Nutrition and Diet Therapy 12Th Edition Roth Solutions Manual Full Chapter PDF

Solution Manual for Nutrition and Diet Therapy 12th
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Instructor’s Manual to Accompany Nutrition & Diet Therapy,

12th Edition, by Ruth A. Roth and Kathy L. Wehrle
CHAPTER 5
LIPIDS (FATS)
Key Terms
cholesterol lecithin plaque

chylomicrons linoleic acid polyunsaturated fats
fatty acids linolenic acid satiety
glycerol lipids saturated fats
high-density lipoproteins lipoproteins trans-fatty acids (TFAs)
(HDLs) low-density lipoproteins triglycerides
hydrogenation (LDLs) very-low-density
hypercholesterolemia monounsaturated fats lipoproteins (VLDLs)
invisible fats omega-3 fatty acids visible fats
Objectives
After studying this chapter, you should be able to:
• State the functions of fats in the body

• Identify sources of dietary fats
• Explain common classifications of fats
• Describe disease conditions with which excessive use of fats is associated
Learning and Teaching Strategies
1. Evaluate the diet of a teenager, a middle-aged adult, and an elderly person to determine the
amount of cholesterol taken in over a 24-hour period. Compare the totals of each age group,
42
Copyright © 2018 Cengage Learning. All Rights Reserved.
Chapter 5 Lipids (Fats) 43
as well as each with the recommended dietary intake of cholesterol. Survey the subjects for
their understanding of the effects of excess cholesterol.
2. Bring a 1-pound block of meat fat to class. Initiate discussion of the correlation of the fat to
adipose tissue and dietary sources of the three different types of fat.
3. Have students evaluate the fat content of their favorite snack foods. Facilitate group learning
by having each student do an oral presentation with a poster depicting his or her favorite
snacks. Have them rank the snacks on the poster in order of fat content from lowest to
highest.

44 Chapter 5 Lipids (Fats)
Additional Discussion Questions
Discussion Question 1
Discuss the various biochemical tests used to evaluate fats or fat consumption in the body.
Using the 5-day food diary, have students calculate fat and cholesterol content.
Fats metabolize to 9 calories per fat gram. Have students determine the caloric intake from fats
in their 5-day food diary.
Answers to Review Questions
1. d
2. a
3. c
4. d
5. a
6. b
7. c
8. d
9. b
10. a
11. c
12. a
13. d
14. a
15. b
16. a
17. d
CASE IN POINT—MURALI: FAMILY HISTORY AND ELEVATED CHOLESTEROL
Murali is from Sri Lanka. He moved to the United States when he was 19 years old. His family has
a history of heart disease and high cholesterol. Murali’s father and brother both died of heart
attacks in their 40s. Murali is now 52 years old. His wife Annika is worried about his health.
Annika has tried to be careful in preparing his meals. For many years, Murali’s cholesterol has
been in the high-normal range and he has not needed medication. He has recently landed a new
contract with a Fortune 500 company at work. He has been very busy with luncheons and dinner
meetings. He has been taking clients to many of the classy restaurants in town for four-course
meals that always include dessert. He has been working on this contract for several months. Due to
the added stress of this new lifestyle, he is rarely taking time to eat healthy. He also has resumed
his old habit of smoking. He is so busy that rarely has time for any exercise. Annika is worried and

convinces Murali to see his physician. His physician orders blood work that reveals a total
cholesterol of 428 mg/dL, an LDL of 263 mg/dL, and an HDL of 28 mg/dL. Due to his family
history his physician orders a cholesterol-lowering medication. However, he stresses to Murali that
this is no replacement for good nutrition and exercise. He refers Murali to a cardiac education class
for both nutrition and fitness information. He also refers Murali to a smoking cessation program.
ASSESSMENT
1. What data do you have about Murali?
a. Not paying attention to diet
b. Family history of heart disease
c. New stress in his life
d. Eating out frequently
e. Smokes
2. As a nurse, what conclusion can you draw from Murali’s lab results?
a. Murali is eating foods high in bad cholesterol.
b. He may also have elevated cholesterol related to family history.
c. He may not be getting much physical activity. His HDL is very low and would
normally be higher with routine exercise.
3. What do you need to know about his current eating habits? Could foods with unknown fat
content have a bearing on his current diet? How could a 24-hour food diary help?
a. You need to know what types of food Murali is consuming.
b. Murali is eating foods prepared in restaurants, so he may not know the total fat
content.
c. His food diary will help him identify the foods that are higher in fat and calories.
4. Should his health habits, like smoking and alcohol use, be of concern?
a. Smoking and excessive drinking add negatively to his health issues.
5. What is Murali doing that is healthy for his heart?

a. Seeking help from his physician and following the recommendations to exercise and
eat right
b. Taking the prescribed medication as directed
DIAGNOSIS
6. What is the cause of Murali’s imbalanced nutrition, more than body requirements?
a. Murali’s busy lifestyle makes it difficult to follow a specific diet.
b. Murali has a lack of knowledge about nutrition and is not making healthy choices.
c. Murali is not getting regular physical activity.
7. Complete this statement: Murali’s change of lifestyle is related to a new career and the
change in work hours and habits because of it.

PLAN/GOAL
8. What are two possible goals you have for Murali?
a. Implement his exercise regime at least five times a week for 30–45 minutes.
b. Keep a food diary and begin to look at the sources of high-fat and high-calorie
content in the foods he is consuming.
c. Enroll in a smoking cessation program.
IMPLEMENTATION
9. What topics do you need to cover related to dietary fats?
a. Cover saturated and unsaturated fats and why this is important
b. Cover the amount of cholesterol Murali is consuming as well as how that compares
to the recommended guidelines
10. Name three things Murali can do to help him recognize hidden fats in fast-food restaurants.
a. Ask how foods are prepared; identify key words that could indicate a higher fat
content
b. Request foods to be prepared with less fat and for condiments to be on the side so
Murali can use them more sparingly
c. Eliminate fried foods
11. Who else should be in class with Murali?

a. His wife
12. What agencies or resources could you provide to support Murali at home?
a. American Heart Association
13. How could the information on the American Heart Association website
(http://www.americanheart.org) be helpful to Murali?
a. Introduce information in a nonthreatening manner
EVALUATION/OUTCOME CRITERIA
14. What can the physician measure to determine the effectiveness of the plan?
a. Cholesterol levels
b. Murali’s weight
c. Murali’s BMI
15. What can Murali provide to demonstrate his compliance with the plan?
a. His food diary and exercise log

THINKING FURTHER
16. What is the worst consequence if Murali does not reduce his cholesterol?
a. Death
17. What does family history have to do with Murali’s results?

a. Family history plays a big part in how our bodies respond to lifestyle changes as
well as how much cholesterol our own bodies produce.
18. What are the challenges of maintaining a diet and exercise plan for life?
a. Boredom
b. Illness
c. Fatigue
d. Stressors
e. Busy schedule
RATE THIS PLATE

Murali attended the nutrition class to learn how to choose healthy foods while eating out. He
attended a dinner meeting with his clients and ordered the following meal. Rate this plate for
foods that contain large amounts of cholesterol and fat.
4 oz shrimp cocktail appetizer

2 cups chicken Caesar salad with 2 Tbsp light vinaigrette dressing
2 hot dinner rolls with creamy butter
1 slice of cheesecake with strawberries
20 oz iced tea
ANSWERS TO RATE THIS PLATE FOR MURALI

Shrimp is very high in fat, but low in cholesterol. The fat is not as detrimental in shrimp as
it is in prime cuts of beef or meat. The chicken Caesar salad is not high in fat or cholesterol.
The chicken does contain some cholesterol, but is considered a lean protein choice. The
dinner rolls are fine, but it is the butter that will add additional calories and fat. The
cheesecake is high in fat. Murali could ask for fresh fruit instead of eating a calorie- and
fat-laden dessert. The iced tea is a good choice.
CASE IN POINT—CECELIA: ELEVATED CHOLESTEROL AND TRANS FATS
Cecelia moved to New York City from Italy with her mother and father when she was a young
girl. Her parents opened an Italian bakery and Cecelia spent much of her time there growing up.
Her parents are now ready to hand the bakery over to Cecelia so they can retire. At 42 years old,
she is very excited about taking charge of the bakery. She has always enjoyed baking and has
learned so much through the years about running a business. Her parents recently had physicals
and they both had elevated cholesterol. They were concerned for Cecelia and asked her to see her
doctor and have her cholesterol tested as well. Cecelia has always been in pretty good health, but
decides this wouldn’t be a bad idea. When Cecelia sees her doctor, he informs her that she, too,

has elevated cholesterol. Her total cholesterol is 282. Her LDL is 186 and her HDL is 27. He
discusses with her the importance of weight loss. She is currently 5-ft 4-in tall and 173 lb. He
also refers her to a dietitian for an assessment of her diet. The dietitian discusses with her the
foods that can affect her cholesterol level. In addition to saturated fats, she mentions trans fats.
Cecelia has heard this term before, but never understood its meaning. The dietitian explains that
trans fats are created from hydrogenating (solidifying) vegetable oils. The dietitian tells Cecelia
that trans fats are usually present in baked goods. She also discusses with Cecelia that New York
City passed a law banning trans fats in restaurants. She educates Cecelia on the importance of
not just eliminating the trans fats from her diet, but making sure that her parents adjusted the
recipes for their bakery items to remove all trans fats as well.
ASSESSMENT
1. Why were Cecelia’s parents concerned about her cholesterol levels?
a. When Cecelia’s parents learned they both had elevated cholesterol, they were
concerned that she may also have elevated cholesterol due to genetics.
2. Cecelia’s doctor shares with her the results of her lipid panel. What are the recommendations
for total cholesterol, LDL, and HDL levels for Cecelia?
a. Total cholesterol less than 200
b. LDL less than 100
c. HDL greater than 40
3. What is Cecelia’s ideal body weight range? Is her current weight within her ideal range?
a. 108–132 pounds
b. Her current body weight of 173 pounds is above her ideal range.
4. What is trans fat and what are the impacts of trans fats on the body?
a. Trans fats are produced when hydrogen atoms are added to unsaturated fats to
produce a semisolid product such as margarine.
b. They are dangerous and will cause elevations in LDL and total cholesterol.
DIAGNOSIS
5. Write a nursing diagnosis for Cecelia.
a. Nursing Diagnosis: Risk for ineffective therapeutic regimen management, risk
factors include knowledge deficit of nutritional requirements to decrease LDL and
total cholesterol.
PLAN/GOAL
6. Cecilia should be educated on what foods will elevate her cholesterol. What are some of
these foods?
a. Saturated fats such as the fats in any animal source products such as meats, milk,
butter, and egg yolks.
b. Palm oil and coconut/coconut oil

7. Cecilia should understand that cholesterol comes not only from foods but also from what
other source?
a. The body. The liver manufactures 800–1,000 mg of cholesterol daily.
8. What goals would you set for Cecelia?

a. Decrease the fat in her diet to no more than 30% and the saturated fats to less than
10% of total calories.
b. Reduce consumption of high-fat meat.
c. Begin consuming low-fat and fat-free dairy products.
IMPLEMENTATION
9. What is important for Cecelia to understand about trans fats?
a. Trans fats can be just as harmful as saturated fats in cholesterol control.
b. How to read food labels to find any trans fats the food contains.
c. She also needs to know the laws in New York City regarding trans fats in
restaurants and bakeries, so that she can run a successful business.
10. How often should Cecelia have her cholesterol assessed?

a. Every 6 months. If her doctor puts her on cholesterol medication, her liver function
needs to be assessed as well.
EVALUATION/OUTCOME CRITERIA
11. How will Cecelia and her doctor know if she has been successful with her goals?
a. Total cholesterol will be under 200
b. LDL under 100
c. HDL over 40
d. Adhering to her low-fat, low-cholesterol diet
e. Weight loss
THINKING FURTHER
12. Search guidelines on the National Cholesterol Education Program website
(http://www.nhlbi.nih.gov) for cholesterol levels and take the 10-year risk assessment at the
bottom of the page. Are you at risk for a cardiac event in the next 10 years? Are there
changes in your diet that could help to decrease your risk?
RATE THIS PLATE

Cecelia would like to modify the following recipe for dark chocolate cake in order to make it
healthier for her family and customers. What ingredient could be adjusted to make it more
healthful?
2 cups boiling water

1 cup unsweetened cocoa powder

2 ¾ cups all-purpose flour

2 teaspoons baking soda
½ teaspoon baking powder
½ teaspoon salt
1 cup butter, softened
2 ¼ cups white sugar
4 eggs
1 ½ teaspoons vanilla extract
ANSWERS TO RATE THIS PLATE FOR CECELIA
One cup of applesauce can be used to replace the 1 cup of softened butter (which is a
saturated fat) to yield a tasty product with less fat. Mashed bananas or ½ cup of fruit puree
may also be used to replace the butter. Canola oil can replace butter in many baking
recipes such as pie crusts, cakes, and muffins, yielding a moister and softer product with no
cholesterol and less saturated fat. She could experiment with ground flax seeds and
almond flour, in place of the all-purpose flour to increase fiber content.
Resource Guide
1. http://health.gov
The U.S. Department of Agriculture and the Department of Health and Human Services
publish jointly the Dietary Guidelines for Americans 2015.
2. http://www.nutrition.gov
This is a U.S. Department of Agriculture website, Food and Nutrition Information Center, a
leader in providing food and human nutrition information since 1971.

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road a brisk fusillade was heard towards Tsikalaria, and as I
was about to return to Halepa a young Turk was seen at a
distance running towards us with a letter in his hand. It was
a message sent by the Albanian corporal stationed at
Tsikalaria asking for assistance. This messenger had hardly
arrived when a gendarme was seen coming down in great haste.
He said that the fight between Christians and Mussulmans
having become general, and there being only another gendarme
with the corporal, armed assistance was immediately required.
I took both these messengers and conveyed them to the gate of
the town, from whence I drove to Halepa to acquaint the Vali
with what was taking place. It was getting dark when I met on
the road his Excellency accompanied by the Italian Consul
going on foot to Canea, having found no available carriage,
and I drove back with them. The position was rather
perplexing. There was no available gendarmerie, and no
soldiers could be sent out, as they would have been fired upon
by the Christians. …
"Early on the day following, that is, on the 4th instant, the
Governor-General visited the village of Tsikalaria and the
villages westward of it in order to ascertain the truth with
regard to the numerous reports which were in circulation since
the preceding evening. It would seem that on hearing of his
son having been killed on the Canea-Suda road, the father of
the wounded Mussulman opened fire on the Christians. Other
Christians maintain that this wounded Mussulman, after having
shot at the Christian on the road, hastened to Tsikalaria, and
together with his father, began firing on the Christians. In a
very short time all the Christians rushed towards the heights,
and the Mussulmans towards the plain. During this evolution a
Christian was killed, it is said, by the father of the wounded
Mussulman, who had been arrested and is in prison. The same
night the women and children took refuge in the villages on
the mountains, while a contingent of 150 armed Christians came
down from Campos and Keramia in order to assist the male
population of Tsikalaria to defend their property. On the
other hand, armed Mussulmans flocked from all parts of the
plain to defend their co-religionists. The Mussulmans at
Perivolia, where they are of nearly equal numerical force,
tried to surround the Christians in order to keep them as
hostages for the safety of their co-religionists in other
villages where the Christians are more numerous. In so doing
they shot down a Christian, on whom they also inflicted
numerous knife stabs, finally cutting his throat. This was
followed by an emigration to, and armed assistance from, the
mountain villages as at Tsikalaria. "In the village of
Varipetro the Mayor, assisted by the corporal of gendarmerie,
a Mussulman Albanian, was doing his utmost to prevent a
conflict between its Christian and Mussulman inhabitants, when
a Christian from Lakkos, whose brother had been murdered two
years ago by a native Mussulman, stealing behind the corporal,
shot him dead. The Christians of Varipetro, with whom the
corporal was popular, having tried to arrest his murderer, the
Lakkiotes, who had come there in order to defend their
co-religionists, turned their arms against them, and prevented
them from carrying out their intention. In consequence of this
murder all the Christians of Varipetro emigrated to the
mountains, and all the Mussulmans to the town of Canea. Nearly
1,000 Christians from the plains of Cydonia and Kissamo came
to defend the inhabitants of Galata and Darazzo, and for a
time blockaded the Turks in the village of Kirtomado, Aghia, &c.
{544}
But the inhabitants of Galata, who are all Christians, have so
much confidence in the Mussulman Albanian Lieutenant called
Islam, who is stationed in their village, that they begged
their co-religionists to withdraw, which they did. …
"As is always the case, each party claims to have been

attacked by the other party, and the truth is not likely to be
ever discovered. Be this as it may, both Christians and
Mussulmans remain under the unshaken conviction that they are
wronged by the other party; this increases the animosity of
one sect against the other, and each member of the two races
will act on this conviction. This is the inevitable
consequence of the absolute want of confidence between the two
elements, and there is not the least hope that this feeling
will disappear, nor even slightly decrease, so long as they
are left to themselves. In the present instance it may be that
the Mussulmans, or some of them, may have considered
themselves bound to retaliate for recent murders committed on
their co-religionists by Christians. … The Christians are
convinced, and all their proceedings are marked by that
conviction, that all the incidents which trouble the public
peace are devices of the native Mussulmans to prevent the
execution of the promised reforms. I do not deny that the
attitude of the authorities at Constantinople may have such an
effect on the low class of Cretan Mussulmans; but it is far
from being so with the educated class who are as, if not more,
anxious than the Christians that the intended reforms should
be carried out without delay. In fact, they know that they
have nothing to hope from Constantinople, and that the only
protection of the minority to which they belong lies in the
promised reforms. On the other hand, I have observed with the
greatest pleasure that the Christians laid down their arms at
the first recommendation of the Consuls to do so, which proves
a sincere desire on their part to live in peace. When the
Christians were taking up arms in former times they used to
remain for weeks, even for months, on the mountains in spite
of the entreaties of the Consuls. Therefore, the Christians
and the Mussulmans are respectively well disposed, but there
is such an insuperable distrust on both sides, that they can
never come to a mutual understanding. Whether the incidents
which cause disturbances or disorders on the island are the
work of the Turks or of the Christians or of both is quite
immaterial to me. The important fact to be taken into
consideration is that an exchange of a few shots between one
or two Christians and as many Mussulmans is sufficient to
cause several districts, four in the present instance (Canea,
Apokorona, Sphakia, and Kissamo), to take up arms, and also
that there can be no doubt that such scenes will be repeated
on every recurrence of such incidents."
To the same effect, Captain Custance, of the British ship

Barfleur, reported on the 15th to Admiral Hopkins: "The
general situation, as I understand it, is, that the Cretan
Christian leaders, urged on by certain interested people at
Athens, have been preparing for some time to make an attempt
to drive the Turkish authorities out of the island in the
spring, if a favourable opportunity offers. The Mussulmans
would not be sorry to see the last of the Turkish Government
if they could only be sure that their lives and property would
be safe under the new regime, which, owing to the bitter
hatred existing between the Christians and Mussulmans, cannot
be expected. The two parties are face to face, armed to the
teeth, with long-standing feuds and wrongs, and with no force
between them capable of maintaining order."
On the 27th of January the Consul-General reported by telegram

to Lord Salisbury: "An outburst of terror, such as has not yet
occurred in Candia, has been caused by the commencement of a
fresh immigration of Mussulmans into the town, and by the
murder, within a week, of two men of that faith, and a few
minor outrages." The next day he reported: "Telegraphic news
from Candia, dated to-day, reports murder of a Mussulman, and
wounding of two others, and murder of seven Christians; murder
of further Mussulmans is rumoured. The Mussulman Military
Commissioner, and the Austrian Military Attache, now in
Candia, report that they met about 1,000 armed Mussulmans
moving inland, and numbers of Mussulman families moving
towards the town." Again, on the 2d of February: "Murder of
four Mussulmans last night, following on wounding of Christian
by Mussulman on the 31st January near Canea. Panic ensued in
Canea and Suda Bay this morning. Shops all closed. Shots fired
in town and Halepa, which resulted in death of two Mussulmans.
Four mixed villages, one large Christian village, and several
farms in environs are in flames." On the 4th, Colonel
Chermside, of the gendarmerie commission, sent the following
statement to Lord Salisbury: "The most that we have been able
to attempt to-night is to get a cordon to separate Christian
and Moslem quarters. Patrolling was tried, but the fire from
the Christians was too heavy to maintain it. Several Turkish
soldiers have been killed and wounded."
Great Britain,
Parliamentary Publications
(Papers by Command:
Turkey, Number 10, 1897, pages 15-45).
TURKEY: A. D. 1897 (February-March).

Greek interference in Crete.
Greek forces in the island.
Demands for annexation of Crete to Greece.
Action of the Powers in the "Concert of Europe."
Pacific blockade of Crete.
Early in February, the difficulties of the attempt which the

leading European powers, acting in what was known as "the
Concert of Europe," were making to settle affairs in Crete by
reforming its Turkish government, were complicated by
interference from Greece. The Greeks, in ardent sympathy with
their Cretan kinsmen, were eager to take up the cause of the
Christian inhabitants of the island, and their government was
driven into independent action to that end, hoping that
Christian sentiment in Europe would constrain the Powers to
give it a free hand. A Greek squadron was sent to Crete, to
bring away fugitives—women and children especially—and to
prevent the landing of Turkish reinforcements. This was
quickly followed by an expedition of 2,000 men, Colonel Vassos
in command. An instant stimulation of the insurrection
occurred, and declarations demanding the annexation of Crete
to the kingdom of Greece began to appear; while the Greek
government represented in a note to the Powers that no
possible solution of the Cretan problem could be found without
concession to that demand. The Greek troops, considerably
increased in number, were landed on the island, joining the
insurgent Cretans, and beginning operations against the Turks.
{545}
On the 13th of February the admirals commanding the foreign

naval forces at Canea joined in sending a warning to the Greek
commodore, requiring him to "desist from all hostile acts and
to conform with international law." On the 15th a mixed force
of British, French, Russian, Italian and Austrian marines was
landed for the protection of the town. On the same day, from
Colombari, Colonel Vassos, the Greek commander, issued a
proclamation, saying: "In the name of His Majesty, George I.,
King of the Greeks, I occupy the Island of Crete, and proclaim
this to its inhabitants without distinction of sex or
nationality. I promise in the name of His Majesty that I will
protect the honour, life and property, and will respect the
religious convictions, of its inhabitants, bringing them peace
and equality rights." On the 17th, the Turkish forces at Canea
were attacked by the Greeks and insurgents, and the attack was
renewed on the 21st; whereupon, after warnings from the
foreign admirals in the harbor, the Russian, German, Austrian
and British ships opened fire on the attacking troops. In the
meantime, considerable bodies of Mohammedans were being
besieged by superior forces at other points in the island,
with great danger of massacre if overcome.
On the 2d of March, the representatives of Great Britain,

Austria-Hungary, France, Germany, Italy and Russia, at
Constantinople, arrived at an agreement of action, and jointly
addressed notes to the governments of Turkey and Greece. To the
Porte they wrote: "The Great Powers, animated by the desire to
assure the maintenance of peace and to see the integrity of
the Ottoman Empire respected, have sought for the means of
ending the disorders that have led to their armed intervention
in Crete, as well as of putting an end to the presence of the
Greek forces in the island. They have recognized that in
consequence of the delay in applying them, the reforms
contemplated in the Arrangement of August 25, 1896, no longer
correspond to the requirements of the present situation, and
they have agreed upon the following points:
1. Crete can in no case be annexed to Greece in the present

circumstances.
2. The island will be endowed by the Powers with an autonomous

administration ('régime').
In notifying these decisions to the Sublime Porte by order of

their Governments, the Representatives of the Great Powers at
Constantinople think it their duty to communicate the
resolution which has been taken by their Governments to
address to Greece a summons to withdraw her troops and naval
forces from Crete."
To the Greek government the same announcement was made, that

"Crete can in no case, in the present circumstances, be
annexed to Greece," and the communication was more explicit in
the further statements, as follows:
"In view of the delays caused by Turkey in the application of

the reforms agreed upon in concert with the Powers, and which
now make it impossible to adapt those reforms to a changed
condition of affairs, the Powers are resolved, while
maintaining the integrity of the Ottoman Empire, to endow
Crete with an absolutely effective autonomous administration
(régime), intended to secure to it a separate government,
under the high suzerainty of the Sultan. The Cabinets are
convinced that these views can only be realized by the
withdrawal of the Greek ships and troops now in the waters and
on the territory of the island which is occupied by the
Powers. We accordingly confidently expect this decision from
the wisdom of His Majesty's Government, which cannot wish to
persist in a course opposed to the decision of the Powers, who
are determined to carry out an early pacification, which is as
necessary for Crete as it is for the maintenance of general
peace. I will not, however, conceal from your Excellency that
I am instructed to warn you that, in case of a refusal of the
Royal Government, the Great Powers have arrived at the
irrevocable decision not to shrink from any measure of
compulsion if, on the expiration of six days, the recall of
the Greek ships and troops from Crete has not been effected."
The Turkish government replied on the 6th: "The Sublime Porte

has had the honour to receive the note which the Ambassadors
of the Great Powers were good enough to address to it on the
2nd of March relative to Crete. The Imperial Government takes
note with satisfaction of the assurances which the Great
Powers are good enough to give it as to their desire to
respect the integrity of the Empire and of the decision which
they have taken to obtain the withdrawal of the Greek ships of
war and troops from Crete. Relying upon their friendly
sentiments, and upon their firm resolve not to impair the
Sultan's rights of sovereignty, the Sublime Porte, which is
itself desirous of assuring the maintenance of peace, accepts
the principle of an autonomy to be accorded to Crete, while
reserving to itself liberty to discuss with the Ambassadors
the form and the details of the administration ('régime') with
which the island is to be endowed."
Two days later, the Greek government replied at greater

length, imploring the Great Powers "not to insist upon the
system of autonomy decided on, but to give back to Crete what
it already possessed at the time of the liberation of the
other provinces which form the Hellenic kingdom, and to
restore it to Greece, to which it already belonged in the time
of the Presidency of Capodistria," and appealing against the
demand for the withdrawal of the Greek military forces from
the island. "Since, in our opinion," wrote M. Skouses, the
Greek minister, "the new autonomous administration ('régime')
condition could not fulfil the noble object of the Powers, it
is clear what would be the condition of the unfortunate island
from now until the establishment of that administration, if
the Great Powers decided to persist in their resolve.
"In this connection, and in the name of humanity, as also in

the interest of the pacification of the island—a pacification
which is the sole object of the solicitude of the Great
Powers—we do not hesitate to appeal to them in regard to the
other measure, relative to the withdrawal of our military
forces. … The presence in the island of the Greek army is …
demanded by the dictates of humanity, and is necessary in the
interest of the definitive restoration of order. It is, above
all, our duty not to leave the Cretan people at the mercy of
Mussulman fanaticism, and of the Turkish army, which has
always intentionally, and by connivance, been a party to the
acts of aggression of the populace against the Christians.
{546}
"Above all, if our troops in the island, who are worthy of the
full confidence of the Great Powers, were intrusted with the
mandate of pacifying the country, their wishes and intentions
would at once be completely satisfied. It would then be
possible, after order had been restored, to obtain a free
expression of the wishes of the Cretan people, with a view to
decide their lot. Not only are the horrors which during
several decades have occurred periodically in Crete, not
committed without profoundly agitating the Hellenic people,
but they also interrupt the social activity, and seriously
disturb the economy and finances of the State. Even if it were
possible for us to forget for a moment that we are
co-religionists of the Cretan people, that we are of the same
race, and allied by blood, we cannot conceal from the Great
Powers that the Hellenic State is unable to resist such shocks
any longer. We therefore appeal to the generous sentiments
which animate the Great Powers, and beg them to allow the
Cretan people to declare how it desires to be governed."
Great Britain, Parliamentary Publications
(Papers by Command: Turkey, Numbers 4 and 5, 1897).
The position taken by the Greek government in this reply was

firmly maintained. Its troops were not withdrawn from Crete,
and the Powers of "the Concert," thus practically defied, had
difficulty in agreeing upon the next steps they would take.
France, England, and Italy would not consent to strong
measures of coercion proposed by Russia, Germany and Austria,
and the decision reached finally was to establish what is
known as a "pacific blockade" of the Cretan coast, to begin on
the 21st of March. This was announced on the 18th by the
admirals commanding on that coast, who gave notice: "The
blockade will be general for all vessels flying the Greek
flag. Vessels of the Six Powers or of neutral Powers will be
allowed to enter the ports in the occupation of the Powers and
land their merchandise there, but only if it is not intended
for the Greek troops or for the interior of the island. The
ships of the international fleets may visit these vessels."
The Greek government was notified to recall its men-of-war
still in Cretan waters, with the warning that "they will be
retained there by force if they have not left by 8 A. M. on
the 21st March."
On the day previous to this announcement of blockade the same

admirals had published a proclamation as follows:
"The undersigned, Commanders-in-chief of the naval forces of

Germany, Austria-Hungary, France, Great Britain, Italy, and
Russia, in Cretan waters, acting under instructions from their
respective Governments, solemnly proclaim and announce to the
people of the island that the Great Powers have arrived at the
irrevocable decision to secure the complete autonomy of Crete,
under the suzerainty of the Sultan. It is well understood that
the Cretans are to be free from all control on the part of the
Sublime Porte as regards their internal affairs. The principal
aim of the Powers being to provide a remedy for the evils
which have afflicted the country, and to prevent their
recurrence, they are drawing up in concert a scheme of
measures intended to regulate the working of the autonomous
régime, to restore peace, to assure to everyone, without
distinction of race or religion, liberty and security of
property, and to facilitate, by the resumption of agricultural
work and trade, the progressive development of the resources
of the country. Such is the aim of the Powers. They wish this
to be understood by all. A new era is commencing for Crete;
let all lay down their arms. The Powers desire peace and
order. They will, if it be required, have the necessary
authority to make their decisions respected. They count on the
co-operation of all the inhabitants of the island, Christian
and Mussulman, to assist them in accomplishing a work which
promises to secure concord and prosperity to the Cretans."
To the promise of an autonomous government for Crete the

insurgent Christians appear to have given no heed; but a great
number of the Mohammedan inhabitants of the island united in
sending telegrams to the British minister at Constantinople,
which were all of the tenor of the following: "Your Excellency
knows that the Christians of Crete, forming the numerical
majority of the population, but incapable of properly
administering the former privileges they enjoyed, have now
again been emboldened to massacre, destroy, and ruin, in the
same way that in the past they have always made ill-use of
their liberties in the country by the treacherous destruction
and ruin of their Moslem fellow-countrymen. Therefore, if the
people are left irresponsible for the government of the
country, which is the very breath of human life, it will
facilitate the completion of their bloodthirsty designs, and
hasten the ruin of the Mussulmans. We are quite sure that this
state of things will not recommend itself to the sympathy of
the Great Powers, the propagators of civilization.
"We therefore beg, in the name of the Mussulman population,

that the internal affairs of the Christian inhabitants of
Crete who have not yet reached even the first step on the path
of civilization, and are led away by the seditious designs of
Greece, may not be removed from the direction of the Sublime
Porte; if this be impossible, we beg that the internal affairs
of the island may be placed under the continual control of the
Great Powers in conjunction with the Porte; and we finally beg
that the necessary measures may be taken for the protection of
the life, honour, and property, as well as the rights of the
20,000 Mussulman inhabitants now living in Turkey, whose
interest in property is greater in value than that of the
Christians, and who are occupied with commerce and other
pursuits, besides those who live In the island, who, if
necessary, are prepared to undergo a census, and who exceed
100,000."
The situation of the Moslem population of the island was

represented a little later by Colonel Chermside, in a despatch
to Lord Salisbury, as follows:
"Over 49,000 Moslems are assembled in Candia and within cordon

area, comprising 25 square miles, viz., about two-thirds of
Moslem population of Crete. Of these, 29,000 are refugees from
central and eastern districts of island. Doles of flour are
issued to 39,000 persons; issue up to date 18 lb. per head; no
other food issued. The mass of the people have no buying power
and no work, but since arrival of British troops, armed
individuals are rare in streets; distress is supported with
great fortitude, in spite of insufficient food and ravages of
small-pox. Population hopes for future foreign protection
against Christian compatriots. "
Great Britain, Papers by Command:

Turkey, Number 10, 1897, pages 153-178.
{547}
TURKEY: A. D. 1897 (March-September).
War with Greece.
Success of the Turkish arms.
Peace sought by the Greek Government.
Notwithstanding the opposition of the Great Powers, the Greeks

were rashly bent upon war with the Turks, and, when balked in
Crete, began hostile demonstrations along the Turkish frontier
in their own peninsula. The events that followed have been
thus described by an eye-witness, who wrote immediately
afterwards: "When I arrived in Athens," says this writer,
"early last March [1897], although the Cretan insurrection was
being openly supported by Greek arms, war had not been
declared against Turkey. It was what I think was once
described in Parliament as 'a condition of war,' but not war.
… King George and his advisers rashly decided to attempt to
hasten matters in their own fashion. Agitation was begun
without and within the Turkish frontier, and the Ethuike
Hetairia manufactured alarms and disturbances in Macedonia and
Epirus. Attempts were made in other directions, but though
money and emissaries were sent, nothing came of it. Meanwhile
the mobilisation of the Greek army was begun, and later on
reserves were called out. Knowing a good deal about the
relative condition of preparedness for war of both Turkey and
Greece, I spoke without reserve on the subject to the King
and, later on, to the Princes. I told them nearly every
military intelligence department in Europe knew that Turkey
had been getting her troops ready for a year past to deal with
insurrection or invasion along the Macedonian frontier. Within
the Salonica military district she had nearly 100,000 men under
arms, all well trained and passably equipped. Besides infantry
she had nearly 10,000 cavalry, and within a month could place
a further force of 70,000 infantry in the field. Against these
the Greeks could not bring more than 60,000 regulars. There no
doubt might be mustered twice that number of men, but they
would be untrained irregulars and volunteers who would take a
month at least before they could be of much use, and Turkey
would have her bands of irregulars out also to offset their
value. It was notorious besides that the Greek army was
indifferently organised, that it had no transport, no
commissariat department, no medical department, and was
without anything like a sufficiency of trained officers. …
"Prepared or not, the Greeks clamoured for war, never doubting

latterly but that they would win. They protested that the
Hellenes were aroused and would fight and die, if need be, to
the last man. Greece would not waive an iota of her demands.
We were told that the Greeks scattered throughout the Turkish
Empire would spring to arms and paralyze the enemy's hands.
There were to be fearful outbreaks in Macedonia, Epirus, and
Albania, and tumults and burnings in all the chief cities
under Turkish rule where Greeks dwelt—Smyrna, Constantinople,
Salonica, and so on. I was informed that insurrectionary bands
were being got ready to invade Macedonia and Epirus, and I was
introduced to several of the leaders of these new expeditions.
… I saw many of these Greek filibusters at Kalabaka and other
places. By order from Athens the local commandants supplied
them with stores, transport, and trenching tools, and sent
guides to direct them, so that they should slip across into
Macedonia at the most suitable points for conducting their
operations. …
"The Greeks had a fairly long innings carrying on the war

within Turkish territory, whilst disingenuously disclaiming
responsibility for the acts of their own levies. Finally, in
April, the Sultan declared war and set his forces in motion.
Prior to that date the Greeks had moved up the whole of their
available strength close to the Thessalian frontier. The army
numbered nearer fifty than sixty thousand, of all ranks. …
Before war was declared the Crown Prince Constantine arrived
in Larissa, and took over the command of the Greek army in
Thessaly. … He had no military experience; and, as events
disclosed, was neither of a martial disposition nor of a firm
temperament. He showed subsequently that he felt keenly his
false position, and he tried to excuse the awful failures made
in the conduct of the campaign of panic and flight. …
"Independence Day having passed without a general invasion of

Macedonia by the Greeks, it is likely that the Turks had
thought the danger over, when suddenly firing began in a night
along the frontier from Nezeros to Ravenni. For a day or two the
Greeks carried all before them, capturing many block-houses
and taking a number of prisoners. They succeeded in
penetrating Turkish territory in some places for two or three
miles. … The Turks were in immediate danger of being
outflanked in one part of the field of operations, and
separated from their main force at Elassona. It was midday,
the 19th of April, when at a critical moment for the safety of
a portion of Edhem's forces an order arrived from the Crown
Prince to cease firing and retire the whole Greek army back
upon their own side of the frontier. … After an interval of
three hours, during which there was little or no firing, a
message arrived from headquarters that a blunder had been made
and the army was to readvance and engage the enemy. It was a
lost opportunity, for the Turks followed up the Greeks and
reoccupied the lines from which they had been driven. … The
cost of the blunder was a serious one to the Greeks, for in a
futile attempt, on the following day, to retake Gresovala,
General Mavromichali lost 2,000 men. …
"On the 21st of April, without any of the pictorial display or

reputed hand-to-hand fighting, some 40,000 Turks, not less,
accompanied by three cavalry regiments and half a score of
batteries, quietly streamed down the zigzag paved way in the
steep Melouna pass into Thessaly. They occupied the village of
Legaria and positions among the lowest foot hills at the
outlet of the pass. The Greeks were not able to embarrass them
as they deployed, although an attempt was made to find the
range with artillery. … For two days there was a fierce
artillery duel, interspersed occasionally with sharp rifle
fire as the infantry became engaged on the right and left of
the line. … All had ended in favour of the Greeks when the sun
set on the 22nd April, and the battle of Mati was over. … It
was the same night that the Crown Prince ordered the army to
retreat upon Larissa, twenty-five miles distant by road. About
8 P. M. the men were roused from their first sleep and
commanded to fall in. They did so very orderly and quietly,
thinking it was intended to deliver a surprise attack upon the
Turks.
{548}
The whole army was on the march, and had got five or six miles
from the battle-field, or close to Turnavos, when the
unaccountable mad panic seized them. Some say it originated
one way, some another. … The army broke into pieces and became
a furious rabble, which fled by road and fields south as hard
as most could run. Arms and ammunition and baggage were cast
aside wholesale. The Greek officers, as a rule, behaved worse
than the men, for they led the fleeing mob, and many of them
never stopped until they reached Pharsala or Vola. … The
whilom Greek army was a mob convinced that the Turkish cavalry
was upon their heels, though it never was near them. It gave
them the strength of despair, and so they covered afoot fifty
to sixty miles within twenty-four hours. The inhabitants of
Larissa and all the surrounding country, terrified at the
sudden calamity, were left by the military and civic
authorities, without hint or warning, to shift for themselves.
… The women and children of Larissa had to carry what they
wished to save upon their own backs. Thousands of these
helpless creatures, together with sick and wounded soldiers,
were left around the railway station, whilst officers rode off
upon the early or later special trains, to fly, as some of
them did, as far as Athens. The troops had gone hours before I
left Larissa, and even then there were no signs of the enemy
to be seen."
Bennet Burleigh,
The Greek War, as I saw it
(Fortnightly Review, July, 1897).
"Not until several hours after the departure of the last
Greek, did a few Turkish cavalrymen cautiously enter the town
[Larissa], some distance ahead of the Turkish army. … It was
the design of the Greeks to save Volo, a wealthy town, and the
haven of refuge of many of the peasants. Accordingly, a line
was formed from two miles beyond Pharsala to the pass which
was the doorway to Volo. About three miles from this pass was
the village of Velestino; and on the hills back of it were the
headquarters of Colonel Smollenske, commander of this, the
right wing of the Greek army. The Greek fleet, with decks
cleared for action, was in the Bay of Volo; having gone there
after the defeat of Mati, hoping that, in case the army
failed, its heavy guns would protect the town. After four
days, the Turks, having digested their victory with cigarettes
and coffee, were ready to renew fighting. Meanwhile, the Greeks
had put themselves in a sort of order. Evidently, the first
intention of the Turks was to force their way through
Smollenske's line and on to Volo. Accordingly, they attempted
to storm Smollenske's rifle-pits; but they were driven back
for the first time, and with the greatest loss that any such
movement had yet encountered in the campaign. … The Turks,
after a slight resistance, withdrew from the villages in front
of Velestino, which they had taken, and were soon moving over
to the left. Their plan of cutting the Greek line in two was
executed with energy. On the morning of May 7, Edhem Pasha
sent his fearless infantry, under heavy fire, up the hollows
between the mountain-ridges which ran at right angles to the
Turkish line across the plain. They intrepidly scaled the
ridges, and forced the Greeks from the position. Smollenske's
force was flanked and separated from the Crown Prince's force:
and he retreated in an orderly manner to Almyro. The Crown
Prince's force had been flanked on its left; at the same time
it was being flanked on its right by the force that had
flanked Smollenske. The Crown Prince, therefore, withdrew to
the heights of Domoko.
"So apparent was now the hopelessness of the Greek cause that
even the new ministry, which had been buoyed up into almost an
aggressive spirit by the 'victory' of Velestino, begged for
the intervention of the Powers. It was granted in the form of
a demand on the Sultan for an armistice. As there are six
Powers, each having a formal foreign office, this took some
time. The Sultan, as usual, was more deliberate than the six
tormentors, whom he in return tormented. Being truly Greek,
the Greek Cabinet seemed to believe that articles of peace
would be signed the moment the necessity of peace appealed to
the ministerial mind. … Two days after Pharsala, the Turkish
army appeared on the plain some ten miles from Domoko. There
it rested quietly for more than a week, leisurely celebrating
the important feast of Bairam. This confirmed the belief of
the Greek generals that the war was at an end. The morning of
May 17 found the Crown Prince's force more than ever convinced
of an armistice, and quite unprepared for an attack. At nine
o'clock the whole Turkish army began to advance upon the
astounded Greeks—most astounded of them all were the Crown
Prince and General Macris—in such a manner as to leave no
doubt as to its intention.
"The battle of Domoko which followed was the most sanguinary

of the campaign. … For three hours, that is, until
sundown,—the attack having begun at four o'clock,—the Greeks
steadily returned the hot fire of the Turks, who soon ceased
to advance, and doggedly hung on to the ground that they had
gained. … During this attack in front the Turks were making a
more important movement, strategically, on the right. … With
amazing intrepidity, during the hot action on the centre, the
Turks had fought their way over the mountains at the Greeks'
far right. Some reserves were sent around at sunset—but too
late. The Turkish left wing was already even with the town of
Domoko. Military experts maintain that the Crown Prince, by
readjusting his forces over night, could have given the
phlegmatic enemy a surprise in the morning, and held him in
check for several days. The retreat over the pass to Lamia
began at ten o'clock in the evening; and the next morning the
battalions covering the retreat were under heavy fire. The
Greeks' next stand was to be at Thermopylæ. Should the Turks
advance spiritedly, Smollenske's army would be cut off from
that of the Crown Prince, and forced to surrender. But the
Sultan, being somewhat appeased by more blood-letting, now
bowed before a letter from him whom the Greeks called 'a vile
enemy,'—the Czar,—who, for this act, saw his influence at
Constantinople supplanted by that of Germany, though the fear
of Russia was undiminished. At last the armistice came,—none
too soon for the demoralized army of Greece. The war had
lasted just thirty-one days."
F. Palmer,
How the Greeks were defeated
(Forum, November, 1897).
{549}
The preliminary treaty of peace, signed September 18, required

Greece to pay to Turkey a war indemnity of nearly eighteen
millions of dollars, arrangements for securing the payment of
which were to be controlled by an international commission
composed of one representative of each of the mediating
Powers. The same Powers were likewise to settle with Turkey a
rectification of the Greek frontier. Greece, in fact, was
helplessly in their hands.
TURKEY: A. D. 1897-1899.
Prolonged anarchy in Crete.
The inharmonious "Concert of Europe."
Final departure of Turkish troops and
officials from the island.
Organization of government under Prince George of Greece.
"The autonomous regime promised to this unfortunate island—the

Cuba of Europe—is still [at the end of 1897] apparently far
from realization. In the meantime a most distressing
condition; amounting to practical anarchy, prevails everywhere
except at some ports where the international gendarmerie
maintain a fair semblance of order. So completely have the
houses and property of the Mahometan population been destroyed
by the insurgents that the coming of winter has brought no
prospect to the former but one of desolation and famine.
Considerable pillaging of Christian houses by Mahometan
refugees was also reported from Candia, Kydonia, and other
points. In Candia the Turkish gendarmerie—recruited from the
worst class of Bashi-Bazouks—have proved worse than useless
for keeping order; they connive with the marauders and share
in the pillage. The British occupation is said to be only
nominal. …
"A strange satire upon the concert of Europe and the pretenses
of Western civilization was the circular letter addressed by
the Sultan to the powers, about mid-October, urging upon them
'in firm language' the necessity of promptness in restoring
tranquillity to the disordered island, and warning them of the
dangers of procrastination in this matter. … To accomplish the
pacification of Crete, the Sultan, in the letter referred to,
suggested that the entire population, Christian and Mahometan,
should be disarmed; that the disarmament should be carried out
by Ottoman troops; that the international troops should
co-operate in the work if the powers so desired; that the
entire force should be commanded by a European general in the
Turkish service; that an Ottoman garrison should be
permanently maintained; that the governor should be a
Christian and an Ottoman subject; and that a corps of
gendarmerie should be formed. … Toward the end of October it
was announced that the powers had finally chosen for the post
of governor-general of Crete Colonel Charles Schaeffer, a
native of the grand duchy of Luxemburg, and a man of extended
experience in the Turkish and Egyptian services, … related to
several of the principal houses of the aristocracy at St.
Petersburg, as well as to some of the most influential

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Instructor’s Manual to Accompany Nutrition & Diet Therapy,

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After studying this chapter, you should be able to:

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Learning and Teaching Strategies

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Additional Discussion Questions

Answers to Review Questions

CASE IN POINT—MURALI: FAMILY HISTORY AND ELEVATED CHOLESTEROL

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5. What is Murali doing that is healthy for his heart?

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11. Who else should be in class with Murali?

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17. What does family history have to do with Murali’s results?

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CASE IN POINT—CECELIA: ELEVATED CHOLESTEROL AND TRANS FATS

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8. What goals would you set for Cecelia?

10. How often should Cecelia have her cholesterol assessed?

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"As is always the case, each party claims to have been

To the same effect, Captain Custance, of the British ship

On the 27th of January the Consul-General reported by telegram

TURKEY: A. D. 1897 (February-March).

Early in February, the difficulties of the attempt which the

On the 13th of February the admirals commanding the foreign

On the 2d of March, the representatives of Great Britain,

1. Crete can in no case be annexed to Greece in the present

2. The island will be endowed by the Powers with an autonomous

In notifying these decisions to the Sublime Porte by order of

To the Greek government the same announcement was made, that

"In view of the delays caused by Turkey in the application of

The Turkish government replied on the 6th: "The Sublime Porte

Two days later, the Greek government replied at greater

"In this connection, and in the name of humanity, as also in

The position taken by the Greek government in this reply was

On the day previous to this announcement of blockade the same

"The undersigned, Commanders-in-chief of the naval forces of

To the promise of an autonomous government for Crete the

"We therefore beg, in the name of the Mussulman population,

The situation of the Moslem population of the island was

"Over 49,000 Moslems are assembled in Candia and within cordon

Great Britain, Papers by Command:

Notwithstanding the opposition of the Great Powers, the Greeks

"Prepared or not, the Greeks clamoured for war, never doubting

"The Greeks had a fairly long innings carrying on the war

"Independence Day having passed without a general invasion of

"On the 21st of April, without any of the pictorial display or

"The battle of Domoko which followed was the most sanguinary

The preliminary treaty of peace, signed September 18, required

"The autonomous regime promised to this unfortunate island—the