www.freebookslides.com Final PDF to printer www.freebookslides.com Wardlaw’s Fifth Edition Contemporary NUTRITION A Functional Approach smi06605_FM_i-xxvii.indd i 12/07/16 11:12 AM www.freebookslides.com WARDLAW’S CONTEMPORARY NUTRITION: A FUNCTIONAL APPROACH, FIFTH EDITION Published by McGraw-Hill Education, Penn Plaza, New York, NY 10121 Copyright © 2018 by McGraw-Hill Education All rights reserved Printed in the United States of America Previous editions © 2015 and 2013 No part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written consent of McGraw-Hill Education, including, but not limited to, in any network or other electronic storage or transmission, or broadcast for distance learning Some ancillaries, including electronic and print components, may not be available to customers outside the United States This book is printed on acid-free paper LMN 21 20 19 18 17 ISBN 978-1-259-70660-8 MHID 1-259-70660-5 Chief Product Officer, SVP Products & Markets: G Scott Virkler Vice President, General Manager, Products & Markets: Marty Lange Managing Director: Lynn Breithaupt Brand Manager: Marija Magner Director, Product Development: Rose Koos Product Developer: Darlene M Schueller Marketing Manager: Jessica Cannavo Market Development Manager: Kristine Rellihan Digital Product Developer: Michael Koot, Ph.D Digital Product Analyst: Christine Carlson Director, Content Design & Delivery: Linda Avenarius Program Manager: Angela R FitzPatrick Content Project Managers: April R Southwood/Jane Mohr/Danielle Clement Buyer: Jennifer Pickel Design: Tara McDermott Content Licensing Specialists: Lori Hancock/Lorraine Buczek Cover Image: © Catherine Murray/Shutterstock Compositor: SPi Global Printer: LSC Communications All credits appearing on page or at the end of the book are considered to be an extension of the copyright page Library of Congress Cataloging-in-Publication Data Names: Wardlaw, Gordon M | Smith, Anne M., 1955 | Collene, Angela Title: Wardlaw’s contemporary nutrition : a functional approach Other titles: Contemporary nutrition : a functional approach Description: Fifth edition / Anne M Smith Ph.D., R.D.N., L.D., Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Angela L Collene M.S., R.D.N., L.D | New York, NY : McGraw-Hill Education, [2018] | Includes index Identifiers: LCCN 2016042223 | ISBN 9781259706608 (alk paper) Subjects: LCSH: Nutrition Classification: LCC QP141 W377 2018 | DDC 613.2—dc23 LC record available at https://lccn.loc.gov/2016042223 The Internet addresses listed in the text were accurate at the time of publication The inclusion of a website does not indicate an endorsement by the authors or McGraw-Hill Education, and McGrawHill Education does not guarantee the accuracy of the information presented at these sites mheducation.com/highered www.freebookslides.com Brief Contents Part One Nutrition: A Key to Health Nutrition, Food Choices, and Health Designing a Healthy Dietary Pattern 37 The Human Body: A Nutrition Perspective 77 Part Two Energy Nutrients and Energy Balance Carbohydrates 119 Lipids 159 Proteins 201 Energy Balance and Weight Control 233 Part Three Vitamins, Minerals, and Water Overview of Micronutrients and Phytochemicals 275 Fluid and Electrolyte Balance 303 10 Nutrients Involved in Body Defenses 333 11 Nutrients Involved in Bone Health 377 12 Micronutrient Function in Energy Metabolism 415 13 Nutrients That Support Blood and Brain Health 443 Part Four Nutrition: Beyond the Nutrients 14 Nutrition: Fitness and Sports 475 15 Eating Disorders 513 16 Undernutrition Throughout the World 545 17 Safety of Our Food Supply 581 Part Five Nutrition: A Focus on Life Stages 18 Nutrition During Pregnancy and Breastfeeding 621 19 Nutrition from Infancy Through Adolescence 663 20 Nutrition During Adulthood 707 Breakfast: ©Corbis/Punchstock; bowl of cereal: ©Medioimages/Photodisc/Getty Images; citrus fruit: ©Creatas/PunchStock; woman hitting volleyball: ©Purestock/SuperStock; pregnant woman: ©Getty Images iii www.freebookslides.com Dear Students, Welcome to the fascinating world of nutrition! Nutrition is our favorite area of science because it is so relevant—we all eat several times a day and the choices we make can have a dramatic influence on health At the same time, though, the science of nutrition can seem a bit confusing One reason for all the confusion is that it seems like “good nutrition” is a moving target; different authorities have different ideas of how we should eat, and nutrition recommendations are subject to change! Do carbohydrates cause weight gain? Do I need to limit saturated fat? Should we eat foods that contain gluten or not? Second, there are so many choices Did you know that the average supermarket carries about 40,000 food and beverage products? The manufacturers of all those products are vying for your attention, but typically, the most aggressively marketed items are not the healthiest How can you identify a healthy product? Third, as a nation, we eat many of our meals and snacks away from home When we eat foods that someone else has prepared for us, we surrender control over what is in our food, where the food came from, and how much of it goes on our plates Undoubtedly, you are interested in what you should be eating and how the food you eat affects you Wardlaw’s Contemporary Nutrition: A Functional Approach is designed to accurately convey changing and seemingly conflicting messages to all kinds of students Our students commonly have misconceptions about nutrition, and many have a limited background in biology or chemistry We teach complex scientific concepts at a level that will enable you to apply the material to your own life This marks the fifth edition of Wardlaw’s Contemporary Nutrition: A Functional Approach We are very excited to introduce you to our newest author, Dr. Colleen Spees! Like our other authors, she is a Registered Dietitian Nutritionist, which means she will help you to translate nutrition science into practical advice At The Ohio State University, Dr Spees is a valued expert on cancer, nutritional genomics, and food security We are thrilled that she brings her unique perspective and contemporary ideas to our team As in previous editions, we have written this book to help you make informed choices about the food you eat We will take you through explanations of the nutrients in food and their relationship to health but will also make you aware of the multitude of other factors that drive food choices To guide you, we refer to many reputable research studies, books, policies, and websites throughout the book With this information at your fingertips, you will be well equipped to make your own informed choices about what and how much to eat There is much to learn, so let’s get started! Anne Smith Angela Collene Colleen Spees www.freebookslides.com Wardlaw’s Fifth Edition Contemporary NUTRITION A Functional Approach Anne M Smith Ph.D., R.D.N., L.D Department of Human Sciences, College of Education and Human Ecology The Ohio State University Angela L Collene M.S., R.D.N., L.D Department of Human Sciences, College of Education and Human Ecology The Ohio State University Colleen K Spees Ph.D., M.Ed., R.D.N., L.D., FAND Division of Medical Dietetics and Health Sciences, College of Medicine The Ohio State University www.freebookslides.com About the Authors Monty Soungpradith; © Open Image Studio ANNE M SMITH, Ph.D., R.D.N., L.D., is an associate professor emeritus at The Ohio State University She was the recipient of the 1995 Outstanding Teacher Award from the College of Human Ecology, the 2008 Outstanding Dietetic Educator Award from the Ohio Dietetic Association, the 2006 Outstanding Faculty Member Award from the Department of Human Nutrition, and the 2011 Distinguished Service Award from the College of Education and Human Ecology for her commitment to undergraduate education in nutrition Dr Smith’s research in the area of vitamin and mineral metabolism has appeared in prominent nutrition journals, and she was awarded the 1996 Research Award from the Ohio Agricultural Research and Development Center She is a member of the American Society for Nutrition and the Academy of Nutrition and Dietetics ANGELA L COLLENE, M.S., R.D.N., L.D., began her career at her alma mater, The Ohio State University, as a research dietitian for studies related to diabetes and aging Other professional experiences include community nutrition lecturing and counseling, owner of a personal chef business, and many diverse and rewarding science writing and editing projects Her interests include novel approaches to glycemic control, weight management, and—quite predictably for the mother of three little girls—maternal and child nutrition Mrs Collene currently teaches nutrition at The Ohio State University and Ohio Northern University She is a member of the Academy of Nutrition and Dietetics © RALPHOTOSTUDIO vi COLLEEN K SPEES, Ph.D., M.Ed., R.D.N., L.D., FAND is an academic instructor and researcher at The Ohio State University College of Medicine She earned her Doctorate in Health Sciences at Ohio State with a research focus on Nutritional Genomics and Cancer and her Master’s degree in Exercise Science and Health Promotion from Vanderbilt University Her primary focus of teaching and research involves interventions aimed at providing optimal nutrition for vulnerable populations (http://go.osu.edu/hope) In addition to teaching nutrition at The Ohio State University and Columbus State Community College, Dr Spees also developed and teaches a graduate level Nutritional Genomics course She is the recipient of several national awards from the Academy of Nutrition and Dietetics, including the 2016 Distinguished Practice Award; 2015 Award for Excellence in Oncology Nutrition Research; 2015 Outstanding Dietetic Educator Award; 2013 Nutrition Informatics Video Challenge Teaching Award; 2009 Top Innovator in Education Teaching Award; and has been a Content Expert and Reviewer for the Nutritional Genomics & Food Security Academy Position Papers Dr Spees is also a recognized Fellow of the Academy of Nutrition and Dietetics www.freebookslides.com Acknowledgements Special Acknowledgements It is because of the tireless efforts of a cohesive team of talented professionals that we can bring you the fifth edition of Wardlaw’s Contemporary Nutrition: A Functional Approach We consider ourselves massively blessed to work with the top-notch staff at McGraw-Hill Education We are grateful to Marija Magner, our Brand Manager, for her strategic leadership and vast knowledge of the higher education market We value the efforts of our Marketing Manager, Jessica Cannavo, who connects instructors across the nation with our work and brings us constructive feedback from the field We thank our award-winning Product Developer, Darlene Schueller, who coordinated the editorial team with her keen eye for detail, strong work ethic, and organizational expertise We are grateful to our Content Project Managers, April Southwood and Jane Mohr, and their staff for the careful coordination of the numerous production efforts needed to create the very appealing and accurate fifth edition We appreciate the meticulous work of our copyeditor, Carey Lange; proofreaders, David Staloch and Gina Delaney; our content licensing specialists, Lorraine Buczek and Lori Slattery; and photo editors, Lori Hancock and Mary Reeg We thank our designer, Tara McDermott, who ensured that every aspect of our work is visually appealing—not just on the printed page, but also in a variety of digital formats Finally, we are indebted to our colleagues, friends, and families for their constant encouragement, honest feedback, and shared passion for the science of nutrition In the preparation of each edition, we have been guided by the collective wisdom of reviewers who are excellent teachers They represent experience in community colleges, liberal arts colleges, institutions, and universities We have followed their recommendations, while remaining true to our overriding goal of writing a readable, student-centered text. Also with this edition, we are very pleased to have been able to incorporate real student data points and input, derived from thousands of our LearnSmart users, to help guide our revision LearnSmart heat maps provided a quick visual snapshot of usage of portions of the text and the relative difficulty students experienced in mastering the content With these data, we were able to hone not only our text content but also the LearnSmart probes With the fifth edition of Wardlaw’s Contemporary Nutrition: A Functional Approach, we remember its founding author, Gordon M Wardlaw We are saddened that he lost his battle with cancer on January 19, 2014 He was a brilliant example of a man who acted decisively, followed his dreams, and created a legacy of learning Dr Wardlaw had a passion for the science of nutrition and the research that supports it With his clear teaching style and nononsense nutrition advice, he demonstrated an exceptional ability to translate scientific principles into practical knowledge both inside and outside the classroom This skill is what made his book truly “contemporary.” He was tireless when it came to staying current and relevant to a changing world Each edition benefited from his genuine interest in responding to feedback from students, colleagues, and instructors He retired from teaching and writing in 2005 to pursue another passion—building his dream home in California There, in a home he built with his own two hands, he spent the last years of his life with his family and friends It has been a privilege for all of us to join Dr Wardlaw as coauthors of this textbook For Anne Smith, he was an extraordinary colleague, mentor, and friend, who patiently taught her every step of the textbook writing process, beginning with the sixth edition of Contemporary Nutrition Angela Collene was blessed to have been one of his graduate students at The Ohio State University, when she first began to assist with revisions to his books Colleen Spees was a student in Dr Wardlaw’s first nutrition class at The Ohio State University and now holds his previous tenure-track position Like so many other students, colleagues, and friends, we remember Dr. Wardlaw as a source of vast knowledge, good humor, and inspiration The best way we know to honor our dear friend and mentor is to carry on his legacy of outstanding textbooks in introductory nutrition Wardlaw’s Contemporary Nutrition: A Functional Approach will continue to evolve and reflect current trends and breakthroughs in nutrition science, but Dr Wardlaw’s fingerprints will remain on every page vii www.freebookslides.com Required=Results ©Getty Images/iStockphoto McGraw-Hill Connect® Learn Without Limits Connect is a teaching and learning platform that is proven to deliver better results for students and instructors Connect empowers students by continually adapting to deliver precisely what they need, when they need it, and how they need it, so your class time is more engaging and effective 73% of instructors who use Connect require it; instructor satisfaction increases by 28% when Connect is required Using Connect improves retention rates by 19.8%, passing rates by 12.7%, and exam scores by 9.1% Analytics Connect Insight® Connect Insight is Connect’s new one-of-akind visual analytics dashboard—now available for both instructors and students—that provides at-a-glance information regarding student performance, which is immediately actionable By presenting assignment, assessment, and topical performance results together with a time metric that is easily visible for aggregate or individual results, Connect Insight gives the user the ability to take a just-in-time approach to teaching and learning, which was never before available Connect Insight presents data that empowers students and helps instructors improve class performance in a way that is efficient and effective Mobile Connect’s new, intuitive mobile interface gives students and instructors flexible and convenient, anytime–anywhere access to all components of the Connect platform Students can view their results for any Connect course www.freebookslides.com Adaptive THE ADAPTIVE READING EXPERIENCE DESIGNED TO TRANSFORM THE WAY STUDENTS READ More students earn A’s and B’s when they use McGraw-Hill Education Adaptive products SmartBook® Proven to help students improve grades and study more efficiently, SmartBook contains the same content within the print book, but actively tailors that content to the needs of the individual SmartBook’s adaptive technology provides precise, personalized instruction on what the student should next, guiding the student to master and remember key concepts, targeting gaps in knowledge and offering customized feedback, and driving the student toward comprehension and retention of the subject matter Available on tablets, SmartBook puts learning at the student’s fingertips—anywhere, anytime Over billion questions have been answered, making McGraw-Hill Education products more intelligent, reliable, and precise www.mheducation.com www.freebookslides.com Chapter 2: Designing a Healthy Dietary Pattern 59 FIGURE 2-11 ⊳ A complete nutritional assessment includes anthropometric, biochemical, clinical, and dietary information Environmental status adds further information, rounding out the ABCDEs of nutritional assessment (anthropometric): © Royalty-Free/Corbis; (biochemical): © C Borland/PhotoLink/Getty Images; (clinical): © Fuse/Getty Images; (dietary): © Mike Kemp/Rubberball/Getty Images; (environmental): © Comstock/PunchStock Anthropometric Anthropometric Anthropometric Biochemical Biochemical Biochemical Dietary Dietary Dietary Environmental Environmental Environmental Clinical Clinical Clinical A practical example using the ABCDEs for evaluating nutritional status can be illustrated in a person who chronically abuses alcohol Upon evaluation, the physician notes that this person needs medical attention, including nutrient repletion based on the following nutritional assessment results: ( A) Low weight for height, recent 10-pound weight loss, muscle wasting in the upper body (B) Low amounts of the vitamins thiamin and folate in the blood (C) Psychological confusion, facial sores, and uncoordinated movement (D) Dietary intake of mostly wine and hamburgers for the last week (E) Currently residing in a homeless shelter; $35 in wallet; unemployed RECOGNIZING THE LIMITATIONS OF NUTRITIONAL ASSESSMENT A long time may elapse between the initial development of poor nutritional health and the first clinical evidence of a problem A dietary pattern high in animal and other solid fat often increases blood cholesterol but without producing any clinical evidence for years However, when the blood vessels become sufficiently blocked by cholesterol and other materials, chest pain during physical activity or a heart attack may occur An active area of nutrition research is the development of better methods for early detection of nutrition-related problems such as heart attack risk Another example of a serious health condition with delayed symptoms is low bone density resulting from a calcium deficiency—a particularly relevant issue for adolescent and young adult females Many young women not consume the needed amount of calcium but suffer no obvious effects in their younger years; however, the bone structures of these women with low calcium intakes not reach full potential during the years of growth, making osteoporosis more likely later in life Furthermore, clinical symptoms of some nutritional deficiencies (e.g., diarrhea, inability to walk normally, and facial sores) are not very specific These may have causes other than heart attack Rapid fall in heart function caused by reduced blood flow through the heart’s blood vessels Often part of the heart dies in the process Technically called a myocardial infarction www.freebookslides.com 60 Contemporary Nutrition: A Functional Approach poor nutrition The long time it takes for symptoms to develop and their potential to be vague often make it difficult to establish a link between an individual’s current dietary pattern and nutritional state CONCERN ABOUT THE STATE OF YOUR NUTRITIONAL HEALTH IS IMPORTANT The good news is that people who focus on maintaining nutritional health are apt to enjoy a long, vigorous life For example, a recent study found that women with a healthy lifestyle had a decreased risk for heart attacks (80% reduction) compared to women without such healthy practices (see the Newsworthy Nutrition) The healthy habits included: ∙ Maintained a healthy dietary pattern: ∙ Varied ∙ Rich in fiber ∙ Included some fish ∙ Low in animal fat and trans fat ∙ Maintained a healthy weight ∙ Occasionally consumed alcohol in small amounts ∙ Exercised for at least 30 minutes daily ∙ Avoided use of tobacco Should all adults follow this example (with optional use of alcohol)? Newsworthy Nutrition Healthy dietary pattern lowers women’s risk of sudden cardiac death Sudden cardiac death (death occurring within hour after symptom onset) is the cause of more than half of all heart-related deaths and usually occurs as the first sign of heart disease, especially in women Lifestyle information from the Nurses’ Health Study (81,722 women) was used to determine if adherence to a healthy lifestyle lowers the risk of sudden cardiac death among women Low-risk lifestyle was considered as not smoking, not overweight, exercising 30 minutes per day or longer, and following the Mediterranean Diet Risk of sudden cardiac death dropped by 92% with a combination of the four healthy lifestyles; and women who ate a diet most similar to the Mediterranean Diet with a high proportion of vegetables, fruits, nuts, omega-3 fats, and fish, along with moderate amounts of alcohol and small amounts of red meat, had a 40% less risk than women whose diets least resembled this diet The conclusion is that a healthy dietary pattern along with other healthy lifestyle factors can protect women from sudden cardiac death Although nutrition recommendations are often made for the entire healthy population, each of us has individual needs based on our particular health status and genetic background It would be more appropriate, but also more expensive, if recommendations were made on an individual basis once a person’s health status is known Source: Chiuve SE and others: Adherence to a low risk, healthy lifestyle and risk of sudden cardiac death among women Journal of the American Medical Association 306:62, 2011 (see Further Reading 2) ✓ CONCEPT CHECK 2.5 What are the ABCDE steps used in assessing nutritional status? 2.6 Specific Nutrient Standards and Recommendations The overarching goal of any healthy dietary plan is to meet nutrient needs To begin, we must determine what amount of each essential nutrient is necessary to maintain health Most www.freebookslides.com Chapter 2: Designing a Healthy Dietary Pattern 61 TABLE 2-9 ■ Dietary Reference Intakes and Daily Value RDA Recommended Dietary Allowance Use to evaluate your current intake for a specific nutrient The further you stray above or below this value, the greater your chances of developing nutritional problems AI Adequate Intake Use to evaluate your current intake of nutrients but realize that an AI designation implies that further research is required before scientists can establish a more definitive recommendation EER Estimated Energy Requirement Use to estimate kilocalorie needs of the average person within a specific height, weight, gender, age, and physical activity pattern UL Upper Level Use to evaluate the highest amount of daily nutrient intake unlikely to cause adverse health effects in the long run in almost all people (97% to 98%) in a population This number applies to chronic use and is set to protect even very susceptible people in the healthy general population As intake increases above the Upper Level, the potential for adverse effects generally increases DV Daily Value Use as a rough guide for comparing the nutrient content of a food to approximate human needs Typically, the Daily Value used on food labels refers to ages years through adulthood It is based on a 2000-kcal diet Some Daily Values also increase slightly with higher kilocalorie intakes (see Fig 2-13 in Section 2.8 on food labeling) of the terms that describe nutrient needs fall under one umbrella term: Dietary Reference Intakes (DRIs) The development of DRIs is an ongoing, collaborative effort between the Food and Nutrition Board of the Institute of Medicine in the United States and Health Canada (see Further Reading 12) Included under the DRI umbrella are Recommended Dietary Allowances (RDAs), Adequate Intakes (AIs), Estimated Energy Requirements (EERs), and Tolerable Upper Intake Levels (Upper Levels or ULs) As you begin your study of nutrition, all these acronyms can seem like an alphabet soup of abbreviations! To help you more easily sift through these nutrient standards, some basic knowledge about their use is summarized in Table 2-9 RECOMMENDED DIETARY ALLOWANCE A Recommended Dietary Allowance (RDA) is the daily amount of a nutrient that will meet the needs of nearly all individuals (about 97%) in a particular age and gender group A person can compare his or her daily intake of specific nutrients to the RDA Although an intake slightly above or below the RDA for a particular nutrient on any given day is no reason for concern, a significant deviation below (about 70%) or above (about three times or more for some nutrients) the RDA for an extended time can eventually result in a deficiency or toxicity of that nutrient, respectively ADEQUATE INTAKE An RDA can be set for a nutrient only if there is sufficient information on the human needs for that particular nutrient Today, there is not enough information on some nutrients, such as chromium, to set such a precise standard as an RDA For this and other nutrients, the DRIs include a category called an Adequate Intake (AI) This standard is based on the dietary intakes of people who appear to be maintaining nutritional health That amount of intake is assumed to be adequate, as no evidence of a nutritional deficiency is apparent ESTIMATED ENERGY REQUIREMENT For kilocalorie needs, we use the Estimated Energy Requirement (EER) instead of an RDA or AI In contrast to the RDAs, which are set somewhat higher than the average needs for nutrients, the EER is set for the average person While a slight excess of vitamins and minerals is Dietary Reference Intakes (DRIs) Term used to encompass nutrient recommendations made by the Food and Nutrition Board of the Institute of Medicine These include RDAs, AIs, EERs, and ULs Recommended Dietary Allowance (RDA) Nutrient intake amount sufficient to meet the needs of 97% to 98% of the individuals in a specific life stage Adequate Intake (AI) Nutrient intake amount set for any nutrient for which insufficient research is available to establish an RDA AIs are based on estimates of intakes that appear to maintain a defined nutritional state in a specific life stage Estimated Energy Requirement (EER) Estimate of the energy (kcal) intake needed to match the energy use of an average person in a specific life stage Tolerable Upper Intake Level (UL) Maximum chronic daily intake level of a nutrient that is unlikely to cause adverse health effects in almost all people in a specific life stage www.freebookslides.com 62 Contemporary Nutrition: A Functional Approach Nutrition Facts 12 servings per container Serving size donut (about 52g) Amount per serving Calories 200 % Daily Value* 18% 15% Total Fat 12g Saturated Fat 3g Trans Fat 4g Cholesterol 5mg Sodium 95mg Total Carbohydrate 22g Dietary Fiber