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Preface xvii
All chapters include Resources and References
Chapter 1
Nutrition Basics 1
Introduction 2
Principles of the Science of Nutrition 2
Essential and Nonessential Nutrients 3
Dietary Intake Standards 3
Standards of Nutrient Intake for
Nutrition Labels 4
Carbohydrates 4
Protein 5
Fats (Lipids) 8
Vitamins 10
Phytochemicals 13
Minerals 13
Water 23
Nutrient Functions at the Cellular Level 23
Nutrition Labeling 36
Nutrition Facts Panel 37
Ingredient Label 37
Dietary Supplement Labeling 37
Herbal Remedies 38
The Life-Course Approach to Nutrition
and Health 39
Meeting Nutritional Needs Across
the Life Cycle 39
Dietary Considerations Based on Ethnicity 39
Dietary Considerations Based on Religion 39
Nutrition Assessment 40
Community-Level Assessment 40
Individual-Level Nutrition Assessment 40
Clinical/Physical Assessment 40
Dietary Assessment 40
Anthropometric Assessment 41
Biochemical Assessment 42
Monitoring the Nation’s Nutritional Health 42
Public Food and Nutrition Programs 42
WIC 43
Nationwide Priorities for Improvements
in Nutritional Health 43

Nutrition and Health Guidelines

for Americans 44
Dietary Guidelines for Americans 44
ChooseMyPlate.gov 44
USDA’s Food Groups 45
Chapter 2
Preconception Nutrition 49
Introduction 50
Preconception Overview 50
2020 Nutrition Objectives for the Nation
Related to Preconception 50
Reproductive Physiology 51
Female Reproductive System 51
Male Reproductive System 54
Nutrition and Fertility 56
Undernutrition and Fertility 56
Body Fat and Fertility 56
Nutrient Status and Fertility 57
Case study 2.1 Cyclic Infertility with Weight Loss

and Gain 57

Nutrition During the Periconceptional

Period 60
Periconceptional Folate Status 60
Periconceptional Iron Status 62
Recommended Dietary Intake
and Healthy Dietary Patterns
for Preconceptional Women 63
Influence of Contraceptives on
Preconceptional Nutrition Status 64
Nutritional Side Effects of Hormonal
Contraception 64
Model Preconceptional Health
and Nutrition Programs 64
Preconceptional Benefits of WIC 65
Decreasing Iron Deficiency in Preconceptional
Women in Indonesia 65
Preconception Care: Preparing for Pregnancy 65
The Nutrition Care Process 66
The Nutrition Care Process Related to the
Preconception Period 66
NutritioN Care ProCess (NCP)
Case study 2.2 Male Infertility 66
Chapter 3
Preconception Nutrition 70
Conditions and interventions
Introduction 71
Weight Status and Fertility 71
Obesity, Body Fat Distribution, and Fertility 71
Case study 3.1 Anna Marie’s Tale 73
Underweight and Fertility 73
Anorexia Nervosa, Bulimia Nervosa,
and Fertility 74
Women, Exercise, and Fertility 74
Diabetes Prior to Pregnancy 75
Nutritional Management of Diabetes
Prior to Pregnancy 76
Polycystic Ovary Syndrome and Fertility 77
Nutritional Management of PCOS 78
Phenylketonuria (PKU) 78
Maternal PKU 79
Nutritional Management of PKU 79
Celiac Disease 79
Case study 3.2 Celiac Disease 80
Nutritional Management of Celiac Disease 80
Premenstrual Syndrome 83
Treatment of PMS 84
Chapter 4
Nutrition During Pregnancy 86
Introduction 87
The Status of Pregnancy Outcomes 87
Infant Mortality 87
Low Birthweight, Preterm Delivery,
and Infant Mortality 89
Reducing Infant Mortality and Morbidity 90
Physiology of Pregnancy 90
Maternal Physiology 90
Normal Physiological Changes During
Pregnancy 91
The Placenta 94
Embryonic and Fetal Growth
and Development 96
Critical Periods of Growth and Development 96
Fetal Body Composition 98
Nutrition, Miscarriage, and Preterm Delivery 100
Developmental Origins of Health and Disease 101
Pregnancy Weight Gain 103
Pregnancy Weight Gain Recommendations 103
Nutrition and the Course and Outcome
of Pregnancy 106
Famine and Pregnancy Outcome 106

Energy and Nutrient Needs During

Pregnancy 107
The Need for Energy 108
The Need for Protein 109
The Need for Fat 109
The Need for Vitamins and Minerals During
Pregnancy 111
Calcium 115
Bioactive Components of Food 117
The Need for Water 118
Factors Affecting Dietary Intake
During Pregnancy 118
Effect of Taste and Smell Changes
on Dietary Intake During Pregnancy 118
Cultural Considerations 119
Healthy Dietary Patterns for Pregnancy 119
Vegetarian Diets in Pregnancy 120
Dietary Supplements During Pregnancy 122
Case study 4.1 Vegan Dietary Patterns During

Pregnancy 123
Food Safety During Pregnancy 124
Assessment of Nutritional Status
During Pregnancy 125
Dietary Assessment During Pregnancy 125
Nutrition Biomarker Assessment 125
Exercise and Pregnancy Outcome 126
Common Health Problems During
Pregnancy 126
Nausea and Vomiting 126
Heartburn 127
Constipation 127
Model Nutrition Programs for Risk
Reduction in Pregnancy 127
Fit Moms/Mamás Activas 127
The WIC Program 127
Chapter 5
Nutrition During Pregnancy 131
Conditions and interventions
Introduction 132
Obesity and Pregnancy 132
Nutritional Recommendations and
Interventions for Obesity During
Pregnancy 132
Hypertensive Disorders of Pregnancy 134
Hypertensive Disorders of Pregnancy, Oxidative
Stress, and Nutrition 134
Chronic Hypertension 134
Gestational Hypertension 135
Preeclampsia 135
Nutritional Recommendations
and Interventions for Preeclampsia 136
Case study 5.1 A Case of Preeclampsia 137
Diabetes in Pregnancy 137
Gestational Diabetes 137
Case study 5.2 Elizabeth’s Story: Gestational

Diabetes 140
Type 2 Diabetes in Pregnancy 141
Management of Type 2 Diabetes in Pregnancy 141
Type 1 Diabetes During Pregnancy 142
Nutritional Management of Type 1 Diabetes in
Pregnancy 142
Multifetal Pregnancies 142
Background Information about Multiple
Fetuses 143
Risks Associated with Multifetal Pregnancy 144
Nutrition and the Outcome of Multifetal
Pregnancy 145
Dietary Intake in Twin Pregnancy 146
Nutritional Recommendations for Women
with Multifetal Pregnancy 146
Case study 5.3 Twin Pregnancy and the Nutrition

Care Process 147

Eating Disorders in Pregnancy 147
Consequences of Eating Disorders
in Pregnancy 148
Treatment of Women with Eating Disorders
During Pregnancy 148
Nutritional Interventions for Women with
Eating Disorders During Pregnancy 148
Fetal Alcohol Syndrome 149
Nutrition and Adolescent Pregnancy 149
Obesity, Excess Weight Gain, and Adolescent
Pregnancy 150
Nutritional Recommendations for Pregnant
Adolescents 150
Evidence-Based Practice 150
Chapter 6
Nutrition During Lactation 153
Introduction 154
Lactation Physiology 154
Functional Units of the Mammary Gland 154
Mammary Gland Development 155
Lactogenesis 155
Hormonal Control of Lactation 155
Secretion of Milk 156
The Letdown Reflex 156

Human Milk Composition 156

Colostrum 157
Water 159
Energy 159
Lipids 159
Protein 159
Milk Carbohydrates 160
Fat-Soluble Vitamins 160
Water-Soluble Vitamins 160
Minerals in Human Milk 161
Taste of Human Milk 161
Benefits of Breastfeeding 161
Breastfeeding Benefits for Mothers 161
Breastfeeding Benefits for Infants 162
Benefits 164
Breast Milk Supply and Demand 164
Establishing a Good Milk Supply
in the First Month 164
Can Women Make Enough Milk? 164
Does the Size of the Breast Limit a Woman’s
Ability to Nurse Her Infant? 164
Is Feeding Frequency Related to the Amount
of Milk a Woman Can Make? 165
Can Women Pump or Express Enough
Milk? 165
Can Women Breastfeed after Breast Reduction
or Augmentation Surgery? 165
The Breastfeeding Process 165
Preparing the Breast for Breastfeeding 165
Breastfeeding Positioning 166
Presenting the Breast to the Suckling
Infant 166
The Breastfeeding Infant 166
Infant Reflexes 166
Mechanics of Breastfeeding 167
Identifying Hunger and Satiety 167
Feeding Frequency 168
Identifying Breastfeeding Malnutrition 168
Case study 6.1 Breastfeeding and Adequate

Nourishment 168

Tooth Decay 169

Vitamin Supplements for Breastfeeding
Infants 169
Maternal Diet 169
Nutrition Assessment of Breastfeeding
Women 170
Energy and Nutrient Needs 170
Maternal Energy Balance and Milk
Composition 171
Weight Loss During Breastfeeding 171
Exercise and Breastfeeding 171
Vitamin and Mineral Supplements 171
Vitamin and Mineral Intakes 172
Functional Foods 172
Fluids 172
Vegetarian Diets 172
Infant Colic 172
Public Food and Nutrition Programs 172
Optimal Duration, Influential Factors,
and U.S. Goals for Breastfeeding 173
Optimal Breastfeeding Duration 173
Breastfeeding Goals for the United States 173
The Surgeon General’s Call to Action to Support
Breastfeeding 173
Breastfeeding Rates in the United States 173
Breastfeeding Promotion, Facilitation,
and Support 175
Prenatal Breastfeeding Education and
Support 175
Breastfeeding Support for Individuals 176
Role of the Health Care System in Supporting
Breastfeeding 176
Lactation Support in Hospitals and Birthing
Centers 177
Model U.S. Baby-Friendly Hospital Programs 177
Lactation Support after Discharge 179
The Workplace 179
The Business Case for Breastfeeding 180
The Community 180
Public Health Support of Breastfeeding 180
Model Breastfeeding Promotion
Programs 181
WIC National Breastfeeding Promotion
Project—Loving Support Makes
Breastfeeding Work 181
Texas 10 Steps to Successful Breastfeeding 181
Chapter 7
Nutrition During Lactation 184
Conditions and interventions
Introduction 185
Common Breastfeeding Conditions 185
Sore Nipples 185
Flat or Inverted Nipples 185
Letdown Failure 186
Hyperactive Letdown 186
Hyperlactation 186
Engorgement 186
Plugged Duct 187
Mastitis 187
Case study 7.1 Chronic Mastitis 188
Low Milk Supply 189
Maternal Medications 189
Herbal Remedies 192
Specific Herbs Used in the United States 193
Alcohol and Other Drugs and Exposures 195
Alcohol 195
Nicotine (Smoking Cigarettes) 196
Marijuana 197
Caffeine 197
Other Drugs of Abuse 198
Opioids 198
Environmental Exposures 198
Neonatal Jaundice and Kernicterus 199
Bilirubin Metabolism 200
Physiologic Versus Pathologic Newborn
Jaundice 200
Hyperbilirubinemia and Breastfeeding 201
Prevention and Treatment for Severe Jaundice 203
Information for Parents 203
Breastfeeding Multiples 203
Infant Allergies 204
Food Allergy (Hypersensitivity) 204
Food Intolerance 204
Case study 7.2 Breastfeeding Premature

Infants 205
Late-Preterm Infants 205
Human Milk and Preterm Infants 206
Medical Contraindications
to Breastfeeding 207
Breastfeeding and HIV Infection 208
Human Milk Collection and Storage 208
Milk Banking 209
Model Programs 210
Breastfeeding Promotion in Physicians’
Office Practices (BPPOP) 210
The Rush Mothers’ Milk Club 210
Chapter 8
Infant Nutrition 213
Introduction 214
Assessing Newborn Health 214
Birthweight and Gestational Age as Outcome
Measures 214
Infant Mortality 215
Combating Infant Mortality 215
Newborn Growth Assessment 215
Normal Physical Growth and Development 216
Motor Development 216
Critical Periods 217
Cognitive Development 218
Digestive System Development 218
Parenting 218
Energy and Nutrient Needs 219
Energy Needs 219
Protein Needs 219
Fat Needs 219
Metabolic Rate, Energy, Fats, and
Protein—How Do They All Tie
Together? 220
Other Nutrient and Non-Nutrient
Needs 220
Growth Assessment 221
Interpretation of Growth Data 222
Feeding in Early Infancy 224
Breast Milk and Formula 224
Cow Milk 225
Development of Infant Feeding Skills 225
Introduction of Complementary Foods 226
Case study 8.1 Baby Samantha Will Not Eat 227
The Importance of Infant Feeding
Position 227
Preparing for Drinking from a Cup 227
Food Texture and Development 228
Complementary Feeding 228
Inappropriate and Unsafe Food Choices 229
Fluids 229
How Much Food Is Enough for Infants? 229
Influence of Food Preferences on Feeding
Behavior 229
Nutrition Guidance 229
The Infant’s Home Environment 230
Supplements for Infants: Special
Circumstances 230
Cross-Cultural Considerations 230
Common Nutritional Issues and
Concerns 231
Colic 231
Iron Deficiency and Iron-Deficiency
Anemia 231
Diarrhea and Constipation 231
Early Childhood Caries (ECC) 232
Food Allergies 232
Lactose Intolerance 233
Peanut Allergy 233
Vegetarian Diets 233
Nutrition Intervention for Risk Reduction 234
Primary Prevention of Obesity during Infancy 234
Model Programs 234

Chapter 9
Infant Nutrition 237
Conditions and interventions
Introduction 238
Infants at Risk 238
Families of Infants with Special Health Care
Needs 239
Energy and Nutrient Needs of Preterm
Infants and Infants with Special Health
Care Needs and/or Developmental Delay 239
Energy Needs 239
Protein Requirements 240
Forms of Protein 240
Fat 240
Vitamins and Minerals 240
Growth of Infants at Risk or with
Special Health Care Needs 241
Growth in Preterm Infants 241
Corrected Age 242
Does Intrauterine Growth Predict Extrauterine
Growth? 242
Interpretation of Growth 244
Nutrition for Infants with Special
Health Care Needs 245
Nutrition Risks to Development 245
Severe Preterm Birth and Nutrition 245
How Sick Babies Are Fed 246
Food Safety 246
What to Feed Preterm Infants 246
Preterm Infants and Feeding 247
Infants with Congenital Anomalies
and Chronic Illness 248
Case study 9.1 Premature Birth in an At-Risk
Family 249
Infants with Genetic Disorders 249
Feeding Problems 250
Case study 9.2 Noah’s Cardiac Condition 251
Nutrition Interventions 251
Nutrition Services 252
Chapter 10
Toddler and Preschooler
Nutrition 254
Introduction 255
Definitions of the Life-Cycle Stage 255
Importance of Nutrition 255
Tracking Toddler and Preschooler Health 255
Healthy People 2020 255
Normal Growth and Development 255
Measuring Growth 256
The WHO and CDC Growth Charts 256
WHO Growth Standards 258
Common Problems with Measuring and Plotting
Growth Data 258
Physiological and Cognitive Development 258
Toddlers 258
Case study 10.1 Meal Time with a Toddler 260
Preschool-Age Children 260
Temperament Differences 261
Food Preference Development, Appetite,
and Satiety 261
Energy and Nutrient Needs 263
Energy Needs 263
Protein 263
Vitamins and Minerals 264
Common Nutrition Problems 264
Iron-Deficiency Anemia 264
Dental Caries 266
Constipation 267
Elevated Blood Lead Levels 267
Food Security 268
Food Safety 268
Prevention of Nutrition-Related
Disorders 269
Overweight and Obesity in Toddlers
and Preschoolers 269
Assessment of Overweight and Obesity 269
Prevention of Overweight and Obesity 269
Treatment of Overweight and Obesity Expert
Committee: Recommendations 270
Dietary Guidelines for Americans 2010 270
Nutrition and Prevention of Cardiovascular
Disease in Toddlers and Preschoolers 271
Vitamin and Mineral Supplements 272
Herbal Supplements 272
Dietary and Physical Activity
Recommendations 272
Dietary Guidelines for Americans 2010 273
ChooseMyPlate 273
Recommendations for Intake of Iron,
Fiber, Fat, and Calcium 274
Fat-Soluble Vitamins 274
Recommended Versus Actual Food Intake 276
Cross-Cultural Considerations 277
Vegetarian Diets 277
Child Care Nutrition Standards 278
Physical Activity Recommendations 278
Nutrition Intervention for Risk Reduction 278
Nutrition Assessment 278
Bright Futures: Nutrition 279

Public Food and Nutrition Programs 279

WIC 279
WIC’s Farmers’ Market Nutrition Program 280
Head Start and Early Head Start 280
Supplemental Nutrition Assistance Program 280
Chapter 11
Toddler and Preschooler
Nutrition 282
Conditions and interventions
Introduction 283
Who Are Children with Special Health
Care Needs? 283
Nutrition Needs of Toddlers and
Preschoolers with Chronic Conditions 285
Growth Assessment 286
Feeding Problems 286
Behavioral Feeding Problems 287
Case study 11.1 A Picky Eater 288
Excessive Fluid Intake 288
Feeding Problems and Food Safety 288
Feeding Problems from Disabilities Involving
Neuromuscular Control 288
Nutrition-Related Conditions 290
Failure to Thrive 290
Toddler Diarrhea and Celiac Disease 290
Autism Spectrum Disorders 292
Muscle Coordination Problems and
Cerebral Palsy 292
Case study 11.2 Early Intervention Services
for a Boy at Risk for Nutrition
Support 293
Pulmonary Problems 294
Food Allergies and Intolerance 294
Dietary Supplements and Herbal
Remedies 295
Sources of Nutrition Services 295
Chapter 12
Child and Preadolescent
Nutrition 298
Introduction 299
Definitions of the Life-Cycle Stage 299
Importance of Nutrition 299
Tracking Child and Preadolescent Health 299
Healthy People 2020 299
Normal Growth and Development 300
The 2000 CDC Growth Charts 300
WHO Growth References 301
Physiological and Cognitive
Development of School-Age Children 302
Physiological Development 302
Cognitive Development 303
Development of Feeding Skills and Eating
Behaviors 303
Energy and Nutrient Needs
of School-Age Children 306
Energy Needs 306
Protein 306
Vitamins and Minerals 306
Common Nutrition Problems 306
Iron Deficiency 307
Dental Caries 307
Prevention of Nutrition-Related Disorders
in School-Age Children 307
Overweight and Obesity in School-Age
Children 307
Addressing the Problem of Pediatric
Overweight and Obesity 310
Nutrition and Prevention of Cardiovascular
Disease in School-Age Children 311
Case study 12.1 Pediatric Overweight 311
Dietary Supplements 312
Dietary Recommendations 312
Recommended Versus Actual Food Intake 314
Cross-Cultural Considerations 315
Vegetarian Diets 315
Physical Activity Recommendations 315
Recommendations Versus Actual Activity 316
Determinants of Physical Activity 317
Organized Sports 317
Nutrition Intervention for Risk Reduction 318
Nutrition Education 318
Nutrition Integrity in Schools 319
Public Food and Nutrition Programs 321
The National School Lunch Program 321
School Breakfast Program 322
Impact of the Healthy, Hunger-Free Kids Act 323
Summer Food Service Program 323
Team Nutrition 323
Nutrition Assessment 323
Model Programs 324
Chapter 13
Child and Preadolescent
Nutrition 326
Conditions and interventions
Introduction 327
“Children Are Children First”—What Does
That Mean? 327

Counting Children with Special Health

Care Needs 327
Nutritional Requirements of Children
with Special Health Care Needs 328
Energy Needs 328
Protein Needs 329
Other Nutrients 329
Growth Assessment 329
Growth Interpretation in Children
with Chronic Conditions 330
Body Composition and Growth 330
Case study 13.1 Adjusting Energy Intake for a
Child with Spina Bifida 331

Specialized Growth Charts 332

Nutrition Recommendations 332
Methods of Meeting Nutritional
Requirements 333
Fluids 335
Eating and Feeding Problems in
Children with Special Health Care
Needs 335
Feeding Challenges for Children with
Health Care Needs 335
Specific Disorders 335
Food Allergies 341
Dietary Supplements and Herbal
Remedies 342
Sources of Nutrition Services 342
Case study 13.2 Dealing with Food Allergies in
School Settings 344
Nutrition Intervention Model Program 345
Chapter 14
Adolescent Nutrition 347
Introduction 348
Nutritional Needs in a Time of Change 348
Normal Physical Growth and Development 348
Changes in Weight, Body Composition,
and Skeletal Mass 350
Psychosocial and Cognitive Development 351
Health and Nutrition-Related Behaviors
During Adolescence 352
Snacking 353
Meal Skipping 354
Eating Away from Home and Family Meals 354
Vegetarian Diets 354
Case study 14.1 Moral and Ethical Dietary
Considerations Leading to
Changes in Dietary Habits in Late
Adolescence 355
Physical Activity 356
Dietary Requirements, Intake,
and Adequacy Among Adolescents 356
Energy and Nutrient Requirements
of Adolescents 356
Energy 357
Protein 358
Carbohydrates 358
Dietary Fiber 358
Fat 359
Calcium 359
Iron 359
Vitamin D 360
Folate 361
Dietary Intake and Nutritional Adequacy 361
Nutrition Screening, Assessment,
and Intervention 362
Dietary Assessment and Screening 362
Nutrition Education and Counseling 368
Promoting Healthy Eating and Physical
Activity Behaviors 368
The Home Environment and Parental
Involvement 369
School-Based Education, School Meals,
and Wellness Activities 369
Community Engagement to Create Nutritionally
Supportive Environments 373
Chapter 15
Adolescent Nutrition 376
Conditions and interventions
Introduction 377
Overweight and Obesity 377
Health Implications of Adolescent
Overweight and Obesity 378
Assessment and Treatment of Adolescent
Overweight and Obesity 378
Supplement Use Among Adolescents 381
Vitamin/Mineral Supplements 381
Ergogenic Supplements Used by Teens 382
Nutrition for Adolescent Athletes 383
Special Dietary Concerns Among
Adolescents 385
Substance Use 385
Iron-Deficiency Anemia 386
Hypertension 386
Hyperlipidemia 388
Diabetes and Metabolic Syndrome 389
Children and Adolescents with Chronic
Health Conditions 389
Dieting, Disordered Eating, and Eating
Disorders 390

Disordered Eating Behaviors and Eating

Disorders 391
Case study 15.1 Following Ana’s Medical

History 396

Chapter 16
Adult Nutrition 399
Introduction 400
Importance of Nutrition 400
Tracking Adult Nutritional Health
and Its Determinants 400
Health Objectives for the Nation 401
Health Disparities Among Groups of Adults 402
Physiological Changes During
the Adult Years 404
Hormonal and Climacteric Changes 404
Body Composition Changes in Adults 404
Continuum of Nutritional Health 405
States of Nutritional Health 406
Energy Recommendations 407
Age-Related Changes in Energy Expenditure 407
Estimating Energy Needs in Adults 407
Energy Adjustments for Weight Change 408
Tracking Energy Expenditure 408
Energy Balance 408
Nutrient Recommendations 408
Macro and Micro Nutrient Recommendations 408
Risk Nutrients 410
Dietary Recommendations for Adults 411
Total Diet Approach 411
Water Intake Recommendations 413
Beverage Intake Recommendations 413
Caffeine and Coffee Intake 413
Alcoholic Beverages 413
Dietary Supplements and Functional Foods 413
Phenolic Compounds: Everyday Functional
Foods 414
The Eating Competence Model 415
Physical Activity Recommendations 416
Guidelines for Physical Activity 416
Promotion of Physical Activity 416
Physical Activity, Body Composition,
and Metabolic Change 417
Diet and Physical Activity 417
Case study 16.1 Run, Kristen, Run 418
Nutrition Intervention for Risk Reduction 418
A Model Health-Promotion Program 419
Public Food and Nutrition Programs 420
Putting It All Together 420
Chapter 17
Adult Nutrition 422
Conditions and interventions
Introduction 423
Overweight and Obesity 423
Prevalence of Obesity and Overweight 423
Etiology of Obesity 423
Effects of Obesity 425
Screening and Assessment 425
Nutrition Assessment 426
Intervention in Obesity and Overweight 426
Comprehensive Weight Management
Program 428
Weight Loss Goals 428
Cognitive Behavioral Therapy
for Weight Management 428
Physical Activity for Weight Management 429
The Challenge of Weight Maintenance 429
Pharmacotherapy for Weight Loss 429
Case study 17.1 Maintaining a Healthy
Weight 430
Bariatric Surgery 430
Cardiovascular Disease 430
Prevalence of CVD 431
Etiology of Atherosclerosis 432
Physiological Effects of Atherosclerosis 432
Risk Factors for CVD 432
Screening and Assessment of CVD 432
Nutrition Assessment 432
Nutrition Interventions for CVD 434
Pharmacotherapy of CVD 435
Metabolic Syndrome 435
Prevalence of Metabolic Syndrome 436
Etiology of Metabolic Syndrome 436
Effects of Metabolic Syndrome 436
Screening and Assessment 436
Nutrition Interventions
for Metabolic Syndrome 437
Case study 17.2 Managing Metabolic
Syndrome in Adults: Dan Goes
Dancing 437
Diabetes Mellitus 437
Prediabetes 437
Prevalence of Diabetes 438
Etiology of Diabetes 438
Physiological Effects of Diabetes 438
Screening and Assessment 438
Nutrition Assessment 439
Interventions for Diabetes 439
Carbohydrate Management 441

Self-Monitored Blood Glucose 442

Physical Activity in Diabetes Management 442
Pharmacotherapy for Type 2 Diabetes 442
Herbal Remedies and Other Dietary
Supplements 442
Cancer 443
Prevalence of Cancer 443
Etiology of Cancer 443
Physiological and Psychological Effects
of Cancer 443
Screening and Assessment 444
Nutrition Assessment Following Diagnosis
and During Treatment 444
Nutrition Interventions for Cancer 444
Alternative Medicine and Cancer
Treatment 445
HIV Disease 445
Prevalence of HIV 446
Etiology of HIV 446
Physiological Effects of HIV 446
Nutrition Assessment in HIV 446
Nutrition Interventions in HIV 447
Chapter 18
Nutrition and Older Adults 449
Introduction 450
What Counts as Old Depends on Who Is
Counting 450
Food Matters: Nutrition Contributes to a Long
and Healthy Life 450
A Picture of the Aging Population:
Vital Statistics 451
Global Population Trends: Life Expectancy
and Life Span 451
Health Objectives for Older Adults 452
Theories of Aging 452
Programmed Aging 453
Wear-and-Tear Theories of Aging 453
Calorie Restriction to Increase Longevity 454
Physiological Changes 455
Body-Composition Changes 455
Changing Sensual Awareness: Taste and Smell,
Chewing and Swallowing, Appetite
and Thirst 456
Nutritional Risk Factors 457
Dietary Recommendations
for Older Adults 462
Nutrient Recommendations 463
Estimating Energy Needs 463
Nutrient Recommendations for Older
Adults: Energy Sources 465
Age-Associated Changes: Nutrients
of Concern 466
Nutrient Supplements: When, Why, Who,
What, and How Much? 469
Dietary Supplements, Functional Foods,
and Complementary Medicine 470
Nutrient Recommendations: Using the Food
Label 472
Cross-Cultural Considerations in Making
Dietary Recommendations 472
Food Safety Recommendations 472
Physical Activity Recommendations 473
Physical Activity Guidelines 473
Nutrition Policy and Intervention
for Risk Reduction 474
Nutrition Education 474
Case study 18.1 JT—Spiraling Out
of Control? 474
Community Food and Nutrition
Programs 475
Store-to-Door: A Nongovernmental Service
that Supports Aging in Place 476
OAANP: Promoting Socialization and Improved
Nutrition 476
The Promise of Prevention: Health Promotion 477
Chapter 19
Nutrition and Older Adults 479
Conditions and interventions
Introduction: The Importance of Nutrition 480
Nutrition and Health 481
Heart Disease 482
Prevalence 482
Risk Factors 482
Nutritional Remedies for Cardiovascular
Diseases 482
Stroke 484
Prevalence 484
Etiology 484
Effects of Stroke 484
Risk Factors 484
Nutritional Remedies 485
Hypertension 485
Prevalence 485
Etiology 485
Effects of Hypertension 485
Risk Factors 486
Nutritional Remedies 486

Diabetes: Special Concerns

for Older Adults 486
Effects of Diabetes 487
Nutritional Interventions 488
Obesity 489
Definition 489
Prevalence 489
Etiology, Effects, and Risk Factors
of Obesity 489
Nutritional Remedies 490
Osteoporosis 491
Definition 491
Prevalence 491
Etiology 491
Effects of Osteoporosis 492
Nutritional Remedies 493
Other Issues Affecting Nutritional
Remedies 493
Oral Health 494
Gastrointestinal Diseases 495
Gastroesophageal Reflux Disease
(GERD) 495
Stomach Conditions Affect Nutrient Availability:
Vitamin B12 Malabsorption 495
Constipation 497
Inflammatory Diseases: Osteoarthritis 499
Etiology 499
Effects of Osteoarthritis 499
Risk Factors 499
Case study 19.1 Bridget Doyle Remembers

Laura 500
Cognitive Impairment, Dementia,
and Alzheimer’s Disease 501
Definition 501
Prevalence 501
Etiology of Cognitive Impairment 501
Effects of Cognitive Impairment 502
Nutrition Interventions for Cognitive
Impairment 502
Polypharmacy: Prescription and
Over-the-Counter Medications 503
Medication Effects on Physical, Mental,
and Financial Status 503
Medication Effects on Food
Consumption 503
Low Body Weight/Unintentional
Weight Loss 505
Definition 505
Etiology and Effects 505
Case study 19.2 Ms. Wetter: A Senior Suffering
Through a Bad Stretch 505

Nutrition Interventions 506

Dehydration 506
Definition 506
Etiology 507
Effects of Dehydration 507
Nutritional Interventions 507
Rehydrate Slowly 507
Dehydration at End of Life 507
Bereavement 508
Answers to Review Questions 510

Appendix A
Measurement Abbreviations
and Equivalents 517
Appendix B
Body Mass Index (BMI) 519
References 520
Glossary 563
Index 573

Nutrition Basics

Introduction

Need to freshen up your knowledge of nutrition? Or,

do you need to get up to speed on basic nutrition for
the course? This chapter presents information about
nutrition that paves the way to understanding
specific needs and benefits related to nutrition by
life-cycle stage.
Nutrition is an interdisciplinary science focused on
the study of how foods, nutrients, and other food
constituents affect health. The body of knowledge
about nutrition is large and is growing rapidly,
changing views on what constitutes the best nutrition
advice. You are encouraged to stay up-to-date on
the best nutrition advice for diet and health-related
issues.
This chapter centers on (1) the principles of the
science of nutrition, (2) nutrients and other
constituents of food, (3) healthy dietary patterns, (4)
public food and nutrition programs, (5) nutritional
assessment, and (6 ) nationwide priorities for
improvements in the public's nutritional health.

1.1 Principles of the Science of Nutrition Every field

of science is governed by a set of principles that
provides the foundation for growth in knowledge.
These principles change little with time. Knowledge
of the principles of nutrition, listed in Table 1.1, will
serve as a springboard to greater understanding of
the nutrition and health relationships explored in the
chapters to come.
Principle #1 Food is a basic need of humans.
Humans need enough food to live and the right
assortment of foods for optimal health (Illustration
1.1).
People who have enough food to meet their needs
at all times experience food security. They are able
to acquire food in socially acceptable ways—without
having to scavenge or steal food. Food insecurity
exists when the availability of safe, nutritious foods,
or the ability to acquire them in socially acceptable
ways, is limited or uncertain.1

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