Understanding Normal and Clinical Nutrition 11th Edition by Sharon Rady Rolfes Ebook PDF

Understanding Normal and Clinical
Nutrition 11th Edition by Sharon Rady

Rolfes (eBook PDF)
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Understanding
normal and
Clinical nutrition
eleventh e d i t i o n
Rolfes pinna
whitney
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
Brief Contents
ChaPtER 1 An Overview of Nutrition 3
highlight 1 > Nutrition Information and Misinformation 30
ChaPtER 2 Planning a Healthy Diet 37
highlight 2 > Vegetarian Diets 64
ChaPtER 3 Digestion, Absorption, and Transport 71
highlight 3 > Common Digestive Problems 90
ChaPtER 4 The Carbohydrates: Sugars, Starches, and Fibers 99
highlight 4 > Carbs, kCalories, and Controversies 128
ChaPtER 5 The Lipids: Triglycerides, Phospholipids, and Sterols 133
highlight 5 > High-Fat Foods—Friend or Foe? 164
ChaPtER 6 Protein: Amino Acids 171
highlight 6 > Nutritional Genomics 194
ChaPtER 7 Energy Metabolism 201
highlight 7 > Alcohol in the Body 222
ChaPtER 8 Energy Balance and Body Composition 235
highlight 8 > Eating Disorders 256
ChaPtER 9 Weight Management: Overweight, Obesity, and Underweight 265
highlight 9 > The Latest and Greatest Weight-Loss Diet—Again 296
ChaPtER 10 The Water-Soluble Vitamins: B Vitamins and Vitamin C 301
highlight > 10 > Vitamin and Mineral Supplements 335
ChaPtER 11 The Fat-Soluble Vitamins: A, D, E, and K 343
highlight 11 > Antioxidant Nutrients in Disease Prevention 364
ChaPtER 12 Water and the Major Minerals 371
highlight 12 > Osteoporosis and Calcium 400
ChaPtER 13 The Trace Minerals 407
highlight 13 > Phytochemicals and Functional Foods 433
ChaPtER 14 Life Cycle Nutrition: Pregnancy and Lactation 441
highlight > 14 > Fetal Alcohol Syndrome 473
ChaPtER 15 Life Cycle Nutrition: Infancy, Childhood, and Adolescence 477
highlight 15 > Childhood Obesity and the Early Development of Chronic Diseases 516
ChaPtER 16 Life Cycle Nutrition: Adulthood and the Later Years 523
highlight 16 > Hunger and Community Nutrition 547
ChaPtER 17 Nutrition Care and Assessment 555
highlight 17 > Nutrition and Immunity 574
vii
Chapter 18 Nutrition Intervention 581
highlight 18 > Food Allergies 595
Chapter 19 Medications, Diet-Drug Interactions, and Herbal Products 599
highlight 19 > Complementary and Alternative Medicine 613
Chapter 20 Enteral Nutrition Support 619
highlight 20 > Inborn Errors of Metabolism 638
Chapter 21 Parenteral Nutrition Support 643
highlight 21 > Ethical Issues in Nutrition Care 659
Chapter 22 Metabolic and Respiratory Stress 663
highlight 22 > Multiple Organ Dysfunction Syndrome 681
Chapter 23 Upper Gastrointestinal Disorders 685
highlight 23 > Oral Health and Chronic Illness 704
Chapter 24 Lower Gastrointestinal Disorders 709
highlight 24 > Probiotics and Intestinal Health 735
Chapter 25 Liver Disease and Gallstones 739
highlight 25 > Anemia in Illness 757
Chapter 26 Diabetes Mellitus 763
highlight 26 > The Metabolic Syndrome 788
Chapter 27 Cardiovascular Diseases 793
highlight 27 > Coping with Feeding Disabilities 820
Chapter 28 Kidney Diseases 825
highlight 28 > Dialysis 847
Chapter 29 Cancer and HIV Infection 851
highlight 29 > Foodborne Illness 871
appendix a Cells, Hormones, and Nerves
appendix B Basic Chemistry Concepts
appendix C Biochemical Structures and Pathways
appendix d Measures of Protein Quality
appendix e Nutrition Assessment: Supplemental Information
appendix F Estimated Energy Needs
appendix G Choose Your Foods: Food Lists for Diabetes and Weight Management
appendix h Table of Food Composition
appendix i WHO Nutrition Recommendations
appendix J Healthy People 2020
appendix K Aids to Calculation
appendix L Enteral Formulas
Glossary GL-1
Index IN-1
inside Covers
Dietary Reference Intakes (DRI) A
Daily Values (DV) for Food Labels Y
Body Mass Index (BMI) Z
viii Brief Contents
Table of Contents
Preface xvii 2-2 Diet-Planning Guides 42
Acknowledgments xxiii USDA Food Patterns 42
Reviewers xxiv Food Lists 49
Putting the Plan into Action 50
ChaPtER 1 From Guidelines to Groceries 51
an overview of nutrition 3 2-3 Food Labels 56
1-1 Food Choices 4 The Ingredient List 56
Nutrition Facts Panel 56
1-2 The Nutrients 6
Claims on Labels 60
Nutrients in Foods and in the Body 6 Consumer Education 60
The Energy-Yielding Nutrients: Carbohydrate, Fat,
highlight 2 > Vegetarian Diets 64
and Protein 8
The Vitamins 11
The Minerals 11 ChaPtER 3
Water 12 digestion, absorption, and transport 71
1-3 The Science of Nutrition 12 3-1 Digestion 72
Conducting Research 12 Anatomy of the Digestive Tract 72
Analyzing Research Findings 16 The Muscular Action of Digestion 75
Publishing Research 17 The Secretions of Digestion 76
1-4 Dietary Reference Intakes 18 The Final Stage 77
Establishing Nutrient Recommendations 18 3-2 Absorption 78
Establishing Energy Recommendations 20 Anatomy of the Absorptive System 79
Using Nutrient Recommendations 21 A Closer Look at the Intestinal Cells 80
Comparing Nutrient Recommendations 21 3-3 The Circulatory Systems 82
1-5 Nutrition Assessment 22 The Vascular System 82
Nutrition Assessment of Individuals 22 The Lymphatic System 84
Nutrition Assessment of Populations 24 3-4 The Health and Regulation of the GI Tract 85
1-6 Diet and Health 26 Gastrointestinal Microbiome 85
Chronic Diseases 26 Gastrointestinal Hormones and Nerve Pathways 85
Risk Factors for Chronic Diseases 27 The System at Its Best 87
highlight 1 > Nutrition Information and Misinformation 30 highlight 3 > Common Digestive Problems 90
ChaPtER 2 ChaPtER 4
Planning a healthy diet 37 the Carbohydrates: Sugars, Starches,
2-1 Principles and Guidelines 38 and Fibers 99
Diet-Planning Principles 38 4-1 The Chemist’s View of Carbohydrates 100
Dietary Guidelines for Americans 40 Monosaccharides 100
Disaccharides 102
Polysaccharides 103
4-2 Digestion and Absorption of Carbohydrates 105
HSNphotography/Shutterstock.com
Carbohydrate Digestion 105

Carbohydrate Absorption 107
Lactose Intolerance 107
4-3 Glucose in the Body 108
A Preview of Carbohydrate Metabolism 109
The Constancy of Blood Glucose 110
ix
4-4 Health Effects and Recommended Intakes of Sugars 113 Roles of Proteins 179
Health Effects of Sugars 114 A Preview of Protein Metabolism 182
Recommended Intakes of Sugars 117 6-4 Protein in Foods 185
Alternative Sweeteners 118 Protein Quality 185
4-5 Health Effects and Recommended Intakes of Starch Complementary Proteins 185
and Fibers 120 6-5 Health Effects and Recommended Intakes of Protein 186
Health Effects of Starch and Fibers 121 Health Effects of Protein 186
Recommended Intakes of Starch and Fibers 123 Recommended Intakes of Protein 188
From Guidelines to Groceries 124 From Guidelines to Groceries 189
highlight 4 > Carbs, kCalories, and Controversies 128 Read Food Labels 190
Protein and Amino Acid Supplements 190
ChaPtER 5 highlight 6 > Nutritional Genomics 194
the Lipids: triglycerides, Phospholipids,
and Sterols 133 ChaPtER 7
5-1 The Chemist’s View of Fatty Acids and Triglycerides 134 Energy Metabolism 201
Fatty Acids 134 7-1 Chemical Reactions in the Body 202
Triglycerides 136
7-2 Breaking Down Nutrients for Energy 205
Characteristics of Solid Fats and Oils 136
Glucose 206
5-2 The Chemist’s View of Phospholipids and Sterols 140 Glycerol and Fatty Acids 208
Phospholipids 140 Amino Acids 210
Sterols 140 The Final Steps of Energy Metabolism 211
5-3 Digestion, Absorption, and Transport of Lipids 142 7-3 Feasting and Fasting 216
Lipid Digestion 142 Feasting—Excess Energy 217
Lipid Absorption 144 The Transition from Feasting to Fasting 218
Lipid Transport 144 Fasting—Inadequate Energy 218
5-4 Lipids in the Body 148 Low-Carbohydrate Diets 220
Roles of Triglycerides 148 highlight 7 > Alcohol in the Body 222
Essential Fatty Acids 148
A Preview of Lipid Metabolism 150 ChaPtER 8
5-5 Health Effects and Recommended Intakes of Saturated Fats, Energy Balance and Body Composition 235
Trans Fats, and Cholesterol 150
8-1 Energy Balance 236
Health Effects of Saturated Fats, Trans Fats,
and Cholesterol 151 8-2 Energy In: The kCalories Foods Provide 236
Recommended Intakes of Saturated Fat, Trans Fat, Food Composition 236
and Cholesterol 152 Food Intake 237
5-6 Health Effects and Recommended Intakes of 8-3 Energy Out: The kCalories the Body Expends 240
Monounsaturated and Polyunsaturated Fats 153 Components of Energy Expenditure 240
Health Effects of Monounsaturated and Estimating Energy Requirements 244
Polyunsaturated Fats 153 8-4 Body Weight and Body Composition 245
Recommended Intakes of Monounsaturated Defining Healthy Body Weight 246
and Polyunsaturated Fats 154 Body Fat and Its Distribution 248
From Guidelines to Groceries 154 8-5 Health Risks Associated with Body Weight and Body Fat 251
highlight 5 > High-Fat Foods—Friend or Foe? 164 Health Risks of Underweight 252
Health Risks of Overweight 252
ChaPtER 6 Fit and Fat versus Sedentary and Slim 253
Protein: amino acids 171 highlight 8 > Eating Disorders 256
6-1 The Chemist’s View of Proteins 172
Amino Acids 172
Proteins 173
Nejron Photo/Shutterstock.com
6-2 Digestion and Absorption of Proteins 175

Protein Digestion 175
Protein Absorption 175
6-3 Proteins in the Body 177
Protein Synthesis 177
x table of Contents
Nonvitamins 323
Interactions among the B Vitamins 323
10-3 Vitamin C 327
Blacknote/Shutterstock.com
Vitamin C Roles 327
Vitamin C Recommendations 329
Vitamin C Deficiency 329
Vitamin C Toxicity 330
Vitamin C Food Sources 330
highlight 10 > Vitamin and Mineral Supplements 335
ChaPtER 9
Weight Management: overweight, obesity, ChaPtER 11
and Underweight 265 the Fat-Soluble vitamins: a, d, E, and K 343
9-1 Overweight and Obesity 266 11-1 Vitamin A and Beta-Carotene 344
Fat Cell Development 266 Roles in the Body 344
Fat Cell Metabolism 267 Vitamin A Deficiency 346
Set-Point Theory 267 Vitamin A Toxicity 347
9-2 Causes of Overweight and Obesity 268 Vitamin A Recommendations 348
Genetics and Epigenetics 268 Vitamin A in Foods 349
Environment 270 11-2 Vitamin D 351
9-3 Problems of Overweight and Obesity 272 Roles in the Body 351
Health Risks 272 Vitamin D Deficiency 353
Perceptions and Prejudices 273 Vitamin D Toxicity 354
Dangerous Interventions 273 Vitamin D Recommendations and Sources 354
9-4 Aggressive Treatments for Obesity 274 11-3 Vitamin E 357
Drugs 275 Vitamin E as an Antioxidant 357
Surgery 275 Vitamin E Deficiency 357
9-5 Weight-Loss Strategies 276 Vitamin E Toxicity 357
Changes, Losses, and Goals 277 Vitamin E Recommendations 358
Eating Patterns 277 Vitamin E in Foods 358
Physical Activity 281 11-4 Vitamin K 358
Environmental Influences 284 Roles in the Body 358
Behavior and Attitude 285 Vitamin K Deficiency 359
Weight Maintenance 287 Vitamin K Toxicity 359
Prevention 288 Vitamin K Recommendations and Sources 360
Community Programs 289 highlight 11 > Antioxidant Nutrients in Disease Prevention 364
9-6 Underweight 289
Problems of Underweight 289 ChaPtER 12
Weight-Gain Strategies 290 Water and the Major Minerals 371
highlight 9 > The Latest and Greatest Weight-Loss
12-1 Water and the Body Fluids 372
Diet—Again 296
Water Balance and Recommended Intakes 372
Blood Volume and Blood Pressure 374
ChaPtER 10
Fluid and Electrolyte Balance 376
the Water-Soluble vitamins: B vitamins Fluid and Electrolyte Imbalance 379
and vitamin C 301 Acid-Base Balance 379
10-1 The Vitamins—An Overview 302 12-2 The Minerals—An Overview 381
10-2 The B Vitamins 304 12-3 The Major Minerals 382
Thiamin 305 Sodium 382
Riboflavin 308 Chloride 386
Niacin 309 Potassium 387
Biotin 312 Calcium 388
Pantothenic Acid 313 Phosphorus 394
Vitamin B6 313 Magnesium 395
Folate 315 Sulfate 397
Vitamin B12 320 highlight 12 > Osteoporosis and Calcium 400
Choline 322
table of Contents xi
CHAPTER 13 Infant Formula 483
The Trace Minerals 407 Special Needs of Preterm Infants 484
Introducing Cow’s Milk 484
13-1 The Trace Minerals—An Overview 408 Introducing Solid Foods 485
13-2 The Trace Minerals 410 Mealtimes with Toddlers 488
Iron 410 15-2 Nutrition during Childhood 488
Zinc 419 Energy and Nutrient Needs 488
Iodine 422 Hunger and Malnutrition in Children 491
Selenium 424 The Malnutrition-Lead Connection 492
Copper 425 Hyperactivity and “Hyper” Behavior 494
Manganese 426 Food Allergy and Intolerance 495
Fluoride 426 Childhood Obesity 496
Chromium 427 Mealtimes at Home 502
Molybdenum 428 Nutrition at School 504
13-3 Contaminant Minerals 429 15-3 Nutrition during Adolescence 507
Highlight 13 > Phytochemicals and Functional Foods 433 Growth and Development 507
Energy and Nutrient Needs 507
CHAPTER 14 Food Choices and Health Habits 509
Life Cycle Nutrition: Pregnancy and Lactation 441 Highlight 15 > Childhood Obesity and the Early Development
14-1 Nutrition prior to Pregnancy 442
of Chronic Diseases 516
14-2 Growth and Development during Pregnancy 443
CHAPTER 16
Placental Development 443
Fetal Growth and Development 443
Life Cycle Nutrition: Adulthood and the Later
Critical Periods 444 Years 523
14-3 Maternal Weight 448 16-1 Nutrition and Longevity 524
Weight prior to Conception 448 Observation of Older Adults 525
Weight Gain during Pregnancy 448 Manipulation of Diet 526
Exercise during Pregnancy 450 16-2 The Aging Process 528
14-4 Nutrition during Pregnancy 451 Physiological Changes 529
Energy and Nutrient Needs during Pregnancy 452 Other Changes 531
Vegetarian Diets during Pregnancy and Lactation 455 16-3 Energy and Nutrient Needs
Common Nutrition-Related Concerns of Pregnancy 455 of Older Adults 532
14-5 High-Risk Pregnancies 456 Water 532
The Infant’s Birthweight 457 Energy and Energy Nutrients 533
Malnutrition and Pregnancy 457 Vitamins and Minerals 533
Food Assistance Programs 458 Dietary Supplements 534
Maternal Health 458 16-4 Nutrition-Related Concerns
The Mother’s Age 460 of Older Adults 535
Practices Incompatible with Pregnancy 461 Vision 535
14-6 Nutrition during Lactation 464 Arthritis 536
Lactation: A Physiological Process 464 The Aging Brain 537
Breastfeeding: A Learned Behavior 465 Alcohol 539
Maternal Energy and Nutrient Needs during 16-5 Food Choices and Eating Habits of Older Adults 540
Lactation 465 Malnutrition 541
Maternal Health 467 Food Assistance Programs 541
Practices Incompatible with Lactation 468 Meals for Singles 542
Highlight 14 > Fetal Alcohol Syndrome 473 Highlight 16 > Hunger and Community Nutrition 547
CHAPTER 15
Life Cycle Nutrition: Infancy, Childhood,
Aydindurdu/ Dreamstime.com
and Adolescence 477

15-1 Nutrition during Infancy 478
Energy and Nutrient Needs 478
Breast Milk 480
xii Table of Contents
19-2 Diet-Drug Interactions 602
Drug Effects on Food Intake 604
Drug Effects on Nutrient Absorption 604
Dietary Effects on Drug Absorption 604
Drug Effects on Nutrient Metabolism 605
Dietary Effects on Drug Metabolism 606
Drug Effects on Nutrient Excretion 607
Rob Lewine/Getty Images

Dietary Effects on Drug Excretion 607
Diet-Drug Interactions and Toxicity 607
19-3 Herbal Supplements 608
Effectiveness and Safety of Herbal Products 609
Use of Herbal Products in Illness 611
ChaPtER 17 highlight 19 > Complementary and Alternative
nutrition Care and assessment 555 Medicine 613
17-1 Nutrition in Health Care 555

ChaPtER 20
Effects of Illness on Nutrition Status 556
Responsibility for Nutrition Care 556
Enteral nutrition Support 619
Nutrition Screening 557 20-1 Oral Supplements 620
The Nutrition Care Process 558 20-2 Tube Feedings in Medical Care 621
17-2 Nutrition Assessment 561 Candidates for Tube Feedings 621
Historical Information 561 Tube-Feeding Routes 621
Food Intake Data 562 20-3 Enteral Formulas 624
Anthropometric Data 565 Types of Enteral Formulas 624
Biochemical Data 569 Formula Characteristics 625
Physical Examination 571 Formula Selection 626
highlight 17 > Nutrition and Immunity 574 20-4 Administration of Tube Feedings 627
Safe Handling 627
ChaPtER 18 Initiating and Advancing a Tube Feeding 628
nutrition intervention 581 Meeting Water Needs 631
Medication Delivery during Tube Feedings 632
18-1 Implementing Nutrition Care 581
Tube-Feeding Complications 632
Approaches to Nutrition Care 582
Transition to Table Foods 634
Documenting Nutrition Care 584
highlight 20 > Inborn Errors of Metabolism 638
18-2 Energy Intakes in Hospital Patients 585
Indirect Calorimetry 586
Predictive Equations 586
ChaPtER 21
18-3 Dietary Modifications 588
Parenteral nutrition Support 643
Modified Diets 588 21-1 Indications for Parenteral Nutrition 643
Alternative Feeding Routes 591 Peripheral Parenteral Nutrition 644
Nothing by Mouth (NPO) 592 Total Parenteral Nutrition 645
18-4 Foodservice 592 21-2 Parenteral Solutions 646
Menu Planning 592 Parenteral Nutrients 646
Food Selection 592 Solution Preparation 648
Food Safety 592 21-3 Administering Parenteral Nutrition 650
Improving Food Intake 593 Insertion and Care of Intravenous Catheters 650
highlight 18 > Food Allergies 595 Administration of Parenteral Solutions 651
Discontinuing Parenteral Nutrition 652
ChaPtER 19 Managing Metabolic Complications 653
Medications, diet-drug interactions, 21-4 Nutrition Support at Home 655
and herbal Products 599 Candidates for Home Nutrition Support 655
Planning Home Nutrition Care 655
19-1 Medications in Disease Treatment 599
Quality-of-Life Issues 656
Medication Administration 600
Risks from Medications 600
highlight 21 > Ethical Issues in Nutrition Care 659
Patients at High Risk of Adverse Effects 602
table of Contents xiii
ChaPtER 22 ChaPtER 25
Metabolic and Respiratory Stress 663 Liver disease and Gallstones 739
22-1 The Body’s Responses to Stress and Injury 664 25-1 Fatty Liver and Hepatitis 740
Hormonal Responses to Stress 664 Fatty Liver 740
The Inflammatory Response 665 Hepatitis 741
22-2 Nutrition Treatment of Acute Stress 666 25-2 Cirrhosis 742
Determining Nutritional Requirements 667 Consequences of Cirrhosis 743
Approaches to Nutrition Care in Acute Stress 670 Treatment of Cirrhosis 746
Patients with Burn Injuries 670 Nutrition Therapy for Cirrhosis 746
22-3 Respiratory Stress 672 25-3 Liver Transplantation 750
Chronic Obstructive Pulmonary Disease 673 25-4 Gallstone Disease 751
Respiratory Failure 676 Types of Gallstones 751
highlight 22 > Multiple Organ Dysfunction Syndrome 681 Consequences of Gallstones 752
Risk Factors for Cholesterol Gallstones 752
ChaPtER 23 Treatment of Gallstones 753
Upper Gastrointestinal disorders 685 highlight 25 > Anemia in Illness 757
23-1 Conditions Affecting the Esophagus 686
Dysphagia 686 ChaPtER 26
Gastroesophageal Reflux Disease 689 diabetes Mellitus 763
23-2 Conditions Affecting the Stomach 692 26-1 Overview of Diabetes Mellitus 763
Dyspepsia 692 Symptoms of Diabetes Mellitus 765
Nausea and Vomiting 693 Diagnosis of Diabetes Mellitus 765
Gastroparesis 693 Types of Diabetes Mellitus 765
Gastritis 694 Prevention of Type 2 Diabetes Mellitus 767
Peptic Ulcer Disease 694 Acute Complications of Diabetes Mellitus 767
23-3 Gastric Surgery 696 Chronic Complications of Diabetes Mellitus 769
Gastrectomy 696 26-2 Treatment of Diabetes Mellitus 771
Bariatric Surgery 699 Treatment Goals 771
highlight 23 > Oral Health and Chronic Illness 704 Evaluating Diabetes Treatment 772
Nutrition Therapy: Dietary Recommendations 773
ChaPtER 24 Nutrition Therapy: Meal-Planning Strategies 775
Insulin Therapy 778
Lower Gastrointestinal disorders 709
Antidiabetic Drugs 781
24-1 Common Intestinal Problems 709 Physical Activity and Diabetes Management 781
Constipation 710 Sick-Day Management 783
Intestinal Gas 712 26-3 Diabetes Management in Pregnancy 784
Diarrhea 712 Pregnancy in Type 1 or Type 2 Diabetes 784
24-2 Malabsorption 714 Gestational Diabetes 784
Fat Malabsorption 714 highlight 26 > The Metabolic Syndrome 788
Bacterial Overgrowth 715
24-3 Conditions Affecting the Pancreas 717
Pancreatitis 717
Cystic Fibrosis 719
24.4 Conditions Affecting the Small Intestine 721
Celiac Disease 721
Inflammatory Bowel Diseases 723
Dmitry Lobanov/Shutterstock.com
Short Bowel Syndrome 726

24.5 Conditions Affecting the Large Intestine 728
Irritable Bowel Syndrome 728
Diverticular Disease of the Colon 729
Colostomies and Ileostomies 730
highlight 24 > Probiotics and Intestinal Health 735
xiv table of Contents
CHAPTER 27 CHAPTER 29
Cardiovascular Diseases 793 Cancer and HIV Infection 851
27-1 Atherosclerosis 794 29-1 Cancer 851
Consequences of Atherosclerosis 794 How Cancer Develops 852
Development of Atherosclerosis 795 Nutrition and Cancer Risk 852
Causes of Atherosclerosis 796 Consequences of Cancer 854
27-2 Coronary Heart Disease (CHD) 797 Treatments for Cancer 856
Symptoms of Coronary Heart Disease 797 Nutrition Therapy for Cancer 858
Evaluating Risk for Coronary Heart Disease 797 29-2 HIV Infection 862
Lifestyle Management to Reduce CHD Risk 799 Prevention of HIV Infection 862
Vitamin Supplementation and CHD Risk 803 Consequences of HIV Infection 863
Lifestyle Changes for Hypertriglyceridemia 803 Treatments for HIV Infection 865
Drug Therapies for CHD Prevention 805 Nutrition Therapy for HIV Infection 866
Treatment of Heart Attack 805 Highlight 29 > Foodborne Illness 871
27-3 Stroke 807
Stroke Prevention 807
Stroke Management 807
APPEnDIx A
Cells, Hormones, and Nerves
27-4 Hypertension 808
Factors That Influence Blood Pressure 808 APPEnDIx B
Factors That Contribute to Hypertension 809 Basic Chemistry Concepts
Treatment of Hypertension 810 APPEnDIx C
27-5 Heart Failure 814 Biochemical Structures and Pathways
Consequences of Heart Failure 814
Medical Management of Heart Failure 815
APPEnDIx D
Measures of Protein Quality
Highlight 27 > Coping with Feeding Disabilities 820
APPEnDIx E
CHAPTER 28 Nutrition Assessment: Supplemental Information
Kidney Diseases 825 APPEnDIx F
28-1 Functions of the Kidneys 825 Estimated Energy Needs
28-2 The Nephrotic Syndrome 827 APPEnDIx G
Consequences of the Nephrotic Syndrome 827 Choose Your Foods: Food Lists for Diabetes and Weight
Treatment of the Nephrotic Syndrome 827 Management
28-3 Acute Kidney Injury 830 APPEnDIx H
Causes of Acute Kidney Injury 830 Table of Food Composition
Consequences of Acute Kidney Injury 830
Treatment of Acute Kidney Injury 831 APPEnDIx I
WHO Nutrition Recommendations
28-4 Chronic Kidney Disease 833
Consequences of Chronic Kidney Disease 833 APPEnDIx J
Treatment of Chronic Kidney Disease 834 Healthy People 2020
Kidney Transplants 838
APPEnDIx K
28-5 Kidney Stones 841 Aids to Calculation
Formation of Kidney Stones 841
Consequences of Kidney Stones 842 APPEnDIx L
Prevention and Treatment of Kidney Stones 842 Enteral Formulas
Highlight 28 > Dialysis 847 Glossary GL-1
Index IN-1
InsIDE CoVERs
AJPhoto/Science Source
Dietary Reference Intakes (DRI) A

Daily Values (DV) for Food Labels Y
Body Mass Index (BMI) Z
Table of Contents xv
>how to
t
Think Metric 9 Help Hospital Patients Improve Their Food Intakes 593
Calculate the Energy Available from Foods 10 Reduce the Risks of Adverse Effects from Medications 602
Determine Whether a Website Is Reliable 31 Prevent Diet-Drug Interactions 608
Compare Foods Based on Nutrient Density 39 Help Patients Improve Intakes with Oral Supplements 620
Calculate Personal Daily Values 59 Help Patients Cope with Tube Feedings 629
Reduce the Intake of Added Sugars 118 Plan a Tube-Feeding Schedule 630
Make Heart-Healthy Choices—by Food Group 157 Administer Medications to Patients Receiving Tube Feedings 632
Calculate a Personal Daily Value for Fat 160 Express the Osmolar Concentration of a Solution 645
Understand “% Daily Value” and “% kCalories from Fat” 161 Calculate the Macronutrient and Energy Content of a
Calculate Recommended Protein Intakes 189 Parenteral Solution 649
Estimate Energy Requirements 245 Estimate the Osmolarity of a Parenteral Solution 650
Determine BMI 249 Estimate Energy Needs Using Disease-Specific Stress Factors 668
Compare Foods Based on Energy Density 280 Improve Acceptance of Mechanically Altered Foods 689
Identify a Fad Diet or Weight-Loss Scam 299 Manage Gastroesophageal Reflux Disease 691
Evaluate Foods for Their Nutrient Contributions 306 Alter the Diet to Reduce Symptoms of Dumping Syndrome 698
Estimate Niacin Equivalents 310 Alter Dietary Habits to Achieve and Maintain Weight Loss after
Estimate Dietary Folate Equivalents 317 Bariatric Surgery 701
Cut Salt (and Sodium) Intake 384 Follow a Fat-Restricted Diet 717
Estimate Your Calcium Intake 392 Help the Cirrhosis Patient Eat Enough Food 748
Estimate the Recommended Daily Intake for Iron 416 Use Carbohydrate Counting in Clinical Practice 776
Plot Measures on a Growth Chart 479 Treat High Blood Cholesterol to Reduce Atherosclerotic CVD Risk 799
Protect against Lead Toxicity 494 Implement a Heart-Healthy Diet 804
Stretch Food Dollars and Reduce Waste 550 Reduce Sodium Intake 813
Measure Length and Height 566 Help Patients Comply with a Renal Diet 839
Measure Weight 567 Increase kCalories and Protein in Meals 859
Estimate and Evaluate Changes in Body Weight 568 Help Patients Handle Food-Related Problems 860
Estimate Appropriate Energy Intakes for Hospital Patients 587 Prevent Foodborne Illnesses 875
CaSE
StUdY
Nutrition Screening and Assessment 572 Patient with Short Bowel Syndrome 728
Implementing Nutrition Care 594 Young Adult with Irritable Bowel Syndrome 729
Injured Hiker Requiring Enteral Nutrition Support 635 Man with Cirrhosis 749
Patient with Intestinal Disease Requiring Parenteral Child with Type 1 Diabetes 783
Nutrition 654 Woman with Type 2 Diabetes 785
Patient with a Severe Burn 672 Patient with Cardiovascular Disease 813
Elderly Man with Emphysema 676 Woman with Acute Kidney Injury 832
Woman with GERD 692 Man with Chronic Kidney Disease 840
Nutrition Care after Gastric Surgery 699 Woman with Cancer 862
Child with Cystic Fibrosis 720 Man with HIV Infection 868
xvi table of Contents
Preface
As we launch this eleventh edition of Understanding Normal through 13 describe the vitamins, the minerals, and water—
and Clinical Nutrition, nutrition research continues to un- their roles in the body, deficiency and toxicity symptoms, and
cover the many complex relationships between nutrition and sources. Chapters 14 through 16 complete the “normal” chap-
health. Our goals for this edition are to incorporate these ters by presenting the special nutrient needs of people through
current research findings into the core information neces- the life cycle—pregnancy and lactation; infancy, childhood,
sary for an introductory course in nutrition. As with previous adolescence; and adulthood and the later years.
editions, each chapter has been substantially updated and The remaining “clinical” chapters of the book focus on the
revised to include new topics as well as expand on existing nutrition care of individuals with health problems. Chapter
topics. The chapters include practical information and valu- 17 explains how illnesses and their treatments influence nu-
able resources to help readers apply nutrition knowledge and trient needs and describes the process of nutrition assessment.
skills to their daily lives and the clinical setting. Chapter 18 discusses how nutrition care is implemented and
A main objective in writing this book has always been to introduces the different types of therapeutic diets used in
share our enthusiasm about nutrition in a manner that mo- patient care. Chapter 19 explores the potential interactions
tivates students to study and learn. Moreover, we seek to pro- between nutrients and medications and examines the ben-
vide accurate information that is meaningful to the student or efits and risks associated with herbal products. Chapters 20
health professional. Students of nutrition often find the subject and 21 describe specialized methods for providing nutrients
to be both fascinating and overwhelming; there are so many to people who are unable to consume a regular diet. Chapter
details to learn—new terms, new chemical structures, and new 22 describes the inflammatory process and shows how meta-
biological concepts. Taken one step at a time, however, the sci- bolic and respiratory stress influence nutrient needs. Chap-
ence of nutrition may seem less daunting and the facts more ters 23 through 29 explore the pathology, medical treatment,
memorable. We hope that this book serves you well. and nutrition therapy for specific diseases, including gastro-
intestinal disorders, liver disease, diabetes mellitus, cardio-
vascular diseases, renal diseases, cancer, and HIV infection.
a Book tour of this Edition the highlights Every chapter is followed by a highlight
Understanding Normal and Clinical Nutrition presents updated, that provides readers with an in-depth look at a current, and of-
comprehensive coverage of the fundamentals of nutrition and ten controversial, topic that may relate to its companion chap-
nutrition therapy for an introductory nutrition course. The early ter. For example, Highlight 4 examines the scientific evidence
chapters introduce the nutrients and their work in the body as behind some of the current controversies surrounding carbohy-
well as recommendations about nutrition that are essential for drates and their role in weight gain and weight loss. New to this
maintaining health and preventing disease. The later chapters edition are Critical Thinking Questions designed to encourage
provide instruction in clinical nutrition—the pathophysiology readers to develop clear, rational, open-minded, and informed
and nutrition care for a wide range of medical conditions. thoughts based on the evidence presented in the highlight.
the Chapters Chapter 1 begins by exploring why we eat Special Features The art and layout in this edition have
the foods we do and continues with a brief overview of the nu-
been carefully designed to be inviting while enhancing stu-
trients, the science of nutrition, recommended nutrient intakes,
dent learning. For example, numbered steps have been added
and important relationships between diet and health. Chapter
to several figures to clarify sequences and processes. In addi-
2 describes the menu-planning principles and food guides used
tion, special features help readers identify key concepts and
to create diets that support good health and includes instruc-
apply nutrition knowledge. For example, when a new term
tions on how to read a food label. In Chapter 3, readers follow
is introduced, it is printed in bold type, and a definition is
the journey of digestion and absorption as the body breaks
provided. These definitions often include pronunciations and
down foods into absorbable nutrients. Chapters 4 through 6
derivations to facilitate understanding. The glossary at the
describe carbohydrates, fats, and proteins—their chemistry,
end of the text includes all defined terms.
roles in the body, and places in the diet. Chapter 7 shows how
the body derives energy from these three nutrients. Chapters definition (DEF-eh-NISH-en): the meaning of a word.
8 and 9 continue the story with a look at energy balance, the ● de = from
factors associated with overweight and underweight, and the ● finis = boundary
benefits and risks of weight loss and weight gain. Chapters 10

xvii
how to
LEaRninG GPS Many of the chapters include To” in Chapter 1 presents the
The opening page of each chapter provides a Learning GPS that “How To” features that guide steps in calculating energy in-
serves as an outline and directs readers to the main headings (and readers through problem-solv- take from the grams of carbohy-
subheadings) within the chapter. Each main heading is followed ing tasks. For example, a “How drate, fat, and protein in a food.
by a Learn It—a learning objective for the content covered in that
section. The Learn It also appears within the text at the start of
❯ tRY it Each “How To” feature ends with a “Try It” activ-
each main section as well as at the start of each Review It. After
ity that gives readers an opportunity to practice these new
reading and studying the chapter, students should be able to
lessons.
demonstrate competency in the Learn It objectives.
Nutrition in Your Life/Nutrition CaSE

in the Clinical Setting StUdY
Chapters 1 through 16 open with a paragraph called Nutri- The clinical chapters include case studies that present prob-
tion in Your Life that introduces the chapter’s content in a lems and pose questions that allow readers to apply chapter
friendly and familiar way. This short paragraph closes with material to hypothetical situations. Readers who successfully
a preview of how readers might apply that content to their master these exercises will be better prepared to face real-
daily lives by inviting them to use the Nutrition Portfolio life challenges that arise in the clinical setting.
section at the end of those chapters. Similarly, Chapters 17
through 29 open with a Nutrition in the Clinical Setting
paragraph, which introduces real-life concerns associated
with diseases or their treatments. Nutrition Assessment Checklist
The clinical chapters close with Nutrition Assessment Check-
lists that help readers evaluate how various disorders impair
Nutrition Por tfolio/Clinical nutrition status. These sections highlight the medical, di-
etary, anthropometric, biochemical, and physical findings
Portfolio most relevant to patients with specific diseases.
At the end of Chapters 1 through 16, a Nutrition Portfolio

prompts readers to consider whether their personal choices are Diet-
meeting the dietary goals presented in the chapter. Chapters 17 Drug interactions
through 29 finish with a Clinical Portfolio section, which
enables readers to practice their clinical skills by addressing Most of the clinical chapters also include a section on Diet-
hypothetical clinical situations. Many of these assignments in- Drug Interactions that presents the nutrition-related concerns
clude instructions that use the Diet & Wellness Plus program. associated with the medications commonly used to treat the
Such tools help students assess their current choices and make disorders described in the chapter.
informed decisions about healthy options.
❯ REVIEW IT Each major section within a chapter concludes the appendixes The appendixes are valuable references
with a Review It paragraph that summarizes key concepts. Simi- for a number of purposes. Appendix A summarizes back-
larly, Review It tables cue readers to important summaries. ground information on the hormonal and nervous systems,
complementing Appendixes B and C on basic chemistry, the
Also featured in this edition are the 2015–2020 Dietary chemical structures of nutrients, and major metabolic path-
Guidelines for Americans, which are introduced in Chapter 2 ways. Appendix D describes measures of protein quality.
and presented throughout the text whenever their subjects Appendix E provides supplemental coverage of nutrition assess-
are discussed. Look for the following design. ment, and Appendix F presents the estimated energy require-
ments for men and women at various levels of physical activity.
Appendix G presents the 2014 Choose Your Foods: Food Lists for
> diE ta RY GUidEL inE S F oR a MERiC a nS 2 0 15 – 2 0 2 0
Diabetes and Weight Management. Appendix H is a 4000-item
These guidelines provide science-based advice to promote health and
food composition table. Appendix I presents nutrition recom-
to reduce the risk of chronic disease through diet and physical activity.
mendations from the World Health Organization (WHO).
xviii Preface
Appendix J presents the Healthy People 2020 nutrition- Chapter 3
related objectives. Appendix K features aids to calculations, ● Introduced microbiome and revised section on gastroin-
a short tutorial on converting metric measures and handling
testinal bacteria
basic math problems commonly found in the world of nu-
trition. Appendix L provides examples of commercial enteral
formulas commonly used in tube feedings or to supplement
Chapter 4
oral diets. ● Revised table showing nutrients in sugars and other
foods to include potassium and vitamin D
the inside Covers The inside covers put commonly ● Created tables to define glucose for normal and diabetes;
used information at your fingertips. The inside front covers to show the glycemic index of a few common foods; to
(pp. A–C) present the current nutrient recommendations, list the functions of sugars in foods; and to present ways
and the inside back covers feature the Daily Values used on to prevent dental caries
food labels and a glossary of nutrient measures (p. Y on the ● Included fructose metabolism in the highlight
left) as well as suggested weight ranges for various heights
(p. Z on the right). Chapter 5
● Created tables to define blood lipids for heart health; to
notable Changes in this Edition list fat choices among protein foods and among milk
products; to show omega-3 fatty acid quantities in a vari-
Because nutrition is an active science, staying current is para- ety of fish and seafood
mount. Just as nutrition research continuously adds to and ● Created new figure on how to read fish oil supplement
revises the accepted body of knowledge, this edition builds
labels
on the science of previous editions with the latest in nutrition
research. Much has changed in the world of nutrition and in
● Added definitions for resistin and adiponectin
our daily lives since the first edition. The number of foods has
increased dramatically—even as we spend less time than ever Chapter 6
in the kitchen preparing meals. The connections between ● Expanded discussion on the association between dietary
diet and disease have become more apparent—and consumer protein and body weight
interest in making smart health choices has followed. More
people are living longer and healthier lives. The science of Chapter 7
nutrition has grown rapidly, with new facts emerging daily. ● Created new figure illustrating labels on beer, wine, and
In this edition, as with all previous editions, every chapter liquor
has been revised to enhance learning by presenting current
information accurately and attractively. For all chapters and Chapter 8
highlights we have:
● Discussed “3500 kcalorie rule” and its limitations
● Reviewed and updated content
● Created new tables for estimating energy expended on
● Created several new figures and tables and revised others basal metabolism and on thermic effect of foods and for
to enhance learning percent body fat at various BMI
● Included 2015-2020 Dietary Guidelines for Americans ● Revised section on female athlete triad to include
new expanded term—Relative Energy Deficiency in
Chapter 1 Sports (RED-S)—and created new table of its adverse
● Created table to summarize ways to describe six classes consequences
of nutrients ● Added discussion of food addiction to section on binge
● Introduced registered dietitian nutritionist (RDN), another eating disorder
term to describe an RD
Chapter 9
Chapter 2 ● Added discussion of brite adipocytes to section on brown
● Revised section on Dietary Guidelines to reflect 2015– adipocyte tissue and uncoupling proteins
2020 recommendations
● Updated table on FDA-approved weight loss drugs
● Revised figure comparing nutrient density of two break-
● Revised figure on gastric surgery used to treat obesity
fasts to include potassium and vitamin D
● Deleted discussion and figure on unrealistic expectations
● Introduced proposed food labels and revised figure to il-
lustrate differences ● Created new table of national strategies to prevent
obesity
● Introduced front-of-package labeling and added figure to
illustrate ● Updated table on popular weight loss diets
Preface xix
Chapter 11 Chapter 20
● Added a paragraph on “golden rice,” a genetically modi- ● Refined the terms related to nutrition support: intro-
fied rice used in the worldwide fight against vitamin A duced the terms specialized nutrition support and oral
deficiency nutrition support
● Added details on vitamin D’s non-bone-related roles ● Shortened the section on oral supplements
● Rewrote the introduction to vitamin E ● Updated the feeding tube photo
● Rewrote the food sources of vitamin K paragraph to ● Modified the sections on initiating and advancing tube
include the terms phylloquinone (vitamin K 1) and feedings and meeting water needs
menaquinone (vitamin K2)
Chapter 21
Chapter 12 ● Added additional details in the table on patient moni-
● Revised calcium balance figure toring during parenteral nutrition
● Revised the section on discontinuing parenteral nutrition
Chapter 13 ● Revised the glossary definitions in the highlight on ethi-
● Created table of factors influencing iron absorption cal issues
Chapter 14 Chapter 22
● Created several new tables: benefits of WIC, risk factors ● Added glossary definitions for complement, indirect calo-
for gestational diabetes, signs and symptoms of pre- rimetry, and minute ventilation
eclampsia, complications from smoking during preg- ● Revised the sections on estimating energy needs during
nancy, tips to prevent listeriosis
acute stress, use of glutamine or arginine during acute
● Reorganized sections on fetal programming and fetal de- illness, and micronutrient needs in acute stress
velopment of chronic diseases ● Modified the How To feature for estimating energy needs
using stress factors
Chapter 15
● In the table on predictive equations used in ventilator-
● Created several new tables: protective factors in breast
dependent patients, updated the Ireton-Jones and Penn
milk, tips for picky eaters, examples of foods and non-
State equations, and used the Penn State equation in the
food items children can choke on, iron recommenda-
example
tions for adolescents
● Shortened the section on causes of chronic obstructive
● Added information about fluoride and formula
pulmonary disease, and modified some sections on nu-
preparation
trition therapy for respiratory failure
● Added brief discussion about new AAP guidelines for re-
duced, low-fat, and fat-free milk for toddlers Chapter 23
● Added discussion of new school meal initiatives ● Added a discussion about gastroparesis
Modified some material in the sections on gastritis, gas-
Chapter 16
●
troesophageal reflux disease, and bariatric surgery; added

● Created new figure comparing healthy lens with cataract lens glossary definitions for bloating and bacterial overgrowth
In the section on bariatric surgery, added a figure show-
Chapter 17
●
ing the sleeve gastrectomy surgery

● Added a table showing the relationship between the rate
of involuntary weight loss and nutritional risk Chapter 24
● Updated the laboratory values in the table on routine ● Revised some of the material in the sections on constipa-
laboratory tests tion, intestinal gas, acute and chronic pancreatitis, cystic
● Added a paragraph about C-reactive protein in the sec- fibrosis, celiac disease, irritable bowel syndrome, and di-
tion on biochemical analyses verticular disease of the colon
● Revised the discussion on fluid retention ● Added calcium channel activators to the table of laxa-
tives and bulk-forming agents
Chapter 19 ● Revised the table of foods that increase intestinal gas
● Reorganized the beginning paragraphs of the highlight ● Introduced the concept of FODMAPs and added a defini-
on complementary and alternative medicine tion for bacterial translocation
xx Preface
Chapter 25 ● In the section on kidney stones, introduced hypocitratu-
ria as a risk factor and reformatted the table on food
● Shortened the paragraph on nutrition treatment for
sources of oxalates
hepatitis
● Modified some sections about cirrhosis complications, Chapter 29
including the table listing the clinical features of hepatic
● Updated the tables on factors that influence cancer risk
encephalopathy
● Revised the section on biological therapies for cancer to
● Revised the section on the medical treatment for cirrhosis
include more examples of cancer immunotherapy; in-
cluded new definitions for monoclonal antibodies and im-
Chapter 26 mune checkpoint inhibitors
● Updated statistics throughout the chapter
● Revised the section about food safety concerns for im-
● Added a margin table comparing glycated hemoglobin munosuppressed cancer patients
(HbA1c) and plasma glucose levels
● Expanded the section on the prevention of HIV infection
● In the section on diabetic neuropathy, distinguished be- to include a discussion about prophylactic medications
tween peripheral and autonomic neuropathy and added used in persons at risk of HIV exposure
glossary definitions for these two different forms of
● Updated the definition of AIDS-wasting syndrome to re-
neuropathy
flect current guidelines
● Revised various sections on nutrition therapy to reflect
the updated clinical guidelines
● Revised the discussion on exchange lists to reflect the Student and instructor Resources
food lists released in 2014 (Appendix G was also up-
dated to show the 2014 food lists) nutrition Mindtap for Understanding normal
● Added inhaled insulin and sodium-glucose cotrans- and Clinical nutrition
porter 2 (SGLT2) inhibitors to the tables listing the dif- MindTap is well beyond an eBook, a homework solution or
ferent types of insulin and antidiabetic drugs digital supplement, a resource center website, a course deliv-
ery platform, or a Learning Management System. More than
● Revised the discussion on insulin use in type 2 diabetes 70 percent of students surveyed said that it was unlike any-
● Updated several sections in the Nutrition in Practice on thing they have ever seen before. MindTap is a new personal
metabolic syndrome learning experience that combines all of your digital assets—
● Added a figure showing how metabolic syndrome varies readings, multimedia, activities, and assessments—into a
among ethnic groups and removed the figure showing singular learning path to improve student outcomes.
how it varies with age
diet & Wellness Plus
Chapter 27 Diet & Wellness Plus helps you gain a better understanding
● Revised various paragraphs in the sections on atheroscle- of how nutrition relates to your personal health goals. It en-
rosis, cardiovascular disease (CVD) risk assessment, CVD ables you to track your diet and activity, generate reports,
lifestyle management, hypertension, and heart failure and analyze the nutritional value of the food you eat! It in-
cludes over 55,000 foods in the database, custom food and
● Revised the How To feature about identifying and treat- recipe features, the latest Dietary References, as well as your
ing high blood cholesterol goal and actual percentages of essential nutrients, vitamins,
● Eliminated the box on assessing risk of heart disease and minerals. It also helps you to identify a problem behav-
● Updated the section on hypertension treatment ior and make a positive change. After completing a Wellness
● In the highlight on feeding disabilities, revised the sec- Profile questionnaire, Diet & Wellness Plus will rate the level
tion related to altered energy requirements of concern for eight different areas of wellness, helping you
determine the areas where you are most at risk. It then helps
Chapter 28 you put together a plan for positive change by helping you
select a goal to work toward, complete with a reward for all
● Modified the table on causes of acute kidney injury, and your hard work. Diet & Wellness Plus is also available as an
revised the discussion about the evaluation of acute kid- App that can accessed from the App dock in MindTap and
ney injury can be used throughout the course for students to track their
● Updated the section on the evaluation of chronic kidney diet, activity, and behavior change.
disease to reflect new clinical practice guidelines
● Clarified and updated some sections related to nutri- Global health Watch
tion therapy for chronic kidney disease to reflect current Updated with today’s current headlines, Global Health
recommendations Watch is your one-stop resource for classroom discussion
and research projects. This resource center provides access to
Preface xxi
thousands of trusted health sources, including academic
journals, magazines, newspapers, videos, podcasts, and more.
Closing Comments
It is updated daily to offer the most current news about topics We have taken great care to provide accurate information
related to your health course. and have included many references at the end of each chap-
ter and highlight. To keep the number of references man-
Cognero test Bank ageable over the decades, however, many statements that
Cengage Learning Testing Powered by Cognero is a flexible, appeared in previous editions with references now appear
online system that allows you to: without them. All statements reflect current nutrition knowl-
● Author, edit, and manage test bank content from mul- edge, and the authors will supply references upon request.
tiple Cengage Learning solutions In addition to supporting text statements, the end-of-chapter
references provide readers with resources for finding a good
● Create multiple test versions in an instant
overview or more details on the subject. Nutrition is a fas-
● Deliver tests from your learning management system cinating subject, and we hope our enthusiasm for it comes
(LMS), your classroom, or wherever you want through on every page.
instructor’s Companion Site Sharon Rady Rolfes

Everything you need for your course in one place! This col- Kathryn Pinna
lection of book-specific lecture and class tools is available Ellie Whitney
online via www.cengage.com/login. Access and download
PowerPoint presentations, images, the instructor’s manual,
videos, and more.
xxii Preface
Acknowledgments
To produce a book requires the coordinated effort of a team thoughtful suggestions and efficient analysis of reviews, Carol
of people—and, no doubt, each team member has another Samet for her management of this project, Tom Ziolkowski
team of support people as well. We salute, with a big round for his energetic efforts in marketing, Miriam Myers for her
of applause, everyone who has worked so diligently to en- dedication in developing online animations and study tools,
sure the quality of this book. and Christine Myaskovsky for her assistance in obtaining
We thank our partners and friends, Linda DeBruyne and permissions.
Fran Webb, for their valuable consultations and contribu- We also thank Gary Hespenheide for creatively designing
tions; working together over the past 30-plus years has been these pages, Mathangi Anantharaman at Lumina Datamatics
a most wonderful experience. We especially appreciate Linda’s Limited for selecting photographs that deliver nutrition messages
research assistance on several chapters. Special thanks to Da- attractively, Debbie Stone for copyediting, and MPS Limited for
vid Stone for his help in critiquing and proofreading various proofreading close to 1000 final text pages. We would also like
sections in the clinical chapters. Thanks also to Chelsea Mack- to extend our gratitude to Edward Dionne, our project manager,
enzie for her work on manuscript preparation and to Taylor and the talented team at MPS Limited for their assistance with
Newman for her assistance in creating informative tables and layout, production, and indexing. To the hundreds of others in-
descriptive figures. volved in production and sales, we tip our hats in appreciation.
Our heartfelt thanks to our editorial team for their efforts We are especially grateful to our friends and families for
in creating an outstanding nutrition textbook—Krista Mastroi- their continued encouragement and support. We also thank
anni for her leadership and support, Lauren Oliveira for her our many reviewers for their comments and contributions.
xxiii
Reviewers of Understanding
Normal & Clinical Nutrition
Becky Alejandre Sue Fredstrom Rebecca A. Kleinschmidt
American River College Minnesota State University, Mankato University of Alaska Southeast
Janet B. Anderson Trish Froehlich Vicki Kloosterhouse
Utah State University Palm Beach Community College Oakland Community College
Sandra D. Baker Stephen P. Gagnon Donna M. Kopas
University of Delaware Hillsborough Community College Pennsylvania State University
Angelina Boyce Leonard E. Gerber Susan M. Krueger
Hillsborough Community College University of Rhode Island University of Wisconsin, Eau Claire
Lynn S. Brann Jill Golden Barbara Lange
Syracuse University Orange Coast College College of Central Florida
Shalon Bull Barbara J. Goldman Melissa Langone
Palm Beach Community College Palm Beach State College Pasco-Hernando Community College
Dorothy A. Byrne Debra Goodwin Grace Lasker
University of Texas, San Antonio Jacksonville State University Lake Washington Institute of Technology
Angela Caldwell Kathleen Gould Darlene M. Levinson
Black River Technical College Towson University Oakland Community College, Orchard
John R. Capeheart Margaret Gunther Ridge
University of Houston, Downtown Palomar College Kimberly Lower
Leah Carter Charlene Hamilton Collin County Community College
Bakersfield College University of Delaware Mary Marian
James F. Collins Debra Head University of Arizona
University of Florida University of Central Arkansas Melissa B. McGuire
Cathy Cunningham D. J. Hennager Maple Woods Community College
Texas Tech University Kirkwood Community College Diane L. McKay
Diane Curis Catherine Hagen Howard Tufts University
Los Rios Community College District Texarkana College Anne Miller
De Anza College
Lisa K. Diewald Samantha Hutson
Montgomery County Community College Tennessee Technological University Anahita M. Mistry
Eastern Michigan University
Kelly K. Eichmann Jasminka Z. Ilich
Fresno City College Florida State University Lisa Morse
Arizona State University
Shannon Fenster Ernest B. Izevbigie
Bellevue College Jackson State University Mithia Mukutmoni
Sierra College
Shawn Flanagan Craig Kasper
Steven Nizielski
University of Iowa Hillsborough Community College
Grand Valley State University
Mary Flynn Shawnee Kelly
Carmen L. Nochera
Brown University Pennsylvania State University
Grand Valley State University
Betty J. Forbes Younghee Kim
Yvonne Ortega
West Virginia University Bowling Green State University
Santa Monica College
xxiv
Another random document with
no related content on Scribd:
This was about three o’clock. General McCall, with his staff, had
arrived on the ground only to hear of a victory won. Knowing that an
advance would be fatal, he ordered a recall, and with the wounded
and dead, and the trophies of war, the troops returned from the field.
The brave and victorious band arrived at Langley’s about nine
o’clock in the evening, where they were met by thousands of their
shouting and exultant comrades.
The rebel troops engaged in this battle were on the same errand.
Two hundred wagons had been sent out by General Stuart, their
commander, under the care of a foraging party, escorted by the
Eleventh Virginia, Colonel Garland; the Sixth South Carolina, under
Lieutenant-Colonel A. J. Secrest; the Tenth Alabama, Colonel John
H. Forney; the First Kentucky, Colonel Sam. Taylor; the Sumter
Flying Artillery, Captain Cutts, and detachments from Ransom’s and
Radford’s Cavalry. The rebel troops fought well, and did honor to
themselves as soldiers, whose nerve and bravery would have been
worthy of triumph in a sacred cause. Their loss was seventy-five
killed, one hundred and fifty wounded, and thirty prisoners. Of the
Federals, seven were killed and sixty-one wounded.
EXPEDITION TO SHIP ISLAND.
December, 1861.
General B. F. Butler, after having been stationed for a short time at

Fortress Monroe, was assigned to the North-Eastern Department,
and located his headquarters at Boston, where he superintended the
organization of the New England troops, and the fitting out of an
expedition intended to make a demonstration at some point on the
Southern coast. A portion of his troops sailed from Boston on the
23d of November, in the steam transport Constitution, which arrived
at Fortress Monroe on the 26th, with the Twenty-sixth
Massachusetts, and the Ninth Connecticut regiments, and Captain
Manning’s battery—making a total of one thousand nine hundred
men. Brigadier-General J. W. Phelps here took the command, and
reached Ship Island harbor, in Mississippi Sound, December 3.
On the west end of this island there was a partly-finished fort,
occupied by Lieutenant Buchanan and one hundred and seventy
sailors and marines, with several ship guns in position. The rebels
had evacuated the island in September, destroying what they could
not carry away with them.
General Phelps, on assuming the command of Ship Island,
published a proclamation “To the loyal citizens of the South-west,” in
which he defined the political “motives and principles” by which his
command would be governed. He then at the very opening of his
address, declared that every slave State admitted into the Union
since the adoption of the Constitution, had been admitted in direct
violation of that instrument. That every slave State that existed as
such at the adoption of the Constitution, was by that act placed
under the “highest obligation of honor and morality to abolish
slavery.” The rest of the “proclamation” was in harmony with these
statements. General Phelps made an official report of his expedition
to General Butler, who reported the facts to the Adjutant-General of
the United States. General Phelps was commended for the successful
manner in which he had performed his military duties, but his
proclamation was pronounced superfluous and uncalled for.
The occupancy of Ship Island being secured, the forces remained
in undisturbed possession, awaiting the future movements of the
commander of the expedition.
ENGAGEMENT AT MOUNT ZION.
December 28, 1861.
On the 23d of December, General Prentiss, commanding the army

of Northern Missouri, having his headquarters at Palmyra, received
orders to disperse a body of the enemy’s forces that had concentrated
in Boone County. In pursuance of his instructions he started on the
following morning with two hundred of the Third Missouri Cavalry,
Colonel John Glover, and five companies of Sharpshooters, under
Colonel Birge, and arrived at Sturgeon on the evening of the 26th.
During the following day, having learned that there was a
concentration of rebels near the village of Hallsville, in Boone
County, General Prentiss sent forward one company of cavalry,
commanded by Captain Howland, to reconnoitre in that vicinity.
Captain Howland proceeded to Hallsville, but found no rebels. After
proceeding about two miles beyond, his advance guard encountered
the rebels in force, commanded by Colonel Dorsey. Captain Howland
endeavored to draw off his company, having taken nine prisoners,
but was overpowered. Being wounded, and having lost his horse, he
was taken prisoner, with one private of his company. The remainder
of his men made good their retreat, arriving at Sturgeon at nine
o’clock, P. M.
Having learned the position of the enemy, General Prentiss
ordered his command, numbering in all four hundred and seventy, to
march at two o’clock, A. M., at which hour he started, and after
marching a distance of sixteen miles, at eight o’clock A. M. of the 28th
inst. found one company of rebels, commanded by Captain Johnson,
in position to the left of the road leading from Hallsville to Mount
Zion. General Prentiss ordered two companies of sharpshooters to
pass to the rear of the enemy, and one of cavalry to dismount and
engage them in the front.
Colonel Glover opened fire, and succeeded in killing five and
capturing seven prisoners, from whom was ascertained the number
and position of the main force—the enemy being posted at a church,
known as Mount Zion, in Boone County, one mile and a half in
advance, numbering near nine hundred men. General Prentiss
ordered the cavalry under Colonel Glover forward, accompanied by
two companies of Birge’s sharpshooters. Colonel Birge, arriving near
the encampment, ordered one troop of cavalry to dismount and
engage the enemy. The sharpshooters were afterward ordered
through a field on the right to skirmish with the enemy’s left, and if
possible drive them from the woods.
The firing being heavy, and these three companies proving unable
to drive the enemy from his cover, Colonel Glover, with his available
force, moved in double-quick to their aid, and for half an hour longer
the battle raged and became a hand-to-hand fight. Captain Boyd’s
company of sharpshooters were in the midst of the rebel camp. Also,
Major Carrick, with Company C of the Cavalry. When Colonel Glover
arrived, the enemy retreated, leaving in the Federal hands 90 horses
and 105 stand of arms. The battle was brought to a close about 11 A.
M.
The reserve of two companies coming into action at the moment
the enemy gave way, the victory was complete. After collecting the
wounded, the Federals proceeded to care for those of the enemy,
placing them in the church, and sent for farmers and friends in the
vicinity to render assistance, when they returned to Sturgeon, where
they arrived at 9, P. M. The loss in the battle of Mount Zion, and in the
engagement of the evening previous, was: Killed, 3; slightly
wounded, 46; severely wounded, 17. Rebel loss: Killed, 25; wounded,
150.
ARKANSAS, AND THE INDIANS.
The prominent and active men in the State of Arkansas, and

particularly all who held official positions, were allied politically with
the South Carolina conspirators, while the majority of the people, in
the early stages of the insurrection, were loyal. Hence, the leaders
were slow in their movements to carry the State out of the Union; but
when the Confederate government had become organized, and
transferred to Richmond, and the rebellion had been fully
inaugurated by the attack on Fort Sumter, followed by the
proclamation of President Lincoln, they deemed that the time had
come for the development of their plans. The Governor of the State,
Henry M. Rector, on the 22d of April, 1861, directed the seizure by
State troops of the United States stores at Napoleon; followed on the
24th by the capture of Fort Smith by the forces under Colonel
Borland.
The Legislature being convened at Little Rock, an unconditional
ordinance of Secession was passed on the 6th of May, and on the
18th the Confederate Congress at Richmond declared the admission
of Arkansas to the Southern Confederacy.
It was the misfortune of the loyal men of the State that they did not
number in their ranks any citizens of power and influence, who had
energy sufficient to organize the Unionists, and oppose a barrier to
the acts of the enemies of the Federal Government. Unarmed and
unorganized, while the conspirators were in a state of preparation for
any resistance that might be made, protest and opposition were of no
avail, and the loyal men of the State were compelled to submit, and
endure the persecutions and depredations of the more numerous
secessionists.
A great deal of excitement was occasioned during the month of
November by the discovery that the Union men of Izard, Fulton,
Independent and Searcey counties had secret organizations and
societies for mutual protection and co-operation. This accidental
disclosure exasperated the conspirators, who adopted the most
violent measures to disperse the Unionists, and break up their
associations. Many were taken to Little Rock and hanged, while
others were arrested in the woods, attempting to escape beyond the
State, and shared the same fate. Large numbers of refugees, however,
succeeded in reaching Missouri, where they remained, and
subsequently, under Captain Ware, a member of the Arkansas
Legislature, organized as a military body at Rolla, Missouri, and
entered the service under General Curtis, receiving large accessions
on the marching of Curtis’ expedition into the State.
Impressed with the importance of securing the services of the
Indian tribes within the limits of Arkansas, as well as the adjoining
territory, the agents of the Richmond government were instructed to
negotiate with the Cherokees and Creeks on the borders of Arkansas,
promising the payment of the United States annuities by the
Confederacy in case of their allegiance. On the 24th of August an
agreement was entered into by some of the Cherokee chiefs, and the
two tribes raised 2,000 men for the war. The nations were divided on
the question, the most intelligent being convinced that loyalty to the
Federal Government was their true policy not less than their duty.
The Choctaws, Chickasaws, and other tribes were treated in a similar
manner, and with the same results—secession having the effect of
dividing the Red Men of the forest as it had divided the pale faces of
the east.
From authentic sources it was learned from the Seminole agency
that Opothleyoholo, a loyal chief, had collected together four or five
thousand Indians, and about thirteen hundred negroes, who had
gone to him with the hope of being rendered free. When General
Cooper (rebel,) at the head of the Creek, Choctaw and Chickasaw
regiments, with other Indians, amounting to near five thousand,
advanced upon Opothleyoholo’s camp, his followers fled, leaving all
behind. Opothleyoholo left with a few adherents for the south-west.
Most of his followers were reported to be with Colonel Cooper, who
was said to have a very large Indian force with him.
BOMBARDMENT AT FORT PICKENS.
On the 1st of January, 1862, Fort Pickens with the rebel forts and
batteries on the Bay of Pensacola again awoke the thunders of their
heavy artillery, whose tremendous explosions reverberated for thirty
miles along the Florida coast.
The loyal garrison at the fort had been long chafing under the
restraints of continued inaction. The commander, Colonel Harvey
Brown, Fifth United States Artillery, had been anxiously awaiting the
time when a sufficient force would be at his command to drive the
unwelcome foe from his position near the fort.
Lieutenant Adam J. Slemmer, of Pennsylvania, of the First United
States Artillery, the former brave commander, who saved the fort by
his courage and loyalty, on the 12th of January, 1861, had been
relieved, on account of ill-health. He received a Major’s commission
in the Sixteenth United States Infantry, May 14th, 1861.
On the first day of the year a small steamer was seen from Fort
Pickens making her way toward the Navy Yard. She was a saucy,
defiant looking craft, and some one on board waved a secession flag
ostentatiously in sight, as if challenging a fire. This was an
exasperating insult to the restive men shut up in the fort. Colonel
Brown had frequently warned General Bragg against forcing the
presence of these insolent steamers upon him, and when this
presumptuous little craft approached Fort Pickens, with its flag in
commotion, he opened fire upon her. She drew in her flag and
retreated instantly with a crestfallen, retrograde movement, in
amusing contrast with her first approach.
The fire from Fort Pickens was directly answered by all the rebel
batteries, and in a brief time the engagement became general. The
firing on both sides was kept up through the entire day, and at night
Pickens maintained a slow fire from her thirteen-inch mortars, which
was promptly returned by the rebels.
About midnight a conflagration broke out in the Navy Yard. It
flamed up furiously, consuming the buildings of the Yard, and
spreading to the town of Woolsey, adjoining the Navy Yard on the
north, where it raged all night.
The scene during the night was wonderfully magnificent. Every
shell could be tracked in its course through the air from the moment
it left the gun until it exploded, scattering destruction all around.
These shells, rising up against a cloud of surging flame, which sent
its red light in a continued glare landward and seaward, formed an
appalling spectacle. The minutest outline of the grim fort seemed
sketched on a back-ground of fire, rendering the light which Colonel
Brown hung out from its walls, in scornful bravado, offering a sure
mark to the enemy, scarcely more than one of the ten thousand
sparks that filled the atmosphere with gleams of gold. Far off over
the beautiful land the light of that conflagration spread, filling the
inhabitants with alarm; and so brightly did it flame over the ocean,
that the United States steamer Mercedita floated in the glow of its
ruddy light when over twenty miles at sea.
Through the heat of this conflagration the guns kept up their slow
booming thunder, adding to the sublime interest of the scene. The
firing on both sides was remarkable for its extreme accuracy. Shells
in countless numbers fell inside of Fort Pickens, and were returned
with double vigor by its guns.
All the batteries were engaged, and did their work admirably. Fort
McRae, which had been so roughly handled by the Federal squadron
at the last engagement, resumed its accustomed vigor, and Battery
Scott kept up a constant fire throughout the engagement.
Several ships of the squadron were present, but took no part in the
fight. It was well they did not, for nothing could have been gained,
and probably much would have been lost had they attempted to
oppose their wooden sides to stone walls and earthworks.
The bombardment was the old story of fort against fort, at a
distance too great for any decisive result. The Unionists gained
nothing, yet expended a large amount of powder, shot and shell, and
the enemy had no greater advantage. Apart from the burning of
Warrington, the Navy Yard and Woolsey, no injury worth speaking of
was sustained. The next day Fort Pickens stood out against the sky
grim and strong as it was before the bombardment. There were but
few if any casualties worth recording during this affair. Even Colonel
Brown’s lantern, hung out to guide the rebel shot, failed to invite any
real injury; and except that it left a wide field of devastation behind,
the bombardment of Fort Pickens had few important results.
ROUT OF GENERAL MARSHALL AT
PAINTSVILLE, KY.
January 7, 1862.
On the 7th of January, Colonel Garfield, who had his encampment

on Muddy Creek, in Eastern Kentucky, marched to attack the rebel
General Marshall, who with a large force of men and a battery of four
pieces, was known to have an entrenched camp at Paintsville, the
capital of Johnson county. Colonel Garfield’s command, composed of
the Forty-second Ohio, the Fourteenth Kentucky, and Major
McLaughlin’s squadron of Ohio cavalry, making an effective force of
about fifteen hundred men, broke up their camp on Muddy Creek,
and moved toward Paintsville. While on the march they were
reinforced by a battalion of the First Virginia cavalry, under Colonel
Bolles, and by three hundred of the Twenty-second Kentucky, raising
the force to about twenty-two hundred men. The enemy, under
Humphrey Marshall, numbering three thousand five hundred men,
and having a battery of four pieces, learned of the approach, and also
that of the Fortieth Ohio and of four hundred of Colonel Wolford’s
cavalry by the way of Mount Sterling and the valley of the Paint
Creek. They had, two days previously, after burning large quantities
of grain, broken up their intrenched camp, and effected a retreat to
the heights on Middle Creek, two miles distant from Prestonburg.
They had left a corps of observation at the mouth of Jennie Creek,
three miles west from Paintsville, of three hundred cavalry, and a
large force of infantry about seven miles up Jennie Creek, to protect
and facilitate the passage of their trains.
Immediately on arriving Colonel Garfield, learning the position of
this cavalry, but unaware of the whereabouts of the other divisions of
the rebel force, immediately commenced the erection of a pontoon or
floating bridge across the Paint Lick Creek, at Paintsville. At four P. M.
he crossed with eight companies of the Forty-second Ohio, and two
companies of the Fourteenth Kentucky, with a view of making an
armed reconnoissance, and if possible of cutting off and capturing
the cavalry. At two P. M. he had dispatched Colonel Bolles’ cavalry and
one company of the Forty-second, under the command of Captain S.
M. Barber, with orders to give a good account of the cavalry. But later
in the day, on learning the possibility of cutting them off, he had sent
orders to Colonel Bolles not to attack them until he had obtained
time to get in their rear. Not receiving the last orders, and indeed
before they were issued, Colonel Bolles, in obedience to his first
directions, crossed the Paint by fording, and vigorously assaulting
the enemy, soon put them to flight up the valley of Jennie. In their
haste, followed as they were by the cavalry, they strewed the road
with their equipments, while here and there a dead or wounded
soldier gave proof that they were losing men also. The pursuit was
kept up for seven miles, right into the infantry division which was
guarding the train. Stationed on either side of the road, that did not
permit more than two to ride abreast, it opened a heavy cross-fire on
the Union cavalry, compelling them to fall back, and finally to
retreat, which they did in good order, having inflicted a loss of
twenty-five in killed and wounded, according to rebel account, and
losing but two killed and one wounded. Fifteen rebels were taken
prisoners. Meanwhile Colonel Garfield, with his command, having
remained a short time to fully explore the enemy’s deserted
fortifications, (consisting of lunettes, breastworks, rifle-pits and a
fort situated on the top of a conical hill,) and wholly unaware of what
had taken place, pressed forward to the hoped for consummation of
the march. But few miles had been traversed, however, when the
evidences of a hasty retreat became so apparent that all were
convinced that the enemy had flown. The object of the march having
been thus thwarted, an early return to Paintsville became desirable,
and it was accomplished at the dawn.
BATTLE OF MIDDLE CREEK, KY.
January 10, 1862.
Having recruited his men by a night’s rest at Paintsville, Colonel

Garfield was preparing to start in immediate pursuit on the morning
of the 8th, but receiving information of the superior force of the
enemy, he awaited the arrival of the Fortieth Ohio regiment, and
Wolford’s Kentucky cavalry, by way of Mount Sterling. These troops
joined him on that day, raising his effective force to about two
thousand four hundred men, after deducting Colonel Bolle’s Virginia
cavalry, which, in obedience to orders, had returned to Guyandotte
in that State. On the 9th, Colonel Garfield detailed from the Forty-
second and Fortieth Ohio, and Fourteenth Kentucky each three
hundred men, and from the Twenty-second Kentucky two hundred
men, and taking the immediate command, supported, however, by
Colonel Craner of the Fortieth, and Major Burke of the Fourteenth.
After detaching Colonel Wolford’s and Major McLaughlin’s cavalry
up Jennie’s Creek, he marched up the river road leading to
Prestonburg. Early on the morning of the 10th, Colonel Sheldon of
the Forty-second Ohio, in command at the camp, received a dispatch
from Colonel Garfield, stating that he had found the enemy, and
asking reinforcements. In compliance with the order, at six A. M. on
the tenth, Colonel Sheldon marched with eight hundred men, who
eagerly pressed forward on their way to the scene of action. As
Colonel Garfield had stated, he had found the enemy two miles from
Prestonburg, on Middle Creek, in a chosen position among the hills,
with between four and five thousand men and four pieces of artillery.
The Fifth Virginia regiment, Colonel Trigg, Colonel John S. Williams’
Kentucky regiment, Colonel Moore’s Kentucky regiment, Markham
and Wicher’s cavalry, and the Fourth Virginia infantry, lay in full
strength on the hills at the forks of the creek, while their battery
seemed to forbid all approach. Nothing deterred by the formidable
position and number of the enemy, Colonel Garfield, not fully aware
of their exact locality, sent skirmishers forward with a view of
drawing the enemy’s fire, and thus ascertaining his whereabouts. Not
succeeding in this, about noon he sent forward his escort of cavalry,
some twenty strong, in a headlong charge. This accomplished the
object, for the enemy, thinking the whole Union force upon them,
opened with musketry, shot and shell upon the cavalry, and a small
party of the skirmishers under Adjutant Olds of the Forty-second,
then in a cornfield immediately in front of the position of Colonel
Williams’ Kentucky regiment, and flanked on the left by the artillery
and Trigg’s Virginia regiment. The cavalry made a hasty retreat, and
the enemy concentrated their whole fire on Adjutant Olds and his
party, but without effect. After replying with some fifteen rounds of
musketry, and observing a large force thrown out on his right, with
intent to cut him off, he fell back upon the main body. The position
of the enemy thus disclosed was as follows: Colonel Williams’
regiment was behind a ridge at the head of the gorge, and on the
right of the road, so that his fire commanded the gorge and road for a
half-mile. Colonel Trigg’s regiment, the Fourth Virginia, was on the
crest of the crescent-shaped hill on the left of the road, commanding
it by their flanking fire. The artillery was between the two at the forks
of the creek and the turn in the road and gorge. The evident design of
the enemy was to draw the Unionists up the road in front of their
cannon and between the cross-fire of the three regiments, but this
well-formed plan failed in its execution, as in their impotence or
nervousness they neglected to reserve their fire for the approach of
the main body. The remainder of their force were in the rear of their
cannon, in a strong supporting position. Occupying Graveyard Point,
the end of a high ridge on the right of the creek north of his main
body, Colonel Garfield dispatched a hundred men across the creek to
ascend the horn of the crescent farthest up the gorge. The ascent was
most difficult, the men being compelled to creep on their hands and
knees most of the way. On attaining the summit, they were greeted
with the whole fire of Trigg’s regiment, stationed at the base, and
deployed along the other horn; also by a fire from the artillery and
the reserve in the rear. On the top of the ridge, and at points nearly
equi-distant from each other, were three piles of stone, the
possession of which was eagerly sought for by the contending parties.
The small band on the summit of the ridge were now reinforced by
two hundred men, and assisted by the reserve at Graveyard Point,
who poured a galling fire on the deployed right flank of the enemy,
they soon drove him from the first stone pile, and took possession of
it.
A force of two hundred men was then thrown out by Colonel
Garfield for the ascent of the lower horn of the crescent. These soon
reached the summit, where being reinforced by Colonel Craner of the
Fortieth with three hundred men, they captured the third stone pile,
while the rebels were thus confined to the second or central one. The
fire was now exceedingly heavy. Both parties betook themselves to
the shelter of the rocks and trees, and the battle raged furiously, the
shots tearing through the branches and surging up the defiles of the
mountains in a wild tumult of sounds.
About half-past four a burst of loud cheering heralded in
reinforcements for the Union troops. A detachment of brave soldiers
came in simultaneously with the shouts that welcomed them,
panting, and almost breathless from the fatigue of a long march; for
fifteen miles they had struggled through the mud of a broken road
without breakfast, and at a tiresome pace. Excited by the sound of
the conflict, they had marched the last two miles on the double-
quick, and came in bathed with perspiration, bespattered with mud,
and half the men carrying their coats on their arms.
Though fatigued with the forced march, and faint with hunger,
these noble fellows demanded only to be led at once into battle. After
a short rest, they were thrown across the creek to ascend the right
horn of the crescent, but were finally ordered back, as it had now
become too dark to advance with safety, and the storm of battle, by
mutual consent, ceased. Resting upon their arms, determined to
renew the battle in the morning, the Union troops spent the night;
but when morning dawned, the enemy, it was found, had vanished.
Under cover of the darkness he had burned his heavy baggage and
retreated. He left twenty-seven dead on the field, and it is definitely
ascertained had some one hundred and twenty-five wounded, of
whom forty-two subsequently died. The Federals lost two killed and
twenty-five wounded.
The Richmond papers claimed a brilliant Confederate victory on
this occasion, estimating the Federal forces at 8,000 men, and their
loss at 400 killed and wounded.
BATTLE OF SILVER CREEK, MO.
January 8, 1862.
It was the misfortune of Missouri, more than any other State, to be

a battle-ground for the guerrilla forces of the rebels, and for the
skirmishing engagements of the war. These minor battles, while they
had but little effect on the great result, inflicted untold horrors on the
people dwelling there.
At the opening of the year 1862, General Pope had command of the
North-western District of the State, with his headquarters at
Otterville, Cooper county.
Having heard that the enemy was busily engaged in recruiting men
in Roanoke and adjoining counties, Major W. M. G. Torrence of the
First Iowa Cavalry was ordered to concentrate and take command of
several small bodies of Federal troops, then guarding important
points in the district, and to break up the rebel encampments.
From Booneville, Major Torrence proceeded to Fayette, Howard
county, and for several days was actively engaged in scouring the
country and endeavoring to ascertain the position and strength of the
rebel forces. He found that Colonel Poindexter was recruiting in
various places in the county, and that he was encamped with his
principal force, of from five to seven hundred men, on Silver Creek,
and had other camps to reinforce him when ready to move, to the
number of from twelve to fifteen hundred men.
They further reported that he had pledged himself to his men that
he would clean out the Federals in the county of Howard in a very
few days. Night after night was selected to surprise the Union camp
with his whole force, but through some mishap they never appeared.
On the morning of January 8th, all was in motion in the Federal
camp, under orders from Major Torrence to hold themselves in
readiness to move with all their able-bodied men at an early hour.
They took up their line of march for Roanoke, and, after moving a
few miles, were joined by Major Hubbard’s command. The forces
now comprised a portion of Merrill’s horse, under Major Hunt, one
company of the Fourth Ohio, under Captain Foster, a part of the
Missouri First, under Major Hubbard, and four companies of the
First Iowa, under Major Torrence. After passing the town of
Roanoke, the whole column moved rapidly about five miles, and
halted to have position and duties assigned to the several commands.
Learning that the enemy were in a strong position on the Creek,
where it probably would be impossible to charge them with mounted
men, it was determined to dismount and fight as infantry.
Captain Foster was assigned the advance, followed by Merrill’s
Horse and the Missouri First, all armed with carbines. The First Iowa
were to make a descent upon the camp with drawn sabers, and if
impossible to make a charge mounted, they were to dismount and
move on foot. Lieutenant Dustin, of the First Iowa, with ten men,
formed the advance guard. All being in readiness, they moved
forward very rapidly, and followed the tortuous windings of a road
leading through narrow lanes and thick timber, till the sharp crack of
a rifle warned them that they were upon the rebel pickets. This was
the signal to rush forward, which was done. On, on they pushed,
through underbrush and defiles, till the advanced guard rushed to
the entrance of their camp, and found the enemy drawn up in line of
battle. It was now found that the thick timber and underbrush
forbade a charge upon the camp. The order to dismount passed along
the lines, and a column of armed infantry emerged from the lines on
the roadside, ready for the onset. The battle now commenced in
earnest, and volley after volley of musketry told that the work of
death had begun.
The enemy rushed from their line of battle, after their second
volley, into the intrenchment formed by the creek, and behind trees,
logs, etc., opened fire upon the Union lines, which was promptly
answered by their forces, armed with carbines, by a continued fire.
Major Torrence now ordered his men forward with revolver and
sabre, to make a charge on the camp; and with a yell running wildly
along their lines they advanced, in the face of the enemy’s fire, and
rushed into their camp. So great was the eagerness to move forward,
that three companies claimed the honor of being first in camp.
The enemy now gave way tumultuously, and ran from their camp,
leaving guns, horses, camp equipage, powder, and a large quantity of
new clothing for men in Price’s army. It was a complete rout, as the
appearance of the camp fully attested. It was now nearly dark, with a
heavy fog, and fearing that the enemy had only retired as a ruse to
rally and come to the attack again, the order was given to destroy the
whole camp and equipage. The work of destruction was soon
complete—wagons, saddles, tents, blankets, clothing, etc., were
gathered up, flung on the fires, and soon became one heap of burning
ruins. The Federals now looked up their dead and wounded, and
cared for them. The enemy’s dead lay in all portions of the camp, and
the groans of their dying mingled with the exultant shouts of the
victors. It was a fearful struggle, as the soldiers all knew that they
never could retreat, and it was victory or death to them. The cool
courage and gallant bearing of the officers in command, were worthy
of Americans.
The loss of the enemy was 12 killed, 22 wounded and 15 prisoners.
That of the Federals 3 killed and 10 wounded.

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Understanding Normal and Clinical

Nutrition 11th Edition by Sharon Rady

Carbohydrate Digestion 105

6-2 Digestion and Absorption of Proteins 175

and Adolescence 477

Rob Lewine/Getty Images

17-1 Nutrition in Health Care 555

table of Contents xiii

Short Bowel Syndrome 726

xiv table of Contents

Dietary Reference Intakes (DRI) A

xvi table of Contents

benefits and risks of weight loss and weight gain. Chapters 10

Nutrition in Your Life/Nutrition CaSE

At the end of Chapters 1 through 16, a Nutrition Portfolio

troesophageal reflux disease, and bariatric surgery; added

ing the sleeve gastrectomy surgery

instructor’s Companion Site Sharon Rady Rolfes

General B. F. Butler, after having been stationed for a short time at

December 28, 1861.

On the 23d of December, General Prentiss, commanding the army

The prominent and active men in the State of Arkansas, and

On the 7th of January, Colonel Garfield, who had his encampment

January 10, 1862.

Having recruited his men by a night’s rest at Paintsville, Colonel

It was the misfortune of Missouri, more than any other State, to be

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