Etextbook 978 1305627963 Nutrition For Health and Healthcare

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To my newest grandson, Cruz Kai DeBruyne. You are welcomed with so much love
and aloha.
LINDA KELLY DEBRUYNE
To my mom, Tina C. Pinna, who started me on the path to good nutritional

practices in my earliest years.
KATHRYN PINNA
iii
Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
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About the Authors
LINDA KELLY DEBRUYNE, M.S., R.D., received her B.S. and her M.S. degrees in
nutrition and food science from Florida State University. She is a founding member
of Nutrition and Health Associates, an information resource center in Tallahassee,
Florida, where her specialty areas are life cycle nutrition and fitness. Her other publica-
tions include the textbooks Nutrition and Diet Therapy and Health: Making Life Choices
and a multimedia CD-ROM called Nutrition Interactive. As a consultant for a group of
Tallahassee pediatricians, she has taught infant nutrition classes to parents. She is a reg-
istered dietitian and maintains a professional membership in the Academy of Nutrition
and Dietetics.
KATHRYN PINNA, PH.D., R.D., received her M.S. and Ph.D. degrees in nutrition
from the University of California at Berkeley. She has taught nutrition, food science,
and human biology courses in the San Francisco Bay area for over 25 years and has also
worked as an outpatient dietitian, Internet consultant, and freelance writer. Her other
publications include the textbooks Understanding Normal and Clinical Nutrition and
Nutrition and Diet Therapy. She is a registered dietitian and a member of the American
Society for Nutrition and the Academy of Nutrition and Dietetics.
Brief Contents
Chapter 1 Chapter 13
Overview of Nutrition and Health 1 Nutrition Care and Assessment 371
Digestion and Absorption 39 Nutrition Intervention and Diet–Drug
Interactions 395
Chapter 3
Carbohydrates 63 Chapter 15
Enteral and Parenteral Nutrition
Chapter 4 Support 425
Lipids 91
Chapter 16
Chapter 5 Nutrition in Metabolic and Respiratory
Protein 119 Stress 459
Energy Balance and Body Composition 141 Nutrition and Upper Gastrointestinal
Disorders 479
Chapter 7
Weight Management 167 Chapter 18
Nutrition and Lower Gastrointestinal
Chapter 8
Disorders 503
The Vitamins 193
Chapter 19
Chapter 9
Nutrition and Liver Diseases 535
Water and the Minerals 231
Chapter 20
Chapter 10
Nutrition and Diabetes Mellitus 553
Nutrition through the Life Span: Pregnancy
and Lactation 265 Chapter 21
Nutrition and Cardiovascular
Chapter 11
Diseases 583
Nutrition through the Life Span: Infancy,
Childhood, and Adolescence 297 Chapter 22
Nutrition and Renal Diseases 611
Chapter 12
Nutrition through the Life Span: Later Chapter 23
Adulthood 343 Nutrition, Cancer, and HIV Infection 637
vii
Contents
Chapter 1 Chapter 3
Overview of Nutrition and Health 1 Carbohydrates 63
Food Choices 3 The Chemist’s View of Carbohydrates 64
The Nutrients 6 Monosaccharides 64
Six Classes of Nutrients 6 Disaccharides 65
kCalories: A Measure of Energy 7 Polysaccharides 65
Nutrient Recommendations 8 Digestion and Absorption of Carbohydrates 68
Dietary Reference Intakes 8 Regulation of Blood Glucose 68
Acceptable Macronutrient Distribution Ranges 10 Health Effects of Sugars and Alternative Sweeteners 69
National Nutrition Surveys 10 Sugars 69
Coordinating Nutrition Survey Data 11 Alternative Sweeteners: Sugar Alcohols 74
National Health Goals 11 Alternative Sweeteners: Nonnutritive Sweeteners 75
Dietary Guidelines and Food Guides 12 Health Effects of Starch and Dietary Fibers 77
Dietary Ideals 12 Carbohydrates: Disease Prevention
Dietary Guidelines for Americans 13 and Recommendations 77
Fitness Guidelines 16 Carbohydrates: Food Sources 80
The USDA Food Patterns 17 Carbohydrates: Food Labels and Health Claims 82
MyPlate 24 NUTRITION IN PRACTICE The Glycemic Index in Nutrition
Food Labels 24 Practice 86
The Ingredient List 24
Nutrition Facts Panel 25
Claims on Labels 27 Chapter 4
NUTRITION IN PRACTICE Finding the Truth about Nutrition 34 Lipids 91
Roles of Body Fat 92
Chapter 2 The Chemist’s View of Lipids 93
Triglycerides 93
Digestion and Absorption 39 Fatty Acids 94
Anatomy of the Digestive Tract 40 Phospholipids 97
The Digestive Organs 40 Sterols 97
The Involuntary Muscles and the Glands 42 Digestion and Absorption of Lipids 98
The Process of Digestion 45 Health Effects and Recommended Intakes of Fats 98
Digestion in the Mouth 45 Fats and Heart Health 99
Digestion in the Stomach 46 Recommendations 102
Digestion in the Small and Large Intestines 46
Fats in Foods 103
The Absorptive System 47 Finding the Fats in Foods 104
The Small Intestine 48 Cutting Solid Fats and Choosing Unsaturated Fats 106
Absorption of Nutrients 48
NUTRITION IN PRACTICE Figuring Out Fats 113
Transport of Nutrients 50
The Vascular System 50
The Lymphatic System 50 Chapter 5
Transport of Lipids: Lipoproteins 50
Protein 119
The System at Its Best 53
The Chemist’s View of Proteins 120
NUTRITION IN PRACTICE Food Safety 55
The Structure of Proteins 120
Nonessential and Essential Amino Acids 121
ix
Protein Digestion and Absorption 122 Reasonable Strategies for Weight Loss 176
Protein Turnover and Nitrogen Balance 122 A Healthful Eating Plan 177
Protein Turnover 122 Physical Activity 179
Nitrogen Balance 123 Behavior and Attitude 181
Weight Maintenance 183
Roles of Body Proteins 123
Strategies for Weight Gain 184
Protein and Health 126
Protein Deficiency 126 NUTRITION IN PRACTICE Fad Diets 190
Malnutrition 127
Protein Excess 128 Chapter 8
Protein and Amino Acid Supplements 129
Protein Recommendations and Intakes 130 The Vitamins 193
The Vitamins—An Overview 194
Protein in Foods 131
Protein Quality 131 The Fat-Soluble Vitamins 196
Protein Sparing 132 Vitamin A and Beta-Carotene 196
Protein on Food Labels 132 Vitamin D 201
Vitamin E 205
NUTRITION IN PRACTICE Vegetarian Diets 135
Vitamin K 206
The Water-Soluble Vitamins 208
Chapter 6 The B Vitamins 209
Energy Balance and Body Composition 141 Thiamin 210
Riboflavin 210
Energy Imbalance 142
Niacin 211
Feasting 142
Pantothenic Acid and Biotin 212
The Economics of Fasting 143
Vitamin B6 212
Energy Balance 145 Folate 213
Energy In 145 Vitamin B12 214
Energy Out 146 Non-B Vitamins 216
Estimating Energy Requirements 149 Vitamin C 216
Body Weight and Body Composition 150 NUTRITION IN PRACTICE Phytochemicals and Functional
Defining Healthy Body Weight 150 Foods 223
Body Composition 152
How Much Body Fat Is Too Much? 154
Chapter 9
Health Risks of Underweight and Obesity 154
Health Risks of Underweight 155 Water and the Minerals 231
Health Risks of Overweight and Obesity 155 Water and Body Fluids 232
Guidelines for Identifying Those at Risk from Obesity 156 Water Balance 232
Other Risks of Obesity 156 Fluid and Electrolyte Balance 234
NUTRITION IN PRACTICE Eating Disorders 160 Acid-Base Balance 235
The Major Minerals 235
Sodium 236
Chapter 7 Chloride 238
Weight Management 167 Potassium 238
Causes of Obesity 168 Calcium 239
Genetics and Weight 168 Phosphorus 243
Environmental Stimuli 171 Magnesium 244
Sulfate 244
Obesity Treatment: Who Should Lose? 173
The Trace Minerals 245
Inappropriate Obesity Treatments 173 Iron 245
Over-the-Counter Weight-Loss Products 174 Zinc 250
Other Gimmicks 174 Selenium 252
Aggressive Treatments of Obesity 174 Iodine 253
Obesity Drugs 175 Copper 254
Surgery 176 Manganese 254
x Contents
Fluoride 254 Energy and Nutrient Needs 328
Chromium 255 Food Choices and Health Habits 329
Other Trace Minerals 255 NUTRITION IN PRACTICE Childhood Obesity and the Early
NUTRITION IN PRACTICE Vitamin and Mineral Development of Chronic Diseases 337
Supplements 261
Chapter 12
Chapter 10
Nutrition through the Life Span: Later
Nutrition through the Life Span: Pregnancy Adulthood 343
and Lactation 265 Nutrition and Longevity 344
Pregnancy: The Impact of Nutrition on the Future 266 Slowing the Aging Process 345
Nutrition Prior to Pregnancy 266 Nutrition and Disease Prevention 347
Prepregnancy Weight 266 Nutrition-Related Concerns during Late Adulthood 348
Healthy Support Tissues 267 Cataracts and Macular Degeneration 348
The Events of Pregnancy 268 Arthritis 348
Nutrient Needs during Pregnancy 270 The Aging Brain 349
Food Assistance Programs 276
Weight Gain 276 Energy and Nutrient Needs during Late Adulthood 351
Weight Loss after Pregnancy 278 Energy and Energy Nutrients 352
Physical Activity 278 Vitamins and Minerals 354
Common Nutrition-Related Concerns of Pregnancy 279 Nutrient Supplements for Older Adults 355
Problems in Pregnancy 280 The Effects of Drugs on Nutrients 356
Practices to Avoid 281 Food Choices and Eating Habits of Older Adults 356
Adolescent Pregnancy 285 Individual Preferences 357
Breastfeeding 286 Meal Setting 357
Nutrition during Lactation 286 Depression 357
Contraindications to Breastfeeding 288 Food Assistance Programs 357
Meals for Singles 358
NUTRITION IN PRACTICE Encouraging Successful
Breastfeeding 294 NUTRITION IN PRACTICE Hunger and Community Nutrition 365
Nutrition through the Life Span: Infancy, Nutrition Care and Assessment 371
Childhood, and Adolescence 297 Nutrition in Health Care 372
How Illness Affects Nutrition Status 372
Nutrition of the Infant 298 Responsibility for Nutrition Care 373
Nutrient Needs during Infancy 298 Identifying Risk for Malnutrition 374
Breast Milk 300 The Nutrition Care Process 376
Infant Formula 303
The Transition to Cow’s Milk 304 Nutrition Assessment 377
Introducing First Foods 305 Historical Information 377
Looking Ahead 307 Dietary Assessment 378
Mealtimes 307 Anthropometric Data 381
Biochemical Analyses 384
Nutrition during Childhood 308 Physical Examination 387
Energy and Nutrient Needs 308
Hunger and Malnutrition in Children 312 NUTRITION IN PRACTICE Nutritional Genomics 391
Lead Poisoning in Children 313
Food Allergy 314 Chapter 14
Hyperactivity 316
Childhood Obesity 317 Nutrition Intervention and Diet–Drug
Mealtimes at Home 322 Interactions 395
Nutrition at School 325 Implementing Nutrition Care 396
Nutrition during Adolescence 327 Care Planning 396
Growth and Development during Adolescence 328 Approaches to Nutrition Care 398
Contents xi
Dietary Modifications 400 Nutrition Treatment of Acute Stress 463
Energy Intakes in Hospital Patients 400 Determining Nutritional Requirements 464
Modified Diets 401 Approaches to Nutrition Care in Acute Stress 466
Variations in the Diet Order 404 Nutrition and Respiratory Stress 467
Foodservice 406 Chronic Obstructive Pulmonary Disease 467
Food Selection 406 Respiratory Failure 470
Food Safety 407 NUTRITION IN PRACTICE Multiple Organ Dysfunction
Improving Food Intake 407 Syndrome 476
Diet–Drug Interactions 408
Drug Effects on Food Intake 408
Drug Effects on Nutrient Absorption 409 Chapter 17
Dietary Effects on Drug Absorption 410 Nutrition and Upper Gastrointestinal
Drug Effects on Nutrient Metabolism 410
Disorders 479
Dietary Effects on Drug Metabolism 411
Drug Effects on Nutrient Excretion 412 Conditions Affecting the Mouth and Esophagus 480
Dietary Effects on Drug Excretion 412 Dry Mouth 480
Drug–Nutrient Interactions and Toxicity 413 Dysphagia 480
Gastroesophageal Reflux Disease 484
NUTRITION IN PRACTICE Complementary and Alternative
Therapies 417 Conditions Affecting the Stomach 486
Dyspepsia 487
Nausea and Vomiting 487
Chapter 15 Gastritis 488
Peptic Ulcer Disease 488
Enteral and Parenteral Nutrition
Gastric Surgery 490
Support 425 Gastrectomy 490
Enteral Nutrition 426 Bariatric Surgery 493
Oral Supplements 426
NUTRITION IN PRACTICE Nutrition and Oral Health 499
Candidates for Tube Feedings 427
Tube Feeding Routes 427
Enteral Formulas 430 Chapter 18
Administration of Tube Feedings 434
Medication Delivery during Tube Feedings 437 Nutrition and Lower Gastrointestinal
Tube Feeding Complications 437 Disorders 503
Transition to Table Foods 439 Common Intestinal Problems 504
Parenteral Nutrition 440 Constipation 504
Candidates for Parenteral Nutrition 440 Intestinal Gas 506
Venous Access 440 Diarrhea 506
Parenteral Solutions 441 Malabsorption 508
Administering Parenteral Nutrition 445 Fat Malabsorption 508
Managing Metabolic Complications 446 Bacterial Overgrowth 512
Nutrition Support at Home 448 Lactose Intolerance 512
Candidates for Home Nutrition Support 448 Disorders of the Pancreas 513
Planning Home Nutrition Care 448 Pancreatitis 513
Quality-of-Life Issues 449 Cystic Fibrosis 515
NUTRITION IN PRACTICE Inborn Errors of Metabolism 454 Disorders of the Small Intestine 516
Celiac Disease 516
Inflammatory Bowel Diseases 519
Chapter 16 Short Bowel Syndrome 522
Nutrition in Metabolic and Respiratory Disorders of the Large Intestine 524
Stress 459 Irritable Bowel Syndrome 524
The Body’s Responses to Stress and Injury 460 Diverticular Disease of the Colon 525
Hormonal Responses to Stress 461 Colostomies and Ileostomies 526
The Inflammatory Response 461 NUTRITION IN PRACTICE Probiotics and Intestinal Health 532
xii Contents
Chapter 19 Stroke 595
Nutrition and Liver Diseases 535 Stroke Prevention 596
Stroke Management 596
Fatty Liver and Hepatitis 536
Fatty Liver 536 Hypertension 597
Hepatitis 536 Factors That Influence Blood Pressure 597
Factors That Contribute to Hypertension 598
Cirrhosis 538 Treatment of Hypertension 598
Consequences of Cirrhosis 539
Treatment of Cirrhosis 542 Heart Failure 602
Nutrition Therapy for Cirrhosis 542 Consequences of Heart Failure 602
Medical Management of Heart Failure 603
Liver Transplantation 546
NUTRITION IN PRACTICE Helping People with Feeding
NUTRITION IN PRACTICE Alcohol in Health and Disease 550 Disabilities 608
Nutrition and Diabetes Mellitus 553 Nutrition and Renal Diseases 611
Overview of Diabetes Mellitus 554 Nephrotic Syndrome 613
Symptoms of Diabetes Mellitus 554 Consequences of Nephrotic Syndrome 613
Diagnosis of Diabetes Mellitus 555 Treatment of Nephrotic Syndrome 613
Types of Diabetes Mellitus 555
Prevention of Type 2 Diabetes Mellitus 557 Acute Kidney Injury 616
Acute Complications of Diabetes Mellitus 557 Causes of Acute Kidney Injury 616
Chronic Complications of Diabetes Mellitus 559 Consequences of Acute Kidney Injury 616
Treatment of Acute Kidney Injury 617
Treatment of Diabetes Mellitus 561
Treatment Goals 561 Chronic Kidney Disease 619
Evaluating Diabetes Treatment 562 Consequences of Chronic Kidney Disease 619
Nutrition Therapy: Dietary Recommendations 563 Treatment of Chronic Kidney Disease 621
Nutrition Therapy: Meal-Planning Strategies 565 Kidney Transplants 626
Insulin Therapy 567 Kidney Stones 628
Antidiabetic Drugs 571 Formation of Kidney Stones 628
Physical Activity and Diabetes Management 571 Consequences of Kidney Stones 629
Sick-Day Management 573 Prevention and Treatment of Kidney Stones 629
Diabetes Management in Pregnancy 573 NUTRITION IN PRACTICE Dialysis 634
Pregnancy in Type 1 or Type 2 Diabetes 574
Gestational Diabetes 575
Chapter 23
NUTRITION IN PRACTICE Metabolic Syndrome 579
Nutrition, Cancer, and HIV Infection 637
Cancer 638
Chapter 21 How Cancer Develops 638
Nutrition and Cardiovascular Diseases 583 Nutrition and Cancer Risk 639
Atherosclerosis 584 Consequences of Cancer 641
Consequences of Atherosclerosis 585 Treatments for Cancer 642
Causes of Atherosclerosis 585 Nutrition Therapy for Cancer 644
Coronary Heart Disease 586 HIV Infection 649

Symptoms of Coronary Heart Disease 586 Prevention of HIV Infection 649
Evaluating Risk for Coronary Heart Disease 587 Consequences of HIV Infection 649
Lifestyle Management to Reduce CHD Risk 588 Treatments for HIV Infection 651
Vitamin Supplementation and CHD Risk 591 Nutrition Therapy for HIV Infection 653
Lifestyle Changes for Hypertriglyceridemia 593 NUTRITION IN PRACTICE Ethical Issues in Nutrition Care 659
Drug Therapies for CHD Prevention 593
Treatment of Heart Attack 595
Contents xiii
Appendix A Table of Food Composition A-2 Chapter 17
Appendix B WHO: Nutrition Recommendations Woman with GERD 486
Canada: Guidelines and Meal Planning B Nutrition Care after Gastric Surgery 493
Nutrition Recommendations from WHO B Chapter 18
Eating Well with Canada’s Food Guide B Patient with Short Bowel Syndrome 523
Beyond the Basics: Meal Planning for Healthy Eating, Young Adult with Irritable Bowel Syndrome 525
Diabetes Prevention and Management B-7 Chapter 19
Appendix C Choose Your Foods: Food Lists for Man with Cirrhosis 545
Diabetes C-1 Chapter 20
The Food Lists C-1 Child with Type 1 Diabetes 574
Serving Sizes C-1 Woman with Type 2 Diabetes 576
The Foods on the Lists C-1
Controlling Energy, Fat, and Sodium C-2 Chapter 21
Planning a Healthy Diet C-3 Patient with Cardiovascular Disease 602
Appendix D Physical Activity and Energy Chapter 22

Requirements D-1 Woman with Acute Kidney Injury 619
Man with Chronic Kidney Disease 626
Appendix E Nutrition Assessment: Supplemental
Information E-1 Chapter 23
Weight Gain during Pregnancy E-1 Woman with Cancer 648
Growth Charts E-1 Man with HIV Infection 655
Measures of Body Fat and Lean Tissue E-2
Nutritional Anemias E-8 How To Features
Cautions about Nutrition Assessment E-12 Chapter 1
Appendix F Aids to Calculation F-1 Calculate the Energy a Food Provides 7
Conversion Factors F-1 Chapter 3
Percentages F-1 Reduce Intakes of Added Sugars 72
Weights and Measures F-2
Chapter 4
Appendix G Enteral Formulas G Make Heart-Healthy Choices—by Food Group 106
Appendix H Answers to Self Check Questions H-1 Chapter 5
Glossary GL-1 Calculate Recommended Protein Intakes 130
Index I-1 Chapter 6
Estimate Energy Requirements 150
Case Studies Chapter 7
Apply Behavior Modification to Manage Body Fatness 182
Chapter 10
Woman in Her First Pregnancy 288 Chapter 8
Estimate Dietary Folate Equivalents 214
Chapter 11
Boy with Disruptive Behavior 317 Chapter 9
Cut Salt Intake 237
Chapter 12 Add Calcium to Daily Meals 243
Elderly Man with a Poor Diet 358 Add Iron to Daily Meals 251
Nutrition Screening and Assessment 388 Protect against Lead Toxicity 314
Implementing Nutrition Care 399 Turn Convenience Foods into Nutritious Meals 360
Chapter 15 Stretch Food Dollars and Reduce Waste 367
Injured Hiker Requiring Enteral Nutrition Support 439 Chapter 13
Patient with Intestinal Disease Requiring Parenteral Measure Length and Height 382
Nutrition 447 Measure Weight 383
Chapter 16 Estimate and Evaluate Changes in Body Weight 384
Patient with a Severe Burn 467
Elderly Man with Emphysema 471
xiv Contents
Chapter 14 Alter the Diet to Reduce Symptoms of Dumping
Estimate Appropriate Energy Intakes for Hospital Syndrome 492
Patients 401 Alter Dietary Habits to Achieve and Maintain Weight Loss after
Help Hospital Patients Improve Their Food Intakes 407 Bariatric Surgery 495
Prevent Diet–Drug Interactions 413 Chapter 18
Chapter 15 Follow a Fat-Restricted Diet 511
Help Patients Improve Intakes with Oral Supplements 427 Chapter 19
Help Patients Cope with Tube Feedings 435 Man with Cirrhosis 545
Plan a Tube Feeding Schedule 436
Administer Medications to Patients Receiving Tube Chapter 20
Feedings 437 Use Carbohydrate Counting in Clinical Practice 566
Express the Osmolar Concentration of a Solution 441 Chapter 21
Calculate the Macronutrient and Energy Content of a Implement a Heart-Healthy Diet 592
Parenteral Solution 444 Reduce Sodium Intake 601
Estimate Energy Needs Using Disease-Specific Stress Help Patients Comply with a Renal Diet 626
Factors 464 Chapter 23
Chapter 17 Increase kCalories and Protein in Meals 645
Improve Acceptance of Mechanically Altered Foods 483 Help Patients Handle Food-Related Problems 646
Manage Gastroesophageal Reflux Disease 486
Contents xv
Preface
We are pleased to present this sixth edition and new concepts to learn. This book contains abundant
pedagogy to help students master the subject matter.
of Nutrition for Health and Health Care, which provides Within each chapter, definitions of important terms
a solid foundation in nutrition science and the role appear in the margins. How To skill boxes help readers
of nutrition in clinical care. Health professionals and work through calculations or give practical suggestions
patients alike rank nutrition among their most serious for applying nutrition advice. The Nursing Diagnosis fea-
concerns, as good nutrition status plays critical roles in ture enables nursing students to correlate nutrition care
both disease prevention and the appropriate treatment with nursing care. Review Notes summarize the informa-
of illness. Moreover, medical personnel are frequently tion following each major heading; these summaries can
called upon to answer questions about foods and diets or be used to preview or review key chapter concepts. The
provide nutrition care. Although much of the material has Self Check at the end of each chapter provides questions
been written for nursing students and is relevant to nurs- to help review chapter information. Each chapter con-
ing care, this textbook can be useful for students of other cludes with a Nutrition on the Net feature, which lists
health-related professions, including nursing assistants, websites relevant to the topics covered in the chapter.
physician assistants, dietitians, dietary technicians, and In the life cycle and clinical chapters, Case Studies
health educators. guide readers in applying nutrition therapy to patient
Each chapter of this textbook includes essential nutri- care. Diet-Drug Interaction boxes in the clinical chapters
tion concepts along with practical information for identify important nutrient-drug and food-drug interac-
addressing nutrition concerns and solving nutrition tions. Clinical Applications throughout the text encourage
problems. The introductory chapters (Chapters 1 and 2) readers to practice mathematical calculations, synthesize
provide an overview of the nutrients and nutrition recom- information from previous chapters, or understand how
mendations and describe the process of digestion and dietary adjustments affect patients. Nutrition Assessment
absorption. Chapters 3 through 5 introduce the attributes Checklists remind readers of assessment parameters
and functions of carbohydrates, lipids, and protein and relevant to specific stages of the life cycle or medical
explain how appropriate intakes of these nutrients sup- problems.
port health. Chapters 6 and 7 introduce the concepts of The Nutrition in Practice sections that follow the chap-
energy balance and weight management and describe ters explore issues of current interest, advanced topics, or
the health effects of overweight, underweight, and eating specialty areas such as dental health or dialysis. Examples
disorders. Chapters 8 and 9 introduce the vitamins and of topics covered include foodborne illness, the glycemic
minerals, describing their roles in the body, appropriate index, vegetarian diets, alcohol in health and disease,
intakes, and food sources. Chapters 10 through 12 explain nutritional genomics, metabolic syndrome, and child-
how nutrient needs change throughout the life cycle. hood obesity and chronic disease.
Chapters 13 and 14 explore how health professionals can
use information from nutrition assessments to identify
and address a patient’s dietary needs. The remaining APPENDIXES
chapters (Chapters 15–23) examine nutrition therapy and The appendixes support the book with a wealth of infor-
its role in the prevention and treatment of common medi- mation on the nutrient contents of thousands of foods,
cal conditions. Canadian nutrient recommendations and food choices,
U.S. nutrient intake recommendations, food lists for dia-
FEATURES OF THIS TEXT betes, physical activity and energy requirements, nutrition
assessments, enteral formulas, aids to calculations, and
Students of nutrition often begin a nutrition course with answers to Self Check questions.
some practical knowledge of nutrition; after all, they may
purchase food, read food labels, and be familiar with
common nutrition problems such as obesity or lactose NEW TO THIS EDITION
intolerance. After just a few weeks of class, however, the Each chapter of this book has been updated to reflect
nutrition student realizes that nutrition is a biological and advances in research and clinical practice since the fifth
chemical science with a fair amount of new terminology edition. In addition, we have made the following changes:
xvi
Chapter 1 • In the Nutrition in Practice section, defined and dis-
• Defined empty kcalories, reorganized the fitness section, cussed RED-S (relative energy deficiency in sport) from
introduced the Dietary Guidelines for Americans 2015 the International Olympic Committee to replace female
• Added a new table of nutrients of concern athlete triad
• Created a new figure showing recommended and actual
intakes of food groups Chapter 7
• Added information about microbiota and obesity and
Chapter 2 defined microbiota
• Added definition of enzymes and more information • In the Nutrition in Practice section, enhanced the
about digestive enzymes in the glossary of digestive discussion of high-protein diets for weight loss and
glands and their secretions maintenance
• Improved the discussion of LDL and HDL
• In the Nutrition in Practice section, enhanced the Chapter 8
instructions for proper hand washing based on new • Added a list of vitamins of concern from the 2015
CDC guidelines Dietary Guidelines Advisory Committee
• Enhanced the discussion of vitamin D and obesity and
Chapter 3 other disease relationships
• Enhanced the discussion of cholesterol-lowering effects
of fiber Chapter 9
• Added more information to Figure 3-5 (Characteristics, • Added a list of minerals of concern from the 2015
Sources, and Health Effects of Fibers) Dietary Guidelines Advisory Committee
• Enhanced Figure 3-6 (Fiber in Selected Foods) by add-
ing tips to increase fiber intakes Chapter 10
• Added a discussion of added sugars and diabetes • Moved the section on infancy to Chapter 11 to focus
only on nutrition for the mother during pregnancy and
Chapter 4 lactation
• Moved the table of major sources of various lipids from • Included the latest FDA and EPA guidelines on fish
the Nutrition in Practice to the chapter consumption during pregnancy
• Added a new table of omega-3 fatty acids in fish and • Added a brief discussion about choline and
seafood pregnancy
• Included a new table of fat options among milk and
milk products Chapter 11
• Updated information on dietary cholesterol restrictions • Added a discussion of the importance of zinc in
based on American Heart Association and new Dietary complementary foods for breastfed infants
Guidelines information • Created a new table listing protective factors in breast
• Emphasized the importance of overall dietary patterns milk and how they function
when reducing the intake of saturated and trans fat • Restructured and simplified table of nutrient
supplements for infants
Chapter 5 • Added a new table: USDA Nutrition Standards for
• Reorganized the malnutrition discussion Foods Sold in Schools.
• Added definitions of wasting, stunting, and marasmic
kwashiorkor Chapter 12
• Included a new How to Calculate Protein Intakes box • Enhanced the discussion of protein needs for older
• In the Nutrition in Practice section, enhanced the glos- adults
sary of vegetarian diets and added a new figure showing • In the Nutrition in Practice section, included new
vegetarian sources and equivalents for protein foods definitions for food security and food insecurity
and milk and milk products • Revised the food security questionnaire
• Included the latest information from the 2013 • Updated nursing diagnoses
American Heart Association/American College of • Added a paragraph about C-reactive protein in the
Cardiology and The Obesity Society Guidelines for the section on biochemical analyses
management of overweight and obesity in adults • Revised the discussion on fluid retention
Preface xvii
• Expanded the section on estimating energy intakes in • Revised the paragraph on nutrition treatment for
hospital patients hepatitis
• Shortened the section on foodservice • Modified some of the sections about cirrhosis
• Modified the paragraph on isoniazid and vitamin B6 in complications
the “Diet–Drug Interactions” section • Revised the sections on the medical treatment and
• Modified the table showing examples of grapefruit nutrition therapy for cirrhosis, introduced the term
juice–drug interactions transjugular intrahepatic portosystemic shunt in the
• In the Nutrition in Practice section, modified the table discussion about ascites treatment, and eliminated the
listing examples of herb–drug interactions description of the peritoneovenous shunt
• Updated the feeding tube photo • Updated statistics throughout the chapter
• Introduced the term cyclic feedings in the section on • Added a note about the types of insulin used in the
formula delivery methods Diabetes Control and Complications Trial
• Shortened the section on discontinuing parenteral • Added a margin table comparing HbA1c and plasma
nutrition glucose levels
• In the Nutrition in Practice on inborn errors, added • Revised various sections on nutrition therapy
a photo showing phenylalanine-free formula and • Added inhaled insulin and sodium-glucose cotrans-
updated the medical foods and treatments used in porter 2 (SGLT2) inhibitors to the tables listing the
phenylketonuria different types of insulin and antidiabetic drugs
• Modified the sections on insulin in type 2 diabetes, use
Chapter 16 of antidiabetic drugs, and maintaining glycemic control
• Revised the section on estimating energy needs during during exercise
acute stress • Updated several sections in the Nutrition in Practice on
• Changed the table on using disease-specific stress fac- metabolic syndrome
tors for estimating energy needs to a “How To” box • Added a figure showing how metabolic syndrome
• Emphasized the Penn State equation in the table on varies among ethnic groups and removed the figure
predictive equations used in ventilator-dependent showing how it varies with age
patients
• Modified the discussion on the use of glutamine and Chapter 21
arginine during critical illness • Revised various paragraphs in the sections on ath-
• Modified some sections on nutrition therapy for respi- erosclerosis, CHD risk assessment, CHD lifestyle
ratory failure management, hypertension, and heart failure
• Eliminated the box on assessing risk of heart disease
Chapter 17 • Updated CHD recommendations to reflect the 2013
• Modified some of the material in the sections on dump- guidelines from the American Heart Association and
ing syndrome and bariatric surgery American College of Cardiology
• Added sleeve gastrectomy to the figure on surgical pro- • Updated the section on hypertension treatment to
cedures for severe obesity reflect 2013 guidelines from the Eighth Joint National
• In the Nutrition in Practice on oral health, revised the Committee (JNC 8).
table on nutrient deficiencies and development of den-
tal caries and modified several sections related to oral Chapter 22
diseases and chronic illness. • Modified sections related to nephrotic syndrome
• Revised the table on causes of acute kidney injury
Chapter 18 • Updated the section on nutrition therapy for acute
• Revised some of the material in the sections on intesti- kidney injury
nal gas, acute and chronic pancreatitis, cystic fibrosis, • Updated the section on the evaluation of chronic kid-
celiac disease, irritable bowel syndrome, and diverticu- ney disease to reflect new clinical practice guidelines
lar disease of the colon • Clarified and updated some sections related to the
• Introduced the concept of FODMAPs and added defini- nutrition therapy for chronic kidney disease to reflect
tions of bloating and bacterial translocation current recommendations
• Eliminated the photo of gluten-free foods and added • Modified the section on prevention of calcium oxalate
photos showing the effect of celiac disease on intestinal stones
tissue • Revised the table on food sources of oxalates
xviii Preface
Chapter 23 learning platform that works alongside your campus LMS
• Rearranged and revised the sections related to the to deliver course curriculum across the range of elec-
consequences of cancer tronic devices in your life. MindTap is built on an “app”
• Introduced the term oral mucositis, modified the model allowing enhanced digital collaboration and deliv-
section on hematopoietic stem cell transplantation, and ery of engaging content across a spectrum of Cengage and
introduced the term graft-versus-host disease non-Cengage resources. Includes the Diet & Wellness
• Revised the paragraph about protein and energy intakes Plus App that helps you understand how nutrition relates
for cancer patients to your personal health goals. Track your diet and activity,
• Revised the section about food safety concerns for generate reports, and analyze the nutritional value of the
immunosuppressed cancer patients food you eat.
• Rearranged and revised some sections related to the Instructor Companion Site: Everything you need for
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Preface xix
Acknowledgments
Among the most difficult words to write are those that express the depth of our
gratitude to the many dedicated people whose efforts have made this book possible.
A special note of appreciation to Sharon Rolfes for her numerous contributions to the
chapters and Nutrition in Practice sections as well as to the Dietary Reference Intakes
on the inside front cover and the appendices. Many thanks to Fran Webb for sharing
her knowledge, ideas, and resources about the latest nutrition developments. Thanks
also to David L. Stone for his assistance with multiple sections in the clinical chap-
ters. Elesha Hyde’s critical eye, numerous suggestions, and unceasing support were
especially helpful in revising both the normal nutrition and the clinical chapters. We
also wish to acknowledge the efforts of the folks at Axxya for their assistance in creat-
ing the food composition appendix. We are indebted to our editorial team—Krista
Mastroianni, Miriam Myers, and Elesha Hyde—and our production team, especially
Carol Samet, for seeing this project through from start to finish. We would also like to
acknowledge Tom Ziolkowski for his marketing efforts. To the many others involved
in designing, indexing, typesetting, dummying, and marketing, we offer our thanks.
We are especially grateful to our associates, family, and friends for their continued
encouragement and support and to our reviewers who consistently offer excellent
suggestions for improving the text.
xx
Chapter 1 Overview of Nutrition
and Health
Chapter Sections and Learning Objectives (LOs)
1.1 Food Choices 1.5 Dietary Guidelines and Food Guides

LO1.1 Describe the factors that influence personal LO1.5 Explain how each of the dietary ideals can
food choices. be used to plan a healthy diet, and how the Dietary
Guidelines and USDA Food Patterns help make diet
1.2 The Nutrients planning easier.
LO1.2 Identify which of the major classes of
nutrients are organic and which yield energy. 1.6 Food Labels
LO1.6 Compare the information on food labels
1.3 Nutrient Recommendations to make selections that meet specific dietary and
LO1.3 Describe the four categories of the health goals.
Dietary Reference Intakes (DRI), the Estimated
Energy Requirement (EER), and the Acceptable 1.7 Nutrition in Practice: Finding the Truth
Macronutrient Distribution Ranges (AMDR). about Nutrition
LO1.7 Discuss how misinformation and reliable
1.4 National Nutrition Surveys nutrition information can be identified.
LO1.4 Describe the ways in which the kinds of
information collected by researchers from nutrition
surveys are used.
Rosenfeld/Flirt/Corbis
EVERY DAY, SEVERAL TIMES A DAY, YOU MAKE CHOICES THAT WILL EITHER
improve your health or harm it. Each choice may influence your health only a little, but
when these choices are repeated over years and decades, their effects become significant.
The choices people make each day affect not only their physical health but also their
wellness—all the characteristics that make a person strong, confident, and able to
function well with family, friends, and others. People who consistently make poor life-
style choices on a daily basis increase their risks of developing diseases. Figure 1-1 shows
how a person’s health can fall anywhere along a continuum, from maximum wellness
on the one end to total failure to function (death) on the other.
As nurses or other health care professionals, when you take responsibility for your
own health by making daily choices and practicing behaviors that enhance your well-
being, you prepare yourself physically, mentally, and emotionally to meet the demands
of your profession. As health care professionals, however, you have a responsibility to
your clients as well as to yourselves.* You have unique opportunities to make your
clients aware of the benefits of positive health choices and behaviors, to show them how
to change their behaviors and make daily choices to enhance their own health, and to
serve as role models for those behaviors.
This text focuses on how nutrition choices affect health and disease. The early chapters
introduce the basics of nutrition to promote good health and reduce disease risks. The
later chapters emphasize medical nutrition therapy and its role in supporting health and
in treating diseases and symptoms.
FIGURE 1-1 The Health Line
No matter how well you maintain your health today, you may still be able to improve
tomorrow. Likewise, a person who is well today can slip by failing to maintain health-
promoting habits.
Wellness—
optimal physical,
mental, emotional,
spiritual, and social health
Person takes responsibility Superior

for all health areas and level of
meets all needs. health
Good Person
Most people function level of covers most
near here—they meet health needs well,
needs at a minimum to but some
Person is prevent symptoms.
physically, areas lack
mentally, attention.
emotionally, Person relies on Moderate
spiritually, medicine to level of
health: a range of states with or socially treat symptoms; health
nonfunctional. needs are not
physical, mental, emotional, met.
spiritual, and social components. At a Marginal
minimum, health means freedom from level of
physical disease, mental disturbances, health
emotional distress, spiritual Death Poor
discontent, social maladjustment, and from level of
other negative states. At a maximum, disease health
health means wellness.
Person meets needs only to
wellness: maximum well-being; the reverse symptoms as they appear.
top range of health states; the goal
of the person who strives toward
realizing his or her full potential *Health care professionals generally use either client or patient when referring to an individual under their care.
physically, mentally, emotionally, The first 12 chapters of this text emphasize the nutrition concerns of people in good health; therefore, the term
spiritually, and socially. client is used in these chapters.
2 CHAPTER 1 Overview of Nutrition and Health
Food Choices
Sound nutrition throughout life does not ensure good health and long life, but
it can certainly help to tip the balance in their favor. Nevertheless, most people
choose foods for reasons other than their nourishing value. Even people who claim
to choose foods primarily for the sake of health or nutrition will admit that other
factors also influence their food choices. Because food choices become an integral
part of their lifestyles, people sometimes find it difficult to change their eating habits.
Health care professionals who help clients make diet changes must understand the
dynamics of food choices because people will alter their eating habits only if their
preferences are honored. Developing cultural competence is an important aspect of
honoring individual preferences, especially for health care professionals who help
clients to achieve a nutritious diet.1
Preference Why do people like certain foods? One reason, of course, is their
iofoto/Shutterstock.com
preference for certain tastes. Some tastes are widely liked, such as the sweet-
ness of sugar and the savoriness of salt. 2 Research suggests that genetics influ-
ence people’s taste preferences, a finding that may eventually have implications
for clinical nutrition.3 For example, sensitivity to bitter taste is an inheritable
trait. People born with great sensitivity to bitter tastes tend to avoid foods with Nutrition is only one of the many
bitter flavors such as broccoli, cabbage, brussels sprouts, spinach, and grape- factors that influence people’s food
fruit juice. These foods, as well as many other fruits and vegetables, contain choices.
bioactive food components —phytochemicals and nutrients—that may reduce
the risk of cancer. Thus, the role that genetics may play in food selection is gaining
importance in cancer research.4 Nutrition in Practice 8 addresses phytochemicals
and their role in disease prevention.
nutrition: the science of foods and
Habit Sometimes habit dictates people’s food choices. People eat a sandwich for lunch the nutrients and other substances
or drink orange juice at breakfast simply because they have always done so. Eating a they contain, and of their ingestion,
familiar food and not having to make any decisions can be comforting. digestion, absorption, transport,
metabolism, interaction, storage,
and excretion. A broader definition
Associations People also like foods with happy associations—foods eaten in the includes the study of the environment
midst of warm family gatherings on traditional holidays or given to them as children and of human behavior as it relates to
by someone who loved them. By the same token, people can attach intense and unal- these processes.
terable dislikes to foods that they ate when they were sick or that were forced on them
cultural competence: an awareness
when they weren’t hungry. and acceptance of one’s own and
others’ cultures, combined with the
Ethnic Heritage and Regional Cuisines Every country, and every region skills needed to interact effectively
of a country, has its own typical foods and ways of combining them into meals. The with people of diverse cultures.
foodways of North America reflect the many different cultural and ethnic backgrounds
of its inhabitants. Many foods with foreign origins are familiar items on North American bioactive food components:
compounds in foods (either nutrients
menus: tacos, egg rolls, lasagna, sushi, and gyros, to name a few. Still others, such as or phytochemicals) that alter
spaghetti and croissants, are almost staples in the “American diet.” North American physiological processes in the body.
regional cuisines such as Cajun and TexMex blend the traditions of several cultures.
Table 1-1 presents selected ethnic diets and food choices. phytochemicals (FIGH-toe-CHEM-
ih-cals): compounds in plants
that confer color, taste, and other
Values Food choices may reflect people’s environmental ethics, religious beliefs, and characteristics. Some phytochemicals
political views. By choosing to eat some foods or to avoid others, people make state- are bioactive food components in
ments that reflect their values. For example, people may select only foods that come functional foods. Nutrition in Practice
in containers that can be reused or recycled. A concerned consumer may boycott 8 provides details.
fruit or vegetables picked by migrant workers who have been exploited. People may foodways: the eating habits and
buy vegetables from local farmers to save the fuel and environmental costs of foods culinary practices of a people, region,
shipped from far away. Labels on some foods carry statements or symbols—known as or historical period.
ecolabels—that imply that the foods have been produced in ways that are considered
ethnic diets: foodways and cuisines
environmentally favorable. typical of national origins, races,
Religion also influences many people’s food choices. Jewish law sets forth an extensive cultural heritages, or geographic
set of dietary rules. Many Christians forgo meat on Fridays during Lent, the period locations.
Food Choices 3
TABLE 1-1 Selected Ethnic Cuisines and Food Choices
Grains Vegetables Fruits Protein Foods Milk
Asian Millet, Baby corn, bamboo Kumquats, Pork; duck and Soy milk
rice, rice shoots, bok choy, loquats, other poultry;
or wheat leafy greens (such lychee, fish, octopus,
Becky Luigart-Stayner/
Encyclopedia/Corbis
noodles as amaranth), mandarin sea urchin,

cabbages, mung oranges, squid, and
bean sprouts, melons, pears, other seafood;
scallions, seaweed, persimmon, soybeans, tofu;
snow peas, straw plums eggs; cashews,
mushrooms, water peanuts
chestnuts, wild yam
Mediterranean Bulgur, Artichokes, Berries, dates, Fish and other Feta, goat,
couscous, cucumbers, figs, grapes, seafood, mozzarella,
focaccia, eggplant, fennel, lemons, gyros, lamb, parmesan,
Italian grape leaves, leafy melons, olives, pork, sausage, provolone,
Photodisc, Inc./
Getty Images
bread, greens, leeks, oranges, chicken, fava and ricotta

pastas, onions, peppers, pomegranates, beans, lentils, cheeses;
pita pocket tomatoes raisins almonds, yogurt
bread, walnuts and yogurt
polenta, rice beverages
Mexican Hominy, Bell peppers, Avocado, Beans, refried Cheese, flan

masa cactus, cassava, bananas, beans, beef, (baked caramel
Photodisc/Getty Images
(corn flour chayote, chili guava, lemons, goat, pork, custard), milk
dough), tor- pepper, corn, limes, mango, chorizo, in beverages
Mitch Hrdlicka/
tillas (corn jicama, onions, oranges, chicken, fish,

or flour), summer squash, papaya, eggs
rice tomatoes, winter plantain
squash, yams
prior to Easter. In Islamic dietary laws, permitted or lawful foods are called
halal. Other faiths prohibit some dietary practices and promote others. Diet
planners can foster sound nutrition practices only if they respect and honor
each person’s values.
Social Interaction Social interaction is another powerful influence on

Monkey Business Images/Shutterstock.com
people’s food choices. Meals are often social events, and the sharing of food
is part of hospitality. Social customs invite people to accept food or drink
offered by a host or shared by a group—regardless of hunger signals.5 Food
brings people together for many different reasons: to celebrate a holiday or
special event, to renew an old friendship, to make new friends, to conduct
business, and many more. Sometimes food is used to influence or impress
someone. For example, a business executive invites a prospective new cli-
ent out to dinner in hopes of edging out the competition. In each case, for
Ethnic meals and family whatever the purpose, food plays an integral part of the social interaction.
gatherings nourish the spirit as
well as the body. Emotional State Emotions guide food choices and eating behaviors.6 Some people
cannot eat when they are emotionally upset. Others may eat in response to a variety of
emotional stimuli—for example, to relieve boredom or depression or to calm anxiety.
A depressed person may choose to eat rather than to call a friend. A person who has
returned home from an exciting evening out may unwind with a late-night snack. Eating
in response to emotions can easily lead to overeating and obesity but may be appropriate
at times. For example, sharing food at times of bereavement serves both the giver’s need
to provide comfort and the receiver’s need to be cared for and to interact with others as
well as to take nourishment.
Availability, Convenience, and Economy The influence of these factors on
people’s food selections is clear. You cannot eat foods if they are not available, if you
cannot get to the grocery store, if you do not have the time or skill to prepare them, or
if you cannot afford them. Consumers who value convenience frequently eat out, bring
home ready-to-eat meals, or have food delivered. Whether decisions based on conve-
nience meet a person’s nutrition needs depends on the choices made. Eating a banana
or a candy bar may be equally convenient, but the fruit provides more vitamins and
minerals and less sugar and fat.
Rising food costs have shifted some consumers’ priorities and changed their shop-
ping habits. They are less likely to buy higher-priced convenience foods and more likely
to buy less-expensive store brand items and prepare home-cooked meals. Those who
frequently prepare their own meals eat fast food less often and are more likely to meet
dietary guidelines for fat, calcium, fruits, vegetables, and whole grains. It is not sur-
prising that, when eating out, consumers choose low-cost fast-food outlets over more
expensive fine-dining restaurants. Foods eaten away from home, especially fast-food
meals, tend to be high in kcalories, sodium, saturated fat, and trans fat—which can
contribute to a variety of health problems.7
Some people have jobs that keep them away from home for days at a time, require
them to conduct business in restaurants or at conventions, or involve hectic schedules
that allow little or no time for meals at home. For these people, the kinds of restaurants
available to them and the cost of eating out so often may limit food choices.
Age Age influences people’s food choices. Infants, for example, depend on others to
choose foods for them. Older children also rely on others but become more active in
selecting foods that taste sweet and are familiar to them and rejecting those whose
taste or texture they dislike. In contrast, the links between taste preferences and food
choices in adults are less direct than in children. Adults often choose foods based on
health concerns such as body weight. Indeed, adults may avoid sweet or familiar foods
because of such concerns.
Body Weight and Image Sometimes people select certain foods and supplements
that they believe will improve their physical appearance and avoid those they believe
might be detrimental. Such decisions can be beneficial when based on sound nutrition
and fitness knowledge but may undermine good health when based on fads or carried
to extremes. Eating disorders are the topic of Nutrition in Practice 6.
Medical Conditions Sometimes medical conditions and their treatments (includ-

ing medications) limit the foods a person can select. For example, a person with heart
disease might need to adopt a diet low in certain types of fats. The chemotherapy
needed to treat cancer can interfere with a person’s appetite or limit food choices by
causing vomiting. Allergy to certain foods can also limit choices. The second half
of this text discusses how diet can be modified to accommodate different medical
conditions.
Health and Nutrition Finally, of course, many consumers make food choices
they believe will improve their health.8 Food manufacturers and restaurant chefs have
responded to scientific findings linking health with nutrition by offering an abundant
selection of health-promoting foods and beverages. Foods that provide health benefits
beyond their nutrient contributions are called functional foods.9 Whole foods—as natu-
ral and familiar as oatmeal or tomatoes—are the simplest functional foods. In other
cases, foods have been modified through fortification, enrichment, or enhancement.
Examples of these functional foods include orange juice fortified with calcium to build
strong bones, bread enriched with folate to promote normal fetal development, and functional foods: whole, fortified,
margarine enhanced with a plant sterol to lower blood cholesterol. Nutrition in Practice enriched, or enhanced foods that
have a potentially beneficial effect
8 offers more discussion of functional foods. on health when consumed as part of
Consumers typically welcome new foods into their diets, provided that these foods are a varied diet on a regular basis at
reasonably priced, clearly labeled, easy to find in the grocery store, and convenient to effective levels.
Food Choices 5
prepare. These foods must also taste good—as good as the traditional choices. Of course,
a person need not eat any “special” foods to enjoy a healthy diet; many “regular” foods
provide numerous health benefits as well. In fact, foods such as whole grains; vegetables
and legumes; fruits; lean meats, seafood, poultry, eggs, nuts, and seeds; and low-fat milk
products are among the healthiest choices a person can make.
Review Notes
• A person selects foods for many different reasons.
• Food choices influence health—both positively and negatively. Individual food
selections neither make nor break a diet’s healthfulness, but the balance of foods
selected over time can make an important difference to health.
• In the interest of health, people are wise to think “nutrition” when making their
food choices.
The Nutrients
You are a collection of molecules that move. All these moving parts are arranged in pat-
terns of extraordinary complexity and order—cells, tissues, and organs. Although the
arrangement remains constant, the parts are continually changing, using nutrients and
energy derived from nutrients.
Almost any food you eat is composed of dozens or even hundreds of different kinds
of materials. Spinach, for example, is composed mostly of water (95 percent), and most
of its solid materials are the compounds carbohydrates, fats (properly called lipids), and
proteins. If you could remove these materials, you would find a tiny quantity of miner-
als, vitamins, and other compounds.
nutrients: substances obtained from

Six Classes of Nutrients
food and used in the body to provide Water, carbohydrates, fats, proteins, vitamins, and minerals are the six classes of nutrients
energy and structural materials and to commonly found in spinach and other foods. Some of the other materials in foods, such
serve as regulating agents to promote as the pigments and other phytochemicals, are not nutrients but may still be important
growth, maintenance, and repair.
Nutrients may also reduce the risks of to health. The body can make some nutrients for itself, at least in limited quantities, but
some diseases. it cannot make them all, and it makes some in insufficient quantities to meet its needs.
Therefore, the body must obtain many nutrients from foods. The nutrients that foods
essential nutrients: nutrients must supply are called essential nutrients.
a person must obtain from food
because the body cannot make them
for itself in sufficient quantities to
Carbohydrates, Fats, and Proteins Four of the six classes of nutrients (carbohy-
meet physiological needs. drates, fats, proteins, and vitamins) contain carbon, which is found in all living things.
They are therefore organic (meaning, literally, “alive”).† During metabolism, three of
organic: in chemistry, substances these four (carbohydrates, fats, and proteins) provide energy the body can use.‡ These
or molecules containing carbon–
carbon bonds or carbon–hydrogen
energy-yielding nutrients continually replenish the energy you expend daily.
bonds. The four organic nutrients
are carbohydrate, fat, protein, and Vitamins, Minerals, and Water Vitamins are organic but do not provide energy
vitamins. to the body. They facilitate the release of energy from the three energy-yielding nutri-
ents. In contrast, minerals and water are inorganic nutrients. Minerals yield no energy
energy-yielding nutrients: the
nutrients that break down to yield
in the human body, but, like vitamins, they help to regulate the release of energy, among
energy the body can use. The their many other roles. As for water, it is the medium in which all of the body’s processes
three energy-yielding nutrients are take place.
carbohydrate, protein, and fat.
inorganic: not containing carbon

†
Note that this definition of organic excludes coal, diamonds, and a few carbon-containing compounds that
or pertaining to living organisms. contain only a single carbon and no hydrogen, such as carbon dioxide ( CO2 ) .
The two classes of nutrients that are ‡
Metabolism is the set of processes by which nutrients are rearranged into body structures or broken down to
inorganic are minerals and water. yield energy.
kCalories: A Measure of Energy
The amount of energy that carbohydrates, fats, and proteins release can be measured
in calories—tiny units of energy so small that a single apple provides tens of thousands
of them. To ease calculations, energy is expressed in 1000-calorie metric units known
as kilocalories (shortened to kcalories, but commonly called “calories”). When you
read in popular books or magazines that an apple provides “100 calories,” understand
that it means 100 kcalories. This book uses the term kcalorie and its abbreviation kcal
throughout, as do other scientific books and journals.§ kCalories are not constituents
of foods; they are a measure of the energy foods provide. The energy a food provides
depends on how much carbohydrate, fat, and protein the food contains.
Carbohydrate yields 4 kcalories of energy from each gram, and so does protein. Fat
yields 9 kcalories per gram. Thus, fat has a greater energy density than either carbohy-
drate or protein. Chapter 7 revisits energy density with regard to weight management.
If you know how many grams of carbohydrate, protein, and fat a food contains, you can
derive the number of kcalories potentially available from the food. Simply multiply the
carbohydrate grams times 4, the protein grams times 4, and the fat grams times 9, and
add the results together (Box 1-1 describes how to calculate the energy a food provides).
Energy Nutrients in Foods Most foods contain mixtures of all three energy-
yielding nutrients, although foods are sometimes classified by their predominant
nutrient. To speak of meat as “a protein” or of bread as “a carbohydrate,” however, is
inaccurate. Each is rich in a particular nutrient, but a protein-rich food such as beef con-
tains a lot of fat along with the protein, and a carbohydrate-rich food such as cornbread
also contains fat (corn oil) and protein. Only a few foods are exceptions to this rule,
the common ones being sugar (which is pure carbohydrate) and oil (which is pure fat).
calories: a measure of heat
Energy Storage in the Body The body first uses the energy-yielding nutrients to energy. Food energy is measured in
build new compounds and fuel metabolic and physical activities. Excesses are then rear- kilocalories (1000 calories equal 1
kilocalorie), abbreviated kcalories
ranged into storage compounds, primarily body fat, and put away for later use. Thus, if or kcal. One kcalorie is the amount
you take in more energy than you expend, the result is an increase in energy stores and of heat necessary to raise the
weight gain. Similarly, if you take in less energy than you expend, the result is a decrease temperature of 1 kilogram (kg) of
in energy stores and weight loss. water 18C. The scientific use of the
term kcalorie is the same as the
Alcohol, Not a Nutrient One other substance contributes energy: alcohol. The popular use of the term calorie.
body derives energy from alcohol at the rate of 7 kcalories per gram. Alcohol is not a energy density: a measure of the
nutrient, however, because it cannot support the body’s growth, maintenance, or repair. energy a food provides relative to the
Nutrition in Practice 19 discusses alcohol’s effects on nutrition. amount of food (kcalories per gram).
BOX 1-1 How to Calculate the Energy a Food Provides

To calculate the energy available from a food, multiply the To determine the percentage of kcalories from fat, for exam-
number of grams of carbohydrate, protein, and fat by 4, 4, and ple, divide the 81 fat kcalories by the total 173 kcalories:
9, respectively. Then add the results together. For example,
one slice of bread with 1 tablespoon of peanut butter on it 81 fat kcal 4 173 total kcal 5 0.468 (rounded to 0.47)
contains 16 grams of carbohydrate, 7 grams of protein, and 9 Then multiply by 100 to get the percentage:
grams of fat:
0.47 3 100 5 47%
16 g carbohydrate 3 4 kcal / g 5 64 kcal
7 g protein 3 4 kcal / g 5 28 kcal Dietary recommendations that urge people to limit fat intake
9 g fat 3 9 kcal / g 5 81 kcal to 20 to 35 percent of kcalories refer to the day’s total energy
intake, not to individual foods. Still, if the proportion of fat
Total 5 173 kcal in each food choice throughout a day exceeds 35 percent of
From this information, you can calculate the percentage of kcalories, then the day’s total surely will, too. Knowing that this
kcalories each of the energy nutrients contributes to the total. snack provides 47 percent of its kcalories from fat alerts a person
to the need to make lower-fat selections at other times that day.
§
Food energy can also be measured in kilojoules (kJ). The kilojoule is the international unit of energy. One
kcalorie equals 4.2 kJ.
The Nutrients 7
Review Notes
• Foods provide nutrients—substances that support the growth, maintenance, and
repair of the body’s tissues.
• The six classes of nutrients are water, carbohydrates, fats, proteins, vitamins, and minerals.
• Vitamins, minerals, and water do not yield energy; instead, they facilitate a variety
of activities in the body.
• Foods rich in the energy-yielding nutrients (carbohydrates, fats, and proteins) provide the
major materials for building the body’s tissues and yield energy the body can use or store.
Dietary Reference Intakes
(DRI): a set of values for the • Energy is measured in kcalories.
dietary nutrient intakes of healthy
people in the United States and
Canada. These values are used for
planning and assessing diets.
Recommended Dietary Allowances Nutrient Recommendations
(RDA): a set of values reflecting the
Nutrient recommendations are used as standards to evaluate healthy people’s energy and
average daily amounts of nutrients
considered adequate to meet the nutrient intakes. Nutrition experts use the recommendations to assess nutrient intakes
known nutrient needs of practically and to guide people on amounts to consume. Individuals can use them to decide how
all healthy people in a particular life much of a nutrient they need to consume.
stage and gender group; a goal for
dietary intake by individuals.
Dietary Reference Intakes
Adequate Intakes (AI): a set of
Defining the amounts of energy, nutrients, and other dietary components that best support
values that are used as guides for
nutrient intakes when scientific health is a huge task. Nutrition experts have produced a set of standards that define the
evidence is insufficient to determine amounts of energy, nutrients, other dietary components, and physical activity that best sup-
an RDA. port health. These recommendations are called Dietary Reference Intakes (DRI) and reflect
requirement: the lowest continuing
the collaborative efforts of scientists in both the United States and Canada.* The inside front
intake of a nutrient that will maintain covers of this book present the DRI values. (A set of nutrient recommendations developed
a specified criterion of adequacy. by the World Health Organization for international use is presented in Appendix B.)
deficient: in regard to nutrient Setting Nutrient Recommendations: RDA and AI One advantage of
intake, describes the amount below
which almost all healthy people can the DRI is that they apply to the diets of individuals. The DRI committee offers
be expected, over time, to experience two sets of values to be used as nutrient intake goals by individuals: a set called the
deficiency symptoms. Recommended Dietary Allowances (RDA) and a set called Adequate Intakes (AI).
Based on solid experimental evidence and other reliable observations,
the RDA are the foundation of the DRI. The AI values are based on less
FIGURE 1-2 Nutrient Intake extensive scientific findings and rely more heavily on scientific judgment.
Recommendations The committee establishes an AI value whenever scientific evidence is
insufficient to generate an RDA. To see which nutrients have an AI and
The nutrient intake recommendations are which have an RDA, turn to the inside front cover.
set high enough to cover nearly everyone’s In the last several decades, abundant new research has linked nutrients
requirements (the boxes represent people).
in the diet with the promotion of health and the prevention of chronic
diseases. An advantage of the DRI is that, where appropriate, they take
Nutrients
EAR
a
RDA into account disease prevention as well as an adequate nutrient intake.
For example, the RDA for calcium is based on intakes thought to reduce
Number of people
the likelihood of osteoporosis-related fractures later in life.

To ensure that the vitamin and mineral recommendations meet the needs
of as many people as possible, the recommendations are set near the top end
of the range of the population’s estimated average requirements (see Figure
1-2). Small amounts above the daily requirement do no harm, whereas
amounts below the requirement may lead to health problems. When peo-
ple’s intakes are consistently deficient, their nutrient stores decline, and
20 30 40 50 60 70 over time this decline leads to deficiency symptoms and poor health.
Daily requirements (units/day)
a
Estimated Average Requirement *The DRI reports are produced by the Food and Nutrition Board, Institute of Medicine of
the National Academies, with active involvement of scientists from Canada.
Facilitating Nutrition Research and Policy: EAR In addition to the RDA
and AI, the DRI committee has established another set of values: Estimated Average
Requirements (EAR). These values establish average requirements for given life stage
and gender groups that researchers and nutrition policymakers use in their work. Nutri-
tion scientists may use the EAR as standards in research. Public health officials may use Estimated Average Requirements
them to assess nutrient intakes of populations and make recommendations. The EAR (EAR): the average daily nutrient
values form the scientific basis on which the RDA are set. intake levels estimated to meet the
requirements of half of the healthy
Establishing Safety Guidelines: UL The DRI committee also establishes upper individuals in a given age and gender
limits of intake for nutrients posing a hazard when consumed in excess. These values, group; used in nutrition research and
policymaking and as the basis on
the Tolerable Upper Intake Levels (UL), are indispensable to consumers who take sup- which RDA values are set.
plements. Consumers need to know how much of a nutrient is too much. The UL are
also of value to public health officials who set allowances for nutrients that are added to Tolerable Upper Intake Levels
(UL): a set of values reflecting the
foods and water. The UL values are listed on the inside front cover. highest average daily nutrient intake
levels that are likely to pose no risk
Using Nutrient Recommendations Each of the four DRI categories serves a of toxicity to almost all healthy
unique purpose. For example, the EAR are most appropriately used to develop and individuals in a particular life stage
evaluate nutrition programs for groups such as schoolchildren or military personnel. and gender group. As intake increases
The RDA (or AI, if an RDA is not available) can be used to set goals for individuals. above the UL, the potential risk of
The UL help to keep nutrient intakes below the amounts that increase the risk of toxic- adverse health effects increases.
ity. With these understandings, professionals can use the DRI for a variety of purposes. Estimated Energy Requirement
In addition to understanding the unique purposes of the DRI, it is important to keep (EER): the dietary energy intake
their uses in perspective. Consider the following: level that is predicted to maintain
energy balance in a healthy adult of
• The values are recommendations for safe intakes, not minimum requirements; a defined age, gender, weight, and
except for energy, they include a generous margin of safety. Figure 1-3 presents an physical activity level consistent with
accurate view of how a person’s nutrient needs fall within a range, with marginal good health.
and danger zones both below and above the range.
• The values reflect daily intakes to be achieved on average, over FIGURE 1-3 N aive versus Accurate View of
time. They assume that intakes will vary from day to day, and they Nutrient Intakes
are set high enough to ensure that body nutrient stores will meet
nutrient needs during periods of inadequate intakes lasting a day or The RDA or AI for a given nutrient represents
two for some nutrients and up to a month or two for others. a point that lies within a range of appropriate
• The values are chosen in reference to specific indicators of n utrient and reasonable intakes between toxicity and
adequacy, such as blood nutrient concentrations, normal growth, deficiency. Both of these recommendations are
and reduction of certain chronic diseases or other disorders when high enough to provide reserves in times of
appropriate, rather than prevention of deficiency symptoms alone. short-term dietary inadequacies, but not so high
as to approach toxicity. Nutrient intakes above
• The recommendations are designed to meet the needs of most healthy or below this range may be equally harmful.
people. Medical problems alter nutrient needs, as later c hapters describe.
• The recommendations are specific for people of both genders as
Danger
well as various ages and stages of life: infants, children, adolescents, of
men, women, pregnant women, and lactating women. toxicity
Setting Energy Recommendations In contrast to the vitamin Marginal

and mineral recommendations, the recommendation for energy, called Tolerable
the Estimated Energy Requirement (EER), is not generous because Safety Upper Intake
Level
excess energy cannot be excreted and is eventually stored as body fat.
Rather, the key to the energy recommendation is balance. For a person Safety
who has a body weight, body composition, and physical activity level
consistent with good health, energy intake from food should match RDA or AI
energy expenditure, so the person achieves energy balance. Enough
RDA Estimated
energy is needed to sustain a healthy, active life, but too much energy
Marginal Average
leads to obesity. The EER is therefore set at a level of energy intake pre- Requirement
dicted to maintain energy balance in a healthy adult of a defined age, Danger Danger
gender, weight, height, and physical activity level.* Another difference of
deficiency
*The EER for children, pregnant women, and lactating women includes energy needs Naive Accurate
associated with the deposition of tissue or the secretion of milk at rates consistent with view view
good health.
Nutrient Recommendations 9
between the requirements for other nutrients and those for energy is that each person
has an obvious indicator of whether energy intake is inadequate, adequate, or excessive:
body weight. Because any amount of energy in excess of need leads to weight gain, the
DRI committee did not set a Tolerable Upper Intake Level.
Acceptable Macronutrient Distribution Ranges

As noted earlier, the DRI committee considers prevention of chronic disease as well as
nutrient adequacy when establishing recommendations. To that end, the committee
established healthy ranges of intakes for the energy-yielding nutrients—carbohydrate,
fat, and protein—known as Acceptable Macronutrient Distribution Ranges (AMDR).
Each of these three energy-yielding nutrients contributes to a person’s total energy
(kcalorie) intake, and those contributions vary in relation to each other. The DRI com-
mittee has determined that a diet that provides the energy-yielding nutrients in the
following proportions provides adequate energy and nutrients and reduces the risk of
chronic disease:
• 45 to 65 percent of kcalories from carbohydrate
• 20 to 35 percent of kcalories from fat
• 10 to 35 percent of kcalories from protein
Review Notes
• The Dietary Reference Intakes (DRI) are a set of nutrient intake values that can be
used to plan and evaluate dietary intakes for healthy people.
• The Estimated Average Requirement (EAR) defines the amount of a nutrient that
supports a specific function in the body for half of the population.
• The Recommended Dietary Allowance (RDA) is based on the EAR and establishes a
goal for dietary intake that will meet the needs of almost all healthy people.
• An Adequate Intake (AI) serves a similar purpose as the RDA when an RDA cannot
be determined.
• The Tolerable Upper Intake Level (UL) establishes the highest average daily nutrient
intake level that appears safe for almost all healthy people.
• The Estimated Energy Requirement (EER) defines the energy intake level needed to
maintain energy balance in a healthy adult of a defined age, gender, weight, height,
and physical activity level.
• The Acceptable Macronutrient Distribution Ranges (AMDR) define the proportions
contributed by carbohydrate, fat, and protein to a healthy diet.
National Nutrition Surveys

How do nutrition experts know whether people are meeting nutrient recommenda-
tions? The Dietary Reference Intakes and other major reports that examine the relation-
ships between diet and health depend on information collected from nutrition surveys.
Researchers use nutrition surveys to learn which foods people are eating and which
Acceptable Macronutrient supplements they are taking, to assess people’s nutritional health, and to determine
Distribution Ranges (AMDR): ranges people’s knowledge, attitudes, and behaviors about nutrition and how these relate to
of intakes for the energy-yielding health. The resulting wealth of information can be used for a variety of purposes. For
nutrients that provide adequate
energy and nutrients and reduce the example, Congress uses this information to establish public policy on nutrition educa-
risk of chronic disease. tion, assess food assistance programs, and regulate the food supply. The food industry
uses the information to guide decisions in public relations and product development.
malnutrition: any condition caused
by deficient or excess energy or Scientists use the information to establish research priorities. One of the first nutrition
nutrient intake or by an imbalance surveys, taken before World War II, suggested that up to a third of the U.S. population
of nutrients. might be eating poorly. Programs to correct malnutrition have been evolving ever since.
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DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)
The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.
NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.
MAKONDE LOCK AND KEY AT JUMBE CHAURO

This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]
MODE OF INSERTING THE KEY
With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
“We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
BRAZIER
Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT
SMOOTHING WITH MAIZE-COB
CUTTING THE EDGE

FINISHING THE BOTTOM
LAST SMOOTHING BEFORE

BURNING
FIRING THE BRUSH-PILE

LIGHTING THE FARTHER SIDE OF
THE PILE
TURNING THE RED-HOT VESSEL
NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK
DRAWING THE BARK OFF THE LOG
REMOVING THE OUTER BARK

BEATING THE BARK
WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT
MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN

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eTextbook 978-1305627963 Nutrition for

Health and Healthcare

To my mom, Tina C. Pinna, who started me on the path to good nutritional

Coronary Heart Disease 586 HIV Infection 649

Appendix D Physical Activity and Energy Chapter 22

Chapter Sections and Learning Objectives (LOs)

1.1 Food Choices 1.5 Dietary Guidelines and Food Guides

FIGURE 1-1 The Health Line

Person takes responsibility Superior

2 CHAPTER 1 Overview of Nutrition and Health

noodles as amaranth), mandarin sea urchin,

bread, greens, leeks, oranges, chicken, fava and ricotta

Mexican Hominy, Bell peppers, Avocado, Beans, refried Cheese, flan

tillas (corn jicama, onions, oranges, chicken, fish,

Social Interaction Social interaction is another powerful influence on

4 CHAPTER 1 Overview of Nutrition and Health

Medical Conditions Sometimes medical conditions and their treatments (includ-

nutrients: substances obtained from

inorganic: not containing carbon

6 CHAPTER 1 Overview of Nutrition and Health

BOX 1-1 How to Calculate the Energy a Food Provides

the likelihood of osteoporosis-related fractures later in life.

8 CHAPTER 1 Overview of Nutrition and Health

Setting Energy Recommendations In contrast to the vitamin Marginal

Acceptable Macronutrient Distribution Ranges

National Nutrition Surveys

10 CHAPTER 1 Overview of Nutrition and Health

Newala, too, suffers from the distance of its water-supply—at least

The water-supply of New Newala is in the bottom of the valley,

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAKONDE LOCK AND KEY AT JUMBE CHAURO

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

Some consolation was afforded me by a brassfounder, whom I

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

LAST SMOOTHING BEFORE

FIRING THE BRUSH-PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

MANUFACTURE OF BARK-CLOTH AT NEWALA

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