Table Of ContentNutrition
Metabolic and Clinical Applications
Human Nutrition
A COMPREHENSIVE TREATISE
General Editors:
Roslyn B. Alfin-Slater, University of California, Los Angeles
David Kritchevsky, The Wistar Institute, Philadelphia
Volume 1 Nutrition: Pre- and Postnatal Development
Edited by Myron Winick
Volume 2 Nutrition and Growth
Edited by Derrick B. Jelliffe and E. F. Patrice Jelliffe
Volume 3A Nutrition and the Adult: Macronutrients
Edited by Roslyn B. AlfinSlater and David Kritchevsky
Volume 3B Nutrition and the Adult: Micronutrients
Edited by Roslyn B. Alfin-Slater and David Kritchevsky
Volume 4 Nutrition: Metabolic and Clinical Applications
Edited by Robert E. Hodges
Nutrition
Metabolic and Clinical Applications
Edited by
Robert E. Hodges
•
University of California
Davis, California
PLENUM PRESS . NEW YORK AND LONDON
library of Congress Cataloging in Publication Data
Main entry under title:
Nutrition, metabolic and clinical applications.
(Human nutrition; v. 4)
Includes bibliographical references and index.
1. Nutrition disorders. 2. Deficiency diseases. 3. Metabolism, Disorders of. 4. Infec-
tion-Nutritional aspects. I. Hodges, Robert Edgar, 1922- II. Series. [DNLM:
1. Nutrition disorders. 2. Metabolic diseases. QU145.3 H9183 v.4]
QP141.H78 vol. 4 [RC620] 612'.3'08s [616.3'9] 78-27208
ISBN-13: 978-1-4615-7215-2 e-ISBN-13: 978-1-4615-7213-8
001: 10.1007/978-1-4615-7213-8
©1979 Plenum Press, New York
Softcover reprint of the hardcover 1st edition 1979
A Division of Plenum Publishing Corporation
227 West 17th Street, New York, N.Y. 10011
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, microftlming,
recording, or otherwise, without written permission from the publisher
This volume is dedicated to all the
scientists whose work has advanced
our understanding of
how to apply knowledge
to benefit human nutrition.
Contributors
Roslyn B. Aljin-SloJer • School of Public Health, University of California, Los
Angeles, California
WiUiam R. Beisel. U.S. Army Medical Research Institute of Infectious Di
seases, Fort Detrick, Frederick, Maryland
Rene Bine, Jr. • Mount Zion Hospital and Medical Center, San Francisco,
California
Pie"e M. Dreyfus. Department of Neurology, School of Medicine, Univer
sity of California, Davis, California
Clifford F. Gastineau • Mayo Medical School, Rochester, Minnesota
/lobert H. Herman. Department of Medicine, Letterman Army Institute of
Research, Presidio of San Francisco, San Francisco, California
Thomas H. Jukes. Division of Medical Physics, University of California,
Berkeley, California
Bryna Kane-Nussen • Department of Nutrition and School of Medicine, Uni
versity of California, Davis, California
Joel D. Kopple • Department of Medicine, University of California at Los
Angeles, and Veterans Administration Wadsworth Medical Center, Los
Angeles, California
Charles S. Lieber. Section of Liver Disease and Nutrition and Alcoholism
Research and Treatment Center, Veterans Administration Hospital,
Bronx, New York, and Mount Sinai School of Medicine of the City
University of New York, New York, New York
John Lindenbaum. Department of Medicine, Harlem Hospital Center, and
Department of Medicine, Columbia University, College of Physicians and
Surgeons, New York, New York
Esteban Mezey. Department of Medicine, Baltimore City Hospitals, and The
Johns Hopkins University School of Medicine, Baltimore, Maryland
Spencer Shaw • Section of Liver Disease and Nutrition and Alcoholism Re
search and Treatment Center, Veterans Administration Hospital, Bronx,
N ew York, and Mount Sinai School of Medicine of the City University of
New York, New York, New York
.ii
IIiii Contributors
Judith S. Stern • Department of Nutrition and School of Medicine, University
of California, Davis, California
Joseph J. Vitale • Section of Nutrition, Department of Pathology, Boston
University School of Medicine, and Nutrition Pathology Unit, Mallory
Institute of Pathology, Boston City Hospital, Boston, Massachusetts
Donald M. Watkin • Lipid Research Clinic, The George Washington Univer
sity Medical Center, Washington, D.C.
Penelope Wells • Cutter Laboratories, Inc., Berkeley, California
Foreword
The science of nutrition has advanced beyond expectation since Antoine La
voisier as early as the 18th century showed that oxygen was necessary to
change nutrients in foods to compounds which would become a part of the
human body. He was also the first to measure metabolism and to show that
oxidation within the body produces heat and energy. In the two hundred years
that have elapsed, the essentiality of nitrogen-containing nutrients and of
proteins for growth and maintenance of tissue has been established; the ne
cessity for carbohydrates and certain types of fat for health has been docu
mented; vitamins necessary to prevent deficiency diseases have been identified
and isolated; and the requirement of many mineral elements for health has
been demonstrated.
Further investigations have defined the role of these nutrients in metabolic
processes and quantitated their requirements at various stages of development.
Additional studies have involved their use in the possible prevention of, and
therapy for, disease conditions.
This series of books was designed for the researcher or advanced student
of nutritional science. The first volume is concerned with prenatal and post
natal nutrient requirements; the second volume with nutrient requirements for
growth and development; the third with nutritional requirements of the adult;
and the fourth with the role of nutrition in disease states. Our objectives were
to review and evaluate that which is known and to point out those areas in
which uncertainties and/or a lack of knowledge still exists with the hope of
encouraging further research into the intricacies of human nutrition.
Roslyn B. Alfin-Slater
David Kritchevsky
ix
Preface
Nutrition, which once was the Cinderella of biochemical research and later
fell into disrepute, is now enjoying a robust reawakening of interest. Much
credit must be given to those steady workers in the field of public health who
demonstrated clearly that the inhabitants of the industrialized nations have
had, since the end of World War II, not only sufficient food to meet their
nutritional needs but a surplus that encouraged dietary excess. No longer were
deficiency syndromes (with the possible exception of iron) common, but obes
ity with its accompanying problems became ever more common.
In the current era the prevalence of various diseases is carefully tabulated
and the causes of death are published regularly. It has become obvious that
while life expectancy (from birth to death) has risen to approximately the
biblical "three-score years and ten," the outlook for an adult who has reached
50 years of age is essentially unchanged from that of his or her grandparents.
The major improvement results from a marked increase in the survival of
infants and children up to the age of two years. No longer do large numbers
of children die from tuberculosis, pneumonia, or whooping cough. And few
die of typhoid, dysentery, or nonspecific diarrhea. The era of modem plumbing
and sanitation buttressed by immunizations, antibiotics, and modem medical
care has been largely responsible for this sharp reduction in the death rate of
young children. Undoubtedly, better nutrition has played a minor role also.
But for the middle-aged or elderly citizens the outlook for survival has
changed scarcely at all. The causes of death may be different, with heart
disease, cancer, and stroke being most common now, but the age of death has
remained substantially unchanged since the early decades of this century.
One might argue that the quality of life for the mature or elderly person
has improved, but has it? People today have, on the average, a lower levei of
physical activity and a greater prevalence of obesity than they did two gen
erations before. It seems doubtful that a sedentary life free from useful or
necessary chores is more enjoyable than that of our forefathers who were
required to be more active.
Another phenomenon has become quite apparent in recent years. People
in all walks of life are more interested in and concerned with nutrition. Many
tum to their physicians who, in some instances, are hard-pressed to give
xi
xii Preface
satisfactory answers, for until recently most medical schools taught little or
nothing about nutrition. It is understandable that large numbers of people have
turned to the self-professed "nutrition experts" who make extravagant claims
and exhibit their paper-bound pUblications in supermarkets, drug stores, and
"health-food" stores.
The general public, as well as the medical profession and many paramed
ical scientists, now recognize a need for accuracy and reasonable detail, cur
rent applicability, and up-to-date references, for patterns of interest are chang
ing constantly. This book represents an attempt to fill part of that need. The
authors, who are highly regarded members of their profession, have written in
a timely fashion about topics of interest to lay persons, medical personnel, and
physicians alike.
An effort has been made to avoid writing an encyclopedia, for such books,
however useful, generally make dull reading. Topics which have been covered
in depth by virtually every author of books dealing with nutrition have been
given brief treatment in this volume.
In every chapter, major emphasis has been placed on expert opinion and
factual interpretation. As a result, the reader will be given a concept that
represents the best judgment of an author who is well-informed and mature.
The obvious roles of nutrients in both health and disease are clearly demon
strated in the following chapters.
Robert E. Hodges
Davis, California
