Human Nutrition - McGraw-Hill Education

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Human Nutrition:

Science for Healthy Living Updated with 2015?2020 Dietary Guidelines for Americans

Tammy J. Stephenson PhD

University of Kentucky

Wendy J. Schiff MS, RDN

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HUMAN NUTRITION: SCIENCE FOR HEALTHY LIVING Updated with 2015-2020 Dietary Guidelines for Americans

Published by McGraw-Hill Education, 2 Penn Plaza, New York, NY 10121. Copyright ? 2016 by McGraw-Hill Education. All rights reserved. Printed in the United States of America. 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.

1 2 3 4 5 6 7 8 9 DOW/DOW 21 20 19 18 17 16

ISBN 978-1-259-91683-0 MHID 1-259-91683-9

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Library of Congress Cataloging-in-Publication Data Names: Stephenson, Tammy J. | Schiff, Wendy. Title: Human nutrition: science for healthy living / Tammy J. Stephenson, Ph.D.,

Wendy J. Schiff, M.S., R.D.FPO. Description: Updated with 2015-2020 dietary guidelines for Americans. | New York, NY:

McGraw-Hill Education, c2016. | Includes index. Identifiers: LCCN 2016008800 | ISBN 9781259916830 (alk. paper) Subjects: LCSH: Human nutrition--Textbooks. Classification: LCC QP141 .S647 2016b | DDC 612.3--dc23 LC record available at

The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a website or photo or mention of a specific product does not indicate an endorsement by the authors or McGraw-Hill Education, and McGraw-Hill Education does not guarantee the accuracy of the information presented at these sites.

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About the Authors

Tammy J. Stephenson, PhD,

received her BS in Food Science and Human Nutrition and PhD in Nutritional Sciences from the University of Kentucky. She has taught a wide variety of food, nutrition, and wellness courses, including introductory nutrition, to majors and nonmajors in the Department of Dietetics and Human Nutrition at the University of Kentucky for the past 15 years. Dr. Stephenson is an active member of the Academy of Nutrition and Dietetics, serving as Chair of the Nutrition Educators of Health Professionals practice group. She has published and presented on service learning, technology in teaching, student-centered learning, and other related topics. Dr. Stephenson has a passion for teaching engaging, interesting, and relevant nutrition courses that has been recognized through multiple teaching and mentoring awards at the university, state, and national levels. Outside of the classroom, she enjoys running, yoga, coaching youth soccer, gardening, cooking, and spending time with her family.

Wendy J. Schiff, MS, RDN,

received her BS in Biological Health/Medical Dietetics and MS in Human Nutrition from The Pennsylvania State University. She has taught introductory food and nutrition courses at the University of Missouri?Columbia as well as nutrition, biology, and personal health courses at St. Louis Community College? Meramec. She has worked as a public health nutritionist at the Allegheny County Health Department (Pittsburgh, Pennsylvania) and State Food and Nutrition Specialist for Missouri Extension at Lincoln University in Jefferson City, Missouri. In addition to coauthoring Human Nutrition: Science for Healthy Living, Wendy has authored Nutrition for Healthy Living and Nutrition Essentials: A Personal Approach. She is a registered dietitian nutritionist and member of the Academy of Nutrition and Dietetics.

To Brian, Bailey, Kylie Mae, and Ansley

--Tammy Stephenson

To Bill and Kevin

--Wendy Schiff

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Welcome to Human Nutrition: Science for Healthy Living Updated with the 2015?2020 Dietary Guidelines for Americans

Dear Students,

Welcome to the study of human nutrition! Before you begin your studies, it is important to understand that nutrition is a science that draws upon knowledge from other sciences, particularly biology, human anatomy and physiology, general chemistry, and biological chemistry. The science of human nutrition also involves learning scientific information about foods and nutrition, and how this information is used to develop dietary recommendations for healthy people and nutritional therapies for those who are not healthy. By understanding the contents of this introductory nutrition textbook, you will recognize the effects that peoples' food choices can have on their health. In addition, you will appreciate the valuable role that registered dietitian nutritionists (RDNs) play as members of the health care team and be well prepared to take more advanced human nutrition courses, if you decide to become a dietitian.

Human Nutrition: Science for Healthy Living has been developed by a team of nutrition educators who have extensive college teaching experience and a passion for teaching relevant, student-centered nutrition, foods, health, and wellness courses. Our overall goal is to prepare you for your career in a health care discipline, and we want you to enjoy your introductory study of human nutrition. Learning about any science can be challenging if the information is not presented in an appealing, interesting manner. We've made a distinct effort to write the content of this book in an understandable way and to provide clear descriptions of concepts that can be difficult to convey, such as the processes of digestion, absorption, and energy metabolism. To enhance your learning, numerous meaningful illustrations and photographs accompany the narrative. Such graphics facilitate learning for all students, but especially for those who are "visual learners." By reviewing pages xv-xxiv of this Preface, you will learn about the features of this book and how to use them to facilitate your study of human nutrition.

We hope you will enjoy using this textbook!

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Brief Contents

Preface xv

1 Introduction to Nutrition 1 2 Evaluating Nutrition Information 25 3 Basis of a Healthy Diet 44 4 Human Digestion, Absorption, and Transport 79 5 Carbohydrates: Sugars, Starches, and Fiber 110 6 Lipids: Triglycerides, Phospholipids, and Sterols 149 7 Proteins: Amino Acids 189 8 Metabolism 227 9 Vitamin Overview and Fat-Soluble Vitamins 267 10 Water-Soluble Vitamins 303 11 Water and Major Minerals 342 12 Trace Minerals 383 13 Obesity, Energy Balance, and Weight Management 416 14 Eating Disorders and Disordered Eating 459 15 Nutrition for Fitness and Sport 480 16 Pregnancy and Lactation 525 17 Infants, Children, and Adolescents 553 18 Nutrition for Older Adults 581 19 Food and Water Safety 604 20 Global Nutrition 640

Appendix A English-Metric Conversions and Metric-to-Household Units A-3 Appendix B Basic Chemistry Concepts A-5 Appendix C Basic Anatomy and Physiology Concepts A-9 Appendix D Major Monosaccharides, Amino Acids, and Vitamins A-13 Appendix E Vitamins Involved in Energy Metabolism A-21 Appendix F Nutrition Assessment A-23 Appendix G Daily Values Table A-33 Appendix H Canada's Food Guide A-35 Appendix I Food Composition Table A-41 Glossary G-1 Credits C-1 Index I-1 Dietary Reference Intakes (DRIs)

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Contents

Preface xv

1 Introduction to Nutrition 1

1.1 The Importance of Nutrition 2 Why Study Nutrition? 2 How to Use This Textbook 2

1.2 The Nutrients 3 The Six Classes of Nutrients 3 Nutrients: Elements 4 Essential Nutrients 5 Macronutrients and Micronutrients 6 Phytochemicals 6

1.3 Food as Fuel 7 Direct Calorimetry 8 Calculating Food Energy 8

1.4 Does Diet Matter? 9 Risk Factors 9

1.5 Factors That Influence Eating Habits 11 Biological and Physiological Factors 12 Cognitive and Psychological Factors 12 Environmental Factors 13

1.6 Key Nutrition Concepts 13 Concept 1: Most Foods Are Mixtures of Nutrients 14 Concept 2: Variety, Moderation, and Balance Can Help Ensure a Diet's Nutritional Adequacy 15 Concept 3: Food Is the Best Source of Nutrients 15 Concept 4: Foods and the Nutrients They Contain Are Not Cure-Alls 17 Concept 5: Malnutrition Includes Overnutrition as Well as Undernutrition 18 Concept 6: Nutrition Is a Dynamic Science 18

Summary 19

2 Evaluating Nutrition Information 25

2.1 Dr. Goldberger's Discovery 26 Identification of the Missing Dietary Substance 26

2.2 Understanding the Scientific Method 27 Animal Research: Laboratory Experiments 27 Human Research: Experimental (Intervention) Studies 29 Human Research: Epidemiological Studies 30 Limitations of Nutrition-Related Studies 31 Reporting Findings 33 Following Up with More Research 34

2.3 Nutrition Information: Fact or Fiction 35 Ask Questions 36 Using the Internet Wisely 37 Directing Questions at Reliable Experts 38

2.4 Nutrition Experts: Registered Dietitians 39 Becoming a Registered Dietitian/ Nutritionist 39

Summary 40

3 Basis of a Healthy Diet 44

3.1 What Is a Nutrient Requirement? 45

3.2 Dietary Reference Intakes: Nutrient and Calorie Standards 45 Estimated Average Requirement 46 Recommended Dietary Allowances 46 Adequate Intakes 46 Tolerable Upper Intake Level 47 Acceptable Macronutrient Distribution Ranges 47 Applying Nutrient Standards 47

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3.3 Major Food Groups 49 Grains 49 Dairy Foods 50 Protein Foods 50 Fruits 50 Vegetables 50 Oils 51 Empty-Calorie Foods or Beverages 51

3.4 U.S. Dietary Guidelines 52 Summary of the 2015?2020 Dietary Guidelines for Americans 53 Applying the Dietary Guidelines 54

Digestion in the Stomach 88

4.5 The Small Intestine 90 Accessory Organs: The Liver, Gallbladder, and Pancreas 90 Digestion in the Small Intestine 91 Nutrient Absorption and Transport 92

4.6 The Large Intestine 94 Functions of the Large Intestine 94

4.7 Microbes in the Digestive Tract 96 Actions of Intestinal Bacteria 96 Probiotics and Prebiotics 96

3.5 Food Guides for Dietary Planning 55 MyPlate 56 Other Menu-Planning Tools 59

3.6 Food and Dietary Supplement Labels 60 Daily Values 61 Nutrition Facts Panel 61 Rating Foods for Nutritional Value 63 Health Claims 64 Structure/Function Claims 64 Nutrient Content Claims 64 Other Descriptive Labeling Terms 65 Dietary Supplement Labels 66 Organic Food 67

3.7 Food and Culture: The Melting Pot 68 African Heritage Diets 70 Religious Influences 72

Summary 73

4.8 Hormonal Regulation of Digestion 98 Gastrin, Secretin, and Cholecystokinin 98

4.9 Common Digestive Tract Disorders 99 Constipation 99 Diarrhea 100 Vomiting 100 Heartburn 101 Peptic Ulcer 102 Irritable Bowel Syndrome 103 Inflammatory Bowel Disease 103

Summary 105

5 Carbohydrates: Sugars, Starches, and Fiber 110

5.1 Introducing Carbohydrates 111

4 Human Digestion, Absorption, and Transport 79

4.1 Overview of the Digestive System 80 The Wall of the GI Tract 80 Sphincters Control the Flow of GI Contents 80 Mechanical and Chemical Digestion 81

4.2 The Mouth 82 Salivary Glands 82 Taste Buds 82 Disorders of Taste and Smell 83

4.3 The Esophagus 85 Choking 85 Peristalsis 86

4.4 The Stomach 87 Secretions of the Stomach 87

5.2 Simple Carbohydrates 112 Monosaccharides 112 Disaccharides 113 What Is High-Fructose Corn Syrup? 114 Nutritive Sweeteners 114 Alternative Sweeteners 115

5.3 Complex Carbohydrates 118 Oligosaccharides 118 Starch and Glycogen 118 Fiber 119

5.4 Carbohydrate Consumption Patterns 121 Added Sugar Consumption 122

5.5 Carbohydrates: Digestion and Absorption 123 Carbohydrate Digestion 123 Carbohydrate Absorption 124 Fiber 124

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5.6 Maintaining Normal Blood Glucose Levels 125

6.9 Reducing Risk of Atherosclerosis: Dietary

Glucose for Energy 126

Changes 175

5.7 Diabetes Mellitus 127 What Is Diabetes? 127 Testing for Diabetes 130 Controlling Diabetes 131 Can Diabetes Be Prevented? 134 What Is Hypoglycemia? 134

5.8 Carbohydrates and Health 135 Are Carbohydrates Fattening? 135

What About Omega-6 and Omega-3 Fats? 175 What about Dietary Cholesterol? 176 Food Selection and Preparation 177 Other Dietary Modifications 178 Weight Loss and Physical Activity 178 What If Lifestyle Changes Do Not Work? 179 Summary 180

Metabolic Syndrome 136

Tooth Decay (Dental Caries) 137 Lactose Intolerance 137

7 Proteins: Amino Acids 189

Does Sugar Cause Hyperactivity? 138 Fiber and Health 138 Summary 141

7.1 Introducing Proteins 190 Proteins' Major Functions in the Body 190

7.2 Amino Acids 191

Essential Amino Acids 191

6 Lipids: Triglycerides, Phospholipids, and Sterols 149

Derivatives of Amino Acids 192

7.3 Protein Synthesis and Structure 192 Protein Structure 193

Protein Denaturation 195

6.1 Introducing Lipids 150 Classes of Lipids 150 Major Functions of Lipids 150

7.4 Proteins in Foods 195 Protein Quality 196 Protein: RDA 197

6.2 Fatty Acids 151 Saturation 151 Omega Fatty Acids 151 Essential Fatty Acids 153 What Are Trans Fats? 153

6.3 Triglycerides 155 Triglycerides in Foods 155

7.5 Protein Digestion, Absorption, and Transport 198 Protein Digestion 198 Protein Absorption and Transport 198

7.6 Protein Metabolism 199 Transamination and Deamination 200 Nitrogen Balance 201

6.4 Phospholipids 157

7.7 Meeting Protein Needs 202

6.5 Cholesterol and Other Sterols 159

Combining Complementary Proteins 202

Plant Sterols and Stanols 160

7.8 Protein Malnutrition 205

6.6 Lipid Digestion, Absorption, and

Excessive Protein Intake 205

Transport 160

Protein Deficiency 205

Lipid Digestion 160 Lipid Absorption 162 Lipid Transportation 163 Enterohepatic Circulation of Bile 165 Lipid Storage Diseases 166

7.9 Food Allergies, Food Intolerances, and Phenylketonuria 207 What Is a Food Allergy? 207 Food Intolerances 208 Phenylketonuria 209

6.7 Lipid Consumption Patterns 167

7.10 Celiac Disease and Gluten Sensitivity 211

6.8 Lipids and Cardiovascular Disease 168

Diagnosing Celiac Disease 211

From Atherosclerosis to Cardiovascular

Treating Celiac Disease 211

Disease 168

Gluten Sensitivity 212

CVD: Major Risk Factors 170

Planning a Gluten-Free Diet 212

Assessing Risk of Atherosclerosis 173

Diet and Autism Spectrum Disorders 213

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