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Nutrition, Health and Disease - A Lifespan Approach

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Bringing together key topics in basic science, clinical nutrition, and public health, Nutrition, Health and Disease is an easy-to-read, student-friendly textbook which clearly demonstrates how the body's demand for nutrients changes throughout life, and thus the variety of ways in which nutrition and diet affect health and disease.The second edition of this successful text includes:* Expanded introductory material to ensure a firm grasp of key concepts* New content on vegetarian, vegan, kosher and other alternative diets* Dieting in adults* Gender and nutrition* Macro- and micronutrients* A range of new diagrams to support visual learners* Background on nutritional epidemiology and statistics.Nutrition, Health and Disease: A Lifespan Approach is an ideal resource for the range of material a student or newly-qualified nutrition or dietetics professional needs to know.

List of contents

Preface xiiAcknowledgements xiiiAbout the companion website xviAbbreviations xviiGlossary of terms used in this book xviii1 Introduction to lifespan nutrition 11.1 The lifespan approach to nutrition 11.2 The concept of balance 21.2.1 A supply and demand model 21.2.2 Overnutrition 21.2.3 Undernutrition Increased demand The metabolic response to trauma Compromised supply and deficiency Malnutrition 61.2.4 Classical balance studies 81.2.5 Overall nutritional status 91.3 The individual response to nutrition 101.3.1 Stage of the lifespan 101.3.2 Genetics 121.4 Assessment of nutritional status 131.4.1 Anthropometric measures 141.4.2 Estimating dietary intakes Indirect measures Direct measures Dietary recall methods Food record methods Food frequency questionnaire methods 171.4.3 Biomarkers of nutritional status 181.4.4 Clinical examination 201.5 Nutritional epidemiology: Understanding diet-disease relationships 201.5.1 Cause and effect 201.5.2 Bias and confounding 211.5.3 Quantifying the relationship between diet and disease 221.5.4 Study designs in nutritional epidemiology Ecological studies Cross?]sectional studies Case-control studies Cohort studies RCTs Systematic review and meta?]analysis 271.6 Dietary reference values 281.6.1 The UK DRV system 281.6.2 DRVs in other countries 312 Before life begins 352.1 Introduction 352.2 Nutrition and female fertility 362.2.1 Determinants of fertility and infertility 362.2.1.1 The endocrine control of female reproduction 362.2.1.2 Disordered reproductive cycling 372.2.1.3 PCOS 382.2.2 Importance of body fat 392.2.3 Role of leptin 392.2.4 Antioxidant nutrients 412.2.5 Caffeine and alcohol 432.3 Nutrition and male fertility 442.3.1 Determinants of fertility and infertility 442.3.2 Obesity 462.3.3 Alcohol 472.3.4 Zinc 482.3.5 Antioxidant nutrients 482.3.6 Selenium 492.3.7 Phytoestrogens and environmental oestrogens 492.3.7.1 Phthalates 502.3.7.2 Phytoestrogens 502.3.7.3 Pesticides 512.4 Preparation for pregnancy 522.4.1 Why prepare for pregnancy? 522.4.2 Maternal weight management 522.4.3 Vitamin A and liver 522.4.4 Folic acid and neural tube defects 542.4.4.1 Supplementation with folic acid 552.4.4.2 Fortification with folic acid 553 Pregnancy 613.1 Introduction 613.2 Physiological demands of pregnancy 623.2.1 Maternal weight gain and body composition changes 633.2.2 Blood volume expansion and cardiovascular changes 633.2.3 Renal changes 643.2.4 Respiratory changes 643.2.5 Gastrointestinal changes 653.2.6 Metabolic adaptations 653.3 Nutrient requirements in pregnancy 663.3.1 Energy protein and lipids 663.3.2 Micronutrients 683.3.2.1 Iron 683.3.2.2 Calcium and other minerals 693.3.2.3 Vitamin D 703.4 Diet in relation to pregnancy outcomes 713.4.1 Miscarriage and stillbirth 713.4.2 Premature labour 723.4.2.1 Pre?]pregnancy BMI and pregnancy weight gain 723.4.2.2 Alcohol and caffeine consumption 733.4.2.3 Oral health 743.4.3 Hypertensive disorders of pregnancy 763.4.3.1 The aetiology of PE 773.4.3.2 Nutrition?]related factors and PE 773.4.4 Abnormal labour 793.5 Nausea and vomiting of pregnancy 793.5.1 Nausea and vomiting of pregnancy as a normal physiological process 793.5.2 Hyperemesis gravidarum 813.6 Cravings and aversions 823.6.1 Pica 833.7 Gastrointestinal disturbances in pregnancy 843.8 High?]risk pregnancies 843.8.1 Gestational diabetes 843.8.2 Multiple pregnancies 863.8.3 Foetal alcohol spectrum disorders 874 Fetal nutrition and disease in later life 944.1 Introduction 944.2 The developmental origins of adult disease 944.2.1 The concept of programming 944.2.2 Fetal programming and human disease 954.2.2.1 Fetal growth 954.2.2.2 Nutrition and the constraint of growth 964.2.2.3 Fetal growth health and disease 974.3 Evidence linking maternal nutrition to disease in later life 994.3.1 Epidemiology 994.3.2 Criticisms of the programming hypothesis 1024.3.3 Experimental studies 1034.3.3.1 Global undernutrition 1044.3.3.2 Micronutrients 1044.3.3.3 Macronutrients 1054.4 Mechanistic basis of fetal programming 1064.4.1 Thrifty phenotypes and genotypes 1064.4.2 Mismatched environments 1084.4.3 Tissue remodelling 1084.4.4 Endocrine imbalance 1094.4.5 Nutrient-gene interactions 1114.4.5.1 Polymorphisms in humans 1114.4.5.2 Gene expression in animals 1124.4.6 Epigenetic regulation 1134.5 Implications of the programming hypothesis 1154.5.1 Public health interventions 1154.5.2 Trans?]generational transmission of disease risk 1175 Lactation and infant feeding 1235.1 Introduction 1235.2 The physiology of lactation 1235.2.1 Anatomy of the breast 1235.2.1.1 The nipple and areola 1235.2.1.2 The lactiferous ducts 1245.2.1.3 The lactiferous sinuses 1245.2.1.4 The alveolar cells 1245.2.1.5 The rooting reflex 1245.2.2 Synthesis of milk 1245.2.2.1 Foremilk and hindmilk 1255.2.2.2 Time of day 1255.2.2.3 Course of lactation 1255.2.2.4 Synthesis of carbohydrates 1255.2.2.5 Origins of milk fats 1265.2.2.6 Milk proteins 1265.2.3 Endocrine control of lactation 1275.2.3.1 The breast during pregnancy 1275.2.3.2 Established lactation 1285.2.3.3 The breast after weaning 1285.2.4 Maintenance of lactation 1295.2.5 Nutritional demands of lactation 1295.3 The advantages of breastfeeding 1305.3.1 Advantages for the mother 1305.3.2 Advantages for the infant 1325.3.3 Recommendation to feed to 6 months 1355.4 Trends in breastfeeding behaviour 1365.4.1 Reasons why women do not breastfeed 1385.4.2 Promoting breastfeeding 1405.5 Situations in which breastfeeding is not advised 1415.6 Alternatives to breastfeeding 1435.6.1 Cow's milk formulas 1435.6.1.1 Milk stages and follow?]on milk 1445.6.2 Preterm formulas 1455.6.3 Soy formulas 1465.6.4 Hydrolysed protein and amino acid?]based formulas 1465.6.5 Other formulas 1466 Nutrition and childhood 1506.1 Introduction 1506.2 Infancy (birth to five) 1506.2.1 The key developmental milestones 1506.2.2 Nutrient requirements 1516.2.2.1 Macronutrients and energy 1526.2.2.2 Micronutrients 1546.2.3 Nutrient intakes and infants 1546.2.4 Transition to an adult pattern of food intake 1566.2.4.1 Complementary feeding 1566.2.4.2 Nutrition?]related problems 1596. Zinc deficiency 1606. Vitamin D deficiency 1606. Iron deficiency 1616. Food additives and hyperactivity 1616.2.4.3 Barriers to healthy nutrition 1626. Faddy eating 1626. Poverty 1636. The impact of advertising 1656. Restrictive dietary practices 1676.3 Childhood (5-13) 1676.3.1 Nutrient requirements of the older child 1676.3.2 School meals and the promotion of healthy eating 1686.3.3 The importance of breakfast 1696.4 Obesity in children 1706.4.1 The rising prevalence of obesity 1706.4.2 The causes of obesity in childhood 1716.4.2.1 Physical activity 1726.4.2.2 Food intake 1736.4.2.3 Genetic disorders 1756.4.3 The consequences of childhood obesity 1766.4.3.1 Immediate health consequences 1766.4.3.2 Tracking of obesity: Consequences for the future 1766.4.4 Treatment of childhood obesity 1786.4.5 Prevention of childhood obesity 1807 Nutrition and adolescence 1897.1 Introduction 1897.2 Physical development 1897.2.1 Growth rate 1897.2.2 Body composition 1907.2.3 Puberty and sexual maturation 1917.2.4 Bone growth 1937.3 Psychosocial development 1967.4 Nutritional requirements in adolescence 1977.4.1 Macronutrients and energy 1977.4.2 Micronutrients 1987.5 Nutritional intakes in adolescence 1997.5.1 Factors that influence food choice 2007.5.2 Food consumed out of the home 2017.5.3 Meal skipping and snacking 2027.6 Potential problems with nutrition 2037.6.1 Dieting and weight control 2037.6.2 The vegetarian teenager 2047.6.3 Sport and physical activity 2047.6.4 Eating disorders 2067.6.4.1 AN 2067.6.4.2 BN 2087.6.5 The pregnant teenager 2097.6.6 Alcohol 2107.6.7 Tobacco smoking 2127.6.8 Drug abuse 2138 The adult years 2198.1 Introduction 2198.2 Changing needs for nutrients 2198.3 Guidelines for healthy nutrition 2208.4 Disease states associated with unhealthy nutrition and lifestyle 2238.4.1 Obesity 2238.4.1.1 Classification of overweight and obesity 2238.4.1.2 Prevalence and trends in obesity 2238.4.1.3 Causes of obesity in adulthood 2248.4.1.4 Treatment of obesity 2248.4.2 Type 2 diabetes 2268.4.3 The metabolic syndrome 2298.4.4 Cardiovascular disease 2308.4.4.1 What is CVD? 2308. Atherosclerosis 2308. CHD 2328. Cerebrovascular disease 2328. Peripheral artery disease 2328. Hypertension 2328.4.4.2 Risk factors for CVD 2338.4.4.3 Nutrition?]related factors and risk of CVD 2338. Obesity 2338. Diabetes 2348. Dietary fat and cholesterol transport 2358. Folic acid and plasma homocysteine 2378. Antioxidant nutrients 2398. Sodium and blood pressure 2408.4.5 Cancer 2428.4.5.1 What is cancer? 2428.4.5.2 Diet is a modifiable determinant of cancer risk 2448.4.5.3 Nutritional epidemiology and cancer 2458. Ecological studies 2458. Migrant studies 2468. Studies of populations with unique characteristics 2478. Case-control studies 2478. Cohort studies 2488. Intervention studies 2488. Cancer risk is a product of the whole diet 2488.4.5.4 Dietary factors that may promote cancer 2498. Obesity 2498. Fat intake 2518. Meat 2528. Alcohol 2538. Specific carcinogens in food 2538.4.5.5 Dietary factors that may reduce cancer risk 2558. Complex carbohydrates 2558. Milk and dairy produce 2578. Antioxidant nutrients 2578. Folic acid 2598. Non?]nutrient components of plant foodstuffs 2609 Nutrition ageing and the elderly 2689.1 Introduction 2689.2 The ageing population 2689.3 The ageing process 2699.3.1 Impact on physiological systems 2699.3.2 Mechanisms of cellular senescence 2709.3.2.1 Oxidative senescence 2719.3.2.2 The role of p53 activation 2719.3.2.3 Telomere shortening 2729.3.2.4 The INK4a/ARF axis 2739.3.3 Nutritional modulation of the ageing process 2739.3.3.1 CR and lifespan 2739.3.3.2 Fetal programming of lifespan 2759.3.3.3 Supplementary antioxidants 2759.4 Nutrient requirements of the elderly 2769.4.1 Macronutrients and energy 2769.4.2 Micronutrients 2769.4.3 Specific guidelines for the elderly 2769.5 Barriers to healthy nutrition in the elderly 2779.5.1 Malnutrition and the elderly 2779.5.2 Poverty 2789.5.3 Social isolation 2789.5.4 Education 2799.5.5 Physical changes 2799.5.6 Combating malnutrition in the elderly 2799.6 Common nutrition?]related health problems 2819.6.1 Bone disorders 2819.6.1.1 Bone mineralization and remodelling 2819.6.1.2 Osteoporosis pathology and prevalence 2829.6.1.3 Risk factors for osteoporosis 2839.6.1.4 Dietary interventions for osteoporosis prevention 2849. Calcium and vitamin D 2849. Minerals and protein 2859. Phytoestrogens 2869. Caffeine 2869.6.1.5 Paget's disease of bone 2869.6.2 Immunity and infection 2869.6.3 Digestive tract disorders 2899.6.3.1 Mouth and oesophagus 2899.6.3.2 Stomach 2899.6.3.3 Small intestine 2899.6.3.4 Large intestine 2899.6.4 Anaemia 2909.6.4.1 Iron deficiency anaemia 2929.6.4.2 Vitamin B12 deficiency 2929.6.4.3 Folic acid deficiency 2939.6.4.4 Cognitive impairment and anaemia 293Appendix An introduction to the nutrients 300A.1 Classification of nutrients 300A.2 Carbohydrates 300A.2.1 Major roles 300A.2.2 Structure and classification of carbohydrates 300A.2.3 Digestion and absorption of carbohydrates 301A.3 Lipids 302A.3.1 Major roles 302A.3.2 Structure and classification of lipids 302A.3.2.1 Fatty acids 302A.3.2.2 Phospholipids and triglycerides 303A.3.3 Digestion and absorption of lipids 303A.4 Proteins 304A.4.1 Major roles 304A.4.2 Amino acids 304A.4.3 Structure of proteins 305A.4.4 Digestion and absorption of proteins 306A.5 Micronutients 306A.5.1 Minerals 306A.5.2 Vitamins 308Index 309

About the author

Simon Langley-Evans is Deputy Head of School of Biosciences & Professor of Human Nutrition, Faculty of Science, University of Nottingham, Nottingham, UK.


Bringing together key topics in basic science, clinical nutrition, and public health, Nutrition, this book clearly demonstrates how the body's demand for nutrients changes across throughout life and thus the variety of ways in which nutrition and diet affect health and disease. It is suitable for dietetic professionals.

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