Manual of Nutritional Therapeutics

656 Pages·2008·3.17 MB·English

by  David H. Alpers

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MANUAL OF NUTRITIONAL THERAPEUTICS
Fifth Edition
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MANUAL OF NUTRITIONAL THERAPEUTICS
Fifth Edition
David H. Alpers, M.D.
William B. Kountz Professor of Geriatrics in Medicine
Assistant Director, Center for Human Nutrition
Washington University School of Medicine
St. Louis, Missouri
William F. Stenson, M.D.
Professor of Medicine
Washington University School of Medicine
St. Louis, Missouri
Beth E. Taylor, R.D., C.N.S.D.
Nutrition Support Specialist, Surgical Intensive Care Unit
Barnes-Jewish Hospital
St. Louis, Missouri
Dennis M. Bier, M.D.
Professor of Pediatrics
Baylor College of Medicine
Director USDA/ARS Children’s Nutrition Research Center
Houston, Texas
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Acquisitions Editor: Charles W. Mitchell
Managing Editor: Sirkka E. Howes
Project Manager: Bridgett Dougherty
Marketing Manager: Angela Panetta
Manufacturing Manager: Kathleen Brown
Design Coordinator: Stephen Druding
Production Services: International Typesetting & Composition
Fifth Edition © 2008
Fourth edition, © 2002
Lippincott Williams & Wilkins, a Wolters Kluwer business
530 Walnut Street
Philadelphia, PA 19106 USA
LWW.com
All rights reserved. This book is protected by copyright. No part of this book may be repro-
duced in any form by any means, including photocopying, or utilized by any information
storage and retrieval system without written permission from the copyright owner, except
for brief quotations embodied in critical articles and reviews. Materials appearing in this
book prepared by individuals as part of their official duties as U.S. government employees
are not covered by the abovementioned copyright.
Printed in the United States
Library of Congress Cataloging-in-Publication Data
Manual of nutritional therapeutics / David H. Alpers . . . [et al.]. -- 5th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-7817-6841-2
ISBN-10: 0-7817-6841-1
1. Diet therapy--Handbooks, manuals, etc. 2. Nutrition--Handbooks,
manuals, etc. I. Alpers, David H.
[DNLM: 1. Diet Therapy--Handbooks. 2. Nutrition Physiology--Handbooks.
WB 39 A456m 2008]
RM217.2.A47 2008
615.8'54--dc22
2007041346
Care has been taken to confirm the accuracy of the information presented and to describe
generally accepted practices. However, the authors, editors, and publisher are not responsible
for errors or omissions or for any consequences from application of the information in this
book and make no warranty, expressed or implied, with respect to the currency, completeness,
or accuracy of the contents of the publication. Application of the information in a particular
situation remains the professional responsibility of the practitioner.
The authors, editors, and publisher have exerted every effort to ensure that drug selection
and dosage set forth in this text are in accordance with current recommendations and practice
at the time of publication. However, in view of ongoing research, changes in government reg-
ulations, and the constant flow of information relating to drug therapy and drug reactions, the
reader is urged to check the package insert for each drug for any change in indications and
dosage and for added warnings and precautions. This is particularly important when the
recommended agent is a new or infrequently employed drug. Some drugs and medical devices
presented in the publication have Food and Drug Administration (FDA) clearance for limited
use in restricted research settings. It is the responsibility of the health care provider to ascertain
the FDA status of each drug or device planned for use in their clinical practice.
To purchase additional copies of this book, call our customer service department at
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To our fathers, who taught us both respect for knowledge
and concern for the individual.
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PREFACE
MANUAL OF NUTRITIONAL THERAPEUTICS,
5TH EDITION
The information on nutritional topics that is useful for health care workers continues to
increase at a steady pace. This manual was conceived as a source of information for physi-
cians, nurses, dietitians, and other health professionals in various disciplines, and for stu-
dents at all levels. The continued use of this manual has supported the need for such an
information source, filtered by the authors to focus on the information we find useful for
the practice of medicine and surgery. We assume that the health care worker has knowledge
of the underlying diseases that might benefit from nutritional intervention. Thus, this edi-
tion of the Manual of Nutritional Therapeutics,like its predecessors, is not intended to be
a textbook of nutrition. It should be used to obtain the information that is needed in man-
aging the nutritional needs of adults, adolescents, and older children. We have tried to be
practical and to provide explanations for the recommendations provided. In many cases,
new systematic reviews of an increasing number of randomized, controlled clinical trials
have provided a much more solid evidence base for these recommendations.
The chapters on individual nutrient components—Section II and Chapter 12 on
diets—have retained their form subdivided by sections that deal with many different indi-
vidual nutrients and/or diets. The original outline form has been modified for many of the
other chapters to better fit the more narrative needs of those chapters. We have added a
dietitian to this edition, Beth Taylor, consultant to the Center for Human Nutrition,
Washington University School of Medicine, who had assisted in reviewing chapters from
previous editions. As a result of this added expertise and viewpoint, the chapters in Section III
(Therapeutic Nutrition) have been completely revised. The information is as current as
possible given the lag time involved in publishing a book. But, nutrient preparations can
change rapidly, or are replaced by other products, so the reader should always check the
local availability of any given preparation. URLs for many web sites containing nutritional
information are included, not only for convenience and to update information not included
in the manual, but also to provide sources of information that the authors use and trust.
The authors are gratified by the reception the book has enjoyed, and hope that its
readers, old and new, will derive as much benefit from it as we, the authors, have received
in revising it. We are grateful to our colleagues at Lippincott Williams & Wilkins for edito-
rial support and advice. Especially we thank our spouses and families for their support in
allowing us the time needed to create the 5th edition of this book.
David H. Alpers, M.D.
William F. Stenson, M.D.
Beth E. Taylor, R.D., C.N.S.D.
Dennis M. Bier, M.D.
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CONTENTS
I: GENERAL CONCEPTS OF NUTRITION
1 Approach to Nutrient Deficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Recommendations for Healthy Young Adults . . . . . . . . . . . . . . . . . . . . . . 26
3 Recommendations for Healthy Elderly Adults . . . . . . . . . . . . . . . . . . . . . 42
4 Pregnancy and Lactation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
II: INDIVIDUAL NUTRIENT COMPONENTS
5 Protein and Calories: Requirements, Intake, and Assessment . . . . . . . . 77
6 Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
7 Minerals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
8 Alternative Nutritional Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
III: THERAPEUTIC NUTRITION
9 Nutritional Support Decision Making . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
10 Enteral Nutritional Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330
11 Parenteral Nutritional Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
12 Use of Diets and Dietary Components in Clinical Practice . . . . . . . . . . . 404
IV: NUTRITIONAL MANAGEMENT OF SPECIFIC DISEASES
13 Dietary Management of Diabetes, Renal Disease,
and Hyperlipidemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485
14 Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 531
15 Nutritional Considerations in Chronic Wasting Diseases
(Cancer, AIDS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562
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x Contents
APPENDIXES
A Facts And Formulas Commonly Used In Nutritional Therapeutics . . . . 585
B Recommended Dietary Allowances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 588
C Food Labeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597
D Dietary Guides For Patient Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 603
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 615