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NUTRITION NUTRITION Sardesai Sardesai
Introduction Itnotroduction to
CLINICCALLIN NICUATRL INTIUOTNRITION
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disease, cancer, diabetes, and dstirsoekaese)., Ncaenvceertr,h delieabsse,t epsh,y asnicdia sntsr ofrkeeq).u Nenetvlye rrtehceeleivses, ipnahdyesiqcuiaantse ftrreaqinuienngtly receive inadequaCte training C
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the physiologic and metabolict hinet eprhreylsaiotiloongsihc ipans do fm aellt anbuotrliiecn itnst earnrdel athtieoinr srhoilpess oinf ahlel anluthtr imenatins taennda ntcheeir roles in health maintenance
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and the prevention of various adnisde athsees p.revention of various diseases.
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Since the publication of the secSoinncde ethdeit ipounb olifc tahtiios nb ooof kth, en eswec donisdc oevdeirtiieosn hoaf vteh irse bvooolukt,i onneiwze ddi stchoev feierlides have revolutionizeId the field I Edition Edition
of clinical nutrition. This is true eosf pcelinciiaclalyl nwuittrhit iroens.p Tehcits t ios gtreunee e–snpuetrciieanllty iwntiethra rcetisopne,c et ptoig genenetei–c npuattrhiewnat yinsteraction, epigeneticC pathways C
that contribute to the activatiothna at ncdo nintraicbtuivtea ttioo nt hoef gacetnivea etixopnr easnsdio inn,a cthtiev arteiolanti oonf sgheinpe o ef xnpurterisesniotsn ,t othe relationship of nutrients to
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telomere length and health, antde lopmeresoren alelinzgedth n auntdri thioena.l tHh,i gahnldig phteirnsgo nthaelizsee da dnvuatrnitcieosn,. nHeiwgh alingdh trienvgi stehdese advances, new and revised
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• Fiber, antioxidants, nutraceut•icFailbse, ra, latenrtnioaxtiivdea nmtse,d nicuitnraec, eauntdic ealpsi,d aeltmerionlaotgivye medicine, and epidemiology
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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
• Personalized nutrition and pe•rsPoenrsaolinzaeldiz mede dnuictirniteion and personalized medicine T T
• Vegetarianism, the Mediterra•nVeeagn edtaiertia, nainsdm o, tthheer Mpoepduitlearrr adnieetaanr yd pierta,c atincde sother popular dietary practices R R
• Obesity and cholesterol • Obesity and cholesterol
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Designed as a textbook for studDeenstigs nine dco ansv ae ntetixotnbaolo mk efodri csitnued,e onsttse ionp caothnyv,e dnetinotnisatlr ym, eddieictienteic,s o, sntuerospinagth,y, dentistry, dieteticIs, nursing, I
pharmacy, and public health, pthhea rbmoaocky f,o acnuds epsu obnli ct hhee aclrtihti,c athl eb iboochoek mfoiccauls easn do np hthyesi ocrloitgiciacla lb aioscpheecmtsical and physiologicOal aspects O
of nutrients. It includes clinical ocfa nseu tsrtieundtise.s I tt oin ccllaurdifye st ocplinicisc aalt c tahsee esntudd oief sm too sctl acrhifayp ttoeprsi casn adt rtehfee reenndc eosf most chapters and references
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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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Composite Composite
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
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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
