Manual of Nutritional Therapeutics

217 Pages·2015·5.48 MB·English

by  David H. Alpers

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Library of Congress Cataloging-in-Publication Data Alpers, David H.,
author.
Manual of nutritional therapeutics / David H. Alpers, Beth E. Taylor, Dennis
M. Bier, Samuel Klein. — Sixth edition.
p. ; cm.
Preceded by: Manual of nutritional therapeutics / David H. Alpers … [et al.].
5th ed. c2008.
Includes bibliographical references and index.
ISBN 978-1-4511-9187-5 (alk. paper) — ISBN 1-4511-9187-1 (alk. paper)
eISBN 978-1-4963-1000-2
I. Taylor, Beth E., author. II. Bier, Dennis M., author. III. Klein, Samuel, 1953-
, author. IV. Title.
[DNLM: 1. Nutrition Therapy. WB 400]
RM217.2
RM217.2
615.8’54—dc23
2014036982
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Given continuous, rapid advances in medical science and health information,
independent professional verification of medical diagnoses, indications,
appropriate pharmaceutical selections and dosages, and treatment options should
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To our fathers, who taught us both respect for knowledge
and concern for the individual.
Preface
MANUAL OF NUTRITIONAL THERAPEUTICS, SIXTH
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 physicians, nurses, dietitians, and other health professionals in
various disciplines, and for students 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
edition of the Manual of Nutritional Therapeutics, which was developed in
collaboration with the Center for Human Nutrition at Washington University
School of Medicine in St. Louis, similar to its predecessors, is not intended to be
a textbook of nutrition. It should be used to obtain the information that is needed
in managing 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 (5–7) and chapter 12 on
diets have retained their form subdivided by sections that deal with many
different individual 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. Several chapters are completely new. Chapter 8 (Dietary
Supplements) contains revised material that was formerly in chapters on
individual nutrients and on diet, to which have been added sections on many
other supplements. Chapter 14 (Obesity) is completely rewritten. Dr. William F.
Stenson, a valued contributor to the first five editions, has not been able to
continue in this role, because of other commitments. We are very grateful to him
for his many contributions over the years. We have added a new author, Samuel
Klein, an internationally renowned expert in obesity and metabolic diseases, and
the director of the National Institutes of Health Nutrition & Obesity Research
Center at Washington University in St. Louis.
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 websites 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 Wolters
Kluwer (especially Kristina Oberle) for editorial support and advice. Especially,
we thank our spouses and families for their support in allowing us the time
needed to create the sixth edition of this book.
David H. Alpers, MD
Beth E. Taylor, DCN, RDN, LD, CNSC, FCCM
Dennis M. Bier, MD
Samuel Klein, MD
Contents
Preface
Section I General Concepts in Nutrition
1 Recommendations for Healthy Young Adults
2 Recommendations for Healthy Elderly Adults
3 Pregnancy and Lactation
4 Approach to Nutrient Deficiency
Section II Individual Nutrient Components
5 Protein and Calories: Requirements, Intake, and Assessment
6 Vitamins
7 Minerals
8 Dietary Supplements
Section III Therapeutic Nutrition
9 Nutritional Support Decision Making
10 Enteral Nutritional Therapy
11 Parenteral Nutritional Therapy
12 Use of Diets and Dietary Components in Clinical Practice
Section IV Nutritional Management of Specific Diseases
Dietary Management of Diabetes, Renal Disease, and
13
Hyperlipidemia
14 Obesity
15 Nutritional Considerations in Chronic Diseases
Appendix A: Facts and Formulas Commonly Used in Nutritional Therapeutics
Appendix B: Food Labeling
INDEX
I
SECTION
General Concepts in Nutrition
1
Recommendations for Healthy Young
Adults

INTRODUCTION
Despite the extensive availability of diverse, often conflicting, information on
nutrition, diet, and health on the Internet or sold in bookstores, virtually all
expert scientific panels reporting guidelines for good nutritional practice have
devised remarkably consistent dietary recommendations for healthy adults.
Further, despite impressions generated by almost daily media reports of new
dietary fads, the principles of healthy eating have not fundamentally changed
over at least the last 50 years, and many of these principles were promoted more
than a century ago. The most widely disseminated general recommendations for
healthy adults are included in several reports. The first, which represents the
combined recommendations of the US Department of Agriculture and the US
Department of Health and Human Services, is called Dietary Guidelines for
Americans, 2010 (1). In 2015, the current guidelines will be updated, although it
is unlikely that these will contain any additions that will change the fundamental
principles that have been the foundation of the Dietary Guidelines for
Americans, since they were first issued in 1980. The current guidelines, the 2015
updates when they are issued, and copies of every prior version of the Dietary