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This book is dedicated to Dr. Janice (Jan) Riordan, the founding editor of
Breastfeeding and Human Lactation and pioneer in the field of human lactation and
the lactation consultant profession.
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S
ince the first edition was published in 1990, much
has changed in the science of nutrition. But the pur-
pose of the text—to provide thorough coverage of
normal metabolism for upper-division undergraduate and
graduate students majoring in nutrition or other health-
related fields—remains the same.
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I
n the preface to the last two editions, we posed the
question, “Why a book on advanced human nutri-
tion?” We responded that there was, and continues
to be, a limited number of intermediate and advanced
textbooks that detail why nutrients are important from
a biochemical, physiologic, and molecular perspective.
Today, the same shortage exists with the exception of
Advanced Human Nutrition, whose initial success and
adoptions exceeded our expectations.
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Improved nutrition during pregnancy, especially beginning in the first
trimester, is associated with improved pregnancy outcomes.1,2 In a sys-
tematic review of food subsidy programs in high-income countries,
Black et al.3
found that pregnant food subsidy program participants had
a 10% to 20% increased intake of nutrients. This was associated with a
small but clinically relevant increase in mean birth weight. In the United
States, the Special Supplemental Nutrition Program for Women, Infants
and Children (WIC) has been proven to have favorable outcomes.4
It
provides nutrition education and foods, promotes breast-feeding, and
provides referrals to health care and social service systems. WIC has
been found to produce improved birth outcomes (i.e., reduced rates of
premature birth and infant mortality), improved nutrient density in the
maternal diet, and improved rates of initiation of breast-feeding.
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Traditionally, a staple food is one that forms the basis of the diet in terms of
both quantity and frequency of consumption, and that provides the highest
proportion of energy. In developed countries it is not always easy to specify
one particular food as the staple. Staple foods vary with geographic region,
but in global terms the most important staple foods are the following.
• Cereals: globally, cereals supply approximately 51% of the world’s
dietary energy supply (DES) with rice, maize, and wheat being the most
important, although other cereals, such as millet and sorghum, are also
important in some regions. Cereals are a good source of carbohydrate,
but also contain reasonable amounts of protein and, depending on
variety and processing, some micronutrients, e.g. Fe and some B vitamins.
• Roots and tubers, and particularly cassava or manioc: in sub-Saharan Africa
these supply 22% of the DES, with this figure rising to over 70% in
individual countries, such as the Democratic Republic of Congo. Other
important roots are potatoes, yams, sweet potatoes, and taro. They are
high in carbohydrate, but low in fat, protein, and, with some important
exceptions e.g. sweet potatoes, micronutrients.
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This volume is premised on the idea that we can best understand the media’s
representations of obesity and eating disorders by conceptualizing them as closely
interlinked, rather than distinct, public health and social phenomena. It questions
the tendency to position the obese and the anorexic body as separate, polar
opposites – as overeating juxtaposed with self-starvation. Instead, this volume
approaches obesity and eating disorders as mutually-implicating conditions that
together draw attention to the material extremes of fat and emaciated bodies,
overeating and self-starvation, and fatty and lean foods.
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One of the downstream consequences of the epidemic of
obesity in the USA is that more women are entering preg-
nancy already suffering from the burden of overweight and
obesity. There are a myriad of adverse outcomes associated
with a pregnancy complicated by obesity, including subfer-
tility,
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It is generally accepted that obesity adversely affects female reproductive function
[ 12 – 14 ]. However, the mechanisms are not fully understood and are a popular area
of research. Obesity likely affects reproductive health through a cumulative process
starting with abnormalities in the hypothalamic–pituitary–ovarian (HPO) axis.
Abnormal signalling through the hypothalamus and pituitary may affect follicular
recruitment and infl uence subsequent oocyte quality thus contributing to overall
subfertility in obese women. Studies of women undergoing assisted reproductive
technologies (ART) provide a unique opportunity for direct visualization of repro-
ductive tissues in obese women and have demonstrated that obesity also has direct
effects on oocytes, embryos and on the endometrium. Several retrospective studies
have associated obesity with increased risk for miscarriage in spontaneous concep-
tions [ 15 ], as well as in obese women receiving donor oocytes after IVF [ 16 , 17 ].
The pathophysiology underlying this association is complex and likely
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Weight regain occurs in 10–20 % of patients after approximately 36 months post-
bariatric surgery (Sheppard et al. 2013). Different philosophies exist, as to whether
weight recidivism is due to a lack of behavioral lifestyle change or simply a
mechanical failure of the procedure (de Gara and Karmali 2014). Several methods
exist for managing such patients. These include revisional surgery, endoscopic
interventions, and medical management. The frequency of undergoing revisional
surgery ranges from 2.5 to 18.4 % (Sheppard et al. 2013). Inevitably, these surgeries
have higher complication rates than primary surgery (Worni et al. 2013). As such,
revisional surgery due to weight regain comprises a long-term direct cost to the
healthcare system that has yet to be quantified.
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At a time of tightening health care budgets
and enormous health system change, re-
searchers are attempting to determine the
specific ways in which poverty affects the
health of children and youth, and policy
makers are searching for the most effective
solutions to poor children’s lack of health
care.
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These revisions include advice regarding dietary cholesterol, eggs, low- fat
diets, and beta- carotene supplements.8 However, my critique of nutri-
tionism is not based on a concern that nutrition scientists sometimes get it
“wrong”— indeed, the claim that there is a clear- cut “right” answer or sci-
entifi c truth regarding the health effects of nutrients is one of the features
of nutritionism itself. The point is not that nutrition science has not
yielded valuable insights into the relationships among nutrients, foods,
and the body, but that these insights have often been interpreted in a re-
ductive manner and then translated into nutritionally reductive dietary
guidelines. This reductive interpretation includes the decontextualiza-
tion, simplifi cation, and exaggeration of the role of nutrients in determin-
ing bodily health.
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principles or proven benefit as based on well-controlled scientific evidence.
Our goal is to help you decide which nutrients, nutritional supplements and
“super foods,” if any, can potentially improve your functional status as you
age as well as improve your chances of reaching your own genetically
determined maximal lifespan. Where applicable, we will also provide you with
information as to which nutritional supplements may help you prevent or treat
diseases that all too commonly affect us as we reach an older age.
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The sports nutrition segment of the dietary supplement industry enjoyed
over a decade of unfettered growth under federal legislation passed in
1994.
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Like you, we teach introductory nutrition at the college level, and our experi-
ences in the classroom have taught us many things. We would like to share two
primary insights that shaped the inception of this textbook and have guided
us throughout the writing of each edition.
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There are certain problems in measuring and evaluating animal welfare and pain and at the same time it is
subjective in nature as there is no measurable parameter,
which can be specifically indicative of pain.
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We are pleased to present the Third Edition of Nutri-
tional Management of Renal Disease. Since the first
edition of this book was published in 1996, the field of
nutrition in renal disease has changed dramatically.
This can be observed simply by documenting the
changes that have occurred in the table of contents of
the current publication as compared to the first edition
and second edition (published in 2004). Among the
key changes in this field is the growth of evidence con-
cerning the importance of inflammatory, oxidative and
carbonyl stress, and the dramatic increase in the preva-
lence and severity of obesity and its adverse clinical
consequences, not only in economically more developed
countries but also in the developing world.
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The International Agency for Research on Cancer (IARC, World Health Organization)
[ 1 ] estimated an incidence of 6,617,855 cancers around the world in 2008 with 4,219,626
deaths associated with this disease (IARC 2011). The American Cancer Society esti-
mates that 1,596,670 new cancer cases will be diagnosed in 2011 with half of all men
and one third of all women developing cancer in their lifetimes; 571,950 Americans are
expected to die of cancer, representing more than 1,500 people a day and accounting for
nearly one of every four deaths (ACS) [ 2 ] , making cancer the second most common
cause of death in the USA, exceeded only by heart disease. The National Institutes of
Health estimates the total costs of cancer in 2010 to be $263.8 billion: $102.8 billion for
direct medical costs (total of all health expenditures), $20.9 billion for indirect morbid-
ity costs (cost of lost productivity due to illness), and $140.1 billion for indirect mortal-
ity costs (cost of lost productivity due to premature death) [ 2 ]
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were not from the general population of adults). Three studies were identified among adolescents
or young people that fitted all other inclusion criteria—these studies are reported separately. The
most recent publication was chosen if several national reports from a single country existed. As the
most recent, revised (2005) definition of the MetS by the United States (U.S.) National Cholesterol
Education Program (NCEP) is similar to that of the 2009 consensus definition (with the only dis-
tinction being that the consensus definition specified ethnicity-specific waist circumference cut-
points, while the NCEP definition had a single waist circumference cut-point for obesity of 102 cm
[male] and 88 cm [female]), studies that used the NCEP definition were also reported. Because of
this, it is acknowledged that for some populations, the waist circumference cut-points used may not
have been appropriate for their ethnicity according to the consensus definition. The original NCEP
definition incorporated a cut-point for hyperglycemia of FPG≥ 6.1 mmol/L (110 mg/dL), whereas in
the revised (2005) definition the corresponding figure was FPG≥5.6 mmol/L (100 mg/dL). Due to
this difference, studies using the original NCEP definition were excluded. The search for relevant
publications was last conducted on April 11, 2013.
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The most reliable source of nutrition information and dietary advice that con-
sumers can access is from their health-care professional. It is imperative therefore
that those working in health care and the health science fi elds be properly informed
and educated. For that reason, this book, Nutritional Health , is an invaluable
resource for nutrition research and health. Beginning with a research overview, the
book then addresses the role of diet in relation to several chronic diseases—diabetes,
obesity, heart disease, and cancer, among others. Chapters on phytochemicals, food
synergy, and food supplements are included. These topics are essential for health-
care professionals and for students working towards careers in this area.
However, Nutritional Health:
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The idea and origination of this project came during a phone conversation with
Dr. Ira Wolinsky, who read a previous book chapter that I had authored. After a
couple more conversations and e-mail exchanges, the idea for this book developed.
The concept of the “Training Table” became the primary interest and direction
of this book for various reasons. The practice known as the “training table,” which
is defined as a table where athletes in a training program eat planned meals to help
in their conditioning/training, leads ultimately to improved adaptation and enhanced
performance.
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Until recently, the etiology of chronic diseases had been described in terms of biochemical and
physiological changes in tissue function. Unfortunately, by the time changes are diagnosed, meta-
bolic dysfunctions already exist, and therapy is designed primarily to reduce the progression of the
disease state. Selective dietary regimens and pharmacologic agents have been used to block or slow
the progression and alleviate some of the side effects of these diseases. Population groups having
similar chronic disease characteristics have consistently been noted to contain responders, nonre-
sponders, and negative responders to each therapeutic regimen.
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Since several decades ago, breast cancer has been recognized as the most frequent
malignant tumour among women in the world. Although it is an extremely known
and frequent health problem in developed societies it has been recently emerging as
a new situation in developing countries. These latter have witnessed a sustained
translocation of cervical cancer moving downward from the fi rst place in their
cancer rankings while breast cancer aroused fi rmly to the top. Such changes have
usually taken place together with the positive evolution of certain indicators of
human development. Breast cancer is a polygenic and multifactorial disease for
which estrogens have been recognized as the main risk factor, and for which lifestyle
plays a key role.
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This book is a combination of experiences in which I have been involved
over my professional career. It brings a combination of ideas together
that include methods of communicating, strategies for behavior change,
ways to assess problems, and methods to facilitate self-management. The
concepts presented in this book have been tested in a variety of clinical
trials where lifestyle change was needed to determine if dietary change
affected disease.
