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NUTRITION GUIDE FOR PHYSICIANS Nutrition and Health Adrianne Bendich, PhD, FACN, Series Editor For other titles published in this series, go to http://www.springer.com/series/7659 NUTRITION GUIDE FOR PHYSICIANS Edited by Ted Wilson, ph.d Winona State University, Department of Biology, Winona, MN Norman J. Temple, ph.d Athabasca University Center for Science, Athabasca, Alberta, Canada Dr. George A. Bray, m.d. Louisiana State University, Pennington Biomedical Research Center, Baton Rouge, LA Marie Boyle Struble, ph.d, r.d. College of Saint Elizabeth, Morristown, NJ and University of Massachusetts, Amherst, MA Editors Ted Wilson Norman J. Temple Department of Biology Athabasca University Winona State University Center for Science Winona MN 54603 Athabasca USA AB T9S 3A3 Dedication To my son Dirk, may your diet become as diverse as the chapters of this book. Ted To Adrian, Sharon, Philip, and Steven Norman To my walking buddies – Kate and McCauley – may there be many more footprints in the sand. Marie To my wife Mitzi with whom I have shared so many wonderful meals. George v Series Editor Introduction The Nutrition and Health series of books have, as an overriding mis- sion, to provide health professionals with texts that are considered essential because each includes (1) a synthesis of the state of the science, (2) timely, in-depth reviews by the leading researchers in their respective fields, (3) extensive, up-to-date fully annotated reference lists, (4) a detailed index, (5) relevant tables and figures, (6) identification of paradigm shifts and the consequences, (7) virtually no overlap of information between chapters, but targeted, inter-chapter referrals, (8) suggestions of areas for future research, and (9) balanced, data-driven answers to patient /health professionals questions which are based upon the totality of evidence rather than the findings of any single study. The series volumes are developed to provide valuable in-depth information to nutrition health professionals and health providers interested in practical guidelines. Each editor has the potential to examine a chosen area with a broad perspective, both in subject matter and in the choice of chapter authors. The international perspective, especially with regard to public health initiatives, is emphasized where appropriate. The editors, whose train- ings are both research and practice oriented, have the opportunity to develop a primary objective for their book, define the scope and focus, and then invite the leading authorities from around the world to be part of their initiative. The authors are encouraged to provide an overview of the field, discuss their own research, and relate the research findings to potential human health consequences. Because each book is developed de novo, the chapters are coor- dinated so that the resulting volume imparts greater knowledge than the sum of the information contained in the individual chapters. “Nutrition Guide for Physicians,” edited by Ted Wilson, Ph.D., Norman J. Temple, Ph.D., George A. Bray, M.D., and Marie B. Struble, Ph.D., R.D., is a very welcome addition to the Nutrition and Health series and exem- plifies the series goals. This volume is especially timely as the number of research papers and meta-analyses in the clinical nutrition arena increases every year and clients and patients are very much interested in dietary components for disease prevention. Certainly, the obesity epidemic remains a major concern especially as the comorbidities, such as the metabolic syndrome, type 2 diabetes, hypertension, and hyperlipidemia, are seen even in young children. The editors have made great efforts to provide health vii viii Series Editor Introduction professionals with the most up-to-date and comprehensive volume that high- lights the key, well-accepted nutrition information available to date. The editors have combined their broad backgrounds in research as well as clinical practice to help the reader better understand the relevant science without the details of complex discussions of in vitro and laboratory animal studies. This comprehensive volume begins with chapters that examine the effects of macro- and micronutrients, fiber, alcohol, and other dietary components on human health and disease prevention. As an example, clear definitions and distinctions are made concerning the types of fats, and their negative and positive health aspects. An excellent explanation concerning the possi- ble reason for disparity between study findings is provided in the positing of insightful questions such as: Were all serum measurements made within hours or weeks following dietary changes? An important chapter on sugars and artificial sweeteners is included that describes the different sweeteners (nutritive and non-nutritive) that are currently available and the differences in national regulations concerning their use in different countries. Defini- tions are provided for the numerous types of vegetable-based diets that are often discussed with health professionals. Unique to this volume, there are in-depth chapters that explain the development of the dietary recommendations and how these are translated into information on food labels. Chapters concerning the growing interest in organic foods and food safety are included. The importance of taste to food consumption is examined and the anatomy and physiology of taste are reviewed. There is an extensive analysis of the recommendations by nations on the contents of a healthy diet and suggestions for physicians and other health professionals in helping patients reach the goal of understand- ing the value of consuming a healthy diet. A separate chapter reviews the importance of certain dietary supplements containing essential vitamins and minerals and provides perspective concerning dietary supplements with less scientific data to support their claims. The next section of the volume examines the role of nutrition in health during the life stages. The chapter on pregnancy includes preconception through lactation and postpartum. Guidelines for weight gain and consumption of essential nutrients and other dietary components that could impact pregnancy outcomes are included; there is a review of the dietary guidance during high-risk pregnancies including gestational diabetes, multiple pregnancies, and hypertension. The chapter on infancy includes a detailed description of the nutritive and other beneficial components of breast milk, but reminds us that “human milk is neither perfect nor a complete food.” Childhood is a time of rapid growth and nutritional status determines the capability of reaching a child’s full growth potential. Discussions about food allergies and sensitivities and deficiencies, including iron deficiency, are Series Editor Introduction ix also included in this chapter. The chapter on adolescence and young adults examines the development of eating disorders including obesity, anorexia, bulimia, and binge eating. Healthy aging is particularly relevant as the pop- ulation is growing older. By 2030 one out of every five people in the USA will be 65 years of age or older. Lifestyle changes and changes in body func- tions (sight, hearing, taste, digestion, bone, and muscle, etc.) can affect food choices and vice versa. This sensitive chapter provides a wealth of important advice to health professionals. The next section contains informative chapters that look at the major diseases that have effects on and are affected by digestion and metabolism. Before examining the disease states, there is a helpful chapter that describes the major methods of nutritional assessment and how the information can be combined with the physical and laboratory biochemical examination of the patient to provide a better picture of their health status. This type of comprehensive medical examination is particularly important in the assessment of patients with eating disorders, and there is a comprehensive chapter that includes a description of these disorders. Several chapters examine the effects of obesity and its comorbidities including insulin resistance, cardiovascular complications, lipid disorders, hypertension, and hormonal imbalances. Separate chapters review the pathophysiology of the metabolic syndrome, type 1 and type 2 diabetes, hypertension, and hyperlipidemia, and relate these to the mechanisms behind the alterations in metabolism that increase chronic disease risk. Practice guidelines and tools for obesity management including up-to-date information on medical nutrition therapy and surgical obesity treatments and their implications for improving human health and reducing obesity-related diseases are tabulated for the reader. The additional chapters on coronary heart disease and blood pressure contain valuable information about salt intake, plant stanols and sterols, homocys- teine, antioxidants, and review the major clinical trials that showed the power of diet to beneficially affect cardiovascular outcomes: the DASH study and the Trial of Hypertension Prevention. Gastrointestinal disorders and disorders of the liver and pancreas are discussed in separate chapters that include malabsorption diseases, GERD, ulcers, constipation, diarrhea, diverticulosis, food allergies, cirrhosis, non- alcoholic fatty liver disease, and acute as well as chronic diseases including cancers of these organ systems. Chronic kidney disease and bone diseases and the effects of nutritional status on these diseases as well as the effects of the diseases on nutritional status are explored in separate chapters. The importance of calcium, phosphorus, vitamin D, and parathyroid hormone to both kidney and bone health becomes apparent after reading these chapters. There is a final chapter in this section that examines the effects of the most prevalent genetically inherited metabolic disorders. The key to successful x Series Editor Introduction treatment is neonatal genetic screening and appropriate, immediate changes in diet to help prevent the early devastating effects of the genetic defects. The final chapters provide guidance on the potential for dietary changes to affect disease manifestation and progression. Specific syndromes in females, including premenstrual syndrome and polycystic ovarian disease, are often linked to dietary factors including obesity and eating disorders. The female athlete triad can result in amenorrhea and premature osteoporosis, whereas heavy menstrual bleeding is associated with iron-deficiency anemia. Health providers who have read this volume will be sensitized to the importance of nutritional monitoring for the overall health of their female patients who may be affected by these disabilities. Diets can contain factors that both increase and decrease the risk of cancer. Charcoal-broiled meats contain polycyclic aromatic hydrocarbons and other molecules that are formed during the cooking process: these are known carcinogens. Alcohol is classified as a human carcinogen. In contrast, fruits and vegetables contain essential nutrients and phytochemicals that can reduce the formation of cancerous cells. Extensive tables of foods and their components are included in this chapter. Food allergies, insensitivities, and intolerances can result in avoidances of food groups and may cause severe morbidity and even mortality (peanut allergy). Examples of the most common diagnostic tests and treatments are provided for the reader. Similarly, there are numerous well-described drug– nutrient interactions that have medically relevant effects for the patient. These are included in a separate comprehensive chapter. Drs Wilson, Temple, Bray, and Struble are internationally recognized leaders in the fields of human nutrition including obesity research and clinical outcomes. These editors are proven excellent communicators and they have worked tirelessly to develop a book that is destined to be the bench- mark in the field because of its extensive covering of the most important aspects of clinical nutrition including complex interactions between diet, health, and disease. The editors have chosen 45 of the most well-recognized and respected authors from around the world to contribute the 35 informative chapters in the volume. Hallmarks of all of the chapters include complete definitions of terms with the abbreviations fully defined for the reader and consistent use of terms between chapters. Key features of this comprehensive volume include the informative key points and keywords that are at the beginning of each chapter and suggested readings as well as bibliogra- phy at the end of each chapter. The editors have added three key appendices including a detailed table of major conversions used in nutrient calculations, suggested sources of reliable nutrition information on the web, and a copy of the dietary reference intake tables from the US Institute of Medicine. The volume also contains more than 60 detailed tables and informative