Visualizing Nutrition

Everyday Choices
Fifth Edition

MARY B. GROSVENOR , M.S., RD

LORI A. SMOLIN, PH.D.

University of Connecticut

with
LAURA R. CHRISTOP H, PH.D.
Franklin Pierce University
Brief Contents

PREFACE iii O NL INE A PPE NDICE S

1 Nutrition: Everyday Choices 1 A PPE NDIX A Dietary Reference Intakes

2 Guidelines for a Healthy Diet 24 A PPE NDIX B Healthy Dietary Patterns

3 Digestion: From Meals to Molecules 51 A PPE NDIX C U

 .S. Nutrition Guidelines and
Recommendations
4 Carbohydrates: Sugars, Starches, and
Fibers 83 Energy Expenditure for Various
A PPE NDIX D 
Activities
5 Lipids: Fats, Phospholipids, and
Sterols 116 A PPE NDIX E Standards for Body Size

6 Proteins and Amino Acids 147 Normal Physiological Standards

A PPE NDIX F 
of Nutritional Relevance
7 Vitamins 175
A PPE NDIX G Choice (Exchange) Lists
8 Water and Minerals 226
A PPE NDIX H Food and Supplement Labels
9 Energy Balance and Weight
Management 273 World Health Organization Nutrition
A PPE NDIX I 
Recommendations
10 Nutrition, Fitness, and Physical
Activity 314 A PPE NDIX J Calculations and Conversions

11 Nutrition During Pregnancy and A PPE NDIX K Popular Dietary Supplements

Infancy 352 A PPE NDIX L Answers to Thinking It Through
12 Nutrition from 1 to 100 384
GLOSSARY GL-1
13 How Safe Is Our Food Supply? 420
REFERENCES R-1
14 Feeding the World 456 INDEX I-1

AP P E N D I X A Dietary Reference Intakes A-1

x
 Contents

1 Nutrition: Everyday Choices 1 6 Proteins and Amino Acids 147

1.1 Food Choices and Nutrient Intake 2 6.1 Proteins in Our Food 148
1.2 Nutrients and Their Functions 6 6.2 The Structure of Amino Acids and Proteins 150
1.3 Nutrition in Health and Disease 9 6.3 Protein Digestion and Absorption 153
1.4 Choosing a Healthy Diet 13 6.4 Protein Synthesis and Functions 154
1.5 Evaluating Nutrition Information 15 6.5 Protein in Health and Disease 159
6.6 Meeting Protein Needs 162
2 Guidelines for a Healthy Diet 24 6.7 Vegetarian Diets 168

2.1 Nutrition Recommendations 25 7 Vitamins 175

2.2 Dietary Reference Intakes (DRIs) 31
2.3 The Dietary Guidelines for Americans 33 7.1 A Vitamin Primer 176
2.4 MyPlate: Putting the Guidelines into Practice 38 7.2 Vitamins and Energy Metabolism 185
2.5 Food and Supplement Labels 42 7.3 Vitamins and Healthy Blood 193
7.4 Antioxidant Vitamins 203
3 Digestion: From Meals to 7.5 Vitamins in Gene Expression 207
7.6 Meeting Needs with Dietary Supplements 218
Molecules 51

3.1 The Organization of Life 52 8 Water and Minerals 226

3.2 The Digestive System 55
3.3 Digestion and Absorption of Nutrients 57 8.1 Water 227
3.4 The Digestive System in Health and Disease 65 8.2 An Overview of Minerals 234
3.5 Delivering Nutrients and Eliminating Wastes 74 8.3 Electrolytes: Sodium, Potassium,
3.6 An Overview of Metabolism 78 and Chloride 241
8.4 Minerals and Bone Health 249
8.5 Minerals and Healthy Blood 258
4 Carbohydrates: Sugars, 8.6 Antioxidant Minerals 262
Starches, and Fibers 83 8.7 Minerals and Energy Metabolism 266

4.1 Carbohydrates in Our Food 84 9 Energy Balance and Weight

4.2 Types of Carbohydrates 87 Management 273
4.3 Carbohydrate Digestion and Absorption 90
4.4 Carbohydrate Functions 95 9.1 The Obesity Epidemic 274
4.5 Carbohydrates in Health and Disease 99 9.2 Body Weight and Health 278
4.6 Meeting Carbohydrate Needs 106 9.3 Energy Balance 283
9.4 What Determines Body Size and Shape? 288
5 Lipids: Fats, Phospholipids, 9.5
9.6
Managing Body Weight 293
Medications and Surgery for Weight Loss 300
and Sterols 116 9.7 Eating Disorders 303

5.1
5.2
Fats in Our Food 117
Types of Lipids 118
10 Nutrition, Fitness, and Physical
5.3 Absorbing and Transporting Lipids 123 Activity 314
5.4 Lipid Functions 128
5.5 Lipids in Health and Disease 132 10.1 Food, Physical Activity, and Health 315
5.6 Meeting Lipid Needs 137 10.2 The Components of Fitness 317
10.3 Recommendations for Physical Activity 320
xi
xii CO NT EN TS

10.4 Fueling Activity 325

10.5 Energy and Nutrient Needs for Physical
14 Feeding the World 456

Activity 331 14.1 The Two Faces of Malnutrition 457

10.6 Food and Drink to Optimize Performance 337 14.2 Causes of Hunger Around the World 459
10.7 Ergogenic Aids 341 14.3 Causes of Hunger in the United States 464
14.4 Eliminating World Hunger 466
11 Nutrition During Pregnancy 14.5 Eliminating Food Insecurity in the United States 473

and Infancy 352 A PPE NDIX A Dietary Reference Intakes A-1

11.1 Changes in the Body During Pregnancy 353 O NL INE A PPE NDICE S
11.2 Nutritional Needs During Pregnancy 358
11.3 Factors That Increase Pregnancy Risks 365 A PPE NDIX A Dietary Reference Intakes
11.4 Lactation 370 A PPE NDIX B Healthy Dietary Patterns
11.5 Nutrition for Infants 373 A PPE NDIX C U.S. Nutrition Guidelines and
Recommendations
12 Nutrition from 1 to 100 384 A PPE NDIX D Energy Expenditure for Various Activities
A PPE NDIX E Standards for Body Size
12.1 The Nutritional Health of America’s Youth 385 A PPE NDIX F Normal Physiological Standards of
12.2 Nutrition for Children 390 Nutritional Relevance
12.3 Nutrition for Adolescents 397
A PPE NDIX G Choice (Exchange) Lists
12.4 Nutrition for the Adult Years 402
12.5 The Impact of Alcohol Throughout Life 412 A PPE NDIX H Food and Supplement Labels
A PPE NDIX I World Health Organization Nutrition
Recommendations
13 How Safe Is Our Food Supply? 420
A PPE NDIX J Calculations and Conversions
13.1 Keeping Food Safe 421 A PPE NDIX K Popular Dietary Supplements
13.2 Pathogens in Food 424 A PPE NDIX L Answers to Thinking It Through
13.3 Preventing and Controlling Microbial
Food-Borne Illness 432 GLOSSARY GL-1
13.4 Agricultural and Industrial Chemicals
in Food 436 REFERENCES R-1
13.5 Technology for Keeping Food Safe 442
13.6 Biotechnology 448 INDEX I-1
 CHAPTER 1

XPACIFICA / National Geographic Image Collection

Nutrition:
CHAPTER OUTLINE

Food Choices and Nutrient Intake 2

Everyday Choices
• Nutrients from Foods, Fortified Foods, and
Supplements
• Food Provides More Than Nutrients
• What Determines Food Choices?
Nutrients and Their Functions 6
How do you choose what to eat? For most of the world’s population, • The Six Classes of Nutrients
the answer is simple: You eat what you can grow, raise, catch, kill, or
• What Nutrients Do
purchase. Subsistence is the principal motivator of food consumption: If
you don’t eat, you die. Historically, the game or crops people could kill Nutrition in Health and Disease 9
or cultivate successfully became staples of their diet. As food production • Undernutrition and Overnutrition
became more sophisticated, a greater array of food choices became avail-
• Diet–Gene Interactions
able. As people explored and migrated across continents, new foods were
discovered: Corn became part of the diet of European settlers in North Debate: Do DNA-Based Diets Improve Health
America, and the potato was brought to the Old World from the New. Outcomes?
Today, in our global society, you may literally choose from the world’s
Choosing a Healthy Diet 13
dinner table.
Biological, social, economic, ecological, and cultural factors as well • Eat a Variety of Foods
as personal tastes affect what you choose from this plethora of foods. • Balance Your Choices
And what you choose affects how healthy you are. Because the nutri- What Should I Eat? Variety, Balance, and
ents in the foods you eat form and maintain the structure of your body, Moderation
you really are what you eat. The challenge is to find a satisfying balance
between what you like and what optimizes your health. The choice is
• Practice Moderation
yours. Thinking It Through: A Case Study on Choosing
a Healthy Diet
Evaluating Nutrition Information 15
• The Science Behind Nutrition
• How Scientists Study Nutrition
• Judging for Yourself
What a Scientist Sees: Behind the Claims
What Is Happening in This Picture?
1
 2 C HA PTER 1 Nutrition: Everyday Choices

1.1 Food Choices and Nutrient Intake

L EARNING OBJECTIVES nutrients we consume. To stay healthy, humans need more
than 40 essential nutrients. Because the foods we eat vary
1. Define nutrient density. from day to day, so do the amounts and types of nutrients and
the number of calories we consume.
2. Compare fortified foods with dietary supplements as
sources of nutrients.
3. Distinguish essential nutrients from Nutrients from Foods, Fortified Foods,
phytochemicals.
4. Identify factors in your food environment that
and Supplements
influence your food choices. Any food you eat adds some nutrients to your diet, but to make
your diet healthy, it is important to choose nutrient-dense foods.
Foods with a high nutrient density contain more nutrients
What are you going to eat today? Will breakfast be a vegetable per calorie than do foods with a lower nutrient ­density. Foods
omelet or a bowl of sugar-coated cereal? How about lunch—a low in nutrient density are often high in empty ­calories,
burger or a bean burrito? The foods we choose determine the which are calories that come with few nutrients ­(Figure 1.1).

FIGURE 1.1 Nutrient density Nutrient density is important in choosing a healthy

diet. ­Nutrient-dense foods provide more nutrients in fewer calories.

Instead of this ... Have this ...

iStockphoto
Loiselle//iStockphoto

400 Low Nutrient Density High Nutrient Density

iStockphoto
bocaminus // iStockphoto
350 Low-fat milk Sweetened iced tea

300
Amount per cup

250
DanielLoiselle

bocaminus
200
Daniel

150 5 chicken nuggets: 230 Cal, Skinless chicken breast:

12 g protein 162 Cal, 25 g protein
100
National

50
Creative
Keenpress // National
Geographic Creative

John Shepherd /
0
Calories Calcium Vitamin D Vitamin A

iStockphoto
iStockphoto
(mg) (IU) (μg)
Geographic
Keenpress

a. An 8-ounce glass of low-fat milk provides you with about the

same number of calories as 8 ounces of bottled iced tea, but the milk
Medium order of fries: Medium baked potato:
also provides calcium, vitamin D, vitamin A, and other nutrients, 380 Cal, 9 mg vitamin C 161 Cal, 17 mg vitamin C
including protein. The calories in the iced tea are from added sugar.
Linton//

National
Sartore // National
Robert Linton

Creative
Geographic Creative
iStockphoto
iStockphoto

b. Typically, less processed foods provide more nutrients per calorie.

For example, a roasted chicken breast is more nutrient dense than
Joel Sartore
Geographic

chicken nuggets that are breaded and fried; a baked potato is more
nutrient dense than French fries; and apples are more nutrient dense Slice of apple pie: 411 Cal, Medium apple: 95 Cal,
Joel

than apple pie. 4 g fiber 2 g fiber

nutrients Substances in food that provide energy and structure to calorie A unit of heat used to express the amount of energy
the body and regulate body processes. provided by food or expended by the body. We typically use the
essential nutrient A nutrient that must be consumed in the word “calorie” or “Calorie” to refer to the number of kilocalories; a
diet because it cannot be made by the body or cannot be made in kilocalorie is technically 1000 calories.
sufficient quantities to maintain body functions. nutrient density A measure of the nutrients provided by a food
relative to its calorie content.
 1.1 Food Choices and Nutrient Intake 3

Unhealthy fats and added sugars provide empty calories. Discretionary fortification of foods is also now common prac-
If a large proportion of your diet consists of foods that are tice (see Figure 1.2). Vitamins and minerals are routinely added
low in nutrient density and high in empty calories, such as to a variety of foods, including breakfast cereals and snack foods.
soft drinks, chips, and candy, you could have a hard time The amounts and types of nutrients added to these voluntarily for-
meeting your nutrient needs without exceeding your cal- tified foods are at the discretion of the manufacturer. These added
orie needs. By choosing nutrient-dense foods, you can nutrients contribute to the diet but are not necessarily designed to
meet all your nutrient needs and have calories left over for address deficiencies and may increase the likelihood of consum-
occasional treats that are lower in nutrients and higher in ing an excess of some nutrients (see Debate in Chapter 7).
calories. Dietary supplements are another source of nutrients,
In addition to nutrients that occur naturally in foods, we but they do not offer all the benefits of food (see Chapters 2
obtain nutrients from fortified foods. The fortification of and 7). More than half of U.S. adults take some sort of daily
foods was begun to help eliminate nutrient deficiencies in the dietary supplement to enhance their nutrient intake.1 Most
population, with the federal government mandating that cer- supplement use is based on personal preference; only 23% of
tain nutrients be added to certain foods. Foods such as milk supplements used are taken at the recommendation of a health
with added vitamin D, salt with added iodine, and grain prod- professional.2
ucts with added B vitamins and iron are examples of this man-
dated fortification that have been part of the U.S. food supply Food Provides More Than Nutrients
for decades. These fortification programs have helped prevent
deficiency diseases caused by low intakes of vitamin D, iodine, In addition to nutrients, food contains substances that, though
niacin, and iron (Figure 1.2). not essential to life, can be beneficial for health. In plants,

FIGURE 1.2 Fortified foods Each of these foods is fortified. In some foods, like the rice and salt
shown in the photo on the left, the nutrients are added to address deficiencies in the population’s diet.
Other foods have nutrients added to replicate those in a food they replace; for example, reduced-fat
milk is fortified with vitamin A to replace the vitamin A that is lost when the fat is removed from whole
milk. Some foods, such as those shown in the photo on the right, are fortified with nutrients chosen by
the manufacturer as a marketing tool and are not necessarily healthy choices.

Discretionary fortification
Mandated fortification
The fortification of salt with iodine in The vitamins and
the 1920’s helped eliminate iodine minerals added to
deficiency diseases as a public fortified cereals are
health problem. often highlighted on the
The fortification of milk with label and distract from
vitamin D was begun in the the large amount of
1930’s to combat the vitamin D added sugar.
deficiency disease rickets.
Vitamin A is added to low-fat
milk because it is low in Nutrient-enhanced
vitamin A and is used in place beverages are often
of vitamin A-rich whole milk. advertised as
“energy-enhancing” and
“immune-supporting.”

Thiamin, riboflavin, niacin, and

iron were first added to refined Fortified snacks often
grain products in the 1940’s to focus on nutrients that
help prevent deficiencies, and appeal to specific
folic acid was added in the groups, such as athletes.
1990’s to prevent neural tube
defects.
John Ambrose
John Ambrose John Ambrose
John Ambrose

fortification The addition of nutrients to foods.

4 C HA PTER 1 Nutrition: Everyday Choices

FIGURE 1.3 Foods that are high in phytochemicals3,4 Fruits, vegetables, and whole grains
provide a variety of phytochemicals, such as those highlighted here. Supplements of individual
phytochemicals are available, but these supplements do not provide the combinations of nutrients and
phytochemicals provided by a diet rich in plant foods.

Garlic, broccoli, and Soybeans are

onions provide a source of
sulfur-containing phytoestrogens,
phytochemicals that hormone-like
help protect us from compounds found
some forms of cancer in plants that may
by inactivating affect the risk of certain
carcinogens, blocking types of cancer and
tumor growth, or delay the progression
stimulating the body’s of heart disease.
natural defenses.

Purple grapes,
Yellow-orange fruits berries, and onions
and vegetables, such provide red, purple,
as peaches, apricots, and pale yellow
carrots, and cantaloupe, pigments called
as well as leafy greens, flavonoids, which
are rich in carotenoids, prevent oxygen
which may inhibit cancer damage and may
growth, prevent oxygen reduce the risk of
from damaging our cells, cancer and heart
and improve the immune disease.
response.
Todd
ToddGipstein
Gipstein//National
National Geographic
Geographic Creative

these health-promoting substances are called phytochemi- termed ­functional foods. The simplest functional foods are
cals ­(Figure 1.3). Although fewer such substances have been unmodified whole foods, such as broccoli and fish, that nat-
identified in animal foods, animal foods also contain sub- urally contain substances that promote health and protect
stances with health-promoting properties. These are called against disease. However, some foods fortified with nutri-
zoochemicals. ents or enhanced with phytochemicals or other substances
Some foods, because of the complex mixtures of nutri- are also classified as functional foods, for example oatmeal
ents and other chemicals they contain, provide health bene- with added soy protein, and orange juice with added calcium
fits that extend beyond basic nutrition. Such foods have been (Table 1.1).6 Functional foods are also called nutraceuticals,

TA BLE 1 .1 Functional foods provide benefits beyond their nutrients5

Food Potential health benefit

Fruits and vegetables May reduce the risk of heart disease and various cancers.

Breakfast cereal with added Helps reduce blood cholesterol levels and the overall risk of heart disease and may reduce the
flaxseed risk of certain cancers.

Yogurt (fermented dairy) May reduce the risk of certain cancers and help control diarrhea.

Garlic Helps reduce cancer risk and lowers blood cholesterol levels and the overall risk of heart disease.

Oatmeal Helps reduce blood cholesterol and the risk of heart disease.

Orange juice with added calcium Helps prevent osteoporosis.

Salmon Reduces the risk of heart disease.

Green tea May reduce the risk of certain types of cancer.

Soybeans May reduce blood cholesterol and heart disease, alleviate menopause symptoms, and reduce
the risk of osteoporosis.

phytochemical A substance found in plant foods that is not an functional food A food that has health-promoting properties
essential nutrient but may have health-promoting properties. beyond basic nutritional functions.
 1.1 Food Choices and Nutrient Intake 5

from “nutrition” and “pharmaceutical.” The terms functional these nutrients to survive, but we generally choose foods for
food and nutraceutical are not defined by the FDA, and there- reasons other than the nutrients they contain.
fore their usage varies. The factors around us that influence what we choose to
eat are referred to as our food environment. This includes
the environmental, sociocultural, and economic factors that
What Determines Food Choices? affect eating habits and patterns (Figure 1.4). It involves fac-
tors such as access to grocery stores and restaurants, avail-
Do you eat oranges to boost your vitamin C intake or ice cream ability of products and pricing of food in those stores and
to add a little calcium to your diet? Probably not. We need restaurants, and the acceptability of those foods based on

NUTRITION INSIGHT FIGURE 1.4 Our food environment affects what we eat. As seen in these examples, food
environment is influenced by our surroundings, as well as by economic and sociocultural factors.

Living in a food desert, where your

▲
only convenient shopping option is a
small corner market, makes it difficult
to choose a varied diet that includes
recommended amounts of fresh fruits
and vegetables.

Richard Levine/Alamy
Richard Stock
Levine / Alamy Photo
Stock Photo

Environmental Factors
In many parts of the world, insects, such as
these cicadas and grasshoppers, are considered
a treat. But in American culture, insects
are considered food contaminants, and
Economics affect which foods are available most people would refuse to eat them. Food
to us. Poverty limits food choices to what Food preferences and eating habits learned as part
is affordable and what is available at food Choices of our familial, cultural, national, and social
assistance programs or food banks. background are part of our food environment.
▲ ▲
Economic Factors Sociocultural Factors
Images
Images

Photo
Stockphoto
Productions / E+ / Getty
SDI Productions/E+/Getty

KevinFoy
Kevin AlamyStock
Foy//Alamy
SDI

food environment The physical, economic, and social factors that

affect eating habits and patterns.
6 C HA PTER 1 Nutrition: Everyday Choices

our family and cultural traditions. What we choose to eat is (see Figure 1.4). The foods we desire when we are sick, cold,
also influenced by what we are enticed to eat. Across much tired, depressed, or lonely depend on what we learned to eat
of America, fast-food restaurants dominate the landscape, and from our family, culture, and friends. What we choose to eat
advertisements for these foods bombard us in the media. The is also affected by our personal convictions, such as environ-
availability, affordability, and familiarity of fast food results in mental consciousness or vegetarianism, as well as our per-
increased consumption. sonal preferences for taste, smell, appearance, and texture.
Food environment can also reduce the consumption of
healthy foods. For example, in many inner city and rural
areas, supermarkets are scarce, so food choices are limited.
Concept Check
An area with limited access to affordable fruits, vegetables,
and other foods that make up a healthy diet is referred to as a 1. W
 hich has a higher nutrient density: sugar-sweetened soda or
food ­desert (see Figure 1.4). Farmer’s markets improve the low-fat milk?
food environment by increasing access to fresh locally grown
2. Why are foods fortified?
produce.
3. W
 hy is it better to meet your vitamin C needs by eating an orange
Food environment also involves social interactions and
than by taking a dietary supplement?
family and cultural traditions; if we were never exposed to
a food as a child, it would not be part of our food environ- 4. What factors determine what you will eat for lunch?
ment, and we might be less likely to choose it as an adult

1.2 Nutrients and Their Functions

L EARNING OBJECTIVES nutrients together are needed to provide for growth, maintain
and repair the body, and support reproduction.
1. List the six classes of nutrients.
2. Discuss the three functions of nutrients in the body. The Six Classes of Nutrients
Carbohydrates, lipids (commonly called fats), and proteins
There are six classes of nutrients: carbohydrates, lipids, proteins, are all organic compounds that provide energy to the body.
water, vitamins, and minerals. Carbohydrates, lipids, proteins, Although we tend to think of each of them as a single nutrient,
and water are considered macronutrients because they are there are actually many different types of molecules in each
needed in large amounts. Vitamins and minerals are referred to of these classes. Carbohydrates include starches, sugars, and
as micronutrients because they are needed in small amounts. fiber (Figure 1.5a). Several types of lipids play important
Together, the macronutrients and micronutrients in our diet roles in our diet and in our health (Figure 1.5b). The most
provide us with energy, contribute to the structure of our bod- recognizable of these are cholesterol, saturated fats, and
ies, and regulate the biological processes that go on inside us. unsaturated fats. There are thousands of ­different proteins
Each nutrient provides one or more of these functions, but all in our bodies and our diets. All proteins are made up of units

organic compound A substance that contains carbon bonded to cholesterol A type of lipid that is found in the diet and in the
hydrogen. body. High blood levels increase the risk of heart disease.
carbohydrates A class of nutrients that includes sugars, starches, saturated fat A type of lipid that is most abundant in solid animal
and fibers. Chemically, they all contain carbon, along with hydrogen fats and is associated with an increased risk of heart disease.
and oxygen, in the same proportions as in water (H2O). unsaturated fat A type of lipid that is most abundant in plant oils
fiber A type of carbohydrate that cannot be broken down by and is associated with a reduced risk of heart disease.
human digestive enzymes. protein A class of nutrients that includes molecules made up of
lipids A class of nutrients, commonly called fats, that includes one or more intertwining chains of amino acids.
­saturated and unsaturated fats and cholesterol; most do not d
­ issolve
in water.
 1.2 Nutrients and Their Functions 7

called amino acids that are linked together in different com- ­ erform a variety of unique functions in the body, such as
p
binations to form different ­proteins (Figure 1.5c). regulating energy metabolism, maintaining vision, protect-
Water, unlike the other classes of nutrients, is only a sin- ing cell membranes, and helping blood to clot. Minerals
gle substance. Water makes up about 60% of an adult’s body are ­elements that are essential nutrients needed in small
weight. Because we can’t store water, the water the body loses amounts to provide a variety of diverse functions in the body.
must constantly be replaced by water obtained from the diet. For example, iron is an element needed for the transport
Vitamins are organic molecules that are needed in small of oxygen in the blood, calcium is an element important in
amounts to maintain health. There are 13 vitamins, which keeping bones strong. We consume vitamins and minerals

FIGURE 1.5 Carbohydrates, lipids, and ­proteins Varying ­combinations of carbohydrates, lipids,
and proteins provide the energy in the foods we eat.

a. Some high-carbohydrate foods, such as rice, pasta, and bread, contain mostly

▲
starch; some, such as berries, kidney beans, and broccoli, are high in fiber; and
others, such as cookies, cakes, and carbonated beverages, are high in empty
calories from added sugars.
Coolidge // Getty
JeffreyCoolidge
Jeffrey Images, Inc.
Getty Images

/ Science
/ Science Source
Source
b. High-fat plant foods such as vegetable oils, avocados,
olives, and nuts are high in healthy unsaturated fats.

Winters
High-fat animal foods such as cream, butter, meat, and

CharlesD.D.Winters
whole milk are sources of cholesterol and are high in
▲

saturated fat, which increases the risk of heart disease.

Charles
Inc.
Images, Inc.
Jeffrey Coolidge / Getty Images,

c. The proteins we obtain from animal foods, such as meat, fish, and
▲

eggs, better match our amino acid needs than do most individual
plant proteins, such as those in grains, nuts, and beans. However,
when plant sources of protein are combined, they can provide all the
Jeffrey

amino acids we need.

 8 C HA PTER 1 Nutrition: Everyday Choices

in almost all the foods we eat. Some are natural sources: What Nutrients Do
Oranges contain vitamin C, milk provides calcium, and car-
rots give us vitamin A. Other foods are fortified with vitamins Nutrients are involved in providing energy, forming body struc-
and minerals; a serving of fortified breakfast cereal often has tures, and regulating physiological processes (­Figure 1.6).
100% of the recommended intake of many vitamins and min- Carbohydrates, lipids, and proteins are often referred to as
erals. Dietary supplements are another source of vitamins and ­energy-yielding nutrients; they provide energy that can be
minerals for some people. measured in calories. The calories people talk about and see

NUTRITION INSIGHT FIGURE 1.6 Nutrient functions The nutrients we consume in our diet provide energy, form body
structures, and regulate body processes.

Energy Whether riding a bike through the fall foliage, walking to the mailbox,

▲
or gardening, physical activity is fueled by the carbohydrates, fat, and protein in
the food we eat.
Creative
GeographicCreative
NationalGeographic

Images
GettyImages
Stockbyte //Getty
Brown //National

Hope//Stockbyte
Skip Brown

Wendy Hope
Wendy
Structure Proteins, lipids, carbohydrates, minerals, and water all
contribute to the shape and structure of our bodies.
▲
100
6% Minerals, ▲
carbohydrates, and Regulation Water helps regulate body temperature. When body
other substances temperature increases, sweat is produced, cooling the body as it
16% Fat evaporates from the skin.
80

16% Protein OH Regulation Lipids, such as

▲
Body weight

60 H3C the hormone testosterone,

(percent)

62% Water illustrated here, help regulate

body processes. Testosterone is
40 H3C
made from cholesterol. In men, it
stimulates sperm production and
the development of secondary
20
sex characteristics, such as body
O and facial hair, a deep voice, and
0
increased muscle mass.
Lean adult male (continues)
 1.3 Nutrition in Health and Disease 9

FIGURE 1.6 (continued)

Images
Images
/ E+ / Getty

/ 123RF
kasa/123RF
GrapeImages/E+/Getty

rattanachot kasa
GrapeImages

rattanachot
▲
Energy The fat stored in our bodies acts as an energy reserve for
▲
Structure Calcium, along with phosphorus and a few other
when intake is less than needs. minerals, form the structure of our bones.

listed on food labels are actually kilocalories (abbreviated cell, and water and dissolved substances fill the cells and the
­kcalorie or kcal), units of 1000 calories. When spelled with spaces around them.
a capital C, Calorie means kilocalorie. Carbohydrates pro- All six classes of nutrients play important roles in regu-
vide 4 Calories/gram; they are the most immediate source of lating body processes. Keeping body temperature, blood pres-
energy for the body. Lipids also help fuel our activities and are sure, blood sugar level, and hundreds of other parameters
the major form of stored energy in the body. One gram of fat relatively constant involves thousands of chemical reactions
provides 9 Calories. Protein can supply 4 Calories/gram but is and physiological processes. Proteins, vitamins, and min-
not the body’s first choice for meeting energy needs because erals are regulatory nutrients that help control how quickly
protein has other roles that take priority. Alcohol, though it is chemical reactions take place throughout the body. Lipids
not a nutrient because it is not needed for life, provides about and proteins are needed to make regulatory molecules called
7 Calories/gram. Water, vitamins, and minerals do not provide hormones that stimulate or inhibit various body processes.
energy (calories). Water helps regulate body temperature, as well as lubricate
With the exception of vitamins, all the classes of nutri- surfaces, and transport materials throughout the body.
ents are involved in forming and maintaining the body’s Figure 1.6 illustrates some of the ways various nutrients
structure. Fat deposited under the skin contributes to our are involved in providing energy, forming body structures, and
body shape, for instance, and proteins form the ligaments and regulating physiological processes.
tendons that hold our bones together and attach our mus-
cles to our bones. Minerals harden bone. Proteins and water Concept Check
make up the structure of the muscles, which help define our
body contours, and proteins and carbohydrates form the car-
1. Which classes of nutrients provide energy?
tilage that cushions our joints. On a smaller scale, lipids, pro-
teins, and water form the structure of individual cells. Lipids 2. What are the three overall functions that nutrients provide?
and proteins make up the membranes that surround each

1.3 Nutrition in Health and Disease

LEARNING OBJECTIVES What we eat has an enormous impact on how healthy we are
now and how likely we are to develop chronic diseases such
as heart disease, obesity, and diabetes. Consuming either
1. Describe the causes of malnutrition.
too much or too little of one or more nutrients or energy
2. Explain ways in which nutrient intake can affect health will result in malnutrition. Malnutrition includes both
in both the short term and the long term.
3. Discuss how the genes you inherit affect the impact
your diet has on your health. malnutrition A condition resulting from an energy or nutrient
intake either below (undernutrition) or above (overnutrition) that
which is optimal.
10 C HA PTER 1 Nutrition: Everyday Choices

FIGURE 1.7 Undernutrition Nutrient deficiencies may be mild enough to cause no obvious
symptoms or severe enough to cause debilitating illness and death.
Collection / Alamy

a. Even though this child

Collection/Alamy

looks normal and healthy,

she has low iron stores. If the

Creative
iron content of her diet is not b. The symptoms of

GeographicCreative
increased, she will eventually starvation, the most obvious
Image
Image

develop iron deficiency anemia. form of undernutrition,

NationalGeographic
Geographic

Mild nutrient deficiencies like occur gradually over time

Geographic

hers may go unnoticed because when the energy provided

the symptoms either are not by the diet is too low to

Garrett//National
immediately apparent or are meet the body’s needs.
Reid / National
Rich Reid/National

nonspecific. Two common Body tissues are broken

nonspecific symptoms of down to provide the energy
Stock Photo

W.E. Garrett
iron depletion are fatigue to support vital functions,
and decreased ability to fight resulting in loss of body fat
Rich

W.E.
infection. and wasting of muscles.

undernutrition, which is due to a deficiency of energy or high in sodium contribute to high blood pressure; an excess
nutrients, and overnutrition, which occurs when there is an intake of saturated fat contributes to heart disease; and a
excess of energy or nutrients. Both undernutrition and over- dietary pattern that is high in red meat and saturated fat and
nutrition can affect your health not just today but 20, 30, or 40 low in fruits, vegetables, and fiber may increase the risk of cer-
years from now. The impact of your diet on your health is also tain cancers.8 Diseases related to a poor diet are the leading
affected by your genetic makeup. causes of death in the United States, exceeding deaths related
to smoking or alcohol consumption (Figure 1.8b).9

Undernutrition and Overnutrition

Diet–Gene Interactions
Undernutrition occurs when intake doesn’t meet the body’s
needs: The more severe the deficiency, the more dramatic What you eat affects your health, but diet alone does not deter-
the symptoms (Figure 1.7). Some nutrient deficiencies occur mine whether you will develop a particular disease. Each of us
quickly. Dehydration, a deficiency of water, can cause symp- inherits a unique combination of genes. Some of these genes
toms in a matter of hours. Drinking water can relieve the head- affect your risk of developing chronic diseases, such as heart dis-
ache, fatigue, and dizziness caused by dehydration almost as ease, cancer, high blood pressure, and diabetes, but their impact
rapidly as these symptoms appeared. Other nutritional defi- is affected by what you eat. Your genetic makeup determines the
ciencies may take much longer to become evident. Symptoms impact a certain nutrient will have on you. For example, some
of scurvy, a disease caused by a deficiency of vitamin C, appear people inherit a combination of genes that makes their blood
after months of deficient intake; osteoporosis, a condition in pressure sensitive to sodium intake. When these individuals
which the bones become weak and break easily, may result consume even an average amount of sodium, they may develop
after years of consuming a calcium-deficient diet. high blood pressure (see Chapter 8). Others inherit genes that
We typically think of malnutrition as undernutrition, allow them to consume more sodium without much of a rise in
but overnutrition, an excess intake of nutrients or calories, is blood pressure. Those whose genes dictate a significant rise in
also a concern. An overdose of iron can cause liver failure, for blood pressure with a high-­sodium diet can reduce their blood
example, and too much vitamin B6 can cause nerve damage. pressure, and the complications associated with high blood
These nutrient toxicities usually result from taking large doses pressure, by eating a diet that is low in sodium.
of vitamin and mineral supplements because foods generally Our increasing understanding of human genetics has
do not contain high enough concentrations of nutrients to given rise to the discipline of nutritional genomics, which
be toxic. However, chronic overconsumption of calories and explores the interaction between human genes, nutrition,
certain nutrients from foods can also cause health problems. and health (Figure 1.9).12 It encompasses both the effects
The typical U.S. diet, which provides more calories than are that the genes people inherit have on how their diet affects
needed, has resulted in an epidemic of obesity in which more health (nutrigenetics) and the effects the nutrients and
than 40% of adults have obesity (Figure 1.8a).7 Diets that are other food components they consume have on gene activity

genes Units of a larger molecule called DNA that are responsible nutritional genomics The study of how our genes affect
for inherited traits. the impact of nutrients or other food components on health
(nutrigenetics) and how nutrients affect the activity of our genes
(nutrigenomics).
 1.3 Nutrition in Health and Disease 11

FIGURE 1.8 Overnutrition Obesity is a form of overnutrition that increases the

risk of a variety of other nutrition-related chronic diseases that contribute to death.

30 b. Four of the top 10 causes of death

in the United States are nutrition
Nutrition related
25 related.11 They are all thought to be

Percentage of all deaths

exacerbated by obesity.
20

15

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energy expenditure over a long period, causing
the accumulation of an excessive amount of body Interpret the Data
fat. Adults are not the only ones whose weight is
Based on this graph showing the leading causes of death in the United States,
affecting their health; 18.5% of U.S. children and
about what percentage of all deaths are due to nutrition-related diseases?
adolescents, ages 2 to 19 years, are obese.10
a. 5% c. 50%
b. 10% d. 90%

FIGURE 1.9 Nutritional genomics Both the genes you inherit and your dietary choices directly
affect your health and disease risk. There is also interplay between these factors such that your
genes, through nutrigenetics, influence how your diet affects your health, and your diet, through
nutrigenomics, affects how your genes impact your health.

Health and Disease Risk

Nutrigenetics Nutrigenomics

Genes Diet
Images
Images
Huang / iStockphoto
zhijian Huang/iStockphoto

Grill / Corbis / Getty

Tom Grill/Corbis/Getty
zhijian

Tom

The genes you inherit affect your tendency to The diet you consume affects your risk of developing
develop nutrition-related chronic diseases nutrition-related chronic diseases.
such as heart disease and diabetes.

Think Critically
Can you become obese even if both of your parents are thin?
12 C HA PTER 1 Nutrition: Everyday Choices

Debate

Do DNA-Based Diets Improve Health Outcomes? The genetics of nutrition-related diseases are complicated,
and some argue that it will be years before the science catches up
The risk of developing chronic diseases such as diabetes with the promises of genetic testing. This is exemplified by a study
and heart disease is affected by the genes we inherit and the that looked at whether variations in three genes that affect carbo-
lifestyle we lead. If a genetic analysis could identify your hydrate and fat metabolism could predict whether subjects would
risk and the best diet to reduce that risk, would you be will- lose more weight on a low-fat or low-carbohydrate diet. The study
ing to change your diet? found no difference in weight loss based on diet or genetic varia-
Current nutrition recommendations are designed for the majority tion.18 Although this study examined only three genes among the
of healthy people but are not optimum for everyone. Nutritional dozens of genes and gene interactions that play a role in weight
genomics suggests that we can reduce our disease risk by tailor- loss, it suggests that we do not yet have the knowledge to prescribe
ing our diet to our individual genetic makeup (see figure).13,14 an optimal personalized weight-loss diet based on our genes.
Although millions of people send samples to DNA-testing compa- We may not yet have the technology to provide complete
nies every year,15 currently only a few of these companies provide DNA-based nutrition prescriptions, but someday we probably
customers with a personalized diet based on their genes.16,17 Can will. Will this approach improve individual or public health?14 In
these “DNA-based diets” deliver accurate recommendations? many cases, DNA-based advice is no different from general rec-
ommendations. For example, if your DNA increases your risk of
developing heart disease, you could decrease your risk by limit-
ing saturated fat and increasing fiber intake. But even if you don’t
have this genetic variant, healthy diet recommendations tell us to
reduce our saturated fat and increase our fiber intake.
Those who advocate personalized diets point out that peo-
ple often do not follow general dietary guidance and may be
more likely to stick to individualized recommendations. One
study found that personalized nutrition advice resulted in greater
dietary improvements than general recommendations,19 but not
all studies support this finding. A meta-analysis (a study that com-
bines the results of many studies) examining whether awareness
of one’s genetic risk influenced diet or other risk-reducing behav-
Zoe’s genetic Nathan’s genetic iors found that it had no effect.20 For example, telling people that
background background they had an increased genetic risk for diabetes did not motivate
them to improve their diet or increase their activity. Perhaps the
priority for public health dollars should not be to fine-tune diet
prescriptions but rather to find out what will motivate people to
change their diets and live healthier lives.
In the future, we may be filling our plates based on our genes.
This could mean planning an individual plate for each person at
the table. Will eating these personalized diets make us healthier
than following general nutrition recommendations? Will person-
alized diets limit the pleasure we get from food and change the
Zoe’s Nathan’s cultural and social roles that food plays in our lives?
individualized diet individualized diet

Think Critically
If genetic testing determines that you are unlikely to
Optimal health become obese, does this mean that you can eat as much
as you want without worrying about weight gain? Why
or why not?
PeopleImages/E+/Getty Images
PeopleImages / E+ / Getty Images

(nutrigenomics). Research in these areas has led to the devel-

opment of the concept of “personalized nutrition.” The goal of Concept Check
personalized nutrition is to prescribe a diet based on the genes
an individual has inherited in order to prevent, moderate, or 1. What causes malnutrition?
cure chronic disease. We know that certain dietary patterns 2. How can your diet today affect your health 20 years from now?
can reduce the risk of many chronic diseases, but it is not clear
3. W
 hy might the diet that optimizes health be different for different
whether personalized diets based on genetic analysis have the
people?
potential to improve individual or public health (see Debate:
Do DNA-Based Diets Improve Health Outcomes?).
 1.4 Choosing a Healthy Diet 13

1.4 Choosing a Healthy Diet

LEARNING OBJECTIVES that you will meet your nutrient needs. If instead you have
a salad, potatoes, and broccoli, you will be getting plenty of
1. List three reasons it is important to eat a variety of foods. vitamins C and A, as well as many other vitamins and min-
erals. Choosing from all the food groups and making varied
2. Explain why you can sometimes eat foods that are low
choices from within each food group is also important because
in nutrient density and still have a healthy diet.
nutrients and other food components interact. Such interac-
3. Discuss how dietary moderation can reduce the risk of tions may be positive, enhancing nutrient utilization, or nega-
chronic disease. tive, inhibiting nutrient availability. Variety averages out these
interactions. Some foods may also contain toxic substances.
Eating a variety of foods reduces the risk that you will con-
A healthy diet is one that provides the right number of calories sume enough of any one toxin to be harmful. For example,
to keep your weight in the desirable range; the proper balance tuna may contain traces of mercury, but as long as you don’t
of carbohydrates, proteins, and fat; plenty of water; and suf- eat tuna too often, you are unlikely to consume a toxic amount.
ficient but not excessive amounts of vitamins and minerals. Variety involves choosing different foods not only each day
This healthy diet is rich in whole grains, fruits, and vegetables; but also each week and throughout the year. If you had apples
high in fiber; and low in added sugars, sodium, and unhealthy and grapes today, for example, have blueberries and canta-
fats. In short, a healthy diet is based on variety, balance, and loupe tomorrow. If you can’t find tasty tomatoes in December,
moderation (see What Should I Eat?). replace them with a winter vegetable such as squash.

Eat a Variety of Foods Balance Your Choices

In nutrition, choosing a variety of foods is important because Choosing a healthy diet is a balancing act. Healthy eating doesn’t
no single food can provide all the nutrients the body needs for mean giving up your favorite foods. There is no such thing as
optimal health. Variety means choosing foods from different a good food or a bad food—only healthy diets and unhealthy
food groups—vegetables, grains, fruits, dairy products, and diets. Any food can be part of a healthy dietary pattern, as long
protein foods. Some of these foods are rich in vitamins as your intake throughout the day or week provides enough of
and phytochemicals, others are rich in protein and minerals, all the nutrients you need without excesses of any. When you
and all are important. choose a food that is low in nutrient density, balance it with one
Variety also means choosing diverse foods from within that is high in nutrient density. For example, when you choose
each food group. Different vegetables provide different nutri- chips for a snack, choose fruit for dessert.
ents. Potatoes, for example, are the only vegetable in many A balanced diet also balances the calories you take in with
Americans’ diets. Potatoes provide vitamin C but are low in the calories you burn in your daily activities so that your body
vitamin A. If potatoes are your only vegetable, it is unlikely weight stays in the healthy range (Figure 1.10).

What Should I Eat?

Variety, Balance, and Moderation • When you have cookies for a snack, have fruit for dessert.
• If you had salty chips with lunch, snack on carrots before
Eat a variety of foods
dinner.
• Mix up your snacks. For example, have salsa and chips one
day and fruit, yogurt, or nuts another day. Choose moderate portions
• Add almonds and diced apples to your salad. • Push back from the table before you are stuffed and go for
• Try a new vegetable or fruit each week. Tired of carrots? Try a walk.
jicama. • Reduce your portions by using a smaller bowl.
• Vary your protein sources. Eat fish one day and beef the • Next time you go out for ice cream, get one scoop instead
next—or skip the meat and have beans. of two.
• Split your restaurant meal with a friend.
Balance choices to assure nutrient density
• Going out to dinner? Have a salad for lunch. Use iProfile to calculate the calories in your favorite
fast-food meal.
• If you eat some extra fries, take some extra steps.
 14 C HA PTER 1 Nutrition: Everyday Choices

FIGURE 1.10 Balance calories in with calories out To keep your weight stable, you need to
burn the same number of calories as you consume. Consuming extra calories during the day can be
­balanced by increasing the calories you burn in physical activity. You may be surprised how much
activity is needed to burn off extra calories.
You can do this by doing jumping jacks
▲
for 3 minutes.
If you grab 4 potato chips and pop them in
your mouth, you will need to burn about 30
▲
extra Calories to maintain your weight.

Mirage_studio/Shutterstock.com
Mirage_studio / Shutterstock
John Ambrose

You could do this by playing golf for about an hour, carrying

▲
your own clubs.

Choosing a Big Mac over a smaller burger means you

will need to increase your energy expenditure by 300
▲
Calories to maintain your weight.

Washnik
Andy Washnik
Washnik
Andy Washnik

Andy
Andy

Creative
GeographicCreative
NationalGeographic

Ask Yourself
If you add a daily
grande Mocha
Thompson // National

Frappuccino to your
usual diet, how many
minutes of jumping
Kate Thompson
Washnik
AndyWashnik

jacks would you need

to do to burn off the
Andy

extra calories?
Kate

▲ ▲
Choosing a grande Mocha Frappuccino over You could do this by jogging for about 30
a regular iced coffee means you will need to minutes.
increase your energy expenditure by 350
Calories to maintain your weight.

Practice Moderation chronic diseases, such as heart disease and cancer, that are on
the rise in the U.S. population.
Moderation means not overdoing it—not having too many The fact that Americans are gaining weight suggests that
calories, too much saturated fat, too much sugar, too much we have not been practicing moderation when it comes to cal-
salt, or too much alcohol. Choosing moderate amounts will orie intake.21 Larger food portions are one factor contributing
help you maintain a healthy weight and prevent some of the to our increasing intake. The sandwiches, soft drinks, and
 1.5 Evaluating Nutrition Information 15

Thinking It Through

A Case Study on Choosing a Healthy Diet hall. Her evening meal plan is “all-you-can-eat,” so she piles food on
her plate and always takes a dessert to get the most for her money.
For many college students, their freshman year is the first time
Suggest two changes that Maya could make to moderate
they are making all their own food choices, and they don’t always
her dinner choices.
make the best ones. Learning to apply the principles of variety,
balance, and moderation can help improve these choices. Your answer:
Maya doesn’t really know how to choose a healthy diet, so she picks
what is familiar, inexpensive, and saves her time. Every day for It is Mexican night at the dining hall. Maya knows that beans are a
breakfast she eats the same cereal, a glass of apple juice, and coffee. healthy choice, so she takes two beef and bean burritos as shown
Suggest ways that Maya could increase the variety in her in the photo.
breakfast while still keeping her food choices inexpensive
and quick.
Your answer:

For lunch Maya has fast food—usually a burger and fries. She
knows this is not the most nutrient-dense choice, but she is always
in a hurry, rushing between school and work. The drive-thru
often seems like the best option.
Suggest some fast and easy lunch choices that would be

RF RF
more nutrient dense than Maya’s current lunch choice.

Resnick / 123
Resnick/123
Your answer:

Suggest some snacks that would add variety and help to

Joshua
Joshua
balance Maya’s repetitious breakfast and lunch.
Your answer:
How does Maya’s Mexican dinner stack up in terms of
variety, balance, and moderation?
Maya has gained a few pounds and is worried that she will become a
victim of the “freshman 15”—the 15 or so pounds frequently gained Your answer:
by college students during the first year away from home. She thinks
her weight gain is due to the dinner that she eats in the college dining Check your answers in Appendix L.

French fry orders served in fast-food restaurants today are two

to five times larger than what they were 50 years ago. The sizes Concept Check
of the snacks and meals we eat at home have also increased.
As these portion sizes have grown, so has the amount we eat— 1. Why is variety in a diet important?
and so has our weight.22 Moderation makes it easier to balance 2. W
 hat could you have for lunch to balance a breakfast that doesn’t
your diet and allows you to enjoy a greater variety of foods (see include any fruits or vegetables?
Thinking It Through). 3. Why does moderation allow more variety in your diet?

1.5 Evaluating Nutrition Information

LEARNING OBJECTIVES We are bombarded with nutrition information almost every
day. The evening news, the morning papers, and the World
1. List the steps of the scientific method and give an Wide Web continually offer us tantalizing tidbits of nutri-
example of how it is used in nutrition. tion advice. Food and nutrition information that used to
take professionals years to disseminate now travels with
2. Discuss three different types of experiments used to
lightning speed, reaching millions of people within hours
study nutrition.
or days. Much of this information is reliable, but some can
3. Describe the components of a sound scientific experiment. be misleading. In order to choose a healthy diet, we need
4. Distinguish between reliable and unreliable nutrition to be able to sort out the useful material in this flood of
information. information.
16 C HA PTER 1 Nutrition: Everyday Choices

The Science Behind Nutrition studies (Figure 1.11). In nutrition, the scientific method is
used to develop nutrient recommendations, understand the
Like all other sciences, the science of nutrition is constantly functions of nutrients, and learn about the role of nutrition in
evolving. As new discoveries provide clues to the right combi- promoting health and preventing disease.
nation of nutrients needed for optimal health, new nutritional
principles and recommendations are developed. Sometimes How Scientists Study Nutrition
established beliefs and concepts give way to new information.
Understanding the process of science can help consumers Many different types of studies are used to expand our knowl-
understand the nutrition information they encounter. edge of nutrition. Some make observations about relationships
The systematic, unbiased approach that allows any sci- between diet and health; these are based on the science of
ence to acquire new knowledge and continuously revise and ­epidemiology. Other types of studies evaluate the effect of a
update our understanding based on new information is the particular dietary change on health. Some of these use human
scientific method. The scientific method involves making subjects, others use animals; some look at whole populations,
observations of natural events, formulating hypotheses to others study just a few individuals; and some use just cells or
explain these events, designing and performing experiments molecules (Figure 1.12).
to test these hypotheses, and developing theories that explain A sound nutrition experiment examines the right experi-
the observed phenomenon based on the results of many mental population, collects quantifiable data, includes proper

PROCESS DIAGRAM FIGURE 1.11 The scientific method The scientific method is a process used to ask and answer
scientific questions through observation and experimentation.
1 The first step of the scientific method is to make an observation and Courtesy
CourtesyLori
Lori Smolin
Smolin
ask questions about that observation.
Observation
More people get colon cancer in the United States than in Japan.

2 The next step is to propose an explanation for this observation.

This proposed explanation is called a hypothesis.
Hypothesis
The lower incidence of colon cancer in Japan than in the United States is
due to differences in the diet.

3 Once a hypothesis has been proposed, experiments like this one are
designed to test it. To generate reliable theories, the experiments done
to test hypotheses must produce consistent, quantifiable results and
must be interpreted accurately.
Experiment 5 If experimental results do not support the hypothesis,
Compare the incidence of colon cancer of Japanese people who move to a new hypothesis can be formulated.
the United States and consume a typical U.S. diet with the American
population as a whole. Result: The Japanese people who eat the U.S.
diet have the same higher incidence of colon cancer as the general
population. Theory
The U.S. diet contributes to the development of colon
cancer.
4 If the results from repeated experiments support the hypothesis, a 6 As new information becomes available, even a theory
scientific theory can be developed. A single experiment is not enough
that has been accepted by the scientific community
to develop a theory; rather, repeated experiments showing the same
for years can be proved wrong.
conclusion are needed to develop a sound theory.

Think Critically
A scientist has hypothesized that the difference in the incidence of colon cancer in Japan and the
United States is due to differences in the genetic makeup of the populations. Based on the results of
the experiment described in this illustration, explain why this hypothesis is not supported.

hypothesis A proposed explanation for an observation or a epidemiology The branch of science that studies health and
scientific problem that can be tested through experimentation. disease trends and patterns in populations.
theory A formal explanation of an observed phenomenon made
after a hypothesis has been tested and supported through extensive
experimentation.
 1.5 Evaluating Nutrition Information 17

NUTRITION INSIGHT FIGURE 1.12 Types of nutrition studies Scientists use a variety of methods to expand our
­understanding of nutrition.

a. Epidemiological studies

10-year heart attack incidence

3000 Comparing saturated fat intake to the
incidence of heart attacks in different

per 10,000 people

populations indicates that diets with
2000 a high percentage of calories from
saturated fat are associated with an
increased incidence of heart attacks.
Think Critically 1000
Does this graph indicate that
a high intake of saturated fat
causes heart attacks? Explain 0
5 10 15 20 25
your answer.
Percentage of calories from saturated fat

Epidemiology does not determine cause-and-effect relationships; it just identifies patterns,

which can be used to generate hypotheses. Many kinds of experiments can be used to test
hypotheses generated through epidemiology.

NationalGeographic
Dale //National Creative
GeographicCreative
RF
/ 123RF
Dmytro/123

Greg Dale
Dmytro

Greg

c. Biochemistry and molecular biology Biochemistry

b. Clinical trials In nutrition, studies called clinical trials can be used to study the chemical reactions that provide
explore the health effects of altering people’s diets—for instance, energy or synthesize molecules, such as cholesterol,
the possible effects of reducing saturated fat intake on blood and molecular biology can be used to study how nutrients
cholesterol levels. interact with our genes.

d. Animal studies Because studying humans is costly,

time-consuming, inconvenient for the subjects, and in
Getty Images
kickers // iStockphoto

some cases impossible for ethical reasons, many studies

are done using animals. Guinea pigs provide a good model
for studying heart disease. However, even the best animal
model is not the same as a human, and care must be taken
kickers

when extrapolating animal results to humans.

18 C HA PTER 1 Nutrition: Everyday Choices

experimental controls, and interprets the data accurately. Academy of Nutrition and Dietetics, The New England Journal of
The experimental population must be chosen to answer a spe- Medicine, and The International Journal of Sport Nutrition. News-
cific question. For example, if a dietary supplement claims letters from reputable institutions, such as the Tufts Health and
to increase bone strength in older women, a study to test this Nutrition Letter, the Harvard Health Letter, and Nutrition Action
should use older women as subjects. For an experiment to deter- Healthletter are also reliable sources of nutrition and health
mine whether a treatment does or does not have an effect, it information. The information in these newsletters comes from
must include enough subjects to demonstrate that the treat- peer-reviewed articles but is written for a consumer audience.
ment causes the effect to occur more frequently than it would Recommendations and policies regarding nutrition and
by chance. The number of subjects needed depends on how healthcare practices are made by compiling the evidence from
likely an effect is to occur without the treatment. For example, the wealth of well-controlled, peer-reviewed studies that are
if weight training without a muscle-building supplement causes available. This is referred to as evidence-based practice.
an increase in muscle mass, a large number of experimental
subjects may be needed to demonstrate that there is a greater
increase in muscle mass with the treatment—in this case, the
Judging for Yourself
muscle-building supplement. Results from studies with only a Not everything you hear is accurate. Because much of the nutri-
few subjects may not be able to distinguish effects that occur tion information we encounter is intended to sell products, that
due to chance and should therefore be interpreted with caution. information may be embellished to make it more appealing.
Data collected in experiments must be quantifiable—that Understanding the principles scientists use to perform nutrition
is, data must include parameters that can be measured reli- studies can help consumers judge the nutrition information they
ably and repeatedly, such as body weight or blood pressure. encounter in their daily lives (see What a Scientist Sees: Behind the
Individual testimonies or opinions alone are not quantifiable, Claims). Some things that may tip you off to misinformation are
objective measures. claims that sound too good to be true, information from unreli-
In order to know whether what is being tested has an effect, able sources, information intended to sell a product, and informa-
one must compare it with something. A control group acts as a tion that is new or untested. The following questions can help you
standard of comparison for the factor, or variable, being studied. evaluate the validity of any nutrition information you encounter.
A control group is treated in the same way as the experimental
group except that the control group does not receive the treat- Does it make sense? Some claims are too outrageous
ment being tested. For example, in a study examining the effect to be true. For example, if a product claims to increase your
of a dietary supplement on weight loss, the control group would muscle size without any exercise or decrease your weight
consist of individuals of similar age, gender, height, weight, and without a change in diet, common sense should tell you that
body composition, eating similar diets and following similar the claim is too good to be true. In contrast, an article that tells
activity patterns as individuals in the experimental group. While you that adding exercise to your daily routine will help you
the experimental group would consume the supplement, the con- lose weight and increase your stamina is not so outrageous.
trol subjects would consume a placebo, a harmless, inactive sub-
stance that is identical in appearance to the dietary supplement. What’s the source? If a claim seems reasonable, find
When an experiment has been completed, the results must out where it came from. Personal testimonies are not a reliable
be interpreted. Accurately interpreting results is just as important source of information. These individual success stories are not
as conducting a study carefully. If a study conducted on a large subjected to scientific evaluation, and therefore it cannot be
group of young women indicates that a change in diet reduces assumed that similar results will occur in other people. Claims
breast cancer risk later in life, the results of that study cannot based on well-controlled research studies can provide reliable,
be used to claim that the same effect will occur if older women reproducible results as long as the data is interpreted correctly.
make a similar dietary change. Likewise, if the study looks only Government recommendations regarding healthy dietary
at the connection between a change in diet and breast cancer, the practices and information disseminated by universities generally
findings can’t be used to claim a reduced risk for other cancers. are reliable information sources. Government recommendations
One way to ensure that the results of experiments are are developed by committees of scientists who interpret the lat-
interpreted correctly is to have them reviewed by experts in the est well-conducted research studies and use their conclusions to
field who did not take part in the study being evaluated. Such deve­lop recommendations for the population as a whole. The
a peer-review process is used in determining whether exper- infor­mation is designed to improve the health of the population.
imental results should be published in scientific journals. The Information that comes from universities is supported by research
reviewing scientists must agree that the experiments were con- studies that are well scrutinized and published in peer-reviewed
ducted properly and that the results were interpreted appropri- journals. Many universities also provide information that tar-
ately. Nutrition articles that have undergone peer review can gets the general public. Not-for-profit ­organizations such as the
be found in many journals, including The American Journal of Academy of Nutrition and Dietetics and the American Medi­­cal
Clinical Nutrition, The Journal of Nutrition, The Journal of the Association are also reliable sources of nutrition information.

control group In a scientific experiment, the group of experimental group In a scientific experiment, the group of
participants used as a basis of comparison. They are similar to participants who undergo the treatment being tested.
the participants in the experimental group but do not receive the
treatment being tested.
 1.5 Evaluating Nutrition Information 19

What a Scientist Sees

Behind the Claims

Blend Images / Getty Images

Before After
Gazimal / Getty Images

Supported by
research:
In a study, 25 overweight
subjects taking one

“I’m Janet, and I SlimEazzy tablet per day

lost 40 pounds on lost an average of 15
SlimEazzy. The pounds in 8 weeks and 20
pounds just melted
subjects stated that they
away, and I have
more energy than felt energized when taking
ever!” the supplement.

Consumers who want to slim down may think this product looks the experimental group said they felt energized, and 21 subjects
amazing. It will allow them to lose weight and to increase their energy in the control groups said they felt energized (see graph).
level! However, a scientist looking at the same ad may have some con- 25 25
cerns. First of all, the testimonial about weight loss is based on Janet’s Experimental group
experience, and not everyone will have the same weight-loss result. Control group
20 20
And, although she claims to have more energy than ever, Janet is bas-
Number of subjects

ing this statement on her feelings and not objective measures.

A scientist would want to carefully examine the research 15 15
Pounds

study to see if the data supports the claim that the product pro-
motes weight loss. A review of the full study shows that it involved
10 10
50 overweight subjects. Half of them consumed a reduced-calorie
diet along with one SlimEazzy tablet per day. The other half ate the
same reduced-calorie diet but took a placebo instead of SlimEazzy. 5 5
Body weight was measured at the beginning of the study and after
8 weeks of the diet. As seen in the graph, both the control and
0 0
experimental groups lost weight. The amount lost in the experi- Weight loss Subjects reporting
mental group is slightly greater, but statistical analysis found at 8 weeks increased energy
that the difference was insignificant. The implication that taking
the supplement helped subjects to lose 15 pounds is misleading Think Critically
because those taking the placebo lost a similar amount of weight.
Do you think the claims made in the ad are supported by
The ad also claims that the supplement energizes you but does
the information in the graph? Explain why you would or
not tell you that a comparable energizing effect occurred in those
would not recommend this product.
not taking the supplement; when interviewed, 20 of 25 subjects in
20 C HA PTER 1 Nutrition: Everyday Choices

If you are looking at an article in print or posted on a Web FIGURE 1.13 Results may be misinterpreted in order to sell
site, checking the author’s credentials can help you evaluate the products These rats, which were given large doses of vitamin E,
credibility of the information. Where does the author work? Does lived longer than rats that consumed less vitamin E. Does this mean
this person have a degree in nutrition or medicine? Although that dietary supplements of vitamin E will increase longevity in
“nutritionists” and “health coaches” may provide accurate infor- people? Not necessarily. The results of animal studies can’t always be
mation, these terms are not legally defined and can be used by extrapolated to humans, but they are often the basis of claims in ads
for dietary supplements.
individuals with no formal nutrition or medical training.
One reliable source of nutrition information is a registered

Collection
/ National Geographic Image Collection
dietitian (RD), also called a registered dietitian nutritionist (RDN).
RD/RDNs are nutrition professionals who are certified to pro- VITAMIN E SUPPLEMENTS
vide nutrition education and counseling. To obtain certification, INCREASE LONGEVITY
an RD/RDN must earn a four-year college degree that includes
coursework approved by the Academy of Nutrition and Dietetics,
complete a supervised internship, and pass a national exam.

Sartore/National
Is it selling something? If a person or company will
profit from the information presented, be wary. Advertise-
ments are designed to increase product sales, and the company

JoelSartore
stands to profit if you believe the claims that are made. Infor-

Joel
mation presented online, in newspapers and magazines, and
on television may also be biased or exaggerated because it is
designed to help boost sales, not necessarily to promote health the work and reaffirm the conclusions. If, for example, someone
and well-being. Even a well-designed, carefully executed study has found the secret to easy weight loss, you will undoubtedly
published in a peer-reviewed journal can be a source of mis- encounter this information again at some later time if the find-
information if its results have been interpreted incorrectly or ing is valid. If the finding is not valid, it will fade away with all
exaggerated (Figure 1.13). the other weight-loss concoctions that have come and gone.

Has it stood the test of time? Often the results

of new scientific studies are on the news the same day they Concept Check
are presented at a meeting or published in a peer-reviewed
journal. However, a single study cannot serve as a basis for a 1. What is the difference between a hypothesis and a theory?
reliable theory. Results need to be reproduced and supported 2. How is an epidemiologic study different from a clinical trial?
numerous times before they can be used as a foundation for 3. Why are control groups important in any scientific experiment?
nutrition recommendations.
4. W
 hy are personal testimonies not a source of reliable nutrition
Headlines based on a single study should therefore be
information?
viewed skeptically. The information may be accurate, but there is
no way to know because there has not been enough time to repeat

What Is Happening in This Picture?

This modest display of fruits and vegetables is typical of what is avail-
able in an inner city corner store. These stores usually also offer an
abundance of candy, chips, beverages, and other snack foods along
with a small selection of staples such as eggs, milk, pasta, bread, and
canned goods. For some people, this is their only shopping option
close to home.

Think Critically
1. If your fruit and vegetable intake was limited to those in the
photo, how would it affect the variety, balance, and moderation
in your diet?
2. Suggest two reasons why this store offers so few options for fresh
produce.
3. Propose a community initiative that would help increase the
Ambrose
John Ambrose

availability of fruits and vegetables in an urban setting.

John
 Summary 21

Summary
1 Food Choices and Nutrient Intake 2 Figure 1.6b Nutrient functions
6% Minerals,
• The foods you choose determine which nutrients you con- 100
carbohydrates, and
sume. Choosing foods that are high in nutrient density allows other substances
you to obtain more nutrients in fewer calories, as shown in this
graph. Fortified foods, or foods to which nutrients have been 80 16% Fat
added, and dietary supplements can also contribute nutrients
to the diet. 16% Protein

Body weight
60

(percent)
62% Water
Figure 1.1a Nutrient density
40
400
350 Low-fat milk Sweetened iced tea
20
300
Amount per cup

250
200 0
Lean adult male
150
100
3 Nutrition in Health and Disease 9
50
0 • Your diet affects your health. The foods you choose contain the
Calories Calcium Vitamin D Vitamin A nutrients needed to keep you alive and healthy and prevent
(mg) (IU) (μg)
­malnutrition, which includes both undernutrition and over-
nutrition. Undernutrition results from consuming too few cal-
ories and/or too few nutrients. Overnutrition can result from a
toxic dose of a nutrient or from a chronic excess of nutrients or
• Food contains not only nutrients but also nonnutritive sub-
calories, which over time contributes to chronic diseases, such
stances, such as phytochemicals, that may provide additional
as those shown in this graph.
health benefits. Foods that provide health benefits beyond
basic nutrition are called functional foods. Some foods are Figure 1.8b Overnutrition
naturally functional, and others are made functional through
fortification. 30
• The food choices we make are affected not just by personal taste Nutrition related
Percentage of all deaths

25
but by our food environment, which includes the environmen-
tal, sociocultural, and economic factors that affect our eating 20
habits and patterns. What foods are available in our community,
what foods are advertised, how much food costs, and what we 15
learn to eat from family, culture, and traditions are all part of our
10
food environment.
5

0
2 Nutrients and Their Functions 6
e
e

ia

e
s

e
s

e
r

as
as

ce

as

te

as
nt

id
ok

on
be

ic
de

se
se

an

se

se
r

• Nutrients are grouped into six classes. Carbohydrates, lipids,

um
St

Su
ia
ci

di
di

di

di
C
Ac

ne
D
ry
rt

’s

ey

proteins, and water are referred to as macronutrients because

ea

/p
er
to

dn
za
ra

m
H

they are needed in large amounts. Vitamins and minerals are

Ki
ei
pi

en
zh
es

flu

micronutrients because they are needed in small amounts to

Al
R

In

maintain health.
• Your genetic makeup and the diet you consume interact to
• Carbohydrates, lipids, and proteins are nutrients that provide affect your health risks. Nutritional genomics studies how
energy, typically measured in calories. Lipids, proteins, car- the genes you inherit affect the impact of diet on health and
bohydrates, minerals, and water perform structural roles, as how the diet you choose affects the activity of your genes.
shown in the following illustration, forming and maintaining
the structure of our bodies. All six classes of nutrients help
4 Choosing a Healthy Diet 13
regulate body processes. The energy, structure, and regulation
provided by nutrients are needed for growth, maintenance and • A healthy diet includes a variety of nutrient-dense foods from
repair of the body, and reproduction. the different food groups as well as a variety of foods from
22 C HA PTER 1 Nutrition: Everyday Choices

within each group. Variety is important to ensure that nutrient • Moderation means not ingesting too many calories or too
needs are met because different foods provide different nutrients much saturated fat, sugar, salt, or alcohol. Eating moderate
and health-promoting substances as well as a variety of tastes. portions helps you maintain a healthy weight and helps pre-
• Balance means mixing and matching foods and meals in order vent chronic diseases such as heart disease, diabetes, and
to obtain enough of the nutrients you need and not too much of cancer.
the ones that can potentially harm your health. Extra calories
you consume during the day can be balanced by increasing the
calories you burn in physical activity, as shown. 5 Evaluating Nutrition Information 15
Figure 1.10 Balance calories in with calories out • Nutrition uses the scientific method to study the relationships
among food, nutrients, and health. The scientific method, illus-
trated below, involves observing and questioning natural events,
formulating hypotheses to explain these events, designing and
performing experiments to test the hypotheses, and developing
theories that explain the observed phenomena based on the exper-
imental results.
• To be valid, a nutrition experiment must provide quantifiable
measurements, study the right type and number of subjects, and
John Ambrose
Ambrose

use appropriate control groups. When a study has been com-

pleted, the results must be interpreted fairly and accurately. The
John

peer-review process ensures that studies published in profes-

sional journals adhere to a high standard of experimental design
and interpretation of results.
• Not all the nutrition information we encounter is accurate. The
/ Shutterstock.com

first step in deciding whether a nutritional claim is valid is to

Mirage_studio/Shutterstock.com

ask whether the claim makes sense. If it sounds too good to be

true, it probably is. It is also important to determine whether the
information came from a reliable source, whether it is trying to
sell a product, and whether it has been confirmed by multiple
Mirage_studio

studies.

Figure 1.11 The scientific method

1 The first step of the scientific method is to make an observation and Courtesy
CourtesyLori
Lori Smolin
Smolin
ask questions about that observation.
Observation
More people get colon cancer in the United States than in Japan.

2 The next step is to propose an explanation for this observation.

This proposed explanation is called a hypothesis.
Hypothesis
The lower incidence of colon cancer in Japan than in the United States is
due to differences in the diet.

3 Once a hypothesis has been proposed, experiments like this one are
designed to test it. To generate reliable theories, the experiments done
to test hypotheses must produce consistent, quantifiable results and
must be interpreted accurately.
Experiment 5 If experimental results do not support the hypothesis,
Compare the incidence of colon cancer of Japanese people who move to a new hypothesis can be formulated.
the United States and consume a typical U.S. diet with the American
population as a whole. Result: The Japanese people who eat the U.S.
diet have the same higher incidence of colon cancer as the general
population. Theory
The U.S. diet contributes to the development of colon
cancer.
4 If the results from repeated experiments support the hypothesis, a 6 As new information becomes available, even a theory
scientific theory can be developed. A single experiment is not enough
that has been accepted by the scientific community
to develop a theory; rather, repeated experiments showing the same
for years can be proved wrong.
conclusion are needed to develop a sound theory.
 Key Terms 23

Key Terms
• amino acid 7 • fortification 3 • organic compound 6
• calorie 2 • functional food 4 • osteoporosis 10
• carbohydrates 6 • genes 10 • overnutrition 10
• cholesterol 6 • hormone 9 • peer-review process 18
• control group 18 • hypothesis 16 • phytochemical 4
• dietary supplement 3 • kilocalorie 9 • placebo 18
• element 7 • lipids 6 • protein 6
• empty calories 2 • macronutrient 6 • saturated fat 6
• energy-yielding nutrient 8 • malnutrition 9 • scientific method 16
• epidemiology 16 • micronutrient 6 • theory 16
• essential nutrient 2 • mineral 7 • undernutrition 10
• evidence-based practice 18 • nutrient density 2 • unsaturated fat 6
• experimental group 18 • nutrients 2 • variable 18
• fiber 6 • nutrigenetics 10 • vitamin 7
• food desert 6 • nutrigenomics 12 • zoochemical 4
• food environment 5 • nutritional genomics 10