Nutrition and Diet Therapy

["26 PART I NUTRITION BASICS AND APPLICATIONS FOOD AND SYMBOLS Food behaviors: result of the social, physiological, psy- Eating behaviors are derived from many sources. To be- chological, environmental, and sociocultural impact come part of a group\u2019s eating pattern, a food must be on a person\u2019s food preferences. available and acceptable within the cultural context. The ways in which a food is determined to be acceptable vary Foodways: way(s) in which a distinct group selects, greatly among societies and among individuals, and both prepares, consumes, and uses food. conscious and unconscious criteria are applied. One such criterion is food symbolism, which is the meaning at- Heritage: that which is transmitted from preceding tached to food. Those foods symbolically designated as generations. positive are acceptable, whereas a negative evaluation causes rejection. Physiological: physical development, state of health, mental attitudes. Most food symbolism is related to security. This se- curity can be emotional, biological, or sociological, or Psychological: body image, perception of self, ways of any combination of the three. For instance, foods be- coping. lieved to have safety and health benefits offer biological security. An example is food faddism\u2014the belief that eat- Society (sociological): interactions between people, gov- ing certain foods will bring special health benefits. ernments, and so forth. Great numbers of food taboos and superstitions are Suboptimal: below desirable, as in below desirable intake. associated with biological symbolism. Food taboos are based on beliefs that certain foods or food combinations BACKGROUND INFORMATION are bad or unsafe. Superstitions arise from beliefs about magical powers of foods. For example, certain herbs are Biologic necessity refers to the nutrient balance that the believed to ward off old age. It does not matter that there body requires in order to maintain life and health. may be little or no scientific basis for these beliefs; it is Cultural patterning, on the other hand, establishes val- what the individual thinks that influences his or her ues, feelings, attitudes, and beliefs regarding food con- choice. sumption. The required nutrient levels may or may not be met under influences of cultural patterning. Nowhere is food symbolism more pronounced than in the context of emotional security. A deep emotional at- In recent years, because of improved research and in- tachment to food begins from the moment an infant re- terpretation of data regarding the nutritional status of ceives his or her first food from a significant other. Eating individuals, scientists are sure that primary malnutri- is associated with love, caring, attention, and satisfac- tion exists in the United States. It is recognized that over- tion. One of the causes of obesity may be a response to nutrition, misinformation, ignorance, poor economic this emotional association. Food may also be used for status, and poor eating habits are prevalent in this coun- discipline, punishment, reward for moral virtue, and try. Malnutrition is difficult to manage in the United bribery; hence, the response elicited by such uses of cer- States because of the diverse cultures, subcultures, val- tain foods may be frustration, anger, and rejection. ues, and experiences present in the country. Common nutritional problems are obesity; iron-deficiency anemia, Food is often used as a weapon or a crutch. A child especially among low-income women of childbearing age learns the hidden meanings of food very quickly and will and among infants; and suboptimal intakes of calcium, use this tool for power and manipulation\u2014for example, ascorbic acid, and vitamin A. Also, special nutritional refusing to eat, throwing a tantrum, or developing sud- problems affect the poor, the elderly, and the adolescent. den whims. For teenagers, strenuous dieting, refusal to eat healthy foods, and voracious overeating are weapons ACTIVITY 1: that gain them attention, enable them to manipulate or avoid situations, and often give them a feeling of control Factors Affecting Food Consumption over their bodies. Used this way, food becomes an emo- tional outlet for boredom, frustration, anxiety, and other Eating behaviors develop from cultural, societal, and psy- stresses. Using food as a crutch is also a contributing fac- chological patterns. These patterns, reflecting food habits tor in obesity. that have been transmitted from preceding generations, are the heritage of any given ethnic group. They may be Food and religion are linked symbolically with emo- influenced by interactions with other groups, so that tional security. In all religions, certain foods are used in some intermingling of patterns is inevitable, but modi- ceremonial rites as a means of demonstrating faith and fications are worked into the total structure over long commemorating events. Prohibition of certain foods is periods of time and are acceptable only if they fit the ex- also common practice. Examples of religious food sym- isting customs. bolism include Holy Communion in Christian churches, the Jewish dietary laws, and the exclusion of animal flesh Food patterns reflect a people\u2019s social organization, by Hindus and Buddhists. Fasting is common to most including their economy, religion, beliefs about the health properties of foods, and attitudes about family. Great emotional significance is attached to the consump- tion of certain foods.","CHAPTER 2 FOOD HABITS 27 religions. Often the reasons for food prohibitions are is an attractive tray. He does not touch the food. As he obscure. speaks no English and the nurse speaks no Spanish, there is a communication gap. Sociological symbolism can include the use of food as status symbols\u2014that is, certain foods are considered 5. What may you assume is the cause of this rejection? desirable because of high cost, difficulty in obtaining or preparing them, and superior quality. Examples include Example D prime rib, imported wines, truffles, caviar, fancy and com- plicated desserts, and other such food choices. Ellen confides to you that her mother once made her sit at the breakfast table for three hours until she ate her bowl Also of sociological significance is the use of foods as of oatmeal and that she will never touch another bite of a means of communication. Eating together denotes ac- oatmeal as long as she lives. \u201cThe thought of cold, sticky, ceptance. Almost all social occasions involve some sort of nasty oatmeal makes me want to throw up,\u201d she says. food or drink. Examples include refreshments at meet- ings, weddings, and feasts. Dinner parties and dinner 6. What factors are involved in Ellen\u2019s feelings about the dates are socially significant events. Foods communicate oatmeal? roles in life often as clearly as actions do. Example E Of the various kinds of security-related food symbol- ism, sociological symbolism is the one most likely to Mrs. Theo F. Jones III, wife of a prominent government change. Social meanings attached to food are not as official, is the guest of honor at a luncheon where ham- deeply imbedded in the psyche as are emotional and bi- burger casserole is the main entr\u00e9e. She barely touches ological meanings. Social symbols change as situations any of her food and leaves immediately afterward, even and experiences change. though she had planned to speak on a pet project. Illness modifies food acceptance. Anxiety, loneliness, 7. Was Mrs. Jones ill, allergic to hamburger, or angry? lack of activity, and the disease process all contribute to 8. What type of food symbolism is manifested here? an alteration of usual eating patterns. Appetite may di- minish, and hostility and apathy about food may occur. Answers to Examples Children may regress to an earlier developmental stage, and adults may regress to less mature states. 1. Biological food symbolism. Food faddism\u2014the belief that certain foods bring special health benefits\u2014is Some examples should help the student to understand very prevalent. the forces at work in the development of eating behaviors. 2. Superstition\u2014a set of beliefs about the magical pow- EXAMPLES OF FOOD BEHAVIORS ers of food. There does not have to be a scientific basis for such beliefs. Example A 3. Emotional food symbolism. Students\u2019 eating patterns Mary W., age 65, states that she takes 2 tbsp of lecithin, change during exam time. They usually eat more, and 1200 mg of organic vitamin E, plus a cup of rose hips the choices are usually high-calorie items. Such eat- tea each day to \u201ckeep her arteries cleared out\u201d and \u201cpre- ing seems to help relieve strain. vent arthritis.\u201d 4. There is no scientific evidence of need for extra calo- 1. What eating behavior is being manifested by Mary? ries while studying. One peanut would probably fur- 2. Is this a superstition or a taboo? nish enough energy for the entire study period. Example B 5. There could be several causes, including anxiety, fear, unfamiliar surroundings, and strange people present- Jane is your roommate. The night before the final exam ing the food, but the major cause is probably that in anatomy and physiology, the two of you go to the store these foods are not culturally acceptable. and purchase six doughnuts, four candy bars, a bag of popcorn, a pound of peanuts, and a carton of cola bever- 6. Ellen is projecting an unpleasant memory associated ages because you do not plan to take time out for dinner. with oatmeal. This frequently causes a food once eaten to become unacceptable. Psychotic patients 3. What eating behavior are you manifesting? often show great agitation by spitting on a food or 4. Was the choice of foods based on scientific evidence of dashing the tray to the floor when it brings back un- pleasant memories. This is another example of emo- the need for extra energy while studying strenuously? tional food symbolism. Example C 7. Angry. Food is used as a status symbol, and ham- burger is not included among status foods in our so- Jesus Martinez, age 35, is admitted to your floor in the ciety. She felt rejected and humiliated by this menu hospital for lab tests tomorrow. His lunch tray contains because she felt it did not reflect her social standing. broiled fish, asparagus, baked potato, Jell\u2013O, and milk. It 8. Sociological food symbolism.","28 PART I NUTRITION BASICS AND APPLICATIONS food, the child receives information that helps form his or her feelings and values; these remain on a subcon- POVERTY, APPETITE, AND BIOLOGICAL scious level and are therefore very difficult to change. FOOD NEEDS Eating habits, then, develop as a complex pattern of feel- ings, values, and customary behavior. Economics is a very strong factor in the determination of food consumption. The costs of producing, transporting, Abstract knowledge is rarely sufficient in itself to mo- and distributing food determine how much and what tivate someone to make a change. All the scientific types of food are available. Lack of money affects not only knowledge and reasoning that can be brought to a per- the prices that people can pay for food but also the kinds son\u2019s attention will have little effect unless these facts of storage facilities they can afford to have within the can be related intimately to the individual\u2019s culture and household. Poor people often must buy cheap foods in eating habits. The person will respond more favorably if small quantities and purchase items that do not require new knowledge is presented within the framework of the special storage facilities such as freezers or refrigerators. individual\u2019s culture, along with social and psychological The cost of transportation may prohibit going to a large conditioning, and situational dimensions. It is essential market, where volume purchases permit cheaper prices. to encourage whatever good elements are found in the Poverty is sometimes classified as a subculture in our so- person\u2019s present eating pattern and to motivate the indi- ciety, and different attitudes and adaptations about foods vidual to change those elements that require alteration. emerge from this class than those found in the middle or upper classes. Nurses should have an extensive knowl- PROGRESS CHECK ON ACTIVITY 1 edge of these differences. SELF-STUDY Eating is generally prompted by hunger or appetite. Analyze your eating patterns. Be as objective as possible. Hunger is a physiological mechanism, controlled by the Answer the following questions about your behaviors. central nervous system. It is an unpleasant sensation. Appetite is a desire for food related to past experiences in 1. What are the determining factors in the way you response to stimuli such as smell, taste, and appearance. eat? Appetite is not necessarily related to biological needs. People who are really hungry will eat many things not 2. What are the determining factors in the amount within their cultural frame of reference. They adapt phys- you eat? iologically and psychologically in order to survive. Appetite, on the other hand, can become uncontrolled 3. What determines your likes and dislikes? behavior and can result in obesity. Obesity is a form of malnutrition, usually resulting in a deficiency of some es- TRUE\/FALSE sential nutrients in addition to excess fat in the body. Circle T for True and F for False. 4. T F Food habits result from human beings\u2019 in- The biological food needs of a person throughout the life cycle have one requirement. The food con- stinctive behavior responses throughout life. sumed must provide essential chemical substances\u2014 5. T F Social class structure in American society is nutrients\u2014which the body can digest, absorb, and me- tabolize. To maintain life and health, the nutrients must largely determined by income, occupation, ed- reach the cells. Adequate nutrient intake depends on ucation, and residence. many factors, including age, sex, activity, size, and indi- 6. T F Lifestyles change as society\u2019s values change. vidual variations. The amounts of required nutrients may 7. T F From the time of birth, eating is a social act, vary, but the types and kinds of nutrients established as building on social relationships. being essential to life and health will remain the same 8. T F High-status foods usually become so because throughout life. Research may add other, as yet unrecog- they have higher nutritional food values. nized, essentials as scientific investigation progresses. 9. T F Food fads are usually long lasting and seldom change. SUMMARY Feelings, attitudes, conditioning, and economics contin- ually affect one\u2019s food consumption throughout life. Except for health professionals, who are very aware of the vital role that nutrition plays in the maintenance of health and the recovery from illness, most people give other as- pects of food a priority over its importance for health. Culture is a way of life. It is useful in adapting a per- son to his or her environment. Beginning with an in- fant\u2019s earliest experiences, individuals acquire customs and attitudes which they begin to internalize. Along with","CHAPTER 2 FOOD HABITS 29 10. T F Special food combinations are effective as re- 19. Common nutritional problems among the many ducing diets and have special therapeutic effects. cultures in the United States include: 11. T F Citrus fruits make the body acidic and produce a. obesity. \u201cacid stomach.\u201d b. iron-deficiency anemia. c. calcium deficiency. 12. T F Lean meat does not contribute to sexual po- d. all of the above tency or virility. 20. Ascorbic acid (vitamin C) deficiency among the 13. T F Gelatin builds strong fingernails. lower economic classes is not due to: MULTIPLE CHOICE a. dislike of citrus fruits. b. inability to digest foods containing vitamin C. Circle the letter of the correct answer. c. ignorance of the daily need for vitamin C. d. lack of funds to purchase citrus fruits. 14. Food fads are likely to develop in response to all of e. any of the above. these except: 21. Some diseases that are directly linked to eating a. the striving of aging persons to regain their patterns in the United States include (circle all youth. that apply): b. different physiological requirements in certain a. heart disease. individuals. b. high blood pressure. c. cancer. c. peer group pressure on teenagers for social d. diabetes. acceptance. ACTIVITY 2: d. the struggle of obese persons to lose weight. Some Effects of Culture, Religion, and 15. The healthy body requires: Geography on Food Behaviors a. specific foods to control specific functions. BASIC CONSIDERATIONS b. certain food combinations to achieve specific Large cultural groups are often subdivided into distinctive physiological effects. subcultures in the United States, and each has an effect on c. \u201cnatural\u201d foods to prevent disease. the group\u2019s eating patterns. While many differences exist d. specific nutrients in a number of different among small cultural groups, we will not attempt here to identify each separately. Religious group affiliations within foods to perform specific body functions. cultural groups also change the patterns of eating as do occupation, income, and social class. Foodways can be 16. Which of the following foods carries the most changed as family units diversify, either perpetuating or feminine symbolism? modifying cultural practices. The influence of advertis- ing, the tendency to move long distances, intermarriage, a. meat the employment of women, and the disruption of families b. peaches often lead to more diversity within a group. c. cheese d. bread When first viewing cultural food practices, it may ap- pear that nutrient intake is substandard. Closer examina- 17. Food habits in a given culture are largely based on tion, however, often reveals that this is not the case, and all of these factors except: that, in fact, the culture has adapted certain practices peculiar to that group that make up for nutrients appear- a. food availability and agricultural development. ing to be missing or limited in the diet. b. genetic group differences in food tastes that REFERENCE TABLES ON FOOD PATTERNS lead to development of likes and dislikes. c. food economics, market practices, and food Table 2-1 describes the typical eating patterns of some prominent cultures in the United States and compares distribution. the foods used with the basic four food groups, with com- d. lifestyles and value systems. ments regarding certain adaptations. Regional differ- ences are noted. 18. Which principle(s) should guide the health worker in helping patients with different cultural Table 2-2 describes some religious dietary practices. food habits meet their nutritional needs? (Circle all that apply.) a. Learn as much as possible about the person\u2019s cultural habits related to nutrition and health. b. Encourage traditional practices that are beneficial. c. Do not interfere with practices that are harmless. d. Try to overcome harmful practices by persua- sion and demonstration.","30 PART I NUTRITION BASICS AND APPLICATIONS TABLE 2-1 Comparison of Eating Patterns of Certain U.S. Cultural Groups with the Basic Four Food Groups Culture Group Foods Widely Used Foods Seldom Comments Used 1. European American Meat Group: beef, pork, poultry, Western European diet similar to a. Western Region fish, shellfish, eggs U.S. pattern Fruit\/Vegetable Group: all Rich desserts popular (strudel, Bread\/Cereal Group: bulgar, dark kuchen [cake], butterhorns, pies, etc.) breads, wheat Milk Group: all cheeses, milk Diet tends to be high in fat, sugar b. Central Region Meat Group: sausages, pork, beef Seasonings include many highly Fruit\/Vegetable Group: sauerkraut, salted items, garlic salt, celery salt, etc. potatoes, onions, carrots, beans Bread\/Cereal Group: all dark breads, Diet high in sodium especially rye Milk Group: cheeses more popular than milk c. Italians Meat Group: spiced sausages, meat Milk Calcium-rich diet sauces with peppers, cheeses, Cheeses popular onions, tomato, fish Diet high in sodium Fruit\/Vegetable Group: root vegeta- bles, tomatoes Bread\/Cereal Group: all pasta, yeast breads Milk Group: cheese Other: olive oil, spices 2. Mexican American Meat Group: meat, poultry, eggs (if Milk Foods are usually fried in animal income permits), dried beans fats. Fruit\/Vegetable Group: chili pep- Green peppers, as well as tomatoes, pers, corn, tomatoes, potatoes, good source of vitamin C; garlic onions used heavily. Lime-soaked corn tortillas supply a good course of Bread\/Cereal Group: tortillas calcium. Coffee used by children Milk Group: cheeses (if income and adults. Diet is high in fat and sodium, low in calcium and folacin. permits) 3. Southern Black Meat Group: dried beans\/peas, fish, Milk Long cooking time for vegetables pork destroys some nutrients. Protein intake may be low if income is Fruit\/Vegetable Group: corn, yams, low. Common food preparation is greens frying in lard. All parts of the hog are used. Blacks have high inci- Bread\/Cereal Group: cornbread, bis- dence of lactose intolerance. cuits, white bread Calcium-rich greens are popular. Diet contains excessive starch, Milk Group: buttermilk occasionally sodium, and fat. Other: heavy seasonings (smoked foods, barbecue sauce, pickled, salt pork cured in brine) 4. Asian Meat Group: beef, pork, poultry, Milk All parts of the animal used, includ- a. Cantonese seafood ing blood. Vegetables are quickly (Southern Chinese) cooked, conserving nutrients. Soy Fruit\/Vegetable Group: mushrooms, sauce used for seasoning; high bean sprouts, Chinese greens, bok salt content in the diet. choy Bread\/Cereal Group: rice predomi- nately Milk Group: limited quantity ice cream b. Northern Chinese Meat Group: beef, poultry, seafood, Milk Diet low in total fat. pork, eggs, tofu A high incidence of lactose intoler- Fruit\/Vegetable Group: soybeans, ance is found among the Chinese Chinese greens, bamboo and al- people. Tea is a favorite beverage. falfa sprouts, bok choy Daily meals try to balance the yin (cold) and yang (hot) concepts. Bread\/Cereal Group: rice, noodles, This is not related to the temper- bread, dumplings ature of foods. Milk Group:","CHAPTER 2 FOOD HABITS 31 TABLE 2-1 (continued) Culture Group Foods Widely Used Foods Seldom Comments Used c. Japanese Americans Meat Group: salt and fresh-water The Issei retains the traditional food fish, both steamed and eaten raw Milk pattern: Nisei, Sansei, and espe- (sushi); beef, pork, eggs, poultry cially Yansei likely to mix patterns or follow Western eating patterns. Fruit\/Vegetable Group: all vegeta- bles and fruits, soy bean products, Traditional diet low in total fat, cho- sesame seeds lesterol, and animal protein (be- cause only small amounts used Bread\/Cereal Group: all complex mixed with other foods). Diet is carbohydrates, especially rice low in sugar. Tea is a favorite bev- erage. Soy sauce and teriyaki Milk Group: sauce are used liberally. High in- cidence of lactose intolerance. 5. Native American Meat Group: wild game, waterfowl, Milk a. Reservation and fish, beef The diet is high in sodium. Certain Rural food combinations are thought Fruit\/Vegetable Group: nuts, roots, harmful or healthful, i.e., harm- b. City berries, squash, beans, corn and ful: cherries and milk; helpful: blue cornmeal pickled plums and rice gruel. Bread\/Cereal Group: mostly from Some tribes do not eat fish. Corn cornmeal, but wheat products are and blue cornmeal are used in also used. childbirth and healing practices. Milk Group: Restrictions on normally acceptable foods are sometimes imposed by Generally assimilated into the pre- Shaman as a healing in pre- and dominant culture: retains many postnatal periods. High incidence traditional foods and food prac- of lactose intolerance among tices in home Native American tribes. TABLE 2-2 Some Religious Practices That Affect Dietary Habits in U.S. Religion Foods and Beverages Prohibited Comments Orthodox Jewish All pork and pork products; all fish without scales Kosher (Kashruth Laws) regulations are strict re- or fins; improperly slaughtered meats; food con- garding slaughter and preparation of animal taining blood; meats and poultry if combined products and also regulate separation of milk with dairy products; all milk, cream and other and meat. Certain foods are designated pareve dairy products with a meat meal or for 6 hrs. (neutral): fruits, uncooked vegetables, grains, following tea, coffee. Two separate sets of dishes, utensils and cooking equipment maintained in kosher households. 24-hour fast on Yom Kippur. Muslim All pork and pork products; meat not slaughtered Fast from dawn to dusk during the month of by a Muslim, Jew, or Christian; alcoholic bever- Ramadan (9th month of the Islamic calendar). ages; stimulant beverages Only kosher gelatin used: this eliminates marsh- mallow, gelatin desserts, and many candies. Only vegetable oils used in food preparation. Seventh Day Pork, pork products, shellfish, blood, all flesh Cereal-based beverages used. Children from strict Adventist foods (if strict), dairy products and eggs (if very vegetarian homes may be low in some nutrients. strict), highly spiced foods, meat broths, stimu- lant and alcoholic beverages Christian Meats may be prohibited on certain religious occa- Moderation in food and beverage intake is encour- sions, alcohol and stimulant beverages prohib- aged in amost denominations. ited by some denominations","32 PART I NUTRITION BASICS AND APPLICATIONS 7. Garlic, wine, and unsalted tomato puree can be sug- gested as ways of lowering the high-sodium content RESPONSIBILITIES OF HEALTH PERSONNEL of the Italian diet. Elimination of cold cuts and sausages may also be necessary. Healthcare personnel have often treated clients with the assumption that they all share the same background and 8. The Jewish diet will usually be high in saturated fats value systems. The influence of religion and culture on and cholesterol. Jewish people have a high incidence a client\u2019s attitude toward food is often overlooked. of diabetes mellitus, obesity, and lactose intolerance. If feeding an orthodox Jewish client in a medical fa- It is not possible to be familiar with the dietary practices cility, a complete line of kosher frozen foods may of all religions and cultures, and there remains a shortage have to be purchased. Pareve used on a food label of published information for the health practitioner on means that the product contains no dairy, meat, or the subject. However, health practitioners need to be aware poultry products. of dietary variations of groups and the diets most likely to be adhered to in order to give the best treatment. For ex- 9. The diet of Mexican Americans tends to be high in ample, an individual\u2019s refusal to eat a particular food or fats and sodium and low in calcium and folacin. The adhere to a particular diet may be due to restrictions im- practice of using the refined wheat tortilla instead of posed by the individual\u2019s religion or culture. the lime-soaked corn tortilla should be discouraged. If spicy foods are limited or omitted from the Some of the health problems of ethnic groups living Mexican diet, the health practitioner should be aware in the United States are due to religious and cultural cus- that this practice will decrease vitamins A and C in toms, as well as genetic differences. Measures for allevi- the diet, as the red and green peppers used are good ating some of these problems are discussed below. sources of these vitamins. 1. Those people whose diets may be low in calcium be- 10. Adaptations of diet for Muslims should not be difficult cause they are lactose-intolerant can frequently tol- if kosher foods are available. Foods considered as erate buttermilk, yogurt, and fermented cheeses. being healthy by Muslims include honey, dates, and sweets. These can be added to the modified diet un- 2. If changes in family eating patterns must be made, less contraindicated (as with diabetes, for example). include the whole family when possible. In many cultures, children share in the preparation of food. 11. A hospitalized vegetarian should not have difficulty selecting from a hospital menu. Vegetarian diets, as 3. The diets of Native Americans tend to be deficient practiced by religions such as the Seventh Day in calories, calcium, riboflavin, vitamin C, and vita- Adventist, tend to be low in saturated fats and cho- min A. Native Americans living on reservations show lesterol and high in fiber. Vegetarians are also taught increased incidence of malnutrition, tuberculosis, how to combine plant proteins to obtain adequate and diabetes. Children often have kwashiorkor, a se- essential amino acids. Between-meal feedings are vere form of malnutrition. Because of religious as discouraged by the Adventist faith and five- to six- well as social requirements, Native Americans sel- hour meal intervals are practiced. This should be dom follow a modified diet. Adding hot spices such taken into consideration when hospital routine con- as chili peppers to the required foods sometimes flicts with their practice. helps in making foods more acceptable to them. PROGRESS CHECK ON ACTIVITY 2 4. Yin and yang are somewhat complex concepts repre- senting opposite conditions. In the Chinese culture, QUESTIONS these conditions should balance each other. Pregnancy and birth are yin conditions for the The following menu is an example of meeting a cultural Chinese. Therefore, the prescribed diet during this variation when planning a nutritionally adequate diet for period balances out with yang foods. The yang foods a Native American woman, age 25. Using it as a guide, plan given are rich in protein and calcium, which are ben- a day\u2019s menu that meets the RDAs for any two cultural eficial. Pregnant women may refuse iron supple- groups studied in this chapter. State the age, sex, and cul- ments for fear of hardening fetal bones. ture or religion of the group about which you are writing. 5. The typical Chinese diet may be low in protein, cal- Breakfast Lunch cium, and vitamin D. Many Asians are vegetarians, and when meat is used, it is used in limited quantity. 1 c cornmeal mush 1 slice fried Indian bread Tofu (soybean curd) is a good source of protein and 1 tbsp sugar 1 c pinto beans iron. If calcium salts are used to precipitate curd, 1 tsp margarine 1\u20442 squash tofu is also a good source of calcium. Some milk *1 c milk, fresh, or 1\u20442 c 1 apple may be acceptable in custards. evaporated 1-1\u20442 oz cheese 1 c orange juice coffee, if desired 6. Soy sauce is a favorite Asian condiment and should coffee, if desired be included in limited amounts instead of eliminated in a sodium-restricted diet. Rice and tea should also be included whenever possible. Alternate seasonings to soy and teriyaki sauce should be encouraged.","CHAPTER 2 FOOD HABITS 33 Dinner Snacks (if desired) Lallukka, T. (2007). Multiple socio-economic circum- stances and healthy food habits. European Journal of 3 oz venison roast any fruits Clinical Nutrition 61: 701\u2013710. 1\u20442 c fried potatoes oatmeal\/raisin cookies greens of choice MacClancy, J., Henry, J. & Macbeth, H. (2007). Con- blackberries suming the Inedible: Neglected Dimensions of Food yogurt or buttermilk Choice. New York: Berghahn Books. *If tolerated MacFie, H., Thomson, D. M. H, & Thomson, J. H. (1994). Measurement of Food Preference. London: Blackie REFERENCES Academic. Archer, S. L. (2004). Differences in food habits and Mann, J. & Truswell, S. (Eds.). (2007). Essentials of cardiovascular disease risk factors among native Human Nutrition. (3rd ed.). New York: Oxford Americans with and without diabetes: The inter-tribal University Press. heart project. 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(1997). Exchange for All Occasions: Your (NCEP), National Heart, Lung, and Blood Institute Guide to Choosing Healthy Foods Anytime. Minne- (NHLBI), National Institutes of Health (NIH). (2001). apolis, MN: IDC. Third report of the expert panel on detection, evalua- tion, and treatment of high blood cholesterol in adults Germov, J. & Williams, L. (Eds.). (2004). A Sociology of (Adult Treatment Panel III). www.NIH.gov. Food & Nutrition: The Social Appetite. New York: Webster-Gandy, J., Madden, A. & Holdworth, M. (Eds.). Oxford University Press. (2006). Oxford Handbook of Nutrition and Dietetics. Oxford, London: Oxford University Press. Guillano, M. (2005). French Women Don\u2019t Get Fat. New York: Knopf. Kittler, P. G. & Sucher, K. P. (2004). Food and Culture (4th ed.). Belmont, CA: Thomson\/Wadsworth.","","OUTLINE CHAPTER 3 Objectives Proteins and Health Glossary Background Information Time for completion ACTIVITY 1: Protein as a Activities: 1 hour Nutrient Optional examination: 1\u20442 hour Definitions, Essentiality, and OBJECTIVES Requirement Protein Sparing Upon completion of this chapter the student should be able to do the following: Functions, Storage, Sources, 1. Identify the structure of proteins and their fuel value. and Utilization 2. Define complete and incomplete protein and essential amino acids. Amino Acid Supplements 3. Discuss protein quality and the concept of limiting amino acids. Progress Check on Activity 1 4. Describe the amino acid requirements of humans and their RDAs for ACTIVITY 2: Meeting Protein protein. Needs and Vegetarianism 5. Explain the method of measuring protein in the body. Requirements for Protein and 6. Summarize the major functions and food sources of protein. 7. Analyze the all-or-none law in protein metabolism and the concept of Amino Acids Vegetarianism: Rationale and protein sparing. 8. Recognize various vegetarian diet regimes and their relationship to ade- Classification Vegetarianism: Diet Evaluation quate protein intake. Vegetarianism: Diet Planning 9. Compare the effects on health of inadequate or excessive protein intake. Excessive and Deficient Protein 10. Specify certain conditions where alteration in protein intake may be Intake needed. Responsibilities of Health GLOSSARY Personnel Progress Check on Activity 2 Amino acids: compounds containing nitrogen that are the building blocks of References the protein molecule. 35","36 PART I NUTRITION BASICS AND APPLICATIONS tions and inaccurate information about it have led to un- usual and sometimes dangerous eating practices. Many Antibody: a protein substance produced within the body athletes take powdered protein supplements in the hope that destroys or weakens harmful bacteria. of increasing their muscle size or strength. The liquid- protein crash diets many people have tried have caused Biologic value of protein (BV): the ability of a protein to some deaths. Some types of protein foods are completely support the formation of body tissue. avoided by some religious sects. The use of protein foods to denote masculinity (meats) and femininity (eggs, Complementary proteins: two or more protein foods milk), and for status symbols (lobster instead of sardines) whose amino acid compositions complement each is significant in learning about people\u2019s lifestyles and cul- other so that one has what the other lacks. tural patterns. Complete protein: a protein containing all the essential The role that protein plays in the healthy diet is an amino acids. important one, but should not be exaggerated. Without an adequate supply of this essential compound, all Essential amino acids: amino acids that cannot be synthe- growth, repair, and maintenance of the body cells cease, sized by the body and must be provided by food. and the body dies. On the other hand, excessive consump- tion of protein, or protein foods eaten to the exclusion of Immobility: the condition of being inactive owing to dis- other types of food, is not healthy. ability, such as that experienced by the person con- fined to bed or a wheelchair. All proteins are not alike. The health practitioner needs a thorough knowledge of the functions, require- Incomplete protein: a protein lacking one or more of the ments, and sources of protein to counsel clients on how essential amino acids or containing some of the amino to meet their protein needs. acids in only very small amounts. ACTIVITY 1: Kwashiorkor: a severe protein deficiency disease that oc- curs in infancy or early childhood and in high-risk Protein as a Nutrient hospitalized patients. DEFINITIONS, ESSENTIALITY, AND Marasmus: a condition characterized by a loss of flesh REQUIREMENT and strength due to underfeeding; a lack of sufficient calories for a prolonged period of time. Proteins are composed of carbon, hydrogen, oxygen, and nitrogen; they provide the foundation for every cell in the Meat analogs: See TVP. body. Proteins are broken down to amino acids by the body. Nonessential amino acids: amino acids that can be syn- Amino acids are classified as essential\u2014that which thesized by the body to meet its needs. cannot be produced by the body and must be obtained Synthesis: the process of building complex compounds from food; and nonessential\u2014that which can be pro- duced by the body. from simple ones when they are furnished to the body. Textured vegetable protein (TVP): protein that is drawn Proteins are also categorized as complete or incom- plete. Whether a protein food can be used for the growth from plant protein, spun into fibers, and manufac- and repair of tissue depends upon its biological value. tured into products that imitate animal protein foods. Proteins of high biological value are complete proteins Also called meat analogs. and contain all essential amino acids in adequate Vegetarianism: the practice of eating no animal flesh. amounts to promote growth. Those of low biological value are called incomplete proteins; they may not sup- BACKGROUND INFORMATION ply all the essential amino acids or may supply some of them in limited amounts. Genetics involves the passing of characteristics from one generation to the next. These characteristics make a per- The essential amino acid that provides the least ade- son unique. The entire genetic process creates one im- quate kind of protein in meeting human nutritional needs portant substance: protein. Each protein molecule is is termed the limiting amino acid. In a complete protein, made of many units, called amino acids. There are 20 to the limiting amino acid poses no problem. In an incom- 25 different amino acids in nature. The word protein plete protein, the limiting amino acid is responsible for comes from the Greek word protos, which means the poor utilization of its fellow essential amino acids. primary. Individuals consuming this incomplete protein must be All living substances, including plants and viruses, provided a source of the limiting amino acid. Animal pro- contain protein. Approximately 18% to 20% of the teins (except gelatin) are complete proteins; vegetable pro- human body is protein. It is present in all body tissues teins (for example, dried beans and peas) are incomplete. and fluids except bile and urine. Protein is made up of about 16% nitrogen, in both body tissue and food. The quantity of protein in a given sample, therefore, is mea- sured by the amount of nitrogen it contains. Nitrogen or protein balance of the body is an important factor in determining the body\u2019s health. Protein is an important factor in the American diet. Individuals\u2019 use and abuse of protein due to misconcep-","CHAPTER 3 PROTEINS AND HEALTH 37 Protein of high biologic value can result from comple- taining both plant and animal products means we will mentary mixtures of vegetable proteins, in which one consume an adequate amount of complete protein and vegetable protein supplies the amino acid that the other carbohydrate. The animal protein will complete the in- vegetable protein is lacking. adequate amino acids pattern of plants, and plant sources will provide the needed carbohydrates. Clinical evidence Foods containing a combination of the essential amino indicates that the human body can deteriorate when fed acids from plant sources need to be consumed over the only essential amino acids. course of a day. A pool of essential amino acids must be present in the blood to make complete proteins for pro- FUNCTIONS, STORAGE, SOURCES, AND tein synthesis. Therefore, the complete proteins should UTILIZ ATION be mixed with the incomplete ones in order to achieve ad- equate growth and repair. Vegetarians must be especially Functions careful to consume complementary proteins. The rec- ommended daily protein intake for adults is 0.8 g per kg The main function of protein is to provide the body with of body weight. Clinical factors such as surgery, burns, the amino acids necessary for growth and maintenance disease, medications (such as chemotherapy), and fevers of body tissues. Cells, enzymes, hormones, antibodies, will increase the protein need. The extent of increase muscles, blood, and all tissues and fluid except bile and should be predicated on the individual problem. urine require protein. Pregnancy and lactation require more protein; RDA re- quirements are set at 15 to 20 g above those for the non- Storage pregnant adult female, but should be altered according to individual need. Requirements during infancy, childhood, Proteins in the form of amino acids are the building and adolescence vary with the growth pattern. Daily pro- blocks of the body. Protein as such is not stored; there- tein intake should be in the form of complete good- fore, a daily intake is required. quality protein and\/or complementary protein foods. Sources PROTEIN SPARING Animal sources of protein include milk and milk prod- There are 20 to 25 amino acids, 20 of which are com- ucts, meat, fish, poultry, and eggs. Plant sources include monly found in food. When an amino acid is considered breads and cereal products, legumes, nuts and seeds, and nonessential, it can be produced by the body using avail- textured vegetable protein. Cereal grains are the primary able oxygen, carbon, hydrogen, and nitrogen. Essential source of protein for the majority of the world\u2019s popula- amino acids must be supplied by the diet. Eight essen- tion. The production of large animals for protein will be- tial amino acids are required by adults; nine are required come less practical as the world\u2019s population grows and by infants. space for humans must take precedence over space for raising large animals. The distinction between essential and nonessential requires further amplification. Individuals cannot sur- The health practitioner should be familiar with the vive without a dietary supply of the proper amounts of the complementary proteins in foods. Animal protein is rel- essential amino acids. However, our bodies need the atively expensive. As the world\u2019s protein supply dimin- nonessential amino acids to achieve optimal protein me- ishes, an understanding of complementarity will become tabolism. Biochemically, we need the carbon skeleton increasingly important. The proper mixing of ingested and amino groups of the essential and nonessential plant protein foods can provide nutritional value similar amino acids, respectively. to that of animal protein. It is of great importance, then, to have good sources Adequate amounts of high-quality protein are not of both essential and nonessential amino acids to pro- difficult to obtain in diets that contain dairy products vide sufficient nitrogen. The ratio of ingested amino and eggs. However, achieving nutritional balance in a acids, which is dependent on adequate food sources, must strict vegetarian diet requires considerable knowledge be present in proper proportion to permit efficient man- of the contributions of various foods to our dietary re- ufacture and repair of all the tissues in the body. In ad- quirements. Activity 2 discusses the use of vegetarian dition, there must be sufficient carbohydrate available diets. to meet energy needs; otherwise, body protein will be broken down for energy use. This is the protein-sparing Utilization action of carbohydrate that is discussed in Chapter 4. Most edible plant products contain more carbohydrate To be absorbed, proteins must be broken down to individ- than protein which is incomplete. However, animal or ual amino acids or small peptides (by-products of pro- muscle foods contain only little carbohydrate and a large tein digestion composed of 2 to 10 amino acids). amount of protein which is complete. Thus, a diet con-","38 PART I NUTRITION BASICS AND APPLICATIONS PROGRESS CHECK ON ACTIVITY 1 The products of protein digestion are absorbed into SHORT ANSWERS the bloodstream as amino acids and are transported via 1. Keep a 24-hour food record. the portal vein to the liver and then to all the body cells. a. List all the complete proteins you consumed. Some amino acids stay in the liver to form liver tissue it- self or to produce a wide variety of blood proteins. The re- b. List all the incomplete proteins you consumed. maining amino acids circulate in the bloodstream, from which they are rapidly removed and utilized by the c. Identify which food(s) has the highest quality tissues. protein. When amino acids are broken down, the nitrogen- 2. Why is it important to spread consumption of containing part is split off from the carbon chain. Most good-quality protein throughout the day? of the nitrogen is converted to urea in the liver and ex- creted via the kidneys. Then the carbon-containing por- 3. Is protein deficiency common in the United States? tion that remains is utilized for energy. Proteins provide 4 kcal per g, the same as carbohydrates. MULTIPLE CHOICE AMINO ACID SUPPLEMENTS Circle the letter of the correct answer. Of all the supplements that have come to market since 4. Substances are classified as protein when they people have been attempting to find magic bullets to pre- contain: vent aging, increase their libido, and improve their bod- ies, amino acid supplements have been at the top of the a. carbon, oxygen, and nitrogen. list. This phenomenon has been greatly enhanced by b. carbon, oxygen, hydrogen, and sulfur. competitive athletes, both professional and amateur, and c. carbon, hydrogen, oxygen, and nitrogen. their coaches. Some 25 to 30 amino acid supplement ad- d. carbon, calcium, phosphorus, and iron. vertisements can be found in any one body building or popular health magazine each month. Two major rea- 5. Adults require essential amino sons are given by athletes for using amino acid supple- acids, and infants require essential ments: (1) the belief that it gives them the \u201ccompetitive\u201d amino acids. edge, and (2) the belief that amino acids build muscle and are a major energy source. Neither of these beliefs is a. 8, 7 correct. Exercise builds muscle, not protein, and carbo- b. 8, 9 hydrates are the body\u2019s major energy source. Excess pro- c. 7, 8 tein (amino acids) is detrimental in that it places an d. 6, 7 undue burden on the kidneys to excrete the excess nitro- gen, and on the metabolism of the body. Excess protein 6. An amino acid is said to be essential if it: will also convert to fat. a. is needed by the body. Two other groups most vulnerable to the claims made b. cannot be synthesized by the body. by companies for their products are the elderly, who are c. contains vitamins and minerals. attempting to avoid health problems and retain their d. combines with nonessential amino acids. youth, and persons with chronic diseases or terminal dis- eases such as AIDS. 7. On days when a person exercises strenuously, his or her protein intake should be: Nutritional supplements have never been regulated by the FDA, and so have not been evaluated for safety or effectiveness. With the passage of the 1994 Supplement Bill (see Chapter 1), they will now come under that scrutiny. This may control future product development and sales, but the existing supplements are not covered, and there are at least 300 of these supplements already on the market. The burden of proof for health claims made for supplements will fall on the FDA, and these criteria are still to be determined. It will take a few more years be- fore the public will know which ones are safe and effec- tive. In the meantime, all health professionals should be aware of the attitudes and beliefs of many of their clients and should attempt to educate them about potential health risks.","CHAPTER 3 PROTEINS AND HEALTH 39 a. increased greatly. TABLE 3-1 Protein Content of Some Selected b. reduced sharply. Foods Using the Exchange List c. about the same as usual. Values* d. reduced by half. Food Serving Size Protein (g) 8. For protein synthesis to occur: Cheese, cheddar 1 oz 7 a. all the essential amino acids must be present. Cheese, cottage 1\u20444 c 7 b. sufficient nitrogen to form nonessential amino Cheese, parmesan, grated 2 tbsp 7 Milk 1c 8 acids is needed. Egg 1 7 c. the diet must have adequate calories from car- Asparagus, cooked 1\u20442 c 2 Leafy green vegetable, bohydrate and fat. 1\u20442 c 2 d. all of the above. cooked 1c 2 raw 1\u20442 c 3 TRUE\/FALSE Green peas, cooked 1 small 3 Potato, baked 1c 3 Circle T for True and F for False. Squash, winter, cooked 1 oz 7 Beef, pork, lamb 1 oz 7 9. T F Foods of animal origin contain substantial Poultry 1 slice 3 quantities of high-quality protein. Bread 4 3 Crackers, saltines 1 oz 7 10. T F Malnutrition affects physical and mental Wild game, any 1 oz 7 development. Fish, any 1\u20444 c 7 Tuna, canned 1 tbsp 7 ACTIVITY 2: Peanut butter 1\u20442 c 2 Tomato juice\/vegetable juice 1\u20442 c 2 Meeting Protein Needs and Vegetarianism Broccoli, cooked REQUIREMENTS FOR PROTEIN AND *This list does not differentiate the amount or type of fat in any AMINO ACIDS of the products, the biological value, or amino acid balance. Modified from data in Appendix F. Recommended protein intakes are based on the amount of nitrogen (quantity) and kind of amino acids (quality) new tissue is being formed, the body retains more nitro- consumed. The quantitative value of protein foods is gen than it excretes, creating a positive nitrogen balance. made by comparing the amount of protein in a serving This is the case during periods of growth such as preg- of food to the amount required by humans. Animal pro- nancy and childhood. Negative nitrogen balance occurs tein sources are highly concentrated, with the single ex- when muscles are breaking down, such as with bedridden ception of bacon, which is considered a fat in the Food persons or when very low-calorie reducing diets are used. Exchange Lists. Soybean products are quite concentrated More nitrogen is excreted than is taken in. in protein, although they contain a limiting amino acid, which reduces the quality of the product. To calculate the protein need of an adult, we need two items of information: The protein content of some common foods is com- pared in Table 3-1. \u2022 Body weight, using the body mass index (see Chapter 7). \u2022 The requirement of protein per kg body weight. The quality of a protein is dependent upon the essen- tial amino acids it contains compared to the essential Accordingly for an adult 19\u201330 years of age, the amino acid needs of the body. Quality is sometimes ex- (Dietary Reference Intakes\/Estimated Average Require- pressed as biological value (BV). This is a measure of the ment) DRI\/EAR is: body\u2019s retention of the nitrogen contained in the ingested protein. Eggs, with a BV of 100, have the highest quality \u2022 Man: 0.66 g\/kg\/day of any dietary proteins. Milk, at 93, follows a close second. \u2022 Nonpregnant woman: 0.66\/kg\/day Most meats, fish, and poultry have a BV of about 75. Any \u2022 Pregnant woman: 0.88\/kg\/day BV of 70 or above is considered sufficient for sustaining \u2022 Lactating woman: 1.05\/kg\/day growth and maintenance of body tissue. Requirements for protein differ by age, sex, and physical state of the For details on the protein requirements (DRI\/RDA) body. Factors influencing protein utilization can be mod- for different age groups (males and females), consult the ified by the digestibility of the protein and the overall Web site www.nas.edu. composition of the diet, as well as the source of the pro- tein and its amino acid balance. The RDA for protein is set by nitrogen-balance stud- ies. A healthy adult should be in nitrogen balance. When","40 PART I NUTRITION BASICS AND APPLICATIONS etarian diet presents no nutritional problems, if the iron intake is sufficient. The requirement for protein and each essential amino acid varies with age in absolute and relative quantities. Those people who follow either lacto- or ovo- Approximately 40% of an infant\u2019s protein must be from vegetarian diets must plan more carefully. While the essential amino acids, but only 20% for an adult. A food protein content of either diet is adequate, the ovo- that may be an adequate protein source for adults may be vegetarian may be low in calcium and phosphorus inadequate for the young child. Protein requirements in- intake because of avoidance of milk. Cases of rickets crease in certain kinds of illnesses or malnutrition. (vitamin D deficiency disease) have been reported in vege- tarian children who have no milk intake. Protein consumption in the United States is quite high, ranging between 100 to 120 g per day. This exceeds The strict vegetarian (vegan) diet presents several the DRI\/RDAs shown previously. Approximately two problems. It tends to be low in calcium, vitamin D, vita- thirds of the protein consumed in the United States is min B12, riboflavin, and zinc. None of the vegetable from animal sources. Excess protein intake has raised sources furnishes adequate calcium. Calcium is poorly questions about health risks. These risks will be discussed absorbed from vegetables because of the fiber content of later in this activity. the calcium-binding oxalic acid found in some greens. Also, a vegan may be lacking in vitamin D, since it is ob- For optimal use of protein, intake should be spread tained from animal sources only. If the person does not throughout the day rather than being consumed at one receive adequate sunlight, which can help vitamin D syn- meal. thesis under the skin, any existing calcium deficiency will be compounded by a dietary lack of vitamin D. VEGETARIANISM: RATIONALE AND CLASSIFICATION Problems with protein quality and quantity often occur among vegans. If vegetables and cereals are the only There are many reasons why individuals eliminate animal sources of protein, not only will they be of low quality but foods from their diets. The most common reasons are the digestibility factor is often low. Because of high fiber economic concerns, religious guidelines, health consid- content, many nonmeat sources are not well digested. erations, and concern for animal life. Beans are especially difficult for children. Although soy- bean protein is fairly similar to animal protein, its low di- When a vegetarian consumes no meat, fowl, or fish gestibility and a lack of flavor prohibit its consumption as as food, the further restrictions on the remaining part such. Soybeans are usually consumed in a highly of the diet can be classified as follows: processed and value-added form, for example, tofu or soy milk. Soy products are derived from soybeans; they are not 1. Fruitarians: individuals who eat only fruit. soybeans. Also, soybeans contain a trypsin inhibitor that 2. Vegans: individuals who eat no animal flesh nor any interferes with the function of trypsin, a major enzyme for digesting protein. Some vegetarian children tend to be food of animal origin. They are sometimes called smaller and show symptoms of undernutrition, but nutri- strict vegetarians. ent deficiencies vary with the number of dietary items 3. Lacto-vegetarians: individuals who eat plant proteins, restricted and the children\u2019s overall meal plans. Com- and also use milk. plementary protein mixes do not give an amino acid pat- 4. Ovo-vegetarians: individuals who eat plant proteins, tern fully usable by the body as animal protein does, but as well as eggs. correct combinations can increase protein quality by up 5. Lacto-ovo-vegetarians: individuals who eat both milk to 50%. Children should not be put on a vegan diet un- and eggs along with plant proteins. less medical and nutritional expertise is available to mon- itor their health. When foods are chosen wisely, a Semivegetarians restrict red meats only\u2014that is, beef, vegetarian child can meet his or her nutritional needs. pork, lamb, and game animals. Fish, poultry, dairy foods, eggs, and plants furnish proteins for their diet. Vegetarianism, when properly managed, can be a healthy way to eat. Children are especially at high risk of VEGETARIANISM: DIET EVALUATION failure to thrive if they are not supplemented with fortified foods containing essential nutrients missing from their Generally, the more restrictive the vegetarian\u2019s diet is, diets. Vegetarians may be at lower risk for gastrointestinal the more likely it is to be deficient in one or more major disorders (such as constipation, diverticulitis) and colon nutrients. The simplest and easiest of the vegetarian diets cancer because of the high fiber content of the diet. On the to balance is the lacto-ovo-vegetarian, with its use of eggs other hand, osteoporosis, which affects three out of five and milk. This diet offers high-quality protein for both women over the age of 60, is a high risk factor among children and adults, but may be low in iron if nonmeat many vegetarians. The avoidance of animal products with sources of this mineral are not included. Both milk and their high saturated fat content may lower the risk of coro- eggs are poor sources of iron. A high intake of legumes, nary heart disease. Because of less fat in the diet, vegetar- seeds, nuts, and enriched grains will increase iron intake ians also tend to have a lower incidence of obesity. substantially. Vegetarian diets may contain so much bulk that the stomachs of children are full before they get enough calories. If this happens, protein may be ineffi- ciently used for energy instead of building. The semiveg-","CHAPTER 3 PROTEINS AND HEALTH 41 VEGETARIANISM: DIET PLANNING TABLE 3-3 Food Groups for Strict Vegetarians To assure adequate intake of nutrients, vegetarians must Food Groups Major Daily carefully follow certain guidelines: Products Servings 1. Include 2 c legumes daily to meet calcium and iron Meat equivalents Legumes, peas and beans, requirements. nuts, textured vegetable 2. Include 1 c dark greens daily to meet iron require- ments for women. proteins (soy meat 3. Include at least 1 tbsp fat daily for proper absorption analogs and other of vitamins. formulated plant Tables 3-2 and 3-3 indicate the food groups for lacto- ovo- and strict vegetarians. Table 3-4 provides sample protein products and menus. spun soy isolates) *2 Figure 3-1 shows some complementary protein com- binations. There are many vegetarian cookbooks available Milk equivalents Soybean milk, preferably today. They have also become quite popular among non- fortified with calcium, vegetarians who wish to change their eating patterns by vitamins B2 and B12 *2 increasing fiber and lowering cholesterol and saturated (if not fortified, supple- fat. Evaluation of some of the recipes included is advised ments, especially before choosing a cookbook, because not all of them meet vitamin B12, may be the criteria of the dietary guidelines. necessary)* (8 oz = 1 serving) The health professional should be aware that some vegetarians believe that all medical problems can be pre- Breads and All varieties 4\u20136 vented or cured by their diet and fail to seek help when cereals All varieties they need it. Vege- Fruits and tables: While some religious groups that are vegetarian or vegetables 4 semivegetarian show a lower incidence of certain dis- eases that afflict the U.S. population (such as colon can- Fruits: cer, coronary heart disease), it must be remembered that 1\u20134** these groups\u2019 general lifestyles also differ from others. *Nut milks are nutritionally inadequate, especially for infants. **Including a source of vitamin C. TABLE 3-4 Sample Vegetarian Menus Vegan Lacto-Ovo-Vegetarian TABLE 3-2 Food Groups for Lacto-Ovo- Breakfast Orange juice Vegetarians Cheese\/mushroom omelet Orange juice Whole wheat toast Food Groups Major Daily Oatmeal\/honey Tea Products Servings Soy milk Toasted soy wheat bread Split pea soup Meat equivalents Legumes, peas and beans, Tea Peanut butter sandwich nuts, textured vegetable proteins (soy meat Lunch on wheat bread analogs and other Fruit and cottage cheese formulated plant Split pea soup Salad\/mayonnaise protein products and Peanut butter sandwich on Milk spun soy isolates), eggs 2 soy wheat bread Vegetable soup Milk and dairy Milk, cheese, yogurt, Fruit salad with sunflower Green salad with nuts products many other milk products (8 oz = seeds and seeds 1 serving) 2 Almonds\/raisins Whole wheat bread with Tea Breads and All varieties 4\u20136 margarine cereals Dinner Yogurt with oranges Fruits and All varieties Vege- Vegetable soup and strawberries vegetables tables: Green salad with nuts and Tea or milk 3 seeds Fruits: Soybean croquettes fried 1\u20133 in oil Pears Soybean milk","42 PART I NUTRITION BASICS AND APPLICATIONS Blackeyed peas and rice (Hopping John) GRAIN Refried beans (or frijoles) and corn tortillas Peanut butter sandwich Soybean curd (tofu) and rice Baked beans with rolls or bread LEGUMES SEEDS Garbanzo and sesame seed Lentil casserole with spread (Tahini) nut topping Split pea soup with sesame seed crackers NUTS Snacks, peanuts, sunflower seeds, pumpkin seeds, raisins, and walnuts FIGURE 3-1 Complementary Vegetable Proteins Examples of Common Foods Eaten Together That Supply Essential Amino Acids They generally avoid tobacco and alcohol, suffer few Excesses stresses, and exercise regularly. These factors contribute to a lower risk for these diseases. Questions raised about excessive protein intake of Americans include the following: It is not possible to document that a vegetarian diet alone promotes better health, but this practice together 1. Excess nitrogen must be cleared by the kidneys. This with other lifestyle changes may lead to healthy habits. may negatively affect kidneys that are malfunctioning, damaged, or underdeveloped. EXCESSIVE AND DEFICIENT PROTEIN INTAKE 2. High protein consumption has recently been cited as Normal tissue growth in infancy and childhood and dur- one factor in bone demineralization, especially if cou- ing pregnancy and lactation requires more amino acids pled with low calcium intake. than those needed for tissue maintenance. As has been demonstrated in many laboratory studies, in the absence 3. While inconclusive at this time, research indicates of adequate protein, growth is slowed down or even that high protein consumption may increase risks of stopped. colon cancer by changing the internal environment and altering the bacteria of the colon. The feeding of infants in strict vegetarian families is of particular concern to the health professional. If breast- 4. Large amounts of protein, especially of animal ori- feeding is not possible, a formula such as nutritionally gin, also contain saturated fats. Most authorities are fortified soybean milk should be provided. The soybean convinced that saturated fats contribute to a high in- formula fortified with vitamin B12 should continue to be cidence of heart disease. given by cup after the child is weaned. A wide variety of foods should be chosen, with emphasis on those that are 5. Since excess protein from any source is converted to high in iron and vitamins A, B complex, and C. In addi- fat and stored as adipose tissue, it can contribute to tion to soybean milk, mixtures of legumes and cereals obesity. are needed to supply sufficient protein. Deficiencies Large losses of protein may occur during illness or sur- gical procedures. These situations require substantial in-","CHAPTER 3 PROTEINS AND HEALTH 43 creases in protein consumption. Lack of increased pro- nourished persons have a shortened life expectancy, and tein intake during illness will result in delayed wound common childhood diseases are often fatal to the mal- healing, slow convalescing, low resistance to infections, nourished child. Enzyme and hormone production is in- and inability to return to optimum health. adequate in these victims. Although they badly need extra nutrients, they are unable to digest and absorb them. Protein energy malnutrition (PEM) is the most seri- ous and widespread deficiency disease in developing Some infants are born with an inability to metabolize countries. The two major types are nutritional maras- phenylalanine, an essential amino acid. Mental retarda- mus, due primarily to caloric deficiency, and kwashior- tion results if the disease is not treated. Phenylketonuria kor, due primarily to a deficiency of protein. will be discussed in Part IV. The protein in specific foods is considered to be the cause of food allergies. In this The clinical features of kwashiorkor and marasmus case, careful addition of protein foods to an infant\u2019s diet are illustrated in Figure 3-2. Although they are treated as must be practiced. two separate diseases, they are closely related. Diets low in calories will almost always be low in protein. Even if RESPONSIBILITIES OF HEALTH PERSONNEL there is adequate protein, the body will use it for energy instead of for growth and development. The health professional should do the following: While primarily considered a child\u2019s disease, PEM also 1. Recommend moderate amounts of animal protein. develops in adults. Adults with PEM exhibit weight loss, Excess protein is wasteful, since the excess is con- fatigue, and other symptoms of acute malnutrition. A verted to energy, and excess energy is converted to low intake of protein and calories also results in the de- fat. Protein food is an expensive form of energy. ficiency of three nutrients: vitamin A, iron (causing ane- mia), and iodine (causing endemic goiter). Vitamin A, 2. Be aware that protein foods are not low in calories. being a fat-soluble vitamin, will be low in a protein- They provide the same number of calories per gram restricted diet. Vitamin A deficiency negatively affects as carbohydrates. Furthermore, protein foods from growth, skin, and vision, sometimes causing blindness. animal sources (such as meats, cheese) frequently Many women die in childbirth from low iron levels. If contain excessive calories from fat. there is an infection from parasites such as hookworm, even less iron is available. PEM will produce stunted 3. Advise clients to eat good-quality protein at each meal growth and mental retardation. A malnourished woman to provide a consistent supply of essential amino is likely to give birth to a premature, often retarded in- acids. Protein cannot be stored in the body and is fant with less resistance to infection and illness. Poorly used constantly in its major functions. Kwashiorkor Nutritional Marasmus Hair changes Normal hair Thin muscles Misery Old man\u2019s face Fat present Thin muscles Thin fat Edema No edema Very underweight Underweight FIGURE 3-2 Comparison of Children with Kwashiorkor and Marasmus Source: D. B. Jelliffe. Clinical Nutrition in Developing Countries, 1968. U.S. Department of Health, Education and Welfare, Public Health Service.","44 PART I NUTRITION BASICS AND APPLICATIONS Case Study 4. Plan some meals for clients around complementary Mary and Leon are married college students, both 21 years of vegetable protein foods for variety, economy, and in- age. They are living on a limited income and became vegetari- creased fiber. ans 2 years ago when they became involved in the ecological movement on campus. Mary, who at 5\u20199\u201d weighs 110 lb., has 5. Be aware that meals containing legumes and grains just discovered that she is pregnant with her first child. She are very nourishing and less expensive than meals requests advice about an appropriate diet. Using the above in- containing meat. formation and research data from other sources (other chapters in this book, instructor, relevant Web sites, and so on), answer 6. Be aware of the importance of eating extra protein the following: during illnesses, which cause excessive breakdown of 15. List other data you will need to gather about her body tissue. diet habits before you can assist her. 7. Recognize that certain illnesses require alterations in amounts and types of protein ingested. 16. What is the basic nutritional increase she will need during her pregnancy? How much increase? 8. Ask clients questions regarding their use of supple- ments and advise them of any undesirable side effects. 17. What is her general protein requirement accord- ing to her weight? PROGRESS CHECK ON ACTIVITY 2 18. Is her weight appropriate for her height? Should MATCHING she gain extra weight over the 24 to 30 lb. in- crease recommended for the normal pregnancy? Match the nutrient listed in Column A to the statement that best describes it in Column B. Terms may be used 19. If she and Leon are vegans, will she be able to get more than once. the quality and quantity of protein she will need? List several food combinations that would help. Column A Column B 20. Why would adequate carbohydrate foods be im- 1. Calcium a. Strict vegetarian diets are at portant in her prenatal diet? 2. Vitamin A risk of being deficient in 3. Iron this nutrient. 21. If she has an adequate diet during her pregnancy, 4. Vitamin B12 will she be in positive or negative nitrogen bal- 5. Thiamin b. Strict vegetarian diets are ance? Explain your answer. 6. Riboflavin generally adequate in this 7. Vitamin D nutrient. Match the food item on the left to the statement on the right that best describes its protein content. Terms may be used more than once. 8. Legumes a. High quality, high quantity 9. Cheese b. Low quality, low quantity 10. Broccoli c. Low quality, high quantity 11. Potato 12. Tuna MULTIPLE CHOICE Circle the letter of the correct answer. 13. An individual who will not eat meat, fish, poultry, or eggs but drinks milk with his or her plant foods is a(n): a. vegan. b. ovo-vegetarian. c. fruitarian. d. lacto-vegetarian. TRUE\/FALSE Circle T for True and F for False. 14. T F Excessive protein intake may place a strain on the kidneys.","CHAPTER 3 PROTEINS AND HEALTH 45 REFERENCES Ling, J. R. (Ed.). (2007). Dietary Protein Research Trends. New York: Nova Science. Anderson, G. H. (2004). Dietary proteins in the regulation of food intake and body weight in humans. Journal of Mann, J. & Truswell, S. (Eds.). (2007). Essentials of Nutrition, 134: 974s\u2013979s. Human Nutrition (3rd ed.). New York: Oxford Uni- versity Press. Bauer, J. D. (2007). Nutritional status of patients who have fallen in an acute care setting. Journal of Human Martin, D. S. (2003). Dietary protein and hypertension: Nutrition and Dietetics, 20: 558\u2013554. Where do we stand? Nutrition, 19: 385\u2013389. Bilsborough, S. (2006). A review of issues of dietary pro- Miller, G. D., Janis, J. K., & McBean, L. D. (2007). tein intake in humans. International Journal of Sport Handbook of Dairy Foods and Nutrition (3rd ed.). Nutrition and Exercise Metabolism, 16: 129\u2013152. Boca Raton, FL: CRC Press. Caballero, B., Allen, L., & Prentice, A. (Eds.). (2005). En- Otten, J. J., Hellwig, J. P., & Meyers, L. D. (Eds.). (2006). cyclopedia of Human Nutrition (2nd ed.). Boston: Dietary Reference Intake: The Essential Guide to Elsevier\/Academic Press. Nutrient Requirements. Washington, DC: National Academics Press. Di Pasquale, M. (2008). Amino Acids and Proteins for the Athlete: The Anabolic Edge (2nd ed.) Boca Raton, FL: Randi, G. (2007). Lipid, protein and carbohydrate intake CRC Press. in relation to body mass index: an Italian study. Public Health Nutrition, 10: 306\u2013310. Driskell, J. A. (2007). Sports Nutrition: Fats and Proteins. Boca Raton, FL: CRC Press. Roboud-Ravaux, M. (Ed.). (2002). Protein Degradation in Health and Disease. New York: Springer. Eastwood, M. (2003). Principles of Human Nutrition (2nd ed.). Malden, MA: Blackwell Science. Rose, H. J. (2005). Fat intake of children with PKU on low phenylalanine diets. Journal of Human Nutrition and Houston, M. S., Holly, J. M. P., & Feldman, E. L. (2006). Dietetics, 18: 395\u2013400. IGF and Protein in Health and Disease. Totowa, NJ: Humana Press. Stipanuk, M. H. (Ed.). (2006). Biochemical, Physiological and Molecular Aspects of Human Nutrition (2nd ed.). Kerstetter, J. E. (2006). Meat and soy protein affect cal- St. Louis, MO: Elsevier Sauders. cium homostasis in healthy women. Journal of Nutrition, 136: 1890\u20131895. Tores, N. (2007). The role of dietary protein in lipotox- icity. Nutrition Reviews, 65: s64\u2013s68. Li, P. (2007). Amino acids and immune function. British Journal of Nutrition, 98: 237\u2013252.","","OUTLINE CHAPTER 4 Objectives Carbohydrates and Fats: Glossary Implications for Health Background Information ACTIVITY 1: Carbohydrates: Time for completion Characteristics and Effects Activities: 1 hour on Health Optional examination: 1\u20442 hour Definitions, Classification, and Requirements Functions Sources, Storage, Sweeteners, and Intake Athletic Activities Health Implications Progress Check on Activity 1 ACTIVITY 2: Fats: Characteristics and Effects on Health Definitions and Food Sources Functions and Storage Diet, Fats, and Health Progress Check on Activity 2 References OBJECTIVES Carbohydrates and Health Upon completion of this chapter the student should be able to do the following: 1. Identify the types of carbohydrates, their fuel value, and storage methods. 2. Summarize the major functions and food sources of carbohydrates. 3. Discuss nutritive and nonnutritive sweeteners. 4. Evaluate blood glucose level as an indicator of certain body conditions. 5. Define fiber and list its functions and food sources. 6. Discuss health problems associated with excess sugar or low-fiber intake. 7. Describe the effects of carbohydrate consumption on athletic activity. Fats and Health Upon completion of this chapter the student should be able to do the following: 1. Classify fats and state their fuel value. 2. List the major functions and food sources of fats. 3. Discuss body utilization of essential fatty acids and cholesterol. 4. Explain the difference between saturated and unsaturated fatty acids and identify their food sources. 5. Evaluate storage of fat in the body and the relationship of fat to normal body weight. 6. Relate a body\u2019s health to excess total fat intake and excess saturated fat intake. 47","48 PART I NUTRITION BASICS AND APPLICATIONS by the body for the synthesis of necessary tissues and fluids. Cholesterol is also found in plaques that line GLOSSARY the inner wall of the artery in atherosclerosis. Fatty acids: the basic unit of all fats. Essential fatty acids Carbohydrates are those that cannot be produced by the body and must be obtained in the diet. A saturated fatty acid is Cellulose: a fibrous form of carbohydrate that makes up one in which the fatty acids contain all the hydrogen the framework of a plant. A component of fiber. they can hold. A monounsaturated fatty acid is one into which hydrogen can be added at one double bond. Complex carbohydrates: a class of carbohydrates called Polyunsaturated fatty acids have two or more double polysaccharides; foods composed of starch and cellu- bonds into which hydrogen can be added. lose. Hydrogenation: the addition of hydrogen to a liquid fat, changing it to a solid or semisolid state. Generally, Cruciform: cross shaped; bearing a cross. The name cru- the harder the product, the higher the degree of sat- ciferous is given to certain vegetables, namely broc- uration with hydrogen. coli, cabbage, Brussels sprouts, and cauliflower. These Lipoproteins: transport form of fat (attached to a pro- plants have four-petaled flowers that resemble a cross, tein) in the bloodstream. hence the botanical name cruciferal, and the term Satiety value: a food\u2019s ability to produce a feeling of full- cruciferous vegetables. ness. Diabetes mellitus: a condition characterized by an ele- BACKGROUND INFORMATION vated level of sugar in blood and urine, increased uri- nation, and increased intake of both fluid and food, Carbohydrates with an absolute or relative insulin deficiency. Complications include heart disease, high blood pres- Carbohydrates are the most abundant organic substances sure, and kidney disease. Diabetes can cause blindness on Earth, comprising approximately 70% of plant struc- and is frequently associated with severe infections. ture. They are the main source of the body\u2019s energy. Diverticulitis: inflammation of the sacs that form at In the United States, about 50% of dietary energy weakened points along the colon lumina, especially comes from carbohydrates. This level of intake is in older people. considered acceptable, but the type of carbohydrates con- sumed has caused concern among health professionals. Fiber: a group of compounds that make up the framework Although both starches and sugars are carbohydrates, of plants. Fiber includes the carbohydrate substances they differ in food sources and nutrient values. Starches (cellulose, hemicellulose, gums, and pectin) and a non- are mainly found in certain fresh and processed prod- carbohydrate substance called lignin. These com- ucts such as vegetables, breads, and cereals. They pro- pounds are not digested by the human digestive tract. vide a large amount of calories and lesser amounts of protein, vitamins, minerals, and water. Sugars, on the Glycogen: the form in which carbohydrate is stored in other hand, furnish only calories and no nutrients. They humans and animals. are derived from sugar cane and sugar beets. The typical Western diet contains more carbohydrates from sugary Insulin: a hormone secreted by the pancreas that is nec- foods than from starches. The government guidelines for essary for the proper metabolism of blood sugar. healthy eating strongly recommend the reverse. Fiber, another plant component, is also an important carbohy- Ketosis: an accumulation of ketone bodies from partly drate. Although it neither furnishes energy nor is di- digested fats due to inadequate carbohydrate intake. gestible, it is important for health. All plant foods contain fiber, and we obtain it mainly from cereal grains, espe- Lactose intolerance: a condition in which the body is de- cially unrefined ones. ficient in lactase, the enzyme needed to digest lactose (the sugar in milk). Leads to abdominal bloating, gas, Fats and watery diarrhea. Affects 70%\u201375% of blacks, al- most all Asians, and 5%\u201310% of whites. Fats, chemically termed lipids, are also organic com- pounds. They are insoluble in water. Most fat in the diet Naturally occurring sugars: sugars found in foods in their is in the form known as triglycerides. Fats differ in chem- natural state; for example, sugar occurs naturally in ical structure from carbohydrates, though both contain grapes and other fruits. carbon, hydrogen, and oxygen. Based on their chemical bonding arrangements, fats can be saturated, monoun- Refined food: food that undergoes many commercial saturated, or unsaturated. Many different properties of processes resulting in the loss of nutrients in the food. fats are determined by the degree of saturation. Fats Atherosclerosis: thickening of the inside wall of the ar- teries by fatty deposits, resulting in plaques that nar- row the arteries and hinder blood flow. Can lead to heart disease. Bile salts: the substance from the gallbladder that breaks fats into small particles for digestion. Cholesterol: a fatlike compound occurring in bile, blood, brain and nerve tissue, liver, and other parts of the body. Cholesterol comes from animal foods and is used","CHAPTER 4 CARBOHYDRATES AND FATS: IMPLICATIONS FOR HEALTH 49 The typical Western diet derives approximately TABLE 4-1 Classification of Carbohydrates 38%\u201340% of its total daily calories from fats, mainly sat- urated fats. Ninety percent of fats in the American diet Carbohydrates come from fats and oils, meat, poultry, fish, and dairy products. We are advised to eat about 30% of our total Starches Sugars daily calories from fat, with no more than 10% in satu- Kinds and Sources Kinds and Sources rated forms. Polysaccharides Monosaccharides Dietary fats are important because they serve as 1. Starch\u2014cereals 1. Glucose\u2014blood sugar stored energy reserves and as carriers of essential fatty 2. Fructose\u2014sugar found acids and fat-soluble vitamins. Fats must combine with grains bile from the gallbladder to be digested. Since they are vegetables in fruit not soluble in water, they must attach themselves to 2. Dextrin\u2014digestion 3. Galactose\u2014digestion proteins before they can travel through the intestinal product walls, lymph system, and bloodstream. From the blood- infant formula product stream they are delivered to body tissues. 3. Cellulose*\u2014stems, leaves Disaccharides coverings 1. Sucrose\u2014table sugar Cholesterol, which is a cross between fat and alcohol, seeds 2. Lactose\u2014sugar found is derived both from foods and body synthesis. Although skins, hulls much maligned because of its implication in heart dis- 4. Pectin*\u2014fruits in milk ease, cholesterol is an important body component and is 5. Glycogen\u2014muscle and 3. Maltose\u2014germinating transported by low-density or high-density lipoproteins in body circulation. Lipoproteins are discussed in Chapter liver seed 16 in relation to cardiovascular disease, and will not be explored here. *Nondigestible. ACTIVITY 1: minerals, fiber, and energy. Sugars, sweets, and unen- riched refined cereals provide calories only. Carbohydrates: Characteristics and Effects on Health Carbohydrates are also good sources of fiber, which is the nondigestible part of plant foods. It is nutritionally DEFINITIONS, CLASSIFICATION, significant in gastrointestinal functioning. Fiber is clas- AND REQUIREMENTS sified as soluble or insoluble. Carbohydrates are composed of carbon, hydrogen, and Insoluble fiber (cellulose and hemicellulose) is found oxygen. Sugars, starches, and fiber are the main forms in in legumes, vegetables, whole grains, fruits, and seeds. which carbohydrates occur in food. Starches and sugars Soluble fibers are the pectins, gums, mucilages, and algae are the major source of body energy. They are the cheap- and are found in vegetables, fruits, oats and oat bran, est and most easily used form of fuel for the body. Fibrous legumes, rye, and barley. materials provide bulk and aid digestion. Although most carbohydrates occur in plant foods, a few are of animal The NAS has established DRIs\/RDA for carbohydrates origin. These include glycogen, which is stored in the for individuals at different stages of life. For example, for liver and muscle as a small reserve supply, and lactose, a an adult aged 19\u201330 years: sugar found in milk. \u2022 Males: RDA is 130 g\/day Carbohydrates are classified as monosaccharides \u2022 Females, not pregnant: RDA is 130 g\/day (simple sugars), disaccharides (double sugars), and polysaccharides (mainly starches). All carbohydrates The NAS has established DRIs\/AI for total fiber for in- must be reduced to simple sugars (monosaccharides) in dividuals at different stages of life. For example, for an the intestine before they can be absorbed into the adult aged 19\u201330 years: bloodstream. Glucose, a simple sugar, is the form in which carbohydrates circulate in the bloodstream. \u2022 Males: AI is 38 g\/day Glucose is commonly referred to as blood sugar. Table \u2022 Females, not pregnant: AI is 25 g\/day 4-1 classifies carbohydrates according to their chemi- cal structures. FUNCTIONS Energy Source The nutrients and calories contributed by different carbohydrates vary. For example, whole grains, enriched Carbohydrates are the most economical and efficient cereal products, fruits, and vegetables provide vitamins, source of energy. They furnish 4 kcal\/g of energy. The body requires a constant source of energy to support its vital functions.","50 PART I NUTRITION BASICS AND APPLICATIONS contain both types of fiber. The recommended daily in- take of fiber, consumed from plant sources, varies though Protein-Sparing Action our DRI\/AI requirements are defined as mentioned pre- viously. Our actual consumption of fiber is unknown and Carbohydrates prevent protein from being used as energy. influenced by such factors as gas formation. The fermen- Carbohydrate, protein, and fat can all be used to produce tation of carbohydrate by intestinal bacteria produces energy. However, the body utilizes carbohydrate first. volatile gases that are socially unacceptable and may oc- When not enough carbohydrate is present, the body uses casionally cause bloating and pain, especially in those protein and fat for its energy needs. Thus, an adequate persons who decide to drastically increase their fiber in- amount of carbohydrate can spare protein that can then take. Clients are advised to do so gradually, to eat a vari- be used for tissue building and repair rather than energy. ety of fiber-containing foods and avoid just one source, such as bran, for all their fiber intake. Metabolic Functions The NCI dietary guidelines, directed especially toward Under normal conditions, the tissues of the central ner- the prevention of colon cancer, recommend high intakes vous system (especially the brain) can use only glucose as of vegetables (especially cruciferous), fruits, and whole an energy source. Muscles can use either glucose or fats as grains, which facilitate the removal of bile salts and cho- fuel. Body fat is used by the muscles only during physical lesterol, along with a low-fat diet. The Dietary Guidelines activity varying from walking up stairs to lifting weights. for Americans and MyPyramid also highly encourage eat- ing these foods and reducing fat in the diet. Some carbohydrate is needed for the proper utilization of fat. In the absence of carbohydrate, fats are not com- Blood Glucose pletely burned, and ketosis results (see later discussion). Severe restriction of carbohydrate in reducing diets can The form of carbohydrate used by the body is a monosac- cause ketosis, which can produce adverse effects. charide\u2014glucose. All forms of carbohydrate except fiber eventually are broken down by the body to glucose. Carbohydrates are important components of certain Glucose is the form of sugar found in the blood, and its substances needed for regulating body processes. They control at normal blood levels is important to health. also encourage the growth of beneficial bacteria involved Without sufficient glucose, the body will use its protein in the production of certain vitamins and in the absorp- to make glucose, since the brain requires glucose to func- tion of calcium and phosphorus. tion. This diverts protein from its important functions of building and repairing tissues. When carbohydrate is Fiber and Health insufficient, the body metabolizes fat differently to pro- duce ketosis, a condition in which unusual by-products Insoluble fiber has a laxative effect. It provides bulk, lead- of fat metabolization break down into ketones and accu- ing to regular elimination of solid wastes. By promoting mulate in the blood. Ketosis during pregnancy can result normal function, insoluble fiber is useful in reducing in brain damage and irreversible mental retardation in pressure on the lumina of the colon, thus helping prevent the infant. Some experts suggest that ketosis is poten- diverticulitis. Insoluble fiber provides a feeling of full- tially dangerous for all adults. ness, thereby reducing the amount of food eaten. Most food sources of insoluble fiber such as legumes, vegeta- Blood glucose levels vary. Normal levels range between bles, and fruits are not calorie dense. These factors are 70 to 120 mg per 100 ml of blood. When blood sugar is less helpful when weight-reduction diets are needed. than 70 mg, hunger occurs. After eating, blood sugar lev- Insoluble fibers also exert a binding effect on bile salts els normally rise. The beta cells in the pancreas respond to and cholesterol, preventing their absorption. Excessive the increase by secreting insulin. Insulin causes the liver, ingestion of fiber, however, is undesirable, as this fiber muscle, and fat cells to increase their uptake of sugar, also binds with minerals such as calcium, zinc, and iron, which in turn reduces the blood sugar levels to normal. which are essential for body function. The glucose entering the cells is then converted to glyco- gen or fat or is used for energy if the body needs it. Insulin Soluble fibers are important factors in preventing dis- also assists in regulating the metabolism of fat by the body. eases such as heart disease, colon cancer, and diabetes mel- litus. They form soft gels by absorbing water, which slows Insulin is the only hormone that directly lowers blood carbohydrate absorption and binds cholesterol and bile sugar levels. If there is insufficient production of insulin acids. Slow absorption reduces fasting blood sugar and low- by the pancreas, or if it is unavailable, the blood cannot ers insulin requirements. Binding of the bile acids and cho- be cleared of excess glucose. This condition is hyper- lesterol permits cholesterol to be excreted instead of glycemia, the term used to describe blood glucose levels absorbed. Studies indicate that bile acids may contribute to above the normal range. It occurs in diabetes mellitus. colon cancer; therefore, this binding capacity is important. This abnormal response to glucose can sometimes be Major sources of soluble fiber include vegetables and fruits. controlled by diet therapy and weight control, but in Combinations of both soluble and insoluble fibers pro- duce the best effects; many of the recommended foods","CHAPTER 4 CARBOHYDRATES AND FATS: IMPLICATIONS FOR HEALTH 51 certain types of diabetes, insulin may have to be admin- Nutritive sweeteners provide calories. Examples in- istered to help lower blood glucose levels. clude sugar, honey, molasses, and syrup (corn, maple). The most common is table sugar, which comes from When blood glucose drops below the normal limits, sugar beets or sugar cane. Table sugar is sucrose, two the condition is called hypoglycemia. Symptoms of hy- simple sugars chemically joined. Sugar can be white poglycemia vary, depending on blood sugar level. Early or brown. White sugar contains mainly sucrose. Brown symptoms include weakness, dizziness, hunger, trem- sugar contains trace amounts of protein, minerals, vi- bling, and mental confusion. If the levels drop very low, tamins, water, and pigment in addition to sucrose. convulsions or unconsciousness may occur. Although it can occur, as a spontaneous reaction in some people, most Synthetic sweeteners are nonnutritive and furnish often it happens when a diabetic uses excess insulin and\/or no calories. They have been used for many years by di- has not eaten for a long period. A glucose-tolerance test abetics and dieters. Since 1969 saccharin was the only will determine true hypoglycemia. People who are not di- legal nonnutritive sweetener until the recent availabil- abetic but are sensitive to changes in blood sugar levels ity of aspartame. Cyclamates were used until 1969, should follow a calculated diet much the same as a dia- when they were banned because they were shown to betic, avoiding sweets and eating regular, balanced meals. cause bladder cancer in rats. Since the consumption of artificially sweetened beverages and foods has in- SOURCES, STORAGE, SWEETENERS, creased drastically in recent years, the Food and Drug AND INTAKE Administration (FDA) is studying saccharin and aspar- tame carefully. Aspartame is made from the amino The major food sources of carbohydrate are plants, which acids aspartic acid and phenylalanine. Although it is vary in the amounts of sugar and starches they provide. on the GRAS (generally recognized as safe) list, pre- Milk and milk products containing lactose are the only cautions are advised about the use of aspartame by significant animal sources of carbohydrates. Food sources pregnant women and young children. Other people of carbohydrate include cereal grains, fruits, vegetables, may be sensitive to aspartame and should avoid using nuts, milk, and concentrated sweets. Table 4-2 compares it. Products sweetened with aspartame carry a warn- the carbohydrate content of selected foods. ing label for people who have phenylketonuria (PKU) to avoid the use of the product. PKU is an inherited dis- TABLE 4-2 Carbohydrate Content of Some order of defective protein metabolism. It is discussed in Selected Foods Chapter 29. The newest synthetic sweetener on the market is acesulfame K (potassium). Brand names are Food Serving Carbohydrate Sweet One and Sunette. Size Content In general, carbohydrate stores in the body are Milk, skim 1c 12 g small. Carbohydrate in excess of the body\u2019s energy Milk, whole 1c 12 g needs is stored in limited amounts in the liver and Bread 1 slice 15 g muscle. Most excess is converted to fat and stored as (white or whole wheat) such. Less than one pound is stored as glycogen. This Oatmeal 1\u20442 c (cooked) 15 g amount can furnish energy for 12 to 24 hours. How- Green peas 1\u20442 c 15 g ever, the excess converted to fat can be stored in unlim- (frozen or canned) ited amounts in the body. Puffed wheat 11\u20442 c 15 g Popcorn (popped) 3c 15 g A carbohydrate deficiency leads to a loss of muscle Yam, sweet potato 1\u20443 c 15 g tissue as protein is burned to meet energy and glucose Mushrooms, cooked 1\u20442 c 5g needs. In addition, fats are incompletely broken down Asparagus 1\u20442 c 5g and a condition of ketosis results. Prolonged carbohy- Green beans 1\u20442 c 5g drate deficiencies can cause damage to the liver. Low- Strawberries, raw\/ 11\u20444 c 15 g fiber diets are associated with constipation and are whole\/unsweetened linked to colon cancer. Scientists now recommend that Pineapple juice 1\u20442 c 15 g 50%\u201360% of the daily caloric intake be from carbohy- (unsweetened) drate foods, especially the complex carbohydrates Cantaloupe, cubed 1\u20443 melon 15 g (starches). Angel food cake \u2044112 cake 15 g Ice cream, any flavor 1\u20442 c 15 g Of the classes of carbohydrate, sugars and sweets Granola 1\u20444 c 15 g are the least desirable. Overconsumption of sugar pro- Cheese pizza, thin crust 1\u20444 of 10\u0408\u0408 pie 30 g motes dental caries and frequently leads to a poor nu- Chile, with beans 1c 30 g tritional quality diet. Table 4-3 shows the sugar content Frozen fruit yogurt 1\u20443 c 15 g of some popular foods. Diabetes mellitus and lactose intolerance are examples of diseases in which carbo- hydrates are not utilized normally by the body.","52 PART I NUTRITION BASICS AND APPLICATIONS TABLE 4-3 Sugar Content of Selected Foods the books in the references for this chapter. They are also available in training manuals for both amateur and pro- Food Serving Total Grams Sugar fessional athletes engaged in endurance sports such as Amount (Sucrose, Glucose, short- and long-distance running. In general such guide- Fructose, Maltose)* lines revolve around the following premises: Apple juice 8 oz 25\u201335 1. Carbohydrate intake before exercise Beer (average of 2. Carbohydrate intake during exercise all brands) 12 oz 3\u20134 3. Carbohydrate intake following exercise Brownie 50 gm 22.5 4. Meal plans and menus Carbonated beverages 12 oz 38\u201341 Chocolate 2 oz 35\u201343 The concept of carbohydrate loading is also practiced Granola (average of by athletes in other sports that are not endurance sports all brands) 1\u20444 c 7\u20138 such as basketball, football, and soccer. However, it is Honey 1 tbsp 14\u201316 recommended that the practice of carbohydrate loading Ketchup 1 tbsp 4\u20136 should be implemented under the directions of a quali- Nondairy creamer 1 tbsp 9\u201311 fied professional, especially for nonadult athletes. Pineapple juice 8 oz 28\u201331 Tomato, red (raw) 1 tomato 4\u20136 HEALTH IMPLICATIONS Tomato paste (canned) 1\u20442 c 23\u201327 Yogurt (sweetened) 8 oz 30\u201340 Health risks are associated with excessive sugar con- sumption, but it is difficult to make positive correlations *Types of sugars in each food not differentiated. Calories for between sugar consumption and the development of each item may be obtained by multiplying total \u03eb 4. many diseases that have been linked to it. Included Source: Adapted from Food Nutrients Database, www.usda.gov. among the associations of sugar and health problems are the following: ATHLETIC ACTIVITIES 1. Obesity\u2014Sugar is often named as being the cause of Except for an increased energy requirement, athletes re- obesity. If persons are obese, they certainly have con- quire the same basic nutrients that all people require. sumed excess calories. It is probably an overall excess The amount of energy expended in training and compe- intake rather than sugar alone. Sugar is usually cur- tition determines the amount of food needed. The recom- tailed in reduction diets along with fats and alcohol mended distribution of nutrients for anyone is 50% to because such foods contribute mainly calories. 60% of daily caloric intake from carbohydrate, 15% to 20% from protein, and 30% to 35% from fat. If energy 2. Cardiovascular disease\u2014Except for certain types of needs increase, the distribution should remain the same, lipid disorder, in which an individual exhibits abnor- with the size of individual portions being increased to mal glucose tolerance along with an elevation of meet the requirements. blood triglycerides, research studies cannot prove any correlation between sugar intake and cardiovascular Carbohydrates are the most efficient energy source disorder. Obesity is probably more closely related to for both athletes and nonathletes and, as such, should this disorder than a high sugar consumption. be used to meet the need for increased energy. Athletes\u2019 carbohydrate needs are better met through extensive use 3. Diabetes\u2014The cause of the malfunction of the pan- of grains, fruits, and vegetables instead of sugary foods. creas is not known, but heredity plays a role as well For the body to convert foods into energy, certain vita- as obesity. The chance of becoming diabetic more mins and minerals are necessary. These are found only in than doubles for every 20% of excess weight, accord- nutrient-dense foods, not in candies and other sweets. ing to the U.S. National Diabetes Commission. While studies have shown that the incidence of diabetes rose Of all athletic activities, endurance performance is in population groups that \u201cWesternized\u201d and started most frequently associated with carbohydrate consump- consuming excess sugary foods, most researchers tion. The premise is simple. A high carbohydrate diet agree that individuals have become fat from excess helps increase body glycogen storage and extend the en- calories, not just sugar. durance of an athlete. In a process called carbohydrate or glycogen loading, athletes adjust their carbohydrate con- 4. Dental caries\u2014Carbohydrates, especially sugar, play sumption and practice schedules to maximize their mus- a role in tooth decay. Sucrose is especially implicated. cle glycogen storage. The frequency of eating sugar, sweets, and similar snacks is more damaging than the amount eaten in There are professional guidelines to help adult ath- one sitting. Good oral hygiene (brushing after meals) letes to implement a safe and effective carbohydrate load- helps prevent dental caries. The general state of ing regimen. Such guidelines are available in some of health also influences susceptibility to caries.","CHAPTER 4 CARBOHYDRATES AND FATS: IMPLICATIONS FOR HEALTH 53 5. Cancer\u2014Population group studies have not linked 5. Name three good food sources of fiber. nonnutritive sweeteners to cancer. Certain groups with increased susceptibility to bladder cancer in- a. clude some heavy saccharine users. This correlation is also associated with heavy cigarette smokers. At b. present, the use of saccharine is in a \u201csuspended\u201d status\u2014that is, if new data show definitive hazards, c. the use of this substance will be banned. 6. Name two health problems related to overcon- 6. Fiber\u2014Low-fiber diets are believed to play a major sumption of sugar. role in the onset of diverticulosis and may contribute a. to appendicitis. The added pressure in the colon caused by a low-fiber intake may increase the occur- b. rence of hemorrhoids, varicose veins, and hiatal her- nia. Colon cancer has been linked to low-fiber diets, 7. Why are diets that severely restrict carbohydrates but the relationship is not clear. There are several dangerous? theories regarding the cause-and-effect relationships, but the current general recommendation is to main- MULTIPLE CHOICE tain a balanced diet with ample intake of fiber and Circle the letter of the correct answer. fluids. No RDA has been set for fiber, but 15 g\/day is recommended in Healthy People 2000. PROGRESS CHECK ON ACTIVITY 1 8. If a 2000 kcal\/day diet derives approximately 1000 kcal from carbohydrates, how many grams of car- bohydrate does that diet contain? SHORT ANSWERS a. 150 b. 200 1. Using meal planning exchange lists in Appendix F, c. 250 rank the following foods by carbohydrate content, d. 400 beginning with the food that has the most carbo- hydrate. If two foods have the same value, give 9. Identify the trend in food consumption in the them the same number. United States that has occurred since the turn of the century. a. 1 orange b. 1 c whole kernel corn a. Potato consumption has continued to increase. b. Consumption of refined sugar and processed c. \u20441 of a devil\u2019s food cake with icing (from 10 sugar products has increased. c. Fruit and vegetable consumption has greatly a mix) increased. d. 1 slice wheat bread d. Consumption of cereals has greatly increased. e. 1\u20442 c zucchini squash f. 1\u20442 c cooked oatmeal 2. Rank the following vegetables by carbohydrate 10. Cellulose is a carbohydrate. content, beginning with the one that has the most carbohydrate. If two foods have the same value, a. digestible give them the same number. b. nondigestible c. disaccharide a. 1\u20442 c green beans, cooked d. processed b. 1\u20442 c cooked carrots c. 1 baked potato 11. Which two of the following food groups contain d. 1 sweet potato the greatest amounts of cellulose and other food e. 1 stalk broccoli fiber? f. 1\u20442 c lettuce, chopped a. meat and dairy products 3. If a person\u2019s carbohydrate intake is greater than his b. whole grain cereals or her energy needs, what happens to the excess? c. fruit juices d. raw fruits and vegetables 4. What is the function of fiber in the diet? 12. Which of the following represent blood sugar lev- els within the normal range? a. 30 to 60 mg per 100 ml b. 70 to 120 mg per 100 ml","54 PART I NUTRITION BASICS AND APPLICATIONS 21. Glycemia c. low blood glucose levels c. 140 to 160 mg per 100 ml 22. Hypoglycemia d. high blood glucose levels d. 100 to 120 mg per 100 ml 23. Glucagon e. hormone that affects the 13. Insulin is secreted by the: uptake of glucose from the blood into various a. alpha cells of the pancreas. body cells b. beta cells of the pancreas. c. nephron of the kidney. Match the carbohydrate in Column A to its type in d. digestive cells in the intestinal wall. Column B. Terms may be used more than once. 14. From the items below, choose the snack that pro- Column A Column B duces the least amount of caries. 24. Sucrose a. polysaccharide a. plain popcorn and an apple b. taffy and raisins 25. Glucose b. monosaccharide c. noodles with butter d. sherbet and 7-Up float 26. Glycogen c. disaccharide 15. Carbohydrates are the raw materials that we eat 27. Lactose mainly as: 28. Grains a. starches and sugars. b. proteins and fats. 29. Fructose c. plants and animals. d. pectin and cellulose. 30. Cellulose 16. Carbohydrates provide one of the main fuel ACTIVITY 2: sources for energy. Which of the following carbohydrate foods provides the quickest source Fats: Characteristics and Effects on Health of energy? DEFINITIONS AND FOOD SOURCES a. slice of bread b. glass of orange juice Although both fats and carbohydrates contain carbon, hy- c. chocolate candy bar drogen, and oxygen, fats are entirely different compounds d. glass of milk from carbohydrates because of their chemical structures. Foods that contribute fat to the diet include whole milk 17. Chemical digestion of carbohydrates is completed and milk products containing whole milk or butterfat, in the small intestine by enzymes from the: such as butter, ice cream, and cheese; egg yolk; meat, fish, and poultry; nuts and seeds; vegetable oils; and hydro- a. pancreas and gallbladder. genated vegetable fats (shortenings and margarine). b. gallbladder and liver. c. small intestine and pancreas. A fat is classified as saturated, monounsaturated, or d. liver and small intestine. polyunsaturated according to the type of fatty acids it con- tains in greatest quantity. Saturated food fats are generally 18. The refined fuel glucose is delivered to the cells by solid at room temperature and come from animal sources. the blood for production of energy. The hormone Saturated fats are found in whole milk and products made controlling use of glucose by the cells is: from whole milk; egg yolk; meat; meat fat (bacon, lard); coconut oil and palm oil; chocolate; regular margarine; a. thyroxin. and hydrogenated vegetable shortenings. Unsaturated food b. growth hormone. fats are generally liquid at room temperature and come c. adrenal steroid. from plant sources. They can be monounsaturated or d. insulin. polyunsaturated. Sources of polyunsaturated fats are saf- flower, sunflower, corn, cottonseed, soybean, and sesame MATCHING oil; salad dressings made from these oils; special mar- garines that contain a high percentage of such oils; and Match the phrases on the right with the terms on the fatty fish such as mackerel, salmon, and herring. Sources left that they best describe. of monounsaturated fats are olive oil and most nuts. Diets rich in saturated fat and\/or cholesterol can lead to ele- 19. Insulin a. hormone that causes the vated blood cholesterol levels. Polyunsaturated and mo- release of glucose into nounsaturated fats appear to lower blood cholesterol level. the blood 20. Hyperglycemia b. glucose in the blood","CHAPTER 4 CARBOHYDRATES AND FATS: IMPLICATIONS FOR HEALTH 55 Cholesterol is a fatlike substance (lipid) that is a key of fat (greater than 35% of calories) generally increases component of cell membranes and a precursor of bile saturated fat intake and makes it more difficult to avoid acids and steroid hormones. Cholesterol travels in the consuming excess calories. A low intake of fats and oils circulation in spherical particles containing both lipids (less than 20% of calories) increases the risk of inade- and proteins called lipoproteins. A lipoprotein is made quate intakes of vitamin E and of essential fatty acids and up of fats (cholesterol, triglycerides, fatty acids, etc.), pro- may contribute to unfavorable changes in high-density tein, and a small amount of other substances. The cho- lipoprotein (HDL) blood cholesterol and triglycerides. lesterol level in blood plasma is determined partly by inheritance and partly by the fat and cholesterol content Fats supply energy and essential fatty acids and serve as of the diet. Other factors, such as obesity and physical a carrier for the absorption of the fat-soluble vitamins A, inactivity, may also play a role. D, E, and K and carotenoids. Fats serve as building blocks of membranes and play a key regulatory role in numerous Organ meats and egg yolk are very rich sources of biological functions. Dietary fat is found in foods derived cholesterol; shrimp is a moderately rich source. Other from both plants and animals. The recommended total fat sources include meat, fish, poultry, whole milk, and foods intake is between 20% and 35% of calories for adults. A fat made from whole milk or butterfat. intake of 30%\u201335% of calories is recommended for chil- dren 2 to 3 years of age, and 25%\u201335% of calories for FUNCTIONS AND STORAGE children and adolescents 4 to 18 years of age. Few Americans consume less than 20% of calories from fat. Fat functions in the body as the following: Fat intakes that exceed 35% of calories are associated with both total increased saturated fat and calorie intakes. 1. A source of essential fatty acids 2. The most concentrated source of energy (9 kcals\/g) Considerations for the General Public 3. A reserve energy supply in the body 4. A carrier for the fat-soluble vitamins (A, D, E, and K) Three major classes of lipoproteins can be measured in 5. A cushion and an insulation for the body the serum of a fasting individual: very-low-density lipopro- 6. A satiety factor (satisfaction from a fatty meal) teins (VLDL), low-density lipoproteins (LDL), and high- density lipoproteins (HDL). The LDL are the major culprits All fats that are not burned as energy are stored as in cardiovascular diseases (CVD) and typically contain adipose tissue. Most people have a large storage of fat in 60%\u201370% of the total serum cholesterol. The HDL usually the body. contain 20%\u201330% of the total cholesterol, and their levels are inversely correlated with risk for coronary heart disease DIET, FATS, AND HEALTH (CHD). The VLDL, which are largely composed of triglyc- erides, contain 10%\u201315% of the total serum cholesterol. All information in this section has been modified from of- ficial publications distributed by the United States To decrease their risk of elevated low-density lipopro- Department of Agriculture (USDA), the National Institute tein (LDL) cholesterol in the blood, most Americans need of Health (NIH), and Food and Drug Administration to decrease their intakes of saturated fat and trans fats, (FDA). There are three major publications: and many need to decrease their dietary intake of choles- terol. Because men tend to have higher intakes of dietary 1. Dietary Guidelines for Americans, 2005. (www. cholesterol, it is especially important for them to meet healthierus.gov, www.usda.gov). See also Chapter 1 this recommendation. Population-based studies of and Chapter 16. American diets show that intake of saturated fat is more excessive than intake of trans fats and cholesterol. There- 2. MyPyramid (www.usda.gov, www.mypyramid.gov). fore, it is most important for Americans to decrease their See also Chapter 1. intake of saturated fat. However, intake of all three should be decreased to meet recommendations. Table 4-4 shows, 3. National Cholesterol Education Program. Third for selected calorie levels, the maximum gram amounts of Report of the Expert Panel on Detection, Evaluation, saturated fat to consume to keep saturated fat intake be- and Treatment of High Blood Cholesterol in Adults low 10% of total calorie intake. This table may be useful (ATP-III), 2001, (www.NIH.gov). See also Chapter 16. when combined with label-reading guidance. Table 4-5 gives a few practical examples of the differences in the sat- Background Information urated fat content of different forms of commonly con- sumed foods. The contribution of saturated fat intake Fats and oils are part of a healthful diet, but the type of varies with the type of foods being consumed. Diets can be fat makes a difference to heart health, and the total planned to meet nutrient recommendations for linoleic amount of fat consumed is also important. High intake acid and \u2423-linolenic acid while providing very low amounts of saturated fats, trans fats, and cholesterol increases the of saturated fatty acids. risk of unhealthy blood lipid levels, which, in turn, may increase the risk of coronary heart disease. A high intake","56 PART I NUTRITION BASICS AND APPLICATIONS TABLE 4-4 Maximum Daily Amounts of Based on 1994\u20131996 data, the estimated average Saturated Fat to Keep Saturated Fat daily intake of trans fats in the United States was about Below 10% of Total Calorie Intake 2.6% of total energy intake. Processed foods and oils provide approximately 80% of trans fats in the diet, Total Calorie Intake Limit on Saturated Fat Intake compared to 20% that occur naturally in food from an- imal sources. Table 4-6 provides the major dietary 1600 18 g or less sources of trans fats listed in decreasing order. Trans fat 2000a 20 g or less content of certain processed foods has changed and is 24 g or less likely to continue to change as the industry reformu- 2200 25 g or less lates products. Because the trans-fatty acids produced 2500b 31 g or less in the partial hydrogenation of vegetable oils account for more than 80% of total intake, the food industry 2800 has an important role in decreasing trans-fatty acid content of the food supply. Limited consumption of Notes: foods made with processed sources of trans fats pro- aThe maximum gram amounts of saturated fat that can be con- vides the most effective means of reducing intake of sumed to keep saturated fat intake below 10% of total calorie trans fats. By looking at the food label, consumers can intake for selected calorie levels. A 2000-calorie example is in- select products that are lowest in saturated fat, trans cluded for consistency with the food label. This table may be fats, and cholesterol. useful when combined with label-reading guidance. bPercent Daily Values on the Nutrition Facts panel of food la- bels are based on a 2000-calorie diet. Values for 2000 and 2500 calories are rounded to the nearest 5 grams to be consistent with the Nutrition Facts panel. Source: Courtesy of the USDA. TABLE 4-5 Differences in Saturated Fat and Calorie Content of Commonly Consumed Foods Food Category Portion Saturated Fat Content (grams) Calories Cheese 1 oz 6.0 114 Regular cheddar cheese 1 oz 1.2 49 Low-fat cheddar cheese Ground beef 3 oz (cooked) 6.1 236 Regular ground beef (25% fat) 3 oz (cooked) 2.6 148 Extra-lean ground beef (5% fat) Milk 1 c 4.6 146 Whole milk (3.25%) 1 c 1.5 102 Low-fat (1%) milk Breads 1 medium 6.6 231 Croissant (med) 1 medium 0.2 227 Bagel, oat bran (4\u201d) Frozen desserts 1\u20442 c 4.9 145 Regular ice cream 1\u20442 c 2.0 110 Frozen yogurt, low-fat Table spreads 1 tsp 2.4 34 Butter 1 tsp 0.7 25 Soft margarine with zero trans fats Chicken 3 oz (cooked) 3.3 212 Fried chicken (leg with skin) 3 oz (cooked) 0.9 140 Roasted chicken (breast no skin) Fish 3 oz 2.8 195 Fried fish 3 oz 1.5 129 Baked fish Note: This table shows a few practical examples of the differences in the saturated fat content of different forms of commonly consumed foods. Comparisons are made between foods in the same food group (e.g., regular cheddar cheese and low-fat cheddar cheese), illustrating that lower saturated fat choices can be made within the same food group. Source: ARS\/USDA Nutrient Database for Standard Reference, Latest Release (www.ars.usda.gov, www.usda.gov).","CHAPTER 4 CARBOHYDRATES AND FATS: IMPLICATIONS FOR HEALTH 57 TABLE 4-6 Contribution of Various Foods to may reduce the risk of mortality from coronary heart disease and that consuming EPA and DHA may reduce Trans Fat Intake in the American the risk of mortality from cardiovascular disease in peo- Diet (Mean Intake = 5.84 g) a ple who have already experienced a cardiac event. Food Group Contribution (percent Federal and state advisories provide current informa- of total trans fats tion about lowering exposure to environmental contam- consumed) inants in fish. For example, methylmercury is a heavy metal toxin found in varying levels in nearly all fish and Cakes, cookies, crackers, 40 shellfish. For most people, the risk from mercury by eat- pies, bread, etc. 21 ing fish and shellfish is not a health concern. However, 17 some fish contain higher levels of mercury that may Animal products 8 harm an unborn baby or young child\u2019s developing ner- 5 vous system. The risks from mercury in fish and shellfish Margarine depend on the amount of fish eaten and the levels of mer- 4 cury in the fish. Therefore, the Food and Drug Adminis- Fried potatoes 5 tration (FDA) and the Environmental Protection Agency are advising women of childbearing age who may become Potato chips, corn chips, pregnant, pregnant women, nursing mothers, and young popcorn children to avoid some types of fish and shellfish and eat fish and shellfish that are lower in mercury. For more Household shortening information, see Chapter 9. Otherb Recommendations aThe major dietary sources of trans fats listed in decreasing order. Processed foods and oils provide approximately 80 per- Lower intakes (less than 7% of calories from saturated fat cent of trans fats in the diet, compared to 20 percent that and less than 200 mg\/day of cholesterol) are recom- occur naturally in food from animal sources. Trans fats con- mended as part of a therapeutic diet for adults with ele- tent of certain processed foods has changed and is likely to vated LDL blood cholesterol (i.e., above their LDL blood continue to change as the industry reformulates products. cholesterol goal [see Table 4-7]. People with an elevated bIncludes breakfast cereal and candy. USDA analysis reported 0 LDL blood cholesterol level should be under the care of grams of trans fats in salad dressing. a healthcare provider. Source: Adapted from Federal Register notice. Food Labeling; Trans Fatty Acids in Nutrition Labeling; Consumer Research to Key recommendations for the general public are as Consider Nutrient Content and Health Claims and Possible follows: Footnote or Disclosure Statements; Final Rule and Proposed Rule. (2003). 68(133), 41433\u201341506. 1. Consume less than 10% of calories from saturated fatty acids and less than 300 mg\/day of cholesterol, To meet the total fat recommendation of 20% to 35% and keep trans-fatty acid consumption as low as pos- of calories, most dietary fats should come from sources sible. of polyunsaturated and monounsaturated fatty acids. Sources of omega-6 polyunsaturated fatty acids are liq- 2. Keep total fat intake between 20 to 35% of calories, uid vegetable oils, including soybean oil, corn oil, and with most fats coming from sources of polyunsatu- safflower oil. Plant sources of omega-3 polyunsaturated rated and monounsaturated fatty acids, such as fish, fatty acids (\u2423-linolenic acid) include soybean oil, canola nuts, and vegetable oils. oil, walnuts, and flaxseed. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are omega-3 fatty acids 3. When selecting and preparing meat, poultry, dry that are contained in fish and shellfish. Fish that natu- beans, and milk or milk products, make choices that rally contain more oil (e.g., salmon, trout, herring) are are lean, low fat, or fat free. higher in EPA and DHA than are lean fish (e.g., cod, had- dock, catfish). Limited evidence suggests an association 4. Limit intake of fats and oils high in saturated and\/or between consumption of fatty acids in fish and reduced trans-fatty acids, and choose products low in such risks of mortality from cardiovascular disease for the gen- fats and oils. eral population. Other sources of EPA and DHA may pro- vide similar benefits; however, more research is needed. Key recommendations for specific population groups Plant sources that are rich in monounsaturated fatty are: acids include nuts and vegetable oils (e.g., canola, olive, high oleic safflower, and sunflower oils) that are liquid at Keep total fat intake between 30 to 35% of calories room temperature. for children 2 to 3 years of age and between 25 to 35% of calories for children and adolescents 4 to 18 years of age, Considerations for Specific Population Groups with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and Evidence suggests that consuming approximately two vegetable oils. servings of fish per week (approximately 8 ounces total)","58 PART I NUTRITION BASICS AND APPLICATIONS TABLE 4-7 Relationship Between LDL Blood Cholesterol Goal and the Level of Coronary Heart Disease Riska If Someone Has: LDL Blood Cholesterol Goal Is: CHD or CHD risk equivalentb Less than 100 mg\/dL Two or more risk factors other than elevated LDL blood cholesterolc Less than 130 mg\/dL Zero or one risk factor other than elevated LDL blood cholesterolc Less than 160 mg\/dL aInformation for adults with elevated LDL blood cholesterol. LDL blood cholesterol goals for these individuals are related to the level of coro- nary heart disease risk. People with an elevated LDL blood cholesterol value should make therapeutic lifestyle changes (diet, physical activity, weight control) under the care of a healthcare provider to lower LDL blood cholesterol. Source: NIH Publication No. 01-3290, U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute, National Cholesterol Education Program Brochure, High blood cholesterol: What you need to know, May 2001. www.nhlbi.nih.gov\/health\/public\/heart\/chol\/hbc_what.htm. bCHD (coronary heart disease) risk equivalent = presence of clinical atherosclerotic disease that confers high risk for CHD events: 1. Clinical CHD 2. Symptomatic carotid artery disease 3. Peripheral arterial disease 4. Abdominal aortic aneurysm 5. Diabetes 6. Two or more risk factors with > 20% risk for CHD (or myocardial infarction or CHD death) within 10 years cMajor risk factors that affect your LDL goal: 1. Cigarette smoking 2. High blood pressure (140\/90 mmHg or higher or on blood pressure medication) 3. Low HDL blood cholesterol (less than 40 mg\/dl) 4. Family history of early heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65) 5. Age (men 45 years or older; women 55 years or older) PROGRESS CHECK ON ACTIVITY 2 TRUE OR FALSE MULTIPLE CHOICE 4. T F Lower intakes (less than 7% of calories from saturated fat and less than 200 mg\/day of cho- 1. Which of the following is incorrect? lesterol) are recommended as part of a thera- peutic diet for adults with elevated LDL blood a. When the total calorie intake is 2200, limit sat- cholesterol. urated fat intake to 24 g or less. 5. T F Fat functions in the body as the major protec- b. When the total calorie intake is 2800, limit sat- tion for the womb and the fetus in a pregnant urated fat intake to 31 g or less. woman. c. When the total calorie intake is 2000, limit sat- 6. T F Regular ground beef (3 oz) has three times urated fat intake to 18 g or less. more fat than extra-lean ground beef (3 oz). d. When the total calorie intake is 2500, limit sat- 7. T F Smoking cigarettes is a one of the major risk urated fat intake to 28 g or less. factors that affect a person\u2019s LDL goal. 2. Cholesterol: 8. T F The risk of CHD increases when one has prostate cancer. a. in blood is determined by height. b. is a key component of cell membranes. FILL-IN c. in shrimp is more than that in eggs. d. is found in some plant foods. 9. The reading for high blood pressure is 3. Describe the key recommendations for a specific . population group. 10. The level of low HDL blood cholesterol is a. Keep total fat intake between 30 to 35% of calories for children 2 to 3 years of age. . b. Keep total fat intake between 35 to 40% of 11. What is highest percentage of total trans fats con- calories for children 2 to 3 years of age. sumed by Americans? c. Keep total fat intake between 25 to 35% of DEFINE calories for children 4 to 11 years of age. 12. LDL: d. Keep total fat intake between 25 to 35% of 13. Lipoprotein: calories for adolescents 11 to 18 years of age.","CHAPTER 4 CARBOHYDRATES AND FATS: IMPLICATIONS FOR HEALTH 59 14. CHD: Topping, D. (2007). Cereal complex carbohydrates and their contribution to human health. Journal of Cereal 15. EPA: Science, 46: 220\u2013229. 16. DHA: Webster-Gandy, J., Madden, A., & Holdworth, M. (Eds.). (2006). Oxford Handbook of Nutrition and Dietetics. REFERENCES Oxford, London: Oxford University Press. Carbohydrates Whitney, E. N. & Rolfe, S. R. (2002). Understanding Nutrition. Belmont, CA: Wadsworth. Aston, L. M. (2006). Glycaemic index and metabolic disease risk. Proceedings of Nutrition Society, 65: 125\u2013134. Fats Bessesen, D. 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Cereal Foods World 46: 461\u2013464, 466\u2013467. Huang, Y. S., Yanagita, Y., & Krapp, H. R. (Eds.). (2006). Dietary Fats and Risk of Chronic Disease. Champaign, Jones, J. R. (2006). Dietary reference intake: Implications IL: AOCS Press. for fiber labeling and consumption. Nutrition Review, 64: 31\u201338. Hunter, J. E. (2006). Dietary trans fatty acids: Review of recent human studies and food industry response. Livesay, G. (2001). Tolerance of low-digestible carbohy- Lipids, 41: 967\u2013992. drates: A review. British Journal of Nutrition, 85: s7\u2013s16. Kelly, D. S. (2007). Docosahexaenoic acid supplementa- Lunn, J. (2007). Carbohydrates and dietary fiber. Nutri- tion improves fasting and postprandial lipid profiles in tion Bulletin, 32: 21\u201364. hyperglyceridemic men. American Journal of Clinical Nutrition, 86: 324\u2013333. Mann, J. & Truswell, S. (Eds.). (2007). Essentials of Human Nutrition (3rd ed.). New York: Oxford Uni- Ma, Y. (2006). Association between carbohydrate intake versity Press. and serum lipids. Journal American College of Nutrition, 25: 155\u2013163. Mussatto, S. I. (2007). Non-digestible oligosaccharides: A review. Carbohydrate Polymers, 68: 587\u2013597. Mann, J., & Truswell, S. (Eds.). (2007). Essentials of Human Nutrition (3rd ed.). New York: Oxford Uni- Scheppach, W. (2001). Beneficial health effect of low- versity Press. digestible carbohydrate consumption. British Journal of Nutrition, 85: s23\u2013s30. Mensink, R. P. (2006). Effects of stearic acid on plasma lipids and lipoproteins in men. Lipids, 40: 1201\u20131205. Seal, C. J. (2006). Whole grains and CVD risk. Pro- ceedings of Nutrition Society, 65: 24\u201334. Messina, M. J. (2003). Potential public health implica- tions of the hypocholesterolemic effects of soy pro- Stipanuk, M. H. (Ed.). (2006). Biochemical, Physiological teins. Nutrition, 19: 280\u2013281. and Molecular Aspects of Human Nutrition (2nd ed.). 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Clinical Nutrition, 86: 341\u2013346. Simopoulos, A. P. (2004). Health effects of eating wal- nuts. Food Reviews International, 20: 91\u201398.","OUTLINE CHAPTER 5 Objectives Vitamins and Health Glossary Background Information Time for completion ACTIVITY 1: The Water-Soluble Activities: 11\u20442 hours Vitamins Optional examination: 1\u20442 hour Reference Tables Progress Check on Activity 1 ACTIVITY 2: The Fat-Soluble Vitamins Reference Tables Antioxidants Vitamins and the Preparation and Processing of Food Progress Check on Activity 2 Responsibilities of Health Personnel Summary Progress Check on Chapter 5 References OBJECTIVES Upon completion of this chapter, the student should be able to do the following: 1. Describe the general characteristics of vitamins. 2. Identify the fat-soluble vitamins and list: a. their functions b. their food sources c. the results of a deficiency or excess d. the conditions requiring an increase e. the specific characteristics of each 3. Identify the water-soluble vitamins and list: a. their functions b. their food sources c. the results of a deficiency or excess d. the conditions requiring an increase e. the specific characteristics of each 4. State RDA\/DRIs for selected vitamins and discuss amounts of foods needed to meet the requirements. 5. Discuss health risks associated with massive intake of vitamins to prevent or treat disease. 6. Evaluate the effectiveness of megavitamin intake. 7. Indicate population groups for whom vitamin\/mineral supplements may be necessary. 61","62 PART I NUTRITION BASICS AND APPLICATIONS and guinea pigs need the same outside sources of vi- tamins as humans do, whereas rabbits, rats, and dogs GLOSSARY are able to manufacture some of them in the body. 3. Vitamins are essential for growth and health. An Carotene: a yellow pigment in plants that can be con- absence or deficiency of vitamins creates specific verted to vitamin A in the intestinal wall. disorders. 4. The amount of vitamins needed is very small. The Cheilosis: a condition in which lesions appear on the lips total daily requirement is less than 1 tsp. and the angles of the mouth (cracks). 5. Currently, 13 vitamins are identified as essential. Continued research may identify additional essential Coenzyme: a substance such as a vitamin that can attach vitamins. to the inactive form of an enzyme to make it an active 6. Synthetic vitamins are nutritionally equivalent to nat- compound or complete enzyme. urally occurring vitamins. Collagen: a gelatin-like protein substance found in con- What Can Vitamins Do? nective tissue and bones; a cementing material be- tween body cells. 1. In the digestive process, vitamins interact with other vitamins and\/or nutrients to enhance absorption. Dermatitis: inflammation of the skin. Enzyme: a compound that speeds up the rate of a chemi- 2. Vitamins can function as coenzymes; that is, they can work with enzymes to speed body chemical reactions. cal reaction without itself being changed in the process. They are used up in the reactions, whereas the en- Glossitis: inflammation of the tongue. zymes remain unchanged. Hypervitaminosis: a toxic condition caused by excessive 3. Vitamins help release energy from biological reac- accumulation of a vitamin in the body. tions during metabolism. They do not provide energy. Intrinsic factor: a factor found inside a system. An in- 4. Vitamins are not a structural part of the body. trinsic factor is a glycoprotein secreted by the gastric glands necessary for the absorption of vitamin B12. How Are Vitamins Named? Megadose: a very large dose of a vitamin, 5 to 100 times or more than the daily recommended allowance. 1. Vitamins are named by letters of the alphabet, some- Organic: (1) containing carbon, a chemical definition; times with a number, such as vitamins A, B1, B2, C, (2) free of chemical fertilizers, pesticides, and addi- and D. tives; a definition used by the lay public. In this chap- ter, organic refers to the first definition. 2. Vitamins are also given chemical names, for exam- Osteomalacia: a disease occurring in adults in which ple, retinol, ascorbic acid, thiamin, and riboflavin bones become softened; caused by a deficiency of vi- refer to vitamins A, C, B1, and B2, respectively. tamin D and calcium. Adult rickets (see Rickets). Osteoporosis: a disease in which calcium is lost from How Are Vitamins Classified? bones, causing them to fracture easily. Provitamin or precursor: an ingested substance that is Vitamins are classified into groups with regard to their converted into a vitamin in the body. For example, solubility in either fat or water. carotene is the precursor of vitamin A, and trypto- phan is the precursor of niacin. 1. The four fat-soluble vitamins are Rickets: the vitamin D- and calcium-deficiency disease in a. vitamin A (retinol) children; results in bone malformation; equivalent to b. vitamin D (cholecalciferol) osteomalacia in adults. c. vitamin E (tocopherol) Scurvy: the vitamin C-deficiency disease; characterized by d. vitamin K (menadione) loss of appetite and growth, anemia, weakness, bleed- ing gums, loose teeth, swollen ankles and wrists, and 2. The nine water-soluble vitamins are tiny hemorrhages in the skin. a. vitamin C (ascorbic acid) b. vitamin B complex: BACKGROUND INFORMATION vitamin B1 (thiamin) vitamin B2 (riboflavin) What Are Vitamins? niacin vitamin B6 (pyridoxine) 1. Vitamins are essential organic substances needed daily vitamin B12 (cobalamin) in very small amounts to perform a specific function folacin or folic acid in the body. Although they are grouped under one pantothenic acid term because they all contain carbon, the essentiality biotin of vitamins for one species may not apply to another. 2. Vitamins cannot be manufactured by the human body; they must be obtained from the diet. Monkeys","CHAPTER 5 VITAMINS AND HEALTH 63 Several vitamins exist in more than one chemical b. means that the host needs a dietary supply every form. other day instead of daily. How Is Food Preparation Related to the c. does not mean that the host is immune to large Solubility of Vitamins? doses. Megadoses are toxic to the body. The solubility of vitamins is directly related to their re- 2. The body does not store excess water-soluble vita- tention in foods during preparation. mins, but instead excretes them in the urine. As a result: 1. Water-soluble vitamins are lost into cooking water. a. Vitamin deficiency appears only a few weeks after For greater vitamin retention, the following general dietary deprivation. guidelines apply: b. The vitamins must be consumed daily. a. Use only a small quantity of cooking water. c. Vitamin supplements do not have extra benefits if b. Use leftover cooking water for making gravies, a person is consuming an adequate diet. Any excess soups, and sauces. Do not discard it. is lost in the urine. c. Minimize cutting food into pieces. d. Some people assume that excess intake of water- d. Use the shortest cooking time. Cooking with a lid soluble vitamins is harmless. However, there are helps to shorten cooking time. reports documenting the ill effect of excess inges- tion of these vitamins. 2. Fat-soluble vitamins are not affected by cooking and preparation in water, but may be destroyed by: A summary of the characteristics of the two classes of a. high cooking heat, sun drying, or other forms of vitamins is found in Table 5-1. dehydration. b. oxidation that accompanies rancidity in fat. Fat- ACTIVITY 1: soluble vitamins are found in fat. The Water-Soluble Vitamins How Are Vitamins Stored? REFERENCE TABLES 1. Excess fat-soluble vitamins are stored in body fat and organs, especially the liver. This storage ability: The water-soluble vitamins, as discussed in the back- a. can delay deficiency for several months, even if the ground information, are ascorbic acid (vitamin C) and the host does not receive such vitamins in the diet. B vitamin complex. Tables 5-2 through 5-10 summarize the specific characteristics of each of these vitamins. Study them in preparation for the progress check that follows. TABLE 5-1 A General Comparison of Water- and Fat-Soluble Vitamins Vitamins Criteria Water-Soluble Fat-Soluble 1. Medium in which soluble Aqueous, such as water Nonpolar, organic, such as oil, fat, or ether 2. Number known to be essential 9 to humans 4 3. Number human body can synthesize 2 High if precursors are provided 1 Optimal amount stored; rest excreted; 4. Body storage capacity Minimal toxicity to body high for two vitamins Bile; if conjugated, urine 5. Body handling of excess intake Mainly excreted; low toxicity to body At longer intervals, e.g., weekly or monthly 6. Means of body disposal Urine Slow At short intervals, e.g., daily C, H, and O only 7. Urgency of dietary intake Fast 8. Rapidity of symptom appearance C, H, and O; S, N, and Co in some if deficient vitamins 9. Chemical constituents","64 PART I NUTRITION BASICS AND APPLICATIONS TABLE 5-2 Vitamin C (Ascorbic Acid) Food Results of Deficiency Conditions Specific Sources\u2020 Characteristics Functions or Excess Requiring Increase Essential in formation For adults 19\u201330 years Deficiency Pregnancy and 1. Vitamin C is easily of collagen, a RDA, male: 90 mg\/d lactation destroyed by heat, protein that binds RDA. female: 75 mg\/d acute deficiency\u2014 storage, exposure cells together. scurvy* Malnutrition to air, dehydration Excellent Sources alkali (such as Needed to heal chili peppers, green delayed wound Alcoholism\/drug baking soda), and wounds build new healing addiction lengthy exposure tissue, and provide peppers to copper and iron strength to sup- parsley failure to thrive Infections, burns, utensils. porting tissue. broccoli (children) injuries, fever kale 2. Vitamin C defi- Aids formation of bone cabbage decayed and breaking Certain drug thera- ciency is rare in de- matrix and tooth strawberries teeth pies, e.g., isoniazid,\u2020 veloped countries, dentin. papaya OCAs** but can occur in oranges (and juice) iron deficient gingivi- any cases of serious Absorbs iron, which lemons tis anemia (if iron High stress conditions neglect such as promotes pro- grapefruit (and juice) intake is also low) psychiatric prob- thrombin formation. guava lems, substance tangerines low resistance to in- abuse, advanced Helps maintain cantaloupe fection (especially age, and lack of elasticity of blood watermelon infants) knowledge about vessels and nutrition. capillaries. Good Sources small vessel hemor- tomatoes (and juice) rhage seen under 3. Extra care must be Acts as an antioxidant, white potatoes (with skin taken in prepara- protecting the cells tion of foods con- from oxidation. skin on) easy bruising taining vitamin C sweet potatoes to prevent exces- Has a sparing effect on honeydew melon Excess sive loss: several vitamins, pineapple especially A, B, and E. (specific effects de- a. use small The only animal pend on the individ- amount water source of vitamin C ual\u2019s tolerance is liver. level) b. avoid prolonged cooking rebound scurvy c. cut up just be- interference with cer- fore use tain drugs d. avoid leftovers gastrointestinal upsets and diarrhea e. cook quickly, covered or bladder irritations steamed kidney stones f. use any cooking liquid (do not interference with drain) anticoagulant drug therapy *See definition in glossary. \u2020Drug used in treatment of tuberculosis. **Oral contraceptive agents. #RDA obtained from Dietary Reference Intakes (DRIs) in Table F-1. PROGRESS CHECK ON ACTIVITY 1 a. B12 b. folacin MULTIPLE CHOICE c. ascorbic acid Circle the letter of the correct answer. d. B6 1. A person on a strict vegetarian diet is most likely 2. Vitamin B6 requirements are increased: to become deficient in which of the following a. with increased energy intake. vitamins? b. with increased protein intake. c. when on a reduction diet. d. with increased carbohydrate intake.","CHAPTER 5 VITAMINS AND HEALTH 65 TABLE 5-3 Vitamin B1 (Thiamin) Results of Deficiency Conditions Specific Functions or Excess Requiring Increase Characteristics Food Sources\u2020 Any condition that in- The B vitamins have creases metabolic four common prop- Releases energy from For adults 19\u201330 years Deficiency rate erties: fat and carbohy- RDA, male: 1.2 mg\/d drate. RDA, female: 1.1 mg\/d acute: beri-beri* Alcoholism 1. All of them func- tion as coenzymes Helps transmits nerve Excellent Sources subacute: loss of ap- Old age (whether eld- in biochemical impulses. sunflower seeds petite, vomiting, leg erly are on low- reactions. sesame seeds cramps, mental de- calories diets or Breaks down alcohol. soybeans pression, edema, not) 2. All are water- wheat germ weight loss soluble. Promotes better ap- peanuts Pregnancy and lacta- petite and func- animal sources: liver, Excess tion growth periods 3. All are natural tioning of the parts of yeast and digestive tract. kidney, pork no evidence of toxicity People on fad diets liver. in excess amounts. Good Sources May create a short- Illness\/stress 4. All promote the enriched cereals age of other B vita- conditions growth of bacteria. enriched pasta mins if taken enriched or brown exclusively Athletic training If there is a deficiency (whenever extra in one of the B vita- rice need for kcal) mins, there will be whole grains deficiencies in the oatmeal others. animal sources: eggs, The B vitamins func- poultry tion together\u2014 excess of one creates greater need for the others. Converted rice con- tains more thiamin than other types of rice. *Beri-beri: means \u201cI cannot.\u201d Major symptoms are paralysis, heart, and vessel impairment. \u2020RDA obtained from Dietary Reference Intakes (DRIs) in Table F-1. 3. A deficiency of vitamin B12 produces: 6. The RDA\/DRI gives a safe and adequate intake for ascorbic acid a 19\u201330 year old male as: a. pernicious anemia. b. cheilosis. a. 400 IU per day. c. microcytic anemia. b. 90 mg per day. d. sickle cell anemia. c. 2 to 3 mg per day. d. 40 g per day. 4. Research studies have shown that a 1 g dose of vitamin C daily: 7. Risks associated with megadose ascorbic acid in- take include all except: a. will reduce the total number of colds among adults. a. bladder infections. b. possible increase in kidney stone formation. b. is no more effective against cold symptoms c. diarrhea. than is 75 mg daily. d. eye infections. c. will lessen the effects of a hangover. 8. Ascorbic acid plays a major role in the formation d. will be stored in the body. of which protein? 5. Which condition(s) may result in folic acid a. histidine deficiency? b. keratin c. collagen a. a strict vegetarian diet d. mucus b. use of contraceptive pills and\/or pregnancy c. malabsorption syndromes d. all of the above","66 PART I NUTRITION BASICS AND APPLICATIONS TABLE 5-4 Vitamin B2 (Riboflavin) Results of Deficiency Conditions Specific Functions Characteristics Food or Excess Requiring Increase Sources\u2020 Releases energy from For adults 19\u201330 years Deficiency Increase in body size, 1. No evidence that fat, carbohydrate, RDA, male: 1.3 mg\/d lesions around the metabolic rate, or the requirement and protein. RDA, female: 1.1 mg\/d growth rate, such as for B2 goes up as mouth and nose pregnancy, lacta- kcal rise. Essential for healthy Excellent Sources hair loss tion, and growth skin and growth. milk scaly skin 2. Few individuals in cheese failure to thrive (chil- Alcoholism the U.S. show any Promotes visual wheat germ deficiency. health. yeast dren) Poverty liver and kidney light sensitivity 3. Foods high in cal- Functions in the pro- clouding of the cornea Old age cium are usually duction of corticos- Good Sources high in B2. teroids* and red meat, poultry, fish of the eye Strict vegetarian diets blood cells. eggs weight loss that prohibit meat, 4. Before riboflavin is dark green leafy glossitis eggs, and milk absorbed it must be phosphorylated vegetables Excess Stress and malabsorp- (combined with dry beans and peas no evidence yet that tion of nutrients phosphorus). Both nuts are found in milk this nutrient is Any condition where and cheeses. toxic in large there is loss of gas- amounts tric secretions 5. Is sensitive to light; (achlorhydria) may should be kept in precipitate a defi- opaque containers. ciency 6. Cooking and dry- Following burns or ing may enhance any surgical proce- the availability. dure where there is extensive protein 7. Only partially loss water-soluble. 8. If a deficiency oc- curs, multiple B vitamins are given because of their interrelationships. 9. B2 is destroyed by alkaline. *Hormones of the adrenal cortex that influence or control key body functions. \u2020RDA obtained from Dietary Reference Intakes (DRIs) in Table F-1. 9. All of the following refer to vitamin B12 except b. is found in abundance in meats, poultry, and which one? fish. a. It requires an intrinsic factor for absorption. b. A deficiency results in pernicious anemia. c. is fat soluble. c. Food sources rich in vitamin B12 include as- d. is none of the above. paragus and broccoli. d. Vitamin B12 is necessary for normal red blood 12. Pyridoxine: cell formation. a. is a coenzyme in protein metabolism and heme 10. Riboflavin is: formation. a. added to white flour for enrichment. b. is found in wheat, corn, meats, and liver. b. found abundantly in milk and cheese. c. aids functioning of the nervous system. c. an essential nutrient. d. is all of the above. d. all of the above 13. Cobalamin: 11. Niacin: a. requires an intrinsic factor from the stomach a. can be made by the body from tryptophan, an for absorption. essential amino acid. b. should be supplemented in the average per- son\u2019s diet. c. is toxic if taken in excess. d. is none of the above.","CHAPTER 5 VITAMINS AND HEALTH 67 TABLE 5-5 Vitamin B6 (Pyridoxine) Results of Deficiency Conditions Specific Functions or Excess Requiring Increase Characteristics Food Sources* Forms reactions For adults 19\u201330 years Deficiency Increased protein 1. B6 deficiencies that break down RDA, male, female: decreased antibody intake occur almost en- and rebuild amino acids. 1.3 mg\/d production Pregnancy tirely in wealthy, de- anemia Produces antibodies Excellent Sources vomiting Use of oral contracep- veloped countries. and red blood yeast failure to thrive cells. sunflower seeds tive agents, isoniazid 2. The essential fatty wheat germ (children) acid, linoleic, is Aids functioning of wheat bran skin lesions Advancing age converted to arachi- the nervous sys- avocado liver and kidney tem and regener- banana donic acid. ation of nerve animal source: liver problems tissue. central nervous sys- 3. Converts trypto- Good Sources phan to niacin. Changes one fatty meats tem abnormalities: acid into another. poultry confusion 4. Involved in conver- fish irritability sions and catabo- whole grains depression lism of all the nuts convulsions amino acids. Excess no toxicity reported with megadoses, but dependency may be induced with large doses *RDA obtained from Dietary Reference Intakes (DRIs) in Table F-1. 14. Factors that may cause a deficiency of water- 18. Which of the following is the poorest source of soluble vitamins include: ascorbic acid? a. cheddar cheese a. taking no vitamin supplement. b. baked potato b. fad diets. c. strawberries c. high-fat diets. d. coleslaw d. none of the above. ACTIVITY 2: 15. A deficiency of vitamin C: The Fat-Soluble Vitamins a. causes delayed wound healing. b. decreases iron absorption. REFERENCE TABLES c. increases capillary bleeding. d. all of the above. The fat-soluble vitamins, as discussed earlier, are vita- mins A, D, E, and K. Other than the general characteris- 16. Water-soluble vitamins: tics noted, these vitamins bear no resemblance to water-soluble vitamins nor to each other. In Tables 5-11 a. are generally stored by the body. through 5-14 the specific characteristics of each fat- b. are destroyed by fats and oils. soluble vitamin are outlined for easy reference. Study c. are minimally excreted. them in preparation for this activity\u2019s progress check. d. none of the above. ANTIOXIDANTS 17. B complex vitamins: Antioxidants are substances that may protect your cells a. function as coenzymes. against the effects of free radicals. Free radicals are b. are best supplied by supplements. c. can be synthesized by the body. d. are excreted in feces.","68 PART I NUTRITION BASICS AND APPLICATIONS TABLE 5-6 Vitamin B12 (Cobalamin)* Results of Deficiency Conditions Specific Functions or Excess Requiring Increase Characteristics Food Sources\u2020 Strict vegetarian diet 1. The normal liver (vegans) will store enough Aids proper formation For adults 19\u201330 years Deficiency B12 to last for two of red blood cells. RDA, male, female: Malabsorption to five years. glossitis Stomach injury Part of the RNA-DNA 2.4 \u00b5g\/d Total gastrectomy 2. B12 is made only by nucleic acids; is anorexia Pregnancy and microorganisms in therefore essential Animal products are the intestines. for normal function the main food weakness lactation of all body cells, sources: Old age 3. Only 30%\u201370% of especially gastroin- weight loss what is consumed testinal tract, clams\/oysters is absorbed. nervous system. organ meats mental and nervous eggs symptoms 4. B12 must bind to Bone marrow shrimp the intrinsic factor, formation. chicken abdominal pain which is a protein pork secreted by the Used in folacin hot dogs constipation\/diarrhea stomach lining. metabolism. macrocytic anemia 5. Calcium is also Prevention of perni- and if intrinsic fac- necessary in this cious anemia. tor also missing: reaction. pernicious anemia (see #4 under 6. Absorption of B12 is characteristics) influenced by body levels of B6. Excess 7. The elderly are at no toxicity observed; highest risk of de- but at high doses, veloping pernicious vitamins are consid- anemia. ered drugs and often create imbal- 8. Smooth, bland ances in the func- foods are indicated tioning of other for megaloblastic nutrients. and pernicious ane- mia (the mouth is sore). 9. All foods needed for blood cell produc- tion included. \u2020*RFDolAicoabctiadindeedficfrioenmcyDiisetfareryquReenfetlryenascseoIcniatatekdesw(iDthRIBs1)2indeTfaicbileenFcy-1, .creating a vicious cycle. molecules produced when your body breaks down food; Antioxidants are found in many foods. These include they are also produced by environmental exposures such fruits and vegetables, nuts, grains, and some meats, poul- as tobacco smoke and radiation. Free radicals can dam- try and fish. Some potential health benefits of antioxi- age cells, and may play a role in heart disease, cancer, dants are: and other disorders. Antioxidants are molecules that can safely interact with free radicals and terminate or pre- 1. Prevent or neutralize the negative effects of free vent the damaging effects of free radicals. Antioxidant radicals. substances include the following: 2. Slow the aging process and protect against heart dis- \u2022 Beta-carotene ease and strokes. \u2022 Lutein \u2022 Lycopene 3. Prevent or interfere with the development of cancer. \u2022 Selenium 4. Retard induced cell damage from exercise and\/or en- \u2022 Vitamin A \u2022 Vitamin C hance recovery. \u2022 Vitamin E Researchers are actively studying the role of antioxi- dants in many human diseases. However, it will take years before definitive results are available.","CHAPTER 5 VITAMINS AND HEALTH 69 TABLE 5-7 Niacin Food Results of Deficiency Conditions Specific Sources\u2020 or Excess Requiring Increase Characteristics Functions For adults 19\u201330 years Deficiency Whenever more kcal 1. Niacin is synthe- Releases energy from RDA, male: 16 mg\/d are consumed, e.g., sized in the body carbohydrates, pro- acute: Pellagra* from tryptophan, tein, fat. RDA. female: pregnancy\/lactation an essential amino 14 mg\/d subacute: weakness, illness acid. Diets ade- Synthesizes proteins indigestion, stress quate in protein and nucleic acids. Excellent Sources anorexia, lack of are adequate in yeast energy, cracked chronic alcoholism niacin. Synthesizes fatty acids peanuts and peanut skin, sore mouth intestinal disorders from glucose. and tongue, failure 2. Niacin is stable in butter to thrive (children), foods; it can with- soybeans insomnia, irritabil- stand reasonable sesame seeds ity, mental depres- periods of heat, sunflower seeds sion; damage to the cooling, and animal sources: beef, skin, gastrointesti- storage. nal tract, and cen- poultry, fish, organ tral nervous system 3. Niacin is water- meats especially soluble; use the high Excess (megadose cooking liquids treatment for cer- (do not drain off). Good Sources tain conditions) meats nuts severe flushing wheat germ enriched cereals, glucose intolerance bread, pasta gastrointestinal disorders irregular heartbeat vision disturbances liver damage *The 3 Ds of Pellagra symptoms: 1. Dermatitis (inflammation of the skin); 2. Diarrhea (inflammation of the gastrointestinal tract); 3. Dementia (mental confusion); (if untreated: add death). \u2020RDA obtained from Dietary Reference Intakes (DRIs) in Table F-1. VITAMINS AND THE PREPARATION AND maturity of the fruit or vegetable will influence the max- PROCESSING OF FOOD* imum content of vitamin C in the food. All foods undergo some processing and are subject to Milling procedures for cereals result in a general loss varying degrees of vitamin loss in content or bioavail- of vitamin content. To compensate for the loss, food prod- ability. Although processing techniques that minimize ucts produced from flours are usually fortified with B vi- nutrient loss are used, the vitamin content of foods can tamins (thiamin, riboflavin, and niacin). A prime example decrease when processed. of a food fortified with vitamins is enriched bread. Further, many breakfast cereals are heavily enriched with Other factors that influence the vitamin content of vitamins. foods are growing conditions, genetic variation, and postharvest or postmortem practices. The factors that Another major source of vitamin loss in foods occurs influence the vitamin content of vegetables, fruits, and during washing, blanching, and cooking. The extent of vi- grain crops are soil conditions, including moisture level tamin loss is dependent on temperature, amount of water and fertilizer use. The vitamin content of eggs, meat, and used in the process, and cooking procedure. Usually the milk is affected by animal breed and strain, health, level loss of vitamin C in foods exceeds that of the B complex of production, as well as the nutrient content of the ra- and fat-soluble vitamins. tions fed. The use of antioxidants (BHT, TBHQ, ascorbic acid, After harvest, the vitamin C content of fruits and veg- tocopherols) as preservatives significantly protect foods etables can dramatically decrease. Moreover, the stage of from excessive vitamin loss. Reducing lipid oxidation and oxidative rancidity in foods can prevent destruction of *The information in this section has been modified from Food Processing Manual (2009), by Y. H. Hui. Published and copyrighted by Science Technology System, West Sacramento, California. Used with permission.","70 PART I NUTRITION BASICS AND APPLICATIONS TABLE 5-8 Folic Acid (Folacin, Folate) Functions Food Results of Deficiency Conditions Specific Sources** or Excess Requiring Increase Characteristics Synthesizes the nu- For adults 19\u201330 years Deficiency Whenever the meta- 1. When there is a cleic acids (RNA- RDA, male, female: slows growth, inter- bolic rate is high: folic acid deficiency, DNA). the diet must in- 400 \u00b5g\/d feres with cell pregnancy\/lactation clude all the other Essential for break- regeneration nutrients needed to down of most of Excellent Sources infections\/fever produce red blood the amino acids. liver\/kidney Macrocytic Anemia cells, i.e., yeast (red blood cells are growth of malignant Necessary for oranges\/orange juice* tumors protein proper formation green leafy vegetables large and too few of red blood cells. asparagus* and have less Hgb hyperthyroidism copper broccoli than normal) anemias wheat germ* iron nuts Megoblastic Anemia Excess alcohol intake (young red blood cells B12\/vitamin C Good Sources Use of oral contracep- melons fail to mature, re- tive agents 2. Persons with sweet potato duction in white macrocytic or pumpkin blood cells; also his- Malabsorptive megoblastic anemia tidine, an amino disorders have sore mouths acid, not utilized) and tongues; soft Certain other diseases, bland foods or liq- Excess e.g., leukemia uids may be needed. no toxic effect from Hodgkin\u2019s disease 3. Prolonged cooking megadose, but will destroys most of the mask pernicious cancer folacin. anemias\u2020, vitamin supplements may Use of drugs in anti- 4. Folic acid deficiency not contain more convulsant therapy is common in the than 0.1 mg\/folacin third trimester of (by law) When chemotherapy pregnancy; the re- is used for cancer quirement is six times the normal amount. *Highest in folacin **RDA obtained from Dietary Reference Intakes (DRIs) in Table F-1. \u2020Pernicious anemia does not respond to iron and folacin; requires treatment with B12. vitamins A, C, and E. Changing the pH of foods and re- A brief discussion will be provided here on the last ap- ducing lipid oxidation will also help to retard the damage plication. The vitamins with antioxidant activities are to and loss of carotenoids and oxygen-sensitive vitamins ascorbic acid, tocopherol, and carotene. Ascorbic acid in foods. will serve as an example for discussion. Ascorbic acid (vi- tamin C) is used extensively in the food industry for two The vitamins that are sensitive to heat are vitamin D, important purposes: vitamin E, thiamin, riboflavin, pyridoxine, pantothenate, and folic acid. Vitamins sensitive to oxygen are the fat- \u2022 As a nutritional ingredient soluble vitamins, ascorbic acid, thiamin, biotin, pan- \u2022 As a food additive to serve multiple processing tothenate, and folic acid. functions Under the laws and regulations governing food addi- tives, vitamins or their derivatives are used as follows: Acting as an antioxidant, ascorbic acid can improve the color, palatability, and related quality of many food prod- 1. They serve as ingredients in dietary supplements. If ucts. Ascorbic acid in its reduced form becomes the so, a separate law on dietary supplement also applies. oxidized form, dehydroascorbic acid. It is an effective an- tioxidant because it can remove available oxygen in its im- 2. They serve as ingredients in medical food used under mediate surroundings under most processing conditions. clinical conditions, orally or intravenously. Beverages 3. They serve as ingredients in animal feeds. 4. They serve as food additives in fortifying foods. The During the manufacture of beverages, especially fruit juices, ascorbic acid is commonly added to improve sen- FDA issues requirements defining which vitamin can sory profiles such as color and palatability. be added to what foods and at what levels, accompa- nied by additional restriction. 5. They serve as antioxidants in food processing.","CHAPTER 5 VITAMINS AND HEALTH 71 TABLE 5-9 Pantothenic Acid Functions Food Results of Deficiency Conditions Specific Sources* or Excess Requiring Increase Characteristics Helps release energy For adults 19\u201330 years Deficiency Rare Situations 1. Most commonly from carbohydrates, AI, male, female: occurring of all the fat, and protein. uncommon; not ob- severe malnutrition vitamins 5 mg\/d served under nor- (e.g., prisoner of Aids in formation of mal conditions war, starving 2. Name taken from cholesterol, hemo- Richest Sources children) the Greek and globin, and other liver, kidney Induced deficiencies means \u201cevery- hormones. fish cause headaches, where\u201d whole grains insomnia, nausea, Assists in synthesizing Is found in every plant vomiting, tingling certain fatty aids. of hands and feet and animal food poor coordination Excess no toxicity observed *AI obtained from Dietary Reference Intakes (DRIs) in Table F-1. TABLE 5-10 Biotin Functions Food Results of Deficiency Conditions Specific Sources* or Excess Requiring Increase Characteristics Acts as a coenzyme in For adults 19\u201330 years Deficiency Anyone consuming 1. Biotin can be bound metabolism of fat AI, male, female: raw eggs in quantity by avidin, a protein and carbohydrate. uncommon; intestinal in raw egg, and be- 30 \u00b5g\/d bacteria produces Some infants under comes unavailable biotin. can be in- age of 6 mo. to the body. Richest Sources duced large-scale liver\/kidney use of raw eggs as egg yolk in tube feedings, milk etc., may cause de- yeast velopment of symp- Is found in almost all toms such as: foods nausea muscle pain dermatitis glossitis abnormal EKG (electro- cardiogram) elevated cholesterol level *AI obtained from Dietary Reference Intakes (DRIs) in Table F-1. Fruits such as apples, bananas, and peaches show dis- 1. To accelerate color development coloration when cut. When these fruits are processed to 2. To inhibit nitrosamine formation produce fruit juices or purees, ascorbic acid may be added 3. To prevent oxidation during the crushing, straining, or pressing stages to pre- 4. To avoid color fading vent enzymatic browning of the raw fruits. Fats and Oils Meat Products When fats and oils are exposed to heat, light, and air, Ascorbic acid is commonly used as an antioxidant in their unsaturated long-chain fatty acids readily oxidize. cured meat processing with the following objectives: This causes rancid odors and flavors because of the","72 PART I NUTRITION BASICS AND APPLICATIONS TABLE 5-11 Vitamin A (Retinol) Functions Food Results of Deficiency Conditions Specific Sources* or Excess Requiring Increase Characteristics Enables eye to adjust For adults 19\u201330 years Deficiency** Self-neglect due to 1. Preformed vita- to changes in light RDA, male: 900 \u00b5g\/d psychiatric distur- min A (retinol) is (formation of night blindness (in- bances, old age, found only in ani- rhodopsin in the RDA. female: ability to see in dim alcoholism, lack of mal sources. retina). 700 \u00b5g\/d light) nutritional knowledge 2. Provitamin A Helps maintain healthy Excellent Sources keratinization (forma- (beta carotene) is skin and mucous liver tion of a horny layer Pregnancy and found in plant membranes as well eggs of skin, cracking of lactation sources and is a as the cornea of the carrots skin) yellow-orange eye. cantaloupe Protein-deficient diets group of pig- sweet potato xerophthalmia ments. It is called Develops healthy teeth winter squash (cornea of eye be- Any condition of fat a precursor. and bones. pumpkin comes opaque, malabsorption apricots causing blindness) 3. Xerophthalmia is Aids reproductive broccoli Infectious hepatitis an important processes. green pepper faulty bone growth, world health dark green leafy defective tooth Gallbladder diseases problem: more Synthesizes glycogen enamel, less resist- than 1,000,000 in the liver. vegetables ance to decay Children and pregnant children go blind women in poverty yearly, especially Regulates fat metabo- Good Sources decreased resistance in developing lism in formation of tomatoes (and juice) to infection, im- countries. cholesterol. butter paired wound margarine healing 4. Very low-fat diets Aids formation of corti- peaches decrease sone in the adrenal Excess absorption. gland. highly toxic in exces- 5. Vitamin A must sive doses (1\u2013 be bound to pro- 3,000 \u00b5g RE\/kg\/ tein for transport. body weight) 6. Bile salts must be accumulates in liver, in the intestine causing enlarge- for absorption. ment, vomiting, skin rashes, hair 7. Is stable at usual loss, diarrhea, cooking tempera- cramps, joint pain, tures. Cover pan dry scaly skin, recommended. anorexia, abnormal bone growth, cere- 8. Processing and bral edema advance prepara- tion cause only minimal loss. 9. Hypervitaminosis is usually from megavitamin supplements. 10. Excess intake of foods with beta carotene may dis- color skin but is not harmful. 11. Beta carotene is being considered for prevention of certain types of skin cancer. *RDA obtained from Dietary Reference Intakes (DRIs) in Table F-1. **Deficiencies more uncommon in Western countries because of dietary abundance.","CHAPTER 5 VITAMINS AND HEALTH 73 TABLE 5-12 Vitamin D (Cholecalciferol) Functions Food Results of Deficiency Conditions Specific Sources* or Excess Requiring Increase Characteristics Promotes the absorp- For adults 19\u201330 years Deficiency severe Invalids (housebound) 1. Ultraviolet light is tion of calcium and filtered out by phosphorus in the AI, male, female: 5 rickets, serious decal- Individuals who are smog, fog, smoke, intestine. \u00b5g\/d cification of bones, rarely exposed to and window glass. osteomalacia (ten- sunlight Helps maintain blood Sources: der, painful bones 2. Can be classified as calcium and phos- irradiated fortified in adults), tooth Premature infants a hormone since it phorus levels for decay can be made by the normal bone vitamin D milk Children of strict veg- body. calcification. etarians who drink minimal amounts Excess no fortified milk 3. Milk, unless Aids in formation of present in fish, egg fortified, is a bone matrix. yolk, butter high blood calcium Pregnancy and poor source of levels lactation vitamin D. Primary food source kidney damage Early childhood 4. As much as 95% of ultraviolet rays for fish, liver (cod liver, growth retardation Breast-fed infants conversion to vita- halibut liver) oils min D may be pre- vomiting, diarrhea, Any disease that inter- vented in dark- Synthetic form weight loss feres with fat ab- skinned races. sorption or vitamin from irradiation of D absorption 5. Vitamin D permits plants; used most in 30 to 35% absorp- supplements and Chronic renal failure tion of ingested dairy products calcium: without Certain drug therapies it only 10% is Principal source that interfere with absorbed. absorption sunlight; ultraviolet rays penetrate a Dark-skinned people cholesterol-like substance in the skin which is con- verted to active vi- tamin D in the kidneys *AI obtained from Dietary Reference Intakes (DRIs) in Table F-1. formation of low-molecular weight compounds. Special a. egg yolks formula preparation containing ascorbic acid can pre- b. potatoes vent this undesirable condition. c. dark green and deep yellow vegetables d. beef liver Dough Products 2. Toxicity symptoms of vitamin A include all except: In the manufacture of bakery products, adding ascorbic acid to the flour improves both bread texture and loaf a. joint pain, loss of hair, jaundice. volume. This ability of ascorbic acid to improve bread b. anorexia, fatigue, weight loss. dough has been appreciated since the 1930s. c. vasodilation, decreased glucose tolerance. d. skin rash, edema. PROGRESS CHECK ON ACTIVITY 2 3. Which of the following foods would you recom- MULTIPLE CHOICE mend in order to increase a person\u2019s vitamin A intake? Circle the letter of the correct answer. a. grapefruit 1. All except are good sources of vita- b. egg whites min A. c. potatoes d. pumpkin","74 PART I NUTRITION BASICS AND APPLICATIONS TABLE 5-13 Vitamin E (Tocopherol) Functions Food Results of Deficiency Conditions Specific Sources* or Excess Requiring Increase Characteristics The only demonstrated For adults 19\u201330 years Deficiency Premature infants (or 1. Does not travel function is as an an- RDA, male, female: none observed except SGA)** well across pla- tioxidant (protects centa of pregnant vitamin A and unsat- 15 mg\/d in premature in- Whenever greater women. urated fats from de- fants or SGA** amounts of polyun- struction; protects Best Sources (plant) infants saturated fats are 2. Is usually given red and white blood vegetable oils ingested with vitamin A cells from destruc- margarines Excess when there is a vi- tion by preventing shortenings headache Possibly in disorders tamin A deficiency. oxidation of cell sunflower seeds nausea resulting in fat membrane). wheat germ fatigue malabsorption 3. Vitamin E content nuts dizziness of breast milk is Protects vitamin C and whole grains blurred vision adequate for the fatty acids. Believed skin changes infant. to enter into bio- Good Sources thrombophlebitis\u2020 chemical changes (animal) 4. Many animal disor- that release energy. ders have re- liver sponded to vitamin Assists in cellular codfish E therapy but have respiration. butter not been effective human milk for humans. For Helps synthesize other this reason, vita- body substances. min E is the most controversial of all Helps maintain intact vitamin therapies. cell membranes. 5. Contrary to popu- lar opinion, excess intake creates side effects. 6. The role of vitamin E as an antioxidant is being linked to retardation of the aging process. *RDA obtained from Dietary Reference Intakes (DRIs) in Table F-1. \u2020Blood clots in veins. **SGA = small for gestational age. 4. Vitamin D is needed by the body to: 7. Vitamin D: a. digest protein. a. enhances calcium and phosphorus absorption. b. absorb amino acids. b. enhances mineralization of bones and c. absorb calcium. d. make collagen. cartilage. c. lowers serum calcium levels. 5. Fat-soluble vitamins: d. all of the above. a. may be altered by exposure to alkali. 8. Excess vitamin D: b. are stable to ordinary cooking. c. can store in liver and tissues. a. is stored in adipose tissue and the liver. d. all of the above. b. can cause calcification of soft tissue such as 6. Carotene, or provitamin A, is contained in signifi- blood vessels and renal tubules. cant amounts in all of these except: c. is excreted in the urine. d. a and b a. corn, cauliflower. b. spinach, collard greens. 9. The only demonstrated function of vitamin E in c. apricots, pumpkin. humans is to: d. green pepper, peaches. a. increase sexual prowess. b. increase fertility.","CHAPTER 5 VITAMINS AND HEALTH 75 TABLE 5-14 Vitamin K (Menadione) Functions Food Results of Deficiency Conditions Specific Sources* or Excess Requiring Increase Characteristics Prothrombin forma- For adults 19\u201330 years Deficiency Newborn infants 1. Deficiency is rare tion (prothrombin since it is synthe- is a protein that AI, male: 120 \u00b5g\/d hemorrhaging when Persons on antibiotics sized by intestinal converts eventually AI, female: 90 \u00b5g\/d blood does not clot bacteria. Food to fibrin, the key Persons with diseases sources not usually substance in blood The two sources are: Excess where there is needed by healthy clotting) 1. intestinal bacteria chronic diarrhea or people. irritation of skin and poor absorption Blood coagulation and respiratory tract 2. The intestinal tract 2. food sources: with the synthetic Possibly prior to of the newborn form, menadione surgery may be free of bac- dark green teria for several vegetables toxicity found only in days. newborns who are cauliflower administered doses 3. Antibiotics kill the tomatoes above 5 mg natural bacteria in soybeans the intestine. wheat bran causes excessive breakdown of red small amounts in: blood cells egg yolk organ meats brain damage cheese **AI obtained from Dietary Reference Intakes (DRIs) in Table F-1. c. act as an antioxidant. 2. Treat borderline vitamin deficiencies by supplying d. prevent heart disease. the appropriate diet and including rich sources of the missing vitamin(s). 10. The only known function of vitamin K is its: 3. Be aware that some patients may not be able to take a. use in forming blood-clotting factors. food or medication by mouth. Nausea and anorexia, b. antioxidant property. common among people suffering from vitamin- c. antirachitic property. deficiency diseases, may require different forms of d. antibiotic property. ingestion. MATCHING 4. Be aware that most outright deficiency diseases occur among alcoholics, drug abusers, psychiatric Match the following statements with the letter of their patients, the aged, low-income groups, or people on corresponding vitamin. extreme diets. 11. Inadequate intake a. vitamin A 5. Be aware that borderline deficiencies cut across all causes osteomalacia b. vitamin D socioeconomic lines, and are caused by poor eating and rickets. c. vitamin E habits and ignorance of essential nutrients. d. vitamin K 12. Inadequate intake 6. Be prepared to give multivitamin and mineral sup- causes poor night vi- plements to allow for the metabolic interrelation- sion and skin infection. ships among the vitamins as well as their action as catalysts and coenzymes. 13. Promotes normal blood clotting. 7. Request extra vitamins for clients with conditions that increase the metabolic rate. 14. Prevents destruction of unsaturated fatty acids. 8. Be aware that very low-fat diets lead to decreased in- take and absorption of the fat-soluble vitamins. RESPONSIBILITIES OF HEALTH PERSONNEL 9. Be aware that the fat-soluble vitamins A and D are 1. Treat clients\u2019 vitamin deficiency diseases by supply- highly toxic in doses that greatly exceed the ing the missing vitamin(s) as drug therapy (through DRIs\/RDA. tablets, capsules, or intravenously) as an adjunct to a high-protein, high-calorie balanced diet. 10. Request fat-soluble vitamin supplements in aque- ous form any time there is a disease where fat mal- absorption occurs, such as celiac disease or cystic fibrosis."]