Fourth Edition Nutritional Sciences From Fundamentals to Food Michelle (Shelley) McGuire, PhD University of Idaho Kathy A. Beerman, PhD Washington State University Australia • Brazil • Canada • Mexico • Singapore • United Kingdom • United States Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. This is an electronic version of the print textbook. Due to electronic rights restrictions, some third party content may be suppressed. Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. 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Nutritional Sciences: From Fundamentals to © 2023, 2018, 2013 Cengage Learning, Inc. Food, Fourth Edition WCN: 02-300 Michelle McGuire, Kathy A. Beerman ALL RIGHTS RESERVED. No part of this work covered by the copyright herein may be reproduced or distributed in any form or by any means, except as SVP, Higher Education Product Management: permitted by U.S. copyright law, without the prior written permission of the Erin Joyner copyright owner. VP, Product Management, Learning Experiences: Unless otherwise noted, all content is Copyright © Cengage Learning, Inc. Thais Alencar Product Director: Maureen Mclaughlin For product information and technology assistance, contact us at Cengage Customer & Sales Support, 1-800-354-9706 Product Manager: Courtney Heilman or support.cengage.com. Product Assistant: Olivia Pan For permission to use material from this text or product, submit all Learning Designer: Paula Dohnal requests online at www.copyright.com. 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Printed in the United States of America Print Number: 01 Print Year: 2022 Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Contents in Brief Chapter 1 The Science of Nutrition 3 Chapter 2 Nutritional Assessment and Dietary Planning 31 Chapter 3 Chemical, Biological, and Physiological Aspects of Nutrition 71 Chapter 4 Carbohydrates 119 Nutrition Matters Nutrition and Diabetes 152 Chapter 5 Protein 167 Nutrition Matters Food Safety 202 Chapter 6 Lipids 219 Nutrition Matters Nutrition and Cardiovascular Health 254 Chapter 7 Energy Metabolism 267 Nutrition Matters Alcohol, Health, and Disease 300 Chapter 8 Energy Balance and Body Weight Regulation 319 Nutrition Matters Disordered Eating 362 Chapter 9 Physical Activity and Health 379 Chapter 10 Water-Soluble Vitamins, Choline, and Carnitine 411 Chapter 11 Fat-Soluble Vitamins 451 Nutrition Matters Nutrition and Cancer 479 Chapter 12 The Major Minerals and Water 495 Nutrition Matters Nutrition and Bone Health 526 Chapter 13 The Trace Minerals 537 Chapter 14 Life Cycle Nutrition 567 Nutrition Matters Food Security, Hunger, and Malnutrition 619 Appendices A Aids to Calculations A-2 B Estimated Energy Requirement (EER) Calculations and Physical Activity Values (PA) A-4 C Summary of the 2020–2025 Dietary Guidelines for Americans A-6 D Dietary Reference Intakes (DRIs) A-7 Commonly Used Weights, Measures, and Metric Conversion Factors A-12 References R-1 Glossary G-1 Index I-1 iii Copyright 2023 Cengage Learning. 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Contents Chapter 1 The Science of Nutrition 3 Everybody Has a Story Choosing Nutrition as a Career How Is Nutrition Research Conducted? 13 Path 4 Step 1: The Observation Must Be Accurate 13 • What Do We Mean by “Nutrition”? 5 Step 2: A Hypothesis Makes Sense of An Nutrients Support All We Do 5 • Foods Contain Nutrients Observation 14 • Step 3: Data Are Collected To Test The and Nonnutrients 6 • Organic Nutrients Are Different Hypothesis 16 • Intervention Studies Test for Causality 17 From Organic Foods 7 • Phytochemicals, Zoonutrients, Are All Nutrition Claims Believable? 21 and Functional Foods 7 Determine The Source of The Information 21 • Focus On Food Understanding What Is Meant by “Organic Credibility of The Researchers Is Important 22 • Who Foods” 8 Paid For The Research? 22 • Evaluate The Experimental What Are the Major Nutrient Classes? 9 Design 22 • Do Public Health Organizations Concur? 22 Carbohydrates Are Vital For Energy and Regulatory Nutrition and Health: What Is the Connection? 23 Roles 9 • Proteins Make Up Muscles and Are Important Public Health Agencies Assess The Health of The for Energy and Regulation 9 • Lipids Do More Than Nation 23 • Mortality and Morbidity Rates Measure Provide Energy 10 • Water Is The Essence of Life Death and Illness Over Time 23 • Life Expectancy Has Itself 10 • Vitamins Regulate Reactions and Promote Increased Dramatically 24 • Diseases Are Either Infectious Growth and Development 10 • Minerals Provide Structure or Noninfectious 25 • Chronic Diseases Are The Leading and Assist with Regulation 10 Causes of Death 26 • Risk Factors Do Not Necessarily How Do Foods Provide Energy? 11 Cause Diseases 26 • Understanding Nutrition Is More Important Than Ever 27 Energy In Food Is Measured In Units Called Calories 11 Focus On Diet and Health Industrialization, Population Growth, and the Nutrition Transition 28 Chapter 2 Nutritional Assessment and Dietary Planning 31 Everybody Has a Story Nutrient Deficiencies—Primary or For Individuals 43 • Adequate Intake (AI) Levels Were Secondary? 32 Set When Data Were Lacking For EARs 44 • Tolerable Upper Intake Levels (ULs) Reflect Safe Maximal What Is The Meaning of “Nutritional Status”? 33 Intakes 44 • Chronic Disease Risk Reduction Intakes Primary and Secondary Malnutrition Can Lead To Poor (CDRRs) 45 • Energy Intake Can Also Be Evaluated 46 Nutritional Status 33 • Adequate Nutrient Intake Can Be Different Among Individuals 34 How Can You Easily Assess and Plan Your Diet? 48 Food Guidance Systems Have Been Part of Dietary Planning How Is Nutritional Status Assessed? 35 For Decades 48 Anthropometry: Body Measurements Provide Information Concerning Nutritional Status 35 • Laboratory Tests 2020 Dietary Guidelines for Americans: Our Current Are Important Biochemical Indicators of Nutritional Recommendations 50 Status 36 • Clinical Evaluations Assess Signs and 2020 Dietary Guidelines For Americans 50 Symptoms of Disease 36 • Analysis of Your Diet Can Also Food Matters Working Toward the Goal: Maximizing Be Helpful 37 • Food Composition Tables and Dietary Nutrient Intake by Increasing Fruit and Vegetable Intake 55 Analysis Software Are Important Tools 38 Nutrients of Public Health Concern 55 • Healthy How Much of a Nutrient Is Adequate? 39 Eating Patterns 56 • MyPlate lllustrates How To Put Dietary Reference Intakes (DRIs) Provide Reference Recommendations Into Practice 56 • Healthy People 2030 Standards 39 • DRI Values Depend on Many Outlines Our Nation’s Goals For Healthy Living 57 Factors 41 • Estimated Average Requirements (EARs) Focus On Diet and Health Are Legumes Protein Foods or Reflect a Population’s Average Need 42 • Recommended Vegetables? 58 Dietary Allowances (RDAs) Are Recommended Intake Goals iv Copyright 2023 Cengage Learning. 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How Can You Use Food Labels to Plan a Healthy Can You Put These Concepts into Action? 66 Diet? 59 Step 1: Set the Stage and Set Your Goals 67 • Step 2: Understanding Nutrition Facts Labels 60 Assess Your Nutritional Status 67 • Step 3: Set The Table Focus On Food What Makes a Food Kosher? 61 To Meet Your Goals 67 • Step 4: Compare Your Plan With Focus On Food The Buy Fresh Buy Local Campaign 64 Your Assessment: Did You Succeed? 68 • There Is No Time Like The Present 68 Nutrient Content Claims, Structure/Function Claims, and Health Claims 65 Chapter 3 Chemical, Biological, and Physiological Aspects of Nutrition 71 Everybody Has a Story Living with Gastroparesis 72 The Esophagus Delivers Food to the How Does Chemistry Apply to the Study of Stomach 94 • Functions of the Stomach Include Storage, Release of Gastric Secretions, and Mixing 95 Nutrition? 73 Focus On Clinical Applications Gastroesophageal Reflux Atoms Are Fundamental Units of Matter That Make up the Disease 96 World Around Us 74 • Chemical Bonds Enable Atoms to Form Millions of Different Molecules 75 • Complex The Small Intestine Is the Primary Site of Chemical Digestion Molecules Are Vital to Cell Function 76 • Acid–Base and Nutrient Absorption 100 Chemistry Is Important to the Study of Nutrition 77 What Is the Role of the Large Intestine? 105 How Do Biological Molecules Form Cells, Tissues, Focus On Clinical Applications Understanding Celiac Organs, and Organ Systems? 78 Disease 106 Substances Cross Cell Membranes By Passive and Active The Large Intestine Aids in the Elimination of Solid Waste Transport 78 • Cell Organelles Carry Out Specialized Products 106 • Fluids and Electrolytes Are Absorbed Functions Critical for Life 80 • Groups of Cells Make Up and Reabsorbed in the Large Intestine 107 • Microbial Tissues, Tissues Make Up Organs, and Organs Make Up Action in the Large Intestine Breaks down Undigested Food Organ Systems 81 Residue 108 How Does the Digestive System Break Down Food Focus On Clinical Applications Irritable Bowel Syndrome into Absorbable Components? 83 and Inflammatory Bowel Disease 109 The GI Tract Has Four Tissue Layers that Contribute to the The Large Intestine Stores and Eliminates Solid Waste Process of Digestion 85 Products from the Body 110 Focus On Clinical Applications The Fecal Microbiome: How Do Gastrointestinal Motility and Secretions Building a Healthy Community 111 Facilitate Digestion? 86 Gastrointestinal (GI) Motility Mixes and Propels Food How Does the Body Circulate Nutrients and Eliminate in the GI Tract 87 • Gastrointestinal (GI) Secretions Aid Cellular Waste Products? 112 Digestion and Protect the GI Tract 87 • Neural and Nutrients Absorbed from the Small Intestine Are Circulated Hormonal Signals Regulate Gastrointestinal Motility and to the Liver 113 • The Cardiovascular System Circulates Secretions 89 Nutrients, Oxygen, and Other Substances 113 • How Does the Gastrointestinal Tract Coordinate The Lymphatic System Transports Fat-Soluble Nutrients Functions to Optimize Digestion and Nutrient Away from the GI Tract 115 • The Kidneys Play an Absorption? 90 Important Role in Excreting Cellular Waste Products 115 Digestion Begins in the Mouth With Chewing and Mixing Focus On Clinical Applications What Urine Says About Food 91 Your Health 117 Focus On Clinical Applications A Loss of Smell Can Spell Trouble 93 Chapter 4 Carbohydrates 119 Everybody Has a Story Getting The Diagnosis 120 Disaccharides Consist of Two Monosaccharides 124 What Are Simple Carbohydrates? 121 What Are Complex Carbohydrates? 127 Monosaccharides Are Single Sugar Molecules 122 Oligosaccharides Are Components of Cell Membranes 127 Focus On Diet and Health Fructose and Nonalcoholic Fatty Polysaccharides Differ in the Types and Arrangements Liver Disease 124 of Sugar Molecules 127 Contents v Copyright 2023 Cengage Learning. 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Focus On Food Are Nonsugar Sweeteners Beneficial Nutrition Matters Nutrition and Diabetes 152 to Health? 128 What Is Diabetes? 152 How Are Carbohydrates Digested, Absorbed, The Discovery of Insulin 152 • Diabetes Is Classified by Its and Circulated in the Body? 136 Underlying Cause 152 Starch Digestion Begins in the Mouth 136 • Disaccharides What Is Type 1 Diabetes? 153 Are Digested in the Small Intestine 138 • Type 1 Diabetes Is Caused by a Lack of Insulin Monosaccharides Are Readily Absorbed from the Small Production 153 • Metabolic Disturbances Result from Intestine 139 Type 1 Diabetes 154 • Type 1 Diabetes Requires Focus On the Process of Science The Evolutionary History Exogenous Insulin 155 of Lactose Tolerance 140 What Is Type 2 Diabetes? 157 Monosaccharides Have Several Functions in the Body 142 Type 2 Diabetes Is Caused by Insulin Resistance 157 • How Do Hormones Regulate Blood Glucose and Energy Genetic and Lifestyle Factors Increase the Risk of Storage? 142 Developing Type 2 Diabetes 159 • Signs and Symptoms The Hormones Insulin and Glucagon Are Produced by of Type 2 Diabetes Are Often Ignored 159 • Managing the Pancreas 143 • Insulin Lowers Blood Glucose and Type 2 Diabetes Can Help Prevent Long-Term Promotes Energy Storage 143 • Glucagon Helps Increase Complications 160 • Lifestyle Practices Can Influence Risk Blood Glucose 146 • Fight-or-Flight Response Provides an of Developing Type 2 Diabetes 161 Immediate Energy Source 148 • Ketones Are the Body’s What Are Secondary Diabetes and Gestational Alternative Energy Source 148 Diabetes? 161 How Much Carbohydrate Do We Require? 148 Some Pregnant Women Develop Gestational Diabetes 161 Dietary Reference Intakes for Carbohydrates 150 Focus On the Process of Science The Story of the Akimel Food Matters Working Toward the Goal: Focus O’odham 162 on Reducing Added Sugars 151 Managing Diabetes Today Can Help Prevent Health Making the Right Food Choices 151 Problems Tomorrow 163 Chapter 5 Protein 167 Everybody Has a Story Living with Peanut Structure and Prosthetic Groups 179 • Denaturing Agents Allergy 168 Alter a Protein’s Shape and Function 179 What Are Proteins? 169 Genetics, Epigenetics, Nutrition, Amino Acids Are the Building Blocks of and Nutrigenomics 180 Proteins 169 • Amino Acids Are Classified As Essential, Genetic Alterations: Mutations and Polymorphisms 181 • Nonessential, or Conditionally Essential 170 Experts Believe That Nutrition May Be Related to Epigenetics 182 • The Human Genome Project Has Are All Food Proteins Equal? 171 Opened the Door to Nutrigenomics 182 Complete and Incomplete Proteins 171 • Protein Focus On the Process of Science Personalized Nutrition Complementation 172 • Protein Quality 172 Based on Genetic Makeup 183 Focus On Food Genetically Modified Organisms (GMOs) and Protein Quality 173 How Are Dietary Proteins Digested, Absorbed, and Circulated? 183 How Are Proteins Made? 173 Protein Digestion Begins in the Stomach 183 • Protein Step 1: Cell Signaling Initiates Protein Synthesis 174 • Digestion Continues in the Small Intestine 184 • Amino Step 2: Transcription Transfers Genetic Information to Acids Are Absorbed in the Small Intestine and Circulated in mRNA 175 • Step 3: Translation Produces a New Peptide the Blood 185 Chain 175 What Are the Major Functions of Proteins and Amino How Do Proteins Get Their Shapes? 175 Acids in the Body? 186 Primary Structure Dictates a Protein’s Basic Proteins Provide Structure 187 • Enzymes Are Proteins Identity 176 That Catalyze Chemical Reactions 188 • Muscle Proteins Focus On Clinical Applications Sickle Cell Anemia and Facilitate Movement 188 • Some Proteins Provide a CRISPR-Cas9 177 Transport Service 188 • Hormones and Cell-Signaling Secondary Structure Folds and Twists a Proteins Are Critical Communicators 188 • Proteins Protect Peptide Chain 177 • Tertiary Structure Adds the Body 189 • Fluid Balance Is Regulated in Part by Complexity 178 • Some Proteins Have Quaternary Proteins 189 • Proteins Help Regulate pH 189 • Proteins vi Contents Copyright 2023 Cengage Learning. 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Are Sources of Glucose and Energy (ATP) 190 • Amino Some Organisms Make Toxins Before We Eat Acids Serve Many Additional Purposes 191 Them 204 • Some Organisms Make Enteric (Intestinal) Toxins After We Eat Them 205 • Some Organisms Invade Protein Turnover, Urea Excretion, and Nitrogen Intestinal Cells 206 • Protozoa And Worms Are Types Of Balance 192 Parasites 206 • Prions Are Inert, Nonliving Proteins That Protein Turnover Helps Maintain an Adequate Supply May Be Infectious 207 of Amino Acids 192 • Nitrogen Is Excreted As Urea 192 • What Is Nitrogen Balance? 192 How Can Noninfectious Substances Cause Foodborne Illness? 208 How Much Protein Do You Need? 193 Algae Toxins Can Make Some Fish and Shellfish Dietary Reference Intakes (DRIs) for Amino Acids 193 • Poisonous 208 • Some Pesticides, Herbicides, Dietary Reference Intakes (DRIs) for Proteins 194 • Antibiotics, And Hormones Are Dangerous 209 • Food Experts Debate Whether Athletes Need More Allergies And Sensitivities Can Also Cause Foodborne Protein 195 • Additional Recommendations for Protein Illness 209 • Generally Recognized As Safe Intake 195 (GRAS) 210 • New Food Safety Concerns Are Always Focus On Sports Nutrition Do Protein and Amino Acid Emerging 210 Supplements Enhance Athletic Performance? 196 How Do Food Manufacturers Prevent Contamination? Food Matters Working Toward the Goal: Obtaining 211 Sufficient Protein While Minimizing Fats 197 Careful Food-Handling Techniques Help Keep Food Vegetarian Diets: Healthier Than Other Dietary Safe 211 • Proper Food Production, Preservation, And Patterns? 197 Packaging Can Prevent Illness 211 There Are Several Forms of Vegetarianism 197 • What Steps Can You Take to Reduce Foodborne Vegetarian Diets Sometimes Require Thoughtful Illness? 213 Choices 198 Check Consumer Advisory Bulletins 213 • The FightBAC!® What Are the Consequences of Protein Deficiency? 199 Campaign Provides Basic Food Safety Advice 214 • Be Protein Deficiency Is Most Common In Early Especially Careful When Eating Out 215 Life 199 • Protein Deficiency In Adults 200 What About Avoiding Foodborne Illness While Traveling Protein Excess: Is There Cause for Concern? 200 or Camping? 215 Red Meat And Processed Meat: Related to Increased Risk for Drink Only Purified or Treated Water 215 • Avoid Or Cancer? 201 Carefully Wash Fresh Fruit And Vegetables 215 • Traveling Nutrition Matters Food Safety 202 In Areas With Variant Creutzfelt-Jakob Disease 215 What Causes Foodborne Illness? 202 What Are Some Emerging Issues of Food Biosecurity? 216 Foodborne Illnesses Are Caused by Infectious and Noninfectious Agents 202 • Different Strains of a Regarding COVID-19 And Foodborne Illness 216 Microorganism Are Called Serotypes 202 • Chapter 6 Lipids 219 Everybody Has a Story Gallbladder Surgery—When Things Mono-, Di-, and Triglycerides: What’s the Do Not Go Smoothly 220 Difference? 232 What Are Lipids? 221 Triglycerides Play Many Roles in the Body 232 Fats and Oils Are Types of Lipids 221 • Fatty Acids Are the What Are Phospholipids and Sterols? 234 Most Common Type of Lipid 221 • Fatty Acids Are Named Phospholipids Are Considered “Amphipathic” 234 • for Their Structures 225 Phospholipids Are Critical for Cell Membranes and Lipid Focus On Diet and Health Global Elimination of Trans Fatty Transport 235 • Sterols and Sterol Esters Are Lipids with Acids 226 Ring Structures 236 Which Fatty Acids Do We Need, and Where Do They How Are Dietary Lipids Digested? 239 Come From? 228 Digestion of Triglycerides Requires Bile and Lipases 239 There Are Two Essential Fatty Acids: Linoleic Acid and Focus On Clinical Applications Gallbladder Disease and Linolenic Acid 228 • Some Fatty Acids Are Conditionally Gallstones 242 Essential 230 • Dietary Sources of Different Types of Fatty Digestion of Phospholipids and Cholesteryl Esters Also Acids 230 Requires Pancreatic Enzymes 243 Focus On Life Cycle Nutrition Optimal Lipid Nutrition How Are Dietary Lipids Absorbed and Circulated in the during Infancy 231 Body? 243 Contents vii Copyright 2023 Cengage Learning. 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Dietary Lipids Are Absorbed in the Small Intestine 243 • Nutrition Matters Nutrition and Cardiovascular Dietary Lipids Are Circulated Away from the Small Intestine Health 254 in Two Ways 244 How Does Cardiovascular Disease Develop? 254 Additional Transport of Lipids Throughout the Body Atherosclerosis Can Lead to Cardiovascular Disease 254 • Requires Additional Lipoproteins 246 Heart Disease Is a Type of Cardiovascular Disease 256 • What Is the Relationship Between Lipid Intake and Stroke Is Another Form of Cardiovascular Disease 257 Health? 248 What Are the Risk Factors for Cardiovascular Lipid Intake, Obesity, and Cardiovascular Disease 248 • Disease? 258 The Relationship Between Dietary Lipids and Cancer Is Nonmodifiable Risk Factors 258 • Modifiable Risk Unclear 249 Factors 258 What Are the Dietary Recommendations for How Does Dietary Intake Influence Cardiovascular Lipids? 249 Risk? 260 Consume Adequate Amounts of the Essential Fatty Hypertension Can Be Partially Controlled with Diet 260 • Acids 249 Controlling Blood Lipid Levels with Diet 261 • Other Focus On the Process of Science The Long and Winding Dietary Factors and Patterns Are Associated with Lower Road of Shifting Lipid Recommendations 250 Risk 262 • Heart-Healthy Dietary Patterns 262 Pay Special Attention to the Long-Chain Omega-3 Fatty What Are the General Nutrition Guidelines for Healthy Acids 251 • Dietary Guidelines for Americans and Hearts? 264 American Heart Association Recommend Limiting Saturated Be Mindful of Energy Intake and Macronutrient Fatty Acid Consumption 251 • Trans Fatty Acids Balance 264 • Vitamins and Minerals Also Matter for Should Be Minimized 251 • Guidelines for Total Lipid Dietary Prevention of Cardiovascular Disease 264 Consumption 251 Food Matters Working Toward the Goal: Getting the Right Lipids in Your Diet 252 Chapter 7 Energy Metabolism 267 Everybody Has a Story The Importance of Newborn Focus On Diet and Health Ketogenic Diets and Seizure Screening 268 Disorders 293 What Is Energy Metabolism? 269 How Is Energy Metabolism Influenced by Feeding and Metabolic Pathways Consist of Linked Chemical Fasting? 293 Reactions 269 • Metabolic Pathways Can Be Catabolic The Fed State Favors Energy Storage 294 • Cells or Anabolic 271 • Biochemical Reactions Require Rely on Stored Energy during the Postabsorptive Enzymes 271 • Energy Metabolism Is Influenced by ATP State 294 • Energy Stores Decline during the Fasting Levels 274 State 296 What Is the Role of ATP in Energy Metabolism? 275 Focus On Diet and Health Chronic Caloric Restriction and Longevity 297 High-Energy Bonds Enable ATP to Store and Release Energy 275 • ATP Is Synthesized by Substrate The Body Conserves Energy Stores during the State of Phosphorylation and by Oxidative Phosphorylation 276 Prolonged Starvation 297 • Versatile Solutions Help the Body Meet Its Energy Needs 298 How Do Catabolic Pathways Release Stored Focus On the Process of Science Keys Starvation Energy? 278 Experiment 299 Catabolic Pathways Metabolize Glucose for Nutrition Matters Alcohol, Health, and Disease 300 Energy 278 • Catabolic Pathways Can Metabolize Protein for Energy 284 • Triglycerides Are an Important Source of What Is Alcohol and How Is It Produced? 300 Energy 285 Alcohol Is Produced by Fermentation 300 • Several Factors How Do Anabolic Pathways Contribute to Energy Influence the Rate of Alcohol Absorption 301 • Alcohol Metabolism? 289 Circulates and Accumulates in the Blood 302 • Alcohol Affects the Central Nervous System 303 • Defining Safe Glycogenesis Generates Glycogen from Glucose 289 • Levels of Alcohol Consumption 303 Lipogenesis Forms Fatty Acids and Triglycerides 289 • Gluconeogenesis Forms Glucose from Noncarbohydrate How Is Alcohol Metabolized? 304 Sources 290 • Ketogenesis Plays an Important Role during The Alcohol Dehydrogenase (ADH) Pathway Metabolizes Times of Limited Glucose Availability 291 the Majority of Alcohol 305 • The Microsomal viii Contents Copyright 2023 Cengage Learning. 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