Contents in Brief PART I Introduction to Basic Principles 15 Weight Management, 245 of Nutrition Science, 1 16 Nutrition and Physical Fitness, 272 1 Food, Nutrition, and Health, 1 PART 4 Clinical Nutrition, 288 2 Carbohydrates, 12 3 Fats, 27 17 Nutrition Care, 288 4 Proteins, 41 18 Gastrointestinal and Accessory Organ 5 Digestion, Absorption, and Metabolism, 56 Problems, 304 6 Energy Balance, 71 19 Coronary Heart Disease and Hypertension, 327 7 Vitamins, 83 20 Diabetes Mellitus, 347 8 Minerals, 110 21 Kidney Disease, 371 9 Water and Electrolyte Balance, 133 22 Surgery and Nutrition Support, 390 23 Nutrition Support in Cancer and HIV, 411 PART 2 Nutrition throughout the Life Cycle, 147 10 Nutrition during Pregnancy and Lactation, 147 References, 434 11 Nutrition during Infancy, Childhood, and Further Reading and Resources, 454 Adolescence, 166 Glossary, 460 12 Nutrition for Adults: The Early, Middle, and Appendix A, 470 Later Years, 186 Appendix B, 471 Appendix C, 480 PART 3 Community Nutrition and Health Care, 202 13 Community Food Supply and Health, 202 14 Food Habits and Cultural Patterns, 228 Williams’ Basic Nutrition and Diet Therapy YOU’VE JUST PURCHASED MORE THAN A TEXTBOOK! Evolve Student Resources for Nix: Williams’ Basic Nutrition and Diet Therapy, Fifteenth edition, include the following: • A nswers to Textbook Case Studies—Answers to detailed case studies are found in specific chapters of the textbook. • C ase Studies—Activities that help you gain further practice in problem solving and application of concepts. • F ood Composition Table—This detailed listing allows you to search the nutrient values of more than 5000 foods contained in Nutritrac Nutrition Analysis Program, Version 5.0 (Online). It is separated and alphabetized into 18 different food categories. • I nfant and Child Growth Charts, United States—The most recent growth charts are now available electronically on Evolve in a format that makes it easier to print and to take with you. • S elf-Test Questions—350 interactive self-assessment questions that provide instant feedback to ensure content mastery and help you prepare for the examination. Activate the complete learning experience that comes with each textbook purchase by registering at http://evolve.elsevier.com/Williams/basic/ REGISTER TODAY! You can now purchase Elsevier products on Evolve! Go to evolve.elsevier.com/html/shop-promo.html to search and browse for products. 15 EDITION Williams’ Basic Nutrition and Diet Therapy Staci Nix, MS, RD, CD Assistant Professor, Lecturer Department of Nutrition and Integrative Physiology Adjunct Faculty, School Of Medicine University of Utah Salt Lake City, Utah 3251 Riverport Lane St. Louis, Missouri 63043 WILLIAMS’ BASIC NUTRITION AND DIET THERAPY ISBN: 978-0-323-37731-7 FIFTEENTH EDITION Copyright © 2017, Elsevier Inc. All Rights Reserved. Previous editions copyrighted 2013, 2009, 2005, 2001, 1995, 1992, 1988, 1984, 1980, 1975, 1969, 1966, 1962, 1958. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Rights Department: phone: (+1) 215 239 3804 (US) or (+44) 1865 843830 (UK); fax: (+44) 1865 853333; e-mail: [email protected]. You may also complete your request on-line via the Elsevier website at http://www.elsevier.com/permissions. Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Library of Congress Cataloging-in-Publication Data Names: Nix, Staci, author. Title: Williams’ basic nutrition and diet therapy / Staci Nix. Other titles: Basic nutrition and diet therapy Description: 15th edition. | St. Louis, Missouri : Elsevier/Mosby, [2017] | Includes bibliographical references and index. Identifiers: LCCN 2016006019 | ISBN 9780323377317 (pbk. : alk. paper) Subjects: | MESH: Diet Therapy | Nutritional Physiological Phenomena | Nutritional Requirements | Food Habits Classification: LCC RM216 | NLM WB 400 | DDC 615.8/54—dc23 LC record available at http://lccn.loc.gov/2016006019 Director, Traditional Education: Kristin Geen Content Development Manager: Laurie Gower Senior Content Development Specialist: Lisa P. Newton Publishing Services Manager: Jeff Patterson Senior Project Manager: Tracey Schriefer Design Direction: Renee Duenow Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 Contributors and Reviewers CONTRIBUTORS REVIEWERS Kelli Boi, MS, RD Penny Fauber, RN, BSN, MS, PhD Adjunct Nutrition Instructor Program Head/Associate Professor Weber State University Director Practical Nursing Program Ogden, Utah Dabney S. Lancaster Community College Clifton Forge, Virginia Caiti Christensen, BS Technician, Memorial Clinic Janelle Hennes, MSN, RN Sunset, Utah Clinical Instructor Lead Instructor, On Campus and Off Campus BSN Theresa Dvorak, MS, RDN, CSSD, ATC Program Associate Instructor College of Nursing and Health Innovation Department of Nutrition and Integrative Physiology University of Texas at Arlington University of Utah Arlington, Texas Salt Lake City, Utah Elizabeth A. Summers, MSN, RN, CNE Sara O. Harcourt, MPH, MS, RD Coordinator of Practical Nursing Program Clinical Dietitian Cass Career Center Salt Lake Regional Medical Center Harrisonville, Missouri Salt Lake City, Utah Nancy York, MSN, RN-BC Jennifer Schmidt, MS, RD District 1199c Training & Upgrading Fund Clinical Nutrition Supervisor Health & Technology Institute University of Utah Healthcare Philadelphia, Pennsylvania Salt Lake City, Utah Kary Woodruff, MS, RD, CSSD Associate Instructor Department of Nutrition and Integrative Physiology University of Utah Salt Lake City, Utah v Preface to the Instructor The field of nutrition is a dynamic human endeavor alert to nutrition news and questions raised by their that is continuously expanding and evolving. Three increasingly diverse clients and patients; and (3) that main factors continue to change the modern face of contact and communication with professionals in the nutrition. First, the science of nutrition continues to field of nutrition will help build a strong team approach grow rapidly with exciting research. New knowledge to clinical nutrition problems in all patient care. in any science challenges some traditional ideas and ORGANIZATION lends to the development of new ones. Instead of pri- marily focusing on nutrition in the treatment of disease, In keeping with the previous format, we have updated we are expanding the search for disease prevention content areas to meet the needs of a rapidly developing and general enhancement of life through nutrition and science and society. healthy lifestyles. Thus was the spirit during the estab- In Part 1, Introduction to Basic Principles of Nutritional lishment of the current Dietary Reference Intakes. Science, Chapter 1 focuses on the directions of health Second, the rapidly increasing multiethnic diversity of care and health promotion, risk reduction for disease the United States population enriches our food pat- prevention, and community health care delivery terns and presents a variety of health care opportuni- systems, with emphasis on team care and the active ties and needs. Third, the public is more aware and role of clients in self-care. Descriptions and illustra- concerned about health promotion and the role of tions accompany the new Healthy People 2020 objec- nutrition, largely because of the media’s increasing tives, the 2015–2020 Dietary Guidelines for Americans, attention. Clients and patients seek more self-directed and MyPlate guidelines. The Dietary Reference Intakes involvement in their health care, and an integral part (DRIs) are incorporated throughout chapter discus- of that care is nutrition. sions in Part 1 as well as throughout the rest of the This new edition continues to reflect upon the text. New and improved illustrations for the visual evolving face of nutrition science. Its guiding principle learner are in this edition of the text for complicated is our own commitment, along with that of our pub- metabolic pathways. Current research updates all of lisher, to the integrity of the material. Our basic goal is the basic nutrient and energy chapters in the remain- to produce a new book for today’s needs, with updated der of Part 1. content, and to meet the expectations and changing In Part 2, Nutrition throughout the Life Cycle, Chapters needs of students, faculty, and practitioners of basic 10, 11, and 12 reflect current material on human growth health care. and development needs in different parts of the life cycle. Current National Academy of Science guidelines for positive weight gain to meet the metabolic demands AUDIENCE of pregnancy and lactation are reinforced. Positive This text is primarily designed for students in licensed growth support for infancy, childhood, and adoles- practical or vocational nursing (LPN/LVN) programs cence is emphasized. The expanding health mainte- and associate degree programs (ADN/RN), as well as nance needs of a growing adult population through for diet technicians or aides. It is also appropriate for the aging process focus on building a healthy lifestyle programs in various professions related to health care. to reduce disease risks. In all cases, statistics represent the most recent publications available at the time of CONCEPTUAL APPROACH print. The general purpose of this text is to introduce the In Part 3, Community Nutrition and Health Care, a basic scientific principles of nutrition and their appli- strong focus on community nutrition is coordinated cations in person-centered care. As in previous edi- with an emphasis on weight management and physi- tions, basic concepts are carefully explained when cal fitness as they pertain to health care benefits and introduced. In addition, our personal concerns are ever risk reduction. The Nutrition Labeling and Education present, as follows: (1) that this introduction to the Act is discussed in terms of its current regulations and science and practice we love will continue to lead stu- helpful label format as well as its effects on food mar- dents and readers to enjoy learning about nutrition in keting. Issues of malnutrition and the cycle of despair the lives of people and stimulate further reading in are discussed and illustrated in Chapter 13. Highlights areas of personal interest; (2) that caretakers will be of food-borne diseases reinforce concerns about food vi PREFACE TO THE INSTRUCTOR vii safety in a changing marketplace. Chapter 14 high- four main sections are introduced as successive lights information on America’s multiethnic cultural developing parts of that unifying theme. food patterns and various religious dietary practices. • Chapter openers. To immediately draw students New information on the topics of obesity and genetics, into the topic for study, each chapter opens with a along with the use of alternative weight-loss methods, short list of the basic concepts involved and a brief is included in Chapter 15 by a contributing author chapter overview leading into the topic to “set the who is a certified specialist in weight management. stage.” Chapter 16 was written by a certified sports dietitian • Chapter headings. Throughout each chapter, the and discusses aspects of athletics, the proliferation of major headings and subheadings in special type or sports drinks, and the performance benefits of a well- color indicate the organization of the chapter mate- hydrated and nourished athlete. rial, providing easy reading and understanding of In Part 4, Clinical Nutrition, chapters are updated to the key ideas. Main concepts and terms also are reflect current medical nutrition therapy and ap- highlighted with color or bold type and italics. proaches to nutrition education and management. • Special boxes. The inclusion of For Further As with previous editions, Drug-Nutrient Interaction Focus, Cultural Considerations, Drug-Nutrient boxes in this section address specific concerns with Interactions, and Clinical Applications boxes leads nutrition and medication interactions. Special areas students a step further on a given topic or presents a include developments in gastrointestinal disease, heart case study for analysis. These boxes enhance under- disease, diabetes mellitus, renal disease, surgery, standing of concepts through further exploration or cancer, and HIV. application. • Case studies. In clinical care chapters, case studies CONTENT AND FEATURES are provided in Clinical Applications boxes to • Book format and design. The chapter format and focus students’ attention on related patient care use of color continue to enhance the book’s appeal. problems. Each case is accompanied by questions Basic chapter concepts and overview, illustrations, for case analysis. Students can use these examples tables, boxes, definitions, headings, and subhead- for similar patient care needs in their own clinical ings make the content easier and more interesting assignments. to read. • Diet therapy guides. In clinical chapters, medical • Learning supplements. Educational aids have been nutrition therapy guides provide practical help in developed to assist both students and instructors in patient care and education. the teaching and learning process. Please see the • Definitions of terms. Key terms important to stu- Ancillaries section on the next page for more detailed dents’ understanding and application of the mate- information. rial in patient care are presented in two ways. They • Illustrations. Color illustrations, including artwork, are identified in the body of the text and are listed graphs, charts, and photographs, help students and in a glossary at the back of the book for quick practitioners better understand the concepts and reference. clinical practices presented. • Summaries. A brief summary in bulleted format • Content threads. This book shares a number of reviews chapter highlights and helps students see features—reading level; Key Concepts; Key Terms; how the chapter contributes to the book’s “big Critical Thinking Questions; Chapter Challenge picture.” Students then can return to any part of the Questions; References; Further Reading and material for repeated study and clarification of Resources; Glossary; and Cultural Considerations, details as needed. For Further Focus, Drug-Nutrient Interactions, and • New Chapter Review Questions. In addition, self- Clinical Applications boxes—with other Elsevier test questions in multiple choice format are pro- books intended for students in demanding and fast- vided at the end of each chapter to allow students paced nursing curricula. These common threads to test their basic knowledge of the chapter’s help promote and hone the skills these students contents. must master. (See the Content Threads page after • References. Background references throughout the this preface for more detailed information on these text provide resources used in each chapter for stu- learning features.) dents who may want to probe a particular topic of interest. • Further Reading and Resources. To encourage LEARNING AIDS further reading of useful materials, expand stu- As indicated, this new edition is especially significant dents’ knowledge of key concepts, and help stu- because of its use of many learning aids throughout dents apply material in practical ways for patient the text. care and education, a brief list of annotated • Part openers. To provide the “big picture” of the resources—including books, journals, and websites book’s overall focus on nutrition and health, the —is provided at the end of the book. viii PREFACE TO THE INSTRUCTOR ANCILLARIES • Food Composition Tables allow you to search the nutrient values of more than 5000 foods con- TEACHING AND LEARNING RESOURCES tained in Nutritrac Nutrition Analysis Program, FOR THE INSTRUCTORS Version 5.0 (Online). It is separated and alphabet- Instructor Resources on Evolve: available at www ized into 18 different food categories. .evolve.elsevier.com/Williams/basic/—provides a • Infant and Child Growth Charts, United States wealth of material to help you make your nutrition are available as useful handouts to encourage use instruction a success. In addition to all of the Student of these valuable resources inside and outside of Resources, the following are provided for faculty: the classroom. • TEACH Lesson Plans: Based on textbook chapter • Self-Test Questions: More than 350 self- Learning Objectives, serve as ready-made, modifi- assessment questions that provide students with able lesson plans and a complete roadmap to link practice questions and immediate feedback to all parts of the educational package. These concise help them prepare for exams. and straightforward lesson plans can be modified • Nutrition Resource Center website: This infor- or combined to meet your particular scheduling and mative website is available at http://nutrition teaching needs. .elsevier.com to provide the reader access to infor- • Examview Test Bank: Contains approximately 700 mation about all Elsevier nutrition texts in one con- multiple-choice and alternate-format questions for venient location. the NCLEX Examination. Each question is coded for correct answer, rationale, page reference, Nursing ACKNOWLEDGMENTS Process Step, NCLEX Client Needs Category, and Cognitive Level. Throughout this process, various staff members from • Image Collection: These images can be used in a Elsevier have kindly provided guidance and assis- unique presentation or as visual aids. tance, and I am grateful to all of them. I would like to • PowerPoint Presentations with incorporated especially acknowledge the professionalism, fortitude, Audience Response Questions and unfolding Case and diligence of Kristin Geen, Director, Traditional Study to accompany each chapter guide classroom Education; Laurie Gower, Content Development Man- lectures. ager; Lisa P. Newton, Senior Content Development Specialist; Tracey Schriefer, Senior Project Manager; FOR STUDENTS and Beth Welch, Copyeditor. Your vision for this text • Nutritrac Nutrition Analysis Program, Version 5.0 is the true power behind the print. (Online): The new edition of this popular tool is I would like to acknowledge the hard work and designed to allow the user to calculate and analyze dedication of Elsevier’s Nursing Marketing Depart- food intake and energy expenditure, taking the ment for supporting this book through its many edi- guesswork out of nutrition planning. The new tions. Their ability to bridge the gap between a product version features comprehensive databases contain- and the end point—students who will hopefully learn ing more than 5000 foods organized into 18 different from and enjoy this text—is integral to the success of categories and more than 175 common/daily recre- this project. The contributions from content experts for ational, sporting, and occupational activities. The Weight Management and Sports Nutrition by Theresa Personal Profile feature allows users to enter and edit Dvorak and Kary Woodruff are cherished and lends an the intake and output of an unlimited number of element of expertise to those chapters that will increase individuals, and the Weight Management Planner the value of the text overall. In addition, I am grateful helps outline healthy lifestyles tailored to various to the reviewers who have provided constructive feed- personal profiles. In addition to foods and activities, back on this edition. Your involvement provides the new program features include an ideal body weight strength and thoroughness that no author can accom- (IBW) calculator, a Harris-Benedict calculator to plish alone. estimate total daily energy needs, and the complete Finally, I want to thank my husband, family, and Exchange Lists for Meal Planning. friends who have compassionately dealt with me and • Evolve Resources “the book.” Your abundant support sustains me. • Answers to Textbook Case Studies—Answers to detailed case studies are found in specific chap- Staci Nix ters of the textbook. • Case Studies engage students with the opportu- nity to apply the knowledge they have learned in real-life situations.