Visualizing Nutrition: Everyday Choices

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Dietary Reference Intakes: Recommended Intakes for Individuals: Vitamins Vitamin Vitamin Pantothenic Life Stage Vitamin A Vitamin C Vitamin D Vitamin E Vitamin K Thiamin Riboflavin Niacin B6 Folate B12 Acid Biotin Cholineg Group (μg/day)a (mg/day) (μg/day)b,c (mg/day)d (μg/day) (mg/day) (mg/day) (mg/day)e (mg/day) (μg/day)f (μg/day) (Mg/day) (μg/Day) (mg/Day)

Infants 0–6 mo 400* 7–12 mo 500* Children 1–3 y 300 4–8 y 400 Males 9–13 y 600 14–18 y 900 19–30 y 900 31–50 y 900 51–70 y 900 ⬎ 70 y 900 Females 9–13 y 600 14–18 y 700 19–30 y 700 31–50 y 700 51–70 y 700 ⬎ 70 y 700 Pregnancy ⱕ18 y 750 19–30 y 770 31–50 y 770 Lactation ⱕ18 y 1200 19–30 y 1300 31–50 y 1300

40* 50*

5* 5*

4* 5*

15 25

5* 5*

6 7

45 75 90 90 90 90

5* 5* 5* 5* 10* 15*

45 65 75 75 75 75

2.0* 2.5*

0.2* 0.3*

0.3* 0.4*

2* 4*

0.1* 0.3*

30* 55*

0.5 0.6

0.5 0.6

6 8

0.5 0.6

11 15 15 15 15 15

60* 75* 120* 120* 120* 120*

0.9 1.2 1.2 1.2 1.2 1.2

0.9 1.3 1.3 1.3 1.3 1.3

12 16 16 16 16 16

5* 5* 5* 5* 10* 15*

11 15 15 15 15 15

60* 75* 90* 90* 90* 90*

0.9 1.0 1.1 1.1 1.1 1.1

0.9 1.0 1.1 1.1 1.1 1.1

80 85 85

5* 5* 5*

15 15 15

75* 90* 90*

1.4 1.4 1.4

115 120 120

5* 5* 5*

19 19 19

75* 90* 90*

1.4 1.4 1.4

Note: This table (taken from the DRI reports, see www.nap.edu) presents Recommended Dietary Allowances (RDAs) in bold type and Adequate Intakes (AIs) in ordinary type followed by an asterisk(*). RDAs and AIs may both be used as goals for individual intakes. RDAs are set to meet the needs of almost all (97 to 98 percent) individuals in a group. For healthy breastfed infants, the AI is the mean intake. The AI for all other life stage and gender groups is believed to cover needs of all individuals in a group, but lack of data or uncertainty in the data prevent being able to specify with confidence the percentage of individuals covered by this intake. a As retinol activity equivalents (RAEs). 1 RAE ⫽ 1 µg retinol, 12 µg ␤-carotene, 24 µg ␣-carotene, or 24 µg ␤-cryptoxanthin in foods. To calculate RAEs from REs of provitamin A carotenoids in foods, divide REs by 2. For preformed vitamin A in foods or supplements and for provitamin A carotenoid in supplements 1 RE ⫽ 1 RAE.

Cholecalciferol. 1 µg cholecalciferol ⫽ 40 IU vitamin D.

b c

In the absence of exposure to adequate sunlight.

As ␣-tocopherol, which includes RRR-␣-tocopherol, the only form of ␣-tocopherol that occurs naturally in foods, and the 2R-stereoisomeric forms of ␣-tocopherol (RRR-, RSR-, RRS, and RSS-␣-tocopherol) that occur in fortified foods and supplements. It does not include the 2S-stereoisomeric forms of ␣-tocopherol (SRR-, SSR-, SRS-, and SSS-␣-tocopherol), also found in fortified foods and supplements.

d

65* 80*

0.4* 0.5*

1.7* 1.8*

5* 6*

125* 150*

150 200

0.9 1.2

2* 3*

8* 12*

200* 250*

1.0 1.3 1.3 1.3 1.7 1.7

300 400 400 400 400 400

1.8 2.4 2.4 2.4 2.4h 2.4h

4* 5* 5* 5* 5* 5*

20* 25* 30* 30* 30* 30*

375* 550* 550* 550* 550* 550*

12 14 14 14 14 14

1.0 1.2 1.3 1.3 1.5 1.5

300 400i 400i 400i 400 400

1.8 2.4 2.4 2.4 2.4h 2.4h

4* 5* 5* 5* 5* 5*

20* 25* 30* 30* 30* 30*

375* 400* 425* 425* 425* 425*

1.4 1.4 1.4

18 18 18

1.9 1.9 1.9

600j 600j 600j

2.6 2.6 2.6

6* 6* 6*

30* 30* 30*

450* 450* 450*

1.6 1.6 1.6

17 17 17

2.0 2.0 2.0

500 500 500

2.8 2.8 2.8

7* 7* 7*

35* 35* 35*

550* 550* 550*

As niacin equivalents (NEs), 1 mg niacin ⫽ 60 mg tryptophan; 0–6 months ⫽ preformed niacin (not NE). e

As dietary folate equivalents (DFE) 1 DFE ⫽ 1 µg food folate ⫽ 0.6 µg folic acid from fortified food or as a supplement consumed with food ⫽ 0.5 µg of a supplement taken on an empty stomach.

f

g Although AIs have been set for choline, there are few data to assess whether a dietary supply of choline is needed at all stages of the lifecycle, and it may be that the choline requirement can be met by endogenous synthesis at some of these stages. h

Because 10–30% of older people may malabsorb food-bound B12 it is advisable for those older than 50 years to meet their RDA mainly by consuming foods fortified with B12 or a supplement containing B12.

i

In view of evidence linking folate intake with neural tube defects in the fetus, it is recommended that all women capable of becoming pregnant consume 400 µg from supplements or fortified foods in addition to intake of food folate from a varied diet.

j

It is assumed that women will consume 400 µg from supplements or fortified foods until their pregnancy is confirmed and they enter prenatal care, which ordinarily occurs after the end of the periconceptional period—the critical time for neural tube formation.

Source: Dietary Reference Intake Tables: The Complete Set. Institute of Medicine, National Academy of Sciences available online at www.nap.edu. Reprinted with permission from Dietary Reference Intakes: The Essential Guide to Nutrient Requirements, 2006, by the National Academy of Sciences, Washington, D.C.

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VISUALIZING NUTRITION EVERYDAY CHOICES

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VISUALIZING NUTRITION EVERYDAY CHOICES

Mary B. Grosvenor, MS, RD Lori A. Smolin, PhD University of Connecticut

In collaboration with

THE NATIONAL GEOGRAPHIC SOCIETY

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C R E D I T S EXECUTIVE VP AND PUBLISHER Kaye Pace MANAGING DIRECTOR Helen McInnis EDITOR Kevin Witt DIRECTOR OF DEVELOPMENT Barbara Heaney MANAGER, PRODUCT DEVELOPMENT Nancy Perry DEVELOPMENT EDITORS Irene Nunes, Carolyn Smith PROJECT EDITOR Lorraina Raccuia EDITORIAL ASSISTANTS Lauren Morris, Alissa Etrheim, Sean Boda EXECUTIVE MARKETING MANAGER Clay Stone SENIOR PRODUCTION MANAGER Micheline Frederick SENIOR MEDIA EDITOR Linda Muriello CREATIVE DIRECTOR Harry Nolan COVER DESIGNER Harry Nolan INTERIOR DESIGN Vertigo Design PHOTO EDITORS Hilary Newman, Teri Stratford PHOTO RESEARCHER Stacy Gold, National Geographic Society SENIOR ILLUSTRATION EDITOR Sandra Rigby PRODUCTION SERVICES Furino Production COVER IMAGE Top photo: ©Bill Bettencourt Bottom inset photos (from left to right): ©Justin Guariglia/ NG Image Collection; ©Jean Claude Revy/Phototake; ©Edward Kinsman/Photo Researchers, Inc.; ©James Forte/ NG Image Collection; ©Mediscan/Visuals Unlimited This book was set in Times New Roman by GGS Higher Education Resources, a Division of PreMedia Global, Inc., printed and bound by Quebecor World. The cover was printed by Quebecor World. Copyright © 2010 John Wiley & Sons, Inc. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise, except as permitted under Sections 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate percopy fee to the Copyright Clearance Center, Inc. 222 Rosewood Drive, Danvers, MA 01923, website www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030-5774, (201) 748-6011, fax (201) 748-6008, Web site www.wiley.com/go/permissions. Evaluation copies are provided to qualified academics and professionals for review purposes only, for use in their courses during the next academic year. These copies are licensed and may not be sold or transferred to a third party. Upon completion of the review period, please return the evaluation copy to Wiley. Return instructions and a free of charge return shipping label are available at “http://www.wiley.com/go/return”. Outside of the United States, please contact your local representative. ISBN: 978-0-470-19758-5 BRV ISBN: 978-0-470-55652-8 Printed in the United States of America 10 9 8 7 6 5 4 3 2 1

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The Wiley Nutrition Advisory Board Wiley Nutrition—Right for You! Wiley is deeply committed to nutrition education. Through our teaching and learning materials, we aspire to excellence in nutrition by providing students with engaging resources that will help them to understand the most difficult concepts in nutrition. Our goal is to provide you and your students with the right resources for your course, such as animations that teach tough topics in nutrition. To ensure that we are producing the highest-quality resources for nutrition, we have assembled an expert advisory board to guide the direction of our materials—to review all data, art, references, and media before publication.

What Is the Nutrition Advisory Board? The mission of the Wiley Nutrition Advisory Board (NAB) is to provide a voice that helps shape and guide Wiley’s vision for nutrition and message to the intended markets. Selected by the Wiley editorial team, NAB members are called on to participate in the following ways: • • • •

Guide Wiley’s vision for nutrition and help develop the message to the market Serve as expert reviewers and contributors Be available for phone conversations or email exchanges on specific topics Contribute ideas and resources for best practices initiative and faculty development • Oversee the accuracy of our nutrition products, including review of manuscript, scientific art, and supplements • Align textbook learning objectives with course and discipline objectives • Assist in the development of animation storyboards

NAB Members

NANCY BERKOFF

LINDA BROWN

California State University–Los Angeles and Los Angeles Trade Technical College

Florida State University and Kaplan

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The Wiley Nutrition Advisory Board

JAYNE L. BYRNE

SYLVIA CRIXELL

College of St. Benedict/ St. John’s University

Texas State University

KAREN ISRAEL

SHANIL JUMA

Anne Arundel Community College

Texas Women’s University

YOUNGHEE KIM

OWEN MURPHY

Bowling Green University

University of Colorado

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The Wiley Nutrition Advisory Board

JUDY MYHAND

JOHN ORTA

Louisiana State University

California State University–Los Angeles

JANET PETERSON

DIANA SPILLMAN

Linfield College

University of Ohio–Miami

PRIYA VENKATASEN

SHAHLA WUNDERLICH

Pasadena City College

Montclair State University

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PREFACE tudents can do more than just read about the world; they can experience it through vivid images and creative videos. In writing Visualizing Nutrition: Everyday Choices, we wanted to take advantage of this uniquely modern way that students can take in information. Using striking images from the National Geographic Society’s photo reservoir, this text integrates photography and illustrations into the learning process while maintaining the rigor needed in the study of science. Information that would be buried in the text of other books is presented within the context of colorful illustrations and vibrant photographs. The images grab students’ attention and, along with the text, tell the absorbing story of nutrition. The text captures the interest of college students from every background and engages them by demonstrating the applications of the science of nutrition to everyday choices. This book is intended to serve as an introductory text for undergraduate students. The accessible format of Visualizing Nutrition: Everyday Choices, which assumes that readers have little prior knowledge of nutrition, allows students to easily make the connection between their individual experience with food and nutrition concepts and the science of nutrition. The text uses a critical thinking approach to teaching human nutrition, bringing nutrition out of the classroom by asking students to apply the logic of science to their own nutrition concerns. Visualizing Nutrition: Everyday Choices educates students about the functions and sources of individual nutrients and also focuses on the total diet, so students understand that no one food choice determines the healthfulness of their overall dietary pattern. The examples and exercises throughout the book allow students to think critically while exploring the similarities and differences in the diets and health concerns of the diverse ethnic and cultural mix of the population of the United States and the rest of the world. The text presents information using a clear, concise writing style and addresses the most recent advances in nutrition science. Each chapter extensively references the most current literature.

S

NATIONAL GEOGRAPHIC SOCIETY Visualizing Nutrition: Everyday Choices offers an array of remarkable photographs, media, and film from the National Geographic Society collections. Students using the book benefit from the long history and rich, fascinating resources of National Geographic. Fact-Checking: The National Geographic Society has also performed an invaluable service in fact-checking Visualizing Nutrition: Everyday Choices. They have verified every fact in the book with two outside sources, to ensure that the text is accurate and up-to-date. viii

Preface

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ORGANIZATION Visualizing Nutrition: Everyday Choices is unique in its integrated approach to the presentation of nutrition science. While the chapter organization follows the traditional format of nutrition books, this book integrates metabolism and health and disease information throughout the text. To make the study of metabolism more accessible, Visualizing Nutrition: Everyday Choices provides a simple overview of metabolism in Chapter 3 and then builds on this base with more complex discussions in subsequent chapters. In Chapter 4, the discussion of carbohydrate metabolism presents the basics of intermediary metabolism. Chapters 5 through 10, which cover lipids, proteins, micronutrients, energy balance, and exercise, review and add to this information. The integration throughout the text of discussions of nutrition, health, and disease serves to consistently engage student interest. By incorporating this information, students can see that a nutrient’s function in metabolism is related to its role in health and disease. This integration continuously reinforces the applicability of nutrition science to students’ lives and helps them appreciate how and why their food choices affect their health. I The first two chapters of this book introduce nutrition science. Chapter 1, “Nutrition: Everyday Choices,” begins by discussing the U.S. diet—how it has changed and how healthy it is—and emphasizing the fact that food choices affect current and future health. This chapter provides an overview of the nutrients and their roles in the body and defines the basic principles of balance, variety, and moderation that are key to a healthy diet. It also introduces the scientific method and the steps students need to follow to sort accurate from inaccurate nutrition information. Chapter 2, “Guidelines for a Healthy Diet,” begins with a history of nutrition recommendations and a discussion of how valuable these recommendations are for assessing the nutritional health of populations and individuals. It then takes the science out of the laboratory and shows how advances in nutrition knowledge have been used to develop the Dietary Reference Intakes (DRIs), the Dietary Guidelines for Americans, and tools for diet planning, including MyPyramid, food labels, and exchange lists.

Cholesterol Triglyceride

Protein

Cholesterol

Phospholipid

I Chapter 3, “Digestion: From Meals to Molecules,” provides the background students need to understand how nutrients are used by their bodies. It discusses how food is digested, how nutrients from foods are absorbed into the body and transported to the cells where metabolism occurs, and how wastes are removed. This chapter provides an overview of metabolism that serves as a launching pad for the more in-depth metabolism information presented in subsequent chapters. Preface

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I Chapters 4, 5, and 6 feature the energy-yielding nutrients carbohydrates, lipids, and proteins. Each of these chapters begins with a discussion of the respective macronutrient in the food we eat. The body of each chapter then illustrates the digestion and absorption of these nutrients, their functions, and the impact of each on health and particular disease states. Each chapter ends with a discussion of how to choose a diet that meets recommendations. Emphasis is placed on the types and proportions of these nutrients that are optimal for health. Chapter 4, “Carbohydrates: Sugars, Starches, and Fibers,” discusses the health impact of refined grains and added sugar versus whole grains and foods that naturally contain sugars. Chapter 5, “Lipids: Fats, Phospholipids, and Sterols,” points out that Americans are not eating too much fat but are often choosing the wrong types of fat for a healthy diet. Chapter 6, “Proteins and Amino Acids,” discusses animal and plant sources of protein and points out that both can meet protein needs, but these protein sources contain different combinations of nutrients. In addition to discussing how to meet protein needs, this chapter includes information on how to plan a healthy vegetarian diet. I The next two chapters present the micronutrients and water. Chapter 7, “Vitamins,” begins with a general overview of vitamins: where vitamins are found in the diet, factors affecting their bioavailability, and how they function. The chapter then discusses each of the vitamins individually, providing information on sources in the diet, functions in the body, impact on health, recommended intakes, and potential for toxicity. The chapter ends with a discussion of dietary supplements, who might benefit from using them, and risks associated with their use. Chapter 8, “Water and Minerals,” addresses water, a nutrient often overlooked, and the major and trace minerals. The chapter presents information on the sources of these nutrients in the diet and discusses their functions in the body, relationships to health and disease, and recommended intakes. A discussion of hypertension illustrates the importance of these nutrients in blood pressure regulation and the impact of the total diet on healthy blood pressure. A discussion of nutrients and bone health includes a section on the relationship between nutrition and the development of osteoporosis. Sections on trace minerals engage students with discussions of health concerns related to both deficiencies and excesses.

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I Chapter 9, “Energy Balance and Weight Management,” begins with a discussion of the obesity epidemic and the effect of excess body fat on health. The chapter explains energy balance, illustrates the impact of small changes in diet and behavior on long-term weight management, and presents up-to-date information on how body weight is regulated and the role of genetic versus environmental factors in determining body fatness. The chapter includes recommendations for healthy body weight and composition and equations for determining energy needs. It also discusses weight-

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loss options that range from simple caloric restriction to potentially risky surgical approaches. The chapter also includes a comprehensive discussion of eating disorders and their causes, consequences, and treatment. I Chapter 10, “Nutrition, Fitness, and Physical Activity,” discusses the relationships among physical activity, nutrition, and health. It emphasizes the importance of exercise for health maintenance as well as the impact nutrition can have on exercise performance. Because nutrients fuel activity, this chapter serves as a review of metabolism. By this point in the text, students have studied all the essential nutrients, so this chapter includes a complete discussion of the macronutrients and micronutrients needed for ATP production. A discussion of ergogenic aids for competitive athletes directs students to use a risk–benefit analysis of these products before deciding whether to use them. I Chapter 11, “Nutrition During Pregnancy and Infancy,” addresses the role of nutrition in human development and discusses the nutritional needs of a woman during pregnancy and lactation as well as the nutritional needs of an infant. The chapter also discusses the benefits and risks of breast versus bottle feeding. Diabetes 200

≥200

200

Prediabetes 180

Normal

140–199

160 140 ≥126 120 100–125