PART 1

NUTRITION ASSESSMENT

1

Intake: Digestion, Absorption, Transport, and Excretion of Nutrients   Peter L. Beyer, MS, RD

2

The Gastrointestinal Tract

2

Brief Overview of Digestive and Absorptive Processes

3

The Small Intestine: Primary Site of Nutrient Absorption

9

The Large Intestine

10

2

Intake: Energy   Carol S. Ireton-Jones, PhD, RD, LD, CNSD, FACN

19

Energy Requirements

19

Components of Energy Expenditure

20

Estimating Energy Requirements

24

Calculating Food Energy

29

3

Intake: The Nutrients and Their Metabolism   Margie Lee Gallagher, PhD, RD

32

Carbohydrates

33

Fats and Lipids

40

Amino Acids and Protein

48

Macronutrient Use and Storage in the Fed State

54

Macronutrient Catabolism in the Fasted State

55

The Fat-Soluble Vitamins

57

The Water-Soluble Vitamins

74

Other Vitamin-Like Factors

89

Mineral Composition of the Body

91

Microminerals/Trace Elements

105

Ultratrace Minerals

117

Other Trace Elements

125

4

Intake: Analysis of the Diet   Kathleen A. Hammond, MS, RN, BSN, BSHE, RD, LD

129

Nutrition Imbalance

129

Nutrition Screening

131

Nutrition Assessment

132

5

Clinical: Nutritional Genomics   Ruth DeBusk, PhD, RD

144

The Human Genome Project

145

Genotype and Nutrition Assessment

146

Genetic Fundamentals

146

Genetics and Nutrition Therapy

153

Ethical, Legal, and Social Implications

159

6

Clinical: Inflammation, Physical, and Functional Assessments   Kathleen A. Hammond, MS, RN, BSN, BSHE, RD, LD Mary Demurest Litchford, PhD, RD, LDN

163

Nutrition and Inflammation

163

Physical and Functional Assessments

165

The Nutrition-Focused Physical Examination

171

Functional Nutrition Assessment

172

7

Clinical: Water, Electrolytes, and Acid-Base Balance   Pamela Charney, PhD, RD

178

Body Water

178

Electrolytes

182

Acid-Base Balance

186

Acid-Base Disorders

186

8

Clinical: Biochemical Assessment   Mary Demarest Litchford, PhD, RD, LDN

191

Definitions and Usefulness of Nutrition Laboratory Data

191

Nutrition Interpretation of Routine Medical Laboratory Tests

193

Assessment of Hydration Status

196

Assessment of Stress-Related Protein-Energy Malnutrition

196

Laboratory Data to Assess for Nutritional Anemias

199

Fat-Soluble Vitamins

201

Water-Soluble Vitamins and Trace Minerals

202

Chronic Disease Risk Assessment

202

9

Clinical: Food-Drug Interactions   Zaneta M. Pronsky, MS, RD, LDN, FADA Sr. Jeanne P. Crowe, PharmD, RPh, RPI

209

Pharmacologic Aspects of Food-Drug Interactions

210

Risk Factors for Food-Drug Interactions

210

Effects of Food on Drug Therapy

212

Effects of Drugs on Food and Nutrition

214

Modification of Drug Action by Food and Nutrients

216

Effects of Drugs on Nutrition Status

218

Excipients and Food-Drug Interactions

224

Medical Nutrition Therapy

225

10

Behavioral-Environmental: The Individual in the Community   Judith L Dodd, MS, RD, LDN, FADA Cynthia Taft Bayed, MS, RD, LDN

229

Nutrition Practice in the Community

230

Needs Assessment for Community-Based Nutrition Services

230

National Nutrition Surveys

232

National Nutrition Guidelines and Goals

233

Food Assistance and Nutrition Programs

235

Foodborne Illness

235

Food and Water Safety

244

Disaster Planning

247

PART 2

NUTRITION DIAGNOSIS AND INTERVENTION

11

Overview of Nutrition Diagnosis and Intervention   Pamela Charney, PhD, RD Sylvia Escott-Stump, MA, RD, LDN

253

The Nutrition Care Process

253

Documentation in the Nutrition Care Record

260

Influences on Nutrition and Health Care

267

Nutrition Interventions

269

Nutrition for the Terminally Ill or Hospice Patient

272

12

Food and Nutrient Delivery; Planning the Diet with Cultural Competency   Deborah H. Murray, MS, RD, LD David H. Holben, PhD, RD, LD Janice L. Raymond, MS, RD, CD

274

Determining Nutrient Needs

274

Worldwide Guidelines

275

Nutritional Status of Americans

276

National Guidelines for Diet Planning

277

Food and Nutrient Labeling

278

Dietary Patterns and Counseling Tips

285

Cultural Aspects of Dietary Planning

285

13

Food and Nutrient Delivery: Bioactive Substances and Integrative Care   Cynthia A. Thomson, PhD, RD

291

Integrative Medicine

291

Dietary Supplementation

295

Dietary Supplement Regulation

299

Assessment of Dietary Supplement Use

300

Guidelines for Counseling

303

14

Food and Nutrient Delivery: Nutrition Support Methods   Janice L. Raymond, MS, RD, CD Carol S. Ireton-Jones, PhD, RD, LD, CNSD, FACN

306

Rationale and Criteria For Appropriate Nutrition Support

306

Enteral Nutrition

309

Parenteral Nutrition

314

Refeeding Syndrome

320

Transitional Feeding

321

Nutrition Support in Long-Term and Home Care

322

Ethical Issues

323

15

Education and’Gounseling: Behavioral Change   Karen Chapman-Novakofski, PhD, RD, LDN

325

Behavior Change

325

Counseling Strategy: Cognitive Behavioral Therapy

329

Counseling Strategy: Motivational Interviewing

329

Not-Ready-To-Change Counseling Sessions

331

Unsure-About-Change Counseling Sessions

333

Resistance Behaviors and Strategies to Modify Them

334

Ready-to-Change Counseling Sessions

335

Evaluation of Effectiveness

336

PART 3

NUTRITION IN THE LIFE CYCLE

16

Nutrition in Pregnancy and Lactation   Miriam Erick, MS, RD, CDE, LDN

340

Preconception and Fertility

340

Conception

341

Pregnancy

342

Lactation

365

17

Nutrition in Infancy   Cristine M. Trahms, MS, RD, CD, FADA Kelly N. McKean, MS, RD, CD

375

Physiologic Development

375

Nutrient Requirements

376

Milk

379

Food

382

Feeding

383

18

Nutrition in Childhood   Betty L. Lucas, MPH, RD, CD Sharon A. Feucht, MA, RD, CD Beth N. Ogata, MS, RD, CD, CSP

389

Growth and Development

389

Nutrient Requirements

390

Providing an Adequate Diet

394

Nutritional Concerns

402

Preventing Chronic Disease

404

19

Nutrition in Adolescence   Jamie S. Stang, PhD, MPH, RD, LD Nicole Larson, PhD, MPH, RD

410

Growth and Development

410

Nutrient Requirements

413

Food Habits and Eating Behaviors

418

Nutrition Screening, Assessment, and Counseling

421

Special Concerns

422

20

Nutrition in the Adult Years   Judith L. Dodd, MS, RD, LDN, FADA

431

Setting the Stage: Nutrition in the Adult Years

431

The Wellness Years

433

Lifestyle and Health Risk Factors

433

Health Disparities

434

Interventions: Nutrition and Prevention

435

Food Trends and Patterns

436

Nutritional Supplementation

436

Functional Foods

437

21

Nutrition in Aging   Nancy S. Wellman, PhD, RD, FADA Barbara J. Kamp, MS, RD

442

The Older Population

442

Gerontology + Geriatrics = The Spectrum of Aging

443

Nutrition in Health Promotion and Disease Prevention

444

Theories on Aging

444

Physiologic Changes

444

Common Health Problems

448

Quality of Life

449

Nutrition Screening and Assessment

451

Nutrition Needs

452

Medicare Benefits

453

Nutrition Support Services

453

Assisted Living and Skilled Care Facilities

456

PART 4

NUTRITION FOR HEALTH AND FITNESS

22

Nutrition in Weight Management   Luanda K. Lysen, RD, RN, BSN Donna A. Israel, PhD, RD, LD, LPC, FADA

462

Body Weight Components

463

Regulation of Body Weight

464

Weight Imbalance: Overweight and Obesity

465

Management of Obesity in Adults

472

Common Problems in Obesity Treatment

482

Weight Management in Children

483

Weight Imbalance: Excessive Leanness or Unintentional Weight Loss

484

23

Nutrition in Eating Disorders   Janet E. Schebendach, PhD, RD

489

Diagnostic Criteria

489

Treatment Approach

492

Clinical Characteristics and Medical Complications

493

Psychological Management

494

Nutrition Rehabilitation and Counseling

495

Medical Nutrition Therapy and Counseling

498

24

Nutrition in Exercise and Sports Performance   Lisa Dorfman, MS, RD, CSSD, LMHC

507

Energy Production

507

Fuels for Contracting Muscles

509

Nutritional Requirements of Exercise

511

Weight Management

511

Macronutrients

512

Carbohydrate

512

Protein

514

Fat

514

Vitamins and Minerals

516

Fluid

518

Other Considerations

520

Ergogenic Aids

521

25

Nutrition and Bone Health   Karen Chapman-Novakofski, PhD, RD, LDN

531

Bone Structure and Bone Physiology

531

Bone Mass

535

Nutrition and Bone

537

Osteopenia and Osteoporosis

541

26

Nutrition for Oral and Dental Health   Diane Rigassio Radler, PhD, RD

547

Nutrition for Tooth Development

547

Dental Caries

548

Early Childhood Caries

554

Caries Prevention

555

Tooth Loss and Dentures

555

Other Oral Disorders

555

Periodontal Disease

556

Oral Manifestations of Systemic Disease

556

PART 5

MEDICAL NUTRITION THERAPY

27

Medical Nutrition Therapy for Adverse Reactions to Food: Food Allergies and Intolerances   L. Kathleen Mahan, MS, RD, CDE Kathie Madonna Swift, MS, RD, LDN

562

Definitions

563

Etiology

564

Pathophysiology

565

IgE-Mediated Reactions

567

Non-IgE-Mediated or Mixed Antibody Reactions

570

Cell-Mediated Reactions

570

Food Intolerances

570

Assessment

573

Medical Nutrition Therapy

576

Preventing Food Allergy

587

28

Medical Nutrition Therapy for Upper Gastrointestinal Tract Disorders   Joseph S. Krenitsky, MS, RD Nora Decker, MS, RD, CNSC

592

Assessment Parameters

592

The Esophagus

593

The Stomach

598

29

Medical Nutrition Therapy for Lower Gastrointestinal Tract Disorders   Nora Decker, MS, RD, CNSC Joseph S. Krenitsky, MS, RD

610

Common Intestinal Problems

611

Diseases of the Small Intestine

628

Intestinal Brush-Border Enzyme Deficiencies

624

Inflammatory Bowel Diseases

628

Nutritional Consequences of Intestinal Surgery

637

30

Medical Nutrition Therapy for Hepatobiliary and Pancreatic Disorders   Jeanette M. Hasse, PhD, RD, LD, CNSC, FADA Laura E. Matarese, PhD, RD, LDN, CNSC, FADA

645

Physiology and Functions of the Liver

645

Diseases of the Liver

646

Treatment of Cirrhosis and its Complications

655

Liver Resection and Transplantation

663

Physiology and Functions of the Gallbladder

663

Diseases of the Gallbladder

665

Physiology and Functions of the Exocrine Pancreas

667

Diseases of the Exocrine Pancreas

669

31

Medical Nutrition Therapy for Diabetes Mellitus and Hypoglycemia of Nondiabetic Origin   Marion J. Franz, MS, RD, LD, CDE

675

Incidence and Prevalence

676

Categories of Glucose Intolerance

676

Screening and Diagnostic Criteria

681

Management of Prediabetes

681

Management of Diabetes

682

Implementing the Nutrition Care Process

694

Acute Complications

702

Long-Term Complications

704

Hypoglycemia of Nondiabetic Origin

706

32

Medical Nutrition Therapy for Thyroid and Related Disorders   Sheila Dean, DSc, RD, LD, CCN, CDE

711

Thyroid Physiology

711

Assessment in Thyroid Disorders

712

Hypothyroidism

714

Polycystic Ovary Syndrome

719

Hyperthyroidism

720

Managing Imbalances of the Hypothalamus-Pituitary-Thyroid Axis

721

Other Endocrine System Disorders

723

33

Medical Nutrition Therapy for Anemia   Tracy Stopler, MS, RD Susan Weiner, MS, RD, CDE

725

Iron-Related Blood Disorders

727

Iron Overload

731

Megaloblastic Anemias

732

Other Nutritional Anemias

738

Nonnutritional Anemias

739

34

Medical Nutrition Therapy for Cardiovascular Disease   Janice L Raymond, MS, RD, CD Sarah C. Couch, PhD, RD, LD

742

Atherosclerosis and Coronary Heart Disease

743

Genetic Hyperlipidemias

746

Hypertension

758

Heart Failure

769

Cardiac Transplantation

777

35

Medical Nutrition Therapy for Pulmonary Disease   Donna H. Mueller, PhD, RD, FADA, LDN

782

The Pulmonary System

782

Aspiration

785

Asthma

785

Chronic Lung Disease of Prematurity and Bronchopulmonary Dysplasia

786

Chronic Obstructive Pulmonary Disease

788

Cystic Fibrosis

790

Lung Cancer

794

Pneumonia

794

Respiratory Failure

794

Tuberculosis

795

36

Medical Nutrition Therapy for Renal Disorders   Katy G. Wilkens, MS, RD Veena Juneja, MSc, RD Elizabeth Shanaman, RD, BS

799

Physiology and Function of the Kidneys

799

Renal Diseases

801

Acute Kidney Injury (Acute Renal Failure)

808

Chronic Kidney Disease

810

Diseases of the Tubules and Interstitium

812

Glomerular Diseases

813

End-Stage Renal Disease

813

37

Medical Nutrition Therapy for Cancer Prevention, Treatment, and Recovery   Barbara L Grant, MS, RD, CSO, LD Kathryn K. Hamilton, MA, RD, CSO, CDN

832

Etiology

833

Pathophysiology

833

Nutrition and Carcinogenesis

835

Nutrients for Cancer Prevention

838

Medical Diagnosis and Staging of Cancer

839

Medical Treatment

841

Medical Nutrition Therapy

842

Nutritional Impact of Cancer Treatments

846

Nutrition Monitoring and Evaluation

854

Pediatric Cancer

855

Nutrition Recommendations for Cancer Survivors

855

Complementary and Integrative Oncology

856

38

Medical Nutrition Therapy for HIV and AIDS   Kimberly R. Dong, MS, RD Cindy Man Imai, MS, RD

864

Epidemiology and Trends

864

Pathophysiology and Classification

865

Medical Management

867

Medical Nutrition Therapy

868

Special Considerations

878

HIV in Women

880

HIV in Children

880

Complementary and Alternative Therapies

881

39

Medical Nutrition Therapy for Metabolic Stress: Sepsis, Trauma, Burns, and Surgery   Marion F. Winkler, PhD, RD, LDN, CNSC Ainsley M. Matone, MS, RD, CNSC

884

Metabolic Response to Stress

884

Starvation versus Stress

886

Systemic Inflammatory Response Syndrome and Multiple Organ Dysfunction Syndrome

887

Malnutrition: The Etiology-Based Definition

888

Trauma and the Open Abdomen

893

Major Burns

893

Surgery

896

40

Medical Nutrition Therapy for Rheumatic Disease   F. Enrique Gómez, PhD Martha Kaufer-Horwitz, DSc, NC

901

Pathophysiology and Inflammation

903

Medical Diagnosis and Treatment

903

Unconfirmed Therapies

904

Osteoarthritis

906

Rheumatoid Arthritis

909

Sjögren’s Syndrome

914

Temporomandibular Disorders

914

Chronic Fatigue Syndrome and Fibromyalgia

915

Gout

916

Scleroderma

918

Systemic Lupus Erythematosus

919

41

Medical Nutrition Therapy for Neurologic Disorders   Valentina M. Remig, PhD, RD, LD, FADA Allisha Weeden, PhD, RD, LD

923

The Central Nervous System

924

Issues Complicating Nutrition Therapy

928

Dysphagia

929

Neurologic Diseases of Nutritional Origin

933

Neurologic Disorders from Trauma

933

Head Trauma or Neurotrauma

935

Spine Trauma and Spinal Cord Injury

937

Neurologic Diseases

939

42

Medical Nutrition Therapy for Psychiatric Conditions   Gretchen K. Vannice, MS, RD

956

Classification

956

Nutrition for the Brain and Nervous System

958

Weight Management

962

Addiction and Substance Abuse Recovery

963

Nutrition Interventions

963

PART 6

PEDIATRIC SPECIALTIES

43

Medical Nutrition Therapy for Low-Birth-Weight Infants   Diane M. Anderson, PhD, RD, CSP, FADA

972

Infant Mortality and Statistics

972

Physiologic Development

973

Nutrition Requirements: Parenteral Feeding

975

Transition from Parenteral to Enteral Feeding

980

Nutrition Requirements: Enteral Feeding

980

Feeding Methods

983

Selection of Enteral Feeding

985

Nutrition Assessment and Growth

988

Discharge Care

989

Neurodevelopmental Outcome

992

44

Medical Nutrition Therapy for Genetic Metabolic Disorders   Cristine M. Trahms, MS, RD, CD, FADA Beth N. Ogata, MS, RD, CD, CSP

996

Newborn Screening

996

Disorders of Amino Acid Metabolism

1001

Disorders of Organic Acid Metabolism

1012

Disorders of Urea Cycle Metabolism

1013

Disorders of Carbohydrate Metabolism

1014

Disorders of Fatty Acid Oxidation

1016

Role of the Nutritionist in Genetic Metabolic Disorders

1017

45

Medical Nutrition Therapy for Intellectual and Developmental Disabilities   Harriet Cloud, MS, RD, FADA

1020

Medical Nutrition Therapy

1021

Chromosomal Aberrations

1026

Neurologic Disorders

1031

Fetal Alcohol Syndrome

1039

Controversial Nutrition Therapy

1040

Community Resources

1040