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5TH
AUSTRALIAN
& NEW ZEALAND
EDITION
Understanding
Nutrition
Eleanor Whitney, Sharon Rady Rolfes,
Tim Crowe, Adam Walsh
5TH
AUSTRALIAN
& NEW ZEALAND
EDITION
Walnuts are a rich

source of heart-healthy
omega-3 fatty acids
Beta-carotene gives
carrots their orange
colour while also
helping our vision
The lycopene in
Understanding
tomatoes gives them
their red colour and is
a natural antioxidant
Nutrition Compounds in ginger

can help reduce
Eleanor Whitney, Sharon Rady ofRolfes,
feelings nausea
Tim Crowe, Adam Walsh

Understanding Nutrition © 2023 Cengage Learning Australia Pty Limited
5th Edition
Eleanor Whitney Copyright Notice
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National Library of Australia Cataloguing-in-Publication Data
Fourth edition published by Cengage in 2019 ISBN: 9780170457972
A catalogue record for this book is available from the National Library of Australia.
Authorised adaptation of Whitney & Rolfes, Understanding Nutrition 16e,
9780357447512 Cengage Learning Australia
Level 7, 80 Dorcas Street
Acknowledgements South Melbourne, Victoria Australia 3205
Chapter opener image credits: Ch1 Opener: Sliced purple onion: Adobe
Stock/alinakho; Ch1 Inset: Slices thick purple onion: Adobe Stock/xamtiw; Ch2 Cengage Learning New Zealand
Opener and inset: Lemon segments: Adobe Stock/filistimlyanin1; Ch3 Opener and Unit 4B Rosedale Office Park
inset: Sliced fresh vegetables and whole radish: Adobe Stock/9dreamstudio; Ch4 331 Rosedale Road, Albany, North Shore 0632, NZ
Inset: Cashew nuts: Adobe Stock/xamtiw; Ch5 Opener and inset: Yellow watermelon:
Adobe Stock/Flaffy; Ch5 End of chapter design: Yellow and pink watermelon: Adobe For learning solutions, visit cengage.com.au
Stock/Flaffy; Ch6 Opener and inset: Spinach leaves: Adobe Stock/ Flaffy; Ch7
Opener and inset: Button mushrooms: Adobe Stock/filistimlyanin1; Ch8 Opener: Printed in China by 1010 Printing International Limited.
Banana bunches: Adobe Stock/mariaaverburg; Ch8 Inset: Sliced banana: Adobe 1 2 3 4 5 6 7 26 25 24 23 22
Stock/Yeti Studio; Ch9 Opener and inset: Sliced beetroot, leek and cucumber: Adobe
Stock/8H; Ch10 Opener and inset: Dried pasta shapes: Adobe Stock/Agnes; Ch11
Opener and inset: Blueberries: Adobe Stock/filistimlyanin1; Ch12 Inset: Mandarin
segments: Adobe Stock/ChaoticDesignStudio; Ch12 Opener: Mandarin and
segments pattern: Adobe Stock/filistimlyanin1; Ch13 Opener and inset: Mixed
vegetables: Adobe Stock/ Flaffy; Ch14 Opener: Coconuts: Adobe Stock/MOVA; Ch14
Inset: Coconut swirls: Adobe Stock/OlgaKot20; Ch15 Opener and inset: Avocados:
Adobe Stock/filistimlyanin1; Ch16 Opener and inset: Cherries: Adobe Stock/Flaffy;
Ch17 Opener and inset: Various green fruit and vegetables: Adobe Stock/Tatiana
Morozova; Ch19 Opener: Sliced cucumber, in rows: Adobe Stock/Ksenia; Ch19 Inset
image: Sliced cucumber: Adobe Stock/Sergey
iii
CONTENTS IN BRIEF
Guide to the text viii
Guide to the online resources xi
Yellow capsicums
Preface xiii are rich in lutein
About the authors xv which belongs
to the vitamin A
Acknowledgements xvi family
CHAPTER 1 An overview of nutrition 1

CHAPTER 2 Planning a healthy diet 39
CHAPTER 3 Digestion, absorption and transport 66
CHAPTER 4 The carbohydrates: sugars, starches and dietary fibre 97
CHAPTER 5 The lipids: triglycerides, phospholipids and sterols 136
CHAPTER 6 Protein: amino acids 177
CHAPTER 7 Metabolism: transformations and interactions 214
CHAPTER 8 Energy balance and body composition 252
CHAPTER 9 Weight management: overweight, obesity and underweight 283
CHAPTER 10 The water-soluble vitamins: B group vitamins and vitamin C 321
CHAPTER 11 The fat-soluble vitamins: A, D, E and K 366
CHAPTER 12 Water and the major minerals 394
CHAPTER 13 The trace minerals 439
CHAPTER 14 Fitness: physical activity, nutrients and body adaptations 476
CHAPTER 15 Life cycle nutrition: pregnancy and lactation 510
CHAPTER 16 Life cycle nutrition: infancy, childhood and adolescence 546
CHAPTER 17 Life cycle nutrition: adulthood and the later years 583
CHAPTER 18 Diet-related disease 614
CHAPTER 19 Concerns about foods and water 654
Appendix A Cells, hormones and nerves 689
Appendix B Basic chemistry concepts 695
Appendix C Biochemical structures and pathways 704
Appendix D Measures of protein quality 721
Appendix E Nutrition assessment 724
Appendix F Physical activity and energy requirements 745
Appendix G Aids to calculation 748
Answers 750
Glossary 754
Index 776
Beetroot sprouts
contain potassium
and nitrates which
is important for
regulating blood
pressure
iv
CONTENTS
Guide to the text viii CHAPTER 4
Pecans are a rich Guide to the online resources xi THE CARBOHYDRATES:
source of fibre,
copper, thiamin Preface xiii SUGARS, STARCHES AND
and zinc DIETARY FIBRE 97
About the authors xv
Acknowledgements xvi 4.1 Chemical structure of carbohydrates 98
4.2 The simple carbohydrates 98
CHAPTER 1 4.3 The complex carbohydrates 102
AN OVERVIEW OF NUTRITION 1 4.4 Digestion and absorption of
1.1 Food choices 2 carbohydrates 104
1.2 Nutrients 5 4.5 Glucose in the body 109
1.3 The science of nutrition 10 4.6 Health effects and recommended
1.4 Nutrient Reference Values 16 intakes of sugars 115
1.5 Nutrition assessment 21 4.7 Alternative sweeteners 118
1.6 Diet and health 25 4.8 Health effects and recommended
CHAPTER ACTIVITIES 29 intakes of starch and dietary fibre 122
CHAPTER ACTIVITIES 128
HIGHLIGHT 1
Nutrition information and misinformation: HIGHLIGHT 4
on the net and in the news 32 Carbs, kilojoules and controversies 131
CHAPTER 2 CHAPTER 5
PLANNING A HEALTHY DIET 39 THE LIPIDS: TRIGLYCERIDES,
PHOSPHOLIPIDS AND STEROLS 136
2.1 Principles and guidelines 40
2.2 Diet-planning guides 44 5.1 Chemical structure of fatty acids and
2.3 Food labels 53 triglycerides 137
CHAPTER ACTIVITIES 58 5.2 Chemical structure of phospholipids
and sterols 144
HIGHLIGHT 2 5.3 Digestion, absorption and transport
Vegetarian diets 61 of lipids 146
5.4 Lipids in the body 152
CHAPTER 3 5.5 Health effects and recommended
DIGESTION, ABSORPTION AND
intakes of saturated fats, trans fats
TRANSPORT 66
and cholesterol 155
3.1 Digestion 67 5.6 Health effects and recommended
3.2 Absorption 73 intakes of monounsaturated and
3.3 The circulatory systems 77 polyunsaturated fats 157
3.4 The health and regulation of the 5.7 From guidelines to groceries 160
GI tract 80 CHAPTER ACTIVITIES 166
CHAPTER ACTIVITIES 87 HIGHLIGHT 5
HIGHLIGHT 3 High-fat foods: friend or foe? 169
Common digestive problems 89
Contents v
CHAPTER 6 CHAPTER 9
PROTEIN: AMINO ACIDS 177 WEIGHT MANAGEMENT:
OVERWEIGHT, OBESITY AND
6.1 Chemical structure of proteins 178 UNDERWEIGHT 283
6.2 Digestion and absorption of protein 182
6.3 Proteins in the body 183 9.1 Overweight and obesity 284
6.4 Protein in foods 194 9.2 Causes of overweight and obesity 287
6.5 Health effects and recommended 9.3 Problems of overweight and obesity 293
intakes of protein 195 9.4 Aggressive treatments for obesity 296
CHAPTER ACTIVITIES 204 9.5 Lifestyle strategies 298
9.6 Underweight 308
HIGHLIGHT 6
Nutritional genomics 207
HIGHLIGHT 9
CHAPTER 7 The latest and greatest weight-loss
METABOLISM: diet – again 315
TRANSFORMATIONS
AND INTERACTIONS 214 CHAPTER 10
THE WATER-SOLUBLE
7.1 Chemical reactions in the body 215 VITAMINS: B GROUP
7.2 Breaking down nutrients for energy 219 VITAMINS AND VITAMIN C 321
7.3 Feasting and fasting 232
CHAPTER ACTIVITIES 239 10.1 The vitamins: an overview 322
10.2 The B group vitamins: as individuals 325
HIGHLIGHT 7
10.3 The B group vitamins: in concert 348
Alcohol in the body 241
10.4 Vitamin C 350
CHAPTER 8
ENERGY BALANCE AND BODY HIGHLIGHT 10
COMPOSITION 252 Vitamin and mineral supplements 360
8.1 Energy balance 253 CHAPTER 11

8.2 Energy in: the kilojoules foods provide 254 THE FAT-SOLUBLE VITAMINS:
8.3 Energy out: the kilojoules the body A, D, E AND K 366
expends 258
8.4 Body weight, body composition and 11.1 Vitamin A and beta-carotene 367
health 264 11.2 Vitamin D 375
8.5 Health risks associated with body 11.3 Vitamin E 380
weight and body fat 269 11.4 Vitamin K 383
CHAPTER ACTIVITIES 272 CHAPTER ACTIVITIES 387
HIGHLIGHT 8 HIGHLIGHT 11
Eating disorders 274 Vitamin D and good health 389
Pears are a good

source of folate,
vitamin C, potassium
and copper
vi Contents
CHAPTER 12 CHAPTER 15
Exposing
WATER AND THE MAJOR LIFE CYCLE NUTRITION:
chanterelle MINERALS 394 PREGNANCY AND LACTATION 510
mushrooms to
sunlight can boost 12.1 Water and the body fluids 395 15.1 Nutrition prior to pregnancy 511
their vitamin D
levels 12.2 The minerals: an overview 407 15.2 Growth and development during
12.3 Sodium 408 pregnancy 512
12.4 Chloride 412 15.3 Maternal weight 517
12.5 Potassium 414 15.4 Nutrition during pregnancy 520
12.6 Calcium 416 15.5 High-risk pregnancies 526
12.7 Phosphorus 422 15.6 Nutrition during lactation 533
12.8 Magnesium 424 CHAPTER ACTIVITIES 539
12.9 Sulphate 426
HIGHLIGHT 15
CHAPTER ACTIVITIES 429 Foetal alcohol syndrome 541
HIGHLIGHT 12
Osteoporosis and calcium 432 CHAPTER 16
LIFE CYCLE NUTRITION:
CHAPTER 13 INFANCY, CHILDHOOD AND
THE TRACE MINERALS 439 ADOLESCENCE 546
13.1 The trace minerals: an overview 440 16.1 Nutrition during infancy 547
13.2 Iron 441 16.2 Nutrition during childhood 559
13.3 Zinc 451 16.3 Nutrition during adolescence 571
13.4 Iodine 455 CHAPTER ACTIVITIES 575
13.5 Selenium 457 HIGHLIGHT 16
13.6 Copper 458 Childhood obesity and the early
13.7 Manganese 459 development of chronic diseases 577
13.8 Fluoride 460
13.9 Chromium 462 CHAPTER 17
13.10 Molybdenum 462 LIFE CYCLE NUTRITION:
13.11 Other trace minerals 463 ADULTHOOD AND THE
CHAPTER ACTIVITIES 466 LATER YEARS 583
HIGHLIGHT 13 17.1 Nutrition and longevity 585
Phytochemicals and functional foods 469 17.2 The ageing process 588
17.3 Energy and nutrient needs of older
CHAPTER 14 adults 592
FITNESS: PHYSICAL ACTIVITY, 17.4 Nutrition-related concerns of
NUTRIENTS AND BODY older adults 595
ADAPTATIONS 476
17.5 Food choices and eating habits
14.1 Fitness 477 of older adults 601
14.2 Energy systems and fuels to support CHAPTER ACTIVITIES 605
activity 484 HIGHLIGHT 17
14.3 Vitamins and minerals to support Nutrient–drug interactions 607
activity 493
14.4 Fluids and electrolytes to support
activity 494
14.5 Diets for physically active people 499
HIGHLIGHT 14
Supplements as ergogenic aids 504
Contents vii
CHAPTER 18 19.4 Pesticides 668

DIET-RELATED DISEASE 614 19.5 Food additives 671
19.6 Consumer concerns about water 675
18.1 Nutrition and infectious diseases 615
18.2 Nutrition and chronic diseases 617
18.3 Cardiovascular disease 620 HIGHLIGHT 19
18.4 Hypertension 628 Food biotechnology 681
18.5 Diabetes mellitus 631
18.6 Cancer 637 Appendix A Cells, hormones and nerves 689
18.7 Recommendations for chronic Appendix B Basic chemistry concepts 695
disease prevention 641 Appendix C Biochemical structures and
CHAPTER ACTIVITIES 643 pathways 704
HIGHLIGHT 18 Appendix D Measures of protein quality 721
Complementary and alternative medicine 645 Appendix E Nutrition assessment 724
Appendix F Physical activity and energy
CHAPTER 19 requirements 745
CONCERNS ABOUT FOODS AND Appendix G Aids to calculation 748
WATER 654 Answers 750
Kale is an
19.1 Food safety and food-borne illnesses 656 Glossary 754 excellent source
Index 776 of vitamin K, but
19.2 Environmental contaminants 665 also contains
19.3 Natural toxins in foods 667 carotenoids which
are important in
eye health
viii
Guide to the text

As you read this text you will find a number of features in every chapter
to enhance your study of nutrition and help you understand
how the theory is applied in the real world.
CHAPTER OPENING FEATURES
CHAPTER
Connect Nutrition in your life with the essential

1
chapter concepts right from the beginning of each
chapter. AN OVERVIEW OF
NUTRITION
Think about your intuitive beliefs related to the
Nutrition in your life
nutrition topics covered in the chapter by taking the Believe it or not, you have probably eaten at least 20 000 meals in your life. Without any
Common sense test at the start of every chapter.

conscious effort on your part, your body uses the nutrients from those meals to make all its
components, fuel all its activities and defend itself against diseases. How successfully your
body handles these tasks depends, in part, on your food choices. Nutritious food choices
Check your answers in the margins when the topic support healthy bodies.
PUTTING COMMON SENSE TO THE TEST

is discussed. These are explained further in the end- Circle your answer
T F For good health, it is best to avoid all processed foods.
of-chapter review. T
T
F
F
Fat has twice the number of kilojoules as carbohydrates or protein.
All published research should be treated with some level of critical appraisal.
T F A Recommended Dietary Intake for a nutrient is the amount that everyone needs to
consume each day.
T F Changing our diet will do little to reduce the risk of many chronic diseases.
Identify the key concepts that the chapter will cover LEARNING OBJECTIVES
with the Learning objectives at the start of each 1.1 Describe how various factors influence
personal food choices.
1.4 Define the four categories of the Nutrient
Reference Values (NRVs) and explain their
1.2 Name six major classes of nutrients and purpose.
chapter. identify which are organic and which yield
energy.
1.5 Explain how the four nutrition assessment
methods for an individual are used to
1.3 Explain the scientific method and how detect energy and nutrient deficiencies and
scientists use various types of research excesses. Chapter 1: An overview of nutrition 9
studies and methods to acquire nutritional 1.6 Identify several risk factors for chronic
information. disease and explain their relationship.
1.7 Recognise misinformation and describe how
to identify reliable nutrition information.
harm it does far exceeds the problems of excess body fat. (Highlight 7 describes
Onions contain antioxidants and the effects of
compounds that fight inflammation,
alcohol on health and nutrition.) decrease triglycerides and reduce
cholesterol levels
Other roles of energy-yielding nutrients

In addition to providing energy, carbohydrates, fats and proteins provide the raw materials for
FEATURES WITHIN CHAPTERS building the body’s tissues and regulating its many activities. In fact, protein’s role as a fuel
source is relatively minor compared with the other two nutrients and its other roles. Proteins
are found in structures such as the muscles and skin and help to regulate activities such as
Chapter 2: Planning a healthy diet 51
digestion and energy metabolism.
Practise common nutrition tasks such as comparing

BK-CLA-WHITNEY_5E-210367-Chp01 copy.indd 1 22/03/22 6:11 PM
HOW TO: CALCULATE THE ENERGY AVAILABLE FROM FOODS
nutrient
Grain-enrichmentdensity or calculating your energy
Practise calculating the energy available from foods.
hem described as refined, enriched nutrients include: 1. To calculate the energy available from 16 g carbohydrate × 17 kJ/g = 272 kJ
e making of grain products, and requirements
• iron
• thiamine
by working through the How to boxes a food, multiply the number of grams 7 g protein × 17 kJ/g = 119 kJ
fined foods may have lost many of carbohydrate, protein and fat by 17, 9 g fat × 37 kJ/g = 333 kJ
had some nutrients (generally throughout
• riboflavin
• niacin the book. 17 and 37, respectively. Then add the Total = 724 kJ
s may be rich in fibre and all the • folate. results together – e.g. 1 slice of bread
upport good health and should with 1 tablespoon of peanut butter on it
contains 16 grams carbohydrate, 7 grams
tified foods on the market. A protein and 9 grams fat.
the added nutrients may not have
AUSTRALIAN From the information you calculated in step 1, you can determine the percentage of kilojoules
when selecting breakfast cereals DIETARY
nerals as, while these may appear GUIDELINES 2013 each of the energy nutrients contributes to the total.
provide the full spectrum of ---------------
Enjoy a wide variety
Connect key Australian Dietary 2. To determine the percentage of kilojoules 333 fat kJ ÷ 724 total kJ = 0.46
might provide. from fat, for example, divide the 333 fat 0.46 × 100 = 46%
other breads. However, due to
ew Zealand (FSANZ), Australian
of nutritious foods
every day, including Guidelines to your understanding of kilojoules by the total 724 kilojoules.
milk, plenty of fruits 3. Then multiply by 100 to get the
d to all bread flours, except for
ortification of bread flour was
and vegetables of
2 differentUnderstanding Nutrition
the chapter. percentage.
types Dietary recommendations that urge people to limit fat intake to 20 to 35 per cent of kilojoules
acid is important in the healthy and colours and
refer to the day’s total energy intake, not to individual foods. Still, if the proportion of fat in
f neural tube defects. In New legumes/beans.
each food choice throughout a day exceeds 35 per cent of kilojoules, then the day’s total
o 50 per cent of packaged sliced
surely will, too. Knowing that this snack provides 46 per cent of its kilojoules from fat alerts
d for bread making required to be
Welcome to the world of nutrition. Although you may not always have been aware of it, a person to the need to make lower-fat selections at other times that day.
In general, a nutrition has played a significant role in your life. And it will continue to affect you in major
chronic disease ways, depending on the foods you select.
progresses slowly or
with little change and
Extend your learning with the Vitamins
Every day, several times a day, you make food choices that influence your body’s health for
better or worse. Each day’s choices may benefit or harm your health only a little, but when
Vitamins are organic but they do not provide energy. Instead, they facilitate the release
lasts a long time. By
comparison, an acute additional information notes highlighting
these choices are repeated over years and decades, the rewards or consequences become major.
of energy from carbohydrate, fat and protein and participate in numerous other activities
That being the case, paying close attention to good eating habits now can bring health benefits
throughout the body. The water-soluble
disease develops
quickly, produces interesting or important information about
later. Conversely, carelessness about food choices can contribute to many chronic diseases
prevalent in later life, including heart disease and cancer. Of course, some people will become
Each of the 13 different vitamins has its own special role to play. One vitamin enables
vitamins are vitamin C
and the eight B vitamins:
sharp symptoms and the eyes to see in dim light, another helps produce functional red blood cells, and still another
runs a short course.
• chronos = time
the topic being discussed.
ill or die young no matter what choices they make, and others will live long lives despite
making poor choices. For most of us, however, the food choices we make each and every day
helps make the sex hormones – among other things. When you cut yourself, one vitamin
thiamin, riboflavin, niacin,
vitamins B6 and B12, folate,
helps stop the bleeding and another helps repair the skin. Vitamins busily help replace old red biotin and pantothenic
• acute = sharp will benefit or impair our health in proportion to the wisdom of those choices.
blood cells and the lining of the digestive tract. Almost every action in the body requires the acid. The fat-soluble
Although most people realise that their food habits affect their health, they often choose
assistance of vitamins. vitamins are vitamins A, D,
foods for other reasons. After all, foods bring to the table a variety of pleasures, traditions and E and K. The water-soluble
Vitamins can function only if they are intact, but because they are complex organic
s the endosperm; that is why they are so nutritious. Refined associations as well as nourishment. The challenge, then, is to combine favourite foods and vitamins are the subject
molecules, they are vulnerable to destruction by heat, light and chemical agents. This is why
ded back, they are not as nutritious as wholegrain fun times with a nutritionally balanced diet. of Chapter 10, and the
the body handles them carefully, and why nutrition-wise cooks do, too. The strategies of
cooking vegetables at moderate temperatures for short times and using small amounts of water fat-soluble vitamins are
r are: discussed in Chapter 11.
ground endosperm that is usually enriched with nutrients 1.1 Food choices help to preserve the vitamins.
uest Photographic, Inc.
iteness; sometimes called white flour.

ur made from the endosperm of the wheat kernel. People decide what to eat, when to eat and even whether to eat in highly personal ways, often
any flour made from the entire wheat kernel. based on behavioural or social motives rather than on an awareness of nutrition’s importance
n white flour and white wheat is noteworthy. Typically, white to health.
flour (as defined above). Most flour – whether refined, white,
ade from red wheat. Wholegrain products made from red
own and full-flavoured.
Guide to the text
Chapter 1: An overview of nutrition 5
ix
ultra-processed foods. Ultra-processed foods no longer resemble whole foods. They are
made from substances that are typically used in food preparation but not consumed as foods
themselves (e.g. oils, fats, flours, refined starches and sugars). These substances undergo
further processing by adding little, if any, processed foods, salt and other preservatives, and
additives such as flavours and colours. Examples of ultra-processed foods include soft drinks,
corn chips, confectionery, chicken nuggets and pastries. Notably, these foods cannot be made
FEATURES WITHIN CHAPTERS in a home kitchen using common grocery ingredients. Dominating the global foods market,
ultra-processed foods tend to be attractive, tasty and cheap – as well as high in fat and sugar.
Consumers who want to make healthy food choices will select fewer ultra-processed foods and
more whole foods and minimally processed foods.4 Chapter 1:
Chapter 1: An
An overview
overview of
of nutrition
nutrition 27
5
CURRENT RESEARCH IN NUTRITION
The perils of highly processed foods

TABLE
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Explore relevant and up-to-date nutrition research in Physical
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High Ultra-processed
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little if any whole food. Ultra-processed foods often include ingredients not commonly used
High cholesterol 2.4
in home cooking such as flavourings, colourings, emulsifiers and other additives. A key
CURRENT
Diet low in fruitRESEARCH IN NUTRITION 2.0
feature of ultra-processed foods is that they are usually appetising and pleasing to the taste
buds,
Diet
The low convenient,
in vegetables
perils of highly sold in large packages
processed foods and highly marketed. 1.1
Do low
Diet Ultra-processed
you believe
in wholethe grains foods
key to goodare health
the types is to of
justfoods
cut outthat are over-represented
processed foods?1.1 The term in ‘processed
the list of
discretionary food choices. Such foods are not an essential part of a nutritious diet. Now
a food’ may seem like a dietary demon that we need to avoid, but it is a concept that has little
DALY: Disability-Adjusted Life Year. The DALY is a measure of overall disease burden, expressed as the
nutritional
meaning
number researchers
andlost
of years is unhelpful are linking
in informing
due to ill-health, these
disability foods
food as
choices.
or early a major driver of overweight
death.Almost everything you eat is processed and obesity,
while
to also contributing
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moredisease, type 2
helpful concept
Australian Institute of Health and Welfare, Australian Burden of Disease Study: impact and causes of illness and death in
diabetes
is to divide
Australia
and
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2011, (2016).
certain cancers. based on their degree of processing.
into categories
CC-BY 3.0 Licence. (https://www.aihw.gov.au/copyright). So, on the positive side
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NUTRITION
d methodsPORTFOLIO used in a nutrition assessment.
• Reflect on your own personal nutritional choices Each chapter in this book ends with simple ‘Nutrition
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NUTRITION
portfolio’ QUESTIONS
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activities that invite you to review key messages
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identify the factors that most influence your choices.
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examine how your knowledge and behaviours • Describe lifestyle changes you can make to improve
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organic?
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you too much energy or nutrients? Define malnutrition,
• Review the major chapter concepts in STUDY
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and 1.2)
reducing your risk of chronic diseases. undernutrition and overnutrition. Describe the
four methods used to detect energy and nutrient
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questions 4 The energy-yielding nutrients are:
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yield
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the book.
11
deficiencies and excesses. (Section 1.5)
a fats, minerals and water
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• Expand your knowledge by exploring the online protein, 30 grams carbohydrate and 11 grams fat.
NUTRITION ON THE NET
______________ = ____ % kJ from carbohydrate
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resources listed in Nutrition on the net. Analyse the nutrient composition of foods online: To
learn more about the nutrient content of the foods you
BK-CLA-WHITNEY_5E-210367-Chp01 copy.indd 29
the World Health Organization: http://www.fao.org
and http://www.who.org
22/03/22 6:11 PM
eat, you can access the full NUTTAB Food Composition • Read about the Selected Highlights from the 2017–18
Database provided by Food Standards Australia New National Health Survey https://www.abs.gov.au/
Zealand from http://www.foodstandards.gov.au/science/ statistics/health/health-conditions-and-risks/ 22/03/22 6:11 PM
monitoringnutrients/pages/default.aspx
national-health-survey-first-results/2017-18 22/03/22 6:11 PM
• Search for ‘nutrition’ at the National Health and • Read about food and nutrition monitoring in New
Medical Research Council site: http://www.nhmrc. Zealand by searching ‘nutrition survey’ at http://www.
gov.au health.govt.nz
• Review the Nutrient Reference Values: http://www. • Visit the food and nutrition centre at the Mayo Clinic:
nrv.gov.au http://www.mayohealth.org
• Review nutrition recommendations from the Food and
Agriculture Organization of the United Nations and
x Understanding Nutrition
HIGHLIGHTS 32 Understanding Nutrition
Every chapter is followed by a highlight that provides

1.7 NUTRITION INFORMATION
readers with an in-depth look at a current, and often
HIGHLIGHT
1 AND MISINFORMATION: ON
controversial, topic that relates to its companion THE NET AND IN THE NEWS
chapter Do keto diets really help with weight loss, or is it better to
practise intermittent fasting? What is plant-based eating
Nutrition on the net
Got a question? The internet has an answer. The
all about? Will nutrigenomics have the answers to all our
internet offers endless opportunities to obtain high-
• Develop your understanding of these key topics

health questions? Is the microbiome helpful or harmful?
quality information, but it also delivers an abundance of
Food and nutrition trends such as these have always
incomplete, misleading or inaccurate information. Simply
swirled around the world of nutrition. Some arise out
put, anyone can publish anything. Determining whether
by responding to the critical thinking questions.
of the latest research and have the backing of scientific
information is balanced, accurate, and credible has become
evidence. They have staying power, whereas those based
Chapter 1: An overview of nutrition 37 increasing challenging in recent years.1
on nonsense fade away as soon as the next fanciful trend
38 Understanding Nutrition chapters present the With hundreds of millions of websites, a person
catches our attention. Upcoming
• Research these thought-provoking topics further scientific findings of these and other trending topics, but it
is most important that readers be able to spot a trend and
searching for valid nutrition information can be
overwhelmed with uncertainty. When using the
internet, keep in mind that the quality of health-related
by exploring the weblinks listed in Nutrition on

determine its validity.
pollution. Countries have different laws regarding sales of must heed the caution, ‘Buyer beware’. information available covers a broad range. You must
How can people distinguish valid nutrition information
drugs, dietary supplements and other health products, but In summary, when you hear nutrition news, consider
REFERENCES
evaluate websites for their accuracy, just like every other
from misinformation? One excellent approach is to notice
applying these laws to the internet marketplace is almost its source. Ask yourself these two questions: Is the person source. The ‘How to’ box that follows provides tips for
the net.
who is providing the information. The ‘who’ behind the
impossible. Even if illegal activities could be defined and providing the information qualified to speak on nutrition? determining whether a website is reliable.
information is not always evident, though, especially in
identified, finding the person responsible for a particular Is the information based on valid scientific research? One of the most trustworthy sites used by scientists
the world of electronic media. Keep in mind that people
CHAPTER
website is not always possible. Websites can open and close If not, find a better source. After all, your health and others is the US National Library of Medicine’s
create apps, blogs, and websites on the internet, just as
in a blink of a cursor. Now more than ever, consumers depends on it. 1 L. Hwang and co-authors, New insight into human sweet taste: PubMed, which provides
(New Zealand), free access
Nutrient Reference Values to
for over 30 and
Australia million
New
people write books and report the news. In all cases,
A genome-wide association study of the perception and intake of Zealand,
research Canberra:
papers Commonwealth
published of Australia
in scientific and New
journals Zealandthe
around
consumers need toAmerican
sweet substances, determine Journalwhether
of Clinicalthe person
Nutrition 109is(2019): Government (2006).
HIGHLIGHT ACTIVITIES qualified
2 This
to provide nutrition information.
1724–1737.
highlight
C. Smith begins Secular
and co-authors, by examining
changes in the unique
intakes of foods among
world. Many abstracts provide links to websites where full
10 Department of Community Services and Health, National dietary
articles are available. Figure H1.1 introduces this
survey of adults, 1983. No. 2. Nutrient intakes, Canberra: AGPS valuable
Publicon
Health resource.
New Zealand
potential as welladults fromproblems
as the 1997 to 2008/09,
of relying theNutrition
internet (1987); Department of Community Services and Health, National
(2015): doi: 10.1017/S1368980015000890 Ifdietary
you survey
have of received an email
schoolchildren (10–15warning of No.
years): 1985. the2.health
Nutrient
CRITICAL THINKING QUESTIONS and the media for nutrition information. It continues
3 S. L. Johnson, Developmental and environmental influences on intakes, Canberra: AGPS
dangers associated with(1989);
reusing Australian Bureauplastic
or freezing of Statistics,
water
withyoung
a discussion of how preferences
children’s vegetable to identify and reliable nutrition
consumption, Advances in National Nutrition Survey: Nutrient intakes and physical measurements,
1 How would you judge the accuracy or validity of to say that this DEADLY POISON causes blindness, information
bottles, you have been a victim of urban scarelore. When
Nutrition 7that applies
(2016): to all resources, including the
220S–213S. Australia, 1995, ABS Catalogue Number 4805.0, Canberra: ABS
nutrition information? multiple sclerosis, brain tumours, and cancer! The internet
4 and the
L. Schnabel and news. (The
co-authors, Glossary
Association defines
between related food
ultraprocessed nutrition
(1998);information
Australian Bureauarrives in unsolicited
of Statistics, emails,
National health survey:befirst
message alleges that aspartame remains on the consumption and risk of mortality among middle-aged adults in
terms.)
suspicious if:
results, 2017–2018, ABS Catalogue Number 4364.0.55.001, Canberra:
2 You have just received a forwarded email from a friend
market because of a conspiracy between FSANZ and France, JAMA Internal Medicine 179 (2019): 490–498. • theABS person
(2018). sending it to you did not write it and
warning that the artificial sweetener aspartame is a This discussion recognises that identifying nutrition
the manufacturer to keep these dangers hidden from 5 M. M. Lane and co-authors, Ultraprocessed food and chronic 11 you
Newcannot
Zealand Ministry
determineof Health,
who Nutrition
did or ifSurvey, available at
that person is a
TOXIN that causes muscle spasms, leg numbness, misinformation
noncommunicable requires
diseases:more than simply
A systematic review and gathering
meta analysis http://www.health.govt.nz/nz-health-statistics/national-collections-
the public. How can you determine whether these nutrition expert
stomach cramps, vertigo, dizziness, headaches, accurate information,
of 43 observational although
studies, Obesity that
Reviews is 9a(2020):
good start; it
doi: 10.1111/ and-surveys/surveys/current-recent-surveys/nutrition-survey
claims are legitimate warnings or an irresponsible • theNewphrase
Zealand‘Forward
Ministry of this toNew
everyone
Zealandyou know’ appears
tinnitus, joint pain, depression, anxiety, slurred requires critical thinking. Critical thinking allows a person
obr.13146 12 Health, Nutrition Survey,
hoax? 6 • the phrase ‘This is not a hoax’ appears; chances are
speech, blurred vision, and memory loss. It goes on whoM. has B. gathered
Katan and co-authors,
information Which to:are the greatest recent discoveries available at https://www.health.govt.nz/nz-health-statistics/national-
and the greatest future challenges in nutrition? European Journal of that it is
collections-and-surveys/surveys/new-zealand-health-survey
• understand the connections between concepts
Clinical Nutrition 63 (2009): 2–10. 13
• theNewnews Zealand is Ministry of Health,
sensational andMortality
you have webnever
tool, available
heard at about
• identify and evaluate the pros and cons of an argument
NUTRITION ON THE NET 7 J. P. A. Ioannidis, The challenge of reforming nutritional https://www.health.govt.nz/publication/mortality-web-tool
it from legitimate sources
• detect inconsistencies
epidemiologic andof errors
research, Journal the American Medical Association 320 14 Australian Institute of Health and Welfare, Australian Burden of
• Analyse the nutrient composition of foods online: • For foods commonly eaten in New Zealand, you can • the language is emphatic and the text is sprinkled with
• solve
(2018): problems
969–970. Disease Study: Impact and causes of illness and death in Australia 2011
To learn more about the nutrient content of the analyse their nutrient content from the database 8 J. P. A. Ioannidis and J. F. Trepanowski, Disclosures in nutrition capitalised
(2016). words and exclamation marks
• identify the relevance of information.
foods you eat, you can access the full NUTTAB Food maintained by Plant and Food New Zealand: research: Why it is different, Journal of the American Medical • no
15 references
A. Fardet are given
and Y. Boirie, or, if present,
Associations between foodareand
of beverage
To that end, the questions at the end of the highlights
Association 319 (2018): 547–548. groups and major
questionable diet-related
validity when chronic diseases: An exhaustive review
examined.
Composition Database provided by Food Standards http://www.foodcomposition.co.nz that Australian
9 follow all chapters Department
Government are intended to help
of Health develop
and Ageing, National of pooled/meta-analyses and systematic reviews, Nutrition Reviews 72
Australia New Zealand at http://www.foodstandards. • Learn more about quackery from Stephen Barrett’s critical
Healththinking skills.
and Medical Research Council (Australia), Ministry of Health (2014): 741–762.
gov.au/science/monitoringnutrients/pages/default. Quackwatch: http://www.quackwatch.org
aspx • Visit the National Council against Health Fraud:
• Find an accredited practising dietitian in your http://www.ncahf.org HIGHLIGHT
area by consulting the Dietitians Australia • Check out health-related hoaxes and urban legends: 1 S. Rowe and N. Alexander, On post-truth, fake news, and trust, 3 M. Adamski and co-authors, Are doctors nutritionists? What is the
website; also find out which nutrition and dietetics http://www.urbanlegends.about.com Nutrition Today 52 (2017): 179–182. role of doctors in providing nutrition advice? Nutrition Bulletin 43
2 C. Korownyk and co-authors, Televised medical talk shows – What (2018): 147–152.
courses are accredited by the association: https:// • Find reliable research articles: https://pubmed.ncbi.
they recommend and the evidence to support their recommendations:
dietitiansaustralia.org.au nlm.nih.gov A prospective observational study, British Medical Journal 349 (2014):
• Learn about the Registered Nutritionist program at doi 10.1136/bmj.g7346
the Nutrition Society of Australia: http://www.nsa.
asn.au
• Read about the professional registration of
nutritionists in New Zealand: http://www.
nutritionsociety.ac.nz/registration

xi
Guide to the online resources

FOR THE INSTRUCTOR
Cengage is pleased to provide you with a selection of resources

that will help you to prepare your lectures and assessments,
when you choose this textbook for your course.
Log in or request an account to access instructor resources
at cengage.com.au/instructors for Australia or
cengage.co.nz/instructors for New Zealand.
MINDTAP
Premium online teaching and learning tools are available on the MindTap platform – the personalised
eLearning solution.
MindTap is a flexible and easy-to-use platform that helps build student confidence and gives you a clear
picture of their progress. We partner with you to ease the transition to digital – we’re with you every step of
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The Cengage Mobile App puts your course directly into students’ hands with course materials available
on their smartphone or tablet. Students can read on the go, complete practice quizzes or participate in
interactive real-time activities.
MindTap for Whitney’s Understanding Nutrition is full of innovative resources to support critical thinking and
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MindTap is a premium purchasable eLearning tool. Contact
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INSTRUCTOR’S MANUAL
The Instructor’s Manual includes:
• Learning objectives • Worksheets and handouts
• Lecture presentation outlines and enrichments • Classroom activities
• Answers to study questions • New Zealand instructor information
• Critical thinking questions with answers
xii Understanding Nutrition
COGNERO® TEST BANK

A bank of questions has been developed in conjunction with the text for creating quizzes, tests and exams for
your students. Create multiple test versions in an instant and deliver tests from your LMS, your classroom,
or wherever you want using Cognero. Cognero test generator is a flexible online system that allows you to
import, edit, and manipulate content from the text’s test bank or elsewhere, including your own favourite test
questions.
POWERPOINT™ PRESENTATIONS
Use the chapter-by-chapter PowerPoint presentations to enhance your lecture presentations and handouts to
reinforce the key principles of your subject.
ARTWORK FROM THE TEXT

Add the digital files of graphs, tables, pictures and flow charts into your course management system, use
them in student handouts, or copy them in your lecture presentations.
FOR THE STUDENT
MINDTAP
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MindTap gives you the resources you need to study – all in one place and available when you need them. In the
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If your instructor has chosen MindTap for your subject this semester, log in to MindTap to:
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When your instructor creates a course using MindTap, they
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xiii
PREFACE
Nutrition is a science. The details of a nutrient’s chemistry or a cell’s biology can be
overwhelming and confusing to some, but it needn’t be. When the science is explained step by
step and the facts are connected one by one, the details become clear and understandable. That
has been the goal since this book was first developed and as it has continued to be updated in
this fifth edition: to reveal the fascination of science and share the excitement of nutrition
with readers. We have learned from the hundreds of university teachers and nutrition
professionals and more than a million students who have used previous editions of this book
through the years that readers want to understand nutrition so that they can make healthy
choices in their daily lives.
With its focus on Australia and New Zealand, the text incorporates current nutrition
recommendations and public health issues, and food culture relevant to those studying and
working in nutrition in this region of the world.
Because nutrition is an active science, staying current is paramount. To that end, this
edition incorporates the latest in nutrition research. The connections between diet and disease
have become more apparent – and our interest in making smart health choices has followed.
More people are living longer and healthier lives. The science of nutrition has grown rapidly,
with new research emerging daily. In this edition, as with previous editions, every chapter
has been substantially revised to reflect the many changes that have occurred in the field of
nutrition and in our daily lives over the years. We hope that this book serves you well.
THE CHAPTERS
Understanding Nutrition presents the core information of an introductory nutrition course.
The early chapters introduce the nutrients and their work in the body, and the later chapters
apply that information to people’s lives – describing the role of foods and nutrients in energy
balance and weight control, in physical activity, in the life cycle and in disease prevention, and
food safety. At the beginning of each chapter are clearly stated learning objectives to outline
the key concept areas to be covered. Each chapter also clearly flags for the reader practical
applications of nutritional research and presents the most recent research in the topic area.
THE HIGHLIGHTS
Every chapter is followed by a highlight that provides readers with an in-depth look at a
current, and often controversial, topic that relates to its companion chapter. Each highlight
closes with critical thinking questions designed to encourage readers to develop clear, rational,
open-minded and informed thoughts based on the evidence presented in the text.
THE APPENDICES
The appendices are valuable references for a number of purposes. Appendix A summarises
background information on the hormonal and nervous systems, complementing Appendices B
and C on basic chemistry, the chemical structures of nutrients and major metabolic pathways.
Appendix D describes measures of protein quality. Appendix E provides detailed coverage of
nutrition assessment with updated infant and child growth charts, and Appendix F presents
estimated energy requirements for men and women at various levels of physical activity.
Appendix G presents common calculation and conversion tips.
Chillis are part of the

capsicum family and a rich
source of vitamin C
xiv
THE COVERS
The book’s inside covers put commonly used information at your fingertips, including current
nutrient recommendations and suggested weight ranges for various heights.
We have taken great care to provide accurate information and have included many
references at the end of each chapter. However, to keep the number of references manageable,
many statements appear without references. All statements reflect current nutrition knowledge
and the authors will supply references upon request. In addition to supporting text statements,
the references provide readers with resources for finding a good overview or more details on a
subject.
In this new edition, the art and layout have been carefully designed to be inviting while
enhancing student learning. For all chapters and highlights, content has been reviewed and
updated. Several new figures and tables have been created and others revised to enhance
learning. Each chapter also features a true–false ‘common sense’ test presented at the
beginning to allow students to test their core knowledge on practical nutrition concepts related
to the topic. Answers to these common-sense questions are revealed throughout the chapter
and a brief explanation is given at the end. This new edition has also been revised throughout
to include more content and related nutrition issues that are specific to New Zealand. For
example, Chapter 2 features the recent updates to the Eating and Activity Guidelines for New
Zealand Adults. And to acknowledge the growing interest in the gastrointestinal microbiome
in health, an expanded section in Chapter 3 has been added with an additional focus on
nutrition, the microbiome and mental health as well as a research focus in Chapter 4.
Nutrition is a fascinating subject, and we hope our enthusiasm for it comes through on
every page.
Tim Crowe
Adam Walsh
Ellie Whitney
Sharon Rady Rolfes
Dragon fruit seeds are

an excellent source of
Oleic and Linoleic acids
which may lower risk of
cardiovascular disease
xv
Compounds
ABOUT THE AUTHORS in garlic can

help reduce
blood pressure
Eleanor Noss Whitney, PhD, received her BA in Biology from Radcliffe College in 1960 and improve
cholesterol
and her PhD in Biology from Washington University, St Louis, in 1970. Formerly on the levels
faculties at Florida State University and Florida A&M University and a dietitian registered
with the American Dietetic Association, Ellie now devotes full time to research, writing and
consulting in nutrition, health and environmental issues. Her earlier publications include
articles in science, genetics, and other journals. Her textbooks include Nutrition Concepts and
Controversies 12th edn, Understanding Nutrition 12th edn, Understanding Normal and Clinical
Nutrition 9th edn and Nutrition and Diet Therapy 7th edn, all with Cengage Wadsworth. She
also recently co-authored Priceless Florida (Pineapple Press), a comprehensive text examining
the ecosystems in her home state. Her additional interests include energy conservation, solar
energy use, alternatively fuelled vehicles and ecosystem restoration.
Sharon Rady Rolfes received her MS in nutrition and food science from Florida State
University. She is a founding member of Nutrition and Health Associates, an information
resource centre that maintains a research database on over 1000 nutrition-related topics.
Sharon’s publications include the college textbooks Understanding Nutrition 12th edn
and Nutrition for Health and Health Care 4th edn. In addition to writing and research,
she occasionally teaches at Florida State University and serves as a consultant for various
educational projects. Her volunteer work includes serving on the board of Working Well, a
community initiative dedicated to creating a healthy workforce.
Dr Tim Crowe is an Advanced Accredited Practising Dietitian who has spent most of his
career in the world of university nutrition teaching and research. He now works chiefly as a
health and medical writer and scientific consultant and speaks on many health topics to the
public through both the media, social media and writing for consumer publications.
Dr Adam Walsh is a Senior Lecturer in Nutrition and Dietetics in the School of
Behavioural and Health Sciences at Australian Catholic University in Melbourne, and an
Advanced Accredited Practising Dietitian. He teaches in the undergraduate and postgraduate
nutrition and dietetics programs in the areas of clinical dietetics, nutritional physiology, and
paediatric health. Adam’s area of research is the influence of fathers on young children’s
nutrition and physical activity behaviours.
xvi
ACKNOWLEDGEMENTS
The adaptation and updating of this textbook has been a team effort with us all focused on
improving a book that has been well-received throughout nutrition courses in Australia and
New Zealand. Many thanks must go to the team of external reviewers who gave valuable
feedback and advice on each of the chapters in order to improve the relevance of the text
to the teaching of nutrition in Australia and New Zealand. The team at Cengage have been
instrumental in guiding us through the entire process and have been a pleasure to work with
through all stages of development. It is rewarding to see the text now in print after all our hard
work.
From Tim Crowe: Many thanks go to my nutrition and dietetic friends and colleagues
who have been down the publication path before and assured me that the late nights and long
weekends of writing and proofing would be time well spent in producing a piece of work to be
proud of. They were right.
From Adam Walsh: Thanks to my two wonderful boys for keeping me grounded and
reminding me what life is all about. They have, on more than one occasion, reminded me that
even though I’m the dietitian in the house, I’m still just Dad to them.
The authors and Cengage Learning would like to thank our reviewers who provided incisive
and helpful feedback:
• Louise Brough – Massey University
• Tamara Bucher – University of Newcastle, Central Coast Campus
• Alison Coates – University of South Australia, City East
• Cathryn Conlon – Massey University
• Kirsten Fagan – Holmesglen Institute Waverley
• Chris Irwin – Griffith University, Gold Coast
• Peter Lerossignol – Australian Catholic University, Banyo
• Isabelle Lys – Australian Catholic University, Banyo
• Sophie Scott – Fitness Institute Australia.
Tumeric contains
the potent
anti-inflammatory
curcumin
1
CHAPTER
AN OVERVIEW OF
NUTRITION
Nutrition in your life

Believe it or not, you have probably eaten at least 20 000 meals in your life. Without any
conscious effort on your part, your body uses the nutrients from those meals to make all its
components, fuel all its activities and defend itself against diseases. How successfully your
body handles these tasks depends, in part, on your food choices. Nutritious food choices
support healthy bodies.
PUTTING COMMON SENSE TO THE TEST

Circle your answer
T F For good health, it is best to avoid all processed foods.
T F Fat has twice the number of kilojoules as carbohydrates or protein.
T F All published research should be treated with some level of critical appraisal.
T F A Recommended Dietary Intake for a nutrient is the amount that everyone needs to
consume each day.
T F Changing our diet will do little to reduce the risk of many chronic diseases.
LEARNING OBJECTIVES
1.1 Describe how various factors influence 1.4 Define the four categories of the Nutrient
personal food choices. Reference Values (NRVs) and explain their
1.2 Name six major classes of nutrients and purpose.
identify which are organic and which yield 1.5 Explain how the four nutrition assessment
energy. methods for an individual are used to
1.3 Explain the scientific method and how detect energy and nutrient deficiencies and
scientists use various types of research excesses.
studies and methods to acquire nutritional 1.6 Identify several risk factors for chronic
information. disease and explain their relationship.
1.7 Recognise misinformation and describe how
to identify reliable nutrition information.
Onions contain antioxidants and

compounds that fight inflammation,
decrease triglycerides and reduce
cholesterol levels
2 Understanding Nutrition
Welcome to the world of nutrition. Although you may not always have been aware of it,
In general, a nutrition has played a significant role in your life. And it will continue to affect you in major
chronic disease ways, depending on the foods you select.
progresses slowly or Every day, several times a day, you make food choices that influence your body’s health for
with little change and better or worse. Each day’s choices may benefit or harm your health only a little, but when
lasts a long time. By
these choices are repeated over years and decades, the rewards or consequences become major.
comparison, an acute
That being the case, paying close attention to good eating habits now can bring health benefits
disease develops
quickly, produces later. Conversely, carelessness about food choices can contribute to many chronic diseases
sharp symptoms and prevalent in later life, including heart disease and cancer. Of course, some people will become
runs a short course. ill or die young no matter what choices they make, and others will live long lives despite
• chronos = time making poor choices. For most of us, however, the food choices we make each and every day
• acute = sharp will benefit or impair our health in proportion to the wisdom of those choices.
Although most people realise that their food habits affect their health, they often choose
foods for other reasons. After all, foods bring to the table a variety of pleasures, traditions and
associations as well as nourishment. The challenge, then, is to combine favourite foods and
fun times with a nutritionally balanced diet.
1.1 Food choices

People decide what to eat, when to eat and even whether to eat in highly personal ways, often
based on behavioural or social motives rather than on an awareness of nutrition’s importance
to health.
Personal preference
As you might expect, the primary reason people choose foods is taste – they like certain
flavours. Two widely shared preferences are for the sweetness of sugar and for the savouriness
of salt. Liking high-fat foods also appears to be a universally common preference. Other
preferences might be for the hot chilli common in Mexican cooking or the curry spices of
Indian cuisine. Some research suggests that genetics may influence people’s food preferences.1
Hunger and satiety

People eat for a variety of reasons, but clearly hunger is a key driver of seeking food. Hunger is
a physiological response to a need for food triggered by chemical messengers originating and
acting in the brain. After a meal, the feeling of satiety suppresses hunger and allows a person
to not feel the need to eat for a while. The complex interplay between hunger, hormones and
the feeling of fullness are covered in greater depth in Section 8.2 of Chapter 8 which explores
energy balance and body composition.
Habit
People sometimes select foods out of habit. They eat cereal every morning, for example, simply
because they have always eaten cereal for breakfast. Eating a familiar food and not having to
make any decisions can be comforting. Similarly, people may find certain foods and beverages
most appropriate at certain times of day – orange juice in the morning, for example.
Ethnic heritage or tradition

Among the strongest influences on food choices are ethnic heritage and tradition. People eat
the foods they grew up eating. Every country – and, in fact, every region of a country – has its
own typical foods and ways of combining them into meals. The ‘Australian diet’ includes many
ethnic foods from various countries, such as Greece, Italy, Thailand and China, all
adding variety to the diet. The New Zealand diet has been influenced by British,
Pacific and, more recently, Asian migrants. Recent trends in the New Zealand
diet include a reduction in beef, lamb and potatoes and an increase in poultry,
pasta and rice, which reflects international food trends, food prices and ease of
preparation.2
Social interactions
Most people enjoy companionship while eating. It’s fun to go out with friends for
pizza or Thai. Meals are social events, and sharing food is part of hospitality. Social
customs invite people to accept food or drink offered by a host or shared by a group
regardless of hunger signals. Such social interactions can be a challenge for people
Getty Images/Fuse
trying to limit their food intake; Chapter 9 describes how people tend to eat more
food when socialising with others. People also tend to eat the kinds of foods eaten
by those in their social circles, thus helping to explain why obesity seems to spread
in social networks and weight loss is easier with a partner.
An enjoyable way to learn about other

Marketing cultures is to taste their ethnic foods.
The food industry competes for our food dollars, persuading consumers to eat more –
more food, more often. These marketing efforts pay off well, generating billions of
dollars in new sales each year. In addition to building brand loyalty, food companies attract
busy consumers with their promises of convenience.
Availability, convenience and economy

People eat foods that are accessible, quick and easy to prepare, and within their financial
means. Today’s consumers value convenience and are willing to spend more than half of their
food budget on meals that require little, if any, further preparation. Consumers’ food choices
and behaviours shifted when the COVID-19 pandemic forced restaurants to close and trips
to the supermarket were infrequent. But what was seen during this time was part of a long-
growing trend where people would frequently eat out, bring home ready-to-eat meals or have
food delivered. Even when they venture into the kitchen, they want to prepare a meal in 15 to
20 minutes, using fewer than half a dozen ingredients – and those ‘ingredients’ are often semi-
prepared foods, such as canned soups. This emphasis on convenience limits food choices to the
selections offered on menus and products designed for quick preparation. Whether decisions
based on convenience meet a person’s nutrition needs depends on the choices made. Eating a
banana or a chocolate bar may be equally convenient, but the fruit offers more vitamins and
minerals and less sugar and fat.
Given the abundance of convenient food options, fewer adults are learning the cooking
skills needed to prepare meals at home, which has its downside. They are more likely to eat
out where the choice is often low-cost fast-food outlets. People who are competent in their
cooking skills eat more of their meals at home and tend to make healthier food choices.
Positive and negative associations

People tend to like particular foods associated with happy occasions – such as meat pies at
football games or cake at birthday parties. By the same token, people can develop aversions and
dislike foods that they ate when they felt sick or that were forced on them.3 Similarly, children
learn to like and dislike certain foods when their parents use foods as rewards or punishments.
Negative experiences can have long-lasting influences on food preferences.
Emotions
Emotions are another factor that guide food choices
and eating behaviours. Some people cannot eat when
they are emotionally upset. Others may eat in response
to a variety of emotional stimuli; such as, to relieve
boredom or depression, or to calm anxiety. A lonely
person may choose to eat rather than to call a friend.
A person who has returned home from an exciting
evening out may unwind with a late-night snack.
Alamy Stock Photo/Wave Royalty Free
These people may find emotional comfort, in part

because foods can influence the brain’s chemistry and
the mind’s response. Eating in response to emotions
can easily lead to overeating and obesity, but it may
be appropriate at times. For example, sharing food at
times of grief serves both the giver’s need to provide
comfort and the receiver’s need to be cared for and to
interact with others, as well as to take nourishment.
To enhance your health, keep nutrition in mind when selecting foods. Values
Food choices may reflect people’s religious beliefs,
political views or environmental concerns. For
example, many Christians forgo meat during Lent (the period prior to Easter), Jewish law
includes an extensive set of dietary rules that govern the use of foods derived from animals,
and Muslims fast between sunrise and sunset during Ramadan (the ninth month of the
Islamic calendar). A concerned consumer may boycott fruit picked by migrant workers
who have been exploited. People may buy vegetables from local farmers to save the fuel and
environmental costs of foods shipped in from far away. They may also select foods packaged
in containers that can be reused or recycled. Some consumers accept or reject foods that have
been irradiated or genetically modified, depending on their approval of these processes (see
Chapter 19 and Highlight 19 for a complete discussion).
Body weight and health

Sometimes people select certain foods and supplements that they believe will improve their
body weight, health or allergies and avoid those they believe might be detrimental. Such
decisions can be beneficial when based on nutrition science, but decisions based on fads
or carried to extremes undermine good health, as pointed out in later discussions of eating
disorders (Highlight 8) and dietary supplements commonly used by athletes (Highlight 14).
Nutrition and health benefits

PUTTING
Finally, of course, many consumers make food choices that will benefit their health. Making
COMMON SENSE healthy food choices 100 years ago was rather easy; the list of options was relatively short,
TO THE TEST and markets sold mostly fresh, whole foods. Examples of whole foods include vegetables,
legumes, fruits, seafood, meats, poultry, eggs, nuts, seeds, milk and whole grains. Today, tens
For good health, it
of thousands of food items fill the shelves of super-grocery stores and most of those items
is best to avoid all
processed foods. are processed foods. Whether a processed food is a healthy choice depends, in part, on
how extensively the food was processed. When changes are minimal, processing can provide
FALSE
an abundant, safe, convenient, affordable and nutritious product. Examples of minimally
processed foods include frozen vegetables, fruit juices, smoked salmon, cheeses, and breads.
The nutritional value diminishes, however, when changes are extensive, creating
ultra-processed foods. Ultra-processed foods no longer resemble whole foods. They are
made from substances that are typically used in food preparation but not consumed as foods
themselves (e.g. oils, fats, flours, refined starches and sugars). These substances undergo
further processing by adding little, if any, processed foods, salt and other preservatives, and
additives such as flavours and colours. Examples of ultra-processed foods include soft drinks,
corn chips, confectionery, chicken nuggets and pastries. Notably, these foods cannot be made
in a home kitchen using common grocery ingredients. Dominating the global foods market,
ultra-processed foods tend to be attractive, tasty and cheap – as well as high in fat and sugar.
Consumers who want to make healthy food choices will select fewer ultra-processed foods and
more whole foods and minimally processed foods.4
CURRENT RESEARCH IN NUTRITION
The perils of highly processed foods

Do you believe the key to good health is to just cut out processed foods? The term ‘processed
food’ may seem like a dietary demon that we need to avoid, but it is a concept that has little
meaning and is unhelpful in informing food choices. Almost everything you eat is processed
to an extent. Even cooking food is a form of food processing. A much more helpful concept
is to divide food into categories based on their degree of processing. So, on the positive side
think more of food that has been minimally processed and is still close to its natural state in
appearance and nutritional quality. Here it is all about fruits vegetables, fruits, wholegrains,
nuts, milk, fresh meats and legumes. And against that, we have the foods we should be most
concerned about – ultra-processed foods.
Ultra-processed foods are industrial formulations of food-derived substances that contain
little if any whole food. Ultra-processed foods often include ingredients not commonly used
in home cooking such as flavourings, colourings, emulsifiers and other additives. A key
feature of ultra-processed foods is that they are usually appetising and pleasing to the taste
buds, convenient, sold in large packages and highly marketed.
Ultra-processed foods are the types of foods that are over-represented in the list of
discretionary food choices. Such foods are not an essential part of a nutritious diet. Now
nutritional researchers are linking these foods as a major driver of overweight and obesity,
while also contributing to non-communicable diseases, such as heart disease, type 2
diabetes and certain cancers.
A recent systematic review and meta-analysis looked at the links between ultra-processed
foods and chronic disease.5 From 21 cross-sectional and 19 prospective studies, increasing
consumption of ultra-processed foods was linked to a greater risk of overweight or obesity;
metabolic syndrome; depression; cardiometabolic diseases, such as heart disease or
diabetes; frailty; irritable bowel syndrome; cancer and all-cause mortality.
Most of the food we eat is processed to some degree. But it is only the foods considered
to be ultra-processed that we should aim to eat less of. Eating food as close to its natural
state as possible, making food from original ingredients and choosing a wide variety of
mostly plant-based foods are the keys to eating a healthy diet.
A person selects foods for a variety of reasons. Whatever those reasons may be, food choices
REVIEW IT
influence health. Individual food selections neither make nor break a diet’s healthfulness, but the
balance of foods selected over time can make an important difference to health. For this reason,
people are wise to think ‘nutrition’ when making their food choices.
1.2 Nutrients
Biologically speaking, people eat to receive nourishment. Do you ever think of yourself as a
biological being made of carefully arranged atoms, molecules, cells, tissues and organs? Are
you aware of the activity going on within your body even as you sit still? The atoms, molecules
and cells of your body continually move and change, even though the structures of your tissues
and organs and your external appearance remain

relatively constant. To maintain your ‘self’, you must
continually replenish, from foods, the energy and
the nutrients you deplete as your body maintains
itself.
Nutrients in foods and in the body

Amazingly, our bodies can derive all the energy,
structural materials and regulating agents we need
Shutterstock.com/Maridav
from the foods we eat. This section introduces the

nutrients that foods deliver and shows how they
participate in the dynamic processes that keep people
alive and well.
Nutrient composition of foods

Chemical analysis of a food such as a tomato shows
As Chapter 5 that it is composed primarily of water (95%). Most
explains, most lipids of the solid materials are carbohydrates, lipids and proteins. If you could remove these
are fats. materials, you would find a tiny residue of vitamins, minerals and other compounds. Water,
carbohydrates, lipids, proteins, vitamins and some of the minerals found in foods are nutrients –
substances the body uses for the growth, maintenance and repair of its tissues.
This book focuses mostly on nutrients; however,
FIGURE 1.1 Body composition of healthyfoods contain other compounds as well, such as fibre,
weight men and women The human body is made phytochemicals, pigments, additives, alcohols and others. Some
of compounds similar to those found in foods – mostly are beneficial, some are neutral and a few are harmful. Later
water (60%) and some fat (13–21% for young men, sections of the book touch on these compounds and their
23–36% for young women who are of a healthy weight), significance.
with carbohydrate, protein, vitamins, minerals and other
minor constituents making up the remainder. (Chapter
8 describes the health hazards of too little or too much Nutrient composition of the body
body fat.) A complete chemical analysis of your body would show that it is
made of materials similar to those found in foods (see Figure 1.1). A
healthy 70 kilograms body contains about 41 kilograms of water
and about 9 to 21 kilograms of fat. The remaining kilograms
are mostly protein, carbohydrate and the major minerals of the
bones. Vitamins, other minerals and incidental extras constitute
a fraction of a kilogram.
Chemical composition of nutrients

The simplest of the nutrients are the minerals. Each mineral is a
chemical element; its atoms are all alike. As a result, its identity
never changes; for example, iron may have different electrical
charges, but individual iron atoms remain the same when
they are in a food, when a person eats the food, when the iron
becomes part of a red blood cell, when the cell is broken down
and when the iron is lost from the body by excretion. The next
simplest nutrient is water, a compound made of two elements –
Key: hydrogen and oxygen. Minerals and water are inorganic
% Carbohydrates, proteins, vitamins, minerals in the body nutrients, which means they do not contain carbon.
The other four classes of nutrients – carbohydrates, lipids,
% Fat in the body
proteins and vitamins – are more complex. In addition to
% Water in the body hydrogen and oxygen, they all contain carbon, an element
found in all living things. They are therefore called organic compounds (meaning, literally,
alive). Protein and some vitamins also contain nitrogen and may contain other elements as
well (see Table 1.1). The use of the term ‘organic’ when describing the chemistry of substances
should not be confused with the use of this term in the farming and produce sense to describe
how food is grown under a certification system, as Chapter 19 explains.
TABLE 1.1 Elements in the six classes of nutrients

Notice that organic nutrients contain carbon.
CARBON HYDROGEN OXYGEN NITROGEN MINERALS

Inorganic nutrients
Minerals ✓
Water ✓ ✓
Organic nutrients
Carbohydrates ✓ ✓ ✓
Lipids (fats) ✓ ✓ ✓
Proteins a ✓ ✓ ✓ ✓
Vitamins b ✓ ✓ ✓
a
Some proteins also contain the mineral sulphur.
b
Some vitamins contain nitrogen; some contain minerals.
Essential nutrients
The body can make some nutrients, but it cannot make all of them. Also, it makes some in
insufficient quantities to meet its needs and, therefore, must obtain these nutrients from
foods. The nutrients that foods must supply are essential nutrients. When used to refer to
nutrients, the word essential means more than just ‘necessary’; it means ‘needed from outside
the body’ – normally from foods.
Energy-yielding nutrients: carbohydrate, fat and protein

In the body, three organic nutrients can be used to provide energy: carbohydrate, fat and
protein. In contrast to these energy-yielding nutrients, vitamins, minerals and water do not
yield energy in the human body.
Carbohydrate, fat, and protein are sometimes called macronutrients because the body
requires them in relatively large amounts (many grams daily). In contrast, vitamins and
minerals are micronutrients, required only in small amounts (milligrams or micrograms daily).
Table 1.2 summarises some of the ways the six classes of nutrients can be described.
TABLE 1.2 The six classes of nutrients

NUTRIENT ORGANIC INORGANIC ENERGY-YIELDING MACRONUTRIENT MICRONUTRIENT
Carbohydrates ✓ ✓ ✓
Lipids (fats) ✓ ✓ ✓
Proteins ✓ ✓ ✓
Vitamins ✓ ✓
Minerals ✓ ✓
Water ✓
Energy measured in kilojoules

The international The energy released from carbohydrates, fats and proteins can be measured in joules. In
unit for measuring some countries (particularly the US), ‘calorie’ is still the preferred measure of food energy,
food energy is the though in this context it is actually kilocalories (or kcalories) that is the implied unit of energy
joule, a measure of measure for food and the prefix of ‘kilo’ is normally dropped in everyday speaking. When you
work energy. The read in popular books or magazines that an apple provides ‘100 calories’, it actually means
energy in food is 100 kcalories, which is the same as 420 kilojoules. This book uses the term kilojoules and its
normally expressed in abbreviation kJ throughout.
kilojoules. To convert
kcalories to kilojoules,
multiply by 4.2; to Energy from foods
convert kilojoules to The amount of energy a food provides depends on how much carbohydrate, fat and protein
kcalories, multiply it contains. When completely broken down in the body, a gram of carbohydrate yields about
by 0.24. 17 kilojoules (4 kcals) of energy, a gram of protein also yields 17 kilojoules (4 kcals) and a
gram of fat yields 37 kilojoules (9 kcals) (see Table 1.3). Fat, therefore, has a greater energy
density than either carbohydrate or protein. The energy yield from carbohydrate of 17
kilojoules per gram (kJ/g) is considered an average figure as monosaccharides (e.g. glucose),
PUTTING
COMMON SENSE disaccharides (e.g. sucrose) and starch all yield slightly different amounts of energy per gram.
TO THE TEST The upcoming ‘How to’ box explains how to calculate the energy available from foods.
Fat has twice the TABLE 1.3 Kilojoule and kcalorie values of energy nutrients
number of kilojoules Notice that organic nutrients contain carbon.
as carbohydrates or
protein. NUTRIENTS ENERGY kJ/g ENERGY kcal/g
TRUE Carbohydrate 17 4
Protein 17 4
Fat 37 9
Note: Alcohol contributes 29 kilojoules per gram that can be used for energy, but it is not considered a
nutrient because it interferes with the body’s growth, maintenance and repair.
One other substance contributes energy – alcohol. Alcohol is not considered a nutrient
because it interferes with the growth, maintenance and repair of the body, but it does yield
energy (29 kJ or 7 kcal per gram) when metabolised in the body. (Highlight 7 and Chapter 18
present the potential harms and possible benefits of alcohol consumption.)
Most foods contain all three energy-yielding nutrients as well as water, vitamins, minerals
and other substances. For example, meat contains water, fat, vitamins and minerals as well as
protein. Bread contains water, a trace of fat, a little protein and some vitamins and minerals
in addition to its carbohydrate. Only a few foods are exceptions to this rule, the common ones
being sugar (pure carbohydrate) and oil (essentially pure fat).
Energy in the body

The body uses the energy-yielding nutrients to fuel all its activities. When the body uses
carbohydrate, fat or protein for energy, the bonds between the nutrient’s atoms break. As the
bonds break, they release energy. Some of this energy is released as heat, but some is used
The processes by
which nutrients are to send electrical impulses through the brain and nerves, to synthesise body compounds and
broken down to yield to move muscles. Thus the energy from food supports every activity, from quiet thought to
energy or used to vigorous sports.
make body structures If the body does not use these nutrients to fuel its current activities, it rearranges them into
are known as storage compounds (e.g. body fat), to be used between meals and overnight when fresh energy
metabolism, which is supplies run low. If more energy is consumed than expended, the result is an increase in
defined and described energy stores and weight gain. Similarly, if less energy is consumed than expended, the result is
further in Chapter 7. a decrease in energy stores and weight loss.
When consumed in excess of energy needs, alcohol, too, can be converted to body fat and
stored. When alcohol contributes a substantial portion of the energy in a person’s diet, the
harm it does far exceeds the problems of excess body fat. (Highlight 7 describes the effects of
alcohol on health and nutrition.)
Other roles of energy-yielding nutrients

In addition to providing energy, carbohydrates, fats and proteins provide the raw materials for
building the body’s tissues and regulating its many activities. In fact, protein’s role as a fuel
source is relatively minor compared with the other two nutrients and its other roles. Proteins
are found in structures such as the muscles and skin and help to regulate activities such as
digestion and energy metabolism.
HOW TO: CALCULATE THE ENERGY AVAILABLE FROM FOODS

Practise calculating the energy available from foods.
To calculate the energy available from

1. 16 g carbohydrate × 17 kJ/g = 272 kJ
a food, multiply the number of grams 7 g protein × 17 kJ/g = 119 kJ
of carbohydrate, protein and fat by 17, 9 g fat × 37 kJ/g = 333 kJ
17 and 37, respectively. Then add the Total = 724 kJ
results together – e.g. 1 slice of bread
with 1 tablespoon of peanut butter on it
contains 16 grams carbohydrate, 7 grams
protein and 9 grams fat.
From the information you calculated in step 1, you can determine the percentage of kilojoules
each of the energy nutrients contributes to the total.
2. To determine the percentage of kilojoules 333 fat kJ ÷ 724 total kJ = 0.46
from fat, for example, divide the 333 fat 0.46 × 100 = 46%
kilojoules by the total 724 kilojoules.
3. Then multiply by 100 to get the
percentage.
Dietary recommendations that urge people to limit fat intake to 20 to 35 per cent of kilojoules
refer to the day’s total energy intake, not to individual foods. Still, if the proportion of fat in
each food choice throughout a day exceeds 35 per cent of kilojoules, then the day’s total
surely will, too. Knowing that this snack provides 46 per cent of its kilojoules from fat alerts
a person to the need to make lower-fat selections at other times that day.
Vitamins
Vitamins are organic but they do not provide energy. Instead, they facilitate the release
of energy from carbohydrate, fat and protein and participate in numerous other activities
throughout the body. The water-soluble
vitamins are vitamin C
Each of the 13 different vitamins has its own special role to play. One vitamin enables
and the eight B vitamins:
the eyes to see in dim light, another helps produce functional red blood cells, and still another
thiamin, riboflavin, niacin,
helps make the sex hormones – among other things. When you cut yourself, one vitamin vitamins B6 and B12, folate,
helps stop the bleeding and another helps repair the skin. Vitamins busily help replace old red biotin and pantothenic
blood cells and the lining of the digestive tract. Almost every action in the body requires the acid. The fat-soluble
assistance of vitamins. vitamins are vitamins A, D,
Vitamins can function only if they are intact, but because they are complex organic E and K. The water-soluble
molecules, they are vulnerable to destruction by heat, light and chemical agents. This is why vitamins are the subject
the body handles them carefully, and why nutrition-wise cooks do, too. The strategies of of Chapter 10, and the
cooking vegetables at moderate temperatures for short times and using small amounts of water fat-soluble vitamins are
help to preserve the vitamins. discussed in Chapter 11.
Minerals
In the body, some minerals are put together in orderly arrays in such
structures as bones and teeth. Minerals are also found in the fluids of the
body, which influences fluid properties. Whatever their roles, minerals do
not yield energy.
Only 16 minerals are known to be essential in human nutrition. The
major minerals are calcium, phosphorus, potassium, sodium, chloride,
magnesium and sulphate. The trace minerals are iron, iodine, zinc,
chromium, selenium, fluoride, molybdenum, copper and manganese.
(Chapters 12 and 13 are devoted to the major and trace minerals,
respectively.) Others are being studied to determine whether they play
significant roles in the human body. Still other minerals are environmental
contaminants that displace the nutrient minerals from their workplaces in
the body, disrupting body functions. The problems caused by contaminant
Shutterstock.com/marcstock
minerals are described in Chapter 13.

Because minerals are inorganic, they are indestructible and do not
require the special care that vitamins do. Minerals can, however, be bound
by substances that interfere with the body’s ability to absorb them. They
can also be lost during food-refining processes or during cooking when they
leach into water that is discarded.
Water itself is an essential nutrient and carries many

minerals naturally. Water
Water, indispensable and abundant, provides the environment in which
nearly all the body’s activities are conducted. It participates in many
metabolic reactions and supplies the medium for transporting vital materials to cells and
carrying waste products away from them. Water is discussed fully in Chapter 12 but is
mentioned in every chapter.
Foods provide nutrients – substances that support the growth, maintenance and repair of the body’s
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tissues. The six classes of nutrients are:

• carbohydrates • vitamins
• lipids (fats) • minerals
• proteins • water.
Foods rich in the energy-yielding nutrients (carbohydrates, fats and proteins) provide the major
materials for building the body’s tissues and yield energy for the body’s use or storage. Energy is
measured in kilojoules. Vitamins, minerals and water facilitate a variety of activities in the body.
1.3 The science of nutrition

The science of nutrition is the study of the nutrients and other substances in foods and the
body’s handling of them. It has its foundation in several other sciences, including biology,
biochemistry, and physiology. Nutrition is a relatively young science, but much has happened
in its short life. And it is currently experiencing a tremendous growth spurt as scientists
apply knowledge gained from sequencing the human genome. The integration of nutrition,
genomics and molecular biology has opened a new world of study called nutritional
genomics – the science of how nutrients affect the activities of genes and how genes affect
the interactions between diet and disease. Highlight 6 describes how nutritional genomics
is shaping the science of nutrition, and examples of nutrient–gene interactions appear
throughout later sections of the book.
What has the field of nutritional research achieved in the way of significant discoveries
over the last 30 years? And what are the greatest challenges for the coming 30 years?
These questions were debated by an eminent panel of nutrition experts at a symposium in
Wageningen, the Netherlands, and their viewpoints (see Table 1.4) make for an interesting
summary of the milestone discoveries in nutrition.6 The research area of the gut microbiome
and its implications for our health has exploded since the list was compiled in 2009 and this
would now be a worthy addition. The gut microbiome is discussed in greater depth in Chapter 3.
As for future challenges, controlling obesity and insulin resistance, delaying cognitive decline
by diet, and restoring the balance between private and public control of nutritional research
are all considered top priorities.
TABLE 1.4 Greatest discoveries in nutritional research in the past 30 years

RANK DISCOVERY
1 Folic acid supplements reduce the risk of birth defects
2 Health effects of trans fatty acids
3 Nutritional regulation of gene transcription
4 Progress in measuring energy intake – from questionnaires to doubly labelled water
5 Fat tissue as an endocrine organ
6 The LDL-cholesterol receptor and its regulation by diet
7 Obesity is a normal response to an abnormal environment
8 Alcohol causes breast cancer
9 Body fatness is the second most avoidable cause of cancer
10 Plant stanols and sterols and their effects on lipid metabolism
11 Diabetes can be prevented by diet and lifestyle
12 Interaction of carbohydrate/glycaemic load with insulin resistance
13 Vitamin E supplements do not reduce the risk of cardiovascular disease
14 Long-chain polyunsaturated fatty acids reduce mortality in coronary heart disease patients
15 The multisystemic role of vitamin D
Adapted from M. B. Katan and co-authors, ‘Which are the Greatest Recent Discoveries and the Greatest Future Challenges
in Nutrition?’, European Journal of Clinical Nutrition, 63 (2009): 2−10.
Conducting research
Consumers sometimes depend on personal experience or social media to gather information
on nutrition. Known as anecdotes, such personal accounts of an experience are not accepted A personal account of
as reliable scientific information. In contrast, researchers use the scientific method to guide an experience or event
their work (see Figure 1.2 and the glossary for definitions of research terms). As the figure is an anecdote and is
shows, research always begins with a problem or a question. For example, ‘What foods or not accepted as reliable
nutrients might protect against the common cold?’ In search of an answer, scientists make an scientific information.
educated guess (hypothesis), such as ‘foods rich in vitamin C reduce the number of common
colds’. Then they systematically conduct research studies to collect data that will test the
hypothesis. Some examples of various types of research designs are presented in Figure 1.3.
Each type of study has strengths and weaknesses (see Table 1.5), and, consequently, some
provide stronger evidence than others.
FIGURE 1.2 The scientific method

Research scientists follow the scientific method. Note that most research generates new questions,
not final answers. Thus the sequence begins anew, and research continues in a somewhat cyclical
way.
OBSERVATION AND QUESTION

Identify a problem to be solved or ask
a specific question to be answered.
HYPOTHESIS AND PREDICTION

Formulate a hypothesis – a tentative
solution to the problem or answer to
the question – and make a prediction
that can be tested.
EXPERIMENT
Design a study and conduct the
research to collect relevant data.
RESULTS AND INTERPRETATIONS

Summarise, analyse, and interpret
the data; draw conclusions.
HYPOTHESIS SUPPORTED HYPOTHESIS NOT SUPPORTED
THEORY NEW OBSERVATIONS

Develop a theory that integrates AND QUESTIONS
conclusions with those from
numerous other studies.
Controls
In studies examining the effectiveness of vitamin C in treating the common cold, for example,
researchers typically divide the subjects into two groups. One group (the experimental
group) receives a vitamin C supplement, and the other (the control group) does not.
Researchers observe both groups to determine whether one group has fewer or shorter
colds than the other. The following discussion describes some of the pitfalls inherent in an
experiment of this kind and ways to avoid them.
In sorting subjects into two groups, researchers must ensure that each person has an
equal chance of being assigned to either the experimental group or the control group. This is
accomplished by randomisation; that is, the subjects are chosen randomly from the same
population by flipping a coin or some other method involving chance. Randomisation helps to
ensure that results reflect the treatment and not factors that might influence the grouping of
subjects.
FIGURE 1.3 Examples of research designs

North EPIDEMIOLOGICAL STUDIES
Atlantic
Ocean France
Slovenia
Cross-sectional Example: The people of the
Croatia
Bosnia Black Sea
Researchers observe how much and Mediterranean region drink lots of
Italy Montenegro
Spain Albania
what kinds of foods a group of people wine, eat plenty of fat from olive oil
Greece Turkey
eat and how healthy those people and have a lower incidence of heart
are. Their findings identify factors that
Syria
disease than northern Europeans and
Morocco
Algeria
Mediterranean Sea
Lebanon
Israel
Jordan
might influence the incidence of a Australians.
Tunisia
disease in various populations.
Libya Egypt
Science Photo Library/Dr M. A. Ansary
Case-control Example: People with goitre lack

Researchers compare people who do iodine in their diets.
and do not have a given condition such
as a disease, closely matching them in
age, gender and other key variables
so that differences in other factors
will stand out. These differences may
account for the condition in the group
that has it.
Cohort Example: Data collected periodically

Heart attacks
Researchers analyse data collected over the past several decades from
from a selected group of people (a over 5000 people randomly selected
cohort) at intervals over a certain from the town of Framingham,
period of time. Massachusetts, in 1948 have revealed
that the risk of heart attack increases as
blood cholesterol increases.
Blood cholesterol
EXPERIMENTAL STUDIES laboratory where all conditions can be

Getty Images/Remi Benali
Laboratory-based animal studies controlled.

Researchers feed animals special diets Example: Mice fed a high-fat diet eat
that provide or omit specific nutrients less food than mice given a lower-fat
and then observe any changes in diet, so they receive the same number
health. Such studies test possible of kilojoules – but the mice eating the
disease causes and treatments in a fat-rich diet become severely obese.
Laboratory-based in-vitro studies Example: Laboratory studies find that

iStock.com/Mediaphotos
Researchers examine the effects of fish oils inhibit the growth and activity
a specific variable on a tissue, cell of the bacteria implicated in ulcer
or molecule isolated from a living formation.
organism.
Shutterstock.com/wavebreakmedia
Human intervention (or clinical) trials Example: Heart disease risk factors
Researchers ask people to adopt a new improve when men receive fresh
behaviour (for example, eat a citrus squeezed orange juice daily for two
fruit, take a vitamin C supplement months compared with those on a
or exercise daily). These trials help diet low in vitamin C – even when
determine the effectiveness of such both groups follow a diet high in
interventions on the development or saturated fat.
prevention of disease.
TABLE 1.5 Strengths and weaknesses of research designs

TYPE OF RESEARCH STRENGTHS WEAKNESSES
Epidemiological studies determine the • Can narrow down the list of • Cannot control variables that may
incidence and distribution of diseases in a possible causes influence the development or the
population. Epidemiological studies include • Can raise questions to pursue prevention of a disease
cross-sectional, case-control and cohort (see through other types of studies • Cannot prove cause and effect
Figure 1.3)
Laboratory-based studies explore the effects • Can control conditions • Cannot apply results from test
of a specific variable on a tissue, cell or • Can determine effects of a variable tubes or animals to human beings
molecule. Laboratory-based studies are often
conducted in test tubes (in vitro) or on animals
Human intervention or clinical trials involve • Can control conditions (for the • Cannot generalise findings to all
human beings who follow a specified regimen most part) human beings
• Can apply findings to some groups • Cannot use certain treatments for
of human beings clinical or ethical reasons
Importantly, the two groups of people must be similar and must have the same track
record with respect to colds to rule out the possibility that observed differences in the rate,
severity or duration of colds might have occurred anyway. If, for example, the control group
would normally catch twice as many colds as the experimental group, then the findings prove
nothing.
In experiments involving a nutrient, the diets of both groups must also be similar,
especially with respect to the nutrient being studied. If those in the experimental group were
receiving less vitamin C from their usual diet, then any effects of the supplement may not be
apparent.
Sample size
To ensure that chance variation between the two groups does not influence the results, the
groups must be large. For example, if one member of a group of five people catches a bad cold
by chance, they will pull the whole group’s average towards bad colds; but if one member of
a group of 500 catches a bad cold, they will not unduly affect the group average. Statistical
methods are used to determine whether differences between groups of various sizes support a
hypothesis.
Placebos
If people who take vitamin C for colds believe it will cure them, their chances of recovery may
improve. Taking anything believed to be beneficial may hasten recovery. This phenomenon, the
result of expectations, is known as the placebo effect. In experiments designed to determine
vitamin C’s effect on colds, this mind–body effect must be rigorously controlled.
One way researchers control for the placebo effect is to give pills to all participants. Those
in the experimental group, for example, receive pills containing vitamin C, and those in the
control group receive a placebo – pills of similar appearance and taste containing an inactive
ingredient. This way, the expectations of both groups will be equal. It is not necessary to
convince all subjects that they are receiving vitamin C, but the extent of belief or unbelief
must be the same in both groups. A study conducted under these conditions is called a blind
experiment – that is, the subjects do not know (are blind to) whether they are members of
the experimental group (receiving treatment) or the control group (receiving the placebo).
Double blind
When neither the subjects nor the researchers know which subjects are in which group, the
study is called a double-blind experiment. Being fallible human beings and having an
emotional and sometimes a financial investment in a successful outcome, researchers might
record and interpret results with a bias in the expected direction. To prevent such bias, the pills PUTTING
would be coded by a third party, who does not reveal to the researchers which subjects were in COMMON SENSE
which group until all results have been recorded. TO THE TEST
All published
research should be
Analysing research findings treated with some
Research findings must be analysed and interpreted with an awareness of each study’s level of critical
limitations. Scientists must be cautious about drawing any conclusions until they have appraisal.
accumulated a body of evidence from multiple studies that have used various types of research TRUE
designs. As evidence accumulates, scientists begin to develop a theory that integrates the
various findings and explains the complex relationships.
Correlations and causes

Researchers often examine the relationships between two or more
variables – for example, daily vitamin C intake and the number of colds
or the duration and severity of cold symptoms. Importantly, researchers
must be able to observe, measure or verify the variables selected. Findings
sometimes suggest no correlation between variables (regardless of the
amount of vitamin C consumed, the number of colds remains the same).
Other times, studies find either a positive correlation (the more vitamin
C, the more colds) or a negative correlation (the more vitamin C, the
fewer colds). Correlational evidence proves only that the variables are
associated, not that one is the cause of the other. People often jump to
conclusions when they notice correlations, but their conclusions are often
wrong. To prove that A causes B, scientists have to find evidence of the Knowledge about the nutrients and their effects on
mechanism – that is, an explanation of how A might cause B. health comes from scientific study.
Cautious conclusions
When researchers record and analyse the results of their experiments, they must exercise
caution in their interpretation of the findings. For example, in an epidemiological study,
scientists may use a specific segment of the population (e.g. men aged 18–30 years). When
the scientists draw conclusions, they are careful not to generalise the findings to older
men or women of any age or to imply a cause-and-effect relationship.7 Similarly, scientists
performing research studies using animals are cautious in applying their findings to humans.
Conclusions from any one research study are always tentative and take into account findings
from studies conducted by other scientists. As evidence accumulates, scientists gain confidence
about making recommendations that affect people’s health and lives. Still, their statements
are worded cautiously, such as ‘A diet high in fruits and vegetables may protect against some
cancers’.
Evaluating the reliability of research

Wherever or however nutrition information is presented, it pays to retain a healthy scepticism.
However, there are some ways in which the question of evaluating reliability can be approached
more systematically. For research published in a journal, the findings are evaluated by a board
of reviewers composed of other scientists who rigorously evaluate the study to assure that the
scientific method was followed – a process known as peer review. The reviewers critique
the study’s hypothesis, methodology, statistical significance and conclusions. They also note
the funding source, recognising that financial support and other conflicts of interest may
bias scientific conclusions.8 If the reviewers consider the conclusions to be well supported by
the evidence – that is, if the research has validity – they endorse the work for publication
in a scientific journal where others can read it. This raises an important point regarding
information found on the internet: much gets published without the rigorous scrutiny of peer
review. Consequently, readers must assume greater responsibility for examining the data and
conclusions presented – often without the benefit of journal citations. Highlight 1, found later
in this chapter, gives guidance in determining whether website information is reliable. Table 1.6
describes the parts of a typical research article.
TABLE 1.6 Parts of a typical research article

Abstract • Provides a brief overview of the article
Introduction • Clearly states the purpose of the current study and provides a
comprehensive review of the relevant literature
Methodology • Defines key terms and describes the study design, subjects, and procedures
used in conducting the study
Results • Report the findings and may include tables and figures that summarise the
information
Discussion • Draws tentative conclusions that are supported by the data and reflect
the original purpose as stated in the introduction. Usually, it answers a few
questions and raises several more
References • Reflect the investigator’s knowledge of the subject and should include an
extensive list of relevant studies
Even when a new finding is published or released to the media, it is still only preliminary
and not very meaningful by itself. Other scientists will need to confirm or disprove the
findings through replication. To be accepted into the body of nutrition knowledge, a finding
must stand up to rigorous, repeated testing in experiments performed by several different
researchers. What we ‘know’ in nutrition results from years of replicating study findings.
Communicating the latest finding in its proper context without distorting or oversimplifying
the message is a challenge for scientists and journalists alike. For a helpful scientific overview
of topics in nutrition, look for review articles in scholarly journals, such as Nutrition Reviews.
A review may be either a systematic review, which provides a qualitative summary of the
evidence and attempts to minimise bias in its interpretation or a meta-analysis, which provides
a quantitative summary.
With each report from scientists, the field of nutrition changes a little – each finding
contributes another piece to the whole body of knowledge. People who know how science
works understand that single findings, like single frames in a movie, are just small parts of a
larger story. Over time, nutrition knowledge gradually changes, and dietary recommendations
change to reflect the current understanding of scientific research. Highlight 5 provides a
detailed look at how dietary fat recommendations have evolved over the past several decades as
researchers have uncovered the relationships between the various kinds of fat and their roles in
supporting or harming health.
Scientists learn about nutrition by conducting experiments that follow the protocol of scientific
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research. Researchers take care to establish similar control and experimental groups, large sample
sizes, placebos and blind treatments. Their findings must be reviewed and replicated by other scientists
before being accepted as valid.
1.4 Nutrient Reference Values

Using the results of thousands of research studies, nutrition experts have produced a set of
standards that define the amounts of energy, nutrients, other dietary components and physical
activity that best support health. These recommendations are called Nutrient Reference
Values (NRVs) and they reflect the collaborative efforts of researchers in both Australia and
New Zealand.9 The inside-cover pages of this book provide a handy reference for the NRVs.
There is also a handy online calculator at https://www.nrv.gov.au/nutrients-energy-calc to
determine your own individual nutrient and energy needs.
Establishing nutrient recommendations

The NRV Working Party consisted of highly qualified scientists who based their estimates
of nutrient needs on careful examination and interpretation of scientific evidence. These
recommendations apply to healthy people and may not be appropriate for people with diseases
that increase or decrease nutrient needs. The next few paragraphs discuss specific aspects of
how the committee went about establishing the values that make up the NRV:
• Estimated Average Requirement (EAR)
• Recommended Dietary Intake (RDI)
• Adequate Intake (AI)
• Upper Level of Intake (UL).
A further set of values, termed Suggested Dietary Targets (SDTs), was also established.
These relate to nutrients for which there was a reasonable body of evidence indicating a
potential chronic disease preventive effect at levels substantially higher than the EAR, RDI or AI.
Estimated Average Requirement (EAR)

The NRV Working Party reviewed hundreds of research studies to determine the requirement
for each nutrient – how much is needed in the diet. The working party selected a different
criterion for each nutrient based on its various roles in performing activities in the body and in
reducing disease risks.
An examination of all the available data reveals that each person’s body is unique and has
its own set of requirements. Men differ from women, and needs change as people grow from
infancy to old age. For this reason, recommendations for people are clustered into groups
based on age and sex. Even so, the exact requirements for people of the same age and sex are
likely to be different. For example, person A might need 40 units of a particular nutrient each
day, person B might need 35 and person C might need 57. Looking at enough people might
reveal that their individual requirements fall into a symmetrical distribution, with most near
the midpoint and only a few at the extremes (see the left-hand side of Figure 1.4). Using this
information, the working party determined an Estimated Average Requirement (EAR)
for each nutrient – the average amount that appears sufficient for half of the population.
In Figure 1.4, the EAR is shown as 45 units.
FIGURE 1.4 Estimated Average Requirement (EAR) and Recommended Dietary Intake
(RDI) compared
EAR EAR RDI

Number of people
Number of people
A A
B B
C C
20 30 40 50 60 70 20 30 40 50 60 70
Daily requirement for nutrient X (units/day) Daily requirement for nutrient X (units/day)
The EAR for a nutrient is the amount that The RDI for a nutrient (shown here in green)
meets the needs of about half of the is set well above the EAR, meeting the needs
population (shown here by the red line). of about 98 per cent of the population.
PUTTING Recommended Dietary Intake (RDI)

COMMON SENSE Once a nutrient requirement is established, the working party had to decide what intake to
TO THE TEST
recommend for everybody – the Recommended Dietary Intake (RDI). As you can see by
A Recommended the distribution in Figure 1.4, the EAR (shown in the figure as 45 units) is probably closest
Dietary Intake to everyone’s need. However, if people consumed exactly the average requirement of a given
for a nutrient is nutrient each day, half of the population would develop deficiencies of that nutrient – in
the amount that Figure 1.4, for example, person C would be among them. Recommendations are therefore set
everyone needs to high enough above the EAR to meet the needs of most healthy people.
consume each day. Small amounts above the daily requirement do no harm, whereas amounts below the
FALSE requirement may lead to health problems. When people’s nutrient intakes are consistently
deficient (less than the requirement), their nutrient stores decline, and over time this decline
leads to poor health and deficiency symptoms. Therefore, to ensure that the nutrient RDI meet
the needs of as many people as possible, the RDI are set near the top end of the range of the
population’s estimated requirements.
In this example, a reasonable RDI might be 63 units a day (see the right side of Figure 1.4).
Such a point can be calculated mathematically so that it covers about 98 per cent of a population.
Almost everybody – including person C, whose needs were higher than the average –
would be covered if they met this dietary goal. Relatively few people’s requirements would
exceed this recommendation, and even then, they wouldn’t exceed it by much.
Adequate Intake (AI)

For some nutrients, there is insufficient scientific evidence to determine an EAR (which is
needed to set an RDI). In these cases, the working party established an Adequate Intake (AI)
instead of an RDI. An AI reflects the average amount of a nutrient that a group of healthy
people consumes. Like the RDI, the AI may be used as nutrient goals for individuals.
Although both the RDI and the AI serve as nutrient intake goals for individuals, their
differences are noteworthy. An RDI for a given nutrient is based on enough scientific evidence
to expect that the needs of almost all healthy people will be met. An AI, on the other hand,
must rely more heavily on scientific judgements because sufficient evidence is lacking.
The percentage of people covered by an AI is unknown; an AI is expected to exceed average
requirements, but it may cover more or fewer people than an RDI would cover (if an RDI could
be determined). For these reasons, AI values are more tentative than RDI. The table on the
inside back cover identifies which nutrients have an RDI and which have an AI. Later chapters
present the RDI and AI values for the vitamins and minerals.
Upper Level of Intake (UL)

Individual tolerances for high doses of nutrients vary and somewhere above the recommended
intake is a point beyond which a nutrient is likely to become toxic. This point is known as the
Upper Level of Intake (UL). It is naive – and inaccurate – to think of recommendations as
minimum amounts. A more accurate view is to see a person’s nutrient needs as falling within
a range, with marginal and danger zones both below and above it (see Figure 1.5).
Paying attention to upper levels is particularly useful in guarding against the
overconsumption of nutrients, which may occur when people use large-dose supplements and
fortified foods regularly. Later chapters discuss the dangers associated with excessively high
intakes of vitamins and minerals, and the inside cover presents tables that include the upper-
level values for selected nutrients.
Establishing energy recommendations

In contrast to the RDI and AI values for nutrients, the recommendation for energy is not
generous. Excess energy cannot be readily excreted and is eventually stored as body fat. These
reserves may be beneficial when food is scarce, but they can also lead to obesity and its
associated health consequences.
FIGURE 1.5 Inaccurate versus accurate view for nutrient intakes

The RDI or AI for a given nutrient represents a point that lies within a range of appropriate and
reasonable intakes between toxicity and deficiency. Both of these recommendations are high
enough to provide reserves in times of short-term dietary inadequacies, but not so high as to
approach toxicity. Nutrient intakes above or below this range may be equally harmful.
Danger of toxicity
Marginal
Tolerable
Safety Upper Intake
Level
Safety
Intake
RDI or AI
RDI Estimated
Marginal Average
Requirement
Danger
Danger of deficiency
Inaccurate view Accurate view
Estimated Energy Requirement (EER)

The energy recommendation – called the Estimated Energy Requirement (EER) –
represents the average dietary energy intake (kJ per day) that will
maintain energy balance in a person who has a healthy body weight and FIGURE 1.6 Energy nutrient contributions
level of physical activity. Appendix F lists EER values for children and to the total
adults engaging in different levels of physical activity. Balance is the The three energy nutrients – carbohydrate, fat,
key to the energy recommendation. Enough energy is needed to sustain and protein – all contribute to the total energy
a healthy and active life, but too much energy can lead to weight gain intake. Each of these three bars illustrates
and obesity. Because any amount in excess of energy needs will result in percentages that fall within the AMDR. Notice
that whenever the percentage of any one of them
weight gain, no upper level for energy has been determined.
increases or decreases, the contribution of the
others shifts as well.
Acceptable Macronutrient Distribution Range (AMDR) 100
People do not eat energy directly; they derive energy from foods 10% 15%
containing carbohydrate, fat and protein. Each of these three energy- 80 35%
25%
yielding nutrients contributes to the total energy intake, and those
35%
contributions vary in relation to each other. The NRV Working Party
60
determined that the composition of a diet that provides adequate 20%
energy and nutrients, maintains current body weight and reduces the
40
risk of chronic diseases is: 65%
• 45–65 per cent kilojoules from carbohydrate 45% 50%
20
• 20–35 per cent kilojoules from fat
• 15–25 per cent kilojoules from protein.
0
These values are known as Acceptable Macronutrient
Distribution Range (AMDR).
Figure 1.6 illustrates that diets with varying amounts of Key:
carbohydrate, fat, and protein can all fall within the AMDR and when Protein
the contribution of any of the energy nutrients increases or decreases, Fat
the contribution of the others shifts as well. The following ‘How to’ box Carbohydrate
explains how to convert AMDR percentages into kilojoules and grams.
HOW TO: CALCULATE THE AMDR IN GRAMS AND KILOJOULES

The Acceptable Macronutrient Distribution Range (AMDR) present the amounts of
carbohydrate, fat, and protein for a healthy diet as a percentage of the total energy intake.
The previous ‘How To’ shows how to calculate the percentage each of the energy nutrients
contributes to the total. Those percentages can then be used to determine whether intakes
fall within the AMDR. Alternatively, you can calculate the amounts of carbohydrate, fat, and
protein in kilojoules or grams based on AMDR goals.
1 Consider a daily energy intake of 8000 kilojoules, for 8000 kJ x 0.45 = 3600 kJ
example. Multiply total energy intake by 45 per cent to 3600 kJ ÷ 17 g/kJ = 212 g
find the lower end of the carbohydrate AMDR, and then
divide by 17 to convert kilojoules to grams.
2 Now multiply total energy intake by 65 per cent to find 8000 kJ x 0.65 = 5200 kJ
the upper end of the carbohydrate AMDR, and then divide 5200 kJ ÷ 17 g/kJ = 306 g
by 17 to convert kilojoules to grams.
3 For carbohydrate, the AMDR of 45–65 per cent for an
8000-kilojoule diet is 3600–5200 kilojoules, or 212–
306 grams. Similar calculations can be done for fat and
protein AMDR. Multiply total energy intake by 20 per cent
to find the lower end of the fat AMDR (and by 35 per cent
to find the upper end), and then divide by 37 to convert
kilojoules to grams. Multiply total energy intake by 10 per
cent to find the lower end of the protein AMDR (and by
35 per cent to find the upper end), and then divide by 17
to convert kilojoules to grams.
TRY IT Calculate the kilojoules and grams of carbohydrate, fat, and protein of a meal plan
that provides 9200 kilojoules, with 50 per cent carbohydrate, 30 per cent fat, and 20 per
cent protein.
Using nutrient recommendations

Although the intent of nutrient recommendations seems simple, they are the subject of
much misunderstanding and controversy. Perhaps the following facts will help put them in
perspective:
1 Estimates of adequate energy and nutrient intakes apply to healthy people. They need to
be adjusted for malnourished people or those with medical problems who may require
supplemented or restricted intakes.
2 Recommendations are not minimum requirements, nor are they necessarily optimal
intakes for all individuals. They can only target ‘most’ of the people and cannot account for
individual variations in nutrient needs.
3 Most nutrient goals are intended to be met through diets composed of a variety of foods
whenever possible. Because foods contain mixtures of nutrients and non-nutrients, they
deliver more than just those nutrients covered by the recommendations. Excess intakes of
vitamins and minerals are unlikely when they come from foods rather than supplements.
4 Recommendations apply to average daily intakes. Trying to meet the recommendations
for every nutrient every day is difficult and unnecessary. The length of time over which a
person’s intake can deviate from the average without risk of deficiency or overdose varies
for each nutrient, depending on how the body uses and stores the nutrient. For most
nutrients (e.g. thiamin and vitamin C), deprivation would lead to rapid development of
deficiency symptoms (within days or weeks); for others (e.g. vitamin A and vitamin B12),
deficiencies would develop more slowly (over months or years).
5 Each of the NRV categories serves a unique purpose. For example, the EARs are most
appropriately used to develop and evaluate nutrition programs for groups such as
schoolchildren or military personnel. The RDI (or AI if an RDI is not available) can be
used to set goals for individuals. The UL serves as a reminder to keep nutrient intakes below
amounts that increase the risk of toxicity – not a common problem when nutrients derive
from foods, but a real possibility for some nutrients if supplements are used regularly. With
these understandings, professionals can use the NRV for a variety of purposes. Using the
online NRV calculator at http://www.nrv.gov.au you can gain a practical understanding of
your own requirements.
Comparing nutrient recommendations

At least 80 different nations and international organisations have published nutrient standards
similar to those used in Australia and New Zealand. Slight differences may be apparent,
reflecting differences both in the interpretation of the data from which the standards
were derived and in the food habits and physical activities of the populations they serve.
Terminologies may also vary between countries. For example, North America uses the term
Dietary Reference Intakes (DRI) in place of NRV and adopts the term Recommended Dietary
Allowance (RDA) instead of RDI. In the United Kingdom, Dietary Reference Values (DRV) are
used, with Reference Nutrient Intake (RNI) used in place of RDI.
Recommendations have also been developed by two international groups – the FAO (Food
and Agriculture Organization) and WHO (World Health Organization). The FAO/WHO
recommendations are considered sufficient to maintain health in nearly all healthy people
worldwide.
The Nutrient Reference Values (NRV) are a set of nutrient intake values that can be used to plan and
REVIEW IT
evaluate diets for healthy people. The Estimated Average Requirement (EAR) defines the amount of
a nutrient that supports a specific function in the body for half of the population. The Recommended
Dietary Intake (RDI) is based on the EAR and establishes a goal for dietary intake that will meet the
needs of almost all healthy people. An Adequate Intake (AI) serves a similar purpose when an RDI
cannot be determined. The Suggested Dietary Target (SDT) is a daily average intake from food and
beverages for certain nutrients that may help in prevention of chronic disease. The Estimated Energy
Requirement (EER) defines the average amount of energy intake needed to maintain energy balance,
and the Acceptable Macronutrient Distribution Range (AMDR) defines the proportions contributed
by carbohydrate, fat and protein to a healthy diet. The Upper Level of Intake (UL) establishes the
highest amount that appears safe for regular consumption.
1.5 Nutrition assessment

What happens when a person does not get enough or gets too much of a nutrient or energy? If
the deficiency or excess is significant over time, the person will exhibit signs of malnutrition.
With a deficiency of energy, the person may display the symptoms of undernutrition by
becoming extremely thin, losing muscle tissue and becoming prone to infection and disease.
With a deficiency of a nutrient, the person may experience skin rashes, depression, hair loss,
bleeding gums, muscle spasms, night blindness or other symptoms.
With an excess of energy, the person may become obese and vulnerable to diseases
associated with overnutrition, such as heart disease and diabetes. With a sudden nutrient
overdose, the person may experience hot flushes, yellowing skin, a rapid heart rate, low blood
pressure or other symptoms. Similarly, over time, regular intakes in excess of needs may also
have adverse effects.
This discussion presents the basics of nutrition assessment; many more details are offered
in later chapters and in Appendix E.
Nutrition assessment of individuals

To prepare a nutrition assessment, a dietitian or other trained healthcare professional uses:
• historical information
• anthropometric data
• physical examinations
• laboratory tests.
Each of these methods involves collecting data in various ways and interpreting each
finding in relation to the others to create a total picture. Nutrition screening is often the
first part of the process to help identify people who are already malnourished or at risk of
becoming so. After nutritional screening, nutrition assessment can then be undertaken.
Nutrition assessment differs from nutrition screening by its use of a comprehensive
assessment of a person’s nutrition status through such measures as health, medication use,
diet histories, anthropometric and laboratory tests.
Historical information
One step in evaluating nutrition status is to obtain information about a person’s history with
respect to health status, socioeconomic status, medication use and diet. The health history
reflects a person’s medical record and may reveal a disease that interferes with the person’s
ability to eat or the body’s use of nutrients. The person’s family history of major diseases is also
noteworthy, especially for conditions such as heart disease that have a genetic tendency to run
in families. Economic circumstances may show a financial inability to buy foods or inadequate
kitchen facilities in which to prepare them. Social factors, such as marital status, ethnic
background and educational level, also influence food choices and nutrition status. A drug
history, including all prescribed and over-the-counter medications as well as narcotics, may
highlight possible interactions that lead to nutrient deficiencies (as described in Highlight 17).
A diet history that examines a person’s intake of foods, beverages and supplements may reveal
either a surplus or inadequacy of nutrients or energy.
To take a diet history, the assessor collects data about the foods a person eats. The data
may be collected by recording the foods the person has eaten over a period of 24 hours, three
days, or a week or more, or by asking what foods the person typically eats and how much
of each. The days in the record must be fairly typical of the person’s diet, and portion sizes
must be recorded accurately. To determine the amounts of nutrients consumed, the assessor
usually enters the foods and their portion sizes into a computer using a diet analysis program.
The assessor then compares the calculated nutrient intakes with the NRV to determine the
probability of adequacy (see Figure 1.7). Alternatively, the diet history might be compared
FIGURE 1.7 Using the NRV to assess the dietary intake of a healthy individual
High
Intake If a person’s usual intake falls above the RDI, the intake is
Usual intake of nutrient X (units/day)
probably probably adequate because the RDI covers the needs of

adequate almost all people.
RDI
Intake A dual intake that falls between the RDI and the EAR is more
possibly difficult to assess; the intake may be adequate, but the
inadequate chances are greater or equal that it is inadequate.
EAR
Intake
If the usual intake falls below the EAR, it is probably
probably
inadequate.
inadequate
Low
against standards such as the Australian Guide to Healthy Eating, the Australian Dietary
Guidelines or the Eating and Activity Guidelines for New Zealand Adults (described in Chapter 2).
An estimate of energy and nutrient intakes from a diet history, when combined with other
sources of information, can help confirm or rule out the possibility of suspected nutrition
problems. A sufficient intake of a nutrient does not guarantee adequacy, and an insufficient
intake does not always indicate a deficiency. Such findings, however, warn of possible
problems.
Anthropometric data
A second technique that may help to reveal nutrition problems is taking anthropometric
measures, such as height and weight. The assessor compares a person’s measurements with
standards specific for gender and age or with previous measures on the same individual.
(Chapter 8 presents information on body weight and its standards.)
Measurements taken periodically and compared with previous measurements reveal
patterns and indicate trends in a person’s overall nutrition status, but they provide little
information about specific nutrients. Instead, measurements out of line with expectations may
reveal such problems as children’s failure to thrive, the wasting or swelling of body tissues in
adults, and obesity – conditions that may reflect energy or nutrient deficiencies or excesses.
Physical examinations
A third nutrition assessment technique is a physical examination looking for clues to poor
nutrition status. Every part of the body that can be inspected may offer such clues: hair, eyes,
skin, posture, tongue, fingernails and others. The examination requires skill because many
physical signs reflect more than one nutrient deficiency or toxicity – or even non-nutrition
conditions. Like the other assessment techniques, a physical examination alone does not
yield firm conclusions. Instead, physical examinations reveal possible imbalances that must
be confirmed by other assessment techniques, or they confirm results from other assessment
measures.
Laboratory tests
A fourth way to detect a developing deficiency, imbalance or toxicity is to take samples of
blood or urine, analyse them in the laboratory and compare the results with normal values
for a similar population. A goal of nutrition assessment is to uncover early signs of Assessment may one
malnutrition before symptoms appear, and laboratory tests are most useful for this purpose. In day depend on measures
addition, they can confirm suspicions raised by other assessment methods. of how a nutrient
influences genetic
activity within the cells,
Iron, for example
instead of quantities in the
The mineral iron can be used to illustrate the stages in the development of a nutrient blood or other tissues.
deficiency and the assessment techniques useful in detecting them. The overt, or outward,
signs of an iron deficiency appear at the end of a long sequence of events. Figure 1.8 describes
what happens in the body as a nutrient deficiency progresses, and shows which assessment
methods can reveal those changes.
First, the body has too little iron – either because iron is lacking in the person’s diet (a
primary deficiency) or because the person’s body doesn’t absorb enough, excretes too much
or uses iron inefficiently (a secondary deficiency). A diet history provides clues to primary
deficiencies; a health history provides clues to secondary deficiencies.
Next, the body begins to use up its stores of iron. At this stage, the deficiency might be
described as subclinical. It exists as a covert condition, and although it might be detected by
laboratory tests, no outward signs are apparent.
Finally, the body’s iron stores are exhausted. Now it cannot make enough iron-containing
red blood cells to replace those that are ageing and dying. Iron is needed in red blood cells to
carry oxygen to all the body’s tissues. When iron is lacking, fewer red blood cells are made, the
FIGURE 1.8 Stages in the development of a nutrient deficiency

Internal changes precede outward signs of deficiencies. However, outward signs of sickness need
not appear before a person takes corrective measures. Laboratory tests can help determine
nutrient status in the early stages.
WHAT HAPPENS IN WHICH ASSESSMENT
THE BODY METHODS REVEAL CHANGES
Primary deficiency caused by Diet history

inadequate diet
or
Secondary deficiency caused
by problem inside the body Health history
Declining nutrient stores

(subclinical)
Laboratory tests
and
Abnormal functions inside the body
(covert)
Physical signs and Physical examination and

symptoms (overt) anthropometric measures
new ones are pale and small, and every part of the body feels the effects of oxygen shortage.
Now the overt symptoms of deficiency appear – weakness, fatigue, pallor and headaches –
reflecting the iron-deficient state of the blood. A physical examination will reveal these
symptoms.
Nutrition assessment of populations

To assess a population’s nutrition status, researchers conduct surveys using techniques
similar to those used on individuals. The data collected are then used by various agencies for
numerous purposes, including the development of national health goals.
National nutrition surveys

National nutrition surveys gather information about the population’s dietary, nutritional,
and related health status. The US, the UK and many continental European nations have
had ongoing, systematic programs for monitoring the diet and nutritional status of their
populations for many years. Australia has conducted only four national surveys of diet in
the past 40 years: a national dietary survey of adults in 1983, one of children in 1985, the
National Nutrition Survey in 1995 and the most recent National Health Survey in 2017–18.10
In the absence of a regular, comprehensive and coordinated national nutrition monitoring
survey in Australia, several state and territory governments have established monitoring
systems that survey health behaviours, including food habits. In New Zealand, Adult Nutrition
Surveys were carried out by the Ministry of Health in 1997 and 2008–09 and the National
Children’s Nutrition Survey was carried out in 2002.11 The Ministry of Health also collects
information as part of its ongoing Health Survey, which includes some dietary habits questions
and self-reported weight and height.12
The information gained from national nutrition surveys is used for a variety of purposes.
For example, the government uses this information to establish public policy on nutrition
education, public health nutrition programs and the regulation of the food supply. Scientists
use the information to establish research priorities. The food industry uses these data to guide
decisions in public relations and product development. The NRV and other major reports
that examine the relationships between diet and health depend on the information collected
from these nutrition surveys. These data also provide the basis for developing and monitoring
national health goals.
National trends
What do we eat and how has it changed over the past 60 years? The short answer to both
questions is ‘a lot’. We eat more meals away from home, particularly at fast-food restaurants.
We eat larger portions. We drink more sweetened beverages and eat more energy-dense,
nutrient-poor foods, such as lollies and chips. We snack frequently. As a result of these dietary
habits, our energy intake has risen and, consequently, so has the incidence of overweight and
obesity. Overweight and obesity, in turn, profoundly influence our health – as the next section
explains.
People become malnourished when they get too little or too much energy or nutrients. Deficiencies,
REVIEW IT
excesses and imbalances of nutrients lead to malnutrition diseases. To detect malnutrition in
individuals, healthcare professionals use four nutrition assessment methods. Reviewing dietary data
and health information may suggest a nutrition problem in its earliest stages. Laboratory tests may
detect it before it becomes overt, whereas anthropometrics and physical examinations pick up on the
problem only after it causes symptoms. National surveys use similar assessment methods to measure
people’s food consumption and to evaluate the nutrition status of populations.
1.6 Diet and health

Diet has always played a vital role in supporting health. Early nutritional research focused on
identifying the nutrients in foods that would prevent such common diseases as rickets and
scurvy, the vitamin D- and vitamin C-deficiency diseases. With this knowledge, industrialised
countries have successfully defended against nutrient deficiency diseases. More recently,
nutritional research has focused on chronic diseases associated with energy and nutrient
excesses. Once thought to be ‘rich countries’ problems’, overconsumption of unhealthy foods
and chronic diseases have escalated worldwide in recent decades.
Chronic diseases
Table 1.7 lists the 10 leading causes of death in Australia. These ‘causes’ are stated as if a single
condition, such as heart disease, caused death, but most chronic diseases arise from multiple
factors over many years. A person who dies of heart disease may have been overweight, had
high blood pressure, been a cigarette smoker, and spent years eating a diet high in saturated
fat and getting too little exercise. In New Zealand, the leading causes of death in 2018 were
cancer, ischaemic heart diseases and cerebrovascular diseases (with 114, 48 and 23.1 deaths
per 100 000 population, respectively).13
Of course, not all people who die of heart disease fit this description, and nor do all people
with these characteristics die of heart disease. People who are overweight might die from the
complications of diabetes instead, or those who smoke might die of lung cancer. They might PUTTING
even die from something totally unrelated to any of these factors, such as a car accident. Still, COMMON SENSE
TO THE TEST
statistical studies have shown that certain conditions and behaviours are linked to certain
diseases. Changing our
Notice that Table 1.7 highlights five of the top 10 causes of death as having a link with diet will do little
diet. Coronary heart disease, colorectal cancer, stroke and diabetes account for a quarter of to reduce the risk
all deaths each year. Sometimes the problem is a matter of ‘too much’, as is true for sodium, of many chronic
processed meats, red meats, and sugar-sweetened beverages. Other times, the problem is a diseases.
matter of ‘too little’, as is true for nuts and seeds, seafood omega-3 fats, vegetables, fruits, FALSE
whole grains, and polyunsaturated fats.
TABLE 1.7 Leading causes of death in Australia (2019)

PERCENTAGE OF TOTAL DEATHS
1 Ischaemic heart disease 10.8
2 Dementia including Alzheimer’s disease 8.9
3 Cerebrovascular disease (stroke) 5.9
4 Lung cancer 5.2
5 Chronic lower respiratory diseases 5.0
6 Colorectal cancer 3.2
7 Diabetes 2.9
8 Lymph and blood cancer 2.8
9 Influenza and pneumonia 2.4
10 Diseases of the urinary system 2.3
Note: The diseases highlighted in blue have relationships with diet.
Australian Bureau of Statistics, Causes of Death, Australia, ABS Catalogue Number 3303.0,
(Canberra: ABS, 2020). CC BY 2.5 Australia.
Risk factors for chronic diseases

Factors that increase or reduce the risk of developing chronic
diseases can be identified by analysing statistical data. A strong
association between a risk factor and a disease means that when
the factor is present, the likelihood of developing the disease
increases. It does not mean that all people with the risk factor
will develop the disease. Similarly, a lack of risk factors does not
guarantee freedom from a given disease. On the average, though,
iStock.com/Sportstock
the more risk factors in a person’s life, the greater that person’s
chances of developing the disease. Conversely, the fewer risk
factors in a person’s life, the better the chances for good health.
Risk factors persist

Risk factors tend to persist over time. Without intervention, a
Physical activity can be both fun and beneficial.
young adult with high blood pressure will most likely continue to
have high blood pressure as an older adult, for example. Thus, to
minimise the damage, early intervention is most effective.
Risk factors cluster

Risk factors tend to cluster. For example, a person who is obese may be physically inactive,
have high blood pressure and have high blood cholesterol – all risk factors associated with
heart disease. Interventions that focus on one risk factor often benefit the others as well; for
example, physical activity can help reduce weight. The physical activity and weight loss will, in
turn, help to lower blood pressure and blood cholesterol.
Risk factors in perspective

The most prominent factors contributing to death in Australia (see Table 1.8)14 and New
Cigarette smoking Zealand all have dietary and lifestyle causes. Risk factors, such as smoking, poor dietary
is responsible for over habits, physical inactivity and alcohol consumption are personal behaviours that can be
one in every 10 deaths changed. Decisions to not smoke, to eat a well-balanced diet, to engage in regular physical
each year.
activity and to drink alcohol in moderation (if at all) improve the likelihood that a person will
enjoy good health. For this reason, guidelines, such as the Australian Guide to Healthy Eating
and Australian Dietary Guidelines (both described in Chapter 2), have been developed to help
individuals and health authorities determine what constitutes a healthy diet that will help
lower disease risk.
TABLE 1.8 Factors contributing to deaths and disease burden in Australia

RISK FACTOR PERCENTAGE OF TOTAL DALYa
Tobacco 9.0
Alcohol 5.1
Physical inactivity 5.0
High body mass 5.5
High blood pressure 4.9
High plasma glucose 2.7
High cholesterol 2.4
Diet low in fruit 2.0
Diet low in vegetables 1.1
Diet low in whole grains 1.1
a
DALY: Disability-Adjusted Life Year. The DALY is a measure of overall disease burden, expressed as the
number of years lost due to ill-health, disability or early death.
Australian Institute of Health and Welfare, Australian Burden of Disease Study: impact and causes of illness and death in
Australia 2011, (2016). CC-BY 3.0 Licence. (https://www.aihw.gov.au/copyright). https://www.aihw.gov.au/reports/burden-of-
disease/abds-impact-and-causes-of-illness-death-2011/contents/highlights
APPLICATIONS OF NUTRITIONAL RESEARCH
The key dietary patterns of long-term health

Diet plays a big part in health. As the typical Western diet moved to more overly refined
and energy dense foods, rates of obesity and type 2 diabetes mirrored this change. A major
scientific review has taken things back to basics to reinforce where the best health gains are
to be found with diet.15
The review looked at the diet and chronic disease links from 304 meta-analyses and
systematic reviews published in the last 63 years. Type 2 diabetes, overweight and obesity,
cancer and cardiovascular disease together accounted for most of the chronic disease links
found.
As for dietary patterns, the findings showed that plant-based foods were more protective
against the risk of developing chronic disease compared with animal-based foods. Among
plant foods, grain-based foods seemed to have a small edge over fruits and vegetables. So
much for the anti-grain sentiment that is popular at the moment!
For animal-based foods, dairy products overall were considered neutral on health, and
fish was considered protective. Red and processed meats were linked to a higher disease
risk. For tea-lovers, the research confirmed this popular drink as being the most protective
against disease risk. On the other end of the spectrum, to no-one’s surprise, soft drinks had
few redeeming health benefits.
The findings from this major review are close to a carbon copy of existing dietary
guidelines that have changed little over decades. Eat more plant-based foods than animal
foods, choose whole grains over refined grains, limit red and processed meat and choose
other beverages in preference to soft drink. Such recommendations may not get media
attention or help sell books in numbers like the latest fad diet, but they are the cornerstone
of long-term health.
Other risk factors, such as genetics, sex and age, also play important roles in the
development of chronic diseases, but they cannot be changed. Health recommendations
acknowledge the influence of such factors on the development of disease, but they must focus
on the factors that are changeable. For the two out of three Australians who do not smoke or
drink alcohol excessively, the one choice that can influence long-term health prospects more
than any other is diet.
The next several chapters provide many more details about nutrients and how they support
health. Whenever appropriate, the discussion shows how diet influences each of today’s major
diseases. Dietary recommendations appear again and again, as each nutrient’s relationships
with health are explored. Most people who follow the recommendations will benefit and can
enjoy good health into their later years.
Within the range set by genetics, a person’s choice of diet influences long-term health. Diet has no
REVIEW IT
influence on some diseases but is linked closely to others. Personal life choices, such as engaging in
physical activity and using tobacco or alcohol, also affect health, for better or worse.
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Ebook Understanding Nutrition Fifth Edition PDF Full Chapter PDF

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Understanding Nutrition, Fifth Edition -

Walnuts are a rich

Nutrition Compounds in ginger

Tim Crowe, Adam Walsh

CHAPTER 1 An overview of nutrition 1

8.1 Energy balance 253 CHAPTER 11

Pears are a good

CHAPTER 18 19.4 Pesticides 668

Guide to the text

CHAPTER OPENING FEATURES

Connect Nutrition in your life with the essential

Common sense test at the start of every chapter.

PUTTING COMMON SENSE TO THE TEST

Other roles of energy-yielding nutrients

Practise common nutrition tasks such as comparing

HOW TO: CALCULATE THE ENERGY AVAILABLE FROM FOODS

iteness; sometimes called white flour.

CURRENT RESEARCH IN NUTRITION

The perils of highly processed foods

The review looked at the

Consolidate your learning with the Review it and The plant-based

summary paragraph at the end of each A-head

the key learning outcomes. BK-CLA-WHITNEY_5E-210367-Chp01

introduced in the How to chapter features. 101%

HIGHLIGHTS 32 Understanding Nutrition

Every chapter is followed by a highlight that provides

• Develop your understanding of these key topics

by exploring the weblinks listed in Nutrition on

BK-CLA-WHITNEY_5E-210367-Chp01 copy.indd 37 22/03/22 6:11 PM

Guide to the online resources

Cengage is pleased to provide you with a selection of resources

COGNERO® TEST BANK

ARTWORK FROM THE TEXT

FOR THE STUDENT

Chillis are part of the

Dragon fruit seeds are

ABOUT THE AUTHORS in garlic can

Nutrition in your life

PUTTING COMMON SENSE TO THE TEST

Onions contain antioxidants and

1.1 Food choices

Hunger and satiety

Ethnic heritage or tradition

An enjoyable way to learn about other

Availability, convenience and economy

Positive and negative associations

These people may find emotional comfort, in part

Body weight and health

Nutrition and health benefits

CURRENT RESEARCH IN NUTRITION

The perils of highly processed foods

and organs and your external appearance remain

Nutrients in foods and in the body

from the foods we eat. This section introduces the

Nutrient composition of foods

Chemical composition of nutrients

TABLE 1.1 Elements in the six classes of nutrients

CARBON HYDROGEN OXYGEN NITROGEN MINERALS

Energy-yielding nutrients: carbohydrate, fat and protein

TABLE 1.2 The six classes of nutrients

Energy measured in kilojoules

Energy in the body

Other roles of energy-yielding nutrients

8.1 Energy balance 253 CHAPTER 11

CHAPTER 18 19.4 Pesticides 668