Introduction to Clinical Nutrition, Third Edition

687 Pages·2011·5.8 MB·English

by  Sardesai

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and the prevention of various adnisde athsees p.revention of various diseases.
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• DNA, gene–nutrient interact•ioDn,N eAp,i ggeenneet–icnsu, tarinedn tt einlotemraecrteiosn, epigenetics, and telomeres
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• Nutritional aspects of kidney• dNisuetarsiteio, ndaial baestpeesc, tasn odf kmidentaebyo dliics esaysned,r doimabeetes, and metabolic syndrome
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• Obesity and cholesterol • Obesity and cholesterol
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to facilitate further study. to facilitate further study.
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Edition Edition
Vishwanath SVaisrhdwesaaniath Sardesai
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Introduction to
CLINICAL
NUTR ITION
Third Edition

Introduction to
CLINICAL
NUTR ITION
Third Edition
Vishwanath Sardesai
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
CRC Press
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Contents
Preface to the Third Edition ........................................................................................................xxiii
Preface to the Second Edition ........................................................................................................xxv
Preface to the First Edition ..........................................................................................................xxvii
Acknowledgments .........................................................................................................................xxix
Part I Biology and Biochemistry
Chapter 1 Introduction: Fundamentals of Nutrition .....................................................................3
1.1 Terminology ......................................................................................................3
1.1.1 Metabolism ...........................................................................................4
1.1.2 Homeostasis..........................................................................................4
1.2 Nutritional Labeling ..........................................................................................5
1.3 The Need for a Variety of Foods .......................................................................5
1.3.1 Fruits and Vegetables—More Matters .................................................6
1.3.2 Red and Processed Meat—Less Is Better ............................................6
1.4 The Need for Energy .........................................................................................7
1.5 The Need for Digestion, Absorption, and Utilization of Nutrients ...................7
1.6 Enteral and Parenteral Nutrition ........................................................................8
1.6.1 Enteral Feeding ....................................................................................8
1.6.2 Parenteral Feeding................................................................................8
1.7 Adaptation .........................................................................................................9
1.8 Water as a Nutrient ..........................................................................................10
1.8.1 Requirement for Athletes ...................................................................11
1.9 Food Allergy ....................................................................................................12
1.9.1 Allergies—Read It and Eat ................................................................14
1.9.2 Cell Phone Allergy .............................................................................14
1.10 Guidelines for Americans ................................................................................15
1.11 Exercise for Health ..........................................................................................16
1.12 Healthy Advice ................................................................................................20
References ..................................................................................................................21
Case Bibliography ......................................................................................................22
Chapter 2 Digestion of Carbohydrates, Lipids, and Proteins ......................................................23
2.1 Introduction .....................................................................................................23
2.2 Carbohydrates ..................................................................................................26
2.2.1 Digestion and Absorption ...................................................................26
2.2.2 Carbohydrate Intolerance ...................................................................27
2.3 Lipids ...............................................................................................................29
2.3.1 Digestion and Absorption ...................................................................29
2.3.2 Lipid Malabsorption ...........................................................................31
2.4 Proteins ............................................................................................................32
2.4.1 Digestion and Absorption ...................................................................32
2.4.2 Defects in Protein Digestion and Absorption .....................................33
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2.5 Malabsorption Syndromes ...............................................................................34
2.5.1 Celiac Disease ....................................................................................34
2.5.2 Cystic Fibrosis ....................................................................................36
2.5.3 Tropical Sprue ....................................................................................37
2.5.4 Inflammatory Bowel Diseases ...........................................................37
2.5.5 Short Bowel Syndrome .......................................................................38
2.6 Microorganisms ...............................................................................................38
References ..................................................................................................................40
Case Bibliography ......................................................................................................40
Chapter 3 Requirements for Energy: Carbohydrates, Fats, and Proteins ...................................41
3.1 Energy..............................................................................................................41
3.1.1 Calories...............................................................................................41
3.1.2 Basal Metabolism ...............................................................................42
3.1.3 Resting Energy Expenditure ..............................................................43
3.1.4 Thermic Effect of Food ......................................................................43
3.1.5 Caloric Density ...................................................................................43
3.1.6 Caloric Requirement ..........................................................................44
3.1.7 Calorie Intake and Body Weight ........................................................45
3.2 Respiratory Quotient .......................................................................................46
3.3 Carbohydrates ..................................................................................................47
3.3.1 Glycemic Index and Glycemic Load ..................................................49
3.3.2 Carbohydrates and Health ..................................................................49
3.4 Fat ....................................................................................................................51
3.4.1 Need for Fat in the Diet ......................................................................53
3.4.2 Dietary Fat and Health .......................................................................54
3.5 Proteins ............................................................................................................54
3.5.1 Amino Acid Catabolism .....................................................................56
3.5.2 Anabolism or Catabolism ...................................................................57
3.5.3 Protein Reserves .................................................................................58
3.5.4 Nitrogen Balance ................................................................................59
3.5.5 Nutritional Quality of Proteins ...........................................................59
3.5.6 Protein Needs in Disease ...................................................................60
3.5.7 Protein-Energy Malnutrition ..............................................................62
3.6 Use of Body Energy Sources during Hypometabolism
and Hypermetabolism .....................................................................................64
3.6.1 Starvation—Hypometabolism ............................................................64
3.6.2 Stress—Hypermetabolism .................................................................65
References ..................................................................................................................66
Case Bibliography ......................................................................................................67
Chapter 4 Role of Essential Fatty Acids .....................................................................................69
4.1 Fatty Acids .......................................................................................................69
4.2 Neutral Fat .......................................................................................................70
4.3 Properties of Fat ..............................................................................................70
4.3.1 Iodine Number....................................................................................70
4.3.2 Rancidity ............................................................................................70
4.3.3 Hydrogenation ....................................................................................71
4.3.4 Trans Fatty Acids ...............................................................................71
4.3.5 Conjugated Linoleic Acid ...................................................................71
Contents vii
4.4 Dietary Sources and Health Effects of Trans Fatty Acids ..............................71
4.5 Saturated Fatty Acids ......................................................................................73
4.6 Monounsaturated Fatty Acids .........................................................................73
4.7 Essential Fatty Acids .......................................................................................74
4.7.1 Functions ............................................................................................76
4.7.2 Deficiency of Essential Fatty Acids ...................................................77
4.7.3 Requirements ......................................................................................79
4.7.4 Effect of Excess Essential Fatty Acids ...............................................80
4.7.5 Food Sources ......................................................................................80
4.7.6 Dietary ω Fatty Acids and Health .....................................................81
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References ..................................................................................................................84
Case Bibliography ......................................................................................................85
Chapter 5 Eicosanoids .................................................................................................................87
5.1 Prostaglandins .................................................................................................87
5.1.1 Chemistry and Nomenclature.............................................................87
5.1.2 Biosynthesis ........................................................................................88
5.1.3 Catabolism ..........................................................................................89
5.1.4 Physiological Actions .........................................................................89
5.2 Thromboxanes .................................................................................................90
5.3 Prostacyclins ....................................................................................................91
5.4 Leukotrienes ....................................................................................................91
5.4.1 Metabolism of Leukotrienes ..............................................................91
5.4.2 Physiological Actions .........................................................................91
5.5 Lipoxins ...........................................................................................................92
5.6 Cytochrome P450–Derived Products ..............................................................92
5.7 Inhibitors of Eicosanoid Biosynthesis .............................................................93
5.7.1 Cyclooxygenase 2: A Target for Treatment
of Diseases ..........................................................................................95
5.7.2 Cyclooxygenase 3 ...............................................................................96
5.8 Eicosanoids and Chronic Diseases ..................................................................97
5.9 Effects of Diet on Eicosanoids ........................................................................97
5.9.1 Factors Affecting the Formation of 20-Carbon PUFAs .....................97
5.9.2 Factors Affecting Eicosanoid Synthesis .............................................98
5.10 Alternative Medicine for Pain .........................................................................98
5.10.1 Turmeric .............................................................................................99
5.10.2 Avocado Soy Unsaponifiable ............................................................100
5.10.3 Glucosamine and Chondroitin .........................................................100
References ................................................................................................................101
Case Bibliography ....................................................................................................102
Chapter 6 Inorganic Elements (Minerals) .................................................................................103
6.1 Essential Macrominerals ...............................................................................103
6.1.1 Calcium ............................................................................................103
6.1.2 Phosphorus .......................................................................................108
6.1.3 Magnesium .......................................................................................109
6.1.4 Potassium..........................................................................................110
6.1.5 Sodium .............................................................................................112
6.1.6 Chloride ............................................................................................113
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6.1.7 Sulfur ................................................................................................114
6.1.8 Role of Macrominerals and Other Factors in Hypertension ............114
6.2 Essential Trace Elements ...............................................................................120
6.2.1 Iron ...................................................................................................120
6.2.2 Copper ..............................................................................................124
6.2.3 Zinc...................................................................................................127
6.2.4 Cobalt ...............................................................................................130
6.2.5 Molybdenum .....................................................................................131
6.2.6 Selenium ...........................................................................................133
6.2.7 Manganese ........................................................................................136
6.2.8 Iodine ................................................................................................138
6.2.9 Chromium ........................................................................................141
6.2.10 Fluoride ............................................................................................143
6.3 Ultratrace Minerals .......................................................................................149
6.3.1 Silicon ...............................................................................................149
6.3.2 Nickel ...............................................................................................149
6.3.3 Boron ................................................................................................150
6.3.4 Arsenic .............................................................................................151
6.3.5 Tin ....................................................................................................151
6.3.6 Vanadium .........................................................................................152
References ................................................................................................................152
Case Bibliography ....................................................................................................156
Chapter 7 Vitamins—An Overview .........................................................................................157
7.1 Historical Perspective ....................................................................................157
7.2 Definition .......................................................................................................157
7.3 Names ............................................................................................................157
7.4 Classification .................................................................................................158
7.5 Functions .......................................................................................................158
7.6 Deficiency ......................................................................................................159
7.7 Need for Supplements ....................................................................................160
7.8 Hypervitaminosis ..........................................................................................161
7.9 Antivitamins ..................................................................................................162
7.10 Enrichment of Foods .....................................................................................162
References ................................................................................................................164
Case Bibliography ....................................................................................................164
Chapter 8 Fat-Soluble Vitamins ................................................................................................165
8.1 Vitamin A ......................................................................................................165
8.1.1 Chemistry .........................................................................................165
8.1.2 Food Sources ....................................................................................165
8.1.3 Absorption ........................................................................................166
8.1.4 Transport ..........................................................................................167
8.1.5 Biochemical Role .............................................................................167
8.1.6 Deficiency .........................................................................................171
8.1.7 Units .................................................................................................174
8.1.8 Recommended Dietary Allowance ..................................................174
8.1.9 Assessment of Vitamin A Status ......................................................174
8.1.10 Toxicity .............................................................................................174