Nutrition Concepts and Controversies, 14th ed pdf free download

Updated throughout and featuring the new Dietary Guidelines, this clear and engaging market leader strikes the perfect balance of scientific research, core concepts, and relevant applications. With a lively and approachable writing style, the authors dispel existing misconceptions and empower you to make better nutrition choices and enact real, lasting behavior change.

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View as Instructor. Whether you need access offline or online, in print or on your mobile device, we have cost saving options. Tell me about Rentals. Administrative dietitians manage the foodservice system; clinical dietitians provide client care and are leaders in disease prevention services see Table C ; and nutrition support team dietitians coordinate nutrition care with the efforts of other health-care professionals. In government, public health nutritionists play key roles in delivering nutrition services to people in the community.

In some facilities, a dietetic technician assists registered dietitians in both administrative and clinical responsibilities. A dietetic technician has been educated and trained to work under the guidance of a registered dietitian; upon passing a national examination, the technician earns the title dietetic technician, registered DTR.

The U. To refine the search, try setting limits on dates, types of articles, languages, and other criteria to obtain a more manageable number of abstracts to peruse. Initials are optional. Use the Journals Database to find journal titles. Still, few physicians have the knowledge, time, or experience to develop diet plans and provide detailed diet instruction for clients, and they often refer their clients to nutrition specialists. Table C lists the best specialists to choose.

Additionally, some states require that nutritionists, as well as dietitians, obtain a license to practice. Who Are the True Nutrition Experts? Most people turn to their physicians for dietary advice.

Physicians are expected to know all about health-related matters. Only about 30 percent of all medical schools in the United States require students to take a comprehensive nutrition course; less than half require the minimum 25 hours of nutrition instruction recommended by the National Academy of Sciences. This plan would bring access to reliable nutrition information to more people. If you look closely, you can see signs that their expertise is fake.

In contrast, a fake nutrition expert may display a degree from a six-month correspondence course; such a degree is simply not the same. In some cases, schools posing as legitimate correspondence schools offer even less.

Buyers ordering multiple degrees are given discounts. A dietetic technician, registered DTR has also passed a national examination and maintains registration through continuing professional education. See also registered dietitian. Licensed dietitians may use the initials LD after their names. Some nutritionists are RDs, whereas others are self-described experts whose training is questionable and who are not qualified to give advice. In states with responsible legislation, the term applies only to people who have master of science MS or doctor of philosophy PhD degrees from properly accredited institutions.

The program must be approved or accredited by the American Dietetic Association or Dietitians of Canada. New emphasis is placed on genetics, complementary care, and reimbursement. In a similar stunt, Ms. To find out whether a school is properly accredited for a dietetics degree, write the American Dietetic Association, Division of Education and Research, West Jackson Boulevard, Chicago, IL ; call ; or visit their website www. The American Council on Education publishes a directory of accredited institutions, professionally accredited programs, and candidates for accreditation in Accredited Institutions of Postsecondary Education Programs available at many libraries.

Dieticians also play leading roles in health promotion and disease prevention. TAB LE examinations. Lack of proper accreditation is the identifying sign of a fake educational institution. To guard educational quality, an accrediting agency recognized by the U. She made every attempt to fail, intentionally answering all the examination questions incorrectly. Department of Education. Some correspondence schools are accredited; others are diploma mills.

For her efforts, Sassafras received a wallet card and is experience. Your health is your most precious asset, and protecting it is well worth the time and effort it takes to do so. Sassafras is a poodle. Charlie Herbert is also a professional member of such an organization; Charlie is a cat. State laws do not necessarily help consumers distinguish experts from fakes; some states allow anyone to use the title dietitian or nutritionist.

But other states have responded to the need by allowing only RDs or people with certain graduate degrees and state licenses to call themselves dietitians. Dismiss government dietary recommendations as too simplistic to help you plan your diet? Consume the portions offered in restaurants and fast-food places, believing them to be in keeping with nutrition recommendations? Wish that your foods could boost your health by providing substances beyond the nutrients they contain? In practice, eating well proves harder than it appears.

Many people are overweight, or undernourished, or suffer from nutrient excesses or deficiencies that impair their health—that is, they are malnourished.

You may not think that this statement applies to you, but you may already have less than optimal nutrient intakes and activity without knowing it. Accumulated over years, the effects of your habits can seriously impair the quality of your life. Putting it positively, you can enjoy the best possible vim, vigor, and vitality throughout your life if you learn now to nourish yourself optimally.

To learn how, you first need some general guidelines and the answers to several basic questions. How much energy and how much of each nutrient should you consume?

How much physical activity do you need to balance your energy intake from food? Which types of foods supply which nutrients? How much of each type of food do you have to eat to get enough? And how can you eat all these foods without gaining weight? This chapter begins by identifying some ideals for nutrient intakes and ends by showing how to achieve them.

Nutrition experts use the recommendations to assess intakes and to offer advice on amounts to consume. Individuals may use them to decide how much of a nutrient they need to consume and how much is too much. Values for other food constituents that may play roles in health maintenance are forthcoming.

Another set of nutrient standards is practical for the person striving to make wise choices among packaged foods. These are the Daily Values, familiar to anyone who has read a food label. Read about the Daily Values and other nutrient standards in Table , p. Nutrient standards—the DRI and Daily Values—are used and referred to so often that they are printed on the inside front covers of this book.

Descriptions of the DRI values are found in Table on page Daily Values nutrient standards that are printed on food labels. Based on nutrient and energy recommendations for a general 2,calorie diet, they allow consumers to compare the nutrient and energy contents of packaged foods. The Daily Values are U. Most people need to focus on only two kinds of DRI values: those that set nutrient intake goals for individuals RDA and AI, described next and those that define an upper limit of safety for nutrient intakes UL, addressed later.

The RDA are the indisputable bedrock of the DRI recommended intakes for they derive from solid experimental evidence and reliable observations. AI values, in contrast, are based as far as possible on the available scientific evidence but also on some educated guesswork.

Though not scientifically equivalent, both the RDA and AI values are intended to be used as nutrient goals for individuals so, for the consumer, there is no practical need to distinguish between them. Goal 2. Public health officials may also use them to assess nutrient intakes of populations and make recommendations.

Goal 3. The UL are indispensable to consumers who take supplements or consume foods and beverages to which vitamins or minerals have been added—a group that includes almost everyone. Nutrient needs fall within a range, and a danger zone exists both below and above that range.

Figure on page 33 illustrates this point. Some nutrients do not have UL values. The absence of a UL for a nutrient does not imply that it is safe to consume it in any amount, however.

It means only that insufficient data exist to establish a value. Goal 4. Preventing Chronic Diseases The DRI committee also takes into account chronic disease prevention, wherever appropriate. In the last decade, abundant new research has linked nutrients in the diet with the promotion of health and the prevention of chronic diseases, and the DRI committee uses this research in setting intake recommendations.

For example, the committee set lifelong intake goals for the mineral calcium at the levels believed to lessen the likelihood of osteoporosis-related fractures in the later years. Their names make sense when you learn their purposes.

These values are used for planning and assessing diets: 1. Recommended Dietary Allowances RDA nutrient intake goals for individuals; the average daily nutrient intake level that meets the needs of nearly all 97 to 98 percent of healthy people in a particular life stage and gender group. Adequate Intakes AI nutrient intake goals for individuals; the recommended average daily nutrient intake level based on intakes of healthy people observed or experimentally derived in a particular life stage and gender group and assumed to be adequate.

Tolerable Upper Intake Levels UL the highest average daily nutrient intake level that is likely to pose no risk of toxicity to almost all healthy individuals of a particular life stage and gender group. Usual intake above this level may place an individual at risk of illness from nutrient toxicity. Estimated Average Requirements EAR the average daily nutrient intake estimated to meet the requirement of half of the healthy individuals in a particular life stage and gender group; used in nutrition research and policymaking and is the basis upon which RDA values are set.

Acceptable Macronutrient Distribution Ranges AMDR values for carbohydrate, fat, and protein expressed as percentages of total daily caloric intake; ranges of intakes set for the energy-yielding nutrients that are sufficient to provide adequate total energy and nutrients while reducing the risk of chronic diseases.

The DV allow comparisons among foods with regard to their nutrient contents. The chapters on the energy-yielding nutrients come back to these ranges with regard to nutrient intakes. All in all, the DRI values are designed to meet the diverse needs of individuals, the scientific and medical communities, and others. Table sums up the names and purposes of the nutrient intake standards just introduced.

A later section comes back to the Daily Values, also listed in the table. KEY POINT The DRI provide nutrient intake goals for individuals, supply a set of standards for researchers and public policymakers, establish tolerable upper limits for nutrients that can be toxic in excess, and take into account evidence from research on disease prevention.

It has made separate recommendations for specific age ranges and groups of people: men, women, pregnant women, lactating women, infants, and children, and for specific age ranges. Children aged four to eight years, for example, have their own DRI recommended intakes.

Each individual can look up the recommendations for his or her own age and gender group. Within your own age and gender group, the committee advises adjusting nutrient intakes in special circumstances that may increase or decrease nutrient needs, such as illness, smoking, or vegetarianism.

Later chapters provide details about which nutrients may need adjustment. For almost all healthy people, a diet that consistently provides the RDA or AI amount for a specific nutrient is very likely to be adequate in that nutrient. On average, you should try to get percent of the DRI recommended intake for every nutrient to ensure an adequate intake over time.

The DRI recommended intake values fall within a safety range with the UL marking tolerable upper levels. The values are based on the concepts of probability and risk. The DRI recommended intakes are associated with a low probability of deficiency for people of a given life stage and gender group, and they pose almost no risk of toxicity for that group. They include a generous safety margin and meet the needs of virtually all healthy people in a specific age and gender group.

The DRI are designed for health maintenance and disease prevention in healthy people, not for the restoration of health or repletion of nutrients in those with deficiencies. Under the stress of serious illness or malnutrition, a person may require a much higher intake of certain nutrients or may not be able to handle even the DRI amount.

Therapeutic diets take into account the increased nutrient needs imposed by certain medical conditions, such as recovery from surgery, burns, fractures, illnesses, malnutrition, or addictions.

A, B, and C are Mr. A, Mr. B, and Mr. Each has a different requirement. Balance studies are valid only for nutrients like calcium chemical elements that do not change while they are in the body. Estimated Energy Requirement EER the average dietary energy intake predicted to maintain energy balance in a healthy adult of a certain age, gender, weight, height, and level of physical activity consistent with good health.

To do so, we review studies of deficiency states, nutrient stores and their depletion, and the factors influencing them. We then select the most valid data for use in our work. Of the DRI family of nutrient standards, the setting of an RDA value demands the most rigorous science and tolerates the least guesswork. One experiment we would review or conduct is a balance study. For each individual subject, we can determine a requirement to achieve balance for nutrient X. With an intake below the requirement, a person will slip into negative balance or experience declining stores that could, over time, lead to deficiency of the nutrient.

We find that different individuals, even of the same age and gender, have different requirements. A needs 40 units of the nutrient each day to maintain balance; Mr. B needs 35; Mr. C, If we look at enough individuals, we find that their requirements are distributed as shown in Figure —with most requirements near the midpoint here, 45 and only a few at the extremes. To set the value, we have to decide what intake to recommend for everybody.

Should we set it at the mean 45 units in Figure ? Actually, the data for most nutrients indicate a distribution that is much less symmetrical. But if people took us literally and consumed exactly this amount of nutrient X each day, half the population would begin to develop internal deficiencies and possibly even observable symptoms of deficiency diseases.

C at 57 would be one of those people. Perhaps we should set the recommendation for nutrient X at or above the extreme, say, at 70 units a day, so that everyone will be covered. This might be a good idea in theory, but what about a person like Mr. B who requires only 35 units a day? The recommendation would be twice his requirement and to follow it he might spend money needlessly on foods containing nutrient X to the exclusion of foods containing other vital nutrients.

The decision we finally make is to set the value high enough so that 97 to 98 percent of the population will be covered but not so high as to be excessive Figure illustrates such a value. In this example, a reasonable choice might be 63 units a day. Moving the DRI further toward the extreme would pick up a few additional people, but it would inflate the recommendation for most people, including Mr.

A and Mr. The committee makes judgments of this kind when setting the DRI recommended intakes for many nutrients. Relatively few healthy people have requirements that are not covered by the DRI recommended intakes. Setting Energy Requirements In contrast to the recommendations for nutrients, the value set for energy calories , the Estimated Energy Requirement EER , is not generous; instead, it is set at a level predicted to maintain body weight for an individual of a particular age, gender, height, weight, and physical activity level consistent with good health.

Because even small amounts of excess energy consumed day after day cause weight gain and associated diseases, the DRI committee did not set a Tolerable Upper Intake Level for energy. They derive energy from foods containing carbohydrate, fat, and protein, each in proportion to the others.

These ranges resurface in later chapters of this book wherever intakes of the energy-yielding nutrients are discussed with regard to chronic disease risks. Most careful diet planners are already familiar with the Daily Values because they are used on U. After learning about the DRI, you may wonder why yet another set of nutrient standards is needed for food labels.

One answer is that the DRI values vary from group to group, whereas on a label, one set of values must apply to everyone. This strength is also their limitation, however. Because the Daily Values apply to all people, from children of age four through aging adults, they are much less useful as nutrient intake goals for individuals.

Nutrient Recommended Intake: RDA Example Intake recommendations for most vitamins and minerals are set so that they will meet the requirements of nearly all people boxes represent people. Estimated Energy Requirements are energy intake recommendations predicted to maintain body weight and to discourage unhealthy weight gain.

Chapter 9 provides more details about using EER values. The Dietary Guidelines apply to most people age two years or older. To meet its recommendations, most U. A basic premise of both the Dietary Guidelines and of this book is that foods, not supplements, should provide the needed nutrients whenever possible. Another focus of the Dietary Guidelines is on limiting potentially harmful dietary constituents.

Meet recommended intakes within energy needs by adopting a balanced eating pattern, such as the USDA Food Guide explained in a later section. Keep total fat intake between 20 to 35 percent of calories, mostly from foods that provide unsaturated fats, such as fish, nuts, olives, and vegetable oils. Select and prepare foods that are lean, low fat, or fat-free. To prevent gradual weight gain over time, make small decreases in food and beverage calories and increase physical activity.

Achieve physical fitness by including cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises or calisthenics for muscle strength and endurance. Choose fiber-rich fruits, vegetables, and whole grains often Chapter 4. Choose and prepare foods and beverages with little added sugars. Reduce the incidence of dental caries by practicing good oral hygiene and consuming sugar- and starch-containing foods and beverages less frequently. At the same time, consume potassium-rich foods, such as fruits and vegetables Chapter 8.

Select a variety of fruits each day. Include vegetables from all five subgroups dark green, orange, legumes, starchy vegetables, and other vegetables several times a week. Make at least half of the grain selections whole grains.

Select fat-free or low-fat milk products. Emphasize cereals, breads, other grain products, vegetables, and fruits. Choose lower-fat dairy products, leaner meats, and foods prepared with little or no fat.

Achieve and maintain a healthy body weight by enjoying regular physical activity and healthy eating. Limit salt, alcohol, and caffeine. To avoid microbial foodborne illness, keep foods safe: clean hands, food contact surfaces, and fruits and vegetables; separate raw, cooked, and ready-to-eat foods; cook foods to a safe internal temperature; chill perishable food promptly; and defrost food properly Chapter People are also asked to consume less salt and to choose sensibly if they use alcohol.

Finally, foods should be kept safe from spoilage or contamination see Chapter Canadian Guidelines also recommend many of the same ideals. Notice that the Dietary Guidelines do not require that you give up your favorite foods or eat strange, unappealing foods.

If the experts who develop such guidelines were to ask us, we would add one more recommendation to their lists: take time to enjoy and savor your food. The joys of eating are physically beneficial to the body because they trigger health-promoting changes in the nervous, hormonal, and immune systems. When the food is nutritious as well as enjoyable, then the eater obtains all the nutrients needed for healthy body systems, as well as for the healthy skin, glossy hair, and natural attractiveness that accompany robust health.

Remember to enjoy your food. They require exercising regularly, seeking out milk products, whole grains, fruits, and vegetables, while limiting intakes of saturated and trans fats, sugar, salt, and alcohol.

More detailed recommendations are found in Chapter By using it wisely and by learning about the energy-yielding nutrients and vitamins and minerals in various foods as you will in coming chapters , you can achieve the goals of a nutritious diet first mentioned in Chapter 1: adequacy, balance, calorie control, moderation, and variety. A different kind of planning tool is the exchange system see Appendix D. Developed for use by those with diabetes, the exchange system focuses on controlling the carbohydrate, fat, protein, and energy calories in the diet.

As a nation, Americans eat too few of the foods that supply certain key nutrients listed in the margin and too many that are rich in calories and fats. In addition, many people should reduce total calorie intakes. Foods on any single exchange list can be used interchangeably. See the U. These foods contribute vitamin A, vitamin C, potassium, and fiber.

Apples, apricots, avocados, bananas, blueberries, cantaloupe, grapefruit, grapes, guava, kiwi, mango, oranges, papaya, peaches, pears, pineapples, plums, raspberries, strawberries, watermelon; dried fruit; unsweetened juices. Canned or frozen fruit in syrup; juices, punches, ades, and fruit drinks with added sugars; fried plantains. These foods contribute folate, vitamin A, vitamin C, magnesium, potassium, and fiber.

Dark green vegetables: Broccoli, leafy greens such as arugula, beet greens, collard greens, kale, mustard greens, romaine lettuce, spinach, and turnip greens. Orange and deep yellow vegetables: Carrots, carrot juice, pumpkin, sweet potatoes, and winter squash. Legumes: Black beans, black-eyed peas, garbanzo beans chickpeas , kidney beans, lentils, pinto beans, soybeans, soy products such as tofu, and split peas.

Starchy vegetables: Cassava, corn, green peas, hominy, and potatoes. Other vegetables: Artichokes, asparagus, bamboo shoots, bean sprouts, beets, bok choy, brussels sprouts, cabbages, cactus, cauliflower, celery, cucumbers, eggplant, green beans, iceburg lettuce, mushrooms, okra, onions, peppers, seaweed, snow peas, tomatoes, vegetable juices, zucchini. Baked beans, candied sweet potatoes, coleslaw, french fries, potato salad, refried beans, scalloped potatoes, tempura vegetables.

These foods contribute folate, niacin, riboflavin, thiamin, iron, magnesium, and fiber. Whole grains barley, brown rice, bulgur, millet, oats, rye, wheat and whole-grain, low-fat breads, cereals, crackers, and pastas. Enriched bagels, breads, cereals, pastas couscous, macaroni, spaghetti , rice, rolls, tortillas. Meat, poultry, fish, and eggs contribute protein, niacin, thiamin, vitamin B6, vitamin B12, iron, magnesium, potassium, and zinc; legumes and nuts are notable for their protein, folate, thiamin, vitamin E, iron, magnesium, potassium, zinc, and fiber.

Bacon; baked beans; fried meat, fish, poultry, eggs, or tofu; refried beans; ground beef; hot dogs; luncheon meats; marbled steaks; poultry with skin; sausages; spare ribs. These foods contribute protein, riboflavin, vitamin B12, calcium, magnesium, potassium and, when fortified, vitamin A and vitamin D.

Fat-free milk and fat-free milk products such as buttermilk, cheeses, cottage cheese, yogurt; fat-free fortified soy milk. Select the recommended amounts of oils from among these sources. These foods contribute vitamin E and essential fatty acids see Chapter 5 , along with abundant calories. Liquid vegetable oils such as canola, corn, flaxseed, nut, olive, peanut, safflower, sesame, soybean, and sunflower oils; mayonnaise, oil-based salad dressing, soft trans-free margarine.

Unsaturated oils that occur naturally in foods such as avocados, fatty fish, nuts, olives, and shellfish. Solid fats deliver saturated fat and trans fat, and intake should be kept low. Solid fats and added sugars contribute abundant calories but few nutrients, and intakes should not exceed the discretionary calorie allowance—calories to meet energy needs after all nutrient needs have been met with nutrient-dense foods.

Alcohol also contributes abundant calories but few nutrients, and its calories are counted among discretionary calories. See Table on page 42 for some discretionary calorie allowances; Table E-1 of Appendix E includes others. Solid fats that occur in foods naturally such as milk fat and meat fat see lists. Matthew Farruggio Added sugars such as brown sugar, candy, honey, jelly, molasses, soft drinks, sugar, and syrup.

Alcoholic beverages include beer, wine, and liquor. This standardization is needed to ensure that a diet based on the plan will deliver a certain amount of a given nutrient. It also provides a healthy balance among the energy-yielding nutrients—carbohydrate, fat, and protein. The USDA Food Guide also teaches people to recognize key nutrients provided by foods within each group; these are listed in Figure Note that the Food Guide also sorts foods within each group by nutrient density as the key to Figure explains.

The foods in each group are well-known contributors of the key nutrients listed in the Food Guide, but you can count on these foods to supply many other nutrients as well. If you design your diet around this plan, it is assumed that you will obtain adequate and balanced amounts not only of the nutrients of greatest concern but also of the two dozen or so other essential nutrients, as well as beneficial phytochemicals, because all of these are distributed among the same food groups.

Choosing a variety of foods, both among the food groups and within each group, helps to ensure adequate nutrients and also protects against large amounts of toxins or contaminants from any one source, as Chapter 1 made clear. Vegetables, for example, are sorted into subgroups according to their nutrient contents.

Controlling Calories: The Discretionary Calorie Allowance To help people control calories and prevent unhealthy weight gain, the USDA developed the concept of the discretionary calorie allowance illustrated in Figure A person with a discretionary calorie allowance to spend may choose to consume the following within the limits of the allowance: 1.

Extra servings of the same nutrient-dense foods that make up the base of the diet, for example, an extra piece of skinless chicken or a second ear of corn. This easy-to-follow, nutritionally sound diet can help anyone shed pounds quickly-and keep them off. This volume deals with an ongoing debate relating to the definition and measurement of nutritional status. It focuses on the problems of measuring undernutrition and its links with poverty, both as a cause and an effect.

This best-selling introductory nutrition text in colleges and universities has been used by more than one million students! This comprehensive text includes up-to-date coverage of the newest research and emerging issues in nutrition. The pedagogical features of the text, as well as the authors' approachable style, help to make complex topics easily understandable for students.

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