Dietary Reference Intakes (DRI)

T he Dietary Reference Intakes (DRI) include two sets of values that serve as goals for nutrient intake—Recommended Dietary Allowances (RDA) and Adequate
Intakes (AI). The RDA reflect the average daily amount of a nutrient considered adequate to meet the needs of most healthy people. If there is insufficient
evidence to determine an RDA, an AI is set. AI are more tentative than RDA, but both may be used as goals for nutrient intakes. (Chapter 1 provides more details.)
In addition to the values that serve as goals for nutrient intakes (presented in the tables on these two pages), the DRI include a set of values called Tolerable
Upper Intake Levels (UL). The UL represent the maximum amount of a nutrient that appears safe for most healthy people to consume on a regular basis. Turn the
page for a listing of the UL for selected vitamins and minerals.

Estimated Energy Requirements (EER), Recommended Dietary Allowances (RDA), and

Adequate Intakes (AI) for
Water, Energy, and the Energy Nutrients
t,
t,

igh

)
igh

y)

ay
/d cid c
I

y) d
/m 2 BM

e
da
we

/d
he

y)
A ( rat

/d id
al/

da

da

kg
)

)
a
y)

c
r
(kg ence

cm ence

kg ence

ay

ay

ay

ay
yd

AI fibe

AI ic a

AI nic
da

g/

g/

g/
(kc
)

AI fat
)

/d

/d
oh
te r a

RD n

RD n
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EE y
(in

A(

A(
(lb

(L/

ole

ole

te i

te i
erg
Rb

(g

(g

(g

(g
fer

fer

fer

tal

tal
rb

Pro

Pro
RD
Wa

Lin

Lin
Ca
Age(yr)
En
Re

Re

Re

AI

To

To
Males
0–0.5 — 62 (24) 6 (13) 0.7e 570 60 — 31 4.4 0.5 9.1 1.52
0.5–1 — 71 (28) 9 (20) 0.8f 743 95 — 30 4.6 0.5 13.5 1.5
1–3g — 86 (34) 12 (27) 1.3 1046 130 19 — 7 0.7 13 1.1
4–8g 15.3 115 (45) 20 (44) 1.7 1742 130 25 — 10 0.9 19 0.95
9–13 17.2 144 (57) 36 (79) 2.4 2279 130 31 — 12 1.2 34 0.95
14–18 20.5 174 (68) 61 (134) 3.3 3152h 130 38 — 16 1.6 52 0.85
19–30 22.5 177 (70) 70 (154) 3.7 3067h 130 38 — 17 1.6 56 0.8
31–50 3.7 3067h 130 38 — 17 1.6 56 0.8
50 3.7 3067h 130 30 — 14 1.6 56 0.8
Females
0–0.5 — 62 (24) 6 (13) 0.7e 520 60 — 31 4.4 0.5 9.1 1.52
0.5–1 — 71 (28) 9 (20) 0.8f 676 95 — 30 4.6 0.5 13.5 1.5
1–3g — 86 (34) 12 (27) 1.3 992 130 19 — 7 0.7 13 1.1
4–8g 15.3 115 (45) 20 (44) 1.7 1642 130 25 — 10 0.9 19 0.95
9–13 17.4 144 (57) 37 (81) 2.1 2071 130 26 — 10 1.0 34 0.95
14–18 20.4 163 (64) 54 (119) 2.3 2368 130 26 — 11 1.1 46 0.85
19–30 21.5 163 (64) 57 (126) 2.7 2403i 130 25 — 12 1.1 46 0.8
31–50 2.7 2403i 130 21 — 12 1.1 46 0.8
50 2.7 2403i 130 21 — 11 1.1 46 0.8
Pregnancy
1st trimester 3.0 0 175 28 — 13 1.4 25 1.1
2nd trimester 3.0 340 175 28 — 13 1.4 25 1.1
3rd trimester 3.0 452 175 28 — 13 1.4 25 1.1
Lactation
1st 6 months 3.8 330 210 29 — 13 1.3 25 1.1
2nd 6 months 3.8 400 210 29 — 13 1.3 25 1.1
NOTE: For all nutrients, values for infants are AI. Dashes indicate that values have not been c The linolenic acid referred to in this table and text is the omega-3 fatty acid known as alpha-
determined. linolenic acid.
a The water AI includes drinking water, water in beverages, and water in foods; in general, d The values listed are based on reference body weights.

drinking water and other beverages contribute about 70 to 80 percent, and foods, the remain- e Assumed to be from human milk.

der. Conversion factors: 1 L
33.8 fluid oz; 1 L
1.06 qt; 1 cup
8 fluid oz. f Assumed to be from human milk and complementary foods and beverages. This includes
b The Estimated Energy Requirement (EER) represents the average dietary energy intake that will
approximately 0.6 L (~3 cups) as total fluid including formula, juices, and drinking water.
maintain energy balance in a healthy person of a given gender, age, weight, height, and physical g For energy, the age groups for young children are 1–2 years and 3–8 years.

activity level. The values listed are based on an “active” person at the reference height and weight h For males, subtract 10 kcalories per day for each year of age above 19.

and at the midpoint ages for each group until age 19. Chapter 8 and Appendix F provide equa- i For females, subtract 7 kcalories per day for each year of age above 19.

tions and tables to determine estimated energy requirements.

SOURCE: Adapted from the Dietary Reference Intakes series, National Academies Press. Copyright 1997, 1998, 2000, 2001, 2002, 2004, by the National Academies of Sciences.
 Recommended Dietary Allowances (RDA) and Adequate Intakes (AI) for Vitamins

da acid

ay e
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(m nic

)
/d

/d

/d

/d

/d

/d
g/ 2

ay
da
A( 6

A( 1
da

R D in B

RD n B

AI in D
RD avin

g/

g/
R D in C

R D in A

AI in K
mg

mg

mg

mg

mg

mg
R D in E
AI the

/d

/d
g/

g/
R D in

g/

e
i

( g

( g
n
in
A(

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iam

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tin

am

am

am

am

am
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ofl

(

oli
lat
nt
ac
RD

RD
Rib

Bi o

Vit

Vit
Age (yr)

Vit

Vit

Vit

Vit

Vit
Ch
Th

AI

AI
Pa

Fo
Ni
Infants
0–0.5 0.2 0.3 2 5 1.7 0.1 65 0.4 125 40 400 5 4 2.0
0.5–1 0.3 0.4 4 6 1.8 0.3 80 0.5 150 50 500 5 5 2.5
Children
1–3 0.5 0.5 6 8 2 0.5 150 0.9 200 15 300 5 6 30
4–8 0.6 0.6 8 12 3 0.6 200 1.2 250 25 400 5 7 55
Males
9–13 0.9 0.9 12 20 4 1.0 300 1.8 375 45 600 5 11 60
14–18 1.2 1.3 16 25 5 1.3 400 2.4 550 75 900 5 15 75
19–30 1.2 1.3 16 30 5 1.3 400 2.4 550 90 900 5 15 120
31–50 1.2 1.3 16 30 5 1.3 400 2.4 550 90 900 5 15 120
51–70 1.2 1.3 16 30 5 1.7 400 2.4 550 90 900 10 15 120
70 1.2 1.3 16 30 5 1.7 400 2.4 550 90 900 15 15 120
Females
9–13 0.9 0.9 12 20 4 1.0 300 1.8 375 45 600 5 11 60
14–18 1.0 1.0 14 25 5 1.2 400 2.4 400 65 700 5 15 75
19–30 1.1 1.1 14 30 5 1.3 400 2.4 425 75 700 5 15 90
31–50 1.1 1.1 14 30 5 1.3 400 2.4 425 75 700 5 15 90
51–70 1.1 1.1 14 30 5 1.5 400 2.4 425 75 700 10 15 90
70 1.1 1.1 14 30 5 1.5 400 2.4 425 75 700 15 15 90
Pregnancy
18 1.4 1.4 18 30 6 1.9 600 2.6 450 80 750 5 15 75
19–30 1.4 1.4 18 30 6 1.9 600 2.6 450 85 770 5 15 90
31–50 1.4 1.4 18 30 6 1.9 600 2.6 450 85 770 5 15 90
Lactation
18 1.4 1.6 17 35 7 2.0 500 2.8 550 115 1200 5 19 75
19–30 1.4 1.6 17 35 7 2.0 500 2.8 550 120 1300 5 19 90
31–50 1.4 1.6 17 35 7 2.0 500 2.8 550 120 1300 5 19 90

NOTE: For all nutrients, values for infants are AI. c Vitamin A recommendations are expressed as retinol activity equivalents (RAE).
a Niacin recommendations are expressed as niacin equivalents (NE), except for recommendations d Vitamin D recommendations are expressed as cholecalciferol and assume an absence of adequate
for infants younger than 6 months, which are expressed as preformed niacin. exposure to sunlight.
b Folate recommendations are expressed as dietary folate equivalents (DFE). e Vitamin E recommendations are expressed as
-tocopherol.

Recommended Dietary Allowances (RDA) and Adequate Intakes (AI) for Minerals
)

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ium

g/
g/

g/

g/
RD nesiu
mg

mg

mg

mg

AI ane
RD ium

/d

RD de
AI miu
AI de
g/

g/

g/

g/

g/

g/
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AI um
AI um

RD r

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RD e

lyb
A(

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A(

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ng

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lor

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ro
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RD

RD

RD

Mo
Iod
Ma

Zin

Ma

Age (yr)
Flu
Iro
Ch

Co

Ch
Ca

Ph
Po
AI
So

AI
Se

Infants
0–0.5 120 180 400 210 100 30 0.27 2 110 15 200 0.003 0.01 0.2 2
0.5–1 370 570 700 270 275 75 11 3 130 20 220 0.6 0.5 5.5 3
Children
1–3 1000 1500 3000 500 460 80 7 3 90 20 340 1.2 0.7 11 17
4–8 1200 1900 3800 800 500 130 10 5 90 30 440 1.5 1.0 15 22
Males
9–13 1500 2300 4500 1300 1250 240 8 8 120 40 700 1.9 2 25 34
14–18 1500 2300 4700 1300 1250 410 11 11 150 55 890 2.2 3 35 43
19–30 1500 2300 4700 1000 700 400 8 11 150 55 900 2.3 4 35 45
31–50 1500 2300 4700 1000 700 420 8 11 150 55 900 2.3 4 35 45
51–70 1300 2000 4700 1200 700 420 8 11 150 55 900 2.3 4 30 45
70 1200 1800 4700 1200 700 420 8 11 150 55 900 2.3 4 30 45
Females
9–13 1500 2300 4500 1300 1250 240 8 8 120 40 700 1.6 2 21 34
14–18 1500 2300 4700 1300 1250 360 15 9 150 55 890 1.6 3 24 43
19–30 1500 2300 4700 1000 700 310 18 8 150 55 900 1.8 3 25 45
31–50 1500 2300 4700 1000 700 320 18 8 150 55 900 1.8 3 25 45
51–70 1300 2000 4700 1200 700 320 8 8 150 55 900 1.8 3 20 45
70 1200 1800 4700 1200 700 320 8 8 150 55 900 1.8 3 20 45
Pregnancy
18 1500 2300 4700 1300 1250 400 27 12 220 60 1000 2.0 3 29 50
19–30 1500 2300 4700 1000 700 350 27 11 220 60 1000 2.0 3 30 50
31–50 1500 2300 4700 1000 700 360 27 11 220 60 1000 2.0 3 30 50
Lactation
18 1500 2300 5100 1300 1250 360 10 14 290 70 1300 2.6 3 44 50
19–30 1500 2300 5100 1000 700 310 9 12 290 70 1300 2.6 3 45 50
31–50 1500 2300 5100 1000 700 320 9 12 290 70 1300 2.6 3 45 50
 Tolerable Upper Intake Levels (UL) for Vitamins*

y) c
y) a

ay b
ay a
g/ B6

( g in D
y)
y)
y)

( g in A
(m in C

(m in E
)
)
)

ay

da
da
da
(m in
da
da

(m ne

/d
/d
(m in

/d
am

am
am
am
am

g/
g/
g/
g/

o li
lat
ac

( g
Vit

Vit
Vit
Vit
Vit
Ch
Age (yr)

Fo
Ni
Infants
0–0.5 — — — — — 600 25 —
0.5–1 — — — — — 600 25 —
Children
1–3 10 30 300 1000 400 600 50 200
4–8 15 40 400 1000 650 900 50 300
9–13 20 60 600 2000 1200 1700 50 600
Adolescents
14–18 30 80 800 3000 1800 2800 50 800
Adults
19–70 35 100 1000 3500 2000 3000 50 1000
70 35 100 1000 3500 2000 3000 50 1000
Pregnancy
18 30 80 800 3000 1800 2800 50 800
19–50 35 100 1000 3500 2000 3000 50 1000
Lactation
18 30 80 800 3000 1800 2800 50 800
19–50 35 100 1000 3500 2000 3000 50 1000

* UL  The maximum level of daily nutrient intake that is a The UL for niacin and folate apply to synthetic forms
likely to pose no risk of adverse effects. Unless otherwise obtained from supplements, fortified foods, or a combina-
specified, the UL represents total intake from food, water, tion of the two.
and supplements. Due to lack of suitable data, ULs could not b The UL for vitamin A applies to preformed vitamin A only.

be established for vitamin K, thiamin, riboflavin. vitamin B12, c The UL for vitamin E applies to any form of supplemental

pantothenic acid, biotin, or carotenoids. In the absence of
-tocopherol, fortified foods, or a combination of the two.
ULs, extra caution may be warranted in consuming levels
above recommended intakes.

Tolerable Upper Intake Levels (UL) for Minerals*

g/ rus

da m
y) d

y)
y)
y)
y)
y)

(m esiu
(m pho
(m ide

da
da
da
da
da

(m um
(m m

gn

g/
g/
diu

g/
g/
g/

lor

os
lci

n
(m
Ma

Iro

Age (yr)
Ch

Ph
Ca
So

Infants
0–0.5 —e —e — — — 40
0.5–1 —e —e — — — 40
Children
1–3 1500 2300 2500 3000 65 40
4–8 1900 2900 2500 3000 110 40
9–13 2200 3400 2500 4000 350 40
Adolescents
14–18 2300 3600 2500 4000 350 45
Adults
19–70 2300 3600 2500 4000 350 45
70 2300 3600 2500 3000 350 45
Pregnancy
18 2300 3600 2500 3500 350 45
19–50 2300 3600 2500 3500 350 45
Lactation
18 2300 3600 2500 4000 350 45
19–50 2300 3600 2500 4000 350 45

* UL  The maximum level of daily nutrient intake that is likely to pose no risk of adverse effects. Unless
otherwise specified, the UL represents total intake from food, water, and supplements. Due to lack of
suitable data, ULs could not be established for arsenic, chromium, and silicon. In the absence of ULs,
extra caution may be warranted in consuming levels above recommended intakes.
d The UL for magnesium applies to synthetic forms obtained from supplements or drugs only.
e Source of intake should be from human milk (or formula) and food only.
This page intentionally left blank
 Nutrition
Digital Stock

Through the Life Cycle

THIRD EDITION

Judith E. Brown
Ph.D., M.P.H., R.D.
University of Minnesota

with
Janet S. Isaacs, Ph.D., R.D.
Johns Hopkins Hospital

U. Beate Krinke, Ph.D., M.P.H., R.D.

University of Minnesota

Maureen A. Murtaugh, Ph.D., R.D.

University of Utah School of Medicine

Carolyn Sharbaugh, M.S., R.D.

Nutrition Consultant

Jamie Stang, Ph.D., M.P.H., R.D.

University of Minnesota
Photo Disc

Nancy H.Wooldridge, M.S., R.D., L.D.

University of Alabama at Birmingham
brand X pictures

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Contents in Brief
Preface xix Chapter 13
Chapter 1 Child and 335
Nutrition Basics 1 Preadolescent Nutrition
CONDITIONS AND INTERVENTIONS
Chapter 2
Preconception Nutrition 47 Chapter 14
Adolescent Nutrition 353
Chapter 3
Preconception Nutrition 67 Chapter 15
CONDITIONS AND INTERVENTIONS
Adolescent Nutrition 383
CONDITIONS AND INTERVENTIONS
Chapter 4
Nutrition during Pregnancy 83 Chapter 16
Adult Nutrition 407
Chapter 5
Nutrition during Pregnancy 129 Chapter 17
CONDITIONS AND INTERVENTIONS
Adult Nutrition 437
CONDITIONS AND INTERVENTIONS
Chapter 6
Nutrition during Lactation 155 Chapter 18
Nutrition and Older Adults 455
Chapter 7
Nutrition during Lactation 189 Chapter 19
CONDITIONS AND INTERVENTIONS
Nutrition and Older Adults 487
CONDITIONS AND INTERVENTIONS
Chapter 8
Infant Nutrition 219 Appendix A
CDC Growth Charts A-1
Chapter 9
Appendix B
Infant Nutrition 245
CONDITIONS AND INTERVENTIONS Nutrient Intakes of Adults
Aged 70 and Older A-9
Chapter 10
Appendix C
Toddler and 265
Preschooler Nutrition Measurement Abbreviations
and Equivalents A-11
Chapter 11
Appendix D
Toddler and 293
Preschooler Nutrition Body Mass Index (BMI) A-13
CONDITIONS AND INTERVENTIONS Glossary G-1
Chapter 12
Index I-1
Child and 307
Preadolescent Nutrition

v
Contents

Preface xix Nutritional Assessment 36

Community-Level Assessment 36
Individual-Level Nutritional Assessment 36
All chapters include Resources and References Dietary Assessment 36
Anthropometric Assessment 38
Biochemical Assessment 38

Chapter 1 Monitoring the Nation’s Nutritional Health 38

Nutrition Basics 1 Public Food and Nutrition Programs 39

WIC 39
Introduction 2
Nationwide Priorities for Improvements
Principles of the Science of Nutrition 2
in Nutritional Health 39
Essential and Nonessential Nutrients 3
U.S. Nutrition and Health Guidelines 40
Dietary Intake Standards 3
Carbohydrates 4
Protein 5
Fats (Lipids) 6 Chapter 2
Vitamins 12
Other Substances in Food 13
Preconception Nutrition 47
Minerals 13 Introduction 48
Water 21
Preconception Overview 48
Nutritional Labeling 32 2010 Nutrition Objectives for the Nation Related
Nutrition Facts Panel 32 to the Preconceptional Period 48
Ingredient Label 33
Reproductive Physiology 49
Dietary Supplement Labeling 33
Female Reproductive System 49
Herbal Remedies 33
Male Reproductive System 52
Functional Foods 34
Sources of Disruptions in Fertility 52
Meeting Nutritional Needs across
the Life Cycle 35 Nutrition-Related Disruptions in Fertility 52
Dietary Considerations Based on Ethnicity 35 Undernutrition and Fertility 53
Dietary Considerations Based on Religion 35 Body Fat and Fertility 54

Nutrition Time Line

1621
Photo Disc

1734
First Thanksgiving Scurvy recognized
feast at Plymouth
1702
Photo Disc

colony
First coffeehouse
in America opens
in Philadelphia
vi
 Contents vii

Exercise and Infertility 55 Diabetes Mellitus prior to Pregnancy 72

Diet and Fertility 55 A Closer Look at Insulin Resistance 72
Other Factors Contributing to Infertility in Males 57 Nutritional Management of Type 2 Diabetes 73
Other Components of the Nutritional Management of
Nutrition and Contraceptives 58
Type 2 Diabetes 74
Oral Contraceptives and Nutritional Status 59
Reducing the Risk of Type 2 Diabetes 75
Contraceptive Injections 59
Contraceptive Implants 59 Polycystic Ovary Syndrome 75
Contraceptive Patches 59 Nutritional Management of Women with PCOS 76
Emerging Forms of Contraceptives 60 Disoders of Metabolism 76
Other Preconceptual Nutrition Concerns 60 Phenylketonuria (PKU) 76
Very Early Pregnancy Nutrition Exposures 60 Nutritional Management of Women with PKU 76
Recommended Dietary Intakes for Preconceptional Celiac Disease 77
Women 61 Nutritional Management of Celiac Disease 77

Model Preconceptional Nutrition Programs 61 Herbal Remedies for Fertility-Related Problems 78

Preconceptional Benefits of WIC 61
Decreasing Iron Deficiency in Preconceptional Women
in Indonesia 62 Chapter 4
Preconception Care: Preparing for Pregnancy 62
Nutrition during Pregnancy 83
Introduction 84
Chapter 3 The Status of Pregnancy Outcomes 84
Preconception Nutrition 67 Infant Mortality 85
Low Birth Weight, Preterm Delivery, and Infant Mortality 86
Conditions and Interventions
Reducing Infant Mortality and Morbidity 87
Introduction 68 Health Objectives for the Year 2010 87
Premenstrual Syndrome 68 Physiology of Pregnancy 87
Caffeine Intake and PMS 68 Maternal Physiology 87
Exercise and Stress Reduction 68 Normal Physiological Changes during Pregnancy 88
Magnesium, Calcium, Vitamin D, and Vitamin B6 Supplements The Placenta 91
and PMS Symptoms 69 Embryonic and Fetal Growth and Development 93
Obesity and Fertility 69 Critical Periods of Growth and Development 93
Central Body Fat and Fertility 70 Fetal Body Composition 95
Weight Loss and Fertility 70 Variation in Fetal Growth 95
Nutrition, Miscarriages, and Preterm Delivery 97
Hypothalamic Amenorrhea 70
Nutritional Management of Hypothalamic Amenorrhea 71 The Fetal-Origins Hypothesis of Later Disease Risk 97
Mechanisms Underlying the Fetal-Origins Hypothesis 98
The Female Athlete Triad and Infertility 71 Limitations of the Fetal-Origins Hypothesis 99
Nutritional Management of the Female Athlete Triad 71
Pregnancy Weight Gain 99
Eating Disorders and Fertility 72 Pregnancy Weight Gain Recommendations 100
Nutritional Management of Women with Anorexia Composition of Weight Gain in Pregnancy 101
Nervosa or Bulimia Nervosa 72 Postpartum Weight Retention 101

Nutrition Time Line

Photo Disc

Photo Disc

1750 1762
1744 1747 Ojibway and Sandwich invented
Sioux war over by the Earl of
First record of ice cream Lind publishes control of wild Sandwich
in America at Maryland “Treatise on rice stands
Photo Disc

colony Scurvy,” citrus

identified as cure
 viii Contents

Nutrition and the Course and Outcome

of Pregnancy 103
Chapter 5
Famine and Pregnancy Outcome 103
Contemporary Prenatal Nutrition Research Results 104
Nutrition during 129
Energy Requirement in Pregnancy 104 Pregnancy
Carbohydrate Intake during Pregnancy 105 Conditions and Interventions
Alcohol and Pregnancy Outcome 105
Protein Requirement 105 Introduction 130
Vegetarian Diets in Pregnancy 106 Hypertensive Disorders of Pregnancy 130
Maternal Intake of Omega-3 Fatty Acids and Hypertensive Disorders of Pregnancy, Oxidative Stress,
Pregnancy Outcome 107 and Nutrition 131
The Need for Water during Pregnancy 109 Chronic Hypertension 131
Folate and Pregnancy Outcome 109 Gestational Hypertension 131
Folate and Congenital Abnormalities 110 Preeclampsia–Eclampsia 131
Vitamin A and Pregnancy Outcome 111 Preeclampsia Case Presentation 133
Vitamin D Requirement 111 Nutritional Recommendations and Interventions
Calcium Requirements in Pregnancy 112 for Preeclampsia 133
Fluoride 113
Iron Status and the Course and Outcome of Pregnancy 113 Diabetes in Pregnancy 134
Zinc Requirement in Pregnancy 115 Gestational Diabetes 134
Iodine and Pregnancy Outcome 116 Potential Consequences of Gestational Diabetes 135
Antioxidants from Plants 116 Risk Factors for Gestational Diabetes 136
The Need for Sodium during Pregnancy 116 Diagnosis of Gestational Diabetes 136
Caffeine Use in Pregnancy 116 Treatment of Gestational Diabetes 137
Presentation of a Case Study 137
Healthy Diets for Pregnancy 117
Exercise Benefits and Recommendations 137
Effect of Taste and Smell Changes on Dietary Intake
Nutritional Management of Women with Gestational
during Pregnancy 117
Diabetes 137
Pica 117
Consumption of Foods with a Low Glycemic Index 139
Assessment of Dietary Intake during Pregnancy 117
Postpartum Follow-Up 140
Vitamin and Mineral Supplementation during Pregnancy 119
Prevention of Gestational Diabetes 140
Herbal Remedies and Pregnancy 120
Type 1 Diabetes during Pregnancy 140
Exercise and Pregnancy Outcome 120
Exercise Recommendations for Pregnant Women 120 Multifetal Pregnancies 140
Background Information about Multiple Fetuses 142
Food Safety Issues during Pregnancy 121 Risks Associated with Multifetal Pregnancy 143
Mercury Contamination 121 Interventions and Services for Risk Reduction 143
Common Health Problems during Pregnancy 121 Nutrition and the Outcome of Multifetal Pregnancy 144
Nausea and Vomiting 121 Dietary Intake in Twin Pregnancy 144
Heartburn 122 Nutritional Recommendations for Women
Constipation 122 with Multifetal Pregnancy 145

Model Nutrition Programs for Risk Reduction HIV/AIDS during Pregnancy 145
in Pregnancy 123 Treatment of HIV/AIDS 146
The Montreal Diet Dispensary 123 Consequences of HIV/AIDS during Pregnancy 146
The WIC Program 123 Nutritional Factors and HIV/AIDS during Pregnancy 146

Nutrition Time Line

1771 1774 1775 1816

Stephanno Bianchetti/CORBIS

Potato heralded Americans drink Lavoisier (“the father Protein and

as famine food more coffee in of the science of amino acids
protest over nutrition”) discovers identified
Britain’s tea tax the energy-producing followed by
property of food carbohydrates
and fats in the
mid 1800s
 Contents ix

Nutritional Management of Women with HIV/AIDS Benefits of Breastfeeding 164

during Pregnancy 147 Breastfeeding Benefits for Mothers 164
Breastfeeding Benefits for Infants 164
Eating Disorders in Pregnancy 147
Consequences of Eating Disorders in Pregnancy 147 Breast Milk Supply and Demand 167
Treatment of Women with Eating Disorders during Can Women Make Enough Milk? 167
Pregnancy 147 Does the Size of the Breast Limit a Woman’s Ability
Nutritional Interventions for Women with Eating to Nurse Her Infant? 167
Disorders 148 Is Feeding Frequency Related to the Amount of Milk
a Woman Can Make? 167
Fetal Alcohol Spectrum 148
Pumping or Expressing Milk 167
Effects of Alcohol on Pregnancy Outcome 148
Can Women Breastfeed after Breast Reduction or
The Fetal Alcohol Syndrome 148
Augmentation Surgery? 168
Nutrition and Adolescent Pregnancy 149 Does Silicone from Breast Implants Leach
Growth during Adolescent Pregnancy 149 into the Milk? 168
Dietary and Other Recommendations for Pregnant
Adolescents 149 The Breastfeeding Infant 168
Optimal Duration of Breastfeeding 168
Evidence-Based Practice 150 Reflexes 168
Breastfeeding Positioning 168
Identifying Hunger and Satiety 169
Chapter 6 Feeding Frequency 169
Vitamin Supplements for Breastfeeding Infants 169
Nutrition during Lactation 155 Identifying Breastfeeding Malnutrition 170
Tooth Decay 171
Introduction 156
Maternial Diet 172
Breastfeeding Goals for the United States 156 Energy and Nutrient Needs 172
Lactation Physiology 157 Maternal Energy Balance and Milk Composition 172
Functional Units of the Mammary Gland 157 Weight Loss during Breastfeeding 172
Mammary Gland Development 158 Exercise and Breastfeeding 172
Lactogenesis 158 Vitamin and Mineral Supplements 173
Hormonal Control of Lactation 159 Vitamin and Mineral Intakes 173
Secretion of Milk 159 Functional Foods 174
The Letdown Reflex 159 Fluids 174
Human Milk Composition 160 Alternative Diets 174
Colostrum 160 Infant Colic 174
Water 160
Factors Influencing Breastfeeding Initiation
Energy 160
and Duration 174
Lipids 162
Obesity and Breastfeeding 174
Protein 162
Socioeconomic 174
Milk Carbohydrates 162
Fat-Soluble Vitamins 163 Breastfeeding Promotion, Facilitation, and Support 175
Water-Soluble Vitamins 163 Role of the Health Care System in Supporting
Minerals in Human Milk 163 Breastfeeding 175
Taste of Human Milk 164 Prenatal Breastfeeding Education and Support 175

Nutrition Time Line

Bettmann/CORBIS

1833 1871
Bettmann/CORBIS

1895
Beaumont’s Proteins, carbohydrates, First milk station
experiments on and fats determined providing children
a wounded to be insufficient with uncontaminated
man’s stomach to support life; that milk opens in
greatly expands there are other New York City
knowledge “essential” components
about digestion
 x Contents

Lactation Support in Hospitals and Birthing Centers 177 Breastfeeding Multiples 206
Lactation Support after Discharge 177
Infant Allergies 207
The Workplace 179
Food Intolerance 207
The Community 180
Public Food and Nutrition Programs 180 Near-Term Infants 208
National Breastfeeding Policy 180 Human Milk and Preterm Infants 208
USDA WIC Program 181
Medical Contraindications to Breastfeeding 210
Model Breastfeeding Promotion Programs 181
Breastfeeding and HIV Infection 210
WIC National Breastfeeding Promotion Project—Loving
Support Makes Breastfeeding Work 181 Human Milk Collection and Storage 212
Wellstart International 182 Milk Banking 212

Model Programs 213

Chapter 7 Breastfeeding Promotion in Physicians’ Office Practices
(BPPOP) 213
Nutrition during Lactation 189 The Rush Mothers’ Milk Club 213
Conditions and Interventions
Introduction 190 Chapter 8
Common Breastfeeding Conditions 190
Sore Nipples 190
Infant Nutrition 219
Letdown Failure 190 Introduction 220
Hyperactive Letdown 191
Assessing Newborn Health 220
Engorgement 191
Birthweight as an Outcome 220
Plugged Duct 191
Infant Mortality 220
Infection 191
Combating Infant Mortality 220
Maternal Medications 192 Standard Newborn Growth Assessment 221
Herbal Remedies 195 Infant Development 221
Specific Herbs Used in the United States 197 Motor Development 221
Critical Periods 223
Alcohol and Other Drugs and Exposures 198 Cognitive Development 223
Alcohol 198 Digestive System Development 223
Nicotine (Smoking Cigarettes) 199 Parenting 223
Marijuana 200
Caffeine 200 Energy and Nutrient Needs 224
Other Drugs of Abuse 200 Caloric Needs 224
Environmental Exposures 200 Protein Needs 224
Fats 225
Neonatal Jaundice and Kernicterus 201 Metabolic Rate, Calories, Fats, and Protein—How Do
Bilirubin Metabolism 202 They All Tie Together? 225
Physiologic versus Pathologic Newborn Jaundice 203 Other Nutrients and Non-nutrients 225
Hyperbilirubinemia and Breastfeeding 204
Prevention and Treatment for Severe Jaundice 206 Physical Growth Assessment 226
Information for Parents 206 Interpretation of Growth Data 227

Nutrition Time Line

Bettmann/CORBIS

1896 1910 1912

Atwater publishes Pasteurized milk Funk suggested
Proximate Composition introduced scurvy, beriberi,
of Food Materials and pellagra
Photo Disc

1906 caused by
deficiency of
Pure Food and Drug Act passed “vitamines” in
by President Theodore Roosevelt the diet
to protect consumers against
contaminated foods
 Contents xi

Feeding in Early Infancy 228 Energy and Nutrient Needs 247

Breast Milk and Formula 228 Energy Needs 247
Cow’s Milk during Infancy 228 Protein Requirements 248
Fats 248
Development of Infant Feeding Skill 229 Vitamins and Minerals 248
Introduction of Solid Foods 231
The Importance of Infant Feeding Position 232 Growth 249
Preparing for Drinking from a Cup 232 Growth in Preterm Infants 249
Food Texture and Development 233 Does Intrauterine Growth Predict Growth Outside? 250
First Foods 233 Interpretation of Growth 251
Inappropriate and Unsafe Food Choices 235 Nutrition for Infants with Special Health
Water 235 Care Needs 251
How Much Food Is Enough for Infants? 235 Nutrition Risks to Development 252
How Infants Learn Food Preferences 236
Severe Preterm Birth and Nutrition 253
Nutrition Guidance 236 How Sick Babies Are Fed 253
Infants and Exercise 236 What to Feed Preterm Infants 254
Supplements for Infants 236 Preterm Infants and Feeding 254
Common Nutritional Problems and Concerns 237 Infants with Congenital Anomalies and Chronic Illness 256
Failure to Thrive 237 Infants with Genetic Disorders 257
Nutrition Intervention for Failure to Thrive 237
Colic 238 Feeding Problems 258
Iron-Deficiency Anemia 238 Nutrition Interventions 260
Diarrhea and Constipation 239
Prevention of Baby-Bottle Caries and Ear Nutrition Services 260
Infections 239
Food Allergies and Intolerances 239
Lactose Intolerance 240 Chapter 10
Cross-Cultural Considerations 240 Toddler and Preschooler 265
Vegetarian Diets 240 Nutrition
Nutrition Intervention for Risk Reduction 241 Introduction 266
Model Program: Newborn Screening and Expanded Definitions of the Life-Cycle Stage 266
Newborn Screening 241 Importance of Nutrition 266
Tracking Toddler and Preschooler Health 266
Healthy People 2010 266
Chapter 9
Normal Growth and Development 266
Infant Nutrition 245 The 2000 CDC Growth Charts 267
Conditions and Interventions Common Problems with Measuring and Plotting
Growth Data 268
Introduction 246
Physiological and Cognitive Development 268
Infants at Risk 246 Toddlers 268
Families of Infants with Special Health Care Needs 247 Preschool-Age Children 271

Nutrition Time Line

1914 1916 1917

Photo Disc

Goldberger identifies the First dietary guidance First food groups

cause of pellagra (niacin material produced for published, The Five
deficiency) in poor the public was released. Food Groups: Milk and
children to be a missing It was titled “Food for Meat;Vegetables and
1913 component of the diet Young Children.” Fruits; Cereals; Fats
First vitamin rather than a germ as and Fat Foods; Sugars
discovered (vitamin A) others believed and Sugary Foods
 xii Contents

Temperament Differences 273

Food Preference Development, Appetite, and
Chapter 11
Satiety 273 Toddler and Preschooler 293
Energy and Nutrient Needs 275 Nutrition
Energy Needs 275
Protein 275 Conditions and Interventions
Vitamins and Minerals 275 Introduction 294
Common Nutrition Problems 276 Who Are Children with Special Health
Iron-Deficiency Anemia 276 Care Needs? 294
Dental Caries 277 Nutrition Needs of Toddlers and Preschoolers
Constipation 278 with Chronic Conditions 295
Lead Poisoning 278
Food Security 278 Growth Assessment 295
Food Safety 279 Feeding Problems 296
Prevention of Nutrition-Related Disorders 279 Behavioral Feeding Problems 297
Overweight and Obesity in Toddlers and Excessive Fluid Intake 297
Preschoolers 279 Feeding Problems and Food Safety 298
Prevention and Treatment of Overweight and Feeding Problems from Disabilities Involving
Obesity 280 Neuromuscular Control 298
Nutrition and Prevention of Cardiovascular Disease Nutrition-Related Conditions 299
in Toddlers and Preschoolers 280 Failure to Thrive 299
Vitamin and Mineral Supplements 281 Toddler Diarrhea and Celiac Disease 299
Herbal Supplements 281 Autism 300
Muscle Coordination Problems and Cerebral Palsy 300
Dietary and Physical Activity Recommendations 282
Pulmonary Problems 301
Dietary Guidelines 282
Developmental Delay and Evaluations 302
Food Guide Pyramid 282
Recommendations for Intake of Iron, Fiber, Fat, and Food Allergies and Intolerance 303
Calcium 283
Fluids 285 Dietary Supplements and Herbal Remedies 303
Recommended versus Actual Food Intake 285 Sources of Nutrition Services 303
Cross-Cultural Considerations 286
Vegetarian Diets 286
Child Care Nutrition Standards 286 Chapter 12
Physical Activity Recommendations 287
Child and 307
Nutrition Intervention for Risk Reduction 287
Model Program 287 Preadolescent Nutrition
Introduction 308
Public Food and Nutrition Programs 288
Definitions of the Life Cycle Stage 308
WIC 288
Importance of Nutrition 308
WIC’s Farmers’ Market Nutrition Program 288
Head Start and Early Head Start 288 Tracking Child and Preadolescent Health 308
Food Stamps 288 Healthy People 2010 308

Nutrition Time Line

Morton Salt Co.

1928
Photo Disc

1921 American Society

First fortified food produced: lodized for Nutritional
salt. It was needed to prevent Sciences and 1929
widespread iodine deficiency goiter the Journal of Essential
in many parts of the United States Nutrition founded fatty acids
identified
 Contents xiii

Normal Growth and Development 309

The 2000 CDC Growth Charts 309
Chapter 13
Physiological and Cognitive Development
Child and 335
of School-Age Children 310 Preadolescent Nutrition
Physiological Development 310
Cognitive Development 311 Conditions and Interventions
Development of Feeding Skills 311 Introduction 336
Energy and Nutrient Needs of School-Age Children 313 “Children Are Children First”—What Does
Energy Needs 313 That Mean? 336
Protein 314
Nutritional Requirements of Children with
Vitamins and Minerals 314
Special Health Care Needs 337
Common Nutrition Problems 314 Energy Needs 337
Iron Deficiency 314 Protein Needs 337
Dental Caries 314 Other Nutrients 337

Prevention of Nutrition-Related Disorders Growth Assessment 338

in School-Age Children 314 Growth Assessment and Interpretation in Children
Overweight and Obesity in School-Age Children 315 with Chronic Conditions 338
Prevention of Overweight and Obesity 316 Body Composition and Growth 338
Nutrition and Prevention of Cardiovascular Disease Nutrition Recommendations 339
in School-Age Children 318 Methods of Meeting Nutritional Requirements 340
Dietary Supplements 319 Fluids 342
Dietary Recommendations 319 Eating and Feeding Problems in Children
Recommendations for Intake of Iron, Fiber, Fat, and Calcium 319 with Special Health Care Needs 342
Recommended versus Actual Food Intake 321 Specific Disorders 342
Cross-Cultural Considerations 322
Vegetarian Diets 322 Dietary Supplements and Herbal Remedies 347

Physical Activity Recommendations 322 Sources of Nutrition Services 348

Recommendations versus Actual Activity 323 USDA Child Nutrition Program 348
Determinants of Physical Activity 323 Maternal and Child Health Block Program
Organized Sports 324 of the U.S. Department of Health and
Human Services (HHS) 348
Nutrition Intervention for Risk Reduction 324 Public School Regulations: 504 Accommodation
Nutrition Education 324 and IDEA 348
Nutrition Integrity in Schools 324 Nutrition Intervention Model Program 349
Model Programs 325
Model Program: High 5 Alabama 326
Chapter 14
Public Food and Nutrition Programs 327
The National School Lunch Program 327 Adolescent Nutrition 353
School Breakfast Program 328
Introduction 354
Summer Food Service Program 329
Team Nutrition 329 Nutritional Needs in a Time of Change 354

Nutrition Time Line

Photo Disc

1937 1941
1930s Pellagra found First refined
to be due to grain-enrichment
Vitamin C identified a deficiency standards developed
in 1932, followed of niacin
by pantothenic acid
and riboflavin in
1933, and vitamin K
in 1934
 xiv Contents

Normal Physical Growth and Development 355 Supplement Use 387

Changes in Weight, Body Composition, Vitamin–Mineral Supplements 387
and Skeletal Mass 356 Herbal Remedies 390
Ergogenic Supplements Used by Teens 390
Normal Psychosocial Development 357
Health and Eating-Related Behaviors during Nutrition for Adolescent Athletes 391
Adolescence 358 Fluids and Hydration 391
Vegetarian Diets 360 Special Dietary Practices 391
Dietary Intake and Adequacy Among Adolescents 362 Substance Use 392
Energy and Nutrient Requirements of Adolescents 362
Iron-Deficiency Anemia 392
Energy 365
Protein 365 Cardiovascular Disease 393
Carbohydrates 366 Hypertension 393
Dietary Fiber 366 Hyperlipidemia 394
Fat 366
Calcium 366 Disordered Eating, Dieting, and Eating Disorders 395
Iron 367 The Continuum of Eating Concerns and Disorders 395
Zinc 368 Prevalence of Eating Disorders 395
Folate 368 Anorexia Nervosa 395
Vitamin A 369 Bulimia Nervosa 396
Vitamin E 369 Binge-Eating Disorder 397
Vitamin C 369 Disordered Eating Behaviors 398
Dieting Behaviors 398
Nutrition Screening, Assessment, and Intervention 369
Body Dissatisfaction 399
Nutrition Education and Counseling 374
Etiology of Eating Disorders 400
Physical Activity and Sports 375 Treating Eating Disorders 400
Factors Affecting Physical Activity 375 Preventing Eating Disorders 401
Eating Disorders among Adolescents: Summing Things Up 402
Promoting Healthy Eating and Physical Children and Adolescents with Chronic Health Conditions 402
Activity Behaviors 377
Effective Nutrition Messages for Youth 377
Parent Involvement 377
School Programs 377
Chapter 16
Community Involvement in Nutritionally Supportive
Environments 380
Adult Nutrition 407
Introduction 408
Definition of Adulthood in the Lifecycle 408
Chapter 15 Importance of Nutrition 408

Adolescent Nutrition 383 Healthy People 2010 Objectives 408

Conditions and Interventions Physiological Changes of Adulthood 408

Sensory Changes 409
Introduction 384
Hormonal Changes 409
Overweight and Obesity 384 Physiological Changes in Males: Climacteric 409
Health Implications of Adolescent Overweight 385 Physiological Changes in Females: Menopause 410

Nutrition Time Line

1941 1946 1947

FDR Library

First Recommended National School Vitamin B12

Dietary Allowances (RDAs) Lunch Act passed identified
announced by President
Photo Disc

Franklin Roosevelt on radio

 Contents xv

Maintaining a Healthy Body 412 Nutrition Intervention 439

Energy for Weight Management 412 Alternative Medicine and Cancer Treatment 439
Determining Energy Needs 412
Energy for Weight Change 413 Cardiovascular Disease: Coronary Heart Disease 439
Actual Energy Intake 413 Definition 440
Fad Diets 414 Prevalence 440
Etiology 440
Dietary Recommendations 415 Effects of CHD 441
Dietary Recommendations to Combat Nutritional Risk Factors 441
Concerns 415 Nutrition Interventions 441
Food Advice 416 Dietary Supplements and Heart Disease 443
MyPyramid 417
Overweight and Obesity 444
Food Advice Reflects Cultural Food Patterns 417
Definition 444
Alcohol: Food, Drug, and Nutrient 417
Prevalence 445
Water and Other Fluids 419
Etiology 445
Diuretic Effects of Caffeine and Alcohol 420
Effects of Obesity 445
International Guidance Related to Fluids 420
Nutrition Interventions 446
Nutrient Recommendations 420 Bariatric Surgery and Role of the RD 447
Nutrients of Public Health Concern 420
Diabetes Mellitus 447
Actual Intake of Food 422
Prevalence 447
Supplements: Vitamins and Minerals 424
Etiology 448
Supplements and CAM (Complementary and Alternative
Insulin Resistance 448
Medicine) 424
Effects of Diabetes 448
Cross-Cultural Considerations 424
Risk Factors 448
Cross-Cultural Dietary Guidance 426
Nutrition Interventions for Type 2 Diabetes 448
Vegetarian Diets 426
Glucophage and Statins 449
Physical Activity Recommendations 428 Metabolic Syndrome 450

Nutrition Intervention for Risk Reduction 430 HIV/AIDS 450

A Model Health-Promotion Program 430 Definition 450
Public Food and Nutrition Programs 430 Prevalence 450
Nutrition and Health Promotion 431 Etiology 450
Effects of HIV/AIDS 452
Nutrition Interventions 452
Chapter 17
Adult Nutrition 437 Chapter 18
Conditions and Interventions Nutrition and 455
Introduction 438 Older Adults
Cancer 438 Introduction 456
Definition 438 What Counts As Old? 456
Prevalence/Etiology 438 Food Matters: Nutrition Contributes to a Long
Risk Factors 438 and Healthy Life 456

Nutrition Time Line

Photo Disc

1965 1966
Photo Disc

1953 T G
C
A
C

T
G
A

Double helix G
C
Food Stamp Act Child Nutrition
structure
T

C
A
passed, Food Stamp Act added school 1968
of DNA A
T
G
program established breakfast to the
G
National School First national nutrition
discovered C T
A C
G

Lunch Program survey in United States

launched (the Ten
State Nutrition
Survey)
 xvi Contents

A Picture of the Aging Population:Vital Statistics 457 Community Food and Nutrition Programs 481
Global Population Trends: Life Expectancy Elderly Nutrition Programs 481
and Life Span 457 Senior Nutrition Program 481
Nutrition: A Component of Health Objectives The Promise of Prevention: Health Promotion 482
for the Older Adult Population 458
Theories of Aging 458 Chapter 19
Programmed Aging 459
Wear-and-Tear Theories of Aging 459 Nutrition and 487
Calorie Restriction and Longevity 459
Physiological Changes 460
Older Adults
Body Composition Changes 460 Conditions and Interventions
Changing Sensual Awareness: Taste and Smell, Chewing Introduction: The Importance of Nutrition 488
and Swallowing, Appetite and Thirst 461
Nutrition and Health 488
Nutritional Risk Factors 462
Heart Disease/Cardiovascular Disease 489
Dietary Recommendations 465 Prevalence 489
Food-Based Guidance: MyPyramid 465 Risk Factors 489
Actual Food Group Intake 466 Nutritional Remedies for Cardiovascular Diseases 489
Eating Occasions 466
Stroke 489
Nutrient Recommendations 467 Definition 489
Estimating Energy Needs 467 Prevalence 489
Nutrient Recommendations: Macro- and Micronutrients Etiology 489
of Concern 467 Effects of Stroke 489
Recommendations for Fluid 470 Risk Factors 490
Age-Associated Changes in Metabolism: Nutrients Nutritional Remedies 491
of Concern 470
Low Dietary Intake: Nutrients of Concern 472 Hypertension 491
Nutrient Supplements:Why,When,Who,What, Definition 491
and How Much? 473 Prevalence 492
Dietary Supplements, Functional Foods, Nutraceuticals: Etiology 492
Special Interest for Older Adults 475 Effects of Hypertension 492
Nutrient Recommendations: Using the Food Label 475 Risk Factors 492
Cross-Cultural Considerations in Making Dietary Nutritional Remedies 492
Recommendations 477 Cancer 492
Food Safety Recommendations 477 Prevalence of Cancer 492
Etiology and Effects of Cancer 492
Physical Activity Recommendations 478 Risk Factors 493
Exercise Guidelines 478 Nutritional Remedies for Cancer 493
Nutrition Policy and Intervention for Risk Diabetes 494
Reduction 479 Effects of Diabetes 494
Nutrition Education 479 Risk Factors 494
Model Programs Exemplify Intervention Goals 480 Nutritional Interventions 495

Nutrition Time Line

1970 1972 1977 1978 1989

First Canadian national Special Supplemental Dietary Goals First Health First national
nutrition survey launched Food and Nutrition for the United Objectives scientific consensus
(Nutrition Canada Program for Women, States issued for the Nation report on diet and
National Survey) Infants, and Children released chronic disease
(WIC) established published
 Contents xvii

Obesity 496 Medications and Polypharmacy 508

Definition 496
Prevalence 496 Low Body Weight/Underweight 509
Etiology/Effects/Risk Factors of Obesity 496 Etiology 510
Nutritional Remedies 496 Nutrition Interventions 510

Osteoporosis 497 Dehydration 511

Definition 497 Etiology 512
Prevalence 497 Effects of Dehydration 512
Etiology 497 Nutritional Interventions 512
Inadequate Bone Mass 497 Rehydrate Slowly 513
Increased Bone Loss 498 Dehydration at End-of-Life 513
Effects of Osteoporosis 498
Bereavement 513
Risk Factors 498
Nutritional Remedies 498
Other Issues Impacting Nutritional Remedes 500 Appendix A
Oral Health 500 CDC Growth Charts A-1
Gastrointestinal Diseases 501
Gastroesophageal Reflux Disease (GERD) 501 Appendix B
Changes in Nutrient Availability:Vitamin B12
Deficiency 502
Nutrient Intakes of Adults
Pernicious Anemia 502 Aged 70 and Older A-9
Food-bound Vitmain B12 Malabsorption 503
Constipation 504
Appendix C
Inflammatory Diseases: Osteoarthritis 504
Definition 504 Measurement Abbreviations
Etiology 505
Effects of Osteoarthritis 505
and Equivalents A-11
Risk Factors 505
Nutritional Remedies 505 Appendix D
Cognitive Disorders: Alzheimer’s Body Mass Index (BMI) A-13
Disease 506
Prevalence of Dementia 507
Etiology of Cognitive Disorders 507
Glossary G-1
Effects of Cognitive Disorders 507
Nutrition Interventions for Cognitive Disorders 507 Index I-1

Nutrition Time Line

1997 1998
Photo Disc

2003 2006
RDAs expanded to Folic acid Sequencing of DNA in the Obestity and
Dietary Reference fortification human genome completed. diabetes become
Intakes (DRIs) of refined grain Marks beginning of new era global epidemics
products begins of research innutrient–gene
interactions