxoplasmosis—Infection with the protozoan Toxoplasma gondii; when infected in utero, infant may suffer mental retardation, blindness, and epilepsy. Trace minerals—Those present in the body in amounts less than 5 grams; daily intake of less than 100 milligrams needed; also called microminerals or trace elements. Traction—The process of using weights to draw a part of the body into alignment. Transcellular fluid—Located in body cavities and spaces; constantly being secreted and absorbed; examples: cerebrospinal fluid, pericardial fluid, pleural fluid. Transferrin—Protein in the blood that binds and transports iron. Trauma—A physical injury or wound caused by an external force; an emotional or psychological shock that usually results in disordered behavior. Triceps skinfold—Measure of skin and subcutaneous tissue over the triceps muscle in the upper arm; used in body fat assessment. Trichinella spiralis—A wormlike parasite that becomes embedded in the muscle tissue of pork. Trichinosis—The infestation of Trichinella spiralis, a parasitic roundworm, transmitted by eating raw or insufficiently cooked pork. Triglyceride—Three fatty acids joined to a glycerol molecule. Triiodothyronine (T3)—A hormone secreted by the thyroid gland that increases the rate of metabolism and energy production. Trousseau sign—Spasms of the forearm and hand upon inflation of the blood pressure cuff; sign of tetany or lack of ionized calcium in the blood. Trust—First stage of Erikson’s theory of psychosocial development, in which the infant learns to rely on those caring for it. Trypsin—An enzyme formed in the intestine that assists in protein digestion. Tryptophan—An essential amino acid, often lacking in legumes; serves as provitamin for the production of niacin by the liver. Tubular reabsorption—The movement of fluid back into the blood from the renal tubule. Tubule—A small tube or canal. Tumor suppressor gene—Gene that inhibits growth and division of the cell. Turgor—Resilience of skin; when pinched, quickly returns to original shape in well-hydrated young person; test for deficient fluid volume that is not reliable for elderly clients. Type 1 diabetes—Persons with this disorder must take insulin to survive and are prone to ketoacidosis; formerly called insulin-dependent diabetes mellitus (IDDM) and juvenile diabetes.
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Type 2 diabetes—Although some persons with this disorder take insulin, it is not necessary for their survival; formerly called non–insulin-dependent diabetes (NIDDM) and adult-onset diabetes mellitus. Tyramine—A monoamine present in various foods that will provoke a hypertensive crisis in persons taking monoamine oxidase inhibitors (MAOIs). Ulcer—An open sore or lesion of the skin or mucous membrane. Ulcerative colitis—Inflammatory disease of the large intestine that usually begins in the rectum and spreads upward in a continuous pattern. Ultrasound bone densitometer—Machine that uses sound waves to estimate bone density as a screening test. Uncomplicated starvation—A food deprivation without an underlying stress state. Undernutrition—The state that results from a deficiency of one or more nutrients. Underwater weighing—Most accurate measure of body fatness. Universal precautions—A list of procedures developed by the Centers for Disease Control and Prevention for when blood and certain other body fluids should be considered contaminated and treated as such. Unsaturated fat—A fat in which the majority of fatty acids contain one or more carbon-to-carbon double bonds. Urea—The chief nitrogenous constituent of urine; the final product, along with CO2, of protein metabolism. Uremia—A toxic condition produced by the retention of nitrogen-containing substances normally excreted by the kidneys. Ureter—The tube that carries urine from the kidney to the bladder. Urinary calculus—A kidney stone, or deposit of mineral salts. Urinary tract infection (UTI)—The condition in which disease-producing microorganisms invade a client’s bladder, ureter, or urethra. USDA Dietary Guidelines—Guidelines for health promotion issued by the U.S. Department of Agriculture and U.S. Department Health and Human Services; revised in 2010. U.S. Pharmacopeia (USP)—Compendium of standards of strength and purity for drugs; issued and revised periodically by a national committee. Usual food intake—A description of what a person habitually eats. Vaginitis—Inflammation of the vagina, most often caused by an infectious agent.
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Vagotomy—surgical cutting of vagus nerve to reduce gastric acid secretion; achieving similar results by the use of medications is termed medical vagotomy. Vasopressin—Antidiuretic hormone; abbreviated ADH. Ventilation—Process by which gases are moved into and out of the lungs; two aspects of ventilation are inhalation and exhalation. Very low-calorie diet (VLCD)—Diet that contains less than 800 kilocalories per day. Very low-density lipoprotein (VLDL)—A plasma protein containing mostly triglycerides with small amounts of cholesterol, phospholipid, and protein; transports triglycerides from the liver to tissues. Villi—Multiple minute projections on the surface of the folds of the small intestine that absorb fluid and nutrients; plural of villus. Virus—Very small noncellular parasite that is entirely dependent on the nutrients inside host cells for its metabolic and reproductive needs. Viscera—Internal organs enclosed in a cavity. Visible fat—Dietary fat that can be easily seen, such as the fat on meat or in oil. Vitamin—Organic substance needed by the body in very small amounts; yields no energy and does not become part of the body’s structure. Waist-to-hip ratio (WHR)—Waist measurement divided by hip measurement; if greater than 0.8 in women or greater than 0.95 in men, indicates increased risk of health problems related to obesity. Warfarin—Anticoagulant that interferes with the liver’s synthesis of vitamin K–dependent clotting factors II, VII, IX, and X. Water intoxication—Excess intake or abnormal retention of water. Weight cycling—The repeated gain and loss of body weight. Wernicke–Korsakoff syndrome—A disorder of the central nervous system resulting from thiamine deficiency; often seen in chronic alcoholism; signs and symptoms include motor, sensory, and memory deficits. Wernicke encephalopathy—Inflammatory, hemorrhagic, degenerative lesions in several areas of the brain resulting in double vision, involuntary eye movements, lack of muscle coordination, and mental deficits; caused by thiamin deficiency, often seen in chronic alcoholism but also in gastrointestinal tract disease and hyperemesis gravidarum. Whey—Component of milk; in human milk, contains soluble proteins that are easily digested; major whey protein in breast milk is alphalactalbumin, with an amino acid pattern much like that of the body tissues.
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Whipple procedure—Pancreatoduodenectomy; surgical procedure for cancer of the head of the pancreas; removal of the head of the pancreas, lower portion of common bile duct, most of duodenum, and possibly part of stomach. WIC—See Supplemental Feeding Program for Women, Infants, and Children. Wilson disease—Rare genetic defect of copper metabolism that permits copper to accumulate in various organs; inherited as an autosomal recessive trait.
Xerophthalmia—Drying and thickening of the epithelial tissues of the eye; can be caused by vitamin A deficiency. Xerostomia—Dry mouth caused by decreased salivary secretions. X-linked inheritance—Hereditary pattern involving a gene on the X chromosome; in females, a dominant gene or two recessive genes will cause the trait to be manifested; in males, with only one X chromosome, the trait will be manifested whether the gene is dominant or recessive.
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APPENDIX E
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Chapter 2 Academy of Nutrition and Dietetics Position Paper: Use of Nutritive and Nonnutritive Sweeteners. J Acad Nutr Diet 112:5, 2012. American Dietetic Association: ADA’s nutrition trends survey result. J Am Diet Assoc 102:7(Suppl), 2002. American Dietetic Association Position Paper: Health Implications of Dietary Fiber, J Am Diet Assoc 108:10, 2008. American Diabetes Association and American Dietetic Association: Exchange lists for meal planning. American Dietetic Association, Alexandria, VA, 2003. American Diabetes Association and American Dietetic Association: Choose Your Foods: Exchange Lists for Diabetes. American Dietetic Association, Alexandria, VA, 2009. Aspartame Information Center. Accessed June 2008. Available at www.aspartame.org Bachman, JL, et al: Sources of food group intakes among the U.S. population, 2001–2002. J Am Diet Assoc 108: 804, 2008. Duyff, LD: American Dietetic Association Complete Food and Nutrition Guide, ed 2. John Wiley and Sons, Hoboken, NJ, 2002. Ervin, RB, and Ogden, CL: Consumption of added sugars among US adults, 2005–2010, NCHS Data Brief Number 122, May 2013. Food and Nutrition Board, National Academy of Science, Institute of Medicine: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. National Academy Press, Washington, DC, 2005.
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Fowler, MJ: Classification of diabetes: not all hypoglycemia is the same. Clin Diabetes 25:74, 2007. Goran, M: High fructose corn syrup and diabetes prevalence: a global perspective. Global Public Health, November 27, 2012. Gottschlich, MM (ed): The A.S.P.E.N. Nutrition Support Core Curriculum: A Case-based Approach—The Adult Patient. American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, 2007. Holt, R, Roberts, G, and Scully, C: Dental damage, sequelae, and prevention. BMJ 320:1719, 2000. Korol, DL: Enhancing cognitive function across the life span. Ann N Y Acad Sci 959:167, 2002. Nielson, SJ, and Popkin, BM: Patterns and trends in food portion sizes, 1977–1998. JAMA 289:450, 2003. Roberts, RO, Roberts, LA, Geda, YE, et al: Relative intake of macronutrients impacts risk of mild cognitive impairment or dementia. J Alzheimers Dis 32:329, 2012. Uhlman, M, and Ridder, K: Nutrition information, questionable serving sizes confuse Americans. Salt Lake City Tribune, October 20, 2002. U.S. Department of Agriculture: Continuing survey of food intake by individuals, 1994–1996. Accessed April 2005. Available at www.usda.gov. U.S. Department of Agriculture: Dietary Guidelines for Americans 2010. Accessed October 2012. Available at www.dietaryguidelines.gov. U.S. Department of Agriculture: MyPlate. Accessed October 2012. Available at www.ChooseMyPlate.gov. U.S. Department of Agriculture: FDA food labeling Guide 2009. Accessed October 2012. Available at www.fda.gov/Food/GuidanceRegulation/Guidance DocumentsRegulatoryInformation/LabelingNutrition/ ucm2006828.htm Valeo, T: Controlling blood glucose may fend off cognitive decline. The Dana Foundation, 2009 podcast transcript. Accessed October 2012. Available at www.dana.org/ Publications/Brainwork/Details.aspx?id=43776 Weight Control Information Network, National Institute of Diabetes and Digestive and Kidney Diseases: Weightloss and nutrition myths, how much do you really know? (Publication No. 04-4561). March 2009. Accessed March 2013. Available at www.win.niddk. nih.gov/publications/PDFs/Myths.pdf Yaffe, K, Blackwell, T, Kanaya, AM, et al: Diabetes, impaired fasting glucose and development of cognitive impairment in older women. Neurology 63, 658, 2004.
Chapter 3 Agricultural Research Service Dietary Guidelines Committee: Dietary Guidelines for Americans 2000. Accessed December 2012. Available at www.ars.usda.gov/dgac American Dietetic Association: International Dietetics and Nutrition Terminology (IDNT) Reference Manual. American Dietetic Association, Chicago, 2008. American Dietetic and Diabetic Associations: Exchange Lists for Meal Planning. American Dietetic Association, Chicago, 2003. Blundell, JE, and Stubbs, J: Diet composition and the control of food intake in humans. In Bray, GA,
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Bouchard, C (eds): Handbook of Obesity: Etiology and Pathophysiology. Marcel Dekker, New York, 2004. Caballero, B: A nutrition paradox—underweight and obesity in developing countries. N Engl J Med 352:1514, 2005. Carlson, A, and Frazao, E: Are healthy foods really more expensive? It depends on how you measure the price. USDA Economic Information Bulletin Number 96, May 2012. Centers for Disease Control and Prevention, Polyunsaturated Fats and Monounsaturated Fats. Accessed December 2012. Available at www.cdc.govnutrition/everyone/basics/ fat/unsaturatedfat.html.. Chanmugan, P, Guthrie, JF, Cecilio, S, et al: Did fat intake in the United States really decline between 1989–1991 and 1994–1996? J Am Diet Assoc 103:867, 2003. Cunningham, E, and Marason, W: Should my client’s diet contain plant sterol/sterol esters to lower cholesterol? J Am Diet Assoc 102:81, 2002. Dausch, J: Trans-fatty acids: A regulatory update. J Am Diet Assoc 102:18, 2002. Food and Nutrition Board, Institute of Medicine: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. National Academy Press, Washington, DC, 2002/2005. Frisardi, V, Panza, F, Seripa, D, Imbimbo, BP, et al: Nutraceutical properties of Mediterranean diet and cognitive decline: possible underlying mechanisms. J Alzheimers Dis. 22(3):715, 2010. Gottschlich, MM (ed): The A.S.P.E.N. nutrition support core curriculum: A case-based approach—the adult patient. American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, 2007. Hise, ME, and Brown, JC: Lipids. In The A.S.P.E.N. nutrition support core curriculum: A case-based approach— the adult patient. American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, 2007. International Food Information Council (IFIC) and The Food and Drug Administration (FDA): The benefits of balance: Managing fat in your diet. International Food Information Council and Food and Drug Administration, Washington, DC, 1998. Kendler, BS: Recent nutritional approaches to the prevention and therapy of cardiovascular disease. Prog Cardiovasc Nurs 12:3, 1997. Koletzko, B, Baker, S, Cleghorn, G, Neto, UF, et al: Global Standard for the Composition of Infant Formula: Recommendations of an ES,PGHAN Coordinated International Expert Group. J Pediatric Gastroent and Nutr, 41:584, 2005. Lichtenstein, AH: Trans fatty acids and hydrogenated fat: What do we know? Nutr Today 30:102, 1995. Lichtenstein, AH, Kennedy, E, Barrier, P, et al: Dietary fat consumption and health. Nutr Rev 56:53, 1998. Morris, MC: Consumption of fish and n-3 fatty acids and risk of incident Alzheimer disease. Arch Neurol 60:940, 2003. National Institutes of Health, National Heart, Lung, and Blood Institute: Clinical Guidelines on the Identification and Treatment of Overweight and Obesity in Adults. U.S. Department of Health and Human Services, Bethesda, MD, 1998.
Pearson, TA, Blair, SN, Daniels, SR, et al: AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update. Consensus panel guide to comprehensive risk reduction for adult patients without coronary or other vascular diseases. Circulation 106: 388, 2002. Roberts, RO, Cerhan, JR, Geda, YE, Knopman, DS, et al: Polyunsaturated fatty acids and reduced odds of MC,I: the Mayo Clinic Study of Aging. J Alzheimers Dis, 21(3):853, 2010. Solfrizzi, V, Panza, F, Frisardi, V, Seripa, D, et al: Diet and Alzheimer’s disease risk factors or prevention: the current evidence. Expert Rev. Neurother. 11(5):677, 2011. Tucker, KL, Hallfrisch, J, Qiao, N, et al: The combination of high fruit and vegetable and low saturated fat intakes is more protective against mortality in aging men than is either alone: Baltimore longitudinal study of aging. J Nutr 135:556, 2005. U.S. Department of Agriculture: Dietary Guidelines for Americans, 2010. Accessed August 6, 2012. Available at www.usda.gov/dietaryguidelines/dga U.S. Department of Agriculture: Dietary saturated fat and cardiovascular health: A review of the evidence. Nutrition Insights 44, 2011. U.S. Department of Agriculture, Center for Nutrition Policy and Health Promotion: Nutrition insights: The role of nuts in a healthy diet. Accessed December 2008. Available at www.usda.gov/cnpp World Health Organization: Years of healthy life can be increased 5–10 years. Accessed December 2012. Available at www.who.int/mediacentre/releases/ pr84/en/print.html Wiese, HF, Hansen, AE, and Adam, DJD: Essential fatty acids in infant nutrition. J Nutr 58:345, 1958. Willett, WC: Diet, nutrition, and the prevention of cancer. In Shils, ME (ed): Modern Nutrition in Health and Disease, ed 9. Williams & Wilkins, Baltimore, 1999.
Chapter 4 American Dietetic Association: Exchange lists for Diabetes American Dietetic Association, Chicago, 2008. American Dietetic Association: Food nutrient data for choose your foods: exchange lists for diabetes, 2007. Accessed December 6, 2012. Available at www.eatright. org/search.aspx?search=Exchange%20lists Amit, M: Vegetarian diets in children and adolescents. Paediatr Child Health 15:303, 2010. Atherton, PJ, Etheridge, T, Watt, PW, et al: Muscle full effect after oral protein: time-dependent concordance and discordance between human muscle protein synthesis and mTORC1 signaling. Am J Clin Nutr 92:1080, 2010. Benson, JM, and Therrell, BL, Jr: History and current status of newborn screening for hemoglobinopathies. Semin Perinatol 34:134, 2010. Benton, MJ, Whyte, MD, and Dyal, BW: Sarcopenic obesity: strategies for management. Am J Nurs 111: 38, 2011. Blau, N, van Spronsen, FJ, and Levy, HL: Phenylketonuria. Lancet. 376:1417, 2010.
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Hanley, WB: Finding the fertile woman with phenylketonuria. Eur J Obstet Gynecol Reprod Biol 137:131, 2008. Harmon, KG, Drezner, JA, Klossner, D, and Asif, IM: Sickle cell trait associated with a RR, of death of 37 times in National Collegiate Athletic Association football athletes: a database with 2 million athlete-years as the denominator. Br J Sports Med 46:325, 2012. Hughes, GJ, Ryan, DJ, Mukherjea, R, and Schasteen, CS: Protein digestibility-corrected amino acid scores (PDCAAS) for soy protein isolates and concentrate: criteria for evaluation. J Agric Food Chem 59:12707, 2011. Katayama, M, and Wilson, LA: Utilization of soybeans and their components through the development of textured soy protein foods. J Food Sci 73:S158, 2008. Katz, KA, Mahlberg, MJ, Honig, PJ, and Yan, AC: Rice nightmare: kwashiorkor in two Philadelphia-area infants fed Rice Dream beverage. J Am Acad Dermatol 52:S69, 2005. Koch, R: Maternal phenylketonuria and tetrahydrobiopterin. Pediatrics 122:1367, 2008. Koch, R, Moseley, K, and Guttler, F: Tetrahydrobiopterin and maternal PK,U. Mol Genet Metab 86:S139, 2005. Matthews, DE: Proteins and amino acids. In Ross, AC, Caballero, B, Cousins, RJ, et al (eds): Modern Nutrition in Health and Disease, ed 11. Lippincott Williams & Wilkins, Philadelphia, 2014. Mazariegos, GV, Morton, DH, Sindhi, R, et al: Liver transplantation for classical maple syrup urine disease: long-term follow-up in 37 patients and comparative United Network for Organ Sharing experience. J Pediatr 160:116, 2012. Mitchell, JJ, Trakadis, YJ, and Scriver, CR: Phenylalanine hydroxylase deficiency. Genet Med 13:697, 2011. Morley, JE: Protein-energy undernutrition. Merck Manual, October 2012. Accessed November 27, 2012. Available at www.merckmanuals.com/professional/nutritional_ disorders/undernutrition/protein-energy_undernutrition. html?qt=ketones for energy&alt=sh National Collegiate Athletic Association: Background on sickle cell trait and the NCAA. September 9, 2010. Accessed November 18, 2012. Available at www.ncaa.org/ wps/wcm/connect/public/NCAA/Resources/Latest+News/ 2010+news+stories/September+latest+news/Background+ on+sickle+cell+trait+and+the+NCAA National Heart, Lung, and Blood Institute: Food exchange lists. June 28, 2013. Accessed June 28, 2013. Available at www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/ fd_exch.htm Ngudi, DD, Kuo, YH, Van Montagu, M, and Lambein, F: Research on motor neuron diseases konzo and neurolathyrism: trends from 1990 to 2010. PLoS Negl Trop Dis 2012;6:e1759, 2012. Nzwalo, H, and Cliff, J: Konzo: from poverty, cassava, and cyanogen intake to toxico-nutritional neurological disease. PLoS Negl Trop Dis 5:e 1051, 2011. Accessed November 13, 2012. Available at www.ncbi.nlm.nih. gov/pmc/articles/PMC3125150 Olowoyeye, A, and Okwundu, CI: Gene therapy for sickle cell disease. Cochrane Database Syst Rev. 2010 Aug 4:CD007652.
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Pasiakos, SM, and McClung, JP: Supplemental dietary leucine and the skeletal muscle anabolic response to essential amino acids. Nutr Rev 69:550, 2011. Piercecchi-Marti, MD, Louis-Borrione, C, Bartoli, C, et al: Malnutrition, a rare form of child abuse: Diagnostic criteria. J Forensic Sci 51:670, 2006. Prick, BW, Hop, WC, and Duvekot, JJ: Maternal phenylketonuria and hyperphenylalaninemia in pregnancy: pregnancy complications and neonatal sequelae in untreated and treated pregnancies. Am J Clin Nutr 95:374, 2012. Ramirez-Zea, M, and Caballero, B: Protein-energy malnutrition. In Ross, AC, Caballero, B, Cousins, RJ, et al (eds): Modern Nutrition in Health and Disease, ed 11. Lippincott Williams & Wilkins, Philadelphia, 2014. Rice, A: The peanut solution. New York Times, September 2, 2010. Accessed November 30, 2012 at www.nytimes.com/2010/09/05/magazine/05Plumpy-t. html?pagewanted=all Seyler, J, and Layman, DK: The role of protein in overall health: quality, quantity, and timing considerations. Scan’s Pulse (Continuing Education approved by Academy of Nutrition and Dietetics) 31:3, 2012. Tierney, EP, Sage, RJ, and Shwayder, T: Kwashiorkor from a severe dietary restriction in an 8-month infant in suburban Detroit, Michigan: case report and review of the literature. Int J Dermatol 49:500, 2010. Tipton, KD: Efficacy and consequences of very-highprotein diets for athletes and exercisers. Proc Nutr Soc 70:205, 2011. Trefz, FK, and Belanger-Quintana, A: Sapropterin dihydrochloride: a new drug and a new concept in the management of phenylketonuria. Drugs Today (Barc) 46:589, 2010. U.S. Department of Agriculture: Peas and beans are unique foods, June 22, 2011. Accessed February 18, 2013. Available at www.choosemyplate.gov/food-groups/ dry_beans_peas_table.html U.S. Department of Agriculture: What counts as an ounce equivalent in the protein foods group? June 4, 2011. Accessed February 18, 2013. Available at www.choosemyplate.gov/food-groups/proteinfoods_ counts_table.html van Loon, LJ: Leucine as a pharmaconutrient in health and disease. Curr Opin Clin Nutr Metab Care 15:71, 2012. Van Winckel M, Vande Velde, S, De Bruyne, R, and Van Biervliet, S: Clinical practice: vegetarian infant and child nutrition. Eur J Pediatr 170:1489, 2011. Venes, D (ed): Tabor’s Cyclopedic Medical Dictionary, ed 21. FA Davis, Philadelphia, 2009. Vernon, HJ, Koerner, CB, Johnson, MR, et al: Introduction of sapropterin dihydrochloride as standard of care in patients with phenylketonuria. Mol Genet Metab 100:229, 2010. Wells, J: Can Plumpy’nut solve global hunger? Accessed December 1, 2012. Available at www.cnbc.com/id/ 48894202/Can_Plumpy_Nut_Solve_Global_Hunger Widaman, KF: Phenylketonuria in children and mothers: genes, environments, behavior. Curr Dir Psychol Sci 18:48, 2009.
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Chapter 5 Centers for Disease Control and Prevention: How much physical activity do adults need? 2011. Accessed December 29, 2012 at www.cdc.gov/physicalactivity/ everyone/guidelines/adults.html Centers for Disease Control and Prevention: Low-energydense foods and weight management: cutting calories while controlling hunger. Reasearch to Practice Series, No. 5. Accessed December 20, 2012 at www.cdc.gov/ nccdphp/dnpa/nutrition/pdf/r2p_energy_density.pdf Dalee-Grave, R, Calugi, S, Centis, E, El Ghoch, M, & Marchesini, G: Cognitive-behavioral strategies to increase the adherence to exercise in the management of obesity. J Obes 2011. Accessed February 20, 2014. Available at http://www.hindawi.com/journals/ jobe/2011/348293 Jamurtas, AZ, Tofas, T, Fatouros, I, et al: The effects of low and high glycemic index foods on exercise performance and beta-endorphin responses. J Int Soc Sports Nutr 8:15, 2011. Kreymann, G, Adolph, M, and Mueller, MJ: Energy expenditure and energy intake—Guidelines on Parenteral Nutrition, Chapter 3. German Med Sci (e-journal) 7:Doc25, 2013. Accessed February 20, 2014. Available at www.egms.de/static/en/journals/ gms/2009-7/000084.shtml O’Riordan, CF, Metcalf, BS, Perkins, JM, and Wilkin, TJ: Reliability of energy expenditure prediction equations in the weight management clinic. J Hum Nutr Dietetics 23:169, 2010. Scott, CB: Glucose and fat oxidation: bomb calorimeter be damned. Scientific World Journal 2012:375041, 2012. Shrapnel, B: Is energy density a useful concept for understanding and preventing obesity? Nutr Dietetics 67:281, 2010. Sum, S, Mayer, L, and Warren, MP: Bone mineral density accrual determines energy expenditure with refeeding in anorexia nervosa and supersedes return of menses. J Osteoporosis 7, 2011. U.S. Department of Agriculture and U.S. Department of Health and Human Services: Dietary Guidelines for Americans 2010, ed 7. Washington, DC: U.S. Government Printing Office, December 2010. U.S. Department of Agriculture, Agricultural Research Service: Energy intakes: percentage of energy from protein, carbohydrate, fat, and alcohol, by gender and age. What we eat in America, NHANES 2009–2010, 2012. Retrieved on December 21, 2012 at www.ars. usda.gov/ba/bhnrc/fsrg Walpole, SC, Prieto-Merino, D, Edwards, P, Cleland, G, Stevens, G, and Roberts, I: The weight of nations: an estimation of adult human biomass. BMC Public Health 12:439, 2012. World Health Organization: Obesity and overweight, 2013. Accessed June 9, 2013. Available at www.who.int/ mediacentre/factsheets/fs311/en/
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Chapter 8 Almond, CS, Shin, AY, Fortescue, EB, et al: Hyponatremia among runners in the Boston Marathon. N Engl J Med 352:1550, 2005. Anderko, L, Chalupka, S, Gray, WA, and Kesten, K: Greening the “proclamation for change”: healing through sustainable health care environments. Am J Nurs 113:52, 2013. Bailey, JL, Sands, JM, and Franch, HA: Water, electrolytes, and acid-base metabolism. In Ross, AC, Caballero, B, Cousins, RJ, et al (eds): Modern Nutrition in Health and Disease, ed 11. Lippincott Williams & Wilkins, Philadelphia, 2014. Becker, JA, and Stewart, LK: Heat-related illness. Am Fam Physician 83:1325, 2011. Accessed July 21, 2013. Available at www.aafp.org/afp/2011/0601/p1325.html Centers for Disease Control and Prevention: Heat illness among high school athletes—United States, 2005–2009. Morb Mortal Wkly Rep 59:1009, August 20, 2010. Accessed October 31, 2012. Available at www.cdc. gov/mmwr/preview/mmwrhtml/mm5932a1.htm?s_ cid=mm5932a1_w Centers for Disease Control and Prevention: Heat-related deaths after an extreme heat event — four states, 2012, and United States, 1999–2009. Morb Mortal Wkly Rep 62:433, June 7, 2013. Accessed July 21, 2013. Available at www.cdc.gov/mmwr/preview/mmwrhtml/mm6222a1. htm?s_cid=mm6222a1_w Centers for Disease Control and Prevention: Heat stress. Updated May 18, 2012. Accessed October 22, 2012. Available at www.cdc.gov/niosh/topics/heatstress Centers for Disease Control and Prevention: Nonfatal sports and recreation heat illness treated in hospital emergency departments—United States, 2001–2009. Morb Mortal Wkly Rep 60:977, July 29, 2011. Accessed July 19, 2013. Available at www.cdc.gov/mmwr/preview/ mmwrhtml/mm6029a1.htm Chalupka, S: Tainted water on tap. Am J Nurs 105:40, 2005. Chepelinsky, AB: Structural function of MIP/aquaporin 0 in the eye lens; genetic defects lead to congenital inherited cataracts. Handb Exp Pharmacol 190:265, 2009. Consumer Reports. Bottled doesn’t mean better. September 2011: 7. Consumer Reports. Do you know where your bottled water comes from? July 2012: 9. Accessed October 28, 2012. Available at www.consumerreports.org/cro/magazine/ 2012/07/do-you-know-where-your-bottled-watercomes-from/index.htm Consumer Reports. Water filters. May, 2010: 33. Didier, S: Water bottle pollution facts. National Geographic Green Living, undated. Accessed October 18, 2012. Available at greenliving.nationalgeographic.com/ water-bottle-pollution-2947.html
Discover Chiropractic: Tap water vs. bottled water. March 4, 2012. Accessed October 20, 2012. Available at dcpdx.com/tap-water-vs-bottled-water Eckhard, A, Gleiser, C, Arnold, H, et al: Water channel proteins in the inner ear and their link to hearing impairment and deafness. Mol Aspects Med 33:612, 2012. Esposito, P, Piotti, G, Bianzina, S, et al: The syndrome of inappropriate antidiuresis: Pathophysiology, clinical management and new therapeutic options. Nephron Clin Pract 119:c62, 2011. Fishman, C: U.S. bottled water sales are booming (again) despite opposition. National Geographic Newswatch, May 17, 2012. Accessed October 18, 2012. Available at http://newswatch.nationalgeographic.com/2012/05/17/ u-s-bottled-water-sales-are-booming-again-despiteopposition Fournier, M: Perfecting your acid-base balancing act. Am Nurse Today 4:17, 2009. Frouget, T: The syndrome of inappropriate antidiuresis. Rev Med Interne. 33:556, 2012. Gardner, JW: Death by water intoxication. Mil Med 167:432, 2002. Giorgianni, A: Bottled water: $346 per year. Tap water: 48 cents. Any questions? Consumer Reports, July 12, 2011. Accessed October 28, 2012. Available at http://news. consumerreports.org/money/2011/07/a-dollar-for-abottle-of-water-what-would-martians-think.html Gorelick, MH, Gould, L, Nimmer, M, et al: Perceptions about water and increased use of bottled water in minority children. Arch Pediatr Adolesc Med 165:928, 2011. Gropper, SS, and Smith, JL: Advanced Nutrition and Human Metabolism, ed 6. Wadsworth, Belmont, CA, 2013. Hobson, WL, Knochel, ML, Byington, CL, et al: Bottled, filtered, and tap water use in Latino and non-Latino children. Arch Pediatr Adolesc Med 161:457, 2007. Holmes, RP: The role of renal water channels in health and disease. Mol Aspects Med 33:547, 2012. Huang, LH, Anchala, KR, Ellsburg, DL, and George, CS: Dehydration treatment and management. Medscape Reference. Updated March 12, 2012. Accessed December 23, 2012. Available at http://emedicine. medscape.com/article/906999-treatment Huerta-Saenz, L, Irigoyen, M, Benavides, J, and Mendoza, M: Tap or bottled water: Drinking preferences among urban minority children and adolescents. J Community Health 37:54, 2012. Institute of Medicine: Dietary Reference Intakes for Water, Potassium, Sodium Chloride, and Sulfate. National Academy Press, Washington, DC, 2004. Accessed October 13, 2012 at www.nap.edu/openbook.php? record_id=10925&page=74 Ishibashi, K, Hara, S, and Kondo, S: Aquaporin water channels in mammals. Clin Exp Nephrol 13:107, 2009. Ishibashi, K, Kondo, S, Hara, S, and Morishita, Y: The evolutionary aspects of aquaporin family. Am J Physiol Regul Integr Comp Physiol 300:R566, 2011. Kerr, ZY, Casa, DJ, Marshall, SW, and Comstock, RD: Epidemiology of exertional heat illness among U.S. high school athletes. Am J Prev Med 44:8, 2013.
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APPENDIX E ■ BIBLIOGRAPHY Knochel, JP: Heatstroke. Merck Manual. February 2010. Accessed October 22, 2012. Available at www. merckmanuals.com/professional/injuries_poisoning/ heat_illness/heatstroke.html Laforenza, U: Water channel proteins in the gastrointestinal tract. Mol Aspects Med 33:642/2012. Lechtzin, N: Hyperventilation syndrome. Merck Manual. Updated July 2012. Accessed July 25, 2013. Available at www.merckmanuals.com/professional/pulmonary_ disorders/symptoms_of_pulmonary_disorders/ hyperventilation_syndrome.html?qt=hyperventilation& alt=sh Leiba, N, Gray, S, and Houlihan, J: EWG bottled water scorecard. 2011. Accessed October 17, 2012. Available at www.ewg.org/bottled-water-2011-summary-findings Muckelbauer, R, Libuda, L, Clausen, K, et al: Promotion and provision of drinking water in schools for overweight prevention: randomized, controlled cluster trial. Pediatrics 123:e661, 2009. Accessed October 25, 2012. Available at pediatrics.aappublications.org/content/ 123/4/e661.long Mueller, FO, and Colgate, B: Annual Survey of Football Injury Research. American Football Coaches Association, Waco, TX, 2010. Accessed October 31, 2012 at www.unc.edu/depts/nccsi/2009AnnualFootball.pdf Natural Resources Defense Council: Bottled water: Pure drink or pure hype? Executive summary. Revised June 25, 2000. Accessed October 17, 2012 at www. nrdc.org/water/drinking/bw/exesum.asp Natural Resources Defense Council: Bottled water. Revised April 25, 2008. Accessed October 18, 2012. Available at www.nrdc.org/water/drinking/qbw.asp O’Brien, KK, Montain, SJ, Corr, WP, et al: Hyponatremia associated with overhydration in U.S. Army trainees. Mil Med 166:405, 2001. Overgaard-Steensen, C. Initial approach to the hyponatremic patient. Acta Anaesthesiol Scand 55:139, 2011. Pease, S, Bouadma, L, Kermarrec, N, et al: Early organ dysfunction course, cooling time and outcome in classic heatstroke. Intensive Care Med 35:1454, 2009. Peate, WF: Hyponatremia in marathon runners [letter]. N Engl J Med 353:427, 2005. Popkin, BM, D’Anci, KE, and Rosenberg, IH: Water, hydration, and health. Nutr Rev 68:439, 2010. Scanlon, VC, and Sanders, T: Essentials of anatomy and physiology, ed 6. FA Davis, Philadelphia, 2011. Sharfstein, JM: Testimony before Committee on Energy and Commerce, U.S. House of Representatives, July 8, 2009. Revised April 19, 2011. Accessed October 18, 2012. Available at www.hhs.gov/asl/testify/2009/ 07/t20090708a.html Sterns, RH, Hix, JK, and Silver, S: Treatment of hyponatremia. Curr Opin Nephrol Hypertens 19:493, 2010. Strauch, KA: Invisible pollution: The impact of pharmaceuticals in the water supply. AAOHN J 59:525, 2011. U.S. Environmental Protection Agency: Arsenic in drinking water. March 6, 2012. Accessed September 25, 2012. Available at http://water.epa.gov/lawsregs/rulesregs/ sdwa/arsenic/index.cfm
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U.S. Food and Drug Administration: Disposal of unused medicines: What you should know. Updated July 15, 2013. Accessed July 31, 2013. Available at www.fda. gov/Drugs/ResourcesForYou/Consumers/Buying UsingMedicineSafely/EnsuringSafeUseofMedicine/Safe DisposalofMedicines/ucm186187.htm Vaidya, C, Ho, W, and Freda, BJ: Management of hyponatremia: Providing treatment and avoiding harm. Cleve Clin J Med 77:715, 2010. Vantyghem, MC, Balavoine, AS, Wémeau, JL, and Douillard, C: Hyponatremia and antidiuresis syndrome. Ann Endocrinol (Paris) 72:500, 2011. Venes, D (ed): Taber’s Cyclopedic Medical Dictionary, ed 21. FA Davis, Philadelphia, 2009. Venes, D (ed): Taber’s Cyclopedic Medical Dictionary, ed 22. FA Davis, Philadelphia, 2013. Verkman, AS: Aquaporins: translating bench research to human disease. J Exp Bio. 212:1701, 2009. Williams, LS, and Hopper, PD: Understanding Medical Surgical Nursing, ed 4. FA Davis, Philadelphia, 2011. Xu, M, Su, W, Xu, QP: Aquaporin-4 and traumatic brain edema. Chin J Traumatol 13:103, 2010. Yool, AJ, Brown, EA, and Flynn, GA: Roles for novel pharmacological blockers of aquaporins in the treatment of brain oedema and cancer. Clin Exp Pharmacol Physiol 37:403, 2010. Zelenina, M: Regulation of brain aquaporins. Neurochem Int 57:468, 2010.
Chapter 9 Academy of Nutrition and Dietetics: Celiac Disease (CD) Evidence-Based Nutrition Practice Guideline, Accessed April 2013. Available at http:.//andevidencelibrary.com. Castrogiovanni, A: Communication facts: Special populations: Dysphagia—2008 edition. Accessed April 2013. Available at http://www.asha.org/research/reports/ dysphagia/ Colaizzo-Anas, T: Nutrient intake, digestion, absorption, and excretion. In Gottschlich, MM, DeLegge, MH, Mattox, T, et al (eds): The A.S.P.E.N. Nutrition Support Core Curriculum: A Case-Based Approach—The Adult Patient. American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, 2007. McCallum, SL: The National Dysphagia Diet: Implementation at a regional rehabilitation center and hospital system. J Am Diet Assoc 103:285, 2003. National Institutes of Health: Celiac Disease Awareness Campaign, December 18, 2012a. Available at www. celiac.nih.gov National Institutes of Health, National Digestive Diseases Information Clearinghouse: Celiac disease (NIH Pub. No. 08-4269). January 27, 2012b. National Institutes of Health: Dysphagia (NIH Pub. No. 10-4307). October 2010. Ojetti, V, Gabrielli, M, Migneco, A, Lauritano, C, et al: Regression of lactose malabsorption in coeliac patients after receiving a gluten-free diet. Scand J Gastroenterol 4:5, 2007. Scanlon, VC, and Sanders, T: Essentials of Anatomy and Physiology, ed 4. FA Davis, Philadelphia, 2003.
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Chapter 10 Adoptive Breastfeeding Resource Website. Accessed December 15, 2012 at www.fourfriends.com/abrw Agarwal, M, and Phadke, S: Neural tube defects: A need for population-based prevention program. Ind J Hum Genet 18.2:145, 2011. Allerberger, F, and Wagner, M: Listeriosis: A resurgent foodborne infection. Clin Microbiol Infect 16:16, 2010. Amar, C., Little, C., Gillespie, L., et al: Keep it cool. Midwives. 13(3):29, 2010. American Academy of Pediatric Dentistry: Policy on use of fluoride. Revised 2012. Available at www.aapd.org/ media/Policies_Guidelines/P_FluorideUse.pdf American Academy of Pediatrics: AAP reaffirms breastfeeding guidelines. February 27, 2012. Accessed October 23, 2012 at www.aap.org/en-us/about-the-app/aap-pressroom/pages/AAPArora, M: Maternal dietary intake of polyunsaturated fatty acids modifies the relationship between lead levels in bone and breast milk. J Nutr 138:73, 2008. Au, KS, Ashley-Koch, A, and Northrup, H: Epidemiologic and genetic aspects of spina bifida and other neural tube defects. Dev Disabil Res Rev 16:6, 2010. Bakhireva, LN, and Savage, DD: Focus on: biomarkers of fetal alcohol exposure and fetal alcohol effects. Alcohol Res Health 29, Spring 2011. Blumenfeld, XJ, Reynolds-May, MF, Altman, RB, and El-Sayed, YY: Maternal-fetal and neonatal pharmacogenomics: a review of current literature. J Perinatol 30:571, 2010. Bowen, A, and Tumback, L: Alcohol and breastfeeding: Dispelling the myths and promoting the evidence. Nurs Women Health 14:456, 2010–2011. Casey, G: Breastfeeding and drugs. Kai Taki Nurs N Z 18:20, 2012. Centers for Disease Control and Prevention: Adolescent and school health. Accessed June 17, 2013. Available at www.cdc.gov/healthyyouth/nutrition/facts.htm Centers for Disease Control and Prevention: Breastfeeding report card—United States, 2012. Accessed November 1, 2012. Available at www.cdc.gov/breastfeeding/data/ reportcard.htm Centers for Disease Control and Prevention: Alcohol use and binge drinking among women of childbearing age—United States, 2006–2010. Morb Mortal Wkly Rep 61(28), July 20, 2012. Centers for Disease Control and Prevention: Fetal alcohol spectrum disorders (FASDs). Accessed December 1, 2012. Available at www.cdc.gov/NCBDDD/fasd/ alcohol-use.html Centers for Disease Control and Prevention Grand Rounds: Additional opportunities to prevent neural tube defects with folic acid fortification. Morb Mortal Wkly Rep 59(31), 980, August 13, 2010. Centers for Disease Control and Prevention: Listeria outbreaks. Accessed November 18, 2012. Available at www.cdc.gov/listeria/outbreaks/index.html Centers for Disease Control and Prevention: Manifestations of low vitamin B12 levels. Accessed October 31, 2012. Available at www.cdc.gov/ncbddd/b12/manifestations.html
Cheung, NW: The management of gestational diabetes. Vasc Health Risk Manage 2009:5: 153, 2009. Cho, GJ, Shin, J, Yi, KW, et al: Adolescent pregnancy is associated with osteoporosis in postmenopausal women. Menopause 19:456, 2012. Cooper, MD: Pica. Access. 24(5):39–41, 2010. Davanzo, R, Copertino, M, De Cunto, A, et al: Antidepressant drugs and breastfeeding: A review of the literature. Breastfeed Med 6:89, 2011. Dibaba, Y: Child spacing and fertility planning behavior among women in mana district, Jimma Zon, South West Ethiopia. Ethiop J Health Sci 20:83, 2010. Dror, DK, and Allen, LH: Effects of Vitamin B12 deficiency on neurodevelopment in infants: Current knowledge and possible mechanisms. Nutr Rev 66:250, 2008. Dror, DK, and Allen, LH: Vitamin D inadequacy in pregnancy: Biology, outcomes, and interventions. Nutr Rev 68:465, 2010. Ettinger, AS, Lamadrid-Figueroa, H, Tellez-Rojo, MM, et al: Effect of calcium supplementation on blood lead levels in pregnancy: A randomized placebo-controlled trial. Environ Health Perspect 117:26, 2009. Faraz, A. Clinical recommendations for promoting breastfeeding among Hispanics. J Am Acad Nurse Practit 22:292, 2010. Fehr, KRS, Fehr, KDH, and Penner Protudjer, JL: Knowledge and use of folic acid in women of reproductive age. Can J Dietetic Pract Res 72:197, 2010. Galloway, R, and McGuire, J: Daily versus weekly: How many iron pills do pregnant women need? Nutr Rev 54:318, 1996. Garad, R, McNamee, K, Bateson, D, and Harvey, C: Update on contraception. Aust Nurs 20:34, 2012. Gautam, CS, Saha, L, Kavita, S, and Saha, PK. Iron deficiency in pregnancy and the rationality of iron supplements prescribed during pregnancy. Med J Med 10:283, 2008. Accessed October 31, 2012. Available at www.ncbi.nlm.nih.gov/pmc/articles/PMC2644004/ ?report=printatble Giovannini, M, Verduci, E, Salvatici, E, et al: Phenylketonuria: Nutritional advances and challenges. Nutr Metab 9:7, 2012. Groth, SW, and Kearney, MH: Diverse women’s beliefs about weight gain in pregnancy. J Midwifery Women’s Health 54:452, 2009. Guez, S, Chiarelli, G, Menni, F, et al: Severe vitamin B12 deficiency in an exclusively breastfed 5-month-old Italian infant born to a mother receiving multivitamin supplementation during pregnancy. BMC Pediatr 12:85, 2012. Hacker, AN, Fung, EB, and King, JC: Role of calcium during pregnancy: Maternal and fetal needs. Nutr Rev 70:397, 2012. Institute of Medicine: Weight gain during pregnancy; Reexamining the guidelines. Accessed November 1, 2013. Available at iom.edu/Reports/2009/WeightGain-During-Pregnancy-Reexamining-theGuidelines.aspx Janevic, T, Stein, CR, Savitz, DA, et al: Neighborhood deprivation and adverse birth outcomes among diverse ethnic groups. Ann Epidemiol 20:445, 2010.
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APPENDIX E ■ BIBLIOGRAPHY Jordan, SJ, Siskind, V, Green, AC et al: Breastfeeding and risk of epithelial ovarian cancer. Cancer Causes Control 21:109, 2010. Jones, W, and Breward, S: Drugs and breastfeeding. Commun Pract 83:41, 2010. Karagus, MR, Choi, AI, Oken, E, et al: Evidence on the human health effects of low-level methylmercury exposure. Environ Health Perspect 120:799, 2012. Kim, J, Zhao, K, Jiang, P, et al: Transcriptome landscape of the human placent. BMC Genomics 13:115, 2012. Kotsopoulous, J, Lubinski J, Salmena L, et al: Breastfeeding and the risk of breast cancer in BR,CA1 and BR,CA2 mutation carriers. Breast Cancer Res 14:R42, 2012. Latva-Pukkila, U, Isolauri, E, and Laitinen, K: Dietary and clinical impacts of nausea and vomiting during pregnancy. J Hum Nutr Diet, 23:69, 2009. Leung, AM, Pearce, EN, and Braverman, LE: Iodine nutrition in pregnancy and lactation. Endocrinol Metab Clin North Am 40:765, 2011. Livville, T, Ritchie, S, Novak, D: Vomiting, Failure to thrive in a breastfed infant. Contemp Pediatr 29:32, 2012. Madadi, P, Moretti, M, Djokanovic, N, et al: Guidelines for maternal codeine use during breastfeeding. Can Fam Physician 55:1077, 2009. Magee, LA, Abalos, E, von Dadelszen, P, et al: How to manage hypertension in pregnancy effectively. Br J Clin Pharmacol 72:394, 2011. Mahadevan, S, Kumaravel, V, and Bharath, R: Calcium and bone disorders in pregnancy. Ind J Endocrinol Metab: 16:356, 2012. Mahffey, DR, Sunderland, EM, Chan, HM, et al: Balancing the benefits of n-3 ployunstaurated fatty acids and the risks of methylmercury exposure from fish consumption. Nutr Rev 69:493, 2011. Malvasi, A, Tinelli, A, Buia, A, and De Luca, GF: Possible long-term teratogenic effects of isotretinoin in pregnancy. Eur Rev Med Pharmocol Sci 13:393, 2009. Maslova, E, Bhattacharya, S, Lin, SW, and Michels, KB: Caffeine consumption during pregnancy and risk of preterm birth: A meta-analysis. Am J Clin Nutr 92:1120, 2010. Mayo Clinic: Pregnancy week by week. 2012. Accessed December 11, 2012. Available at www.mayoclinic. com/health/pregnancy-weight-gain/PR00111/ NSECTIONGROUP=2 McArdle, HJ, Lang, C, Hayes, H, and Gambling, L: Role of the placenta in regulation of fetal iron status. Nutr Rev 69(Suppl 1):S17, 2011. Milman, N: Oral iron prophylaxis in pregnancy: Not too little and not too much. J Pregnancy 2012:514345, 2012. Mulu, A, Kassu, A, Huruy, K, et al: Vitamin A deficiency during pregnancy of HIV infected and non-infected women in tropical settings of Northwest Ethiopia. BMC Public Health 11:569, 2011. Mustafa, R, Ahmed, S, Gupta, A, and Venuto, RC: A comprehensive review of hypertension in pregnancy. J Pregnancy 2012:105918, 2012. National Center on Birth Defects and Developmental Disabilities: Annual report: Folic acid: Reducing folic acidpreventable neural tube defects. Accessed October 12, 2012. Available at http://www.cdc.gov/ncbddd/aboutus/
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annualreport2012/documents/ncbdddannualrepor2012full-report.pdf Nayeri, UA: Hyperemesis in pregnancy: Taking a tiered approach. July 2012. Accessed February 20, 2014. Available at http://digital.healthcaregroup.advanstar. com/nxtbooks/advanstar/obgyn_201207/index.php? startid=22 Pangillnan, F, Molloy, AM, Mills, JL, et al: Evaluation of common genetic variants in 82 candidate genes as risk factors for neural tube defects. BMC Med Genet 13:62, 2012. Phelan, S, Phipps, MG, Abrams, B, et al: Practitioner advice and gestational weight gain. J Women Health (Larchmt) 20:585, 2011. Phillips, F: Healthy eating in pregnancy. Pract Nurse 42(1):24–28, 2012. Picciano, MF, and McGuire, MK: Use of dietary supplements by pregnant and lactating women in North America. Am J Clin Nutr 89(Suppl):663S, 2009. Pinto, S, and Schub, T: Fetal alcohol syndrome. Cinahl Information Systems, June 2012. Purnell, LD: Transcultural Health Care: A Culturally Competent Appoach, ed 4. FA Davis, Philadelphia, 2013. Rahbari, AH, Keshavarz, H, Shojaee, S, et al: IgG avidity EL,ISA test for diagnosis of acute toxoplasmosis in humans. Korean J Parasitol 50:99, 2012. Ramirez de Arellano, AB: The primacy of prevention: folic acid fortification. P R Health Sci J 29:121, 2012. Rice, GE, Illanes, SE, and Mitchell, MD: Gestational diabetes mellitus: A positive predictor of type 2 diabetes? Int J Endocrinol 2012;721653, 2012. Rioux, FM, Belanger-Plourde, J, LeBlanc, CP, and Vigneau, F: Relationship between maternal DH,A and iron status and infants’ cognitive performance. Can J Dietetic Pract Res 72, Summer 2011. Rofail, D, Collins, A, Abetz, L: Factors contributing to the success of folic acid public health campaigns. J. Public Health (Oxf) 34:90, 2012. Safi, J, Joyeux, L, and Chlauhi, GE: Periconceptional folate deficiency and implications in neural tube defects. J Pregnancy 2012:295083, 2012. San Joaquin, MA, Molyneux, ME: Malaria and vitamin A deficiency in African children: A vicious circle? Malaria J 8:134, 2009. Schwartz, J, Drossard, C, Dube, K, et al: Dietary intake and plasma concentrations of PU,FA and LC,-PUFA in breastfed and formula fed infants under real-life conditions. Eur J Nutr 49:189, 2010. Scholl, TO: Maternal iron status: Relation to fetal growth, length of gestation and the neonate’s iron endowment. Nutr Rev 69(Suppl 1):S23, 2011. Shennan, AH, and Vousden, N: Commentary: nonpharmacological approaches to hypertension in pregnancy need further evaluation. Birth 37: 307, 2010. Simpson, JL, Shulman, LP, Brown, H, and Holzgreve, W: Closing the folate gap in reproductive aged women. Contemporary OB,/GYN 55:34, 2010. Smith, MAE, and MacLaurin, TL: Who is telling pregnant women about listeriosis? Can J Public Health 102:441, 2011.
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Stillwaggon, E, Carrier, CS, Sautter, M, and McLeod, R: Maternal serologic screening to prevent congenital toxoplasmosis: A decision-analytic economic model. PLoS Negl Trop Dis. 5:e1333, 2011. Summers, A: Emergency management of hyperemesis gravidarum. Emerg Nurse 20:24, 2012. The Academy of Breastfeeding Medicine Protocol Committee: ABM Clinical Protocol #21: Guidelines for breastfeeding and the drug-dependent women. Breastfeed Med 4: 225, 2009. Trottier, M, Erebara, A, and Bozzo, P: Treating constipation during pregnancy. Can Fam Physician 58:836, 2012. Ural, SH: Prenatal nutrition. 2001. Accessed July 9, 2012. Available at Medscape, http://emedicine.medscape. com/article/259059-overview U.S. Department of Agriculture: ChooseMyPlate.gov. Accessed November 18, 2012. Available at www. choosemyplate.gov/pregnancy-breastfeeding.html U.S. Department of Agriculture: The special supplemental nutrition program for women, infants and children, August 2011. Accessed November 18, 2012. Available at www.fns.usda.gov/wic U.S. Department of Agriculture and U.S. Department of Health and Human Services: Dietary Guidelines for Americans 2010. ed 7. U.S. Government Printing Office, Washington, DC, December 2010. Uzan, J, Carbonnel, M, Piconne, O, et al: Pre-eclampsia: Pathophysiology, diagnosis, and management. Vasc Health Risk Manage 11:467, 2011. Wagner, CL, Taylor, SN, Dawodu, A, et al: Vitamin D and its role during pregnancy in attaining optimal health of mother and fetus. Nutrients 4:208, 2012. Weddig, J, Baker, SS, and Auld, G: Perspectives of hospitalbased nurses on breastfeeding initiation best practices. J Obstetr Gynecol Neonatal Nurs 40:166, 2011. Wegrzyniak, LJ, Repke, JT, and Ural, SH: Treatment of hyperemesis gravidarum. Rev Obstetr Gynecol 5:78, 2012. World Health Organization: Baby friendly hospital initiative. Accessed November 18, 2012. Available at www.who.int/nutrition/topics/bfhi/en/index.html Young, G: Leg cramps. Clin Evidence. 3:1113, 2009. Zera, C, McGirr, S, Oken, E: Screening for obesity in reproductive-aged women. Prev Chronic Sid. 8:A125, 2011. Accessed November 15, 2012. Available at www.cdc.gov/ped/issues/2011/nov/11_0032
Chapter 11 Academy of Nutrition and Dietetics: Feeding vegetarian infants and toddlers (1995–2012). Accessed November 22, 2012. Available at www.eatright.org/Public/content.aspx? id=8060#.UNByM6ytKH8 Afrazi, A, Sodhi, CP, Richardson, W: New insight into the pathogenesis and treatment of necrotizing enterocolitis: toll-like receptors and beyond. Pediatr Res 69:183, 2011. Alexander, DD, Schmitt, DF, Tran, NL, et al: Partially hydrolyzed 100% whey protein infant formula and atopic dermatitis risk reduction: a systematic review of the literature. Nutr Rev 68:232, 2010.
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Gonoi, W, Abe, O, Yamasue, H, et al: Age-related changes in regional brain volume evaluated by atlas-based method. Neuroradiology 52:865, 2010. Gowda, C, Hadley, C, and Aiello, AE: The association between food insecurity and inflammation in the US, adult population. Am J Public Health 102:1579, 2012. Hafsteinsdottir, TB, Mosselman, M, Schoneveld, C, et al: Malnutrition in hospitalized neurological patients approximately doubles in 10 days of hospitalization. J Clin Nurs 19:639, 2012. Hanson, LC, Carey, TS, Caprio, AJ, et al: Improving decision-making for feeding options in advanced dementia: A randomized, controlled trial. J Am Geriatr Soc 59:2009, 2011. Hass, R, Maloney, S, Pausenberger, E, et al: Clinical decision making in exercise prescription for fall prevention. Phys Ther 92:666, 2012. Heisters, D., and Bains, J: Side effects of treatment for Parkinson’s disease. Nurs Residential Care 14:230, 2012. Hines, S, Wilson, J, McCrow, J, Dip, G, Abbey, J, and Sacre, S: Oral liquid nutritional supplements for people with dementia in residential aged care facilities. Int J Evid Based Healthc 8(4):248, 2010. Jennings, LA, Auerbach, AD, Maselli, J, et al: Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture. J Am Geriatr Soc 58:650, 2010. Johnson, R, and Taylor, C: Can playing pre-recorded music at mealtimes reduce the symptoms of agitation for people with dementia? Int J Ther and Rehabil 18(12):700, 2011. Kaiser, MJ, Bauer, JM, Ramsch, C, et al: Frequency of malnutrition in older adults: A multinational perspective using the mini nutritional assessment. J Am Geriatr Soc 58:1734, 2010. Kasper, CE: Skeletal muscle and genetics. Ann Rev Nurs Res 29:191, 2011. Kulminski, AM, Arbeev, KG, Kulminskaya, IV, et al: Body mass index and nine-year mortality in disabled and nondisabled older U.S. individuals. J Am Geriatr Soc 56:105, 2008. Losing your sense of smell? Harv Health Lett 38:5, 2012. Li, Z, and Heber, D: Sarcopenic obesity in the elderly and strategies for weight management. Nutr Rev 70:57, 2011. Nazarko, L: Diabetes, ageing and bladder function. Br J Healthc Assistants 4:352, 2010. National Institutes of Health and Office of Dietary Supplements: Dietary Fact Sheet: Calcium. March 19, 2013. Assessed May 1, 2013. Available at www.ods. od.nih.gov/factsheets/Calcium-QuickFacts National Institute on Aging: Exercise & physical activity: Your everyday guide from the National Institute on Aging. Accessed March 7, 2014. Available at www.nia.nih.gov/ health/publication/exercise-physical-activity-youreveryday-guide-national-institute-aging-0 Neelemaat, F, Lips, P, Bosmans, JE, Thijs, A, Seidell, JC, and van Bokhorst-de van der Schueren, MAE: Short-term oral nutritional intervention with protein and vitamin D decreases falls in malnourished older adults. J Amer Geriatr Soc 69(4):691, 2012.
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APPENDIX E ■ BIBLIOGRAPHY New Alzheimer’s guidelines define early stages of the disease. Harv Women Health Watch 1991:1, 2011. Pinheiro C, and Silva, M: Colour, vision and ergonomics. Work 41:5590, 2012. Posthauer, ME: Nutrition strategies for wound healing. J Legal Nurse Consult 23:15, 2012. Raghoonandan, P, Cobban, SJ, and Compton, SM: A scoping review of the use of fluoride varnish in elderly people living in long term care facilities. Can J Dent Hygiene 45:217, 2011. Ross, LJ, Mudge, AM, Yound, AM, and Banks, M: Everyone's problem but nobody’s job: Staff perceptions and explanations for poor nutritional intake in older medical patients. Nutr Diet 68:41, 2011. Shepherd, A: Practical care: Feeding and assisting residents to eat. Nurs Residential Care 13:487, 2011. Smell: Engaging emotions and memories. Can Nurs Home 19:4, 2008. Swann, JI: Osteoporosis: The fragile bone disease. Br J Healthc Assist 6:59, 2012. Tasi, AC, Chou, YT, and Chang, TL: Usefulness of the mini nutritional assessment in predicting the nutrional status of people with mental disorders in Taiwan. J Clin Nurs 20:341, 2011. Toles, M, Young, HM, and Ouslander, J: Improving care transitions in nursing homes. J Am Soc Aging 36:78, 2012–2013. Travers, SP, and Geran, LC: Bitter-responsive brainstem neurons: Characteristics and functions. Physiol Behav 97:592, 2009. Tun, PA, Williams, VA, Small, BJ, and Hafter, ER: The effects of aging on auditory processing and cognition. Am J Audiol 21:344, 2012. Turner, J. Your brain of food: A nutrient-rich diet can protect cognitive health. J Am Soc Aging 35:99, 2011. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, and National Center for Health Statistics: Health, United States, 2011. Accessed March 7, 2014. Available at www.cdc.gov/nchs/ data/hus/hus11.pdf#022 U.S. Census Bureau: Current population survey, annual social and economic supplement, 2011. Accessed April 4, 2013. Available at www.census.gov/population/ age/data/2011.html Verdijk, LB, Snijders, T, Beelen, M, et al: Characteristics of muscle fiber type are predictive of skeletal muscle mass and strength in elderly men. J Am Geriatr Soc 58:2069, 2010. Villarroel, P, Flores, S, Pizarro, F, et al: Effect of dietary protein on heme iron uptake by caco-2 cells. Eur J Nutr 50:637, 2011. Vitamins unlikely to revitalize the mind. Harv Ment Health Lett, February: 4, 2010. Ward, J: Sarcopenia and sarcopenic obesity: Is it time the health system accepted fitness of older people as a health responsibility? Australas J Ageing 30:61, 2011. Walker, R, Davidson, M, and Gray, W: Gender differences in 1-year survival rates after weight loss in people with idiopathic Parkinson’s disease. Int J Palliat Nurs 18:35, 2012.
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Chapter 13 Academy of Nutrition and Dietetics: Overview of oncology, side effect management, neutropenia. 2012. Accessed March 2013. Available at www.nutritioncaremanual.org Albrecht, JA, Nagy-Nero, D, and the American Dietetic Association: Position of the American Dietetic Association: Food and water safety. J Am Diet Assoc 109:1449, 2009. Centers for Disease Control and Prevention: Food safety. September 24, 2012. Accessed March 2013. Available at www.cdc.gov/foodsafety/facts Centers for Disease Control and Prevention: Estimates of foodborne illness in the United States. February 6, 2013a. Accessed March 2013. Available at www. cdc.gov/foodborneburden/index Centers for Disease Control and Prevention: Norovirus and working with food. March 21, 2013b. Accessed March 2013. Available at www.cdc.gov/norovirus/food-handlers Centers for Disease Control and Prevention: BSE (bovine spongiform encephalopathy, or mad cow disease). February 21, 2013c. Accessed March 2013. Available at www.cdc.gov/ncidod/dvrd/bse Dolan, L, Matulka, RA, and Burdock, GA: Naturally occurring food toxins. Toxins (Basel) 2:2289, 2010. Environmental Protection Agency: History of food irradiation. June 27, 2012a. Accessed March 2013. Available at www.epa.gov/radiation/sources/food Environmental Protection Agency: Labeling. June 27, 2012a. Accessed March 2013. Available at www.epa. gov/radiation/sources/food Food and Drug Administration: Food irradiation: What you need to know. May 9, 2012. Accessed March 2013. Available at www.fda.gov/Food/Resources For You Foodsafety.gov: Causes of food poisioning. Accessed March 22, 2013. Available at [0]www.foodsafety.gov/ poisoning/causes/index.html Fox, N, and Freifeld, AG: The Neutropenic Diet reviewed: Moving toward a safe food handling approach. Oncology (Williston Park) 26:572, 2012. Friedman, M, Fleming, LE, Fernandez, M, et al: Ciguatera fish poisoning: Treatment, prevention and management. Mar Drugs 6:456, 2008. Jubelirer, S: The benefit of the neutropenic diet: fact or fiction? Oncologist April 6, 2011. published online April 2011: 101634/theoncologist.2011.0001 National Institutes of Health: Aflatoxin. January 30, 2013. Accessed March 2013. Available at www.nlm.nih.gov Scharff, RL: Economic burden from health losses due to foodborne illness in the United States. J Food Prot 75:123, 2012. Trifilio, S, Helenowski I, Giel M, et al: Questioning the role of a neutropenic diet following hematopoetic stem cell transplantation. Biol Blood Marrow Transplant 18:1385, 2012. U.S. Department of Health and Human Services: Healthy people 2020. Food safety, 2012. Accessed March 22, 2013. Available at www.healthypeople.gov/2020 U.S. Department of Health and Human Services: Food safety for pregnant women, 2011. Accessed March 2013. Available at www.fda.gov/Food/ResorcesForYou/ Consumers/SelectedHealthTopics/ucm312704
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World Health Organization: Hepatitis E fact sheet. July 2012. Fact sheet N280. Accessed March 2013. Available at www.who.int/mediacenter/factsheets/fs280/en/
Chapter 14 Academy of Nutrition and Dietetics: Critical Illness Update Evidence-Based Nutrition Practice Guideline, 2012. Accessed August 2012. Available at http:// andevidencelibrary.com American Dietetic Association: International Dietetics and Nutrition Terminology (IDNT) Reference Manual, ed 1. American Dietetic Association, Chicago, 2008. American Dietetic Association: Manual of Clinical Dietetics, ed 6. American Dietetic Association, Chicago, 2000. A.S.P.E.N.: Clinical guidelines, nutrition screening, assessment, and intervention in adults. A.S.P.E.N., Silver Spring, MD, 2011. A.S.P.E.N.: Definition of terms, style, and conventions used in A.S.P.E.N. Board of Directors-approved documents, Silver Spring, MD, May 2012. A.S.P.E.N.: Position paper: Parenteral nutrition glutamine supplementation, A.S.P.E.N., Silver Spring, MD, 2011. A.S.P.E.N.: Tube feeding misconnections: Fatal medical mistakes. Press release April 15, 2008. American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, 2008. Bankhead R, Boullata J, Brantley S, et al: Enteral nutrition practice recommendations. JPEN J Parenter Enteral Nutr 33:122, 2009. Barker, L, Gout, BS, and Crowe, TC: Hospital malnutrition: Prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health 8:514, 2011. Blouch, AC, and Mueller, C: Enteral and parenteral nutrition support. In Food, Nutrition and Diet Therapy. Elsevier, Philadelphia, 2004. Buff, D: Against the flow: Tube feeding and survival in patients with dementia. AAHPM Bull 7:1, Spring 2006. Butterworth, CE: The skeleton in the hospital closet. Nutr Today 9:8, 1975. Butterworth, CE, and Blackburn, GL: Hospital malnutrition and how to assess the nutritional status of a patient. Nutr Today 10:8, 1975. Candy, B, Sampson, EL, and Jones, L: Enteral tube feeding in older people with advanced dementia: Findings from a Cochrane systematic review. Int J Palliat Nurs 15:396, 2009. Delegge, MH: Tube feeding in patients with dementia: Where are we? Nutr Clin Pract Apr-May;24(2):214-6.: 2009. Dupertuis, YM: Physical characteristics of total parenteral nutrition bags significantly affect the stability of vitamins C and B1: A controlled prospective study. J Parenter Enteral Nutr 26:310, 2002. Falk, A: Evaluating the effectiveness of a micronutrient assessment tool for long-term total parenteral nutrition patients. Nurs Clin Pract 17:240, 2002. Fessier, T: Malnutrition: A serious concern for hospitalized patients. Today’s Dietitian 10:44, 2008.
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Chapter 15 Academy of Nutrition and Dietetics: Vitamin K and prothrombin time. Nutrition Care Manual, Chicago, 2012. Academy of Nutrition and Dietetics: Supplements and ergogenic aids for athletes. Reviewed January 2013. Accessed March 25, 2013. Available at www.eatright. org/Public/content.aspx?id=7088 Ahn, SC, and Brown, AW: Cobalamin deficiency and subacute combined degeneration after nitrous oxide anesthesia: A case report. Arch Phys Med Rehabil 86:150, 2005.
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Chapter 22 Academy of Nutrition and Dietetics: What is the effect of enteral nutrition versus parenteral nutrition on the cost medical care in critically ill patients? February 15, 2011. Accessed May 26, 2013. Available at http:// andevidencelibrary.com/evidence.cfm?evidence_ summary_id=16&auth=1ns. Aversa, Z, Alamdari, N, and Hasselgren, P: Molecules modulating gene transcription during muscle wasting in cancer, sepsid, and other critical illness. Crit Rev Clin Lab Sci 48:71, 2011. Barnett, M: Providing nutritional support for patients with COPD. J Commun Nurs 25:4, 6, 8, 2011. Dahl, D, Wajtal, GG, Breslow, MJ, et al: The high cost of low-acuity ICU outliers. J Healthc Manage 57: 421, 2012. McClave, SA, Martindale, RG, Vanek, VW, et al: Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient. J Parenter Enteral Nutr 33:290, 2009. Makic, MB, VonRueden, KT, Rauen, CA, and Chadwick, J: Evidence-based practice habits: Putting more sacred cows out to pasture. Crit Care Nurse 31:38, 2011. Qaseem, A, Humphrey, LL, Chou, R, et al: Use of intensive insulin therapy for the management of glycemic control in hospitalized patients: A clinical practice guideline from the American College of Physicians. Ann Int Med 154:260, 2011. Robson, W, and Daniels, R: Diagnosis and management of sepsis in adults. Nurs Prescrib 11:76, 2013. Rojas, Y, Finnerty, CC, Radhakrishnan, RS, and Herndon, DN: Burns: An update on current pharmacotherapy. Exp Opin Phamacother 13:2485, 2012. Rowley-Conway, G: Management of major burns in the emergency department. Nurs Standard 27:62, 2013. Shepherd, A: The nutritional management of COPD: An overview. Br J Nurs 19:559, 2010. Sinno, S, Lee, DS, and Khachemoune, A: Vitamins and cutaneous wound healing. J Wound Care 20:287, 2011. Ziegler, TR: Parenteral nutrition in the critically ill patient. N Engl J Med 361:1088, 2009.
Chapter 23 American Dietetic Association: Position of the American Dietetic Association: Nutrition intervention and human immunodeficiency virus infection. J Am Diet Assoc 110:1105, 2010. Cahill, S, and Valadez, R: Growing older with HIV/AIDS: New public health challenges. Am J Pub Health 103:e7, 2013.
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Centers for Disease Control: Basic information on HIV/ AIDS. April 11, 2012. Accessed March 14, 2013. Available at www.cdc.gov/hiv/topics/basic/#origin Centers for Disease Control and Prevention. HIV Surveillance Report 23, 2011. Published February 2013. Accessed March 10, 2013. Available at www.cdc.gov/ hiv/topics/surveillance/resources/reports Eyawo, O, Fernandes, KA, Brandson, EK, et al: Suboptimal use of HIV drugs resistance testing in a universal health-care setting. AIDS Care 23:42, 2011. Gagnon, M, and Holmes, D: Bodies in mutation: Understanding liposystrophy among women living with HIV/AIDS. Res Theory Nurs Pract 25:23, 2011. Kondro, W: Tuberculosis infection rate declining. Can Med Assoc J 184(17): E898, 2012. Kirk, JB, and Bidwell-Goetz, M: Human immunodeficiency virus in an aging population, a complication of success. J Am Geriatr Soc 57: 2129, 2009. Mehta, S, Mugusi, FM, Spiegelman, D, et al: Vitamin D status and its association with morbidity including wasting and opportunistic illness in HIV-infected women in Tanzania. AIDS Patient Care STDs 25: 579, 2011. Mohandas, A, Reifsnyder, J, Jacobs, M, and Fox, T: Current and future directions in frailty research. Popul Health Manag 14:277, 2011. Moss, JA: HIV/AIDS review. Radiol Technol 84:247, 2012. Neurological disorders strikingly high among HIV/AIDS patients. AIDS Alert 26:121, 2011. Ramsuran, V, Kulkarni, H, He, W, et al: Duffy-null-associated low neutrophil counts influence HIV-1 susceptibility in high-risk South African Black women. Clin Infect Dis 52:1248, 2011. Shah, K, Hilton, TN, Myers, L, et al: A new frailty syndrome: Central obesity and frailty in older adults with the human immunodeficiency virus. Am Geriatr Soc 60:545, 2012. U.S. Department of Health and Human Services, AIDS.gov: Signs and symptoms. June 6, 2012. Accessed February 27, 2013. Available at www.aids.gov/hiv-aids-basics/ hiv-aids-101/signs-and-symptoms U.S. Department of Health and Human Services, AIDS.gov: Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Accessed March 20, 2013. Available at aidsinfo.nih.gov/contentfiles/lvguidelines/ AdultandAdolescentGL.pdf U.S. National Library of Medicine and National Institute of Health: AIDS. April 30, 2012. Accessed March 14, 2013. Available at www.nlm.nih.gov/medlineplus/ency/article/ 000594.htm U.S. Preventative Service Task Force: Screening for HIV. April 2013. Accessed July 23, 2013. Available at www. uspreventiveservicestaskforce.org/uspstf13/hiv/ hivfinalrs.htm World Health Organization: Global summary of the AIDS epidemic. 2011. Accessed March 7, 2013. Available at www.who.int/hiv/data/2012_epi_core_en.png Wyndham, H: Fungal infections. Pract Nurse 42:24, 2012.
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World Health Organization: WHO welcomes news that a child born with HIV now appears “functionally cured” through early antiretroviral treatment. Accessed March 17, 2013. Available at www.who.int/hiv/ mediacentre/hiv_child_20130305/en/index.html
Chapter 24 American Dietetic Association: Position of the American Dietetic Association: Ethical and legal issues in nutrition, hydration, and feeding. J Am Diet Assoc 108:873, 2008. Barrocas, A, Geppert, C, Durfee, SM, et al: A.S.P.E.N. ethics position paper. Nutr Clin Pract 25:672, 2010. Couch, E, Mead, JM, and Walsh, MM: Oral health perceptions of paediatric palliative care nursing staff. Int J Palliat Nurs 19:9, 2013. Cowdell, F: Care and management of patients with pruritus. Nurs Older People 21:35, 2009. Davies, A, and Hall, S: Salivary gland dysfunction (dry mouth) in patients with advanced cancer. Int J Palliat Nurs 17:477, 2011. Fuhrman, MP: Nutrition at the end of life: A critical decision. Today’s Dietitian 10:68, 2008. Hipp, B, and Letizia, MJ: Understanding and responding to the death rattle in dying patients. Medsurg Nurs 18:17, 2009.
Kompanje, EJ, van der Hoven, B, and Bakker, J: Anticipation of distress after discontinuation of mechanical ventilation in the ICU at the end of life. Intensive Care Med 34:1593, 2008. National Hospice and Palliative Care Organization: NHPCA facts and figures. 2012 edition. Accessed March 23, 2013. Available at www.nhpco.org/sites/ default/files/public/Statistics_Research/2012_Facts_ Figures.pdf Parker, M, and Power, D: Management of swallowing difficulties in people with an advanced dementia. Nurs Older People 25:26, 2013. Ruxton, C: Promoting and maintaining healthy hydration in patients. Nurs Standard 26:50, 2012. U.S. Department of Health and Human Services: Medicare hospice benefits. January, 2013. Accessed March 21, 2013. Available at www.medicare.gov/publications/ Pubs/pdf/02154.pdf World Health Organization: Essential medicines in palliative care (2013, January). Accessed March 21, 2013. Available at www.who.int/selection_medicines/ committees/expert/19/applications/PalliativeCare_ 8_A_R.pdf
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Index Note: Page numbers followed by b refer to boxes; f, figures; t, tables.
A Abdominal circumference measurement, 16 Abdominal obesity, 370 Abnormal gait, 125 Absorption calcium and, 137 delayed vs. decreased, 334b disease states and, 207t elimination and, 207 factors decreasing, 207–209, 207t folate and, 122 food allergies and, 209–210 gut failure and, 208, 210f inadequate absorption, 207 indigestible carbohydrates and, 207 iodine and, 157 iron and, 151–152 large intestine and, 206 magnesium and, 148–149 malabsorption, 207–209 medications and, 207t niacin and, 119 parasites and, 207t riboflavin and, 118 small intestine and, 204–206 steatorrhea and, 209 surgical procedures and, 207t thiamin and, 117 vitamin A, 99 vitamin B6 and, 121 vitamin B12 and, 123–124 vitamin C and, 113 vitamin D and, 103–104 water and, 175–177 zinc and, 161 Acceptable macronutrient distribution range (AMDR), 19, 55, 352 Accessory organs, digestion and, 198 Acculturation, 23–24 ACE inhibitors, 344–345, 444–445 Acetaminophen, 351 Acetone, 39 Acetylcholine, 127, 134, 210 Achalasia, 461 Achlorhydria, 272 Acid-base balance extracellular fluid and, 183 intracellular fluid and, 184 ion secretion and, 437 renal system and, 184 respiratory system and, 183 Acid-reflux disorder, 461, 462t–463t Acidosis, 393 Acne, 262–263 Acquired immune deficiency syndrome (AIDS), 532–533, 534 advanced HIV disease phase, 532 AIDS dementia complex, 535–536 client teaching and, 539 clinical latency and, 533
conditions related to, 534–536, 534b counseling clients with, 539b decreased food intake and, 538 early symptomatic phase and, 533 epidemic and, 534 food faddism and quackery and, 539–540 gastrointestinal dysfunction and, 535 hypermetabolism and, 538 increased nutritional requirements and, 538 lipodystrophy and, 536, 536b malabsorption and, 537–538 malnutrition and, 537–538 monitoring and, 539 nutrition and, 537, 538–539 organ dysfunction and, 536 planning nutrient delivery and, 539 Pneumocystis pneumonia and, 535 prevention and counseling and, 536–537 screening HIV-infected clients and, 538–539 signs and symptoms and, 533, 534b treatment for, 533 wasting syndrome and, 536 Acrodermatitis enteropathica, 161 Acute illness, nutrition during, 405–406 Acute iron poisoning, 156 Acute renal failure, 439 Acute respiratory distress syndrome (ARDS), 524, 526 Adaptive response to exercise, 90 Adaptive thermogenesis, 85 Additives, food, 297–298 Adenosine diphosphate, 143 Adenosine triphosphate, 143, 210 Adequate intakes (AIs), 19 Adipex, 377t Adipose cells, 49 Adipose tissue, 17 Adolescence acne and diet, 262–263 anorexia nervosa and, 262 body content increases, 261t breakfast vs. no breakfast effects, 262b calcium and iron and, 261–262 energy drink use in, 261b female athlete triad and, 262b macronutrients for, 261b MyPlate servings and, 261t nutritional needs and concerns and, 261–264 overenthusiastic weight control and, 262 overweight and, 263–264, 263b physical growth and development and, 260–261, 261t psychosocial development and, 260 Adoptive mothers, breastfeeding and, 233 Adrenaline, 54 Advanced directives, 552 Aerobic exercise, 90b Aflatoxins, 295
Aging. See also specific age grouping anorexia of, 279, 280b cardiovascular disease and, 416 demographics and, 270–271 HIV in, 533b physical changes and, 271–274 Agricultural innovations, 11–12 AIDS. See Acquired immune deficiency syndrome Albinism, 162 Albumin, 66b, 180 Alcohol consumption AUDIT-C Questionnaire and, 484 bone health and, 139–140 CAGE questionnaire and, 484 cancer links and, 502 cardiovascular disease and, 422 chronic pancreatitis and, 489–490 iron absorption and, 151 mortality and, 483 pregnancy and lactation and, 224–225 Alcoholic liver disease, 484 Alcoholism hypophosphatemia and, 14 iron overload and, 156 nutritional effects and, 482 and osteoporosis, 139 Aldosterone, 181–182 Alendronate, 334, 335t Alimentary canal digestion and, 197–198 surgical removal of, 207 Alkaline phosphatase, 295 Alkalosis, 141 Alleles, 27 Allergens, 249–251 Allergies, food, 209–210 Allergies in infants anaphylactic food reactions, 250 common food allergens, 249–250 cow’s milk protein-sensitive enteropathy, 251 development of, 249f identifying children with, 249 latex allergies and food hypersensitivity, 251 low risk food for infants and, 248t misdiagnosis and, 251 nonfood transfers of allergens, 250 related food technology and, 251 treatment of, 251 Allergy prevention, breastfeeding and, 243–244 Alli, 377t Alpha-glucosidase inhibitors, 398t Alpha-linolenic acid, 52–53, 218 Alpha-tocopherol, 278 Aluminum, 167–168 Aluminum toxicity in neonates, 168 Alzheimer’s disease, 274, 318 Amenorrhea, 262 American Diabetes Association, 401
655
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656
INDEX
Amino acids aromatic, 486 athletic performance enhancement and, 353–354 branched-chain, 486 conditionally (acquired) essential amino acids, 67, 70 essential amino acids, 66–67, 70 nonessential amino acids, 70 storage and, 210–211 Amish diets, 500b Amlodipine, 337 Amniotic fluid, 218 Ampicillin, 335t Amylase, 202 Anabolic reactions, 211 Anabolism, 71 Anaerobic exercise, 90 Anaphylactic food reactions, 250 Anastomosis, 466–467 Ancestral foods, 27 Anemia, 155, 548b pernicious, 123 Anencephaly, 220 anesthesia, fasting recomendations and, 457 Angina pectoris, 414 Angiotensin II, 182 Anions, 178t Anise, 347 Anorexia cancer patients and, 509 dietary management for, 548b pellagra and, 119, 120 Anorexia nervosa, 380–381 in adolesants, 262 symptoms and, 381 Anorexia of aging, 279, 280b Anthropometric data, 14–16 Anthropometric measurements, 14 Antibiotics, overuse of, 292 Antibodies, 74 Antidepressant medications, cancer patients and, 508t Antidiuretic hormone, 181 Antiemetic drugs, cancer patients and, 508t Antiepileptics, interactions and, 340 Antioxidants, 108, 113 Apoferritin, 151 Appetite, exercise and, 90 Appetite stimulants, cancer patients and, 508t Appetite vs. hunger, 85b Aquaporins, 174 Ariboflavinosis, 118 Aromatic amino acids, 486 Arsenic, 165–166 Arteriosclerosis, 412 Arthritis, older adults and, 278–279 Artificial sweeteners, 37 Ascites, 16, 191 Ascorbic acid, iron absorption and, 151 Aspartame, 37, 69 Aspergillus molds, 295 Aspiration, 318–319, 457t Aspirin, 345 Assisted feeding, 315 Ataxia, 483
Atazanavir, 334 Atherosclerosis, 412–413 Athletic performance enhancement advice for athletes, 357 bicarbonate and, 355 caffeine and, 356–357 carbohydrates and, 352–353 creatine and, 355–356 erogenic aids and, 352–357 exercise fueling basics and, 358t glycerol and, 357 macronutrient recommendations and, 352 nonnutrients and, 355–357 nutrients and, 352 protein and amino acids and, 353–354 water intake and, 354–355 Atkins diet, 379t Atoms, 34, 177b Atopy, 243 Atorvastatin, 335t, 337 Atovaquone, 334, 335t Atrophic gastritis, 124, 272 Atrophy, muscular, 525 Attention deficit/hyperactivity disorder, 259 Autoimmune disease, 124 Autosomal recessive disease, 67 Avidin, 126 Azithromycin, 334, 335t
B Baby-Friendly Hospital Initiative, 232b Baby teeth, 258 Bacteria-derived probiotics, 467b Bacterial foodborne disease complicating factors and, 292–293 food infections and, 290, 292 food intoxication and, 292 food-safety guidelines for pregnancy, 292 growth conditions and, 290 hand washing and, 293, 293f symptoms of, 289–290, 289b temperature guide and, 290f Bariatric surgery, 101, 155 Barium swallow, 199 Behavior modification, weight management and, 375–376, 376b Belviq, 377t Benign tumors, 446 Beriberi, 117 Beta-carotene, 98, 102, 503 Beta-endorphins, 90 Beverages, sodium content in, 429t Bicarbonate, 182, 355 Biguanides, 398t Binge-eating disorder, 381 Binging, 381 Bioavailability, 122, 331 Bioelectrical impedance test, 16 Biotin, 113t, 126 Birth spacing, breastfeeding and, 231 Bitot spot, 101–102 Bladder, 211 Blood-brain barrier, 343 Blood cholesterol, elevated, 418–420 Blood clotting, vitamin K and, 110 Blood components, 174–175, 176f Blood glucose curve, 391
Blood pressure. See also Hypertension classification and, 413t diastolic pressure and, 413 renal control of, 437 systolic pressure and, 413 Blood urea nitrogen (BUN), 273, 440 Body build, obesity propensity and, 375 Body composition, 6, 368 Body density measures, 16 Body fat, 57, 100–101, 368 Body image disturbances, 370 Body mass index (BMI), 17, 365–366, 366t Body processes, regulation of, 5 Body size, energy expenditure and, 87–88 Body structure, proteins and, 70–71 Body tissue lubrication, fats and, 53 Bolus feeding, 199, 320 Bomb calorimeter, 86 Bone health, warfarin and, 278 Bone metabolism, 100–101, 104, 110 Boron, 166 Botanical products, toxicity and, 346 Bottled water costs of, 186 safety of, 185 use of, 186 Botulism, 292 Botulism spores, 241 Bovine spongiform encephalopathy, 293 Bowel obstruction, 548b “Bowel rest,” 475 Bowman’s capsule, 436 Branched-chain amino acids, 486 Brand name vs. generic multivitamins, 129 Breakfast, adolescents and, 262b Breast milk composition, 243, 243t Breastfed infant breast milk composition, 243, 243t cognitive abilities and, 241b colic and, 252 genetic abnormalities and, 244 human breast milk banks, 243 negative association with obesity and, 244 prevention of allergies and, 243 protection against disease and, 243 storage of human milk, 243 Breastfeeding mother adoptive mothers and, 233 altered physiology or pathology and, 234 benefits to mother, 231 birth spacing and, 231 calcium requirements and, 230 cancer risks and, 231 codeine-containing analgesics and, 233 encouraging breastfeeding, 232–233 energy requirements and, 230–231 HIV infection and, 234 maternal contraindications to, 233–234 maternal deficiencies and, 231 medication use and, 233–234 nutritional needs and, 230–231 psychotropic drugs and, 233 techniques and, 231–232, 232f ten steps to successful breastfeeding, 232 toxic chemical exposure and, 234 uterine involution and, 231 Breathing difficulty, terminally ill and, 545
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INDEX Brown fat, 373 Buddhism, 28–29 Buffers, 182 Bulimia, 381 Burns, 519–521, 520f
C C-reactive protein, 518 Cachexia, 511, 548b Caesarean deliveries, 224 Caffeine athletic performance and, 356–357 pregnancy and lactation and, 226 premature infants and, 233 urinary calcium excretion and, 138–139 CAGE questionnaire, 484 Calcidiol, 104 Calcimimetic, 446 Calcitonin, 135 Calcitriol, 104, 437 Calcium absorption and excretion, 137 adolescent requirements and, 261–262 alternate sources of, 136t animal sources of, 135 breastfeeding and, 230 caffeine and, 138–139 control mechanisms and, 134–135 deficiency and, 139–141 dietary protein and, 138 drug interactions and, 332t functions of, 134 hip fractures and, 279 hypercalcemia and, 141 hypertension and, 418 interfering factors and, 137, 137t iron absorption and, 151 kidney disease and, 445–446 kidney stones and, 449–450 magnesium and, 138 milk-alkali syndrome, 141, 143 osteoporosis and, 139–141, 140f oxylates and, 138 phosphorus intake and, 144 phytates and, 138 plant sources of, 137 pregnancy and lactation and, 222 sodium intake and, 138 sources of, 135, 137 supplements, 135, 242t tetany and, 141 toxicities of, 141, 142t, 143 wound healing and, 521 zinc and, 138 Calcium oxylate, 449 Calorimetry, 86 Campylobacter jejuni, 290, 291t, 292 Cancer advanced cancer, 507–512 alcohol intake and, 502 altered immune response and, 510–511 Amish diets and, 500b balance, moderation, and variety in diet, 503 beta-carotene and, 503 breastfeeding and, 231 cachexia and, 511
charting tip and, 512b common nutritional problems and, 509–512 cruciferous vegetables and, 502 decreasing risk of, 499b diet and cancer links, 498–503 dietary habits and, 500t early satiety and anorexia and, 509 end-of-life care, 507–512 immune system role in, 511 incidence and mortality, 497 living after recovery, 506–507 local effects in mouth and, 509–510 malignant cell growth and suppression, 497 metabolism differences and, 501 most common cancers, 498f nausea, vomiting, diarrhea and, 510 normal cell transformation into, 497 nutritional care and, 503–512, 508t obesity and, 500–501 pharmacotherapy and, 508t prevention diet and, 502–503, 502f red or processed meat and, 501 research findings and, 504b–505b self-preserved foods and, 502 taste alterations and, 509 tomato products and, 502 vitamin A and, 101 Cancer survivors, 506–507 Capillary network, 205 Captopril, 334, 335t Carbamazepine, 343 Carbohydrates athletic performance enhancement and, 352–353, 353t carbohydrate-containing foods for sick days, 405t complex carbohydrates, 37–39 composition of, 34, 37 consumption patterns and, 40 counting of, 42 dental caries and, 40–41 diabetes and, 400–402 dietary fiber, 38 dietary recommendations and, 43–44 digestion and, 202 disaccharides, 35–36 energy needs and, 39 exchange list values and, 42 food sources and, 40–42 functions of, 39–40 glycogen, 38–39 health and, 40 indigestible, 208 ketosis and, 39 learning and memory and, 40 monosaccharides, 35 nonnutrative sweeteners, 37 older adults and, 276–277 simple carbohydrates, 35 spare body protein, 39 starches, 37–38, 41–42 sugar alcohols, 36–37 sugars, 36, 41 term infant needs and, 241t thermic effect and, 88 whole grains, 41–42
657
Carbonic acid, 183 Carbonic anhydrase, 160 Carcinogens, 501 Carcinomas, 496 Cardiac output, renal control of, 437 Cardiac sphincter, 200–201, 461 Cardiospasm, 461 Cardiovascular disease age and, 416 alcohol consumption and, 422 atherosclerosis and, 412–413 cerebrovascular accident and, 415–416 cigarette smoking and, 422 coffee and, 423b coronary heart disease, 414 DASH diet and, 422, 424, 424t diabetes mellitus and, 421 dietary changes and, 423t elevated blood cholesterol and, 418–420 family histories and, 416–417 fetal origin hypothesis and, 421, 421b fruits and vegetables and, 424–425 gender and, 416 heart failure, 414–415, 431 hypertension and, 413–414, 413t, 417–418 inherited hyperlipoproteinemias and, 416, 417t lifestyle changes and, 419t metabolic syndrome and, 421–422 myocardial infarction, 429, 431 obesity and inactivity and, 421 occurrence of, 412 older adults and, 274–275 omega-3 fatty acids and, 425–426 plant sterols and, 425 positive feedback cycle and, 414 psyllium and, 426–427 race and, 416 saturated fats and, 425 sodium-controlled diets and, 427–429 soy protein and, 427 strokes, 432 supplements and, 424–425 underlying pathology and, 412 Carotene, 102 Carotenemia, 103 Carotenoids, 98 Catabolic reactions, 210 Catabolism, 71, 521 Catalysts, 74 Catholicism, 29 Cations, 178t Cavity formation, 40–41 Cecum, 206 Ceftriaxone, 331, 335t Cefuroxime, 334 Celiac disease, 208, 473 Cell membrane structure, fats and, 53–54 Cellular immunity, 275, 276t Central parenteral nutrition, 323 Cerebral edema, 177 Cerebral palsy, 343 Cerebrovascular accident, 415–416 Certified diabetes educators, 402 Cheeses, lactose in, 203–204
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658
INDEX
Chemical bonding, 177b–178b Chemical digestion, 198 Chemical foodborne illness, 295–296 Chemical poisoning, 295–296 Children childcare programs, 258 cholesterol screening, 419b diabetes and, 406–407 hourly urine output and, 189 inflammatory bowel disease in, 477b ketogenic diet for seizure control, 336 kidney disease and, 448–449 macronutrients for, 261b overweight, 263–264, 263b preventing medication poisoning in, 156–157 weight management in, 379b Chinese restaurant syndrome, 272 Chinese star anise, 347 Chloride, 142t, 150 Chlorophyll, 34 Choking accidents and children, 248 Cholecalciferol, 103 Cholecystectomy, 487 Cholecystitis, 485, 536 Cholecystokinin, 201 Cholecystotomy, 487 Cholelithiasis, 484 Cholesterol cholesterol-lowering diets, 420t dietary modification and, 54 food sources and, 54 foods high in, 51 functions of, 54 kidney disease and, 447 measurement of, 419–420 relationship to diet, 418–419 screening children and, 419b screening goals and, 419b Choline, 98, 113t, 127 Chromium, 143t, 163–164 Chronic alcohol intake, 123 Chronic disease prevention, vitamin D and, 104–105 Chronic hypertension, pregnancy and, 229 Chronic obstructive pulmonary disease (COPD), 524–525, 527b Chronic renal failure, 439 Chronic respiratory failure, 524 Chvostek’s sign, 141 Chylomicrons, 205, 420 Chyme, 201 Chymotrypsin, 204 Cigarette smoking, cardiovascular disease and, 422 Ciguatera poisoning, 295 Ciprofloxacin, 334, 335t, 339 Circulation, proteins and, 74 Cirrhosis dietary treatment for, 483–484 pathophysiology and, 482–484 progression of pathology and, 485f signs and symptoms of, 486b Citric acid, iron absorption and, 151 Classic triad, diabetes and, 392 Clear-liquid diets, 311, 311b Client care conference, 310
Climate, energy expenditure and, 88 Clinical pharmacists, 13 Clostridium botulinum, 116, 291t, 292 Clostridium perfringens, 291t Cloxacillin, 335t Cobalamin, 124, 125, 219, 242t Cobalt, 143t, 164 Cobalt-chromium hard-metal alloys, 165 Codeine-containing analgesics, 233 Coenzymes, 97 Coffee, heart disease and, 423b Coffee-ground emesis, 466 Cognitive abilities, breastfeeding and, 241 Cognitive strategies, weight management and, 376b Colchicine, 348 Colectomy, 479 Colic breastfeeding infants and, 252 possible causes of, 252 treatment of, 252 Collagen synthesis, 113 Collecting tubule, 436 Colloidal osmotic pressure, 180 Colon. See Large intestine Colostomy, 479 Combination foods exchange list, 570–571 Common diet orders, 310–311 Complementation, 77 Complete parenteral nutrition calculating CPN solution/CPN energy nutrient content, 325 home parenteral nutrition, 326 indications for, 323–324 monitoring of, 325–326 superior vena cava and, 324 transition and combination feedings, 326 Complete proteins, 75 Complex carbohydrates, 34, 37–39 Conditionally (acquired) essential amino acids, 67, 70 Conditionally essential nutrients, 4 Confusion, dehydration and, 278 Congestive heart failure, 527 Constipation, 227–228, 472, 474, 548b Contamination dietary substances and, 347–348 enteral tube feeding and, 319 Continent ileostomies, 479 Continuous ambulatory peritoneal dialysis (CAPD), 441 Continuous cycling peritoneal dialysis (CCPD), 441 Continuous feeding, 319–320 Control diet, cardiovascular disease and, 422 Copper, 143t, 161–162 Corn syrup, 402 Coronary heart disease, 414 Coronary occlusion, 414 Cortisol metabolism, licorice affects on, 339 Cortisone, 54 Cough, dietary management for, 548b Cow’s milk protein-sensitive enteropathy, 251
Coxsackie virus, 163 Cranberry juice, 337–338 Creatine, athletic performance and, 355–356 Creatinine, 440 Cretinism, 158 Creutzfeldt-Jakob disease, 293 Critical care costs of, 519 energy nutrient utilization and, 525–526 fat intake and, 526 feeding techniques and, 526 food intake and, 524 gastrointestinal complications and, 524 hypermetabolism and, 518–521 intensive insulin therapy and, 518b magnesium levels and, 526 nutrition and respiration, 524–525 refeeding syndrome and, 527 serum phosphorus levels and, 526 stress of starvation and, 516–524 vitamins and minerals and, 526 water balance and, 526 Crohn’s disease, 124, 475–479, 475t Cruciferous vegetables, cancer prevention diet and, 502 Cultural considerations acculturation and, 23–24 culturally competent care, 24 eating patterns and, 24–26 ethnocentrism and, 23 food preferences of ethnic groups, 24–29 food restrictions by religious customs, 28–29 in gallbladder disease, 487b nutritional impact of, 22–23 obesity and, 369 water choices and, 187 Curative care, terminally ill and, 546 Cyanide in food, 66, 66b Cyanocobalamin, 125 Cyanosis, terminally ill and, 545–546 Cyclosporine, 335t, 337, 338 Cystic fibrosis case findings and, 490 genetics and, 490 nutritional care and, 491 pathophysiology and, 491 treatment and, 491 Cystitis, 450 Cytochrome P450, 233, 334
D Dairy products, acne and, 262–263 DASH diet, 422, 424, 424t Deciliter, 387 Dehiscence, 457 Dehydration acute illness and, 405–406 confusion and, 278 diabetes and, 393 dietary management for, 548b–549b older adults and, 278t Delayed gastric emptying, 464–465 Delayed vs. decreased absorption, 334 Demeanor, 16
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INDEX Dementia, 125, 275, 318 Dental caries, 40–41, 457 Dental fluorosis, 159, 160 Dental health, 258, 280 Dentures, eating with, 281 Deoxyribonucleic acid (DNA), 74 Development. See also specific age grouping adolescence and, 260–261 infancy and, 239 preschool children and, 256–257 school-age child and, 258 toddlers and, 253–254 Dextrose, 35 Diabetes Control and Complications Trial (DCCT), 394, 439 Diabetes insipidus, 181 Diabetes mellitus acidosis and, 393 acute clinical situations and, 393 alcohol intake and, 405 antidiabetic agents, 230 blood glucose curve and, 391 carbohydrate and monounsaturated fat and, 400–402 carbohydrate counting and, 402–403 cardiovascular disease and, 421 cellular sources of glucose and, 391 children with, 406–407 chronic complications and, 394 classic triad and, 392 classification of, 387–389 client readiness to change and, 399 complications and, 392–394 dehydration and, 393 diabetes causes, 392, 392f diagnosis of, 386–387 distributing energy nutrients and, 399–400 eating out and fast foods and, 406 electrolyte imbalances and, 393 energy nutrient distribution and, 399–400 exchange lists and, 403, 563–575 excretion in, 118 fats and, 402 gastroparesis and, 394, 465 genetic predisposition and, 407 gestational diabetes, 389 glucagon and, 391 glycemic goals for, 395t goal priority and, 398 hyperglycemic hyperosmolar nonketotic syndrome, 393–394 hypoglycemia and, 394, 406 insulin for, 390–391, 397, 397t ketoacidosis and, 393 laboratory tests for, 387–388 macronutrient distribution in, 400–403 magnesium deficiency and, 149 maturity-onset diabetes, 389 meal frequency and, 399 meal-planning approaches and, 399–403 medications for, 396–397 nephropathy and, 394 neuropathy and, 394 nutrition during acute illness and, 405–406 nutritional goals and, 398
nutritional management of, 398–403 oral hypoglycemic agents and, 397, 398t physical activity and, 396 polydipsia and, 392 polyphagia and, 392 polyuria and, 392 prediabetes, 388 pregnancy and, 390 proteins and, 402 renal disease and, 439 retinopathy and, 394 sample 1800-kilocalorie diet and, 401t secondary diabetes, 389–390 self-monitoring of blood glucose and, 395–396 signs and symptoms and, 392 somatostatin and, 391 survival skills and, 399 teaching self-care and, 406–407 treatment and, 393 type 1 diabetes, 387–388, 389t type 2 diabetes, 388–389, 389t vitamin and mineral supplementation and, 404 Diabetic gastroparesis, 394, 465 Diabetic ketoacidosis, 393 Diacetic acid, 39 Diagnostic procedures, diets for, 311–313 Dialysate, 441 Dialysis, kidney disease and, 441 Diarrhea, 470–472, 471t, 475 cancer patients and, 510 dietary management for, 549b Diarrhea in infancy calling physician and, 253 causes of, 252 mortality and, 253 pathophysiology and, 252–253 treatment of, 253 Diastolic pressure, 180, 413 Diazepam, 335t, 337 Diet advancement, infants and, 246–249 Diet history, 15 Diet manuals common diet orders, 310–311 consistency modifications and, 312t diet orders, 310 special diets, 310 Diet orders, 310 Dietary exchange lists. See Exchange lists Dietary Guidelines for Americans, 7–8 Dietary intake, 18 Dietary recommendations, energy balance and, 92 Dietary Reference Intakes, 78–79, 557–562 Dietary status, 12 Dietary Supplement Health Education Act (DSHEA), 346 Dietary supplements. See also Drug interactions areas of concern and, 346 contamination and, 347–348 dangers and, 349–351 diabetic concerns, 404–405 drug interactions and, 349t education regarding, 351–352 garlic, 350
659
ginkgo biloba, 350 ginseng, 350 glucasamine-chondroitin, 350–351 heavy metals and, 347–348 hypertoxicity from, 351 older adults and, 281 potential harm of, 348–349 prescription medicine contamination and, 348 regulation of, 345, 346b reliable information difficulty and, 348 special rules regarding, 345 standardization and, 346–347, 347b untoward effects and, 351 use assessment and, 352 Dietetic technicians, 13 Diethylpropion, 377t Digestion, 197–204. See also Food pathway accessory organs and, 198 alimentary canal and, 197–198 carbohydrate digestion, 202 chemical digestion, 198 dysphagia and, 199–200 end products and, 199 fat digestion, 202–204 food pathway and, 199–204 gallbladder and, 198 gastroparesis and, 201 lactose intolerance and, 202–204 liver and, 198 mechanical digestion, 198 pancreas and, 198 protein digestion, 204 secretions and, 198–199 Digestive disease chief nutrient absorption sites and, 460f critical care patients and, 524 dental caries and, 457 enteral tube feedings and, 318, 321t esophageal disorders, 460–464 gallbladder disease, 484–488 intestinal disorders, 468, 470–480 liver diseases, 480–485 liver functions and, 456t low-fiber diet and, 458t–459t mouth and throat disorders, 460 older adults and, 280–281 pancreatic diseases, 488–491 stomach disorders, 464–468 Diglycerides, 48–49 Digoxin, 335t, 338 Dilutional hyponatremia, 146 Disabled clients, assisted feeding of, 315 Disaccharides, 35–36 Disease prevention, 3–4 Disease protection, breastfeeding and, 243 Disease-specific formulas, 317 Disgeusia, 549b Disordered eating, 262 Diverticular disease, 479–480, 479f Diverticulitis, 480 Diverticulosis, 480 Docosahexaenoic acid (DHA), 274, 425 Documentation, nutritional care, 22 Dopamine, 341–342, 342f Double-bind trials, 345 Double bonds, 49
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660
INDEX
Drinking water. See also Water filtered tap water, 187 fluoride and, 159 pharmaceuticals in, 185b DRIs. See Dietary Reference Intakes Drug interactions antiepileptics and, 340 B vitamins and, 343–344 classification, 332t cranberry juice and, 337–338 delayed vs. decreased absorption, 334 dietary supplements and, 349–351, 349t drug-nutrient interactions, 335t–336t drugs taken on empty stomach and, 334 drugs taken with foods and, 334 enteral feeding and, 340 enzyme activity and, 334 folic acid displacement by aspirin, 345 grapefruit juice and, 337 healthcare professionals and, 358–359 licorice and, 338–339 with minerals/mineral-fortified foods, 339 parenteral nutrition and, 333 polypharmacy and, 358 protein intake and levodopa, 343 salt substitutes and ACE inhibitors, 344–345 screening clients for, 359 sodium, fluids and lithium, 344 transport mechanism changes and, 338–339 type I interactions, 331, 333 type II interactions, 333–340 type III interactions, 340–344 type IV interactions, 344–345 tyramine and monoamine oxidase inhibitors, 341–343 with vitamin B6, 339–340 vitamin D and, 343 vitamin K and warfarin, 340–341 Dry mouth, cancer patients and, 510 Dual-energy x-ray absorptiometry (DEXA), 16 Dumping syndrome, 467, 469t Duodenum, 137, 201 Durable power of attorney, 552 Dying process, 544–546 Dysphagia, 199–200 dietary treatment for, 199b–200b Dyspnea, 549b
E Eating cessation, terminally ill and, 545 Eating disorders anorexia nervosa, 381 bulimia, 391 treating, 381, 381b Eating environment, 314–315 Eating out, diabetes and, 406 Echinacea, 347 Eclampsia, pregnancy and, 229 Edema, 176–177, 177f Edentulous adults, 272 Egg white injury, 126 Eicosapentaenoic acid (EPA), 425 Elderly. See Older adults Electrocardiograms (ECG), 178
Electroencephalograms (EEG), 178 Electrolytes abnormalities and nutritional support, 527 chemical digestion and, 198 chemistry of, 178b diabetes and, 393 diagnostic uses of, 178 major body electrolytes, 178t osmotic pressure and, 179–180 potential hazards and, 178 serum electrolytes, 180 water balance and, 178–180 Elemental formulas, 317 Elements, 34 dietary reference intakes and, 559, 562 Elevated blood cholesterol, 418–420 Elimination, 207 of magnesium, 148–149 Embolus, 414 Embryo, 217 Emulsifier, 298 Enalapril, 335t End products, digestion and, 199 End-stage renal failure, 440, 536 Endocrine system, older adults and, 274 Endogenous insulin, 398 Endogenous protein, 77 Endoscope, 318 Endothelium damage, 229 Energy balance adaptive thermogenesis and, 85 calculating content of food items and, 86 determining energy values, 86 dietary recommendations and, 92 energy expenditure and, 85 energy measurements and, 85 energy sources and, 4 human body and, 86 imbalance and, 367–368 individual foods and, 86 intake and, 85, 91 kilocaloric density of foods and, 91 nutrient density of food and, 92 nutrient values and, 85–86 older adults and, 276 Energy drink use in adolescence, 261b Energy expenditure. See also Energy balance; Physical activity body size and, 87–88 climate and, 88 components of, 87–91 diabetes and, 399–400 energy nutrient utilization, 525–526 gender and, 87 genetic patterns and, 88 human growth and, 87 physical activity and, 88–90 pregnancy needs and, 218, 218t resting energy expenditure, 87–88 thermic food effects and, 88 Energy intake, obesity and, 263 Energy production in cells, 211f Energy requirements breastfeeding and, 230 older adults and, 276 term infant and, 240
Enrichment, foods, 107b Enteral feeding, 340 Enteral tube feeding, 317–323 administration and, 319–320 bolus feeding and, 320 complication and prevention strategies, 320t–321t conditions indicating, 324 contamination and, 319 continuous feeding and, 319–320 critically ill and, 519 gastrointestinal function and, 318 high osmolality and, 321 home enteral nutrition and, 323 intermittent feeding and, 320 medication administration and, 321–322 monitoring and, 322 potential complications and, 320–321 tube placement and, 318–319 Enteritis, 252 Environmental pollutants, 295–296 Enzyme activity, 334 Enzymes, body processes and, 74 Epigastric pain, 464 Epilepsy, 336 Epithelial tissue, vitamin A and, 100 Epoetin alfa, 447 Ergocalciferol, 103 Erikson, Erik, 238, 270t Erogenic aids, 352–357 Erythromycin, 335t Erythropoietin, 437 Escherichia coli, 291t Esophageal disorders achalasia, 461 gastroesophageal reflux disease, 461–462, 549b hiatal hernia, 462t–463t, 464, 464f Esophagostomy, 318 Esophagus, food pathway and, 200–201 Essential amino acids, 66–67, 70 Essential fatty acids, 52–53 Essential hypertension, 413 Essential nutrients, 4 Estimated average requirements (EARs), 19 Estrogen, 54 and bone resorption, 135 Ethical considerations, terminally ill and, 548–552 Ethnic groups, food preferences of, 24–29 Ethnocentrism, 23 European cuisine, 26 Evaporative water loss calculations, 189–190 Exchange lists alcohol exchange list, 573 beans, lentils, and peas exchange list, 564 cereals and grains exchange list, 563 combination foods exchange list, 570–571 crackers exchange list, 564 dairy-like foods exchange list, 566 sweets, desserts, and other carbohydrates exchange list, 573–575 diabetes and, 403, 563–575 fast foods exchange list, 571–573 fats exchange list, 21, 57–59, 567, 568–569 free foods exchange list, 569–570 fruit exchange list, 21, 42, 564–565
3718_Index_655-682 02/07/14 3:35 PM Page 661
INDEX fruit juice exchange list, 565 meat and meat substitutes exchange list, 57–59, 566–567 milk exchange list, 42, 57, 565 plant-based proteins exchange list, 567–568 snacks exchange list, 564 starch/bread exchange list, 42, 563 uses for, 20–22 vegetable exchange lists, 21, 42, 564, 566 Exchange process, dialysis and, 442 Excretion calcium and, 137 folate and, 122 iodine and, 157 iron and, 152 niacin and, 119 riboflavin and, 118 thiamin and, 117 vitamin A and, 99 vitamin B6 and, 121 vitamin B12 and, 123–124 vitamin C and, 113 vitamin D and, 103–104 of waste, 211 zinc and, 161 Exercise. See also Physical activity advanced cancer patients, 507–508 appetite and, 90 cancer survivors, 506–507, 507t diabetes and, 396 fueling basics and, 358t older adults and, 277 thermic effect of, 89–90 Exogenous insulin, 398 Extra lean meat, 59 Extracellular fluids, 175, 175f, 183 Eye considerations, older adults and, 271 Eyes, nutritional status and, 16
F Failure to thrive, 239 Fast foods, diabetes and, 406 Fasting, 312, 457t Fasting blood sugar, 35, 387 Fat cells, obesity and, 373 Fat-free mass, 16 Fat-soluble vitamins. See also specific vitamin elusive international unit and, 98 factors affecting stability of, 99 pregnancy and lactation and, 220–221 vitamin A, 98–103 vitamin D, 103–108 vitamin E, 108–109 vitamin K, 109–111 Fatigue folate deficiency and, 122 vitamin B6 deficiency and, 121 vitamin B12 deficiency and, 125 Fats basic terminology and, 48–49 body fat, 53–54, 57 body tissue lubrication and, 53 cardiovascular risk and, 428 cell membrane structure and, 53–54 cholesterol and, 54
comparison in selected foods, 488t degree of saturation, 49 diabetes and, 402 dietary fat, 56–57 dietary guidelines and, 55 digestion and, 202–204 diglycerides, 48–49 essential fatty acids and, 52–53 exchange lists and, 21, 57–59, 567, 568–569 fat loss vs. water/protein loss, 368–369 fat-soluble vitamins and, 52 fatty acid chain length, 49 fatty foods and acne, 262–263 food sources and, 52–53, 58 fuel reserve and, 53 as fuel source, 52 fuel supply and, 53 hydrogenation and, 51 insulation and, 53 intake as worldwide concern, 54–55 macronutrient distribution range for, 55b monoglycerides, 48–49 monounsaturated fats, 56 older adults and, 277 organ protection and, 53 plant stanols and sterols, 60 polyunsaturated fats, 57 satiety value and, 52 saturated fats, 51 selected kilocalorie levels and, 55 term infant requirements and, 241t thermic effect and, 88 triglycerides, 49 unsaturated fats, 51 Fatty acids classification of, 53f essential, 56b linoleic acid, 52–53 monounsaturated, 49–50, 50f polyunsaturated, 49–50, 50f, 53 pregnancy and lactation and, 218 saturated, 49, 50f storage of, 210–211 trans-fatty acids, 55 Fecal impaction, 228, 475 Federally reimbursable school meal programs, 260t Feeding techniques, critical care patients and, 526 Felodipine, 335t, 337 Female athlete triad, 262b Ferric iron, 151 Ferritin, 151, 447 Ferrous iron, 113, 151 Ferrous sulfate, 156 Fetal alcohol spectrum disorder, 225 Fetal alcohol syndrome, 225 Fetal tissue, 218 Fetus, 217 Fever dietary management and, 549b hypermetabolism and, 521 water loss and, 190 Fiber, 39, 227t, 276–277, 474 Fibrin, 134 Fibrinogen, 134
661
Filtered tap water, 187 Filtration, glomerular, 436–437, 438f First-pass effect, 331 Fistula, 441 Five-hundred rule, 368 Flaxseed, 50f Fluids. See also Water accumulation of, 549b acid-base balance and, 182–184 average gains and losses of, 190t compartments, 173–175 excessive fluid volume, 191t extracellular fluid, 175 insufficient fluid volume, 191t interstitial fluid, 175 intracellular fluid, 174–175 intravascular fluid, 175 kidney disease and, 446–447, 447t lymphatic fluid, 175 physiology of, 177–184 third-space losses, identifying, 191 transcellular fluid, 175 visual assessment of, 191b volume of, 192–193 Fluoride dietary reference intakes and sources, 159 drinking water and, 159, 187 functions of, 159 pregnancy and lactation and, 223 supplementation for infants, 242t toxicity and, 142t, 160 Fluoroquinolones, 339 Folate, 122–123 Folic acid displacement and aspirin, 345 drug interactions and, 332t food fortification and, 122 pregnancy and lactation and, 219–220 Food acceptance records, 310 Food additives accidental use and, 298 common food additives, 297t GRAS substances, 298 intentional use and, 298 prior-sanctioned substances, 298 Food allergies, 209–210, 210b, 297t Food Allergy Network, 251 Food choices, 6–9 Food consumption in the U.S., 9 Food costs, 10–11 Food exchange lists. See Exchange lists Food faddism, 539–540 Food frequency questionnaire, 15 Food groups, good vitamin sources by, 127–128 Food infections Campylobacter jejuni, 290, 291t, 292 Listeria infection, 291t, 292 pathogens, food vehicles, and symptoms, 291t Salmonella infection, 290, 291t Food insecurity, 10–12, 280 Food intake. See also Weight management DRIs. See Dietary Reference Intakes of the elderly, 284b glycemic index and, 372–373 independent living elderly and, 282
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662
INDEX
institutionalized elderly and, 283 lifestyle and, 370–371 macronutrient energy consumption and, 372, 560 monitoring, 380b physiology of, 371–373 Food intoxication, 292 Food irradiation, 289 Food label terminology fat-free, 59b low cholesterol, 59b low-fat, 59b low saturated fat, 59b sugars and, 36–37 Food labels daily values, 298–299 descriptors, 299–300 health claims and, 299 nutritional facts panel on, 299f percent daily values, 299 serving size, 298 standardized format and, 298 structure/function claims and, 299 Food management bacterial foodborne disease and, 289–293 chemical poisoning and, 295–296, 296b environmental pollutants and, 295–296 food additives and, 297–298 food labels and, 298–300 immunosuppressive agents and, 291 infectious agents and, 293–295 microbiological hazards and, 289–295 natural food intoxicants and, 296–297 Food pathway esophagus and, 200–201 oral cavity and, 199 pharynx and, 200 small intestine and, 201–204 stomach and, 201 Food preferences by ethnic groups, 24–29 Food quackery, 539 Food records, 15 Food resources, 10–11 Food restriction psychological consequences of, 370b religious customs and, 28–29 Food service in institutions, 307 Formula-fed infants costs and, 245 feeding techniques and, 245 formula preparations, 244, 244t hazards and, 245 soy protein formulas, 245 special formulas, 245 Fortification, foods, 107b Fractures, older adults and, 279 Free radicals, 101, 511 Fructose, 35 Fruits exchange lists, 21, 42, 564, 565 Fruits, daily recommendation of, 502–503 Fruits and vegetables diet, 424–425 Fuel, carbohydrates as, 39 Fuel reserves, fats and, 52 Full-liquid diets, 311, 312b Functional foods, 5, 5t Furazolidone, 335t
G Galactose, 35 Galactosemia, 244 Gallbladder, digestion and, 198 Gallbladder disease causative factors and, 484–485 dietary modifications and, 487 ethnic variations in prevalence of, 487b medical and surgical interventions, 487–488 symptoms and treatment and, 487–488 Gallstones. See Gallbladder disease Ganciclovir, 334 Garlic, 349t, 350 Gastric acid, 152 Gastric banding, 376–377 Gastric bypass, 376–377 Gastric juice, 201 Gastric lipase, 201 Gastric residual volume (GRV), 518–519 Gastric surgery, 376–377 Gastrin, 198, 201 Gastritis, 464, 464f dietary treatment for, 465b Gastroesophageal reflux disease (GERD), 461–462, 462t–463t Gastrointestinal function, HIV/AIDS and, 535 Gastrointestinal secretions, 189 Gastroparesis, 201, 394 Gastrostomy, 318 General appearance, nutritional assessment and, 14 Generally recognized as safe (GRAS), 103, 298 Generativity, 269 Generic names, 331 Generic vs. brand name multivitamins, 129 Genes, 74 Genetic code, 6 Genetics breastfed infants and, 244 cystic fibrosis and, 490 diabetes and, 407 obesity and, 264, 368 resting energy expenditure and, 88 Germ theory of disease, 28 Gestation, 217 Gestational diabetes, 229–230 Gestational hypertension, 229 Gestational nightblindness, 221 Ginkgo biloba, 349t, 350 Ginseng, 349t, 350 Global food aid deliveries, 11b Glomerular filtration rate, 437, 439, 440t Glomerulonephritis, 439 Glomerulus, 436 Glucagon, diabetes and, 391 Gluconeogenesis, 75, 516–517 Glucosamine-chondroitin, 349t, 350–351 Glucose blood glucose curve, 391 cellular sources of, 391 glucose tolerance test, 387 self-monitoring of blood glucose, 395–396 storage and, 210–211
Glucosuria, 392 Glutamine in PN therapy, 324 Gluteal-femoral obesity, 370, 421 Gluten, 208 Gluten-free substitutions, 209t Gluten intolerance, 297t Gluten-restricted diet, 208t–209t Gluten-sensitive enteropathy, 208 Glycemic goals for diabetics, 395t Glycemic index, 262, 372–373, 403–404 Glycemic load, 403–404, 404t Glycerol athletic performance and, 357 fat molecules and, 48 storage of, 210–211 Glycogen, 38–39 Glycogenolysis, 516 Glycosylated hemoglobin, 388 Goiters, 158, 158f from iodine deficiency, 158b Goitrogens, 158–159 Goldenrice, 12 Gout, 450 Grapefruit juice, 337 Griseofulvin, 334, 335t Growth. See also Development energy expenditure and, 87 growth spurts, 260 infancy and, 239 Gums, nutritional status and, 16 Gut failure, 208, 210f
H Hair, nutritional status and, 16, 66b Halal food, 29 Half-life, 331 Hand washing, 293, 293b, 293f Harris-Benedict equation, 522 Hartnup disease, 120 Health claims, 299 Healthy body weight, 4 Hearing, older adults and, 271 Heart failure, 414–415, 431 Heartburn, pregnancy and, 228 Heat-related illnesses, 187–188, 188t Heavy metals, 295–296, 347–348 Height data, 15 Helicobacter pylori, 465–466 Hematocrit test, 155 Hematuria, 439, 449 Heme, 151 Hemochromatosis, 156 Hemodialysis, 441, 442f, 444 Hemoglobin, 66b, 151 Hemosiderin, 156 Hemosiderosis, 156 Hepatic encephalopathy, 486, 550b Hepatic portal circulation, 205 Hepatitis nutritional care and, 481–482 signs and symptoms and, 481 treatment and, 481 viral infections and, 480–481, 481t Hepatitis A, 294, 481, 481t Hepatitis B, 481, 481t Hepatitis C, 481, 481t Hepatitis E virus, 294–295
3718_Index_655-682 02/07/14 3:35 PM Page 663
INDEX Hepatomegaly, 536 Hepcidin, 151 Hereditary pancreatitis, 489 Herpes infections, breastfeeding and, 234 Heterocyclic amines, 501 Heterozygous individuals, 67 Hiatal hernia, 462t–463t, 464, 464f Hiccups, 549b High-density lipoproteins, 419–420 High-fiber foods, 227t High-fructose corn syrup, 402 Highly active antiretroviral therapy, 533 Hip fractures, 279, 279b HIV. See Human immunodeficiency virus Home enteral nutrition, 323 Home parenteral nutrition, 326 Homeostasis, 84–85 Homocysteine, 429 Homozygous individuals, 67 Honey, as danger to infants, 241 Hormonal responses, hypermetabolism and, 518 Hormones, body processes and, 54, 73–74 Human breast milk banks, 243 Human immunodeficiency virus (HIV) acute infection phase, 533–534 in aging population, 533b AIDS, advancement to, 534 AIDS dementia complex and, 535–536 breastfeeding and, 234 clinical latency and, 534 complications of, 534–536, 534b counseling clients with, 539b gastrointestinal dysfunction and, 535 increased nutritional requirements and, 538 lipodystrophy and, 536, 536b malnutrition and, 537–538 nutrition and, 537 opportunistic infections and, 534–535 organ dysfunction and, 536 Pneumocystis pneumonia and, 535 prevention and counseling and, 533b, 536–537 signs and symptoms and, 533 thrush and, 535 transmission of, 533b treatment and, 533, 536–537 tuberculosis and, 535 wasting syndrome and, 536 Human milk fortifier, 246f Human T-cell leukemia virus, 234 Humoral immunity, 275, 276t Humulin, 397 Hunger vs. appetite, 85b Hydration, athletic performance and, 354–355 Hydrochloric acid, 198 Hydrogenation, 51 Hydrolysis, 198, 243 Hydrostatic pressure, 180 Hydroxocobalamin, 125 Hyperammonemia, 486 Hypercalcemia, 141 Hyperemesis gravidarum, 117, 228, 483 Hyperglycemia, 386 Hyperglycemic hyperosmolar nonketotic syndrome, 393–394
Hyperkalemia, 149 Hyperlipoproteinemias, 416, 417t Hypermetabolism AIDS and, 538 burns and, 519–521 early feeding and, 518–519 hormonal responses and, 518 infections and fever and, 521 kcalorie needs and, 521–523 metabolic responses and, 518 protein needs and, 521 surgery and, 519 trauma and, 521 urine assessment and, 521 Hyperparathyroidism, 145 Hypertension diagnosis of, 413 essential hypertension, 413 high salt intake and, 418 kidney disease and, 439 low potassium and calcium intakes, 418 pregnancy and, 229 renal disease and, 439 secondary hypertension, 413 as silent killer, 414f types of, 413–414 Hyperthyroidism, 158 Hypertonic fluids, 180 Hypervitaminosis A, 103 Hypocalcemia, 141, 141f Hypoglycemia causes of, 394 in diabetes mellitus, 406–407 dietary management for, 549b hospitalized patients, management of, 397 hypoglycemic agents, 397, 398t not related to diabetes mellitus, 406–407 sample meal plan for, 407t Hypokalemia, 148, 444 Hyponatremia, 146, 273 Hypophosphatemia, 144 Hypotension, postprandial, 467–468 Hypothalamus, obesity and, 373b Hypothyroidism, 158 Hypotonic fluids, 180
I Iatrogenic malnutritions, 313 Ibuprofen, 350 Identity, 260 Ileocecal valve, 205 Ileostomy, 477–478 Ileum, 201 Ileus, 518 Immune response, cancer patients and, 510–511 Immunity, 74, 532 Immunosuppressive agents, 291 Impaired fasting glucose, 387 Impaired glucose tolerance, 388 Implantation, 217 Inactivity, obesity and, 263 Incomplete proteins, 76 Incontinence, 545, 549b Incubation period, 294 Independent living elderly, 282 Indigestible carbohydrates, 208, 470
663
Indinavir, 335t Infancy. See also Term infant allergies and, 249–251 avoiding choking accidents and, 248 breast or bottle choice, 245–246 breastfed infant, 243 colic and, 252 common nutritional problems in, 249t diarrhea in, 252–253 diet advancement and, 246–249 feeding and, 248 formula-fed infant, 244–245 growth during, 239 juice consumption and, 255 learning about flavors and, 248 low risk allergy foods and, 248t nutritional problems and, 249–253 physical development and, 239, 240t premature infants, 246 psychosocial development and, 239 semisolid food introduction and, 246–248 vitamin K deficiency and, 341 vitamin-mineral supplementation and, 242t weaning and, 248–249 Infantile beriberi, 118 Infections, hypermetabolism and, 521 Infectious agents, 293–295. See also Bacterial foodborne disease parasitic infections, 293–294 toxic fish and plants, 295 viral infections, 294 Inflammatory bowel disease, 474–475 in children, 477b colostomy and, 479 Crohn’s disease, 475–479, 475t genetic factors, 476 ileostomy and, 477–478 nutritional goals and, 476–477, 477t nutritional therapy and, 476–477 surgical treatment and, 477–479 ulcerative colitis and, 475–479, 475t Inflammatory response, 518 Inherited hyperlipoproteinemias, 416, 417t Insensible water losses, 185, 189 Insoluble fiber, 39 Instant breakfast preparation, 281 Institutionalized elderly, 282–284 Insulation, fats and, 53 Insulin diabetes mellitus and, 397, 397t endogenous and exogenous, 398 functions of, 390–391, 391f intensive therapy in critically ill, 518b metabolic activities inhibited by, 276t metabolic activities promoted by, 276t Insulin-dependent diabetes mellitus (IDDM), 388 Intact nutrients, 318 Integumentary system, older adults and, 271 Intensive care. See Critical care Intermittent feeding, 320 International normalized ratio (INR), 337 Interstitial fluid, 175 Intestinal disorders constipation, 472, 474 diarrhea, 470–472, 471t
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664
INDEX
inflammatory bowel disease, 474–479 irritable bowel syndrome, 470 warfarin interactions and, 341 Intestinal juice, 202 Intestinal motility, 272–273 Intestines, vitamin B12 deficiency and, 124 Intimacy, 269 Intracellular fluids, 174–175, 175f, 184 Intracranial hemorrhage, 228 Intravascular fluids, 175 Intravenous feeding, 35, 323–324 Iodine absorption and excretion and, 157 deficiency and, 157–158, 158b dietary reference intakes and sources, 157 in foods and water, 157 goiters and, 158, 158f hyperthyroidism and, 158 hypothyroidism and, 158 incidental, 157 interfering factors and, 158–159 local effects and, 158 pregnancy and lactation and, 223 systemic effects and, 158 thyroid gland function and control and, 157 toxicity and, 142t, 159 Ion secretion, 437 Ireton-Jones equation, 523, 524 Iron acute iron poisoning, 156 adolescent requirements and, 261–262 assessment data and, 155 bariatric surgical procedures and, 155 cardiovascular risk and, 429 deficiency and, 154–155 dietary absorption of, 151–152, 152f dietary reference intakes, 152 drug interactions and, 333t excretion and, 152 factors affecting absorption rate, 151 factors affecting absorption amounts, 151 factors enhancing absorption, 151–152 factors interfering with absorption, 152 ferrous form of, 113 functions of, 151 hemochromatosis and, 156 iron-deficiency anemia, 155 kidney disease and, 447 morbidity from infections and, 155 obtaining assessment data and, 155 pregnancy and lactation and, 222 sources of, 154 supplementation for infants, 242t supplements and, 155, 169 toxicity and, 142t, 156–157 vegetarian diets and, 153t vitamin C and, 113 Iron-deficiency anemia, 256 Irradiation of food, 289 Irritability, infant, 234 Irritable bowel syndrome, 470–474 Islamic food restrictions, 29 Isocarboxazid, 335t Isoniazid, 334, 335t, 339, 343 Isotonic fluids, 180 Isotretinoin, 221
J Japanese star anise, 347 Jaundice, 103, 550b Jejunoileal bypass, 376 Jejunum, 108, 137, 201 Joule, 85 Juice consumption, 256b
K Keshan disease, 163 Ketoacidosis, 388, 393 Ketoconazole, 334 Ketogenic diet for seizure control, 336 Ketosis, 39, 517 Kidney disease calcium and, 445–446 causes of, 438–439 children and, 448–449 dialysis and, 441 dietary components and, 442–448 fluids and, 446–447 glomerulonephritis, 439 hemodialysis and, 441, 442f iron and, 447 kidney failure and, 439–441 kidney stones and, 449–450 kidney transplant and, 442 kilocalories and, 443 malnutrition and, 443 myocardial infarction and, 438 nephrosclerosis, 439 nephrotic syndrome, 439 nutrient guidelines for adults with, 448, 449t nutrition therapy goals and, 443 nutritional care and, 442–448 nutritional parameters and, 448t peritoneal dialysis and, 441–442 phosphorous intake and, 445–446 potassium intake and, 444–445, 445b protein intake and, 443–444 saturated fats and cholesterol and, 447 sodium and, 444 specific tubular abnormalities, 430 stages of, 440t teaching renal diet, 448 vitamin and mineral supplementation and, 448 vitamin D and, 445–446 Kidney failure halting progression of, 441 sodium depletion and, 440 sodium retention and, 440 uremia and, 440–441 Kidney functions, 277, 436–437 Kidney stones calcium and, 449–450 causes of, 449 oxylates and, 449 prevention of, 451 surgery and, 450 treatment of, 449–450 uric acid stones and, 450 vitamin C and, 116 Kidney structure, 436
Kidney transplant, 442 Kilocalories calculating, 522 energy measurement and, 4, 367 Harris-Benedict equation and, 522 hypermetabolism and, 521–523 Ireton-Jones equation and, 523, 524 kidney disease and, 443 kilocaloric density, 91, 92, 92b Mifflin–St. Jeor equation and, 523–524 stress factors and, 522, 523r Kilojoule, 85 Konzo, 66 Korsakoff’s psychosis, 117, 483 Krebs cycle, 210 Kwashiorkor, 72, 180
L Lact-Aid Nursing Trainer System, 233 Lactaid, 204 Lactase, 202 Lactation. See Breastfed infant; Breastfeeding mother; Pregnancy and lactation Lacteal, 204 Lactose, 36 Lactose intolerance, 202–204, 202t, 209, 297t Lactose-restricted diet, 203t Large intestine, absorption and, 206 Latex allergies and food hypersensitivity, 251 LCAT deficiency, 447 Lead intake, 347 Lead poisoning, 167–168 Lean body mass, 72, 368 Lean meat, 58–59 Leg cramps, pregnancy and, 227 Legal issues, terminally ill and, 548–552 Legumes, 37, 37b, 77 Levodopa, 335t, 339, 343 Levothyroxine, 335t, 339 Licensed practical nurses, 13 Licensed speech pathologists, 13 Licensed vocational nurses, 13 Licorice, 338–339 Life expectancy, 23, 270 Lifestyle factors. See also Obesity; Physical activity cardiovascular disease and, 419t food intake and, 370–371 Limiting amino acids, 76 Linezolid, 335t Linoleic acid, 52–53, 56, 218 Lipectomy, 376 Lipids, 48 Lipodystrophy, 536b Lipoids, 48 Lipolysis, 393, 517 Lipoprotein lipase, 421 Liposuction, 376 Lips, nutritional assessment and, 16 Liquid diets, 311, 311b, 311t, 312b Lisinopril, 335t Listeria infections, 225, 291t, 292 Listeriosis, 225, 292 Lithium, 335t, 344
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INDEX Lithotripsy, 488 Liver digestion and, 198 functions of, 456t metabolic modifications in, 205, 206t Liver disease cirrhosis, 482–483 hepatitis, 480–481 vitamin A and, 103 Long-chain polyunsaturated fatty acids, 218 Lopinavir, 334 Lorcaserin, 377t Lovastatin, 334, 335t Low-birth-weight infants, 217 Low bone density, 262, 526 Low-density lipoproteins (LDL), 419–420, 420t Low FODMAP diet, 470–471 Low-fiber diet, 458t–459t Lung cancer, 503 Lycopene, 502 Lymphatic fluid, 175 Lymphatic system, 204 Lysine, 76
M Macronutrients acceptable distribution ranges, 560 for children and adolescents, 261b energy consumption, 372, 560 parenteral guidelines for, 522 term infant and, 240, 241t Mad cow disease, 293 Magnesium absorption and, 148–149 calcium absorption and, 138 critical care patients and, 526 deficiency and, 149 dietary reference intakes, 149 drug interactions and, 333t elimination and, 148–149 functions and, 148–149 interfering factors and, 149 toxicity and, 142t Magnesium heptogluconate, 149 Malabsorption, 207–209, 537–538 Malignant tumors, 496 Malnutrition, 9–10 AIDS patients and, 537–538, 537b cancer patients and, 505, 511 level in hospitalized patients, 277 nitrogen imbalance and, 72 protein-calorie malnutrition, 281 refeeding and, 528 Maltase, 202 Maltose, 36 Manganese, 143t, 164 Maple syrup urine disease, 69 Marasmus, 72 Mastication, 198 Maternal phenylketonuria, 69 Meal patterns diabetes and, 398, 399–403 pregnancy and lactation and, 224 school-age child and, 259 toddlers and, 254–255
Meal plans, 21–22 Meat exchange lists, 21, 57–59, 566–567 Mechanical complications, enteral tube feedings and, 320t–321t Mechanical digestion, 198 Medical assistants, 13 Medical foods, 315 Medications. See also Drug interactions absorption and, 208 administering through feeding tubes, 321–322 breastfeeding and, 233–234 Mediterranean Diet, 403 MedWatch program, 346 Megadoses, 116 Megaloblastic anemia, 122 Melphalan, 334, 335t Memory, 40, 125. See also Dementia Menaquinone, 110 Meningocele, 220 Meningoencephalocele, 220 Menkes disease, 162 Menstrual dysfunction, 262 Mental alertness, terminally ill and, 546 Mercaptopurine, 335t Mercury contamination, 226 Mercury toxicity, 296 Metabolic chain enzymes, 373 Metabolic complications, enteral tube feedings and, 321t Metabolic responses, hypermetabolism and, 518 Metabolic syndrome, cardiovascular disease and, 421–422 Metabolism. See also Hypermetabolism anabolic reactions and, 211 carbolic reactions and, 210 folate and, 122 niacin and, 119 obesity and, 373 riboflavin and, 118 thiamin and, 117 vitamin A, 99 vitamin B6 and, 121 vitamin B12 and, 123–124 vitamin C and, 113 vitamin D and, 103–104 waste excretion and, 211 Metabolites, 17 Metformin, 335t Methionine, 76 Methotrexate, 123 Microalbuminuria, 395, 439 Micronutrients, term infants and, 240–241 Microvilli, 204 Midarm circumference measurement, 16 Middle adulthood (ages 40 through 70) nutrition in, 270, 270t psychosocial development and, 269–270, 270t Migraine headaches, 550b Milk milk-alkali syndrome, 141, 143, 466 milk anemia, 256 milk-based supplements, 280–281 milk equivalents, 44b
665
Milk exchange list, 565 carbohydrates and, 42 fats and, 57 Milliequivalents, 178, 179 Milligrams, 179 Milling, 41 Milliosmole, 179 Minerals. See also Trace minerals calcium, 134–143 chloride, 150 classification of, 134 diabetes and, 404 functions of, 133–134 kidney disease and, 448 magnesium and, 148–150 major minerals, 136 older adults and, 278 phosphorus, 141–145 potassium, 147–148 pregnancy and lactation and, 221–223 sodium, 145–146 sulfur, 142t supplementation and, 169 term infants and, 240–241 ultratrace minerals, 165–167 Misdiagnosis, poor dietary preparation and, 312–313 Mobility, nutritional status and, 16 Modified Food Guide MyPlate for People Over 70 Years of Age, 275–276 Modular supplements, 316 Molds, 295 Molecules, 34 Molybdenum, 143t, 165 Monoamine oxidase inhibitors (MAOI) foods effects on, 342 tyramine interactions and, 341–343 tyramine-rich foods and, 342–343 Monoglycerides, 48–49 Monosaccharides, 35 Monounsaturated fats, 56, 400–402 Monounsaturated fatty acids, 49–50 Morbidity, 313 Morning sickness, 227 Mortality rates, 23 Motivational interviewing, 399 Mouth disorders of, 460 ulcerations and, 509 Mucosa, 198 Mucus, 198 Multiple causation, cardiovascular risk and, 428–429 Multivitamins, brand-name vs. generic, 129 Muscle fibers fast-twitch, 356b slow-twitch, 356b Musculoskeletal system, older adults and, 273 Muslim Americans, 29 Mycotoxins, 295 Myelin, 123, 125 Myocardial infarction, 429, 431, 438 Myoglobin, 151 MyPlate, 8, 8f, 42 adolescents and, 261t adults and, 270t
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diabetic clients and, 403, 403f food intake information and, 15 general guidelines, 20 older adults and, 275–276, 276t school-aged children and, 259t soybean guide, 427f toddlers and, 255t Myxedema, 158
N Nails, nutritional assessment and, 16 Narcolepsy, 110 Nasogastric tubes, 318 Nasojejunal tubes, 318 National Weight Control Registry, 378 Natural food intoxicants, 296–297 Nausea, 510, 550b Necrotizing enterocolitis, 246 Negative feedback cycle, 157 Negative nitrogen balance, 71–72 Nelfinavir, 334 Neoplasm, 496 Nephritis, 439 Nephron, 436, 437f Nephropathy, diabetes and, 394 Nephrosclerosis, 439 Nephrotic syndrome, 439 Nervous system, older adults and, 273–274 Neural tube defects, 199, 219–220, 220b Neuropathy, diabetes and, 394 NHANES surveys, 263 Niacin deficiency, 119–120 drug interactions and, 333t, 343 niacin equivalents, 120 Nicardipine, 335t, 337 Nickel, 166 Nifedipine, 337 Night blindness, 100 Night blindness, gestational, 221 Nisoldipine, 337 Nitrogen balance, 71–72 Nitrogen-fixing bacteria, 77 Nitrous oxide anesthesia, 343–344 No added sugar, 36 Non-insulin-dependent diabetes mellitus, 388–389 Nonessential amino acids, 70 Nonessential nutrients, 4 Nonheme iron, 151 Nonnutrative sweeteners, 37, 37t Nontropical sprue, 208 Norfloxacin, 336t, 339 Norovirus, 289 Norwalk virus, 291t Nucleoproteins, 74 Nursing-bottle syndrome, 41 Nursing homes, 271, 282–284 Nutraceuticals, 274, 503 Nutrient delivery enteral tube feeding, 317–323 food service in institutions, 307 iatrogenic malnutrition and, 313 meal service patterns, 307 nutritional care importance, 313 nutritional care services, 307–313
oral delivery, 314–317 parenteral nutrition, 323–326 Nutrients. See also Dietary supplements; Drug interactions athletic performance enhancement and, 352 classes of, 4 conditionally essential nutrients, 4 energy values and, 85–86 food density and, 92 nonessential nutrients, 4 nutrient-drug interactions, 332t–333t, 335t storage and, 210–211 Nutrigenetics, 5 Nutrigenomics, 5–6 Nutrition educators, 378–379 Nutrition screening, 308–310 for cholesterol, 419b for drug interactions, 359 of HIV-infected clients, 538–539 of older adults, 282 of terminally ill, 547–548, 547b of young children, 257b Nutritional care, 12–22 Nutritional care services assessment and, 308–310 client care conference and, 310 counseling and, 310 diagnostic procedures and, 311–313 diet manuals and, 310–311 food acceptance records and, 310 monitoring and, 310 nutrient delivery decision-making tree, 309f Nutritional counseling, 310 Nutritional monitoring, 310 Nutritional planning/intervention, 18–19 Nutritional status, 12
O Oatmeal, 38 Obesity. See also Food intake; Weight management abdominal obesity, 370 body build and, 375 body image disturbances and, 370 breastfed infants and, 244 brown fat and, 373 cancer and, 500–501 cardiovascular disease and, 421 children and adolescents and, 263–264, 263b, 264t classification of, 365t cultural expectations and, 369 determining, 374 documented prejudice and, 369 environment and, 368 estimated risk of, 263 fat cell number and, 373 genetics and, 264, 368 gluteal-femoral obesity, 370 hypothalamus and, 373b medical consequences of, 370 metabolic chain enzymes and, 373 metabolism efficiency and, 373 prevalence of, 367, 367f
psychological consequences and, 369–370 renal disease and, 439 risk of, 263 set point theory and, 373 severity of, 369 social consequences of, 369 strategies to prevent in childhood, 264t Obesogens, 373–374 Objective data, nutritional assessment and, 15–16 Obligatory excretion, 185–186 Ofloxacin, 336t, 339 Older adults Alzheimer’s disease and, 274 anorexia of aging, 279 arthritis and, 278–279 carbohydrates and fiber and, 276–277 cardiovascular system changes and, 274–275 dehydration signs and, 278t dementia and, 275 demographics of aging, 270–271 dental health and, 272 dietary interventions and, 280–281 ears and, 271 eating with dentures and, 281 endocrine system changes and, 274 energy nutrients and balance, 276–278 exercise and, 277 eyes and, 271 fats and, 277 food insecurity and, 280, 280b food intake of, 284b gastrointestinal system changes and, 280–281 hospitalization of, 283 immunity changes and, 275, 276t independent living elderly, 282 institutionalized elderly, 282–284 integumentary system changes and, 271 life expectancy and, 270 meal management, 282b minerals and, 278 multi-nutritional assessment and, 281–282 musculoskeletal system changes and, 273 MyPlate guidelines and, 275–276, 276t nervous system changes and, 273–274 nose and tongue and, 271–272 nursing home residency and, 271 nutrition screening tools and, 282 nutritional assessment and, 281–282 nutritional supplements and, 281 oral cavity function, 282b osteoarthritis and, 279 osteoporosis and fractures and, 279 Parkinson’s disease and, 274, 276 physical changes in aging, 271–274 pressure ulcers and, 280 proportion of population, 270–271 protein and, 277 protein-kilocalorie malnutrition and, 279 psychosocial development and, 270t, 271 psychosocial factors, 282b refeeding syndrome and, 527 rheumatoid arthritis and, 279 sensory system changes and, 271–272 sodium intake in, 278t
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INDEX urinary system changes and, 273 vitamins and, 277–278 water and, 278 weight loss and, 279 Oliguria, 439, 545 Omega-3 fatty acids, 56, 274, 425–426 Omega-6 fatty acids, 56 One starch exchange, 21–22 Opportunistic infections, 534–535 Opsin, 100 Optic nerve, 100 Oral cavity, food pathway and, 199 Oral hypoglycemic agents, 397, 398t Oral nutrient delivery assisted feedings vs. self-feeding, 315 disabled client and, 315 disease-specific formulas and, 317 eating environment and, 314–315 elemental or predigested formulas and, 317 intact or polymeric formulas and, 316 menu and, 314 modular supplements and, 316 supplemental feedings and, 315–316 Oral rehydration solutions, 192, 253 Organ dysfunction, HIV/AIDS and, 536 Orlistat, 377t Osmolality, 321 Osmosis, 179 Osmotic demyelinating disease, 181 Osmotic pressure determination of, 179 osmolarity and nutrition, 179–180 serum electrolytes and, 180 Osteoarthritis, 273, 279 Osteoblasts, 110, 134 Osteocalcin, 110 Osteoclasts, 101, 134 Osteodystrophy, 446 Osteomalacia, 106 Osteopenia, 139 Osteoporosis developmental factors and, 139 diagnosis and, 140 lifestyle factors and, 139–140 loss of height and, 273 older adults and, 279 postmenopausal, 223 pregnancy and, 222, 223 prevalence of, 140 treatment of, 140 Ostomy, 318 Overenthusiastic weight control, 262 Oversalting, 272 Overweight. See Obesity; Weight management Ovum, 217 Oxalates, 449 Oxalic acid, 152, 449, 450t Oxalic acid poisoning, 138 Oxidation, 99b, 210 Oxidative stress, 229, 262 Oxylates, 137
P P-glycoprotein, 337 Palliative care, terminally ill and, 546
Pallor, vitamin B12 deficiency and, 125 Palpitations, 122 Pancreas, digestion and, 198 Pancreatic diseases cystic fibrosis, 490–491 pancreatitis, 488–490 Pancreatitis acute pancreatitis, 488–489 chronic pancreatitis, 489–490 heridetary pancreatitis, 489 Pantothenic acid, 112t, 126 Paralytic ileus, 459, 525 Paralytic shellfish poisoning, 295 Parasitic infections, 293–294 Parathyroid deficiency, 141 Parathyroid hormone, 104, 134, 135f, 446 Parenteral nutrition catheter placement and, 323f complete parenteral nutrition, 324–326 drug interactions and, 333 indications for, 324b macronutrient guidelines and, 522 monitoring, 326b peripheral parental nutrition, 323–324 Paresthesias, extremity, 126 Parkinson’s disease, 274, 276b, 343 Parkland formula, 520 Pellagra, 119, 120, 120b Penicillin, 336t Pepsinogen, 201 Peptic ulcers complications and, 466 medications and, 466 pathophysiology and, 465–466 signs and symptoms and, 466 surgery and, 466–467, 468f treatment and, 466–467 Peptidases, 204 Peptide bonds, 66, 201 Peptide hormones, 372 Percent healthy body weight, 17 Percentage body fat, 365 Percutaneous endoscopic jejunostomy, 318 Perforated ulcers, 466 Perinatal mortality, 223–224 Periodontal disease, 272 Perioperative immunonutrition, 457 Peripheral parenteral nutrition, 323–324, 323f Peristalsis, 198, 518 Peritoneal dialysis, 441–442 Peritonitis, 466 Pernicious anemia, 110, 123, 124 Perspiration, water loss and, 185–186 Pesticide residues, 296 Pesticides, 296 pH scale, 182 Pharmaceuticals in drinking water, 185 Pharmacodynamics, 331 Pharmacokinetics, 331 Pharynx, food pathway and, 200 Phenelzine, 336t Phenotypes, 114 Phentermine, 377t Phentermine and extended-release topiramate, 377t Phenylalanine, 69
667
Phenylalanine hydroxylase, 69 Phenylketonuria, 68f, 69–70, 163, 219, 244 Phenytoin, 331, 336t, 337, 343 Phosphate binders, 446 Phospholipids, 127, 143 Phosphorus calcium balance and, 144 control mechanism and, 144 critical care patients and, 526 deficiency and, 144–145 dietary reference intakes and sources, 144 foods high in, 446b hypophosphatemia, 144 kidney disease and, 445–446 refeeding syndrome and, 145 supplementation for infants, 242t toxicity and, 142t, 145 Photosynthesis, 34–35 Phylloquinone, 110 Physical activity. See also Exercise adaptive responses and, 90 aerobic exercises, 90b anaerobic exercises, 90 appetite and, 90 dietary guidelines and, 91 energy expenditure and, 88–90 energy needs and, 89 inactivity in adults, 270b kcalorie expended by activity, 89 thermic effect of exercise and, 89–90 weight management and, 375 Physical growth adolescence and, 260 infancy and, 239, 240t preschool children and, 256–257 school-age child and, 258 toddlers and, 254 Physicians, 13 Phytates, 138 Phytic acid, 138, 152 Phytochemicals, 5 Phytonadione, 110 PIC lines, 323–325 Pica, 228 Pitting edema, 177 Placebo, 345 Placenta, 217 Plant foods, proteins and, 76, 76b Plant stanols and sterols, 60, 425 Plasma proteins, water balance and, 180 Plumbism, 167–168 Plumpy’nut, 73b Pneumocystis pneumonia, 535 Polydipsia, 392 Polymeric formulas, 316 Polypeptides, 66, 201 Polyphagia, 392 Polypharmacy, 358 Polyphenols, iron absorption and, 152 Polysaccharides, 35, 37–39 Polyunsaturated fats, 57 Polyunsaturated fatty acids, 49–51 Polyuria, 392 Poor dietary preparation, misdiagnosis and, 311–312 Positive feedback cycle, 414
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Positive nitrogen balance, 71 Postprandial abdominal pain, 465 Postprandial hypotension, 467–468 Potable water, 11b, 73, 185 Potassium deficiency and, 148 high-potassium foods, 445b hyperkalemia and, 148–149 hypertension and, 418 hypokalemia and, 148 kidney disease and, 444–445, 445b low-potassium foods and beverages, 445b potassium pumps, 179 sources of, 148 toxicity and, 142t, 148 Pravastatin, 337 Prebiotics, 467b Precursors, 99 Predigested formulas, 317 Preeclampsia, 149, 229 Pregnancy and lactation. See also Breastfed infant; Breastfeeding mother alcohol intake and, 224–225 caffeine and, 226 cat litter and, 226 constipation and, 227–228 diabetes and, 390 energy needs and, 218, 218t fatty acid needs and, 218 fish intake and, 226 food assistance and, 224 food-safety guidelines and, 292b gestational diabetes and, 229–230 heartburn and, 228 hyperemesis gravidarum and, 228 hypertensive disorders of pregnancy, 229 leg cramps and, 227 meal patterns and, 224 mineral needs and, 221–223 morning sickness and, 227 neural tube defects and, 219–220 normal pregnancy length, 240 nutritional status and, 217–218 pica and, 228 preeclampsia and, 229 protein needs and, 218–219 ready to eat meals and, 225 recommended weight gain and, 224 soft cheeses and, 225 substances to avoid, 225–226 teenage pregnancy, 223, 224 undercooked meat and, 226 unwashed produce and, 226 vitamin needs and, 219–221, 219t water and weight gain and, 223–224 Premature infants necrotizing enterocolitis and, 246 possible contributors to, 247 providing nourishment and, 246 tracking progress and, 246 Preoperative carbohydrate loading, 458 Preschool children (ages 3 to 6 years) nutrient needs and intake and, 257 nutrition screening for, 257b physical growth and development and, 256–257 psychosocial development and, 256
Pressure ulcers, 280, 308, 550b Presystemic clearance, 331 Primary amenorrhea, 262 Prions, 293 Prior-sanctioned substances, 298 Prioritizing problems, 18–19 Probiotics, 467b Procarbazine, 336t Processed meat, cancer links and, 501 Propofol, 522 Proportionality, medical care goals and, 551 Prostaglandins, 53 Proteins amino acids, 66–67, 70 anabolism and, 71 athletic performance enhancement and, 353–354 blood albumin and, 66 body functions and, 70–75 body processes and, 73–74 calcium absorption and, 138 catabolism and, 71 circulation and, 74 classification of, 75–78 comparative sources of, 79 complementation and, 77 complete proteins, 75 composition of, 65–70 diabetes and, 402 dietary reference intakes and, 78–79 digestion and, 204 as energy source, 74–75 enzymes and, 74 fighting infections and, 521 grams of protein per exchange, 76 hair and, 66 hemoglobin and, 66 hormones and, 73–74 immunity and, 74 incomplete proteins, 76–78 individualized protein requirements, 79 kidney disease and, 443–444 kidney function and, 277 levodopa and, 343 limiting amino acids and, 76 maintenance and growth and, 71–72 mimicking fat-soluble vitamin deficiencies, 111 nitrogen balance and, 71–72 nucleoproteins, 74 older adults and, 277 phenylketonuria and, 69–70 plant foods and, 76, 76b pregnancy and lactation and, 218–219 protein-calorie malnutrition, 72, 279 protein-energy malnutrition, 72, 180 protein-kilocalorie malnutrition, 281 protein loss vs. fat loss, 368–369 provision of structure and, 70 scar tissue and, 66 term infant and, 241t thermic effect and, 88 vegetable sources of, 77, 78 vegetarianism and, 78 warfarin interactions and, 341 wise protein choices, 79
Proteinuria, 439 Prothrombin, 110 Proto-oncogenes, 497 Provitamins, 99 Pruritus, 550b Psychological consequences food restriction and, 370b obesity and, 369–370 Psychosocial development adolescence and, 260 Erikson’s theory of, 238, 239t infancy and, 239 middle adulthood and, 269–270, 270t preschool children and, 256 school-age children and, 258 toddler’s and, 253–254 young adulthood and, 269, 270t Psychotropic drugs, breastfeeding and, 233 Psyllium, 426–427 Puberty, 260 Public policies, effectiveness of, 9 Pulmonary disease, nutrient depletion in, 526 Pulmonary edema, 177, 526 Purging, 381 Purines, 165, 450, 450t Pyelonephritis, 444 Pyloric sphincter, 189, 201 Pyridoxine, 121, 339 Pyruvate, 210
Q Qsymia, 377t Quality of life, terminally ill patients and, 551–552 Quetelet Index, 17. See also Body Mass Index
R Race, cardiovascular disease and, 416 Radiation enteritis, 510 Rasagiline, 342 Reabsorption, tubular, 437, 438f Rebound scurvy, 116 Recommended Dietary Allowances, 19, 19b, 558–560 Rectum, 205 Red meat, cancer links and, 501 Red wine, coronary artery disease and, 429 Reduced body mass, 379–380 Reduced sugar, 36 Refeeding syndrome, 145, 527 Registered dietitians, 13 Registered nurses, 13 Regurgitation, 318 Religious customs, food restrictions and, 28–29 Renal osteodystrophy, 446 Renal solute loads, 242 Renal system, acid-base balance and, 184 Renal tubule, 436 Renin, 181–182 Rennin, 201 Residues, 296, 458t Respiratory acidosis, 526 Respiratory alkalosis, 184, 526 Respiratory failure, 524
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INDEX Respiratory function, impaired nutritional status and, 525 Respiratory system, acid-base balance and, 183 Resting energy expenditure, 87–88 Retina, 100 Retinoic acid syndrome, 221 Retinol, 98 Retinol activity equivalents, 98 Retinopathy, diabetes and, 394 Rhabdomyolysis, 354 Rheumatoid arthritis, older adults and, 279 Rhodopsin, 100 Riboflavin, 118–119 Ribonucleic acid (RNA), 74 Rickets, vitamin D and, 105–106 Rickets, Vitamin D resistant, 145 Rifampin, 334 Rotavirus, 252 Roux-en-Y, 376–377 Rugae, 201
S Saccharin, 37 Salivary glands, 199 Salmonella infection, 290, 291t Salmonellosis, 290 Salt intake, hypertension and, 418 Salt substitutes, 344–345 Sapropterin dihydrochloride, 70 Saquinavir, 350 Sarcomas, 496 Sarcopenia, 273b Satiety, cancer patients and, 509 Satiety value, fats and, 52 Saturated fats, 51, 425, 447 Saturated fatty acids, 49–50 Scar tissue, 66b Schizophrenia, 119 School-age child (ages 6 to 12 years) good nutrition indications and, 259t meal patterns and behaviors, 259 MyPlate serving guidelines and, 259t nutritional needs and concerns, 259 physical growth and development and, 258 psychosocial development and, 258 school nutrition and, 259–260, 260b School foods, 260b Scombroid fish poisoning, 295 Screening. see Nutrition screening Scurvy, 114–115 Seafood, toxic, 295 Secondary diabetes, 390 Secondary hypertension, 413 Secretion, tubular, 437, 438f Secretions, digestion and, 198–199 Seizure control, ketogenic diet for, 336 Selegiline, 336t, 342 Selenium deficiency and toxicity, 163 intakes and sources, 163 toxicity and, 143t Self-care, diabetes and, 406–407 Self-feeding, 315 Self-monitoring blood glucose and, 395–396 weight management and, 376b
Semisolid food introduction, infants and, 246–248 Senior Farmer’s Market Nutrition Program, 280 Sensible water losses, 185–186 Sensory system, older adults and, 271–272 Sepsis, burn patients and, 520–521 Set point theory, obesity and, 373 Sex hormones, 262 Shellfish, 226 Shortness of breath, 122 Sibutramine, 377t Sickle cell disease, 67 Sildenafil, 348 Silicon, 166 Simple carbohydrates, 34–35 Simvastatin, 336t, 337 Sitosterolemia, 425 Skin nutritional status and, 16 synthesis of, 106–107 Vitamin D, as source of, 106–107 Slower eating, weight management and, 376b Small intestine absorption and, 204–206 carbohydrate digestion and, 202 cross-section of, 206f fat digestion and, 202–204 protein digestion and, 204 Smell, older adults and, 272 Social consequences, obesity and, 369 Sodium calcium balance and, 138 deficiency and, 146 dietary reference intakes, 145–146 fluids and lithium and, 344 fresh and processed foods and, 147t hyponatremia and, 146 kidney disease and, 444 kidney failure and, 440 mean intake of, 146f older adults and, 278t sodium pumps, 179 table salt, 145 toxicity and, 142t, 146 Sodium-controlled diets, 427–429, 430t–431t labeling requirements and, 429t sample menus for, 430t–431t sodium content in beverages, 430t Soft cheeses, 225 Solubility, 38 Soluble fiber, 39 Solutes, 175 Somatostatin, 391 South Beach diet, 379t Soy protein, 245, 427 Spare body protein, 39 Special diets, 310 Special formulas, 245 Specific dynamic action, 88 Specific gravity, 190, 344 Sphincters, 197 Spina bifida, 220 Spores, 241 St. John’s wort, 347, 349–350, 349t Standard feedings, 317
669
Standard formulas, 316 Staph infection, 292 Staphylococcus aureus, 292 Starch/bread exchange list, 42, 563 Starches, 21–22, 34, 37–38, 41–42 Starvation critical care and, 516–518 fuel consumption during, 517f gluconeogenesis and, 516–517 glycogenolysis and, 516 ketosis and, 517 lipolysis and, 517 prolonged, 517–518 refeeding syndrome and, 527 uncomplicated, 516 Steatorrhea, 139, 209 Sterols, 48 Stevia, 37 Stimulus control, weight management and, 376b Stoma, 478 Stomach food pathway and, 201 full stomach and breathing, 274 Stomach disorders delayed gastric emptying, 464–465 dumping syndrome, 467, 469t gastritis, 464, 464f peptic ulcers, 465–467 postprandial hypotension, 467–468 vitamin B12 deficiency and, 124 Stomatitis, 440, 509, 550b Strokes, 415, 432 Subjective data, nutritional assessment and, 14 Sucralose, 37 Sucrase, 202 Sucrose, 36 Sugars added sugar in U.S. diet, 36, 36b carbohydrates and, 41 converting grams into teaspoons of, 36 in foods, 36 sugar alcohols, 36–37 sugar-free beverages, 36 Sulfonylureas, 398t Sulfur, 142t, 150 Supplemental feedings, 315–316 Supplemental food assistance, 224 Surgery dietary considerations, 455 postoperative nutrition, 459–460 preoperative nutrition, 456–459 weight management and, 376–378 Survival skills, diabetes and, 399 Swallowing difficulty, cancer patients and, 510 Sweat, 185–186 Symptom control, dietary management for, 548 Syndrome of inappropriate antidivresis (SIAD), 181 Systolic pressure, 180, 413
T T-lymphocytes, 511 Table salt, 145
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INDEX
Tapeworms, 294 Taste, older adults and, 271–272 Taste alterations, cancer patients and, 509 Teenage pregnancy, 223, 224 Teeth, nutritional assessment and, 16 Tenuate, 377t Teratogenic chemicals, 234 Teratogenic hyperglycemia, 390 Term infant energy and macronutrients and, 240, 241t micronutrients and, 240–241 minerals and, 240–241 vitamins and, 240 water requirements and, 241 Terminally ill patients breathing difficulty and, 545 cancer patients, 507–512 cessation of eating and drinking, 545 client preference and, 551 cyanosis and, 545–546 dealing with death, 544 dying process and, 544–546 ethical and legal considerations and, 548–552 fluid restriction and, 545 intervention and symptom control, 548 legal issues and, 552 medical care goals and proportionality, 551 mental alertness and, 546 nutrition screening and, 547–548, 547b oliguria and incontinence, 545 palliative vs. curative care and, 546 quality of life and, 551–552 vital sign changes and, 546 Testosterone, 54 Tetany, 106, 141 Tetracycline, 336t, 339 Theory of psychosocial development, 238, 239t, 270t Therapeutic index, 337 Thermic effect of exercise, 89–90 of food, 88 Thiamin, 117–118 Thiaminase, 118 Thiamine, 228 Thiazolidinedione, 398t Third-space losses, 191 Thirst mechanism, 181 Thoracic lymphatic duct, 205 Throat disorders, 460 Thrombus, 414 Thrush, 535, 535f Thymus gland, 511 Thyroid gland, 157–159 Thyroid-stimulating hormone, 157 Thyroxine, 157 Tissue maintenance, 4 Tocopherols, 277–278 Toddlers (ages 1 to 3 years) childcare programs and, 258 dental health and, 258 developing good habits and, 257 food likes and, 254 iron-deficiency anemia and, 256
mealtimes and, 254–255 milk intakes and, 256 MyPlate servings and, 255t new foods and, 255, 257 nutrient needs and intake, 254–255 nutrition screening for, 257, 257b nutritional concerns and, 255–258 physical growth and development, 254 psychosocial development and, 253–254 vitamins and, 254 Tolerable upper intake levels (ULs), 19, 561–562 Tolerance level, 296 Tomato products, 502 Tongue, brushing of, 272 Tongue, nutritional assessment and, 16 Tooth loss, 271 Toxic chemical exposure, 234 Toxic seafood, 295 Toxoplasma gondii, 294 Toxoplasmosis, 226 Trace minerals adult RDA/AI and, 153t–154t best sources of, 153t–154t chromium, 163–164 cobalt, 164 copper, 161–162 excess and deficiency and, 153t–154t fluoride, 159–160 functions of, 153t–154t iodine, 157–159 iron, 150–152, 154–157 manganese, 164 measuring and analyzing, 150 molybdenum, 165 selenium, 162–163 zinc, 160–161 Trans-fatty acids, 49, 51–52, 55 Transcellular fluid, 175, 176f Transferrin, 151 Transient osteoporosis, 222 Transoral incisionless fundoplication, 462 Transport mechanism changes, 338–339 Tranylcypromine, 336t Trauma, 521 Traveler’s diarrhea, 471–472 Triazolam, 336t, 337 Triceps skinfold measurement, 15–16 Trichinella spiralis, 294 Trichinosis, 294 Triglycerides, 49 Triiodothyronine, 157 Trousseau’s sign, 141 Trust, infancy and, 239 Trypsin, 204 Tube placement, enteral tube feeding and, 318–319 Tuberculosis, 105, 535 isoniazid therapy for, 343 Tubular abnormalities, 439 Tumor suppresser genes, 497 Twenty-four hour dietary recall, 15 Type 1 diabetes, 388, 389t Type 2 diabetes, 28, 388–389, 389t Type I interactions, 331, 333 Type II interactions, 333–340 Type III interactions, 340–344
Type IV interactions, 344–345 Typhoid fever, 291t Tyramine, 341–343, 342t
U Ulcerative colitis, 475–479, 475t colonic sulfur metabolism in, 478b genetic factors, 476 smoking’s relation to, 476b Ulcers, 465–467 Ultrasound bone densitometer, 16 Ultratrace minerals, 165–167 Unbalanced nutrition, 9–22 Uncomplicated starvation, 516 Undercooked meat, 226 Underwater weighing, 16 United Kingdom Prospective Diabetes Study (UKPDS), 395, 439 United States Pharmacopeial Convention (USP), 347 Unsaturated fats, 51 Unsaturated fatty acids, 49–50 Unwashed produce, 226 Urea, 211 Uremia, 440 Uric acid stones, 450 Urinary calculus, 449 Urinary placental growth factor, 229 Urinary system, older adults and, 273 Urinary tract infection, 450 Urine acetone, 387–388 testing, 387, 521 water loss and, 186, 188–189 Uterine involution, 231
V Vaginitis, 392 Vanadium, 167 Vascular calcification, 446 Vasopressin, 181 Vegetable exchange lists, 21, 42, 564, 566 Vegetable sources of protein, 77, 78 Vegetables, daily recommendation of, 502–503 Vegetarian diets cobalamin and, 219 Crohn’s disease and, 477b foods chosen in, 78 iron and zinc nutrition and, 153t iron deficiency in toddlers and, 256 kidney disease and, 444 nutritional supplements and, 78 proteins and, 78 Ventilation, 524 Ventilators, 525 Verapamil, 334, 336t Very low-density lipoproteins (VLDL), 419 Villi, 204 Viral infections, 294 Vision, 100 Vital signs, terminally ill and, 546 Vitamin A absorption, metabolism, and excretion, 99 adult RDI/AI and, 99 Bitot’s spot and, 101f body fat reserves and, 100–101
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INDEX body functions and, 99–100 bone metabolism and, 100–101 cancer and, 101 carotenemia and, 103 deficiency and, 101–102 epithelial tissue and, 100 fat as carrier of, 54 forms of, 98–99 hypervitaminosis A, 103 liver disease and, 103 pregnancy and lactation and, 221, 221t pulmonary infections and, 526 sources and interfering factors, 99, 102 toxicity, 102–103 treatment and prevention of, 102 vision and, 100 wound healing and, 521 xerophthalmia and, 101–102 Vitamin B6, 121–122, 228, 333t absorption, metabolism, and excretion, 121 drug interactions with, 339–340 functions, 121 toxicity, 122 Vitamin B12 absorption, metabolism, and excretion, 123–124 deficiency and, 124–125 drug interactions and, 333t, 343–344 functions and, 124 interfering factors and, 125 pregnancy and lactation and, 219, 228 stomach pathology and, 124 toxicity and, 125 Vitamin B-complex drug interactions and, 343–344 folate and, 122–123 niacin, 119–121 riboflavin, 118–119 thiamin, 117–118 vitamin B6, 121–122 vitamin B12, 123–125 Vitamin C absorption, metabolism, and excretion, 113 adrenal glands and, 113–114 adult RDA and, 112 as antioxidant, 113 collagen synthesis and, 113 deficiency and, 114–115 food processing, use in, 116 functions of, 113–114 genetic susceptibility to scurvy and, 114 interfering factors and, 116 iron absorption and, 113 kidney stones and, 116 megadoses and, 116 pulmonary infections and, 526 rebound scurvy and, 116 sources and, 112 stability and preservation and, 115–116 supplementation for infants and, 242t toxicity and, 116 wound healing and, 521 Vitamin D absorption, metabolism, and excretion, 103–104
adult RDI/AI and, 100 bone metabolism and, 104 chronic disease prevention and, 104–105 deficiency disease and, 100, 105–106 dosage and, 108 DRIs and sources, 106–108 drug interactions and, 333t, 343 fat as carrier of, 54 food sources and, 107 functions of, 104–105 hip fractures and, 279 interfering factors and, 108 kidney disease and, 445–446 osteomalacia and, 106 pregnancy and lactation and, 221 rickets and, 105–106 skin synthesis and, 106–107 sources of, 100, 106t supplements and, 107–108, 242t toxicity and, 108 tuberculosis and, 105 Vitamin E adult RDI/AI and, 100 as antioxidant, 108 deficiency disease and, 100, 109 fat as carrier of, 54 functions and, 108–109 narcolepsy and, 110 neurodegenerative diseases and, 108 older adults and, 277–278 sources, stability, and interfering factors, 100, 109, 109t toxicity and, 109 Vitamin K absorption, metabolism, and excretion, 110 adult RDI/AI and, 100 blood clotting and, 110 bone metabolism and, 110 deficiency disease and, 100, 110–111 fat as carrier of, 54 food and, 111 functions of, 110 hyperemesis gravidarum and, 228 intestinal synthesis and, 111 older adults and, 278 sources of, 100, 111 stability and interfering factors and, 111 supplementation for infants, 242t toxicity and, 111 warfarin interactions and, 340–344, 340t Vitamins. See also specific vitamin classification of, 97–98, 98t diabetes and, 404 dietary reference intakes and, 98, 558, 561 fat-soluble vitamins, 98–111 good sources by food groups, 127–128 kidney disease and, 448 nature of, 97–98 older adults and, 277–278 pregnancy and lactation and, 219–221, 219t specific functions and, 97 supplements, 127–128 term infant and, 240 toddlers and, 254 water-soluble vitamins, 111–127 Vomiting, 510, 550b
671
W Waist circumference, 18, 366 Waist and hip measurements, 16 Waist-to-hip ratio measures, 370 Warfarin, 331 bone health and, 278 interactions and, 336t, 337–338 intestinal conditions and, 341 protein binding and, 341 vitamin K interactions and, 340–344, 340t Waste excretion, 211 Wasting syndrome, 536 Water, 173–177. See also Water loss abnormal fluid volume and, 191t absorption and, 175–176 aldosterone release and, 181–182 antidiuretic hormone and, 181 aquaporins and, 174 athletic performance enhancement and, 354–355 balances and imbalances and, 184–193 body weight and, 173 bottled. see Bottled water bottled and municipal water regulations, 185t critical care patients and, 527 cultural influences and, 187 dietary reference intakes and, 147t, 177 edema and, 176–177, 177f electrolyte effects and, 178–180 excessive fluid volume treatment and, 192–193 fluoridation and, 159 functions of, 176b hormonal control and, 182f insufficient fluid volume treatment, 192 intake regulation and excretion, 181–182 older adults and, 278 osmotic pressure and, 179–180 plasma proteins and water balance, 180 potable, 11b, 73 pregnancy and lactation and, 223–224 protein-energy malnutrition and, 180 as solvent, 175 sources of, 184–185 term infant requirements and, 241 thirst mechanism and, 181 usage of, 175–177 water compartments and, 173–175, 174f water intoxication, 177 Water loss average twenty-four hour losses, 190t children and, 189 evaporative water loss calculations, 189–190 fat loss vs., 368–369 in fever, 190 gastrointestinal secretions and, 189 insensible water losses, 185, 189 intake and output, 190–191 perspiration and, 185–186 sensible water losses, 185–186 through the skin, 190 urine and, 186, 188–189 weight indicators and, 189–190
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672
INDEX
Water-soluble vitamins, 111–127. See also specific vitamin B-complex vitamins, 116–127 factors affecting stability of, 99 pregnancy and lactation and, 219–220 vitamin C, 111–116 Weakness, dietary management for, 550b Weaning the infant, 248–249 Weight management. See also Food intake; Obesity; Overweight achieving weight loss, 374–375 behavior modification and, 375–376 body composition and, 368 body fat stores and, 368 body mass index and, 365–366, 366t cancer survivors, 506 children and, 379b determining overweight and obesity, 374 diet therapy and, 374–375 energy imbalance and, 367–368 fat loss vs. water/protein loss, 368–369 five-hundred rule and, 368 nutrition educators and, 378–379 obesity prevalence and, 367, 367f obesity severity and lean body mass, 369 overweight and obesity costs, 364 overweight prevalence and, 367
percentage body fat and, 365 pharmacotherapy and, 376, 377t physical activity and, 375 popular diets, 379t pregnancy and lactation and, 223–224 realistic goals and, 380b reduced body mass, 379–380 surgery and, 376–378, 377f waist circumference and, 366 weight loss advantages, 374 weight loss goals, 374 weight-loss maintenance and, 378 Weight Watchers, 375 Wernicke-Korsakoff syndrome, 483 Wernicke’s encephalopathy, 118, 228 Whole grains, 41–42 Wilson’s disease, 162 Women, Infants, and Children’s program, 10 World Food Program (United Nations), 11 Wounds, dietary management for, 550b
X X-linked recessive trait, 162 Xenical, 377t Xerophthalmia, 101 Xerostomia, 272, 550b
Y Yin and Yang beliefs, 27–28 Yogurt, 467b YOPI (Young, Old, Pregnant, and Immunocompromised) clients, 288b Young adulthood, psychosocial development and, 269, 270t
Z Zinc absorption and, 161 acrodermatitis enteropathica and, 161 calcium absorption and, 138 common cold and, 160 control and, 161 deficiency and, 111, 122, 161 dietary reference intakes and sources, 161 drug interactions and, 333t excretion and, 161 pregnancy and lactation and, 223 toxicity and, 142t, 161 vegetarian diets and, 153t wound healing and, 521 Zone diet, 379t
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