Nutrition Guide for Physicians

Dedication

Series Editor Introduction

Preface

Contents

Contributors

1 Fat: The Good, the Bad, and the Ugly

1 Introduction

2 Types of Dietary Fat and Their Food Sources

2.1 Saturated Fats

2.2 Monounsaturated Fatty Acids (MUFA)

2.3 Polyunsaturated Fatty Acids (PUFA)

2.4 Essential Fatty Acids and the n--6 and n--3 Families

2.5 Trans Fats

2.6 Sterols

3 Dietary Fat Effects on Health

3.1 Obesity

3.1.1 Role of Total Dietary Fat

3.1.2 Role of Specific Fatty Acids

3.2 Heart Disease

3.3 Type 2 Diabetes and Insulin Resistance

3.3.1 Role of Total Dietary Fat

3.3.2 Role of Specific Fatty Acids

3.4 Cancer

3.5 Inflammation

4 Conclusions

Suggested Further Reading

2 Dietary Fiber: All Fibers Are Not Alike

1 Introduction

2 Definition and Sources of Dietary Fiber

3 Benefits of Adequate Fiber Intake

3.1 Cardiovascular Disease

3.2 Weight Control

3.3 Type 2 Diabetes

3.4 Cancer

3.4.1 Large Bowel Cancer

3.4.2 Breast Cancer

3.5 Bowel Function

3.6 Colon Disease

3.6.1 Diverticulosis

3.6.2 Irritable Bowel Syndrome

4 Potential Negative Effects of Dietary Fiber

5 Conclusions

Suggested Further Reading

3 Sugar and Artificial Sweeteners: Seeking the Sweet Truth

1 Defining Sweeteners Caloric And Noncaloric

2 Consumption Patterns Of Sweeteners

2.1 Methods for Obtaining Sweetener Data

2.2 Global Trends in Availability

2.3 United States per Capita Trends in Total Caloric Sweeteners

2.4 Caloric Sweeteners in Beverages

2.5 Caloric Sweeteners in Foods

2.6 United States per Consumer Trends

3 Health Effects Of Added Caloric Sweeteners

4 Discussion

Suggested Further Reading

4 The Vitamins and Minerals: A Functional Approach

1 Introduction

2 The Antioxidant Nutrients

2.1 Vitamin C

2.2 Vitamin E

2.3 The Vitamin A Precursor: ß-Carotene

2.4 Selenium

3 Nutrients for Healthy Blood

3.1 Folate

3.2 Vitamin B 12

3.3 Vitamin B 6

3.4 Vitamin K

3.5 Iron

3.6 Zinc

3.7 Copper

4 Nutrients for Healthy Bones

4.1 Vitamin D

4.2 Vitamin K

4.3 Calcium

4.4 Phosphorus

4.5 Magnesium

4.6 Fluoride

5 Vitamins, Minerals, and Energy Metabolism

5.1 Thiamin

5.2 Riboflavin

5.3 Niacin

5.4 Iodine

5.5 Chromium

6 Minerals and Fluid Balance

Suggested Further Reading

5 Dietary Reference Intakes: Cutting Through the Confusion

1 Introduction

2 The Dietary Reference Intakes

2.1 Estimated Average Requirement

2.2 Recommended Dietary Allowance

2.3 Adequate Intake

2.4 Tolerable Upper Intake Level

2.5 Estimated Energy Requirement

2.6 Acceptable Macronutrient Distribution Ranges

3 Limits And Uses Of The Dri

3.1 Limits

3.2 Statistical Analysis

3.3 General Guidelines for Diet Assessment of Individuals

4 Dri And The Consumer

5 Summary

Suggested Further Reading

6 Food Labels and Sources of Nutrients: Sorting the Wheat from the Chaff

1 The Nutrition Facts Label

2 Using The Nutrition Facts Label

3 Major Nutrient Contributions Of The Food Groups And Of Various Foods

4 Food Sources Of Select Nutrients

4.1 Lipids

4.2 Dietary Fiber

4.3 Vitamins

4.4 Minerals

5 Health Claims

Suggested Further Reading

7 Vegetarian and Vegan Diets: Weighing the Claims

1 Introduction

2 Health Benefits of Vegetarian Diets

2.1 Vegetarian Diets and Cardiovascular Disease (CVD)

2.1.1 Vegetarian Diet and Serum Lipids

2.1.2 Vegetarian Diets and Blood Pressure

2.2 Vegetarian Diets and Obesity

2.3 Cancer

2.4 Type 2 Diabetes

2.5 Bone Health

3 Nutrient Deficiencies In Vegetarian Diets

3.1 Energy

3.2 Protein

3.3 Calcium

3.4 Iron

3.5 Zinc

3.6 Vitamin B 12 (Cobalamin)

3.7 Vitamin D

3.8 n--3 Fatty Acids

4 Summary

Suggested Further Reading

8 Dietary Recommendations for Non-alcoholic Beverages

1 We are (mainly) what we Drink

2 Coffee Consumption Poses No Health Risk for Most Persons

3 Tea Consumption is Protective and Should Be Encouraged

4 Milk is Good for You

5 Health Benefits Of Fruit Juices

5.1 Health Benefits of Citrus Juice Consumption

5.2 Health Effects of Other Types of Fruit Juice

5.3 And Don't Forget Vegetable Juices

6 Health Effects of Soft Drink Consumption

7 Weight Loss and Weight Management Beverages

8 Sports Beverages

9 Energy Drinks Remain Controversial Beverages

10 What'S the Buzz Regarding Caffeine?

11 Conclusions

Suggested Further Reading

9 Should Moderate Alcohol Consumption Be Promoted?

1 Introduction

2 Phytochemicals In Alcholic Beverages

3 Harmful Effects Of Alcohol

4 Health Benefits Associated With Alcohol Consumption

5 Effect Of Alcohol On Total Mortality

6 What Advice Should A Physician Give?

Suggested Further Reading

10 Issues of Food Safety: Are ``Organic'' Apples Better?

1 Introduction

1.1 Conventional and Organic Food Production Systems

2 What Makes A Food Safe?

3 Nutritional Value of Organic Versus Conventional Fruit and Vegetables

3.1 Comparison of Organically Grown and Conventionally Grown Products

3.1.1 Grapes and Wine

3.1.2 Oranges

3.1.3 Apples

3.1.4 Peach and Pears

3.1.5 Tomatoes

3.2 Other Causes of Differences Between Organic and Conventional Foods

3.2.1 Pesticides

3.2.2 Food Poisoning

3.2.3 GMOs

3.2.4 Antibiotics

3.2.5 Food Additives

3.2.6 Food Palatability

4 Conclusion

11 What Is a Healthy Diet? From Nutritional Science to Food Guides

1 Defining A Healthy Diet

1.1 Controlling Fat Intake and BMI

1.2 All Fats Are Not Alike

1.3 Carbohydrates; Good and Bad

1.4 Whole Fruits and Vegetables Are Better

1.5 Coffee, Tea, and Alcohol

1.6 The Problem with Salt

1.7 Supplements: There Is No Shortcut to a Balanced Diet

1.8 How Safe Is Our Food?

2 Food Guides

2.1 MyPyramid

2.2 Harvard's Healthy Eating Pyramid

2.3 DASH Eating Plan

2.4 Canada's Food Guide

2.5 Traffic Lights Food Guide

Suggested Further Reading

12 Achieving Dietary Change: The Role of the Physician

1 Introduction

2 Efficacy Of Nutrition Counseling By Physicians

3 Medical Office System Support

4 Client-Centered Therapy

5 The 5 A's Counseling Model

6 Models for Inducing Change

6.1 Transtheoretical Model and Stages of Change

6.2 Motivational Interviewing

6.3 Cognitive-Behavioral Theory

6.4 Incorporation of Behavioral Theory Tenets to the 5A Model

7 Summary

Suggested Further Reading

13 Dietary Supplements: Navigating a Minefield

1 Introduction

2 Common Supplements

2.1 Supplements with Strong Supporting Evidence

2.2 Antioxidants

2.3 Detoxification

2.4 Boosting the Immune System

2.5 Herbs and Herbal Cocktails

2.6 Exotic Fruit Juices

2.7 Weight loss Products

2.8 A Repeating Story

2.9 Potential Hazards from Supplements

3 How Dietary Supplements Are Marketed

3.1 Direct Contact with Consumers

3.2 Multilevel Marketing

3.3 Sources of the Supplemental Message

3.4 The Object of the Exercise

4 Regulations On The Marketing Of Supplements

4.1 United States

4.2 Canada

5 Helping Patients Make Informed Choices About Dietary Supplements

Suggested Further Reading

14 Taste Sensation: Influences on Human Ingestive Behavior

1 Introduction

2 Anatomy and Physiology of the Taste System

3 Innate vs. Acquired Tastes for Specific Macronutrients and Salt

3.1 Carbohydrate

3.2 Protein

3.3 Fat

3.4 Sodium Chloride

4 Genetic Variations in Taste

5 Physiological Responses to Taste Perception

6 Taste Sensation Abnormalities and Effects on Nutritional Status

7 Nutritional Implications of Taste in Selected Populations

7.1 Age

7.2 Obesity

7.3 Hypertension

7.4 Diabetes

8 Summary

Suggested Further Reading

15 Pregnancy: Preparation for the Next Generation

1 Introduction

2 Nutrition In The Preconception Period

3 Nutrition During Pregnancy

3.1 Weight Gain in Pregnancy

3.2 Energy and Macronutrient Needs During Pregnancy

3.3 Vitamin and Mineral Needs During Pregnancy

3.4 Substances to Limit or Avoid in Pregnancy

3.5 Food Safety During Pregnancy

3.6 Translating Nutrition Guidelines into Practical Advice About Food

4 Special Concerns During Pregnancy

4.1 Common Complaints

4.2 High-Risk Pregnancies

5 Nutrition For Lactation

6 Nutrition For The Postpartum Period

7 Referals For Services

8 Summary

Suggested Further Reading

16 Infants: Transition from Breast to Bottle to Solids

1 What Is The Best Milk For An Infant?

2 Nutrient Content Of Breast Milk And Infant Formula

3 Bioactivity Of Human Milk And Formulas

4 Health Benefits Of Human Milk

5 Transition To Solid Foods

6 Summary

Suggested Further Reading

17 Young Children: Preparing for the Future

1 Introduction

2 Monitoring Growth

3 Nutrition Guidance

3.1 Energy and Nutrient Needs

3.2 Dietary Guidance

4 Healthy Eating Behaviors

5 Nutrition Concerns During Childhood

5.1 Childhood Obesity

5.2 Food Insecurity

5.3 Food Allergies and Sensitivities

5.4 Iron Deficiency Anemia

5.5 Vitamin and Mineral Supplementation

Suggested Further Reading

18 Adolescents and Young Adults: Facing the Challenges

1 Introduction

2 Growth

3 Energy and Nutrient Requirement

3.1 Energy

3.2 Macronutrients

3.3 Micronutrients

3.4 Nutrition Assessment

4 Special Adolescent Nutritional Considerations

4.1 Overweight and Obesity

4.2 Eating Disorders

4.2.1 Anorexia Nervosa

4.2.2 Bulimia Nervosa

4.2.3 Binge-Eating Disorder

5 Promoting Healthy Food Habits

6 Summary

Suggested Further Reading

19 Healthy Aging: Nutrition Concepts for Older Adults

1 Introduction

2 Physiologic Aging and Nutrition

2.1 Body Composition

2.2 Gastrointestinal Secretions

2.3 Renal System

3 Nutrient Requirements of the Older Adult

3.1 Energy Requirements

3.2 Protein

3.3 Micronutrients

3.3.1 Fat-Soluble Vitamins (A, E, D, and K)

3.3.2 Water-Soluble Vitamins

3.4 Minerals

3.5 Fluid Homeostasis

3.6 Special Benefits of Plant Foods

3.7 Dietary Supplements

4 Body Weight in the Older Adult

4.1 Low Body Weight

4.2 Overweight/Obesity

4.3 Factors Influencing Food Intake in Older Adults

4.3.1 Socioeconomic Factors

4.3.2 Health Factors

4.3.3 Evaluating Nutritional Risk

5 Health Promotion For The Older Adult

Suggested Further Reading

20 Nutritional Status: An Overview of Methods for Assessment

1 Introduction

2 Principles of Nutritional Assessment

2.1 Food Frequency Questionnaires

2.2 Diet and Lifestyle History

2.3 Assessing Current Dietary Intake

2.4 Underreporting of Dietary Intake

2.5 Physical Examination

2.6 Body Composition Analyses

2.7 Laboratory Tests

3 Special Concerns by Age

3.1 Obesity and Age

3.2 Adolescents

3.3 Elderly

3.4 Food Access and/or Food Security

3.5 Other Areas of Concern

4 Healthy Eating Index

5 Conclusion

Suggested Further Reading

21 Eating Disorders: Disorders of Under- and Overnutrition

1 Introduction

2 Anorexia Nervosa

3 Bulimia Nervosa

4 Eating Disorder not Otherwise Specified

4.1 Binge-Eating Disorder

4.2 Night Eating Syndrome

4.3 Purging Disorder

5 Prevalence

6 Treatment

6.1 Psychotherapy

6.2 Psychotropic Medications

7 Prevention

8 Conclusion

Suggested Further Reading

22 Obesity: Understanding and Achieving a Healthy Weight

1 Introduction

2 Definition And Prevalence of Obesity

2.1 Body Mass Index

2.2 Central Adiposity

2.3 Prevalence

2.4 Cost of Obesity

3 Etiology

3.1 Energy Imbalance

3.2 Epidemiologic Model

3.3 Environmental Agents

3.3.1 Intrauterine Factors

3.3.2 Drug-Induced Weight Gain

3.4 Diet

3.4.1 Infant and Child Environment

3.4.2 Fat Intake

3.4.3 Glycemic Index

3.4.4 Calcium Intake

3.4.5 Frequency of Eating

3.4.6 Restrained Eating

3.5 Physical Activity

3.6 Smoking

3.7 Host Agents

3.7.1 Genetic Causes

3.7.2 Physiologic Factors

4 Pathology of Obesity

5 Pathophysiology

5.1 The Fat Cell as an Endocrine Cell

5.2 Visceral Fat

6 Complications of Obesity

6.1 Death

6.2 Diseases

7 Prevention

8 Treatment

8.1 Realities of Treatment

8.2 Diet

8.2.1 Diets Low in Fat and Low in Energy Density

8.2.2 Low-Carbohydrate Diets

8.2.3 Portion-Controlled Diets

8.3 Behavior Modification and Lifestyle Interventions

8.4 Exercise

8.5 Medications

8.5.1 Noradrenergic Drugs

8.5.2 Sibutramine

8.5.3 Orlistat

8.5.4 Drugs Not Approved by the FDA for Treating Obesity

8.6 Surgery

9 Conclusion

Suggested Further Reading

23 Nutrition Therapy Effectiveness for the Treatment of Type 1 and Type 2 Diabetes: Prioritizing Recommendations Based on Evidence

1 Introduction

2 Medical Nutrition Therapy for Diabetes

3 Prioritizing Nutrition Interventions for Type 1 and Type 2 Diabetes

3.1 Type 1 Diabetes Nutrition Interventions

3.1.1 Identify a Usual or Convenient Schedule of Food/Meals and Physical Activity

3.1.2 Integrate Insulin Therapy into the Patient's Lifestyle

3.1.3 Determine Insulin-to-Carbohydrate Ratios

3.1.4 Calculate Insulin Correction Factor

3.1.5 Review Goals

3.2 Type 2 Diabetes Nutrition Interventions

3.2.1 Focus on Metabolic Control

3.2.2 Implement Nutrition Interventions for Glucose Control

3.2.3 Encourage Physical Activity

3.2.4 Monitor Outcomes

4 Support and Continuing Education

5 Macro- And Micronutrients

5.1 Carbohydrate

5.1.1 Amount and Type of Carbohydrate

5.1.2 Glycemic Index

5.1.3 Fiber

5.2 Protein

5.3 Dietary Fat

5.4 Micronutrients

5.5 Alcohol

6 Summary

Suggested Further Reading

24 Lifestyle Interventions to Stem the Tide of Type 2 Diabetes

1 Introduction

2 Diagnosis Of Pre-Diabetes

3 Prevention Trials

4 Lifestyle Intervention Recommendations

4.1 Encourage a Moderate and Maintainable Weight Loss and Provide Participant Support

4.2 Recommend a Cardioprotective, Energy-Restricted Diet

4.3 Recommend 150 Min/Week of Physical Activity

4.4 Other Nutrition-Related Factors

4.4.1 Carbohydrate/Fats

4.4.2 Whole Grains and Dietary Fiber

4.4.3 Glycemic Index/Glycemic Load

4.4.4 Alcohol

5 Summary

Suggested Further Reading

25 Coronary Heart Disease: Nutritional Interventions for Prevention and Therapy

1 Introduction

2 Dietary Fat And Chd

2.1 Fat Intake

2.2 Saturated Fat and Dietary Cholesterol

2.3 Trans Fatty Acids

2.4 n--6 PUFA and MUFA

2.5 n--3 PUFA

3 Plant Sterols And Stanols

4 Thcy And B-Vitamins

5 Alcohol

6 Antioxidants

7 Dietary Fiber

8 Whole Diet Approaches To Chd Risk Reduction

8.1 Fruit, Vegetable, and Whole Grain Cereals

8.2 Nuts

8.3 The Portfolio Diet

9 Obesity

10 Physical Activity

11 Conclusion

Suggested Further Reading

26 Diet and Blood Pressure: The High and Low of It

1 Introduction

2 Definitions of Hypertension

3 Blood Pressure and Body Weight

4 Diet and Bp

4.1 Dietary Sodium

4.2 Potassium and BP

4.3 Dietary Patterns and BP

4.4 Dietary Fat

4.5 Dietary Protein

4.6 Alcohol Intake

5 Summary

Suggested Further Reading

27 Gastrointestinal Disorders: Does Nutrition Control the Disease?

1 Introduction

2 Constipation

3 Diarrhea

4 Irritable Bowel Syndrome

5 Food Allergy

6 Diverticulosis and Diverticulitis

7 Gastroesophageal Reflux Disease

8 Peptic Ulcers

9 Inflammatory Bowel Diseases

10 Colorectal Cancer

11 Celiac Disease

12 Conclusion

Suggested Further Reading

28 Nutrition in Patients with Diseases of the Liverand Pancreas

1 Patients with Liver Disease

2 Liver Disease Associated with Nutritional Support

3 Patients with Pancreatic Disease

4 Conclusion

Suggested Further Reading

29 Medical Nutrition Therapy in Chronic Kidney Disease and Other Disorders

1 Introduction

2 Stages Of Chronic Kidney Disease

3 Overview Of Nutritional Management Of Ckd For Stages 1-4

4 Diet Prescription In Ckd Stages 1-4

5 Medical Nutrition Therapy For Hemodialysis

6 Medical Nutrition Therapy In Peritoneal Dialysis

7 Acute Renal Failure

8 Other Kidney-Related Conditions

9 Summary

Suggested Further Reading

30 Bone Health: Sound Suggestions for Stronger Bones

1 Introduction

2 Calcium

2.1 Dietary Calcium Requirements

2.2 Calcium Sources

3 Vitamin D

3.1 Vitamin D Requirements

3.2 Sources of Vitamin D

3.2.1 Food

3.2.2 Sun

3.2.3 Supplements

3.2.4 Safety

4 Protein

5 Phosphorus

6 Magnesium

Suggested Further Reading

31 Inherited Metabolic Disorders and Nutritional Genomics: Choosing the Wrong Parents

1 Introduction

2 Imd Diagnostic Classifications

2.1 Disorders Presenting as Intoxication or Encephalopathy

2.2 Disorders of Energy Metabolism

2.3 Disorders Involving Complex Molecules

3 Nutritional Management Of Inherited Metabolic Disorders The General Approach

4 Nutritional Management of Inherited Metabolic Disorders Disease-Specific Approach

4.1 Medium-Chain Acyl-CoA Dehydrogenase Deficiency (MCAD Deficiency)

4.2 Maple Syrup Urine Disease (MSUD)

4.3 Phenylketonuria (PKU)

4.4 Homocystinuria

4.5 Galactosemia

5 Conclusions

Suggested Further Reading

32 Nutritional Challenges of Girls and Women

1 Female Reproduction and Nutrition

2 Females, Body Dissatisfaction, and Nutrition

3 Weight Management In Females

4 The Female Athlete Triad

5 Polycystic Ovarian Syndrome

6 Menopause and Nutritional Supplements

7 Summary

Suggested Further Reading

33 Diet, Physical Activity, and Cancer Prevention

1 Introduction

2 Body Fatness

3 Physical Activity

4 Plant Foods

5 Meat Intake

6 Alcohol

7 Conclusions

Suggested Further Reading

34 Food Allergy and Intolerance: Diagnoses and Nutritional Management

1 Introduction

2 Food Allergy

2.1 Pathophysiology

2.2 Diagnosing Food Allergy

2.2.1 Medical History

2.2.2 Physical Examination

2.2.3 Diagnostic Tests

2.2.4 Elimination Diet and Oral Food Challenge

2.3 Nutritional Management

2.4 Prevention

3 Food Intolerance

3.1 Pathology

3.2 Enzymatic Food Intolerance

3.3 Pharmacologic Food Intolerance

3.4 Undefined Intolerance

3.5 Diagnosing Food Intolerance

3.6 Nutritional Management

4 SUMMARY

Suggested Further Reading

35 Drug Interactions with Food and Beverages

1 Introduction

2 Medications To Be Taken On An Empty Stomach

3 Specific Examples Of Food-Drug Interactions

3.1 Effects of Vitamin K on Warfarin Anticoagulation

3.2 Monoamine Oxidase Inhibitors and Tyramine

3.3 Calcium Impairs Certain Antibiotic Absorption

4 Specific Examples Of FoodBeverage Interactions

4.1 Use of Acidic Beverages to Aid Drug Absorption

4.2 Grapefruit Juice Inhibits Drug Metabolism

4.3 Effect of Alcohol on Drug Action

4.4 Effect of Caffeine on Drug Action

5 Conclusion

Suggested Further Reading

Appendix A: Aids to Calculations

Appendix B: Sources of Reliable Information on Nutrition

Appendix C: Dietary Reference Intakes (DRI)

Subject Index