nutrition-and-diet-therapy.pdf

F I F T H E D I T I O N

Nutrition and Diet TherapySelf-Instructional Approaches

Peggy S. Stanfield, MS, RD/LD, CNSDietetic Resources

Twin Falls, Idaho

Y. H. Hui, PhDWest Sacramento, California

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Production CreditsPublisher: Kevin SullivanAcquisitions Editor: Amy SibleyAcquisitions Editor: Emily EkleAssociate Editor: Patricia DonnellyEditorial Assistant: Rachel ShusterSenior Production Editor: Tracey ChapmanMarketing Manager: Rebecca WasleyV.P., Manufacturing and Inventory Control: Therese ConnellComposition: Auburn Associates, Inc.Cover Design: Timothy DziewitCover Image: inacio pires/ShutterStock, Inc.Printing and Binding: Malloy, Inc.Cover Printing: Malloy, Inc.

Library of Congress Cataloging-in-Publication DataStanfield, Peggy.Nutrition and diet therapy : self-instructional approaches / Peggy Stanfield, Y.H. Hui.5th ed.

p. ; cm.Includes bibliographical references and index.ISBN-13: 978-0-7637-6137-0 (pbk.)ISBN-10: 0-7637-6137-0 (pbk.)1. Diet therapyProgrammed instruction. 2. DieteticsProgrammed instruction. I. Hui, Y. H. (Yiu H.) II.Title. [DNLM: 1. Nutritional Physiological PhenomenaProgrammed Instruction. 2. Diet TherapyProgrammed

Instruction. QU 18.2 S785n 2009]RM218.S73 2009615.8'54dc22

2008051158

6048Printed in the United States of America13 12 11 10 09 10 9 8 7 6 5 4 3 2 1

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This fifth edition of Nutrition and Diet Therapy is dedicated withappreciation to our dear friend and first editor, James Keating,who many years ago started our writing careers. His unfailingsupport and encouragement enhances our endeavors and hisfriendship gives us great pleasure.

Much love to you, Jim.

Peggy and Y. H.

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Contents

About the Authors xixPreface xxiAcknowledgments xxiii

PART I Nutrition Basics and Applications 1

CHAPTER 1 Introduction to Nutrition 3Outline 3Objectives 3Glossary 3Background Information 4

Activity 1: Dietary Allowances, Eating Guides, and the Food Guidance System 5Dietary Standards 5Dietary Guidelines 6Food Guidance System 9Food Exchange Lists 15Responsibilities of Health Personnel 15Progress Check on Activity 1 16

Activity 2: Legislation and Health Promotion 17Food Labeling 17Dietary Supplement Law 21National Cholesterol Education Program (NCEP) 21Functional Foods and Nutraceuticals 21Responsibilities of Health Personnel 22Progress Check on Activity 2 22References 23

CHAPTER 2 Food Habits 25Outline 25Objectives 25Glossary 25Background Information 26

Activity 1: Factors Affecting Food Consumption 26Food and Symbols 26Examples of Food Behaviors 27Poverty, Appetite, and Biological Food Needs 28Summary 28Progress Check on Activity 1 28

Activity 2: Some Effects of Culture, Religion, and Geography on Food Behaviors 29Basic Considerations 29Reference Tables on Food Patterns 29Responsibilities of Health Personnel 32

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Progress Check on Activity 2 32References 33

CHAPTER 3 Proteins and Health 35Outline 35Objectives 35Glossary 35Background Information 36

Activity 1: Protein as a Nutrient 36Definitions, Essentiality, and Requirement 36Protein Sparing 37Functions, Storage, Sources, and Utilization 37Amino Acid Supplements 38Progress Check on Activity 1 38

Activity 2: Meeting Protein Needs and Vegetarianism 39Requirements for Protein and Amino Acids 39Vegetarianism: Rationale and Classification 40Vegetarianism: Diet Evaluation 40Vegetarianism: Diet Planning 41Excessive and Deficient Protein Intake 42Responsibilities of Health Personnel 43Progress Check on Activity 2 44References 45

CHAPTER 4 Carbohydrates and Fats: Implications for Health 47Outline 47Objectives 47Glossary 48Background Information 48

Activity 1: Carbohydrates: Characteristics and Effects on Health 49Definitions, Classification, and Requirements 49Functions 49Sources, Storage, Sweeteners, and Intake 51Athletic Activities 52Health Implications 52Progress Check on Activity 1 53

Activity 2: Fats: Characteristics and Effects on Health 54Definitions and Food Sources 54Functions and Storage 55Diet, Fats, and Health 55Progress Check on Activity 2 58References 59

CHAPTER 5 Vitamins and Health 61Outline 81Objectives 61Glossary 62Background Information 62

Activity 1: The Water-Soluble Vitamins 63Reference Tables 63Progress Check on Activity 1 64

Activity 2: The Fat-Soluble Vitamins 67Reference Tables 67Antioxidants 67

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Vitamins and the Preparation and Processing of Food 69Progress Check on Activity 2 73Responsibilities of Health Personnel 75Summary 76Progress Check on Chapter 5 76References 77

CHAPTER 6 Minerals, Water, and Body Processes 79Outline 79Objectives 79Glossary 80Background Information 80Water: A Primer 81

Activity 1: The Essential Minerals: Functions, Sources, and Characteristics 81Reference Tables 81Calcium 81Potassium 84Sodium 85Iron 85Implications for Health Personnel 88

Activity 2: Water and the Internal Environment 92Functions and Distribution of Body Water 92Body Water Balance 92Water Requirements for Athletes 93Responsibilities of Health Personnel 93Summary 93Progress Check on Chapter 6 94References 97

CHAPTER 7 Meeting Energy Needs 99Outline 99Objectives 99Glossary 99Background Information 100

Activity 1: Energy Balance 100Energy Measurement 100Basal Metabolic Rate 101Energy and Physical Activity 101Thermic Effect of Food 101Energy Intake and Output 101Body Energy Need 102Calculating Energy Intake 102Progress Check on Activity 1 104

Activity 2: The Effects of Energy Imbalance 105Definitions 105How to Determine Your Weight 105Body Composition 106Estimate Energy or Caloric Requirements 106Undernutrition 107Obesity 107Progress Check on Activity 2 109

Activity 3: Weight Control and Dieting 110Calories, Eating Habits, and Exercise 110Guidelines for Dieting 112

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The Business of Dieting 113Summary 114Responsibilities of Health Personnel 114Progress Check on Activity 3 115References 115

PART II Public Health Nutrition 117

CHAPTER 8 Nutritional Assessment 119Outline 119Objectives 119Glossary 119Background Information 120

Activity 1: Assessment of Nutritional Status 120Physical Findings 120Anthropometric Measurements 120Laboratory Data 120Diet History and Methods of Evaluating Data 120Responsibilities of Health Personnel 123Summary 126Progress Check on Activity 1 126References 127

CHAPTER 9 Nutrition and the Life Cycle 129Outline 129Objectives 129Glossary 130Background Information 130

Activity 1: Maternal and Infant Nutrition 131Pregnancy: Determining Factors 131Pregnancy: Nutritional Needs and Weight Gain 131Pregnancy: Health Concerns 133Lactation and Early Infancy: An Overview 133Breastfeeding 134Bottle-feeding 135Health Concerns of Infancy 136Introduction of Solid Foods 136Responsibilities of Health Personnel 136Progress Check on Activity 1 137

Activity 2: Childhood and Adolescent Nutrition 139Toddler: Ages One to Three 139Preschooler: Ages Three to Five 140Early Childhood: Health Concerns 140Early Childhood: Nutritional Requirements 142Middle Childhood: General Considerations 142Adolescence: Nutrition and Diet 143Adolescence: Health Concerns 143Responsibilities of Health Personnel 146Progress Check on Activity 2 146

Activity 3: Adulthood and Nutrition 147Early and Middle Adulthood 147The Elderly: Factors Affecting Nutrition and Diet 148The Elderly: Health Problems 149Nutrition Quackery 149Progress Check on Activity 3 151

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Activity 4: Exercise, Fitness, and Stress-Reduction Principles 153Physical Fitness 154Exercise and Nutritional Factors 154An Ideal Program 154Caloric Costs and Running 154A Good Sports Beverage 154Stress and Special Populations 155Progress Check on Activity 4 155Summary 156Responsibilities of Health Personnel 157References 158

CHAPTER 10 Drugs and Nutrition 159Outline 159Objectives 159Glossary 159Background Information 160Progress Check on Background Information 161

Activity 1: Food and Drug Interactions 162Effects of Food on Drugs 162Effects of Drugs on Food 162Food and Drug Incompatibilities 163Clinical Implications 163Progress Check on Activity 1 164

Activity 2: Drugs and the Life Cycle 165Effects on Pregnancy and Lactation 165Effects on Adults 166Effects on the Elderly 166An Example of Side Effects from Medications for Hyperactivity 167Progress Check on Activity 2 167Nursing Responsibilities 168References 168

CHAPTER 11 Dietary Supplements 171Outline 171Objectives 171Glossary 172Background Information 172Progress Check on Background Information 173

Activity 1: DSHE Act of 1994 173Definition of Dietary Supplement 173Nutritional Support Statements 174Ingredient and Nutrition Information Labeling 174New Dietary Ingredients 174Monitoring for Safety 175Understanding Claims 175Progress Check on Activity 1 176

Activity 2: Folate or Folic Acid 177Need for Extra Folic Acid 177Vitamin B12 and Folic Acid 177Folic Acid, Heart Disease, and Cancer 178Folic Acid and Methotrexate for Cancer 178Folic Acid and Methotrexate for Noncancerous Diseases 178Health Risk 178Progress Check on Activity 2 178

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Activity 3: Kava Kava, Ginkgo Biloba, Goldenseal, Echinacea, Comfrey, andPulegone 179

Kava Kava 179Ginkgo Biloba 180Goldenseal 181Echinacea 181Comfrey 181Pulegone 182Progress Check on Activity 3 182

Activity 4: An Example of Side Effects from Medications for Hyperactivity 182More Tips and To-Dos 184Nursing Implications 184FDA Enforcement 187Progress Check on Activity 4 189References 190

CHAPTER 12 Alternative Medicine 191Outline 191Objectives 191Glossary 191Background Information 192Progress Check on Background Information 193

Activity 1: Categories or Domains of Complementary and Alternative Medicine 193Alternative Medical Systems 193Mind-Body Interventions 194Biological-Based Therapies 194Manipulative and Body-Based Methods 194Energy Therapies 194Progress Check on Activity 1 194

Activity 2: Products, Devices, and Services Related to Complementary andAlternative Medicine 195

Acupuncture 196Laetrile 197St.-Johns-Wort 198Nursing Implications 199Progress Check on Activity 2 200References 201

CHAPTER 13 Food Ecology 203Outline 203Objectives 203Glossary 203Background Information 204

Activity 1: Food Safety 204Causes of Food-Borne Illness 204Bacteria and Food Temperature 204Safe Food-Preparation Practices 208Case Histories of Food Poisoning in the United States 209Responsibilities of Health Personnel 210Progress Check on Activity 1 210

Activity 2: Nutrient Conservation 211Storage 211Preparation 212Cooking 212

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Food Additives as Nutrients 212Summary 212Responsibilities of Health Personnel 213Progress Check on Activity 2 213References 213

PART III Nutrition and Diet Therapy for Adults 215

CHAPTER 14 Overview of Therapeutic Nutrition 217Outline 217Objectives 217Glossary 217Background Information 218Progress Check on Background Information 219

Activity 1: Principles and Objectives of Diet Therapy 220Progress Check on Activity 1 220

Activity 2: Routine Hospital Diets 220Regular Diets 220Mechanically Altered or Fiber-Restricted Diets 220Liquid Diets 221Diet for Dysphagia 223Progress Check on Activity 2 223

Activity 3: Diet Modifications for Therapeutic Care 225Modifying Basic Nutrients 225Modifying Energy Value 225Modifying Texture or Consistency 225Modifying Seasonings 226Nursing Implications 226Progress Check on Activity 3 226

Activity 4: Alterations in Feeding Methods 226Special Enteral Feedings (Tube Feedings) 226Parenteral Feedings via Peripheral Vein 227Parenteral Feeding via Central Vein (Total Parenteral Nutrition [TPN]) 227Nursing Implications 229Progress Check on Activity 4 229References 230

CHAPTER 15 Diet Therapy for Surgical Conditions 233Outline 233Objectives 233Glossary 233Background Information 234Progress Check on Background Information 235

Activity 1: Pre- and Postoperative Nutrition 236Preoperative Nutrition 236Postoperative Nutrition 236Rationale for Diet Therapy 236Progress Check on Activity 1 237

Activity 2: The Postoperative Diet Regime 238Goals of Dietary Management 238Feeding the Patient Immediately After the Operation 239Dietary Management for Recovery 239Gastrointestinal Surgery: An Illustration 240

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Nursing Implications 241Progress Check on Activity 2 241References 242

CHAPTER 16 Diet Therapy for Cardiovascular Disorders 245Outline 245Objectives 245Glossary 245Background Information 246

Activity 1: The Lipid Disorders 247Definitions 247Cholesterol and Lipid Disorders 248Dietary Management 249NCEP Recommendations 249Third Edition of NCEP (ATP 3) 249Metabolic Syndrome 249Special Consideration for Different Population Groups 250Racial and Ethnic Groups 252The Role of Fish Oils 252Drug Management 252Nursing Implications 252Progress Check on Activity 1 254

Activity 2: Heart Disease and Sodium Restriction 254Diet and Hypertension 255Diet and Congestive Heart Failure 255The Sodium-Restricted Diet 255Nursing Implications 257Progress Check on Activity 2 257

Activity 3: Dietary Care After Heart Attack and Stroke 258Myocardial Infarction (MI): Heart Attack 258Cerebrovascular Accident (CVA): Stroke 258Nursing Implications 259Progress Check on Nursing Implications 259Progress Check on Activity 3 259References 260

CHAPTER 17 Diet and Disorders of Ingestion, Digestion, and Absorption 261

Outline 261Objectives 261Glossary 261Background Information 262

Activity 1: Disorders of the Mouth, Esophagus, and Stomach 262Mouth 262Esophagus: Hiatal Hernia 263Stomach: Peptic Ulcer 263Gastric Surgery for Ulcer Diseases 266Nursing Implications 266Progress Check on Activity 1 268

Activity 2 : Disorders of the Intestines 268Dietary Fiber Intake 268Constipation 269Diarrhea 270Diverticular Disease 270

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Inflammatory Bowel Disease 271Nursing Implications 272Gastric Surgery for Severe Obesity 272Colostomy and Ileostomy 273Nursing Implications 274Progress Check on Activity 2 274References 275

CHAPTER 18 Diet Therapy for Diabetes Mellitus 277Outline 277Objectives 277Glossary 277Background Information 278

Activity 1: Diet Therapy and Diabetes Mellitus 279Treatment and Diet Therapy 279Basic Nutrition Requirements 280Caloric Requirements 280Nutrient Distribution 282Food Exchange Lists 282Caring for a Diabetic Child 283Insulin Preparations, Oral Hypoglycemic Agents (OHAs or Diabetic Pills),

and New Drug Therapy 283Nursing Implications 285Progress Check on Activity 1 287References 290

CHAPTER 19 Diet and Disorders of the Liver, Gallbladder, and Pancreas 291


Activity 1: Diet Therapy for Diseases of the Liver 293Diet Therapy for Hepatitis 293Diet Therapy for Cirrhosis 293Hepatic Encephalopathy (Coma) 294Cancer of the Liver 295Liver Transplants 295Nursing Implications 296Progress Check on Activity 1 296

Activity 2: Diet Therapy for Diseases of the Gallbladder and Pancreas 298Major Disorders of the Gallbladder 298Diet Therapy for Gallbladder Disease 298Obesity, Dieting, and Gallstones 300Diet Therapy for Acute Pancreatitis 301Diet Therapy for Chronic Pancreatitis 302Nursing Implications for Patients with Gallbladder Disorders 302Nursing Implications for Patients with Pancreatitis 302Progress Check on Activity 2 302References 303

CHAPTER 20 Diet Therapy for Renal Disorders 305Outline 305Objectives 305Glossary 305Background Information 306

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Activity 1: Kidney Function and Diseases 306Acute Nephrotic Syndrome 307Nephrotic Syndrome 307Acute Renal Failure 307Chronic Renal Failure 307Progress Check on Background Information and Activity 1 307

Activity 2: Kidney Disorders and General Dietary Management 308Description and General Considerations 308Dietary Management 309National Kidney Foundations 309Nursing Implications for Activities 1 and 2 310Progress Check on Activity 2 311

Activity 3: Kidney Dialysis 311Definitions and Descriptions 311Nursing Implications for Activity 3 312Patient Education and Counseling 312Major Resources 312Teamwork 313Progress Check on Activity 3 313

Activity 4: Diet Therapy for Renal Calculi 314Causes of Kidney Stones 314Dietary Management 314Nursing Implications 315Progress Check on Activity 4 316References 316

CHAPTER 21 Nutrition and Diet Therapy for Cancer Patients and Patients with HIV Infection 319

Outline 319Objectives 319Glossary 320Background Information 320Progress Check on Background Information 321

Activity 1: Nutrition Therapy in Cancer 321The Bodys Response to Cancer 322The Bodys Response to Medical Therapy 322Planning Diet Therapy 323Nursing Implications 235Progress Check on Activity 1 325

Activity 2: Nutrition and HIV Infections 327Background 327Basic Role of Nutrition in HIV Infections 328General Guidelines for Nutrition Therapy in HIV Infections 328Nutrition in Terminal Illness 328Alternative Nutrition Therapies 330Special Nutritional Care for Children with AIDS 330Food Service and Sanitary Practices 330Nursing Implications 331Progress Check on Activity 2 331References 333

CHAPTER 22 Diet Therapy for Burns, Immobilized Patients, MentalPatients, and Eating Disorders 335

Outline 335Objectives 335

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Glossary 336Background Information 336

Activity 1: Diet and the Burn Patient 336Background Information 336Nutritional and Dietary Care 336Calculating Nutrient Needs 337Enteral and Parenteral Feedings 337Teamwork 338Nursing Implications 338Progress Check on Activity 1 338

Activity 2: Diet and Immobilized Patients 339Introduction 339Nitrogen Balance 339Calories 340Calcium 340Urinary and Bowel Functions 340Progress Check on Activity 2 340

Activity 3: Diet and Mental Patients 341Introduction 341Confusion About Food and Eating 342Mealtime Misbehavior 342Food Rejection 342Nursing Implications 343Progress Check on Activity 3 344

Activity 4: Part IEating Disorders: Anorexia Nervosa 345Background Information 345Clinical Manifestations 345Hospital Feeding 345Nursing Implications 346Progress Check on Activity 4, Part I 346

Activity 4: Part IIOther Eating Disorders 347Background Information 347Bulimia Nervosa 347Chronic Dieting Syndrome 347Management of Bulimia and Compulsive Overeating 347Progress Check on Activity 4, Part II 348References 348

PART IV Diet Therapy and Childhood Diseases 351

CHAPTER 23 Principles of Feeding a Sick Child 353Outline 353Objectives 353Glossary 354Background Information 354Progress Check on Background Information 355

Activity 1: The Child, the Parents, and the Health Team 355Behavioral Patterns of the Hospitalized Child 355Teamwork 355Nursing Implications 356Progress Check on Activity 1 356

Activity 2: Special Considerations and Diet Therapy 357Special Considerations 357Diet Therapy and Dietetic Products 358

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Discharge and Home Nutritional Support 358Nursing Implications 359Progress Check on Activity 2 359References 359

CHAPTER 24 Diet Therapy and Cystic Fibrosis 361Outline 361Objectives 361Glossary 362Background Information 362Occurrence and Type of Disorders 362Clinical Symptoms and Diagnosis 362Progress Check on Background Information 362

Activity 1: Dietary Management of Cystic Fibrosis 363Nutritional Needs and Goals of Diet Therapy 363Use of Pancreatic Enzymes 363General Feeding 363Family Involvement and Follow-Up 364Nutritional and Dietary Management at Different Stages of Childhood 365Nursing Implications 365Progress Check on Activity 1 366References 366

CHAPTER 25 Diet Therapy and Celiac Disease 369Outline 369Objectives 369Glossary 369Background Information 370

Activity 1: Dietary Management of Celiac Disease 370Symptoms 370Principles of Diet Therapy 370Patient Education 371Nursing Implications 371Progress Check on Activity 1 373

Activity 2: Screening, Occurrence, and Complications 374Screening 374Complications 374Nursing Implications 374Progress Check on Activity 2 375References 375

CHAPTER 26 Diet Therapy and Congenital Heart Disease 377Outline 377Objectives 377Glossary 378Background Information 378

Activity 1: Dietary Management of Congenital Heart Disease 379Major Considerations in Dietary Care 379Formulas and Regular Foods 379Managing Feeding Problems 380Discharge Procedures 380Nursing Implications 380Progress Check on Activity 1 381References 382

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CHAPTER 27 Diet Therapy and Food Allergy 383Outline 383Objectives 383Glossary 383Background Information 384

Activity 1: Food Allergy and Children 384Symptoms and Management 384Milk Allergy 385Diagnosis and Treatment 385Nursing Implications 386Progress Check on Background Information and Activity 1 387

Activity 2: Common Offenders 387Common Allergens 387Other Food Allergens 388Peanut Allergy and Deaths 388Progress Check on Activity 2 389

Activity 3: Inspecting Foods to Avoid Allergic Reactions 389Progress Check on Activity 3 390References 391

CHAPTER 28 Diet Therapy and Phenylketonuria 393Outline 393Objectives 393Glossary 394Background Information 394Progress Check on Background Information 394

Activity 1: Phenylketonuria and Dietary Management 395Treatment and Requirement 395Lofenalac and Phenylalanine Food Exchange Lists 395Special Considerations 396Follow-up Care 397Drug Therapy 398Nursing Implications 398Progress Check on Activity 1 398References 399

CHAPTER 29 Diet Therapy for Constipation, Diarrhea, and High-Risk Infants 401


Activity 1: Constipation 402Background Information 402Infants 402Young Children 403Nursing Implications 403Progress Check on Activity 1 403

Activity 2: Diarrhea 404Fecal Characteristics and Causes of Diarrhea 404Treatment and Caution 404Nursing Implications 405Progress Check on Activity 2 405

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Activity 3: High-Risk Infants 406Background Information 406Nutrient Needs 406Initial Feedings 407Use of Breastmilk or Formulas 407Premature Babies: An Illustration 407Nursing Implications 409Progress Check on Activity 3 409References 409

Appendices 411Appendix A: Weights for Adults 413Appendix B: Menus for a Healthy Diet 417Appendix C: Drugs and Nutrition 425Appendix D: CDC Growth Charts 431Appendix E: Weights and Measures 449Appendix F: Food Exchange Lists 451

Answers to Progress Checks 463

Posttests 483

Answers to Posttests 547

Index 557

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About the Authors

Peggy Stanfield is a Registered Dietitian and Professor Emeritus from the College ofSouthern Idaho, Twin Falls. She is a Certified Nutrition Specialist, a professional mem-ber of the Institute of Food Technology (IFT), and has recently completed a second termas president of Text and Academic Authors (TAA), an organization devoted to advancingquality education materials for students and advocating for authors rights. Followingher retirement from CSI, she taught at the University of Hawaii, Manoa, Honolulu.

While at CSI, she helped develop and implement the nutrition component of the nurs-ing curriculum, taught nutrition theory, and supervised nursing students during theirclinical experience in teaching diet therapy to selected patients. She transferred from theNursing Department into the Allied Health division, and while continuing to teach nurs-ing students also taught students with majors in other health professions.

During the years that she taught at CSI, she wrote Nutrition and Diet Therapy withSelf-Instructional Modules, Introduction to the Health Professions, Mastering MedicalTerminology, and Essentials of Medical Terminology (Jones and Bartlett Publishers).These books continue to be revised, and most are in their third and fourth editions.

She is one of the editors in Food Borne Diseases, vol. 1 (Marcel Dekker, New York,2000) and has also contributed chapters on food safety, food regulations, and good man-ufacturing practices in books written or edited by her coauthor, Dr. Y. H. Hui. She remainsactive in all aspects of nutrition education.

Y. H. Hui received his doctoral degree in nutrition biochemistry from the University ofCalifornia at Berkeley in 1970.

Dr. Hui taught nutrition and food science at Humboldt State University from 1971 to1987. Since 1987, he has devoted himself to writing full time, also serving as a publish-ing consultant. From 19921995 he was Editor-in-Chief for the United States Associationfor Food and Drug Officials.

Dr. Hui has authored or edited more than 30 books in nutrition, food science, healthsciences, medicine, and law. In 2000, he published his first book as a publisher; currently,he acts as both an author and publisher. His current areas of interest are: health science,nutrition, food science, food technology, food engineering, and food laws.

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Preface

Many thanks to students and instructors for their continued support of our book, Nutritionand Diet Therapy: Self-Instructional Modules. Your insight and information have beenvery helpful to us in preparing this fifth edition. This book has been in print for over 20years, and it is gratifying to know that it has benefited thousands of students entering thehealth professions over these years.

Sweeping changes have occurred in the field of nutrition since this book first went toprint, and they continue to occur with great rapidity as increasing knowledge of the sub-ject and its effects on our health and longevity are scientifically established. There is nodoubt that every new edition will contain even more changes.

Upon suggestions from instructors and reviewers, we have made three changes on theoverall format of the book:

1. The title of the book has changed slightly to: Nutrition and Diet Therapy: Self-Instructional Approaches.

2. Each module in the book has been changed to a chapter.3. The suggestion in previous editions at the beginning of each chapter on credits has

been eliminated.

The technical contents of the following chapters received major changes:

1. Chapter 1, Introduction to Nutrition, has been completely rewritten to reflect currentthinking on Dietary Reference Intakes, MyPyramid, Dietary Guidelines, FoodExchanges, and Food Labeling

2. Chapter 4, Carbohydrates and Fats: Implications for Health3. Chapter 11, Dietary Supplements4. Chapter 13, Food Ecology5. Chapter 14, Overview of Therapeutic Nutrition

New references have been provided for all chapters in the book.Small or minorbut significantchanges have been made to all other chapters.

Appendix F provides the 2007 Food Exchange Lists from the American Dietetic Associationand the American Diabetes Association.

We hope that the revised contents will expand your knowledge and make the basics ofnutrition and diet therapy a little easier to understand. Please continue to give us feed-back; your constructive suggestions enable us to improve each succeeding edition.

Peggy StanfieldY. H. Hui

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Acknowledgments

We all know how hard it is to prepare the manuscript for a technical book. Actually, theproduction of a book poses equal difficulty, though the challenges are of a different type.Many people are involved in the production of a book, and we have been fortunate to havehad a number of committed people who gave their support and lent their expertise to thefinished product. You are the best judge of the quality of their work.

We also thank the students who helped research and compile new information that ap-pears in this edition. We are especially appreciative of the invaluable assistance of Dr.Wai-Kit Nip (Professor Emeritus, University of Hawaii) for his participation in preparingthis manuscript.

And last, may we again extend thanks to the students and their instructors for contin-ued use of Nutrition and Diet Therapy and valuable feedback through the last four edi-tions. We have tried in this fifth edition to again provide you with the kinds of learningactivities and new information that you have asked for, and hope that our mutual relation-ship continues for another 20 years!!

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Comprehensive Online Resources Available!http://nursing.jbpub.com/

A companion Web site where students and instructors will fi nd complete, current material to support the text!

Chapter ObjectivesStudents can download objectives to help study or prepare for lectures.

Interactive GlossaryAllows students to search key terms and definitions alphabetically or by chapter.

Animated Flash CardsThese study tools provide a definition and ask for the key term; the student types in the answer.

Crossword PuzzlesThese function as real crossword puzzles made up of nursing research terms.

Student Posttest QuestionsMultiple-choice questions for students that further enhance their knowledge of the material.

PowerPoint Slides Download our slides and use them in your course!

Instructors ManualA comprehensive tool for instructors that includes classroom discussion questions, classroom activities, and lecture ideas.

TestBank A TestBank for instructors to pull questions from and assist in preparing tests for their students. Includes critical-thinking short-answer questions as well.

Sample Syllabi A handful of sample syllabi for instructors to get new ideas for presenting the information in their classes.

Web LinksApplicable evidence-based nursing Web resources for easy clicking and linking!

Related TitlesAdditional Jones and Bartlett titles in related areas that might be of interest to the student and the instructor.

Additional Reading Suggestions A list of chapters from other Jones and Bartlett titles in related areasgreat for further study or research projects. Instructors can ask their Jones and Bartlett sales rep to package these, or other, chapters with this textbook for required reading on a particular topic.

For Students

For Instructors

Additional Material

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1P A R T INutrition Basics

and Applications

Chapter 1 Introduction to Nutrition

Chapter 2 Food Habits

Chapter 3 Proteins and Health

Chapter 4 Carbohydrates and Fats: Implications for Health

Chapter 5 Vitamins and Health

Chapter 6 Minerals, Water, and Body Processes

Chapter 7 Meeting Energy Needs

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3C H A P T E R 1Introduction to Nutrition

Time for completionActivities: 112 hoursOptional examination: 12 hour

OUTLINE

Objectives

Glossary

Background information

ACTIVITY 1: DietaryAllowances, Eating Guides,and Food Guidance System

Dietary Standards

Dietary Guidelines

Food Guidance System

Food Exchange Lists

Responsibilities of HealthPersonnel

Progress Check on Activity 1

ACTIVITY 2: Legislation andHealth Promotion

Food Labeling

Dietary Supplement Law

National Cholesterol EducationProgram (NCEP)

Functional Foods andNutraceuticals

Responsibilities of HealthPersonnel

Progress Check on Activity 2

References

OBJECTIVES

Upon completion of this chapter, the student should be able to do thefollowing:

1. Define major concepts and terms used in nutritional science.2. Identify guidelines and rationale used for planning and evaluating food

intake.3. Describe some major concerns about the American diet.4. Use appropriate sources and services to obtain reliable nutrition

information.

GLOSSARY

Adequate diet: one that provides all the essential nutrients and calories neededto maintain good health and acceptable body weight.

Adequate Intake (AI): an estimate of average requirements when evidence isnot available to establish an RDA.

Calorie (Cal): unit of energy, often used for the term kilocalorie (see also kilo-calorie). Common usage indicating the release of energy from food.

Culture: the beliefs, arts, and customs that make up a way of life for a groupof people.

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4 PART I NUTRITION BASICS AND APPLICATIONS

Daily Reference Values (DRVs): a set of values that cov-ers nutrients, such as fat and fiber, that do not appearin the RDA tables. Expressed as % Daily Value (%DV).

Diet: (a) the foods that a person eats most frequently; (b)food considered in terms of its qualities and effectson health; (c) a particular selection of food, usuallyprescribed to cure a disease or to gain or lose weight.

Dietary Guidelines for Americans: dietary recommenda-tions to promote health and to prevent or delay theonset of chronic diseases.

Dietary Reference Intakes (DRIs): a set of dietary refer-ence values including but not limited Adequate Intake(AI), Estimated Average Requirement (EAR), Rec-ommended Dietary Allowance (RDA), and TolerableUpper Intake Level (UL) used for planning and assess-ing diets of individuals and groups.

Energy: capacity to do work; also refers to calories, thatis, the fuel provided by certain nutrients (carbohy-drates, fats, proteins).

Estimated Average Requirement (EAR): intake thatmeets the estimated nutrient needs of one half of theindividuals in a specific group. Used as a basis for de-veloping the RDA.

Food: any substance taken into the body that will help tomeet the bodys needs for energy, maintenance, andgrowth.

Good nutritional status: the intake of a balanced diet con-taining all the essential nutrients to meet the bodys re-quirements for energy, maintenance, and growth.

Gram (g): a unit of weight in the metric system. 1 g =.036 oz. There are 28.385 grams to an ounce. Thisconversion is usually rounded to 30 g for ease in cal-culation, or rounded down to 28 g.

Health: the state of complete physical, mental, and socialwell-being; not merely the absence of disease andinfirmity.

Kilocalorie (kcalorie, kcal): technically correct term forunit of energy in nutrition, equal to the amount of heatrequired to raise the temperature of 1 kg of water 1C.

Malnutrition: state of impaired health due to undernutri-tion, overnutrition, an imbalance of nutrients, or thebodys inability to utilize the nutrients ingested.

Microgram: a unit of weight in the metric system equalto 1/1,000,000 of a gram.

Milligram: a unit of weight in the metric system equal to1/1,000 of a gram.

Monitor: to watch over or observe something for a periodof time.

National Cholesterol Education Program (NCEP): pro-gram designed to educate the public and healthcareproviders about the risks of an elevated cholesterollevel and methods to lower it.

Nutrient: a chemical substance obtained from food andneeded by the body for growth, maintenance, or repairof tissues. Many nutrients are considered essential.The body cannot make them; they must be obtainedfrom food.

Nutrition: the sum of the processes by which food is se-lected and becomes part of the body.

Nutritional status: state of the body resulting from the in-take and use of nutrients.

Optimum nutrition: the state of receiving and utilizingessential nutrients to maintain health and well-beingat the highest possible level. It provides a reserve forthe body.

Overnutrition: an excessive intake of one or more nutri-ents, frequently referring to nutrients providing en-ergy (kcalories).

Poor nutritional status: an inadequate intake (or utiliza-tion) of nutrients to meet the bodys requirements forenergy, maintenance, and growth.

Recommended Dietary Allowances (RDAs): levels of nu-trients recommended by the Food and NutritionBoard of the National Academy of Sciences for dailyconsumption by healthy individuals, scaled accordingto sex and age.

Tolerable Upper Intake Level (UL): maximum intake byan individual that is unlikely to pose risks of adversehealth effects in a healthy individual in a specifiedgroup. There is no established standard for individu-als to consume nutrients at levels above the RDA or AI.

Undernutrition: a deficiency of one or more nutrients, in-cluding nutrients providing energy (calories).

BACKGROUND INFORMATION

The subject of nutrition is both exciting and confusing tothe beginning student. Nutrition has become a majortopic of conversation at places of work, at social gather-ings, and in the media. We are living at a time when thefocus is on prevention of disease and responsibility forones own health. The newest trends in health care em-phasize the importance of nutrition education.

Throughout history, food and its effects on the bodyhave been studied and written about, but most of the in-formation gathered was based on trial and error. Many su-perstitions regarding the magical powers and healingcapabilities of food also evolved.

The study of nutrition as a science is relatively new,developing only after chemistry and physiology becameestablished disciplines. Its growth begins with the endof World War II. Nutrition science is now a highly re-garded discipline. The progressive advances in the sci-ence and technology of this discipline offer us hope incontrolling our destiny by preventing or delaying theonset of a number of chronic diseases related to nutri-tion, food, and lifestyle.

Every specialized field has its own language. A begin-ning student in nutrition needs to comprehend the lan-guage used in this discipline and to understand somebasic concepts upon which the science is based. The ac-tivities in this chapter should assist you in gaining theknowledge and vocabulary necessary to understand thescience of nutrition.

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A C T I V I T Y 1 :Dietary Allowances, Eating Guides, andFood Guidance System

The appropriate diet at any stage of life is one that sup-plies sufficient energy and all the essential nutrients inadequate amounts for health. For more than 50 years,professionals from the government and academics havemade recommendations on such basic needs.

For more than two decades there has been increasingconcern about the eating patterns of American people.National health policy makers have linked several spe-cific dietary factors to chronic diseases among the pop-ulation. This connection between diet and disease has, inturn, led to publication of guidelines to promote health-ier eating habits. Most of these publications have been is-sued by relevant units within the following nationalagencies:

1. U.S. National Academy of Sciences (NAS)2. U.S. Department of Agriculture3. U.S. Department of Health and Human Services4. U.S. National Institute of Health5. U.S. Surgeon General

According to these agencies, the major chronic dis-eases in the United States are coronary heart disease,strokes, hypertension, atherosclerosis, some cancers,obesity, and diabetes. Several high-risk factors for thesediseases are linked to the American diet. A discussion ofthese health factors and a proper diet presented in suchnational publications as Healthy People 2000, AmericanDietary Guidelines, and MyPyramid will be presented inthis chapter. We will first look into the concept of dietarystandards in the United States.

DIETARY STANDARDSThere are two basic questions regarding dietary standards:What are the nutrients in food? How much of each nutri-ent do we need everyday to be healthy? Collectively, this in-formation is the core of the U.S. Dietary Standards. Eachcountry has its own dietary standard, and no two countrieshave the same standards, for a variety of reasons.

For more than half a century the U.S. NationalAcademy of Sciences (NAS) has been the major scientificarm of the federal government to provide answers tothese questions. The NAS in turn depends on one of itsinstitutes, the Institute of Medicine (IOM), to review sci-entific literature to arrive at the appropriate conclusions.IOM has developed many boards of experts to performsuch scientific investigations. One such board is the Foodand Nutrition Board (FNB) which is the actual scientificbody that develops most of the U.S. dietary standards.

At present the FNB is using the concept of dietary ref-erence standards to define the terms describing theamount of nutrients we consume, such as recommen-

dation, requirement, dietary allowances, adequate in-take, upper limits, tolerance, estimation, average re-quirements, and so on. In general, there are four sets ofreference data, collectively called Dietary ReferenceIntakes or DRIs: Estimated Average Requirement (EAR),Recommended Dietary Allowance (RDA), Adequate Intake(AI), and Tolerable Upper Intake Level (UL). They are de-fined as follows:

Estimated Average Requirement (EAR): The intakethat meets the estimated nutrient needs of half of theindividuals in a specific group. This figure is to beused as the basis for developing the RDA and is to be used by nutrition policy makers in evaluating theadequacy of nutrient intakes of the group and for plan-ning how much the group should consume.

Recommended Dietary Allowance (RDA): The intakethat meets the nutrient needs of almost all of thehealthy individuals in a specific age and gender group.The RDA should be used in guiding individuals toachieve adequate nutrient intake aimed at decreasingthe risk of chronic disease. It is based on estimatingan average requirement plus an increase to accountfor the variation within a particular group.

Adequate Intake (AI): When sufficient scientific evi-dence is not available to estimate an average require-ment, Adequate Intakes (AIs) have been set.Individuals should use the AI as a goal for intakewhere no RDAs exist. The AI is derived through ex-perimental or observational data that show a meanintake that appears to sustain a desired indicator ofhealth, such as calcium retention in bone for mostmembers of a population group. For example, AIs havebeen set for infants through 1 year of age using the av-erage observed nutrient intake of populations ofbreastfed infants as the standard. The committee setAIs for calcium, vitamin D, and fluoride.

Tolerable Upper Intake Level (UL): The maximum in-take by an individual that is unlikely to pose risks ofadverse health effects in almost all healthy individu-als in a specified group. This figure is not intended tobe a recommended level of intake, and there is no es-tablished benefit for individuals to consume nutrientsat levels above the RDA or AI. For most nutrients, thisfigure refers to total intakes from food, fortified food,and nutrient supplements.

There are nine tables of DRIs that are of interest to thisbook. They are all issued and distributed by the NationalAcademy Press, the publishing arm of NAS. The data areprepared by the FNB of the NAS. The tables are describedbelow:

Presented inside the front cover of this book:

1. Table F-1: Dietary Reference Intakes (DRIs): Rec-ommended Intakes for Individuals, Vitamins.

2. Table F-2: Dietary Reference Intakes (DRIs): Rec-ommended Intakes for Individuals, Elements.

CHAPTER 1 INTRODUCTION TO NUTRITION 5

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Accessible at the National Academies of Science Website (www.nas.edu):

1. Dietary Reference Intakes (DRIs): Tolerable UpperIntake Levels (UL), Vitamins

2. Dietary Reference Intakes (DRIs): Tolerable UpperIntake Levels (UL), Elements

3. Dietary Reference Intakes (DRIs): Estimated EnergyRequirements (EER) for Men and Women

4. Dietary Reference Intakes (DRIs): Acceptable Macro-nutrient Distribution Ranges

5. Dietary Reference Intakes (DRIs): RecommendedIntakes for Individuals, Macronutrients

6. Dietary Reference Intakes (DRIs): Additional Macro-nutrient Recommendations

7. Dietary Reference Intakes (DRIs): Estimated AverageRequirements for Groups

Because nutritional requirements differ with age, sex,body size, and physiological state, all data are presentedfor males and females in different age and weight groups.Nutrition-related health problems such as prematurebirth, metabolic disorders, infections, chronic diseases,and the use of medications require special dietary andtherapeutic measures. The amount of nutrients in eachtable is determined through scientific research and variesfrom nutrient to nutrient.

To be valuable from a practical standpoint, the tech-nical information supplied by the dietary standards mustbe interpreted in terms of a selection of foods to be eatendaily. The RDAs and other standards should be met byconsuming a wide variety of acceptable, tasty, and afford-able foods and not solely through supplementation orthe use of fortified foods. Various basic diet patterns maybe devised to serve as guides in food selection.

There are many applications of the DRIs, some ofwhich will be discussed in various chapters in this book.

DIETARY GUIDELINESThe Dietary Guidelines for Americans (DietaryGuidelines), first published in 1980, provides science-based advice to promote health and to reduce risk forchronic diseases through diet and physical activity. Therecommendations contained within the DietaryGuidelines are targeted to the general public over 2 yearsof age who are living in the United States. Because of itsfocus on health promotion and risk reduction, theDietary Guidelines form the basis of federal food, nutri-tion education, and information programs.

By law (Public Law 101445, Title III, 7 U.S.C. 5301 et seq.), the Dietary Guidelines is reviewed, updated if necessary, and published every 5 years. The content ofthe Dietary Guidelines is a joint effort of the U.S.Department of Health and Human Services (HHS) andthe U.S. Department of Agriculture (USDA). Visit www.healthierus.gov/dietaryguidelines. The information in

this section has been modified from this document,2005 edition.

Major causes of morbidity and mortality in the UnitedStates are related to poor diet and a sedentary lifestyle.Some specific diseases linked to poor diet and physical in-activity include cardiovascular disease, type 2 diabetes,hypertension, osteoporosis, and certain cancers. Further-more, poor diet and physical inactivity, resulting in an en-ergy imbalance (more calories consumed than expended),are the most important factors contributing to the in-crease in overweight and obesity in this country.Combined with physical activity, following a diet thatdoes not provide excess calories according to the recom-mendations in this document should enhance the healthof most individuals.

The intent of the Dietary Guidelines is to summarizeand synthesize knowledge regarding individual nutrientsand food components into recommendations for a pat-tern of eating that can be adopted by the public. In thispublication, key recommendations are grouped undernine interrelated focus areas. It is important to remem-ber that these are integrated messages that should beimplemented as a whole. Taken together, they encour-age most Americans to eat fewer calories, be more ac-tive, and make wiser food choices.

A basic premise of the Dietary Guidelines is that nu-trient needs should be met primarily through consum-ing foods. Foods provide an array of nutrients and othercompounds that may have beneficial effects on health.In certain cases, fortified foods and dietary supplementsmay be useful sources of one or more nutrients that oth-erwise might be consumed in less than recommendedamounts. However, dietary supplements, while recom-mended in some cases, cannot replace a healthful diet.

Key recommendations of the Dietary Guidelines arepresented below.

Adequate Nutrients Within Calorie NeedsKey recommendations for the general public:

Consume a variety of nutrient-dense foods and bever-ages within and among the basic food groups whilechoosing foods that limit the intake of saturated andtrans fats, cholesterol, added sugars, salt, and alcohol.

Meet recommended intakes within energy needs byadopting a balanced eating pattern, such as the USDAFood Guide or the DASH Eating Plan.

Key recommendations for specific population groups:

People over age 50Consume vitamin B12 in its crys-talline form (i.e., fortified foods or supplements).

Women of childbearing age who may become preg-nantEat foods high in heme-iron and/or consumeiron-rich plant foods or iron-fortified foods with anenhancer of iron absorption, such as foods rich invitamin C.

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Women of childbearing age who may become preg-nant and those in the first trimester of pregnancyConsume adequate synthetic folic acid daily (fromfortified foods or supplements) in addition to foodforms of folate from a varied diet.

Older adults, people with dark skin, and people ex-posed to insufficient ultraviolet band radiation (i.e.,sunlight)Consume extra vitamin D from vitaminD-fortified foods and/or supplements.

Weight ManagementKey recommendations for the general public:

To maintain body weight in a healthy range, balancecalories from foods and beverages with caloriesexpended.

To prevent gradual weight gain over time, make smalldecreases in food and beverage calories and increasephysical activity.


Those who need to lose weightAim for a slow, steadyweight loss by decreasing calorie intake while main-taining an adequate nutrient intake and increasingphysical activity.

Overweight childrenReduce the rate of body weightgain while allowing growth and development. Consulta healthcare provider before placing a child on aweight-reduction diet.

Pregnant womenEnsure appropriate weight gain asspecified by a healthcare provider.

Breastfeeding womenModerate weight reduction issafe and does not compromise weight gain of the nurs-ing infant.

Overweight adults and overweight children withchronic diseases and/or on medicationConsult ahealthcare provider about weight loss strategies priorto starting a weight-reduction program to ensure ap-propriate management of other health conditions.

Physical ActivityKey recommendations for the general public:

Engage in regular physical activity, and reduce seden-tary activities to promote health, psychological well-being, and a healthy body weight.

To reduce the risk of chronic disease in adulthood,engage in at least 30 minutes of moderate-intensityphysical activity, above usual activity, at work or homeon most days of the week.

For most people, greater health benefits can be ob-tained by engaging in physical activity of more vigor-ous intensity or longer duration.

To help manage body weight and prevent gradual, un-healthy body weight gain in adulthood, engage in

approximately 60 minutes of moderate- to vigorous-intensity activity on most days of the week while notexceeding caloric intake requirements.

To sustain weight loss in adulthood, participate in atleast 60 to 90 minutes of daily moderate-intensityphysical activity while not exceeding caloric intakerequirements. Some people may need to consult witha healthcare provider before participating in this levelof activity.

Achieve physical fitness by including cardiovascularconditioning, stretching exercises for flexibility, andresistance exercises or calisthenics for musclestrength and endurance.


Children and adolescentsEngage in at least 60 min-utes of physical activity on most, preferably all, daysof the week.

Pregnant womenIn the absence of medical or ob-stetric complications, incorporate 30 minutes or moreof moderate-intensity physical activity on most, if notall, days of the week. Avoid activities with a high riskof falling or abdominal trauma.

Breastfeeding womenBe aware that neither acutenor regular exercise adversely affects the mothersability to successfully breastfeed.

Older adultsParticipate in regular physical activityto reduce functional declines associated with agingand to achieve the other benefits of physical activityidentified for all adults.

Food Groups to EncourageKey recommendations for the general public:

Consume a sufficient amount of fruits and vegetableswhile staying within energy needs. Two c of fruit and2-12 c of vegetables per day are recommended for areference 2000-calorie intake, with higher or loweramounts depending on the calorie level.

Choose a variety of fruits and vegetables each day. Inparticular, select from all five vegetable subgroups(dark green, orange, legumes, starchy vegetables, andother vegetables) several times a week.

Consume 3 or more ounce-equivalents of whole-grainproducts per day, with the rest of the recommendedgrains coming from enriched or whole-grain prod-ucts. In general, at least half the grains should comefrom whole grains.

Consume 3 c per day of fat-free or low-fat milk orequivalent milk products.


Children and adolescentsConsume whole-grainproducts often; at least half the grains should be wholegrains. Children 2 to 8 years should consume 2 c per

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day of fat-free or low-fat milk or equivalent milk prod-ucts. Children 9 years of age and older should con-sume 3 c per day of fat-free or low-fat milk orequivalent milk products.

FatsKey recommendations for the general public:

Consume less than 10% of calories from saturatedfatty acids and less than 300 mg/day of cholesterol,and keep consumption of trans-fatty acids as low aspossible.

Keep total fat intake between 20% to 35% of calories,with most fats coming from sources of polyunsatu-rated and monounsaturated fatty acids, such as fish,nuts, and vegetable oils.

When selecting and preparing meat, poultry, drybeans, and milk or milk products, make choices thatare lean, low fat, or fat free.

Limit intake of fats and oils high in saturated and/ortrans-fatty acids, and choose products low in such fatsand oils.


Children and adolescentsKeep total fat intake be-tween 30% to 35% of calories for children 2 to 3 yearsof age and between 25% to 35% of calories for childrenand adolescents 4 to 18 years of age, with most fatscoming from sources of polyunsaturated and mo-nounsaturated fatty acids, such as fish, nuts, and veg-etable oils.

CarbohydratesKey recommendations for the general public:

Choose fiber-rich fruits, vegetables, and whole grainsoften.

Choose and prepare foods and beverages with littleadded sugars or caloric sweeteners, such as amountssuggested by the USDA Food Guide and the DASHEating Plan.

Reduce the incidence of dental caries by practicinggood oral hygiene and consuming sugar- and starch-containing foods and beverages less frequently.

Sodium and PotassiumKey Recommendations for the general public:

Consume less than 2300 mg (approximately 1 tsp ofsalt) of sodium per day.

Choose and prepare foods with little salt. At the sametime, consume potassium-rich foods, such as fruitsand vegetables.


Individuals with hypertension, blacks, and middle-aged and older adultsAim to consume no more than1500 mg of sodium per day, and meet the potassiumrecommendation (4700 mg/day) with food.

Alcoholic BeveragesKey recommendations for the general public:

Those who choose to drink alcoholic beverages shoulddo so sensibly and in moderationdefined as the con-sumption of up to one drink per day for women and upto two drinks per day for men.

Alcoholic beverages should not be consumed by someindividuals, including those who cannot restrict theiralcohol intake, women of childbearing age who maybecome pregnant, pregnant and lactating women,children and adolescents, individuals taking medica-tions that can interact with alcohol, and those withspecific medical conditions.

Alcoholic beverages should be avoided by individualsengaging in activities that require attention, skill, orcoordination, such as driving or operating machinery.

Food SafetyKey recommendations for the general public (also seeChapter 13):

To avoid microbial food-borne illness:

Clean hands, food contact surfaces, and fruits and veg-etables. Meat and poultry should not be washed orrinsed.

Separate raw, cooked, and ready-to-eat foods whileshopping, preparing, or storing foods.

Cook foods to a safe temperature to kill micro-organisms.

Chill (refrigerate) perishable food promptly, and de-frost foods properly.

Avoid raw (unpasteurized) milk or any products madefrom unpasteurized milk, raw or partially cooked eggsor foods containing raw eggs, raw or undercooked meatand poultry, unpasteurized juices, and raw sprouts.


Infants and young children, pregnant women, olderadults, and those who are immunocompromisedDonot eat or drink raw (unpasteurized) milk or any prod-ucts made from unpasteurized milk, raw or partiallycooked eggs or foods containing raw eggs, raw or un-dercooked meat and poultry, raw or undercooked fishor shellfish, unpasteurized juices, and raw sprouts.

Pregnant women, older adults, and those who are im-munocompromised: Only eat certain deli meats andfrankfurters that have been reheated to steaming hot.

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FOOD GUIDANCE SYSTEMThe USDA has released the MyPyramid Food GuidanceSystem (www.mypyramid.gov). Along with the newMyPyramid symbol, the system provides many optionsto help Americans make healthy food choices and to beactive every day. Figures 1-1 and 1-2 provide visual pre-sentations of the general goals and food groups or systemof MyPyramid. Consult these two figures as you follow thediscussion in this section.

The general messages in the MyPyramid symbol are:physical activity, variety, proportionality, moderation,gradual improvement, and personalization. The specificmessages are about healthy eating and physical activity,which apply to everyone. MyPyramid helps consumersfind the kinds and amounts of foods they should eat eachday. The Food Guidance System is the core of MyPyramid.

The 2005 Dietary Guidelines for Americans are thebasis for federal nutrition policy. The Food GuidanceSystem provides food-based guidance to help implementthe recommendations of the Dietary Guidelines. The sys-tem was based on both the Dietary Guidelines and theDietary Reference Intakes from the National Academy ofSciences, while taking into account current consump-tion patterns of Americans. The system translates theDietary Guidelines into a total diet that meets nutrientneeds from food sources and aims to moderate or limitdietary components often consumed in excess. An im-portant complementary tool to the system is the nutri-tion data displayed on the labels of food products.

The Food Guidance System provides Web-based in-teractive and print materials for all citizens: consumers,news media, and professionals. They include thefollowing:

Food intake patterns identify what and how much foodan individual should eat for health. The amounts to eatare based on a persons age, sex, and activity level.These patterns have been published in the 2005Dietary Guidelines.

An education framework explains what changes mostAmericans need to make in their eating and activitychoices, how they can make these changes, and whythese changes are important for health.

A glossary defines key terms used in the FoodGuidance System documents.

The education framework provides specific recom-mendations for making food choices that will improvethe quality of an average American diet. These recom-mendations are interrelated and should be used together.Taken together, they would result in the followingchanges from a typical diet:

Increased intake of vitamins, minerals, dietary fiber,and other essential nutrients, especially of those thatare often low in typical diets

Lowered intake of saturated fats, trans fats, and cho-lesterol, and increased intake of fruits, vegetables, andwhole grains to decrease risk for some chronicdiseases

Calorie intake balanced with energy needs to preventweight gain and/or promote a healthy weight

The recommendations in the framework fall underfour overarching themes:

VarietyEat foods from all food groups and sub-groups.

ProportionalityEat more of some foods (fruits, veg-etables, whole grains, fat-free or low-fat milk prod-ucts), and less of others (foods high in saturated ortrans fats, added sugars, cholesterol salt, and alcohol).

ModerationChoose forms of foods that limit intakeof saturated or trans fats, added sugars, cholesterol,salt, and alcohol.

ActivityBe physically active every day.FIGURE 1-1 MyPyramid: Steps to a Healthier YouSource: Courtesy of the USDA.

FIGURE 1-2 MyPyramid: The Food GroupsSource: Courtesy of the USDA.

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The frameworks recommendations are presented askey concepts for educators. The key concepts are organizedby topic area: calories; physical activity; grains; vegetables;fruits; milk, yogurt, and cheese; meat, poultry, fish, drybeans, eggs, and nuts; fats and oils; sugars and sweets; salt;alcohol; and food safety. Under each topic area, informa-tion is presented on the following:

What actions should be taken for a healthy diet How these actions can be implemented Why this action is important for health (the key benefits)

Food GroupsThe core of MyPramid is the Food Guidance System as in-dicated in Figure 1-2. A brief discussion of the foodgroups follows.

Calories and Physical Activity

One must balance calorie intake from foods and bever-ages with calories expended and engage in regular phys-ical activity and reduce sedentary activities.

Grains

The grains group includes all foods made from wheat,rice, oats, cornmeal, barley, such as bread, pasta, oat-meal, breakfast cereals, tortillas, and grits. In general, 1slice of bread, 1 c of ready-to-eat cereal, or 12 c of cookedrice, pasta, or cooked cereal can be considered as 1 ounce-equivalent from the grains group. At least half of allgrains consumed should be whole grains.

Consume 3 or more ounce-equivalents of whole-grainproducts per day. Since the recommended 3 ounce-equivalents may be difficult for young children toachieve, they should gradually increase the amount ofwhole grains in their diets. An ounce-equivalent ofgrains is about 1 slice of bread, 1 c of ready-to-eat cerealflakes, or 12 c of cooked pasta or rice, or cooked cereal.

Vegetables

The vegetable group includes all fresh, frozen, canned,and dried vegetables and vegetable juices. In general, 1 cof raw or cooked vegetables or vegetable juice, or 2 c ofraw leafy greens can be considered as 1 c from the veg-etable group.

Eat the recommended amounts of vegetables, andchoose a variety of vegetables each day. For example,those needing 2000 calories per day need about 2-12 c ofvegetables per day. See food intake patterns in the nextsection for other calorie levels.

Fruits

The fruit group includes all fresh, frozen, canned, anddried fruits and fruit juices. In general, 1 c of fruit or100% fruit juice, or 12 c of dried fruit, can be consideredas 1 c from the fruit group.

Eat recommended amounts of fruit, and choose a va-riety of fruits each day. For example, people who need2000 calories per day need 2 c of fruit per day. See foodintake patterns in the next section for other calorie levels.

Milk, Yogurt, and Cheese

The milk group includes all fluid milk products and foodsmade from milk that retain their calcium content, such asyogurt and cheese. Foods made from milk that have littleto no calcium, such as cream cheese, cream, and butter,are not part of the group. Most milk group choices shouldbe fat free or low fat. In general, 1 c of milk or yogurt, 1-12 ounces of natural cheese, or 2 ounces of processedcheese can be considered as 1 c from the milk group.

Consume 3 c of fat-free or low-fat (1%) milk, or anequivalent amount of yogurt or cheese, per day. Children2 to 8 years old should consume 2 c of fat-free or low-fatmilk, or an equivalent amount of yogurt or cheese, perday. Consume other calcium-rich foods if milk and milkproducts are not consumed.

Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts

For the meat and beans group in general, 1 ounce of leanmeat, poultry, or fish; 1 egg; 1 tbsp peanut butter; 14 ccooked dry beans; or 12 ounce of nuts or seeds can beconsidered as 1 ounce-equivalent from the meat andbeans group.

One should make choices that are low fat or lean whenselecting meats and poultry. Choose a variety of differenttypes of foods from this group each week. Include fish,dry beans, peas, nuts, and seeds, as well as meats, poul-try, and eggs. Consider dry beans and peas as an alterna-tive to meat or poultry as well as a vegetable choice. Keepthe overall amounts of foods eaten from this group withinthe amount needed each day. For example, people whoneed 2000 calories per day need 5-12 ounce-equivalentsper day. See food intake patterns in the next section forother calorie levels.

Fats and Oils

Oils include fats from many different plants and fromfish that are liquid at room temperature, such as canola,corn, olive, soybean, and sunflower oil. Some foods arenaturally high in oils, such as nuts, olives, some fish, andavocados. Foods that are mainly oil include mayonnaise,certain salad dressings, and soft margarine.

Choose most fats from sources of monounsaturatedand polyunsaturated fatty acids, such as fish, nuts, seeds,and vegetable oils. Keep the amount of oils consumedwithin the total allowed for caloric needs. For example,people who need 2000 calories per day can consume 27grams of oils (about 7 tsp). See food intake patterns foramounts for other calorie levels. Choose fat-free, low-fat,or lean meat, poultry, dry beans, milk, and milk prod-ucts. Choose grain products and prepared foods that arelow in saturated and trans fat.

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Limit the amount of solid fats consumed to theamount within the discretionary calorie allowance, aftertaking into account other discretionary calories that havebeen consumed. For example, people who need 2000calories per day have a total discretionary calorie al-lowance of 267 calories.

Sugars and Sweets

Choose and prepare foods and beverages with little addedsugars or caloric sweeteners. Keep the amount of sug-ars and sweets consumed within the discretionarycalorie allowance, after taking into account other discre-tionary calories that have been consumed. For example,people who need 2000 calories per day1 have a total dis-cretionary calorie allowance of 267 calories. See food in-take patterns in the next section for amounts for othercalorie levels. Practice good oral hygiene and consumesugar- and starch-containing foods and beverages lessfrequently.

Salt

Choose and prepare foods with little salt. Keep sodium in-take less than 2300 mg per day. At the same time, con-sume potassium-rich foods, such as fruits and vegetables.

Alcohol

If one chooses to drink alcohol, consume it in modera-tion. Some people, or people in certain situations, shouldnot drink. Keep consumption of alcoholic beverageswithin daily discretionary calorie allowance. For example,people who need 2000 calories per day1 have a total dis-cretionary calorie allowance of 267 calories.

Food Intake PatternsThe suggested amounts of food to consume from thebasic food groups, subgroups, and oils to meet recom-mended nutrient intakes at 12 different calorie levels areprovided in Table 1-1. Nutrient and energy contributionsfrom each group are calculated according to the nutrient-dense forms of foods in each group (e.g., lean meats andfat-free milk). The table also shows the discretionary calo-rie allowance that can be accommodated within eachcalorie level, in addition to the suggested amounts of nu-trient-dense forms of foods in each group. Table 1-2shows the vegetable subgroup amounts per week. Table1-3 shows the calorie levels for males and females by ageand activity level. Calorie levels are set across a widerange to accommodate the needs of different individuals.Table 1-3 can be used to help assign individuals to thefood intake pattern at a particular calorie level.

Discretionary calorie allowance is the remainingamount of calories in a food intake pattern after account-ing for the calories needed for all food groupsusingforms of foods that are fat free or low fat and with noadded sugars.

Table 1-4 shows some weekly sample menus for a daily2000 calorie intake diet. Table 1-5 describes the nutri-ent contribution from these weekly menus.

The original MyPyramid contains many more detailsabout the Food Guidance System. The best sources areyour instructors and the Web site MyPyramid.gov.

At this Web site, consumers can enter their age, gen-der, and activity level, and they are given their own planat an appropriate calorie level. The food plan includes

TABLE 1-1 Daily Amount of Food from Each GroupCalorie Level 1000 1200 1400 1600 1800 2000

Fruits 1 cup 1 cup 1.5 cups 1.5 cups 1.5 cups 2 cups Vegetables 1 cup 1.5 cups 1.5 cups 2 cups 2.5 cups 2.5 cups Grains 3 ozeq 4 ozeq 5 ozeq 5 ozeq 6 ozeq 6 ozeq Meat and Beans 2 ozeq 3 ozeq 4 ozeq 5 ozeq 5 ozeq 5.5 ozeq Milk 2 cups 2 cups 2 cups 3 cups 3 cups 3 cups Oils 3 tsp 4 tsp 4 tsp 5 tsp 5 tsp 6 tsp Discretionary calorie allowance 165 171 171 132 195 267

Calorie Level 2200 2400 2600 2800 3000 3200

Fruits 2 cups 2 cups 2 cups 2.5 cups 2.5 cups 2.5 cups Vegetables 3 cups 3 cups 3.5 cups 3.5 cups 4 cups 4 cups Grains 7 ozeq 8 ozeq 9 ozeq 10 ozeq 10 ozeq 10 ozeq Meat and Beans 6 ozeq 6.5 ozeq 6.5 ozeq 7 ozeq 7 ozeq 7 ozeq Milk 3 cups 3 cups 3 cups 3 cups 3 cups 3 cupsOils 6 tsp 7 tsp 8 tsp 8 tsp 10 tsp 11 tsp Discretionary calorie allowance 290 362 410 426 512 648

Source: Courtesy of the USDA.

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TABLE 1-2 Vegetable Subgroup Amounts per Week Calorie Level 1000 1200 1400 1600 1800 2000

Dark green veg. 1 c/wk 1.5 c/wk 1.5 c/wk 2 c/wk 3 c/wk 3 c/wk Orange veg. .5 c/wk 1 c/wk 1 c/wk 1.5 c/wk 2 c/wk 2 c/wk Legumes .5 c/wk 1 c/wk 1 c/wk 2.5 c/wk 3 c/wk 3 c/wk Starchy veg. 1.5 c/wk 2.5 c/wk 2.5 c/wk 2.5 c/wk 3 c/wk 3 c/wk Other veg. 3.5 c/wk 4.5 c/wk 4.5 c/wk 5.5 c/wk 6.5 c/wk 6.5 c/wk

Calorie Level 2200 2400 2600 2800 3000 3200

Dark green veg. 3 c/wk 3 c/wk 3 c/wk 3 c/wk 3 c/wk 3 c/wk Orange veg. 2 c/wk 2 c/wk 2.5 c/wk 2.5 c/wk 2.5 c/wk 2.5 c/wk Legumes 3 c/wk 3 c/wk 3.5 c/wk 3.5 c/wk 3.5 c/wk 3.5 c/wk Starchy veg. 6 c/wk 6 c/wk 7 c/wk 7 c/wk 9 c/wk 9 c/wk Other veg. 7 c/wk 7 c/wk 8.5 c/wk 8.5 c/wk 10 c/wk 10 c/wk


TABLE 1-3 The Calorie Levels for Males and Females by Age and Activity LevelMales Females

Activity level Sedentary* Mod. active* Active* Activity level Sedentary* Mod. active* Active* Age Age

2 1000 1000 1000 2 1000 1000 1000 3 1000 1400 1400 3 1000 1200 1400 4 1200 1400 1600 4 1200 1400 1400 5 1200 1400 1600 5 1200 1400 1600 6 1400 1600 1800 6 1200 1400 1600 7 1400 1600 1800 7 1200 1600 1800 8 1400 1600 2000 8 1400 1600 1800 9 1600 1800 2000 9 1400 1600 1800

10 1600 1800 2200 10 1400 1800 2000 11 1800 2000 2200 11 1600 1800 2000 12 1800 2200 2400 12 1600 2000 2200 13 2000 2200 2600 13 1600 2000 2200 14 2000 2400 2800 14 1800 2000 2400 15 2200 2600 3000 15 1800 2000 2400 16 2400 2800 3200 16 1800 2000 2400 17 2400 2800 3200 17 1800 2000 2400 18 2400 2800 3200 18 1800 2000 2400

1920 2600 2800 3000 1920 2000 2200 2400 2125 2400 2800 3000 2125 2000 2200 2400 2630 2400 2600 3000 2630 1800 2000 2400 3135 2400 2600 3000 3135 1800 2000 2200 3640 2400 2600 2800 3640 1800 2000 2200 4145 2200 2600 2800 4145 1800 2000 2200 4650 2200 2400 2800 4650 1800 2000 2200 5155 2200 2400 2800 5155 1600 1800 2200 5660 2200 2400 2600 5660 1600 1800 2200 6165 2000 2400 2600 6165 1600 1800 2000 6670 2000 2200 2600 6670 1600 1800 2000 7175 2000 2200 2600 7175 1600 1800 2000 76 and up 2000 2000 2400 76 and up 1600 1800 2000

*Calorie levels are based on the Estimated Energy Requirements (EER) and activity levels from the Institute of Medicines Report on DietaryReference IntakesMacro Nutrients, 2002. Sedentary = less than 30 minutes a day of moderate physical activity in addition to daily activities. Mod. active = at least 30 minutes up to 60 minutes a day of moderate physical activity in addition to daily activities. Active = 60 or more minutes a day of moderate physical activity in addition to daily activities.


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TABLE 1-4 Sample Weekly Sample Menus for a Daily 2000 Calorie Intake Diet

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

BREAKFAST

Breakfast burrito 1 flour tortilla

(7 diameter)1 scrambled egg

(in 1 tsp softmargarine)

13 cup blackbeans*

2 tbsp salsa1 cup orange

juice1 cup fat-free

milk

LUNCH

Roast beef sandwich

1 whole grainsandwich bun

3 ounces lean roastbeef

2 slices tomato14 cup shredded ro-

maine lettuce18 cup sauteed

mushrooms (in1 tsp oil)

1 12 ounce part-skim mozzarellacheese

1 tsp yellowmustard

34 cup baked potatowedges*

1 tbsp ketchup 1 unsweetened

beverage

DINNER

Stuffed broiledsalmon

5 ounce salmonfilet

1 ounce breadstuffing mix

1 tbsp choppedonions

1 tbsp dicedcelery

2 tsp canola oil12 cup saffron

(white) rice1 ounce slivered

almonds12 cup steamed

broccoli1 tsp soft

margarine1 cup fat-free

milk

BREAKFAST

Hot cereal 12 cup cooked

oatmeal2 tbsp raisins1 tsp soft

margarine12 cup fat-free

milk1 cup orange juice

LUNCH

Taco salad2 ounces tortilla

chips2 ounces ground

turkey, sauteedin 2 tsp sun-flower oil

12 cup blackbeans*

12 cup iceberg lettuce

2 slices tomato1 ounce low-fat

cheddar cheese2 tbsp salsa12 cup avocado1 tsp lime juice1 unsweetened

beverage

DINNER

Spinach lasagna1 cup lasagna

noodles, cooked(2 oz dry)

23 cup cookedspinach

12 cup ricottacheese

12 cup tomatosauce tomatobits*

1 ounce part-skimmozzarellacheese

1 ounce wholewheat dinnerroll

1 cup fat-free milk

BREAKFAST

Cold cereal1 cup bran flakes1 cup fat-free

milk1 small banana1 slice whole

wheat toast1 tsp soft

margarine1 cup prune juice

LUNCH

Tuna fishsandwich

2 slices rye bread3 ounces tuna

(packed inwater, drained)

2 tsp mayonnaise1 tbsp diced

celery14 cup shredded

romainelettuce

2 slices tomato1 medium pear1 cup fat-free

milk

DINNER

Roasted chickenbreast

3 ounces bonelessskinlesschicken breast*

1 large bakedsweet potato

12 cup peas andonions

1 tsp softmargarine

1 ounce wholewheat dinnerroll

1 tsp softmargarine

1 cup leafy greenssalad

3 tsp sunfloweroil and vinegardressing

BREAKFAST

1 whole wheatEnglish muffin

2 tsp softmargarine

1 tbsp jam orpreserves

1 mediumgrapefruit

1 hard-cookedegg

1 unsweetenedbeverage

LUNCH

White bean-vegetable soup

1 14 cup chunkyvegetable soup

12 cup whitebeans*

2 ouncebreadstick

8 baby carrots1 cup fat-free

milk

DINNER

Rigatoni withmeat sauce

1 cup rigatonipasta (2 ouncesdry)

12 cup tomatosauce tomatobits*

2 ounces extralean cookedground beef(sauteed in 2tsp vegetableoil)

3 tbsp gratedParmesancheese

Spinach salad1 cup baby

spinach leaves12 cup tangerine

slices

BREAKFAST

Cold cereal1 cup shredded

wheat cereal1 tbsp raisins1 cup fat-free milk1 small banana1 slice whole

wheat toast1 tsp soft

margarine1 tsp jelly

LUNCH

Smoked turkeysandwich

2 ounces wholewheat pitabread

14 cup romainelettuce

2 slices tomato3 ounces sliced

smoked turkeybreast*

1 tbsp mayo-typesalad dressing

1 tsp yellowmustard

12 cup apple slices1 cup tomato

juice*

DINNER

Grilled top loinsteak

5 ounces grilledtop loin steak

34 cup mashed po-tatoes

2 tsp softmargarine

12 cup steamedcarrots

1 tbsp honey2 ounces whole

wheat dinnerroll

1 tsp softmargarine

1 cup fat-free milk

BREAKFAST

French toast2 slices whole

wheat Frenchtoast

2 tsp softmargarine

2 tbsp maplesyrup

12 medium grape-fruit

1 cup fat-freemilk

LUNCH

Vegetarian chilion bakedpotato

1 cup kidneybeans*

12 cup tomatosauce w/tomato tidbits*

3 tbsp choppedonions

1 ounce lowfatcheddar cheese

1 tsp vegetable oil1 medium baked

potato12 cup cantaloupe34 cup lemonade

DINNER

Hawaiian pizza2 slices cheese

pizza1 ounce canadian

bacon14 cup pineapple2 tbsp

mushrooms2 tbsp chopped

onionsGreen salad1 cup leafy greens3 tsp sunflower

oil and vinegardressing

1 cup fat-freemilk

BREAKFAST

Pancakes3 buckwheat

pancakes2 tsp soft

margarine3 tbsp maple

syrup12 cup

strawberries34 cup honey-

dew melon12 cup fat-free

milk

LUNCH

Manhattanclam chowder

3 ounces canned clams (drained)

34 cup mixed vegetables

1 cup cannedtomatoes*

10 whole wheatcrackers*

1 medium orange

1 cup fat-freemilk

DINNER

Vegetable stir-fry

4 ounces tofu(firm)

14 cup green and red bellpeppers

12 cup bok choy

2 tbsp vegetableoil

1 cup brown rice

1 cup lemon-flavored icedtea

(continues)

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TABLE 1-4 (continued)Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

SNACKS

1 cup can-taloupe

*Starred items are foods that are labeled as no-salt-added, low-sodium, or low-salt versions of the foods. They can also be prepared fromscratch with little or no added salt. All other foods are regular commercial products that contain variable levels of sodium. Average sodiumlevel of the 7 day menu assumes no-salt-added in cooking or at the table.


SNACKS12 ounce dry-

roastedalmonds*

14 cup pineapple2 tbsp raisins

SNACKS14 cup dried

apricots1 cup low-fat

fruited yogurt

12 ounce choppedwalnuts

3 tsp sunfloweroil and vinegardressing

1 cup fat-freemilk

SNACKS

1 cup low-fatfruited yogurt

SNACKS

1 cup low-fatfruited yogurt

SNACKS

5 whole wheatcrackers*

18 cup hummus12 cup fruit cock-

tail (in water orjuice)

SNACKS

1 ounce sun-flower seeds*

1 large banana1 cup low-fat

fruited yogurt

Total Grains (ozeq) 6.0Whole Grains 3.4Refined Grains 2.6Total Veg* (cups) 2.6Fruits (cups) 2.1Milk (cups) 3.1Meat/Beans (ozeq) 5.6Oils (tsp/grams) 7.2 tsp/32.4 g

CaloriesProtein, gProtein, % kcalCarbohydrate, gCarbohydrate, % kcalTotal fat, gTotal fat, % kcalSaturated fat, gSaturated fat, % kcalMonounsaturated fat, gPolyunsaturated fat, gLinoleic Acid, gAlpha-linolenic Acid, gCholesterol, mgTotal dietary fiber, gPotassium, mgSodium, mg*Calcium, mgMagnesium, mg Copper, mgIron, mgPhosphorus, mgZinc, mgThiamin, mgRiboflavin, mgNiacin Equivalents, mgVitamin B6, mgVitamin B12, mcgVitamin C, mgVitamin E, mg (AT)Vitamin A, mcg (RAE)Dietary Folate Equivalents, mcg

19949820

264536730167.0

2323211.1

20731

471519481389432

1.921

1830141.92.5

242.9

18.419018.9

1430558

TABLE 1-5 Nutrient Contribution from Weekly Menus in Table 1-4Daily Average Daily Average

Food Group Over One Week Nutrient Over One Week

GrainsVegetables*FruitsMilkMeat & BeansOils

*Vegetable subgroups (weekly totals)

Dk-Green Veg (cups) 3.3Orange Veg (cups) 2.3Beans/Peas (cups) 3.0Starchy Veg (cups) 3.4

Other Veg (cups) 6.6

Source: Courtesy of USDA.

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specific daily amounts from each food group and a limitfor discretionary calories (fats, added sugars, alcohol).Their food plan is one of the 12 calorie levels of the foodintake patterns from the Dietary Guidelines. Visitors tothe Web site can print out a personalized miniposter oftheir plan and a worksheet to help them track theirprogress and choose goals for tomorrow and the future.

FOOD EXCHANGE LISTSThe Food Exchange Lists are the basis of a meal plan-ning system designed by the American DieteticAssociation and the American Diabetes Association. Theyare based upon principles of good nutrition for everyone.There are 11 lists, of which the last one is alcohol. Forsome lists, each contributes an approximate level of nu-trients for each food: calories, carbohydrates, proteins,and fats. For others, the contribution of nutrients varieswithin or between lists. Every time you replace one fooditem with another item in the same or different list, youknow approximately the change in levels of nutrients youwill be consuming.

Choices from each group balance the meal. Healthpractitioners use the exchange system because it is aneasy tool to work with and teaches food selection in apractical way. It also meets the guidelines for limitingsaturated fat and cholesterol intake.

The associations revise and update the exchange sys-tem regularly to reflect current nutrition research andthe national dietary guidelines for health promotion andreduction of chronic disease risk factors as new informa-tion becomes available.

The 2007 edition of the Food Exchange Lists contin-ues the basic principles of 2003 edition, arranging thefood groups into 11 broad categories or listed based ontheir nutrient content. Subcategories that appear withinthese categories provide additional information to assistclients in choosing more healthful foods, as well as morechoices. They reflect todays consumers changing di-etary habits and lifestyles. The 11 lists in this documentare described below, with alcohol as the last category:

Starch listBreadCereals and grainsCrackers and snacksStarchy vegetablesBeans, peas, and lentils

Sweets, desserts, and other carbohydrates listBeverages, sodas, and energy/sports drinks;

brownies, cake, cookies, gelatin, pie, and pudding

Candy, spreads, sweets, sweeteners, syrups, and toppings

Condiments and saucesDoughnuts, muffins, pastries, and sweet breads

Frozen bars, frozen desserts, frozen yogurt, and ice cream

Granola bars, meal replacement bars/shakes, and trail mix

Fruit listFruitsFruit juices

Vegetables (nonstarchy) listMeat and meat substitutes list

Lean meatMedium-fat meatHigh-fat meatPlant-based proteins (for beans, peas, and lentils,

see starch list)Milk list

Fat-free and low-fat milkReduced fatWhole milkDairy-like foods

Fat listMonounsaturated fats listPolyunsaturated fats listSaturated fats list

Fast-foods listBreakfast sandwichesMain dishes/entreesOrientalPizzasSandwichesSaladsSides/appetizersDesserts

Combination foods listEntresFrozen entres/mealsSalads (deli-style)Soups

Free foods listLow-carbohydrate foodsModified-fat foods with carbohydrateCondimentsFree snacksDrinks/mixes

Alcohol list

Chapter 18 and Appendix F provide more details on these lists concerning food, nutrient data, andapplications.

RESPONSIBILITIES OF HEALTH PERSONNEL1. Assume responsibility for ones own health through

changes in eating habits and lifestyle patterns.2. Select, prepare, and consume an adequate diet.3. Promote good eating habits for all age groups.

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4. Use appropriate guidelines when teaching clients re-garding food selection.

5. Facilitate healthy lifestyles by en

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