table b-8 interpretation of lab values (continued)cholecystitis, renal insufﬁ-ciency, alcohol ......

APPENDIX B ¥ DIETETIC PROCESS, FORMS, AND COUNSELING TIPS969

Acetone, ketones

Aldosterone

Ammonia

Amylase

Calcium, normal diet

Cortisol, urinary free

Creatinine clearance

Epinephrine, norepinephrine

Estrogens

Hemoglobin, myoglobin

5-Hydroxyindoleacetic acid

(5-HIAA)

Oxalate pH

Protein (albumin)

SpeciÞc gravity

Sugar

3-Methyl histidine, urine

Urea

Uric acid

Vanillylmandelic acid (VMA)

Volume

TABLE B-8 Interpretation of Lab Values (continued)

Value Normal Range Purpose or Comment Increased In Decreased In

0

6Ð16 mg/24 h

20Ð70 mEq/L

260Ð950 Somogyiunits/24 h

� 250 mg/24 h

10Ð100 g/dL

Males (20 years old):90 mL/min/SA;females (20 yearsold): 84 mL/min/SA;decreases by 6 mL/min/SA per decade

Epinephrine: � 10 g/24 h; Norepineph-rine � 100 g/24 h

4Ð25 mg/24 h inmales; 4Ð60 mg/24 h in females,higher in pregnancy

0

0

20Ð60 mg/24 h

4.6Ð8; average of 6 (dependent on diet)

� 30 mg/24 h (0 qualitative)

1.003Ð1.030

0

20Ð35 g/L

0.2Ð2.0 g/L

� 6.8 mg/24 h

1000Ð1500 mL

Elevation indicates ketosis.

Any amount

Serotonin excretion

Depends on time of sampling andfood ingested

Amino acids in urine should be0.4Ð1 g/L.

Ability to concentrate urine

Indicator of lean body massturnover

Metabolite of both epinephrineand norepinephrine

Varies slightly between individuals

Diabetic ketoacidosis; star-vation; fever; prolongedvomiting; high-protein,high-fat, or low-CHO diet;diarrhea; anorexia

Hepatic disease or coma,renal failure, severe heartfailure, high-protein diet

Perforated peptic ulcer, acutepancreatitis, mumps,cholecystitis, renal insufÞ-ciency, alcohol poisoning

Hyperparathyroidism, highcalcium or vitamin D indiet, immobilization,metastatic bone disease,multiple myeloma, renaltubular acidosis

Elevated in stress

Pregnancy, childhood, exercise.

Stress

Blood loss, urinary tractinjury

Calcium oxalate stones

Alkaline: metabolicalkalemia, proteus infec-tion, aged specimen,large amount of fruitsand vegetables eaten

Nephrotic syndrome

High in antidiuretichormone deÞciency

Hyperglycemia, ketosis, DKA

Increased levels may reßectloss of lean body mass.

Diabetes insipidus

Essential hypertension

Hepatitis, pancreatic insufÞ-ciency, severe burns

Decreased levels may reßectpoor intake. Hypoparathy-roidism, rickets, renal failure, steatorrhea, osteo-malacia

Adrenal insufÞciency

Ascites, dehydration, renalfailure, heart failure,shock, cirrhosis

Acidic: high-protein intake

Low in renal tubular dysfunction

Dehydration

The table provides estimated and sample normal values; normal ranges will vary by the techniques used by the laboratory completing the tests.Developed from: Pagana KD, Pagana TJ. MosbyÕs manual of diagnostic and laboratory tests. 4th ed. Philadelphia: Mosby, 2009.

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970 NUTRITION AND DIAGNOSIS-RELATED CARE

TABLE B-9 Quick Reference: FoodÐDrug Interactions

Drugs Effects and Precautions Drugs Effects and Precautions

Antibiotics

Cephalosporins, Take on an empty stomach to speed absorption penicillin of the drugs.

Erythromycin Do not take with fruit juice or wine, whichdecrease the drugÕs effectiveness.

Sulfa drugs Increase the risk of vitamin B12 deÞciency.

Tetracycline Dairy products reduce the drugÕs effectiveness.Lowers vitamin C absorption.

Anticonvulsants

Dilantin, Increases the risk of anemia and nerve problemsphenobarbital due to a deÞciency in folate and other

B vitamins.

Antidepressants

Fluoxetine Reduces appetite and can lead to excessive weightloss.

Lithium A low-salt diet increases the risk of lithium toxici-ty; excessive salt reduces the drugÕs efÞcacy.

Monoamine oxidase Foods high in tyramine (e.g., aged cheeses,(MAO) inhibitors processed meats, legumes, wine, and beer) can

bring on a hypertensive crisis.

Tricyclics Many foods, particularly legumes, meat, Þsh, andfoods high in vitamin C, reduce absorption ofthe drugs.

Antihypertensives, Heart Medications

Angiotensin- Take on an empty stomach to improve the converting enzyme absorption of the drugs.(ACE) inhibitors

Alpha-blockers Take with liquid or food to avoid excessive drop inblood pressure.

Antiarrhythmic drugs Avoid caffeine, which increases the risk of anirregular heartbeat.

Beta-blockers Take on an empty stomach; food, especially meat,increases the drugÕs effects and can cause dizzi-ness and low blood pressure.

Digitalis Avoid taking with milk and high-Þber foods, whichreduce absorption; increases potassium loss.

Diuretics Increases the risk of potassium deÞciency.

Potassium-sparing Unless a doctor advises otherwise, do not takediuretics diuretics with potassium supplements or salt sub-

stitutes, which can cause potassium overload.

Thiazide diuretics Increases the reaction to MSG.

Asthma Drugs

Pseudoephedrine Avoid caffeine, which increases feelings of anxietyand nervousness.

Theophylline Charbroiled foods and a high-protein diet reduceabsorption. Caffeine increases the risk of drugtoxicity.

Cholesterol-Lowering Drugs

Cholestyramine Increases the excretion of folate and vitamins A,D, E, and K.

GemÞbrozil Avoid fatty foods, which decrease the drugÕs efÞcacy in lowering cholesterol.

Heartburn and Ulcer Medications

Antacids Interfere with the absorption of many minerals;for maximum beneÞt, take medication 1 hourafter eating.

Cimetidine, Avoid high-protein foods, caffeine, and other famotidine, items that increase stomach acidity.sucralfate

Hormone Preparations

Oral contraceptives Salty foods increase ßuid retention. Drugs reducethe absorption of folate, vitamin B6, and othernutrients; increase intake of foods high in thesenutrients to avoid deÞciencies.

Steroids Salty foods increase ßuid retention. Increaseintake of foods high in calcium, vitamin K,potassium, and protein to avoid deÞciencies.

Thyroid drugs Iodine-rich foods may lower the drugÕs efÞcacy.

Laxatives

Mineral oils Overuse can cause a deÞciency of vitamins A, D, E,and K.

Painkillers

Aspirin and Always take with food to lower the risk of stronger gastrointestinal irritation; avoid taking withnonsteroidal anti- alcohol, which increases the risk of bleeding.inßammatory Frequent use of these drugs lowers the drugs absorption of folate and vitamin C.

Codeine Increase Þber and water intake to avoid constipation.

Sleeping Pills, Tranquilizers

Benzodiazepines Never take with alcohol. Caffeine increases anxietyand reduce drugÕs effectiveness.

Weight LossÐInducing Drugs

Many drugs cause weight loss because of changes in appetite or other side effects.



TABLE B-10 Sample Worksheet for Using Standardized Nutrition Terminology

Nutrition Care ProcessÑCritical thinking worksheet to help determine the appropriate standardized language to document and support the NCP

STEPONE: NUTRITIONASSESSMENT

Complete a comprehensive assessment of a patient using the established assessment standards/guidelines set by your facility or practice setting. Be sure to include Òcomparative standards:Ó anthropometrics, estimated needs, and nutrient intake as well as identify the reference standardsused to analyze thecalculated/numerical data such as the DRIs, BMI, and NCHS charts.

STEPTWO: NUTRITIONDIAGNOSIS

(1) List all of the patientÕs problems/issues: (2) Cross off medical problems/medical diagnoses.

(3) Cross off issues that do not have supporting evidence (of signs/symptoms).

(4) Cross off issues where the root etiology (cause of) cannot be determined.

(5) Place a Ò� Ó by the issues you will be able to re-evaluate upon follow-up; be sure to have updatedsigns/symptoms data on the reassessment date.

(6) Of the checked issues, circle those that are the most urgent nutrition problem(s) to resolve and thepriority issue to start addressing.

(7) Based on the problem(s) circled, choose the diagnosis that best suits the nutrition issue in its mostdetailed form.

(8) Write P.E.S statement(s) with the appropriate ÒrootÓ etiology and signs/symptoms:

P: _______________________________________related to E:___________________________________________________ as evidenced byS/S:______________________________________________________________________________________***See examples

STEPTHREE: NUTRITIONINTERVENTION(Direct interventions at the etiology. If a dietitian cannot change the etiology, then direct the interventions at reducingthe signs/symptoms of the nutrition diagnosis).

Nutriti on Prescription: (Proper diet and regimen to meet the nutrient needs of what?) ________________________________________

Based upon scope of practice and clinical privilege established by your facility or practice setting, choose:

1) Recommended Interventions (other practitioner must do)

¥ intervention term:

goal of intervention:





2) Interventions you can/will do on your own (actions)







Goal of intervention � why you chose that intervention/strategy � what the intervention is intended to do/accomplish

STEPFOUR: MONITORING& EVALUATION(Directed at the signs/symptoms to monitor the success of intervention(s) and progress toward goal(s)

1) Indicate when/timeframe during which you plan to reassess: within ____________ days/weeks/months

2) List signs/symptoms from PES above and match to M&E Terms(unshaded) from Assess/M&E list (indicators)

3) Establish criteria for each M&E indicator (pt goals)

¥ Signs/Symptoms:

M&E term:

Criteria-Pt will:

¥ Signs/Symptoms:

M&E term:

Criteria-Pt will:

¥ Signs/Symptoms:

M&E term:

Criteria-Pt will:

Criteria � measurable patient-centered goals

Reassessment or follow-up encounter

1) Do you have the info/data needed to compare previous signs/symptomsto the current time? If no, you need to address this as an interventionrecommendation, and check it at the next encounter. If yes, evaluateprogress toward the M&E criteria on the left (pt goals).

n Pt met goal/criteria n Pt did not meet goal/criteria

2) Based upon progress toward pt goals, evaluate progress toward the resolution of the nutrition problem from the PES:

n Resolved (nutrition problem no longer exists)

n Improvement shown (nutrition problem still exists)

n Unresolved no improvement shown

n No longer appropriate (change in condition)

3) If no improvement is shown, you may need to change intervention(s).

(continued)



TABLE B-10 Sample Worksheet for Using Standardized Nutrition Terminology (continued)

***SAMPLE COMMON PES STATEMENTS

¥ Common Etiology Common Signs/Symptoms Òas evidencedDiagnostic Label Domain Code ¥ Òas related to . . .Ó by . . .Ó [with M/E codes]

Inadequate oral food/ NI-2.1 ¥ Decreased appetite ¥ Poor po intake of � 25% of meals [M&E � FH-1.3.2]beverage intake ¥ Nausea

¥ Emesis¥ Altered mental status

¥ Increased needs with advanced Ca ¥ Wt loss of � 5% in 1Ð2 months [M&E Ð AD-1.1.4]¥ Increased needs due to wound ¥ Poor po intake of � 25% of meals [M&E Ð FH-1.3.2]

healing, infection, multiple frax¥ Increased needs secondary to

catabolic state

¥ Comfort measures only (Hospice) ¥ Consumption of minimal comfort foods � 10% needs[M&E Ð FH-1.2.1]

Inadequate intake NI-2.3 ¥ Current TF formula/rate ¥ Current nutrition regimen only meeting __% of est. from enteral/ ¥ Increased needs sec to surgery needs [M&E Ð FH-1.2.1]parenteral nutrition ¥ Infusion goal not reached due to ¥ TF/TPN only meeting __% of est. needs

intolerance of feeding [M&E Ð FH-1.4.1]

¥ Wt loss of ___% in ___ weeks/months [M&E Ð AD-1.1.4]¥ Delayed wound healing [M&E Ð PD-1.1.8]

Excessive intake from NI-2.4 Decreased needs due to ventilator ¥ Current nutrition regimen meeting � 100% of est. enteral/parenteral needs [M&E Ð FH-1.2.1]nutrition ¥ TF/TPN meeting � 100% of est. needs

[M&E Ð FH-1.4.1]

Increased nutrient NI-5.1 ¥ Increased nutrient demands ¥ Prealb or alb of __g/L (decreased) [M&E Ð BD-1.11.1]needs (protein) (PRO) for: ¥ Loss of skin integrity (surgical wounds)

¥ Wound healing [M&E Ð PD-1.1.8]¥ Surgical wounds ¥ Loss of muscle mass [M&E Ð PD-1.1.4]

¥ Stage __ pressure ulcer [M&E Ð PD-1.1.8]¥ Inadequate protein intakeÐ consuming only __%

pro needs [M&E Ð FH-1.6.2]

Malnutrition NI-5.2 ¥ End-stage liver disease ¥ Decreased albumin of ____g/L [M&E Ð BD-1.11.1]¥ Short gut ¥ Decreased food intake, consuming only ___% meals ¥ Small bowel transplant [M&E Ð FH-1.3.2]

¥ Mental illness ¥ Pt refusing to eat [M&E Ð FH-1.3.2]

¥ Ascites ¥ Wt loss of ___% in ___weeks/months [M&E Ð AD-1.1.4]

¥ ETOH dependency ¥ Evident temporal wasting [M/E Ð PD-1.1.6]

¥ Evident minimal body fat / fat stores [M/E Ð PD-1.1.4]¥ Evident cachexia [M/E Ð PD-1.1.4]¥ Delayed wound healing [M/E Ð PD-1.1.8]

Provided courtesy of Sherri Jones, MS, MBA, RD, LDN. UPMC Presbyterian Shadyside, Pittsburgh PA.



TABLE B-11 Clinical Case Review and Audit

3 Exceeds 2-Met Goals 1-Unsat.Assessment Very detailed Competent Large amt missing Comments

Pathophysiology of disease/disorder

Stage/phase (if applicable)

Relevance of nutrition status in this disorder/disease

Prognosis for this disease

Up-to-date interpretation of evidence-based research

General information noted- Ht, Wt

Social background reviewed

Past medical status/socioeconomic status

Family history; genetics, if relevant

Pertinent medical/surgical status reviewed/documented

Medications and potential drug/nutrient interactions assessed/noted

Laboratory values: skewed values and relevance noted

Typical diet recall or diet Hx analyzed

Correct calculations/anthropometrics used to estimate nutrition needs

3 Exceeds 2-Met Goals 1-Unsat.Nutrition Diagnoses Very detailed Competent Large amt missing Comments

1Ð2 Nutrition diagnosis(es) identiÞed & appropriate

P.E.S statements: logical, able to be managed by an RD in this setting

3 Exceeds 2-Met Goals 1-Unsat.Nutrition Interventions Very detailed Competent Large amt missing Comments

Short- and long-term goals set with pt/signiÞcant other

Recommendations based on etiologies of problems

FoodÐnutrient delivery:

Education:

Counseling:

Coordination of care:

3 Exceeds 2-Met Goals 1-Unsat.Monitoring and Evaluation Very detailed Competent Large amt missing Comments

Progress: day to day analysis Ð Intake

Progress: day to day analysis Ð Clinical

Progress: day to day analysis Ð Behavioral/Environmental

Documented need for f/up; timeframe noted

If education provided, pt/family understanding is documented

Nutrition support Ð kilocalories, protein, ßuid, recommendations proper

Nutrition care plans updated in a timely manner

Meal plan established if warranted

Age-appropriate standards and assessment tools used if needed

Discharge plan or needs discussed

3 Exceeds 2-Met Goals 1-Unsat.Communication and Documentation Very detailed Competent Large amt missing Comments

Organized; follows a comprehensible sequence

Educational ßow sheets documented accurately

Uses correct grammar and terms

Follow-up notes re-evaluate nutrition diagnoses, status, plans

Evaluator:_____________________________ Date:________________ Medical Record #___________________

TOTAL POINTS:________________



TABLE B-12 Tips for Adult Education and Counseling

The adult as a learner During the process of maturation, a person moves from dependency toward increasing self-directedness but at different ratesfor different people and in different dimensions of life. Teachers have a responsibility to encourage and nurture this move-ment. Adults have a deep psychological need to be generally self-directing, but they may be dependent in certain tempo-rary situations.

The learnerÕs experience As people grow and develop, they accumulate an increasing reservoir of experience that becomes an increasingly richresource for learningÑfor themselves and for others. Furthermore, people attach more meaning to lessons they gain fromexperience than those they acquire passively. Accordingly, the primary techniques in education are experiential onesÑlaboratory experiments, discussion, problem-solving cases, Þeld experiences, case reports.

Readiness to learn People become ready to learn something when they experience a need to learn it in order to cope more satisfyingly with real-life tasks and problems. The educator has a responsibility to create conditions and provide tools and procedures for helpinglearners discover their Òneed to know.Ó Learning programs should be organized around life-application categories andsequenced according to the learnersÕ readiness to learn. Key: Attend to learnersÕ developmental readiness.

Orientation to learning Adult learners see education as a process of developing increased competence to achieve their full potential in life. Theywant to be able to apply whatever knowledge and skill they gain today to living more effectively tomorrow. Accordingly,learning experiences should be organized around competency-development categories. People are performance-centered intheir orientation to learning.

Assumptions 1. All learners can think; critical and creative thinking are goals.

2. There needs to be a safe, risk-taking environment and sufÞcient time to learn.

3. The environment for learning should be rich and responsive.

4. Offer challenging problem-solving opportunities.

Chief assessment 1. Socioeconomic factorsfactors for learning 2. Cultural/religious beliefs and background

3. Age and sex of patient and signiÞcant others (SOs)

4. Birth order of patient and family involvement

5. Occupation

6. Medical status and medical history

7. Marital status; number and ages of children

8. Cognitive status; educational level

9. Readiness to learn and staging: precontemplation, contemplation, preparation, action, or maintenance

10. Emotional status (stress, acceptance of illness, chronic disease, or condition)

Health literacy and Low health literacy (the ability to read, understand, and act on health information) is a public health issue. One out of teaching tools Þve American adults reads at the Þfth-grade level or below, and the average American reads at the eighth to ninth grade

level. Most consumers need help understanding healthcare information. Patients prefer medical information that is easy toread and understand. Easy-to-read healthcare materials are essential. Provide important information Þrst.

Written materials Print very clearly and avoid handwritten messages. Use large print; font size should be a minimum of 12 points.

Double space text to avoid crowding. Avoid using all capital letters. Use headings to introduce the upcoming topic.

Avoid abbreviations, and use black ink on light-colored paper.

Information must be current and accurate. Provide important information Þrst.

Highlight the Òneed to knowÓ versus the Ònice to know.Ó

Present information in a Òhow toÓ manner.

Use a conversational style.

Spell out numbers below 10.

Limit syllables to Ñone or two per word. Keep sentences short, and use bullets when possible.

Educational tools Newsletters and bulletin boards

Demonstrations or role-playing

Laboratory reports, ßip charts

Food recall or intake records with feedback

Educational games and fun quizzes

Group classes or supermarket tours

Educational video and audio tapes

(continued)



TABLE B-12 Tips for Adult Education and Counseling (continued)

Visual aids Visuals should be able to stand alone, without words.

Use photographs and realistic images.

Use culturally appropriate food models, empty packages of real foods, and measuring cups and spoons.

Work with restaurant menus where needed.

Share simple recipes.

Principles of learning The recipient must value the information.

Pace should be adequate for learner; take small steps.

Environment should be conducive to learning (free of distractions and stress), and patient should be ready to learn (free from pain).

Information must be meaningful, relevant, and organized. Material should be logical in sequence.

Counselor must be truly interested in sharing the information.

Adequate follow-up should be available for the reinforcement of facts and principles.

For adult learners, information that is useful in the present is more meaningful than facts learned for the Òfuture.Ó

Adults tend to prefer problem-solving information (survival skills) over learning facts.

Principles of teaching The counselor must Þrst listen to the patient. Involve the patient in setting mutual objectives.

Small segments of information should be presented in understandable language in small, manageable Òsound bytes.Ó

An organized plan should be used to teach. Clear objectives should be established, with timelines and short- and long-termoutcomes.

Feedback should be used with each step. Be prepared to receive evaluation (peer review) from the patient; improve as needed.

Good eye contact should be maintained with the patient. Be aware, however, that direct or prolonged eye contact can beseen as rude or threatening by some cultures; know your client.

Appropriate teaching tools or audiovisual aids should be used as appropriate. Using a sixth- to eighth-grade reading level issuggested, preferably with an easy layout, visual appeal, and illustrations.

Questions must be allowed for clariÞcation.

Praise and positive reinforcement should be offered to the learner. Carl Rogers emphasizes the use of Òunconditional positiveregardÓ for all persons.

Counseling tips Knowledge does not automatically ensure compliance. Behavioral change takes time and encouragement.

Trial and error will be common for the patient in learning new behaviors.

An increase in self-esteem comes with an improvement in behavior.

The counselor should appropriately foster independence.

Empathy is an important part of humanistic care.

The counselor serves as an intervention specialist. The Òpatient-centeredÓ approach to counseling is effective.

Assess the stage of change and motivation level of client. Evaluate past experiences with dietary changes and anticipatedchallenges.

Goal-setting requires the patient to recognize the need for change, establish a goal, monitor goal-related activity, and useself-reward for goal attainment.

Identify challenges, obstacles, coping strategies, and skills. Help the client to anticipate lapses and relapses.

Patient assessment of Patient-centered model of behavioral counseling using the 5 As:chronic illness care Assess:Beliefs, behavior, and knowledge.(PACIC tool)

Advise:Provide speciÞc information about health risks and beneÞts of change.

Agree:Collaboratively set goals based on the patientÕs interest and conÞdence in their ability to change behavior.

Assist: Identify personal barriers, strategies, problem-solving techniques, and social/environmental support.

Arrange:Specify a plan for follow-up (e.g., visits, phone calls, mailed reminders).

Counseling in hospice care Attempt to reduce fears related to eating.

Recognize stages of terminal illness: fear of abandonment, Þnding a natural and realistic approach, building bridges, andownership of the experience.

Pain management is most important for quality of life.

Respect the individualÕs cultural beliefs and needs.

Identify a patient advocate who will address concerns as care progresses.

Help maintain self-esteem and dignity.

Comfort foods can be important to patient satisfaction; address these needs on a meal-to-meal basis.

Listen for hidden messages from the patient; communicate with other healthcare team members.



TABLE B-13 Health-Promotion Intervention Models

Because increasing evidence suggests that health-promotion interventions that are based on social and behavioral science theories are more effective thanthose lacking a theoretical base, Þve models are described here (Glanz and Bishop, 2010.)

Behavioral Ecological Model (BEM) Principle Processes Application

Environment inßuences behavior Consequences are produced by the behavior Control or change risky environment

Hierarchy of interacting reinforcement Interaction is key Interaction among both physical and social contingenciescontingencies explain and ultimately control health behavior.

Hovell MF, Wahlgren DR, Gehrman C. The Behavioral Ecological Model: Integrating public health and behavioral science. In DiClemente RJ, Crosby R, Kegler M, (eds.). New andEmerging Theories in Health Promotion Practice & Research.Jossey-Bass Inc., San Francisco, California, 2002.

(continued)

Figure B-4 Behavioral Ecological Model (BEM). (Image courtesy of Hovell et al [2002].)

Behavioral Ecological Model (BEM)

SOCIAL/CULTURAL LEVELNationality

Culture Specific

COMMUNITY LEVELPoliciesLawsMedia

LOCAL LEVELClinical ServicesBuilt and Social

Environment

Specif

ic

Bi Directional Influence

Gener

ic

INDIVIDUAL LEVELNormative Group

Physical

Sources of Interlocked Contingencies



TABLE B-13 Health-Promotion Intervention Models (continued)

Health Belief Model Concept DeÞnition Application

Perceived susceptibility

Perceived severity

Perceived beneÞts

Perceived barriers

Cues to action

Self-efÞcacy

Glanz K, Bishop DB. The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health.31:399, 2010.Glanz, K., Rimer, BK, Lewis, FM. Health Behavior and Health Education. Theory, Research and Practice.San Francisco: Wiley & Sons., 2002.

OneÕs opinion of chances of getting a condition.

OneÕs opinion of how serious a condition and itssequelae are.

OneÕs opinion of the efÞcacy of the advised actionto reduce risk or the seriousness of impact.

OneÕs opinion of the tangible and psychologicalcosts of the advised action.

Strategies to activate readiness.

ConÞdence in oneÕs ability to take action.

DeÞne population(s) at risk, risk levels. Personalize risk basedon a personÕs features or behavior. Heighten perceived sus-ceptibility if too low.

Specify consequences of the risk and the condition.

DeÞne action to take: how, where, when; clarify the positiveeffects to be expected.

Identify and reduce barriers through reassurance, incentives,and assistance.

Provide how-to information; promote awareness, reminders.

Provide training, guidance in performing action.

(continued)

Figure B-5 Health Belief Model (HBM). (Image courtesy of Glanz et al (2002).)

Perceptions andmodifying factors.

Demographic,Sociopsycho and

Structural Variables

Perceivedseriousness and

susceptibility

Assessments

Cost / benefitanalysis

Perceived threat

Likelihood of action

Age, race, ethnicity etc.Peers, personality,social pressure etc.

Prior contact or knowledgeabout the disease

Cue to action

“How dangerousis it?”

Media campagns, lay advice,reminders from G.P.,

magazines, articles, etc.

“Will I get it?”

Health Belief Model

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Direct persuasion is not an effective method forachieving change. Client must articulate andresolve his or her own ambivalence.

Directive, client-centered counseling style for elic-iting behavior change by helping clients toexplore and resolve ambivalence.

Counseling style is a quiet, eliciting one. Partnership is thegoal, not an expertÑrecipient relationship.

Compared with nondirective counseling, it is more focusedand goal-directed. Readiness to change is a ßuctuatingproduct of personal interaction.

Cognitive, vicarious, and self-reßective processes

Self as organizing, proactive, self-reßective

Interactive learning

Positive approaches to goals, tasks, and challenges.

Human adaptation to change

People are not reactive organisms shepherded by environmental forces or concealed inner impulses

ConÞdence comes from practice

Those who believe they can perform well are more likely toview difÞcult tasks as something to be mastered ratherthan something to be avoided.

Motivational Interviewing(MI) Concept DeÞnition Application

Motivation to change comes from the client, not the counselor

Resolution of ambivalence

Rollnick S., & Miller, W.R. What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23: 325, 1995.

Social Cognitive Theory Principle Processes Application

Human functioning is self-regulated

Dynamic interplay of personal, behavioral, and environmental inßuences

People watch and learn from others

Self-efÞcacy is the belief in the ability to succeed in speciÞc situations

Bandura, A. Social foundations of thought and action: A social cognitive theory.Englewood Cliffs, NJ: Prentice Hall, 1986.

Revelance

Reinforcement

Risk

RewardRoad Blocks

Figure B-6 Key Words for Motivational Interviewing.

(continued)

Figure B-7 Self-EfÞcacy as part of Social Cognitive Theory.


Motivational Interviewing

Social Cognitive Theory




TTM Stage DeÞnition Helping Processes

Precontemplation

Contemplation

Preparation for action

Action

Maintenance

Prochaska JO, DiClemente CC. Trans-theoretical therapy Ð toward a more integrative model of change. Psychotherapy: Theory, Research & Practice.19(3):276, 1982.

Individual has the problem (whether he/she recognizes it or not)and has no intention of changing.

Individual recognizes the problem and is seriously thinking aboutchanging.

Individual recognizes the problem and intends to change thebehavior within the next month. Some behavior change effortsmay be reported but the deÞned behavior change criterion hasnot been reached consistently.

Individual has enacted consistent behavior change for less than sixmonths.

Individual maintains new behavior for six months or more.

Consciousness raising (information and knowledge)Dramatic relief (role-playing)Environmental reevaluation (how problem affects physical

environment)

Self-reevaluation (assessing oneÕs feelings regardingbehavior)

Self-liberation (commitment or belief in the ability tochange)

Reinforcement management (overt and covert rewards)Helping relationships (social support, self-help groups)Counterconditioning (alternatives for behavior)Stimulus control (avoid high-risk cues)

Support and encouragement

Precontemplation

Contemplation

Preparation

Action

Maintenance RELAPSE

PROGRESS

Figure B-8 Transtheoretical Model (TTM). (Image courtesy of Prochaska and DiClemente (1982).)

Transtheoretical Model (TTM)



TABLE B-14 Sample Monitoring and Evaluation Audits for Patient Education

This patient education audit identiÞes the ability of the patient to demonstrate or verbalize how he or she will or has changed behaviors after nutritionalinstructions.

(continued)

Any Patient

1. Patient is able to personalize the MyPyramid food guidance system.

2. Patient is able to explain the importance of his or her diet for his or herhealth.

3. Patient is able to plan ____ dayÕs menus and snacks from his/her dietarypattern.

4. Patient is able to incorporate desirable economic/ethnic food choicesinto his/her prescribed diet.

5. Patient has been following _____ diet at home for a period of time andis able to describe the elements of this diet with accuracy.

6. Patient expresses recognition of a need to lose/gain weight.

7. Patient is able to describe speciÞc food allergies and food ingredients toavoid.

8. Patient is able to describe the reasons for following _______ diet (e.g.,improve appearance, increase energy, reduce chances for complications,improve quality of life).

9. Patient is able to describe the impact of appropriate activity or exerciseon health and nutritional well-being.

Cardiac Diet

1. Patient is able to name three beverages that are high in caffeine.

2. Patient is able to describe modiÞcations in his or her diet that will beneeded to prevent further coronary complications: saturated versus poly-and monounsaturated fats, sodium and potassium, Þber, and use of theDASH diet.

3. Patient is able to categorize correctly into the proper food pyramid lists.

4. Patient is able to plan menus for home use that include appropriate modiÞcations.

5. Patient is able to name snack foods that can be included in dietary plan.

Diabetes Diet

1. Patient is able to explain the relationship of diet with complications ofdiabetes.

2. Patient is able to name foods that contain CHO.

3. Patient is able to preplan meals for _____ weeks.

4. Patient is able to verbalize a simple deÞnition of diabetes.

5. Patient is able to describe the role of medications related to food intake.

6. Patient is able to explain the rationale for following a prudent diet toprevent complications such as heart disease.

7. Patient is able to explain how proper spacing of meals affects his/herdisorder.

8. Patient is able to describe symptoms of ketoacidosis and insulin shockand can name foods to take or avoid for each condition.

9. After looking at several food labels, patient is able to point out ingredi-ents that mean carbohydrate.

10. Patient is able to describe techniques for managing special events(travel, parties, restaurants, holiday meals, weekends).

11. Patient is able to describe his or her personal exercise prescription as___ minutes of activity ___ times per week.

12. Patient is able to describe 1Ð2 items to carry in case of episodes of lowblood glucose.

13. Patient is able to deÞne when to call his or her health provider (e.g., when glucose is above/below normal ___ times).

14. Patient is able to discuss proper foot care, the need for eye exams, andthe need for foot exams.

Dumping Syndrome Diet

1. Patient is able to verbalize the effects of diet on dumping syndrome.

2. Patient is able to explain the guidelines to be followed to prevent dump-ing syndrome (e.g., beverages are served 30 minutes before or aftermeals; concentrated sweets are omitted or severely limited).

Gliadin-Free/Gluten-Restricted Diet

1. Patient is able to examine food labels and to name ingredients that mustbe avoided.

2. Patient is able to list products that must be avoided in diet.

3. Patient is able to plan menus that can be used at home.

4. Patient is able to adapt recipes for use at home.

High-Fiber Diet

1. Patient is able to verbalize foods that can be used to increase Þber in hisor her diet, to desired level of ___ grams daily.

2. Patient is able to explain the role of Þber in his or her particular disorder.

3. Patient is able to describe the purpose of adequate ßuids in the dietaryregimen and is able to consume ___ milliliters daily.

Lactose Intolerance Diet

1. Patient is able to name foods or beverages that must be avoided.

2. Patient is able to plan menus that are nutritionally complete for calciumbut are lactose restricted.

3. Patient demonstrates awareness that he or she can tolerate up to ___milliliters of lactose per day at this time.

4. Patient is able to discuss the difference between lactose intolerance andmilk allergy.

Low-Cholesterol and Dyslipidemia Diets

1. Patient is able to describe simple deÞnitions for cholesterol andsaturated, polyunsaturated, and monounsaturated fats.

2. Patient is able to identify foods that have high cholesterol content.

3. Patient is able to name vegetable oils that may be used in the diet.

4. Patient is able to describe three cooking methods that are acceptable forthe dietary regimen.

5. Patient is able to name foods that are good sources of monounsaturatedfats.



Low-Fat Diet

1. Patient is able to name foods that he or she must omit for the low-fat diet.

2. Patient is able to explain the role of fat in his or her condition.

3. Patient is able to note grams of fat from a given food label.

Mineral-Altered Diets (Iron, Potassium, Calcium, Sodium)

1. Patient is able to name foods that are high/low in minerals.

2. Patient is able to accurately select menu choices for days thatinclude/exclude foods that are high in mineral.

3. Patient is able to plan menus for home that are high/low in minerals.

Pregnancy Diet

1. Patient is able to describe nutritional changes to her diet in order tohave a healthy baby.

2. Patient is able to describe why breastfeeding is an important consideration.

Protein-Altered Diets

1. Patient can identify foods that contain protein of high biological value.

2. Patient can name foods to include/omit in diet to increase/decrease theprotein content of meals and snacks.

Renal Diets

1. Patient is able to describe restrictions that are needed in regard to pro-tein, sodium, potassium, ßuid, calories, and phosphorus.

2. Patient is able to plan menus that are balanced for the restricted nutrients.

3. Patient is able to name ÒfreeÓ foods that he or she can eat as desired.

4. Patient is able to discuss how foods, nutrients, and prescribedmedications may interact.

Sodium Restrictions

1. Patient is able to name foods that are naturally high in sodium.

2. Patient is able to name foods that have been processed or prepared withan excess of sodium.

3. Patient is able to explain the difference between ÒsaltÓ and ÒsodiumÓ infoods.

4. Patient is able to list seasonings that can be used at home in place ofsalt and salt-containing seasonings.

5. Patient is able to plan menus for home that will be low in sodium.

6. Patient is able to identify salt substitutes that he or she can use for hisor her condition.

7. Patient is able to discuss how other minerals (potassium, calcium, mag-nesium) play a role in the speciÞc condition.

Vegetarian Diet

1. Patient is able to identify correctly two or more complementary protein foods.

2. Patient is able to plan menus that provide adequate protein and vitaminB12, zinc, and so on for age and gender.

Weight Management Diet

1. Patient is able to verbalize his or her primary motivation for losingweight and current readiness for a change in behaviors.

2. Patient is able to describe his or her realistic goal for weight lossÑeithershort term or long term, including a timetable.

3. Patient is able to list foods that are low in energy and may be eaten assnacks.

4. Patient is able to categorize foods into the proper pyramid foodcategories.

5. Patient is able to demonstrate a proper technique for recording foodintake at home.

6. Patient has demonstrated weight loss over a certain timeframe.

TABLE B-14 Sample Monitoring and Evaluation Audits for Patient Education (continued)


tions listed in Table C-1. Table C-2 summarizes the rankingsgiven by participants to the nutrition acuity by condition ordisease. Concept maps are useful for organizing data to pre-pare assessments or case reviews. Figure C-1 can be used oradapted as a teaching tool for skill development. Figure C-2provides an example of a process chart for considering allaspects of data for a comprehensive functional nutrition plan.

Over 100 dietitians, clinical nutrition managers, and special-ists were surveyed for this acuity ranking for dietitian services,and a summary is given below. Levels of consensus on acuityare indicated for the medical diagnoses and conditions in thistext. Where strong consensus was available, this table providesthe acuity ranking for the nutritional involvement neededfrom a registered dietitian (RD). The survey asked the ques-

Acuity Ranking for DietitianServices and Concept Map

A P P E N D I X CC

983

TABLE C-1 Nutrition Acuity and Medical DiagnosisÐRelated Survey Questions

Rate your opinion about the level of dietitian involvement (over time, not just per visit) for the following diagnoses on a 1 to 5 rating scale where

1 � Little involvement; minimal, can be delegated to others

2 � Some roles in oversight of nutrition care

3 � Moderate involvement needed over time

TABLE C-2 Acuity for Dietitian Roles in Medical Diagnoses

Minimal Role of DietitianÐ1 Some Roles of DietitianÐ2 Moderate Role of DietitianÐ3 Extended Role of DietitianÐ4

NORMAL LIFE-CYCLE CONDITIONSPregnancy, normalLactationInfant, normal (birth up to

6 months)Infant, normal (6Ð12 months)

(1Ð2)

DIETARY PRACTICES ANDMISCELLANEOUS CONDITIONSPeriodontal disease (1Ð2)

Temporomandibular joint (TMJ)dysfunction

Skin disorders (acne, rosacea,eczema, psoriasis)

MŽni•reÕs syndrome

Child, normal (1Ð2)Teenager, normalAdult male, normal

Adult female, normalElderly male, normalElderly female, normal

Complementary medicine and herbal/botanical counseling

Cultural food pattern, advisement andplanning

Vegetarian diet advisement or planning

Religious dietary patterns, advisement/planning

Dental difÞculties (caries, wired jaw,mouth pain, xerostomia) (2Ð3)

Vision and self-feeding problems (lowvision or chewing problems) (1Ð2)blindness, coordination

Food allergy, simple (2Ð3)Foodborne illness, prevention or

counseling

Pregnancy, high risk

Pressure ulcer, stages 1 or 2 (2Ð3)

Vitamin deÞciency prevention orcounseling

Food allergy, multiple or complex(3Ð4)

Pressure ulcer, stages 3 or 4 ormultiple

4 � Extensive involvement needed over time

5 � Unable to determine; no opinion or experience

(continued)

LWBK759-AppC_p983-990.qxd 10/29/10 5:49 PM Page 983 Aptara Inc


TABLE C-2 Acuity for Dietitian Roles in Medical Diagnoses (continued)


PEDIATRICS: BIRTH DEFECTS,GENETIC, ACQUIRED DISORDERS

Attention deÞcit disorders

Autism spectrum disorders (1Ð2)

Adrenoleukodystrophy (variable)

Leukodystrophies (variable)

Otitis media

NEUROLOGICAL ANDPSYCHIATRIC CONDITIONS

Neurological Disorders

Migraine headache, prevention orcounseling

Trigeminal neuralgia (1Ð2)

Eating Disorders

Psychiatric Disorders

Bipolar disorder (1Ð2)

Depression with numerous medications (1Ð2)

Schizophrenia and psychoses(1Ð2)

Substance use disorders

Abetalipoproteinemia (variable)

Biliary atresia (2Ð3)

Congenital heart disease

Cystinosis and FanconiÕs syndrome (variable)

Down syndrome

Fetal alcohol syndrome (1Ð2)

Large for gestational age infant(variable)

Epilepsy or seizure disorders

Multiple sclerosis

Myasthenia gravis and neuromuscularjunction disorders

ParkinsonÕs disease

Tardive dyskinesia

Bronchopulmonary dysplasia (3Ð4)

Cerebral palsy

Cleft palate

Homocystinuria (3Ð4)

Maple syrup urine disease (MSUD)(3Ð4)

Medium-chain acyl-CoA dehydroge-nase deÞciency (MCADD)

Myelomeningocele (variable)

Obesity, childhood (prevention,treatment) (3Ð4)

PraderÐWilli syndrome (3Ð4)

Rickets, nutritional

Spina biÞda and neural tube defects

WilsonÕs disease (hepatolenticulardegeneration)

Amyotrophic lateral sclerosis

Cerebral aneurysm

Guillain-BarrŽ syndrome

HuntingtonÕs chorea (variable)

Spinal cord injury

Stroke (cerebrovascular accident)

Anorexia nervosa

Binge eating disorder (3Ð4)

Bulimia (3Ð4)

Other disordered eating patterns(3Ð4)

AlzheimerÕs disease or other dementias

Failure to thrive, pediatric

Inborn errors of carbohydratemetabolism

HirschsprungÕs disease (congenital megacolon)

HIV infection and AIDS, pediatric

Low birth weight or prematureinfant (3Ð4)

Necrotizing enterocolitis

Phenylketonuria (PKU)

Tyrosinemia (variable)

Urea cycle disorders (variable)

Brain trauma

Coma

(continued)


APPENDIX C ¥ ACUITY RANKING FOR DIETITIAN SERVICES AND CONCEPT MAP985



PULMONARY DISORDERS

Asthma

Bronchiectasis

Bronchitis, acute

Pneumonia (1Ð2)

Pulmonary embolism (1Ð2)

CARDIOVASCULAR DISORDERS

Angina pectoris

Arteritis

Pericarditis and cardiac tamponade

Thrombophlebitis

GASTROINTESTINAL DISORDERS

Upper GI

Dyspepsia or indigestion (1Ð2)

Lower GI

Lactose malabsorption (lactasedeÞciency) (variable)

Constipation (1Ð2)

Fecal incontinence

Hemorrhoids, hemorrhoidectomy

Proctitis

Cor pulmonale (variable)

Interstitial lung disease (1Ð2)

Sarcoidosis

Sleep apnea

Thoracic empyema

Tuberculosis

Peripheral artery disease

Esophageal varices (2Ð3)

Hiatal hernia, esophagitis, and gastroe-sophageal reßux (GERD) (2Ð3)

Gastric retention or gastroparesis (2Ð3)

Peptic ulcer

Diarrhea, dysentery, and travelerÕs diarrhea

Diverticular diseases (2Ð3)

Peritonitis

Colostomy (2Ð3)

Chronic obstructive pulmonary diseases (emphysema or chronicbronchitis)

Cystic Þbrosis

Respiratory distress syndrome (3Ð4)

Transplantation, lung (3Ð4)

Atherosclerosis, coronary heart disease, and dyslipidemias

Cardiomyopathies

Heart failure

Hypertension

Myocardial infarction

Dysphagia (3Ð4)

Esophageal stricture or spasm, achalasia, or ZenkerÕs diverticulum

Esophageal trauma (3Ð4)

Gastritis and gastroenteritis

Giant hypertrophic gastritis(MŽnŽtrierÕs disease)

Gastrectomy and/or vagotomy (3Ð4)

Vomiting, pernicious

Fat malabsorption syndrome

Megacolon, acquired

Irritable bowel disease

Carcinoid syndrome

Ileostomy

Intestinal lymphangiectasia (variable)

WhippleÕs disease (intestinal lipody-strophy) (3Ð4)

Chylothorax

Respiratory failure and ventilatordependency

Cardiac cachexia

Heart transplantation or heartÐlung transplantation

Tropical sprue

Celiac disease

CrohnÕs disease (3Ð4)

Ulcerative colitis

Short bowel syndrome

Intestinal Þstula

Intestinal transplantation

(continued)





HEPATIC, PANCREATIC, AND BILIARY DISORDERS

Jaundice

ENDOCRINE DISORDERS

Adrenocortical insufÞciency,chronic

AddisonÕs disease (variable)

CushingÕs syndrome (variable)

Acromegaly (variable)

Hyperaldosteronism (variable)

Hypopituitarism (variable)

Pheochromocytoma (variable)

Hyperthyroidism

Hypothyroidism

WEIGHT MANAGEMENT, UNDERNUTRITION, AND MALNUTRITION

MUSCULOSKELETAL AND COLLAGEN DISORDERS

Ankylosing spondylitis (variable)

Myofascial pain syndromes:Þbromyalgia or polymyalgiarheumatica

Osteomyelitis, acute (1Ð2)

PagetÕs disease (osteitis deformans) (variable)

Polyarteritis nodosa (variable)

Rheumatoid arthritis

Ruptured intervertebral disc

Scleroderma (systemic sclerosis)(1Ð2)

Ascites and chylous ascites

Hepatitis

Pancreatic insufÞciency (2Ð3)

Gallbladder disease, surgical or nonsurgical

Biliary cirrhosis

Cholestatic liver disease (2Ð3)

Pregnancy-induced

Hypertension and preeclampsia

Syndrome of inappropriate antidiuretichormone (SIADH)

Parathyroid disorders

(altered calcium)

Immobilization, extended

Muscular dystrophy

Osteoarthritis and degenerative jointdisease

Osteopenia and osteomalacia

Osteoporosis

Systemic lupus erythematosus

Alcoholic liver disease

Hepatic cirrhosis

Hepatic encephalopathy, failure orcoma (3Ð4)

Pancreatitis, acute (3Ð4)

Pancreatitis, chronic

ZollingerÐEllison syndrome (variable)

Metabolic syndrome (3Ð4)

Prediabetes (3Ð4)

Diabetic gastroparesis (3Ð4)

Diabetic ketoacidosis (3Ð4)

Hyperosmolar hyperglycemic state(3Ð4)

Hypoglycemia, iatrogenic

Hyperinsulinism and spontaneoushypoglycemia (3Ð4)

Diabetes insipidus

Underweight or unintentionalweight loss (3Ð4)

ProteinÐcalorie malnutrition, mild(3Ð4)

Rhabdomyolysis (variable)

Liver transplantation

Type 1 diabetes

Pancreatic transplantation

Type 2 diabetes mellitus, adults

Type 2 diabetes mellitus, childrenand teens

Gestational diabetes

Overweight or uncomplicatedobesity

Obesity, medical (withcomorbidities)

ProteinÐcalorie malnutrition,moderate or severe

Energy malnutrition

Refeeding syndrome

(continued)





HEMATOLOGY: ANEMIAS ANDBLOOD DISORDERS

Aplastic anemia

Anemia from parasitic infestation

Anemia, sickle cell

Anemia, sideroblastic

Polycythemia vera (OslerÕs disease)

Thalassemia (CooleyÕs anemia)

Thrombocytic purpura

CANCER

SURGICAL DISORDERS

Appendectomy

Cesarean delivery

Hysterectomy, abdominal

Pelvic exenteration

Spinal surgery (1Ð2)

Total hip arthroplasty

Tonsillectomy and adenoidectomy

Anemia, hemolytic from vitamin E deÞciency (2Ð3)

Anemia, iron deÞciency

Anemia, nutritional (folic acid, copper,etc.)

Anemia, pernicious or vitamin B12

deÞciency

Hemochromatosis (iron overloading)

Hemorrhage, acute or chronic

Breast cancer

Choriocarcinoma

Leukemia, chronic

Lung cancer

Myeloma (simple or multiple) (2Ð3)

Prostate cancer

Surgery, general

Sodium imbalances: hyponatremia orhypernatremia

Potassium imbalances: hypokalemia orhyperkalemia

Calcium imbalances: hypocalcemia orhypercalcemia

Magnesium imbalances: hypomagnesemiaor hypermagnesemia

Phosphate imbalances: hypophosphatemiaor hyperphosphatemia

Amputation, one or more limbs

Parathyroidectomy

Brain tumor

Esophageal cancer (3Ð4)

Gastric carcinoma (3Ð4)

Hepatic carcinoma

Intestinal carcinoma (3Ð4)

Leukemia, acute

Lymphoma, HodgkinÕs disease

Lymphoma, non-HodgkinÕs

Oral cancer (3Ð4)

Osteosarcoma (2Ð3)

Pancreatic carcinoma

Radiation colitis or enteritis (3Ð4)

WilmsÕ tumor (embryoma of kidney)

Bowel surgery

Open heart surgery

Pancreatic surgery (3Ð4)

Bone marrow transplantation

Gastric bypass surgery

(continued)





AIDS, INFECTIONS, BURNS,IMMUNOLOGY, AND TRAUMA

Candidiasis

Chronic fatigue syndrome (1Ð2)

Fever � 102�F

Herpes simplex 1 or 2

Herpes zoster (shingles)

Infection, general

Inßuenza (ßu, respiratory)

Intestinal parasites

Meningitis

Mononucleosis

Pelvic inßammatory disease

Poliomyelitis

Rheumatic fever

Toxic shock syndrome

Trichinosis

Typhoid fever

RENAL DISORDERS

Pyelonephritis

Urolithiasis (renal stones) (1Ð2)

ENTERALÐPARENTERAL NUTRITION

Bacterial endocarditis

Burns, minor thermal injury

Encephalitis or ReyeÕs syndrome

Fracture, hip or long bone

Trauma, minor

Inborn errors: polycystic kidney disease

Glomerulonephritis, acute

Glomerulonephritis, chronic

Nephritis (BrightÕs disease) (2Ð3)

Nephrotic syndrome (2Ð3)

AIDS and HIV infection, adult (3Ð4)

Sepsis or septicemia

Trauma, major

Inborn errors: vitamin DÐresistantrickets (3Ð4)

Inborn errors: Hartnup disease(variable)

Nephrosclerosis (2Ð3)

Renal failure, acute

Burns, major thermal injury

Multiple organ dysfunction

Chronic kidney disease

Hemodialysis

Peritoneal renal dialysis

Renal transplantation

Tube feeding, initiation, monitoring, or home

Parenteral nutrition, initiation,monitoring, or home

Thanks to Matthew Dallas, MS, RD, for summarizing this table.



AAnthropometric

Data

BBiochemical

Data CClinical/Client

History

Diagnosis/Reason forNutrition Assessment

DDietary

BMI

Normal Lab Values Abnormal Lab Values

Signs/Symptoms Medications

DiabeticExchanges

Total kcal &Protein

Medical Hx/Tx Activity/Restrictions

Physical Examination Social /Personal/ Family History

IBW/%IBW

% Weight Change

UBW/%UBW

Previous ht/wt

Current ht/wt

Client’s Initials: _____ Client’s Age: _____ Client’s Gender: _____

Current Intake

Total kcal

Standard

Protein

Standard

Fluid

Standard

Nutrient Needs

Food/NutritionHistory Data

Dietary Supplements

Nutrition Support

Current Diet Order

Current Appetite Level

Figure C-1 Concept Map. Used with permission from Molaison, E.F., Taylor, K., Erickson, D., and Connell, C.L. (2009). Perception of conceptmapping as a learning tool by dietetic internship students and preceptors. Journal of Allied Health, 38, e-97Ðe-103.



•Anthropometrics•Fatty Acids•Genomics-SNPs•Glucose/Insulin•Organic acids•Protein/Amino Acids•Vitamins & Minerals

•Digestion•Detoxification•Energy Metabolism•Inflammation•Neuro-Endocrine-Immune•Nutritional Status•Oxidative stress•Structural Integrity

Nutrition CareProcess

AssessmentDiagnosisInterventionMonitoringEvaluation

•Anabolic / Catabolic•Nutrient Cofactors•Cellular Respiration•Eicosanoid Series•Methionine Pathway•Biotransformation•Steroidogenic Pathway•Urea Cycle

Allerg

ens &

Into

leran

ces

Lifestyle

SystemsSigns & Symptoms

Nutrition Physical

CoreImbalances

MetabolicPathways Biomarkers

Negative Thoughts

& Beliefs

Epi

gene

tics

Pathogens

Toxins

•Food•Culture•Environment•Movement•Nature•Relationships

•Sleep•Stress•Spirituality•Sunlight•Supplements•Traditions

•Circulatory•Digestive•Endocrine•Immune•Integumentary•Lymph•Musculoskeletal

•Nervous•Reproductive•Respiratory•Skeletal•Urinary

Figure C-2 Integrative & Functional Medical Nutrition Therapy (IFMNT) Process Guide. (©2010 Copyright. Used with permissionfrom M. Swift, D. Noland & E. Redmond.)


Dietary Reference Intakes

A P P E N D I X DD

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LWBK759-AppD_p991-998.qxd 10/29/10 4:49 PM Page 991 Aptara Inc

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35*

550*

31

–50

y 1,

300

120

5*19

90

* 1.

4 1.

6 17

2.

0 50

0 2.

8 7*

35

* 55

0*

NO

TE

: T

his

tabl

e (t

aken

from

the

DR

I rep

orts

, see

w

ww

.nap

.edu

) pre

sent

s R

ecom

men

ded

Die

tary

Allo

wan

ces

(RD

As)

in

bold

type

and

Ade

quat

e In

take

s (A

Is)

in o

rdin

ary

type

follo

wed

by

an

aste

risk

(*).

RD

As

and

AIs

may

bot

h be

use

d as

goa

ls fo

r in

divi

dual

inta

ke. R

DA

s ar

e se

t to

mee

t the

nee

ds o

f alm

ost a

ll (9

7 to

98

perc

ent)

indi

vidu

als

in a

gro

up. F

or h

ealth

y br

east

fed

infa

nts,

th

e A

I is

the

mea

n in

take

. The

AI f

or o

ther

life

sta

ge a

nd g

ende

r gr

oups

is b

elie

ved

to c

over

nee

ds o

f all

indi

vidu

als

in th

e g

roup

, but

lack

of d

ata

or u

ncer

tain

ty in

the

data

pre

vent

bei

ng a

ble

to

spec

ify w

ith c

onfid

ence

the

perc

enta

ge o

f ind

ivid

uals

cov

ered

by

this

inta

ke.

a As

retin

ol a

ctiv

ity e

quiv

alen

ts (

RA

Es)

. 1 R

AE

= 1

µg

ret

inol

, 12 µ

g �-c

arot

ene,

24 µ

g �-

caro

tene

, or

24 µg

�-cr

ypto

xant

hin.

The

RA

E fo

r di

etar

y pr

ovita

min A

car

oten

oids

is tw

ofol

d gr

eate

r

th

an r

etin

ol e

quiv

alen

ts (

RE

), w

here

as th

e R

AE

for

pref

orm

ed v

itam

in A

is th

e sa

me

as R

E.

b As

chol

ecal

cife

rol.

1 µ

g ch

olec

alci

fero

l = 4

0 IU

vitam

in D

. cIn

the

abse

nce

of a

dequ

ate

expo

sure

to s

unlig

ht.

d As

�-t

ocop

hero

l. �-T

ocop

hero

l inc

lude

s RR

R-�

-toc

ophe

rol,

the

only

form

of �-t

ocop

hero

l tha

t occ

urs

natu

rally

in fo

ods,

and

the

2R-s

tere

oiso

mer

ic fo

rms

of

�-t

ocop

hero

l (RR

R-, R

SR-

, RR

S-,

and

RS

S-�-t

ocop

hero

l) th

at o

ccur

in fo

rtifi

ed fo

ods

and

supp

lem

ents

. It d

oes

not i

nclu

de th

e 2S

-ste

reoi

som

eric

form

s of

�

-toc

ophe

rol (S

RR-

, SS

R-, S

RS

-, a

nd SS

S-�-t

ocop

hero

l), a

lso

foun

d in

fo

rtifi

ed fo

ods

and

supp

lem

ents

. e A

s ni

acin

equ

ival

ents

(N

E).

1 m

g of

nia

cin

= 6

0 m

g o

f try

ptop

han;

0–6

mon

ths

= p

refo

rmed

nia

cin

(not

N

E).

f A

s di

etar

y fo

late

equ

ival

ents

(D

FE

). 1

DF

E =

1 µ

g fo

od fo

late

= 0

.6 µ

g of

folic

aci

d fr

om fo

rtifi

ed fo

od o

r as

a s

uppl

emen

t con

sum

ed w

ith fo

od =

0.5

µg

of a

sup

plem

ent t

aken

on

an e

mpt

y st

omac

h.

g Alth

ough

AIs

hav

e be

en s

et fo

r ch

olin

e, th

ere

are

few

dat

a to

ass

ess

whe

ther

a d

ieta

ry s

uppl

y of

cho

line

is n

eede

d at

all

stag

es o

f the

life

cyc

le, a

nd it

may

be

that

the

chol

ine

requ

irem

ent c

an b

e m

et b

y en

doge

nous

syn

thes

is a

t som

e of

thes

e st

ages

. h B

ecau

se 1

0 to

30

perc

ent o

f old

er p

eopl

e m

ay m

alab

sorb

food

-bou

nd B

12, i

t is

advi

sabl

e fo

r th

ose

olde

r th

an 5

0 ye

ars

to

mee

t the

ir R

DA

mai

nly

by c

onsu

min

g fo

ods

fort

ified

with

B12

or

a su

pple

men

t con

tain

ing

B 12.

i In v

iew

of e

vide

nce

linki

ng fo

late

inta

ke w

ith n

eura

l tub

e de

fect

s in

the

fetu

s, it

is r

ecom

men

ded

that

all

wom

en c

apab

le o

f bec

omin

g pr

egna

nt c

onsu

me

400

µg fr

om s

uppl

emen

ts o

r fo

rtifi

ed

food

s in

add

ition

to in

take

of f

ood

fola

te fr

om a

var

ied

diet

. jk It

is a

ssum

ed th

at w

omen

will

con

tinue

con

sum

ing

400

µg fr

om s

uppl

emen

ts o

r fo

rtifi

ed fo

od u

ntil

thei

r pr

egna

ncy

is c

onfir

med

and

they

ent

er p

rena

tal c

are,

whi

ch o

rdin

arily

occ

urs

afte

r th

e en

d of

the

peric

once

ptio

nal p

erio

d—th

e cr

itica

l tim

e fo

r fo

rmat

ion

of th

e ne

ural

tube

. C

opyr

ight

200

4 by

the

Nat

iona

l Aca

demy

of S

cien

ces. A

ll rig

hts

rese

rved

.


Die

tary

Ref

eren

ce In

take

s (D

RIs

): R

ecom

men

ded

Inta

kes

for

Indi

vidu

als,

Ele

men

ts

Food

and

Nut

ritio

n B

oard

, Ins

titut

e of

Med

icin

e, N

atio

nal A

cade

mie

sLi

fe S

tage

C

alci

um

Chr

omiu

m

Cop

per

Flu

orid

e Io

dine

Ir

on

Mag

nesi

um

Man

gane

se

Mol

ybde

num

P

hosp

horu

s S

elen

ium

Z

inc

Pot

assi

um

Sod

ium

C

hlor

ide

Gro

up

(mg/

d)

(µg/

d)

(µg/

d)

(mg/

d)

(µg/

d)

(mg/

d)

(mg

/d)

(mg/

d)

(µg/

d)

(mg/

d)

(µg/

d)

(mg/

d)

(g/d

) (g

/d)

(g/d

) In

fant

s 0–

6 m

o 21

0*

0.2*

20

0*

0.01

* 11

0*

0.27

* 30

* 0.

003*

2*

10

0*

15*

2*

0.4*

0.

12*

0.18

* 7–

12 m

o 27

0*

5.5*

22

0*

0.5*

13

0*

11

75*

0.6*

3*

27

5*

20*

3 0.

7*

0.37

* 0.

57*

Chi

ldre

n 1–

3 y

500*

11*

340

0.7*

90

7 80

1.

2*

17

460

20

3 3.

0*

1.0*

1.

5*

4–8

y 80

0*15

* 44

0 1*

90

10

130

1.5*

22

50

0 30

5

3.8*

1.

2*

1.9*

M

ales

9–

13 y

1,

300*

25*

700

2*12

0 8

240

1.9*

34

1,

250

40

8 4.

5*

1.5*

2.

3*

14–1

8 y

1,30

0*

35*

890

3*

150

11

410

2.2*

43

1,

250

55

11

4.7*

1.

5*

2.3*

19

–30

y 1,

000*

35

* 90

0 4*

150

8 40

0 2.

3*

45

700

55

11

4.7*

1.

5*

2.3*

31

–50

y 1,

000*

35

* 90

0 4*

150

8 42

0 2.

3*

45

700

55

11

4.7*

1.

5*

2.3*

51

–70

y 1,

200*

30

* 90

0 4*

150

8 42

0 2.

3*

45

700

55

11

4.7*

1.

3*

2.0*

>

70

y 1,

200*

30

* 90

0 4*

150

8 42

0 2.

3*

45

700

55

11

4.7*

1.

2*

1.8*

Fe

mal

es

9–13

y

1,30

0*

21*

700

2*12

0 8

240

1.6*

34

1,

250

40

8 4.

5*

1.5*

2.

3*

14–1

8 y

1,30

0*

24*

890

3*15

0 15

36

0 1.

6*

43

1,25

0 55

9

4.7*

1.

5*

2.3*

19

–30

y 1,

000*

25

* 90

0 3*

150

18

310

1.8*

45

70

0 55

8

4.7*

1.

5*

2.3*

31

–50

y 1,

000*

25

* 90

0 3*

150

18

320

1.8*

45

70

0 55

8

4.7*

1.

5*

2.3*

51

–70

y 1,

200*

20

* 90

0 3*

150

8 32

0 1.

8*

45

700

55

8 4.

7*

1.3*

2.

0*

> 7

0 y

1,20

0*

20*

900

3*15

0 8

320

1.8*

45

70

0 55

8

4.7*

1.

2*

1.8*

P

regn

ancy

14

–18

y 1,

300*

29

* 1,

000

3*22

0 27

40

0 2.

0*

50

1,25

0 60

13

4.

7*

1.5*

2.

3*

19–3

0 y

1,00

0*

30*

1,00

0 3*

220

27

350

2.0*

50

70

0 60

11

4.

7*

1.5*

2.

3*

31–5

0 y

1,00

0*

30*

1,00

0 3*

220

27

360

2.0*

50

70

0 60

11

4.

7*

1.5*

2.

3*

Lact

atio

n

14

–18

y 1,

300*

44

* 1,

300

3*29

0 10

36

0 2.

6*

50

1,25

0 70

14

5.

1*

1.5*

2.

3*

19–3

0 y

1,00

0*

45*

1,30

0 3*

290

9 31

0 2.

6*

50

700

70

12

5.1*

1.

5*

2.3*

31

–50

y 1,

000*

45

* 1,

300

3*29

0 9

320

2.6*

50

70

0 70

12

5.

1*

1.5*

2.

3*

NO

TE

: T

his

tabl

e pr

esen

ts R

ecom

men

ded

Die

tary

Allo

wan

ces

(R

DA

s) in

bol

d ty

pe a

nd A

dequ

ate

Inta

kes

(AIs

) in

ord

inar

y ty

pe fo

llow

ed b

y an

ast

eris

k (*

). R

DA

s an

d A

Is m

ay b

oth

be u

sed

as g

oals

for

indi

vidu

al

inta

ke. R

DA

s ar

e se

t to

mee

t the

nee

ds o

f alm

ost a

ll (

97 to

98

perc

ent)

indi

vidu

als

in a

gro

up. F

or h

eal

thy

brea

stfe

d in

fant

s, th

e A

I is

the

mea

n in

take

. The

AI f

or o

ther

life

sta

ge a

nd g

ende

r gr

oups

is b

elie

ved

to c

over

ne

eds

of a

ll in

divi

dual

s in

the

grou

p, b

ut la

ck o

f dat

a or

unc

erta

inty

in th

e da

ta p

reve

nt b

eing

abl

e to

spe

cify

with

con

fiden

ce th

e pe

rcen

tage

of i

ndiv

idu

als

cove

red

by th

is in

take

.

SO

UR

CE

S: D

ieta

ry R

efer

ence

Inta

kes

for

Cal

cium

, Pho

spho

rous

, M

agne

sium

, Vita

min

D, a

nd F

luor

ide

(19

97);

Die

tary

Ref

eren

ce In

take

s fo

r Thi

amin

, Rib

ofla

vin,

Nia

cin,

Vita

min

B6,

Fol

ate,

Vita

min

B 12,

Pant

othe

nic

Aci

d, B

iotin

, and

Cho

line (19

98);

Die

tary

Ref

eren

ce In

take

s fo

r Vita

min

C, V

itam

in E

, Sel

eniu

m, a

nd C

arot

enoi

ds (

2000

); D

ieta

ry R

efer

ence

Inta

kes

for V

itam

in A

, Vita

min

K, A

rsen

ic, B

oron

, Chr

omiu

m, C

oppe

r, Io

dine

,

Iron,

Man

gane

se, M

olyb

denu

m, N

icke

l, S

ilico

n, V

anad

ium

, and

Zin

c (

2001

); a

nd Die

tary

Ref

eren

ce In

take

s fo

r Wat

er, P

otas

sium

, Sod

ium

, Chl

orid

e, a

nd S

ulfa

te

(200

4).

The

se r

epor

ts m

ay b

e ac

cess

ed v

ia

http

://w

ww

.nap

.edu

.

Cop

yrig

ht 2

004

by th

e N

atio

nal A

cade

my of

Sci

ence

s. A

ll rig

hts

rese

rved

.


Die

tary

Ref

eren

ce In

take

s (D

RIs

): T

oler

able

Upp

er In

take

Lev

els

(ULa ),

Vita

min

sFo

od a

nd N

utrit

ion

Boa

rd, I

nstit

ute

of M

edic

ine,

Nat

iona

l Aca

dem

ies

Life

Sta

ge

Gro

up

Vita

min

A

(µg/

d)b

Vita

min

C

(mg/

d)

Vita

min

D

(µg/

d)

Vita

min

E

(mg/

d)c,

dV

itam

in K

T

hiam

in

Rib

o-fla

vin

Nia

cin

(mg/

d)d

Vita

min

B6

(mg/

d)

Fola

te

(µg/

d)d

Vita

min

B12

P

anto

then

ic

Aci

d B

iotin

C

holin

e (g

/d)

Car

ote-

noid

se

Infa

nts

0Š

6 m

o 60

0 N

Df

25

ND

N

D

ND

N

D

ND

N

D

ND

N

D

ND

N

D

ND

N

D

7Š12

mo

600

ND

25

N

D

ND

N

D

ND

N

D

ND

N

D

ND

N

D

ND

N

D

ND

C

hild

ren

1Š

3 y

600

400

50

200

ND

N

D

ND

10

30

30

0 N

D

ND

N

D

1.0

ND

4Š

8 y

900

650

50

300

ND

N

D

ND

15

40

40

0 N

D

ND

N

D

1.0

ND

M

ales

, Fem

ales

9Š13

y

1,70

0 1,

200

50

600

ND

N

D

ND

20

60

60

0 N

D

ND

N

D

2.0

ND

14

Š18

y 2,

800

1,80

0 50

80

0 N

D

ND

N

D

30

80

800

ND

N

D

ND

3.

0 N

D

19Š7

0 y

3,

000

2,00

0 50

1,

000

ND

N

D

ND

35

10

0 1,

000

ND

N

D

ND

3.

5 N

D

> 7

0 y

3,00

0 2,

000

50

1,00

0 N

D

ND

N

D

35

100

1,00

0 N

D

ND

N

D

3.5

ND

P

regn

ancy

14–1

8 y

2,80

0 1,

800

50

800

ND

N

D

ND

30

80

80

0 N

D

ND

ND

3.

0 N

D

19Š5

0 y

3,00

0 2,

000

50

1,00

0 N

D

ND

N

D

35

100

1,00

0 N

D

ND

N

D

3.5

ND

La

ctat

ion

14

–18

y 2,

800

1,80

0 50

80

0 N

D

ND

N

D

30

80

800

ND

N

D N

D

3.0

ND

19

Š50

y 3,

000

2,00

0 50

1,

000

ND

N

D

ND

35

10

0 1,

000

ND

N

D

ND

3.

5 N

D

a U

L =

The

max

imum

leve

l of d

aily

nut

rient

inta

ke th

at is

like

ly to

pos

e no

ris

k of

adv

erse

effe

cts.

Unl

ess

othe

rwis

e sp

ecifi

ed, t

he U

L re

pres

ents

tota

l int

ake

from

food

, wat

er, a

nd s

uppl

emen

ts. D

ue to

lack

of s

uita

ble

data

, ULs

cou

ld n

ot b

e es

tabl

ishe

d fo

r vi

tam

in K

, thi

amin

, rib

ofla

vin,

vita

min

B12

, pan

toth

enic

aci

d, b

iotin

, car

oten

oids

. In

the

abse

nce

of U

Ls, e

xtra

cau

tion

may

be

war

rant

ed in

con

sum

ing

leve

ls a

bove

rec

omm

ende

d in

take

s.

b As

pref

orm

ed v

itam

in A

onl

y.

c As

�-to

coph

erol

; app

lies

to a

ny fo

rm o

f sup

plem

enta

l �-t

ocop

hero

l. d T

he U

Ls fo

r vi

tam

in E

, nia

cin,

and

fola

te a

pply

to s

ynth

etic

form

s ob

tain

ed fr

om s

uppl

emen

ts, f

ortif

ied

food

s, o

r a

com

bina

tion

of th

e tw

o.

e�-

Car

oten

e su

pple

men

ts a

re a

dvis

ed o

nly

to s

erve

as

a pr

ovita

min

A s

ourc

e fo

r in

divi

dual

s at

ris

k of

vita

min

A d

efic

ienc

y.

f ND

= N

ot d

eter

min

able

due

to la

ck o

f dat

a of

adv

ers

e ef

fect

s in

this

age

gro

up a

nd c

once

rn w

ith r

egar

d to

lack

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bilit

y to

han

dle

exce

ss a

mou

nts.

Sou

rce

of in

take

sho

uld

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om

food

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y to

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high

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ls o

f in

take

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SO

UR

CE

S: D

ieta

ry R

efer

ence

Inta

kes

for

Cal

cium

, Pho

spho

rous

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agne

sium

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min

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nd F

luor

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(19

97);

Die

tary

Ref

eren

ce In

take

s fo

r Thi

amin

, Rib

ofla

vin,

N

iaci

n, V

itam

in B 6

, Fol

ate,

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min

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line

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ence

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kes

for V

itam

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, Vita

min

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elen

ium

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Car

oten

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00);

and

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tary

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eren

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take

s fo

r Vita

min

A, V

itam

in K

, Ars

enic

, Bor

on,

C

hrom

ium

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Iodi

ne, I

ron,

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gane

se, M

olyb

denu

m, N

icke

l, S

ilico

n, V

anad

ium

, and

Zin

c (2

001)

. T

hese

rep

orts

may

be

acce

ssed

via

ht

tp://

ww

w.na

p.ed

u.

Cop

yrig

ht 2

004

by th

e N

atio

nal A

cade

my of

Sci

ence

s. A

ll rig

hts

rese

rved

.


Die

tary

Ref

eren

ce In

take

s (D

RIs

): T

oler

able

Upp

er I

ntak

e Le

vels

(U

La ), E

lem

ents

Food

and

Nut

ritio

n B

oard

, Ins

titut

e of

Med

icin

e, N

atio

nal A

cade

mie

s

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Gro

up

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e-ni

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oron

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g/d)

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ci-

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om-

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C

oppe

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g/d)

Flu

or-

ide

(mg/

d)

Iodi

ne

(µg/

d)

Iron

(m

g/d)

Mag

nes-

ium

(m

g/d)

c

Man

ga-

nese

(m

g/d)

Mol

yb-

denu

m

(µg/

d)

Nic

kel

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d)

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s-ph

orus

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/d)

Pot

as-

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elen

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m

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c (m

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Chl

or-

ide

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fant

s

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mo

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f N

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N

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0 0.

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Mal

es,

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L =

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max

imum

leve

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aily

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rient

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at is

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UL

repr

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ts to

tal i

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om fo

od, w

ater

, and

sup

plem

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to la

ck o

f sui

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ta, U

Ls c

ould

not

be

esta

blis

hed

for

arse

nic,

chr

omiu

m, s

ilico

n, p

otas

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sul

fate

. In

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abse

nce

of U

Ls, e

xtra

cau

tion

may

be

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rant

ed in

con

sum

ing

leve

ls a

bove

rec

omm

ende

d in

take

s.

b Alth

ough

the

UL

was

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ined

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arse

nic,

ther

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ifica

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ng a

rsen

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food

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sup

plem

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he U

Ls fo

r m

agne

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rep

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take

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e ef

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ans,

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ifica

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lthou

gh v

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as n

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ffect

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ans,

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The

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ased

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cern

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ck o

f abi

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to h

andl

e ex

cess

am

ount

s. S

ourc

e of

inta

ke s

houl

d be

from

food

onl

y to

pre

vent

hig

h le

vels

of

inta

ke.

SO

UR

CE

S: D

ieta

ry R

efer

ence

Inta

kes

for

Cal

cium

, Pho

spho

rous

, M

agne

sium

, Vita

min

D, a

nd F

luor

ide

(19

97);

Die

tary

Ref

eren

ce In

take

s fo

r Thi

amin

, Rib

ofla

vin,

Nia

cin,

Vita

min

B6,

Fol

ate,

Vita

min

B 12,

Pan

toth

enic

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d, B

iotin

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Cho

line (19

98);

Die

tary

Ref

eren

ce In

take

s fo

r Vita

min

C, V

itam

in E

, S

elen

ium

, and

Car

oten

oids (20

00);

Die

tary

Ref

eren

ce In

take

s fo

r Vita

min

A, V

itam

in K

, Ars

enic

, Bor

on,

Chr

omiu

m, C

oppe

r, Io

dine

, Iro

n, M

anga

nese

, Mol

ybde

num

, Nic

kel,

Sili

con,

Van

adiu

m, a

nd Z

inc

(20

01);

and

Die

tary

Ref

eren

ce In

take

s fo

r Wat

er, P

otas

sium

, Sod

ium

, Chl

orid

e, a

nd S

ulfa

te

(200

4). T

hese

rep

orts

may

be

acce

ssed

via

http

://w

ww

.nap

.edu

.

Cop

yrig

ht 2

004

by th

e N

atio

nal A

cade

my of

Sci

ence

s. A

ll rig

hts

rese

rved

.



Dietary Reference Intakes (DRIs): Estimated Energy Requirements (EER) for Men and Women 30 Years of Agea

Food and Nutrition Board, Institute of Medicine, National Academies EER, Mend (kcal/day) EER, Womend (kcal/day)

Height (m [in]) PALb

Weight for BMIc

of 18.5 kg/m2

(kg [lb])

Weight for BMI of 24.99 kg/m2

(kg [lb]) BMI of 18.5 kg/m2

BMI of 24.99 kg/m2

BMI of 18.5 kg/m2

BMI of 24.99 kg/m2

1.50 (59) Sedentary 41.6 (92) 56.2 (124) 1,848 2,080 1,625 1,762 Low active 2,009 2,267 1,803 1,956 Active 2,215 2,506 2,025 2,198 Very active 2,554 2,898 2,291 2,489 1.65 (65) Sedentary 50.4 (111) 68.0 (150) 2,068 2,349 1,816 1,982 Low active 2,254 2,566 2,016 2,202 Active 2,490 2,842 2,267 2,477 Very active 2,880 3,296 2,567 2,807 1.80 (71) Sedentary 59.9 (132) 81.0 (178) 2,301 2,635 2,015 2,211 Low active 2,513 2,884 2,239 2,459 Active 2,782 3,200 2,519 2,769 Very active 3,225 3,720 2,855 3,141

a For each year below 30, add 7 kcal/day for women and 10 kcal /day for men. For each year above 30, subtract 7 kcal/day for women and 10 kcal/day for men. b PAL = physical activity level. c BMI = body mass index. d Derived from the following regression equations based on doubly labeled water data:

Adult man: EER = 662 – 9.53 × age (y) + PA × (15.91 × wt [kg] + 539.6 × ht [m]) Adult woman: EER = 354 – 6.91 × age (y) + PA × (9.36 × wt [kg] + 726 × ht [m])

Where PA refers to coefficient for PAL PAL = total energy expenditure ÷÷÷÷ basal energy expenditure

PA = 1.0 if PAL � 1.0 < 1.4 (sedentary) PA = 1.12 if PAL � 1.4 < 1.6 (low active) PA = 1.27 if PAL � 1.6 < 1.9 (active) PA = 1.45 if PAL � 1.9 < 2.5 (very active)

Dietary Reference Intakes (DRIs): Acceptable Macronutrient Distribution Ranges Food and Nutrition Board, Institute of Medicine, National Academies

Range (percent of energy) Macronutrient Children, 1–3 y Children, 4–18 y Adults Fat 30–40 25–35 20–35

n-6 polyunsaturated fatty acidsa (linoleic acid) 5–10 5–10 5–10 n-3 polyunsaturated fatty acidsa (� -linolenic acid) 0.6–1.2 0.6–1.2 0.6–1.2

Carbohydrate 45–65 45–65 45–65 Protein 5–20 10–30 10–35 a Approximately 10% of the total can come from longer-chain n-3 or n-6 fatty acids.

SOURCE: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (2002).


APPENDIX D ¥ DIETARY REFERENCE INTAKES997

Dietary Reference Intakes (DRIs): Recommended Intakes for Individuals, Macronutrients Food and Nutrition Board, Institute of Medicine, National Academies

Life Stage Group Total Watera

(L/d)Carbohydrate (g/d)

Total Fiber (g/d)

Fat (g/d)

Linoleic Acid (g/d)

� -Linolenic Acid (g/d)

Proteinb

(g/d) Infants

0–6 mo 0.7* 60* ND 31* 4.4* 0.5* 9.1* 7–12 mo 0.8* 95* ND 30* 4.6* 0.5* 13.5

Children 1–3 y 1.3* 130 19* ND 7* 0.7* 13 4–8 y 1.7* 130 25* ND 10* 0.9* 19

Males 9–13 y 2.4* 130 31* ND 12* 1.2* 34

14–18 y 3.3* 130 38* ND 16* 1.6* 52 19–30 y 3.7* 130 38* ND 17* 1.6* 56 31–50 y 3.7* 130 38* ND 17* 1.6* 56 51–70 y 3.7* 130 30* ND 14* 1.6* 56

> 70 y 3.7* 130 30* ND 14* 1.6* 56 Females

9–13 y 2.1* 130 26* ND 10* 1.0* 34 14–18 y 2.3* 130 26* ND 11* 1.1* 46 19–30 y 2.7* 130 25* ND 12* 1.1* 46 31–50 y 2.7* 130 25* ND 12* 1.1* 46 51–70 y 2.7* 130 21* ND 11* 1.1* 46

> 70 y 2.7* 130 21* ND 11* 1.1* 46 Pregnancy 14–18 y 3.0* 175 28* ND 13* 1.4* 71 19–30 y 3.0* 175 28* ND 13* 1.4* 71 31–50 y 3.0* 175 28* ND 13* 1.4* 71

Lactation 14–18 y 3.8* 210 29* ND 13* 1.3* 71 19–30 y 3.8* 210 29* ND 13* 1.3* 71 31–50 y 3.8* 210 29* ND 13* 1.3* 71

NOTE: This table presents Recommended Dietary Allowances (RDAs) in bold type and Adequate Intakes (AIs) in ordinary type followed by an asterisk (*). RDAs and AIs may both be used as goals for individual intake. RDAs are set to meet the needs of almost all (97 to 98 percent) individuals in a group. For healthy infants fed human milk, the AI is the mean intake. The AI for other life stage and gender groups is believed to cover the needs of all individuals in the group, but lack of data or uncertainty in the data prevent being able to specify with confidence the percentage of individuals covered by this intake. a Total water includes all water contained in food, beverages, and drinking water. b Based on 0.8 g/kg body weight for the reference body weight.

Dietary Reference Intakes (DRIs): Additional Macronutrient Recommendations Food and Nutrition Board, Institute of Medicine, National Academies

Macronutrient Recommendation Dietary cholesterol As low as possible while consuming a nutritionally

adequate diet Trans fatty acids As low as possible while consuming a nutritionally

adequate diet Saturated fatty acids As low as possible while consuming a nutritionally

adequate diet Added sugars Limit to no more than 25% of total energy

SOURCE: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (2002).


Die

tary

Ref

eren

ce In

take

s (D

RIs

):E

stim

ated

Ave

rage

Req

uire

men

ts fo

r G

roup

s Fo

od a

nd N

utrit

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Boa

rd, I

nstit

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of M

edic

ine,

Nat

iona

l Aca

dem

ies

Life

Sta

ge

Gro

up

CH

O

(g/d

) P

rote

in

(g/d

) V

it A

(µ

g/d)

aV

it C

(m

g/d)

V

it E

(m

g/d)

bT

hiam

in

(mg/

d)

Rib

o-fla

vin

(mg/

d)

Nia

cin

(mg/

d)c

Vit

B6

(mg/

d)

Fola

te

(µg/

d)a

Vit

B12

(µg/

d)

Cop

per

(µg/

d)

Iodi

ne

(µg/

d)

Iron

(m

g/d)

Mag

nes-

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(m

g/d)

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(µg/

d)

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(m

g/d)

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(µg/

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999

A1c levels, 523tAbacavir, 834tAbatacept, 681tAbducens nerve, 221tAbetalipoproteinemia, 144Ð145Absorption, 384Acanthocytosis, 144Ð145Acarbose, 401, 543Accidents, 44tAccolate, 296tAccutane (isotretinoin), 112Acesulfame potassium (Sunette), 533tAcetaldehyde, 174Acetaminophen, 381, 679tAcetylcholine, 224t, 227Acetylcholine receptors (AChRs), 251Achalasia, 390Ð391Achondrosplasia, 45tAchromycin V (tetracycline), 486tAcid-base balance, 860tAciphex (rabeprazole), 409t, 512Acne, 110, 112Acquired autoimmune hemolytic anemia,

705tAcquired immunity, 820tAcquired immunodeÞciency syndrome

(AIDS), 829Ð837clinical indicators, 831Ð832tclinical staging, 830tdrugs and side effects, 833, 834Ð836nutritional guidelines for, 831 t, 833nutritional objectives for, 832Ð833patient education, 833Ð837supplements, 833

ACR16, 245Acrobose (Precose), 547tAcrodermatitis enteropathica, 112Acromegaly, 573Ð574Actigall (ursodiol), 152, 517Actinomycin D, 787Actonel (risedronate), 670t, 673Actos (pioglitazone), 547tAcute anemia, 689tAcute gastritis, 402Acute glomerulonephritis, 879Acute leukemia, 793tAcute lymphocytic leukemia, 793tAcute myelogenous leukemia, 793tAcute necrotizing ulcerative gingivitis, 103Acute pyelonephritis, 894Acute renal failure (ARF), 864Acute respiratory distress syndrome (ARDS),

317Acute stress disorder, 222tAcyclovir, 283, 755t, 835tAdalimumab (Humira), 332 t, 681tAdderall (amphetamine), 147 tAdderol, 356

Addiction, 287Ð289AddisonÕs disease, 582Ð584Adefovir, 834tAdenocarcinoma, 732tAdenoidectomy, 811tAdenoma, 732tAdipex (phentermine), 617 tAdjustment disorder, 222tAdmixture, 899tAdolescents, 33Ð37

body mass index for, 605tdrug effects, 36eating behavior, 34food safety tips, 36growth and development of, 33Ð34HIV infection in, 177Ð179nutritional guidelines for, 36Ð38nutritional objectives for, 35pregnancy in, 36trecommended intakes, 35tsports nutrition, 38supplements, 36type 1 diabetes in, 521ttype 2 diabetes in, 521t, 549Ð551

Adrenal cortex, 570t, 585Ð586Adrenal gland disorders. See alsoEndocrine

disordersAddisonÕs disease, 582Ð584adrenocortical insufÞciency, 582Ð584hyperaldosteronism, 585Ð586pheochromocytoma, 586Ð588

Adrenalin, 570tAdrenergic system blockers, 361tAdrenocortical insufÞciency, 582Ð584Adrenocorticotropic hormone, 569 t, 571Adriamycin (doxorubicin), 774, 835 tAdrucil (5-ßuorouracil), 512Adults, 44Ð56

disorders and related genes, 45Ð46tdrugs and side effects, 49, 52tfood and nutrition, 48Ð49functional foods, 50Ð51tleading causes of death, 44tnutritional guidelines for, 49Ð53nutritional objectives for, 47nutrition-related concerns for women, 48tsingle gene disorders in, 141tsupplements, 49

ADV (adefovir), 834tAdvair, 296tAdvil (ibuprofen), 408, 657, 660tAeroBid (ßunisolide), 296 tAfrican American diet, 85African diet, 85Age-related macular degeneration (AMD),

106Ð108Aging. SeeElderlyAgoraphobia, 223t

Agrylin (anagrelide), 727, 729Albuterol, 296tAlcohol consumption

addiction, 288tbone health and, 665tbreast cancer and, 784calories, 51dietary guideline for, 4theadaches and, 247theart disease and, 338tpregnancy and, 8

Alcoholic liver disease, 474Ð477Alcoholism, 287Aldosterone, 583, 860tAldosterone blockers, 361tAldosteronism, 45tAlendronate (Fosamax), 52t, 670t, 844Alendronic acid, 669Aleve (naproxen), 657Alfalfa, 71tAlfence (rabeprazole), 409tAlferon N, 486tAlimentum, 20Alitame, 533tAlkeran (melphalan), 798Alkylating agents, 744tallergens, 125tAllergic pneumonia, 314tAllergies, 122Ð127

allergens, 125tclinical indicators, 124education, 131food processing concerns, 126tgastrointestinal, 122Ð123in infants, 21tnutritional guidelines for, 124Ð125nutritional objectives for, 124patient education, 126Ð127prevalence of, 122supplements, 126symptoms, 122

Allicin, 736tAllium, 736t, 768Allopregnanolone, 229Allopurinol (Aloprim), 646Allyl sulÞdes, 735t, 736t, 790tAloe vera, 71t, 534tAloprim (allopurinol), 646Alpha carotene, 790tAlpha linolenic acid, 338t, 433Alpha lipoic acid, 71t, 534t5-Alpha reductase, 52tAlpha thalassemia, 720Alpha-1-antitrypsin deÞciency, 45tAlpha-adrenergic blockers, 616tAlpha-carotene, 499tAlpha-glucosidase deÞciency, 176tAlpha-glucosidase inhibitors, 547t

I N D E X

Note: Italicized f Õs and tÕs refer to Þgures and tables

LWBK759-CInd_p999-1020.qxd 10/29/10 5:51 PM Page 999 Aptara Inc

1000 INDEX

Alphanate, 723Alport syndrome, 862Ð863Alprazolam (Xanax), 284t, 616tAluminum hydroxide, 396Ð397, 409tAluminum-containing binders, 872 tAlupent (metaproterenol), 296 tAlzheimerÕs disease, 45t, 227Ð231AM80, 250Amantadine (Symmetrel), 255tAmaryl (glimepiride), 547 tAmica, 71tAmiloride (Midamor), 486 tAmino acids, 520

in breast milk, 13tfor healthy vision, 108tnutritional relevance, 224tin pregnancy, 7

Aminosalicylates, 436Aminosalicylic acid, 332t5-Aminosalicylic acid, 436, 467Amitiza (lubiprostone), 420 tAmitriptyline (Elavil), 284 t, 616t, 657Amnestic disorder, 222tAmoxapine (Asendin), 284tAmoxicillin, 895Amoxil, 895Amphetamines, 147t, 288tAmphogel, 409tAmphotericin, 755 tAmphotericin-B, 835tAmpicillins, 486tAmputations, 524t, 808t, 809tAmylin (Symlin), 547tAmyotrophic lateral sclerosis (ALS), 45t,

232Ð234Anabolic steroids, 258, 288t, 836t, 841tAnadrol-50, 616tAnafranil, 283t, 284tAnagrelide, 727, 729Anakinra (Kineret), 681 tAnalgesics, 235, 258, 364t, 376, 496t, 510t,

679t, 683, 755t, 804, 841tAnastrozole (Arimidex), 784Ancylostoma duodenale, 845tAndersen disease, 176tAndroderm, 616tAndrogens, 570t, 616tAndrostenedione, 40, 42t, 79tAnemia, 687Ð690. See alsoHematologic

disordersaplastic, 696Ð698assessment factors, 687in cancer patients, 739tof chronic disease, 690Ð692CooleyÕs, 720copper deÞciency, 698Ð700Diamond-Blackfan, 692Ð693FanconiÕs, 696Ð698folic acid deÞciency, 701Ð704glucose-6-phosphate dehydrogenase

deÞciency, 705themolytic, 705Ð706iron deÞciency, 89tiron tests, 689tiron-deÞciency, 706Ð709Mediterranean, 720megaloblastic, 713Ð714in neonates, 692Ð694

parasitic, 710Ð712pernicious, 713Ð714of prematurity, 692Ð694of renal diseases, 694Ð696sickle cell, 719sideroblastic, 715Ð716signs and symptoms, 689tspherocytic, 705tVitamin B12 deÞciency, 713Ð714

Anencephaly, 194Anesthesia, 804Anethol, 433, 644Angina pectoris, 343Ð345Angioplasty, 378Angiotensin, 860tAngiotensin II receptor antagonists, 371tAngiotensin II receptor blockers (ARBs), 886Angiotensin receptor blockers, 361tAngiotensin-converting enzyme inhibitors

(ACEI), 361t, 371t, 872t, 886Ankylosing spondylitis, 643Ð644Anorexia, 739tAnorexia athletica (compulsive exercising),

274tAnorexia nervosa, 266Ð268, 581Antabuse (disulÞram), 476Antacids, 391, 394, 396, 398, 402, 409t, 841tAnthocyanidins, 500tAnthocyanins, 734t, 790tAntiangiogenesis, 732tAntiangiogenic agent, 744tAntianxiety agents, 616tAntibiotic lock technique, 804Antibiotic ointments, 841 tAntibiotics, 152, 154, 160, 193, 296t, 310t, 402,

423, 429, 432, 442t, 459t, 486t, 491t,498t

oral, 841tAntibodies, 732tAnticholinergics, 255t, 296tAnticoagulant therapy, 356Anticoagulants, 366, 374, 379Anticonvulsants, 30, 174, 235, 239, 265, 276,

616tAntidepressants, 230t, 255t, 268, 616t, 755t,

835t, 872tAntidiarrheals, 401, 423Ð424, 429, 432, 459tAntidiuretic hormone, 571Antiemetic agents, 9, 411, 559, 744tAntiepileptic drugs, 268Antiestrogen therapy, 784Antifungals, 835tAntihemophilic factor, 723Antihistamines, 126, 616t, 727, 755tAnti-hyperglycemics, 547tAntihypertensive agents, 486t, 586, 685Anti-inßammatory drugs, 230t, 486t, 660t, 683,

685Anti-inßammatory factors, 13tAntimalarials, 651Antimetabolites, 744tAntimicrobial factors, 13tAntineoplastic agents, 745t, 835tAntioxidants, 185, 225t, 337t, 339t, 476,

499Ð500t, 534t, 733, 790t, 835tAntiplatelet drugs, 379Antiproliferative agents, 893tAntipsychotics, 149, 230t, 276, 283t, 616t

Antithymocyte globulin, 755tAnti-tumor necrosis factor alpha, 431,

432Ð433Antiviral agents, 255t, 442t, 486t, 755tAnturane (sulÞnpyrazone), 646Anusol, 466Anxiety disorders, 222tAPalpha, 229Apigenin, 499t, 734tAplastic anemia, 696Ð698Apokyn (apomorphine hydrochloride), 255 tApolipoprotein B deÞciency, 144Ð145Apolipoprotein E, 227, 338tAppendectomy, 809tAppetite stimulants, 836tApresoline (hydralazine), 376Aptivus, 834t, 835tAquaMEPHYTON (phytonadione), 486tArachidonic acid, 186Aralen (chloroquine), 651Arctic root, 77tAredia (pamidronate), 673Arginase, 214tArginine, 214t, 824tArginine vasopressin, 571Argininosuccinate lyase, 214tArgininosuccinate synthetase, 214tArgininosuccinic aciduria, 214tAricept, 168Aricept (donepezil), 230 tArimidex (anastrozole), 784Aripiprazole (Abilify), 283 tAristolochic acid, 79tArnica, 113Aromatic amino acid, 483Arrhythmias, 373Arsenic trioxide (Trisenox), 798Artane (trihexyphenidyl), 255 tArtemisinin, 712tArterial vascular disease, 525tArteritis, 345Ð347Arthritis, 638Ascariasis, 845tAscites, 477Ð479Asendin (amoxapine), 284tAshwagandha, 746tAsian diet, 85Aspart (Novolog), 533tAspartame, 533tAspartate, 224tAspergerÕs disorder, 148Aspiration pneumonia, 314tAspirin, 338t, 366, 374, 381, 679t, 697, 727Astaxanthin, 499tAsthma, 293Ð296Astragalus, 80t, 746tAstralgus, 736tAtamet, 255tAtazanavir, 834tAtenolol (Tenormin), 486 t, 616tAtherogenic dyslipidemia, 540Atherosclerosis, 347Ð351Athletes, 38Ð43

children and adolescent athletes, 38drugs and side effects, 40Ð42female, 38food safety tips, 43meal planning, 41t


INDEX 1001

nutritional guidelines, 40, 42tnutritional objectives for, 39Ð40proteins for, 40tsupplements, 42, 42t

Ativan (lorazepam), 284tAtomoxetine (Strattera), 31, 147tAtonic constipation, 418Ð419Atopic dermatitis, 110Ð111, 112Atorvastatin, 350t, 886Atripla, 834tAtrophic gastritis, 401Atrovent, 296t, 302Attention-deÞcit disorders, 145Ð147, 222tAttention-deÞcit hyperactivity disorder

(ADHD) disorders, 145Ð147Autism, 148Autism spectrum disorder (ASD), 148Ð150Autistic disorder, 222tAutoimmune inner-ear disease, 128Ð129Autoimmune kidney diseases, 879Ð881Autoimmune thyroiditis, 589Autonomic neuropathy, 524tAvandia (rosiglitazone), 547tAvastin (bevacizumab), 744t, 762Avenanthramides, 735tAventyl, 284t, 616tAvlimil, 71tAvonex, 250Axid (nizatidine), 409 tAyuverda, 71tAzathioprine (Imuran), 250, 312, 329t, 364t,

436, 486t, 496t, 510t, 644, 651, 680t,755t

Azilect (rasagiline), 255tAzithromycin, 310tAzmacort (triamcinolone), 296 t

B cells, 821tBaclofen, 160, 250, 265Bacterial diarrheas, 421Bacterial pneumonia, 314tBactrim, 486t, 836t, 895Bad breath, 98tBaking ingredients, 491tBaldness, 52tBan lan gen, 747tBaraclude (Entecavir), 486tBarberry, 71tBariatric surgery, 812Ð815BarrettÕs esophagus, 395Basal cell carcinoma, 732tBasiliximab, 893tBassen-Kornzweig syndrome, 144Ð145Beans, 491t, 535tBecker muscular dystrophy, 653tBeclomethasone, 755tBee pollen, 126Belatacept, 893tBelimumab (Benlysta), 650Belladonna, 79tBenacol (sterol), 615Benadryl (diphenhydramine), 616 tBenazepril (Lotensin), 886BeneÞber, 235, 420t, 424Benemid (probenecid), 646Benlysta (belimumab), 650Benzo-alpha-pyrones, 735tBenzodiazepines, 284t, 616t

Benzoyl peroxide, 110Benztropine (Cogentin), 255 tBeta thalassemia, 720Beta-adrenergic blockers, 616tBeta-agonists, 296tBeta-blockers, 356, 361t, 371t, 394, 476, 486tBeta-carotene, 499t, 734t, 736t, 760, 790tBeta-cryptoxanthin, 790tBeta-galactosidofructose, 486tBetaine, 149, 181, 194, 784Betaine-tHcy methyltransferase (BHMT), 194Betaseron, 250Beta-sitosterol, 736tBevacizumab (Avastin), 744t, 762Beverages, 492tBexxar, 744tBezaÞbrate, 513Bezoar formation, 397Ð399Biaxin (clarithromycin), 315Bicytopenia, 698BiÞdobacterium infantis, 444BiÞdus infantis, 193Bigorexia, 274tBiguanides, 547tBilberry, 72t, 534tBile acid sequestrant, 350tBile salt replacements, 459tBile salts, 498tBiliary atresia, 150Ð152Biliary cirrhosis, 512Ð514Biliary disorders, 471Ð473Bilirubin, 500 tBinge eating disorder, 222t, 269Ð270Biochanin A, 736tBioßavonoids, 736tBiogenic amine, 224tBiogenic monoamines, 224tBiological response modiÞers, 681tBiotherapy, 732tBiotin, 119t, 534tBipolar disorders, 222t, 273Ð276, 279tBisacodyl, 417, 420tBismuth subsalicylate, 409tBisoprolol, 616tBisphosphonates, 310t, 670t, 752, 755t, 798,

844Bitter melon, 72t, 534tBitter orange, 80tBlack cohosh, 72t, 746tBladder cancer, 772Ð773Bleeding disorders, 722Ð724Bleomycin, 764t, 835tBlindness, 106Ð108Blocadren (timolol), 486 tBlood clotting factors, 722tBlood formation, nutritional factors in, 689 tBlood glucose, 526tBlood lipids, 526tBlood pressure, 367Ð369, 526t, 540, 860t, 880Blood urea nitrogen (BUN), 694Body dysmorphic disorder, 222t, 274tBody mass index (BMI), 604Ð605t

for adolescents, 605tfor children, 198, 605tmortality and, 605tfor older adults, 605tfor pregnant women, 604tunderweight and, 622

Body weightin amputees, 808tcalculation of, 604t, 606t

Bone cancer, 751Ð752Bone disorders, 641Ð642Bone marrow transplantation, 753Ð756Boniva (ibandronate), 670tBorage, 80tBorage oil, 72tBoron, 665tBortezomib (Velcade), 798, 893tBosentan, 306Boswellia, 72tBotanicals. SeeComplementary nutritionBotulinum toxin, 195, 246Bowel surgery, 816Ð818Bradycardia, 373Brain. See alsoNeurological disorders

cranial nerves, 221tnutrients for brain health, 225Ð226tparts and functions, 220ttrauma, 234Ð236tumor, 756Ð758

Brainstem, 220Branched-chain amino acids (BCAAs), 483Brancher enzyme deÞciency, 176tBreads, 359tBreast cancer, 46t, 782Ð785. See alsoCancerBreast milk, 12

food antigens in, 17for infants with cerebral palsy, 159nutrient content of, 13 tpremature, 186storage of, 18

Breastfeeding, 12Ð18. See alsoPregnancyfrom 0-6 months, 19Ð20from 6-12 months, 22beneÞts of, 14common problems in, 15tdrugs and, 17food and nutritional recommendations

for, 16Ð17food safety and, 18HIV-infected mothers, 178nutritional objectives for, 14Ð16promotion of, 14recommended intakes in, 16tsupplements, 17

BrewerÕs yeast, 72tBroken jaw, 99Ð100Broken tooth, 98tBromelain, 72t, 661t, 746tBromocriptine (Parlodel), 255 t, 289, 574Bronchiectasis, 297Ð298Bronchitis, 298Ð299, 300Bronchodilators, 154, 296t, 298, 299, 302,

310t, 413Bronchopulmonary dysplasia, 152Ð154Bruxism, 105B-type natriuretic peptide (BNP), 305, 357Buckthorn bark, 72tBuddhism, dietary practices of, 91Budesonide, 296t, 432, 436, 513BuergerÕs disease, 346, 378Bulimia nervosa, 6, 270Ð273Bulking agents, 420t, 444, 451Bumetanide, 486tBumex, 486t


1002 INDEX

Buphenyl (sodium phenylbutyrate), 215Bupleurum, 72tBuprenorphine, 289Bupropion, 284tBurdock, 72tBurns, 838Ð841Busulfan, 727, 755t, 794tButcherÕs broom, 72tButyrophenone (Haldol), 283 tByetta (exenatide), 547t

C93, 787Cachexia, 630, 739tCaffeic acid, 734tCaffeine, 42t, 247t, 280, 288t, 665tCalan (verapamil), 345Calcet, 669tCalciferol, 595Ð596Calcijex (calcitriol), 872 tCalcineurin inhibitors, 893 tCalcitonin, 570tCalcitonin-salmon (Miacalcin), 670tCalcitriol, 111, 208Ð209, 670t, 872tCalcium

anti-cancer roles, 735tbone health and, 665tdepression and, 278in foods, 53t, 735thealth claims, 55timbalance, 806tfor infants, 19for oral tissue and dental care, 97tin post-transplant nutrition, 495 trecommended intakes for children, 29tsources of, 341Ð342tsupplements, 669t

Calcium carbonate, 779Calcium channel blockers, 345, 356, 371t, 391Calcium glucarate, 747tCalcium glycerophosphate (Prelief), 397Calcium oxalate stone, 882Ð883, 884tCalcium polycarbophil (FiberCon), 420 tCalcium supplements, 459tCalcium-containing binders, 872tCalendula, 72t, 113Calories

adding to diet, 302tin post-transplant nutrition, 495 t

Caltrate 600, 669tCampath-1 H, 744tCampesterol, 736tCamptosar (irinotecan), 744tCancer

assessment factors, 731bladder, 772Ð773bone, 751Ð752brain tumor, 756Ð758breast, 782Ð785as cause of death, 44tchoriocarcinoma, 786Ð787clinical indicators, 742tcolorectal, 759Ð762complementary nutrition, 745deÞnitions, 732tdietary fats and, 55tdrugs and chemotherapy agents, 744Ð745tenteral nutrition for, 738 tesophageal, 763Ð766

food safety tips, 745gastric, 767Ð769head and neck, 763Ð766kidney, 772Ð773leukemia, 791Ð794liver, 769Ð771lymphomas, 795Ð796myeloma, 797Ð798nutrition support therapy for, 738 tnutritional guidelines for, 742Ð743nutritional objectives for, 742tpancreatic, 777Ð779patient education, 745, 750tprevention, 733prostate, 788Ð790risk factors, 737trisk reduction, 733selenium and, 56tside effects of treatment, 739Ð741skin, 780Ð782thyroid, 763Ð766treatment guidelines, 738Ð750urinary tract, 772Ð773

Canker sores, 98tCannabidiol, 500tCannabinoids, 250, 500tCanthaxanthin, 499tCapoten (captopril), 886Capsaicin, 72t, 247, 433, 644, 736t, 746tCapsicum, 72tCaptopril (Capoten), 886Carafate (sucralfate), 409tCarbamazepine, 241t, 265, 268, 616tCarbamoylphosphate synthetase, 214tCarbatrol (carbamazepine), 241tCarbazochrome, 466Carbidopa, 255tCarbohydrates

dietary guideline for, 3theart disease and, 338tmalabsorption, 155Ð157metabolic disorders, 155Ð157in post-transplant nutrition, 495 trecommended intakes, 48Ð49recommended intakes for children, 29t

Carcinogens, 733Carcinoid syndrome, 412Ð413Carcinoma, 732tCardiac cachexia, 352Ð354Cardiac glycosides, 361tCardiac neuropathy, 524tCardiac tamponade, 375Ð377Cardiomyopathies, 354Ð356Cardiorenal syndrome, 866Cardiovascular agents, 616tCardiovascular disorders, 336Ð343

angina pectoris, 343Ð345arteritis, 345Ð347assessment factors, 335atherosclerosis, 347Ð351cardiac cachexia, 352Ð354cardiac tamponade, 375Ð377cardiomyopathies, 354Ð356coronary artery disease, 347Ð351diabetes and, 525tdietary recommendations for, 337tdyslipidemia, 347Ð351factors in, 338Ð339t

heart failure, 357Ð362heart valve diseases, 365Ð367herbs and botanical products for, 340thypertension, 367Ð371lipids and, 336myocardial infarction, 372Ð375pericarditis, 375Ð377peripheral artery disease, 377Ð379thrombophlebitis, 379Ð381

Cardizem (diltiazem), 345Cardura (doxazosin), 616tCarmustine, 755t, 798Carnitine, 860t, 872tCarotenoids, 110, 499tCarvedilol, 616tCascara, 72tCatabolic illness, 525tCataract, 106Ð108Catatonic disorder, 222tCatechin, 499t, 734t, 735tCatecholamines, 587tCatechol-O-methyltransferase (COMT)

inhibitors, 255tCatÕs claw, 746tCayenne, 73tCD20 antibody, 681tCeftriaxone, 233, 895Celebrex (celecoxib), 660tCelecoxib, 660t, 679tCelexa, 616tCeliac disease, 414Ð415Central nervous system (CNS), 220Cephalosporins, 315Cephulac, 420t, 486tCerebellum, 220Cerebral aneurysm, 236Ð238Cerebral palsy, 155t, 158Ð160Cerebrovascular accident (CVA), 259Ð263Cerebrum, 220Cerebyx (fosphenytoin), 241tCerefolin, 229Cerivastatin, 350t, 676Ceruloplasmin, 698Cervical radiculopathy, 683Cesarian delivery, 809tCetuximab, 744tCevimeline (Evoxac), 681tChamomile, 73t, 113, 746tChaparral, 79t, 538Chasteberry, 73tCheese, 247tChemical pneumonia, 314tChemotherapy, 332t, 616t, 732t, 739t, 755tChemotherapy agents, 744tChewing problems, 107, 108Ð109Chicoric acid, 500tChildhood disintegrative disorder, 222tChildren

body mass index for, 605tclinical indicators, 28constipation in, 418Ð419daily estimated calories, 30tdietary recommendations for, 32tdrugs and side effects, 30Ð31eating behavior, 27energy requirements/expenditures, 142tfailure to thrive, 169Ð171food and nutrition, 29Ð30


INDEX 1003

food safety tips, 32HIV infection in, 177Ð179immunocompetence of, 822tinfectious diseases, 28lead poisoning, 32tmalnutrition in, 27Ð28measles, 32tnormal growth rates, 164tnutritional guidelines for, 29Ð30, 31nutritional objectives for, 28Ð29obesity in, 27, 197Ð201

clinical indicators, 198tcomplications, 198tdrugs and side effects, 200food safety tips, 201tgenetic markers, 198tnutritional guidelines for, 200Ð201nutritional objectives for, 199Ð200patient education, 200Ð201weight loss diets for, 199tweight loss program for, 201t

pediatric disorders, 137Ð143anthropometric, 138tbehavioral, 138Ð139tclinical, 139Ð140tdevelopmental disabilities, 140teating/feeding skills, 140tgenetic/metabolic, 140 tnutritional risks, 143t

physical activity, 32t, 142trecommended intakes, 29trefeeding, 635sports nutrition, 38supplements, 31type 1 diabetes in, 521t, 523ttype 2 diabetes in, 521t, 523t, 549Ð551

Chili powder, 746tChinese asparagus, 73tChinese diet, 85Chinese herbal medicine, 746tChinese PC-SPES, 746tChitosan, 73tChlorambucil, 727, 794tChloramphenicol, 716Chlordiazepoxide (Librium), 284 t, 616tChloride, 63t, 340Chloride channel activators, 420tChlorogenic acid, 500t, 734tChloroquine (Aralen), 651Chlorothiazide, 486tChlorpromazine (Thorazine), 283 tChocolate, 247t, 288tCholac syrup, 491tCholangiolitic hepatitis, 512Ð514Cholecalciferol, 208Ð209Cholecystitis, 516Ð517Cholecystokinin, 569tCholelithiasis, 516Ð517Cholestasis, 514Ð516Cholesterol, 55tCholesterol spinach, 73tCholestyramine, 152, 350t, 424, 459t, 491t, 515Choline, 121, 181, 226t, 784

deÞciency of, 119ttoxicity of, 121

Cholinesterase inhibitors, 230tCholylsarcosine, 429Chondroitin, 73 t, 660t

Choriocarcinoma, 786Ð787Christianity, dietary practices of, 94Chromium, 97t, 340t, 534tChromium picolinate, 73 t, 581, 615Chronic anemia, 689tChronic gastritis, 401, 402Chronic glomerulonephritis, 879Chronic heart failure (CHF), 353Chronic kidney disease (CKD), 864Ð873.

See alsoRenal disordersacute renal failure, 864chronic renal failure, 865clinical indicators, 866tdrugs and side effects, 872tßuid restriction, 873thypertension and, 368nutritional guidelines for, 869nutritional objectives for, 868Ð869patient education, 869Ð873protein-energy malnutrition in, 866Ð868tstages and symptoms of, 865tsupplements, 869

Chronic leukemias, 793tChronic lymphocytic leukemia, 793tChronic myelogenous leukemia, 793tChronic obstructive pulmonary disease

(COPD), 300Ð303Chronic pancreatitis, 501Ð506Chronic pyelonephritis, 894Chronulac (lactulose), 420t, 486t, 491tChrysanthemum, 73tChurch of Jesus of Latter Day Saints, 94Chylothorax, 304Ð305Chylous ascites, 477Ð479Cialis (tadalaÞl), 52tCidofovir, 835tCimetidine (Tagamet), 283, 409t, 459tCinacalcet (Sensipar), 598, 872tCinnamic acid, 500tCinnamon, 73t, 534tCiproßoxacin, 424, 436, 455, 895Circadian rhythm disorder, 222t, 285Ð286Cirrhosis, 44t, 512Ð514Cisplatin, 764tCitracal, 669tCitrate stones, 884tCitric acid, 500tCitrucel (methylcellulose), 420tCitrulline, 215Citrullinemia, 214 tClarithromycin (Biaxin), 315Cleft lip and cleft palate, 161Ð162CloÞbrate, 350tClomipramine, 149, 284tClonazepam (Klonopin), 160, 241t, 284tClonidine, 149, 459tClorazepate (Tranxene), 284tClosed enteral system, 899tClosed fractures, 842Clostridium difÞcileinfection, 422Clotrimazole (Mycelex), 755t, 835tCloves, 644, 746tClozapine, 264, 283tClozaril, 264, 283t, 616tClub drugs, 288tCNS lymphoma, 757tCobalamin, 181Cocaine, 288t

Coenzyme Q10, 73t, 229, 230t, 262, 340t, 350,357, 362, 676, 736t, 886

Cogentin (benztropine), 255 tCognex (tacrine), 230tColchicine (Colcrys), 646Colcrys (colchicine), 646Colectomy, 816Colesevelam, 350, 350tColestipol, 350t, 515Coleus, 73tColic, 21tColitis, 741tCollagen-IV nephropathies, 862Ð863Colon, loss of, 456tColorectal cancer, 759Ð762Colostomy, 450Ð452Coma, 238Ð239, 900Ð901tCombivent, 296tCombivir, 834tComfrey, 79tComminuted fractures, 842Common cold, 826tComplementary nutrition, 70Ð83

for allergies, 126for cancer patients, 746Ð749tclinical indicators, 82tdrugs and side effects, 83Ð84food safety tips, 83for foodborne illnesses, 135guidelines for, 82thazardous products in, 79Ð81tfor heart disease, 340therbs, botanicals, and supplements in,

71Ð81tfor infants, 22nutritional objectives for, 82patient education, 83for rheumatic disorders, 639supplements, 83

Compound fracture, 842Compression fractures, 842Ð843Compulsive exercising, 274tComtan (entacapone), 255tConcerta (methylphenidate), 147tCondiments, 492tConduct disorder, 222tCone ßower, 73tCongenial hyperinsulinism, 567Ð569Congenital glucose-galactose malabsorption,

155, 157Congenital heart disease (CHD), 163Ð164.

See alsoCardiovascular disordersdrugs and side effects, 164genetic markers, 163incidence of, 163medications for, 159tnutritional guidelines for, 164nutritional objectives for, 163Ð164supplements, 164

Congenital hypothyroidism, 592Congenital megacolon, 175Ð177Congenital muscular dystrophy, 653tCongenital renal glycosuria, 155Conivaptan, 580ConnÕs syndrome, 585Constipation, 418Ð420. See also

Gastrointestinal disorderscancer and, 739t


1004 INDEX

Constipation ( continued)fecal incontinence and, 463tin infants, 21t

Constulose (lactulose), 491tContinent ileostomy, 453Continuous positive airway pressure (CPAP),

324Conversion disorder, 222tCooleyÕs anemia, 720Coordination problems, 106Ð107, 108Copegus (ribavirin), 481Copper, 19, 97t, 294t, 338t, 665t

deÞciency of, 698Ð700, 712tfood sources, 700t

Copper deÞciency anemia, 698Ð700Copper sulfate, 700tCor pulmonale, 305Ð306Corgard (nadolol), 345, 486tCori disease, 176tCorn syrup, 532tCoronary artery bypass graft (CABG), 809tCoronary artery disease (CAD), 347Ð351, 525tCoronary heart disease (CHD), 55t, 56tCoronary occlusion, 372Ð375Cortef, 572Corticosteroids, 30, 152, 217, 258, 296t, 329t,

364t, 417, 432, 436, 442t, 454, 476,486t, 496t, 510t, 572, 616t, 674, 680t,697, 729, 744t, 755t, 796, 835t, 893t

Corticotropin-releasing hormone, 225tCortisol, 572, 583Cortisone, 572Cotazym (pancreatic enzyme), 508Cotrim, 895Coumadin, 317, 318, 356, 374, 381Coumarins, 735tCoumestans, 734tCoviracil, 834tCozaar (losartan), 886Cranberry, 73tCranial arteritis, 346Cranial nerves, 221tCraniopharyngiomas, 757tCraniotomy, 810tC-reactive protein, 338t, 688Creatinine index, 867Creon (pancreatic enzyme), 508CREST syndrome, 684Crestor (rosuvastatin), 886Cretinism, 592Crixivan, 835tCrohnÕs disease, 430Ð433, 760Cromolyn (Intal), 296 tCultural food patterns, 84Ð87

African/African American, 85Asian, 85drugs and side effects, 86Ð87Hispanic/Latino, 85Hmong, 85Indian/Pakistani, 86Mediterranean diet, 86Middle Eastern, 86Native American, 86nutritional objectives, 85patient education, 87religious food practices, 86supplements, 87

Cuprimine (D-penicillamine), 217, 486 t

Curative therapy, 732tCurcumin, 73t, 433, 500t, 644Curry, 73tCushingÕs syndrome, 575Ð576Cyanidin, 500tCyclic vomiting syndrome, 274tCyclizine, 411Cyclobenzaprine (Flexeril), 657Cyclooxygenase-2 (COX-2) inhibitors, 660t,

679t, 719Cyclophosphamide, 312, 651, 697, 727, 744t,

755t, 774, 784, 787, 798, 886Cyclosporine, 126, 329t, 364t, 436, 442t, 496t,

510t, 538t, 644, 646, 680t, 755t, 893tCymbalta (duloxetine), 284t, 657Cyproheptadine HCl (Periactin), 631Cystagon (cysteamine), 166Cystathionine-beta-synthase (CBS), 180Cysteamine (Cystagon), 166Cystic Þbrosis, 46t, 307Ð310Cystine stones, 882, 884tCystinosis, 165Ð166Cystitis, 894Cytochrome P450, 110Cytokines, 13t, 225t, 821t, 838Cytotec (misoprostol), 660tCytotoxic T cells, 821tCytovene, 835tCytoxan (cyclophosphamide), 312, 651, 755t,

774, 784

Da qing ye, 73tDaclizumab, 893tDa-huang, 77tDaidzein, 499t, 736tDairy products, 303t, 338t, 359t, 491tDalmane (ßurazepam), 284tDandelion, 73tDanshen, 340tDantrium (Dantrolene), 160Dantrolene (dantrium), 160Darunavir, 834tDarvon (propoxyphene), 283Dasatinib (Sprycel), 794tDASH diet, 342t, 354, 357, 366, 369, 374Dawn phenomenon, 522tDaytrana (methylphenidate), 147tD-cycloserine, 149Death, leading causes of, 44tDebrancher enzyme deÞciency, 176tDecanoate, 836tDeclomycin (demeclocycline), 580Deferoxamine, 486t, 726Degenerative joint disease, 658Ð661Dehydration, 915tDehydroepiandrosterone, 746tDelavirdine, 834tDelayed gastric emptying (DGE), 558Deli, 492tDelphinidin, 500 tDeltasone, 296tDeltasone (prednisone), 657Delusional disorder, 222tDemeclocycline (Declomycin), 580Dementia, 56t, 227Ð231Demerol (meperidine), 844Dental abscess, 98tDental caries, 56t, 99Ð100, 739t

Dental problems, 96Ð101nutrients for, 97tsymptoms, 98Ð99ttreatment of, 98Ð99t

Depacon, 241tDepakene, 241t, 616tDepakote, 241t, 616tDepen (D-penicillamine), 217, 486tDepersonalization disorder, 223tDeplin (L-methylfolate), 168, 277, 704Depo-Provera, 616tDepression, 277Ð280Depressive disorders, 223tDermatitis herpetiformis, 111, 112, 415Desamino-8-arginine vasopressin (DDAVP),

722Desferal (deferoxamine), 486tDesipramine, 149, 284t, 289Desoxyn (methamphetamine), 147tDesserts, 303tDETERMINE checklist, 60tDevilÕs claw, 73tDexamethasone, 154Dexedrine, 31Dexedrine (dextroamphetamine), 147 tDexferrum, 695Dexmethylphenidate, 147tDextroamphetamine, 31, 147tDextrose, 532tDiabeta (glyburide), 547tDiabetes insipidus, 577Ð578Diabetes mellitus, 44t, 520Ð526. See also

Endocrine disordersassessment factors, 519Ð520assessment in, 519Ð520as cause of death, 338tcomplications of, 522Ð525tetiologic classiÞcation of, 521tevaluation for, 522texercise guidelines for, 536tgestational, 523t, 552Ð555herbs and supplements, 534tmanagement of, 526tprediabetes, 542Ð544pregnancy and, 523ttype 1, 414, 520, 528Ð536

in children, 521 t, 523tclinical indicators, 529drugs and side effects, 531medical nutrition therapy for, 529Ð531patient education, 531Ð536warning signs, 519

type 2, 520in adults, 544Ð549in children, 521 t, 523tin children and teens, 549Ð551clinical indicators, 545t, 550tdrugs and side effects, 547Ð548, 551medical nutrition therapy for, 545 t,

546Ð547, 550Ð551medications for, 547tpatient education, 548Ð549, 551risk factors, 519supplements, 548, 551

type 3, 227Diabetic gastroparesis, 558Ð559Diabetic ketoacidosis (DKA), 522t, 560Ð562Diabetic retinopathy, 106


INDEX 1005

Diallyl sulÞde, 433, 644Dialysis, 874Ð878Diamond-Blackfan anemia, 692Ð693Diarrhea, 421Ð424. See alsoGastrointestinal

disordersbacterial, 421Bristol stool scale, 422tin cancer patients, 740tClostridium difÞcileinfection, 422drugs and side effects, 423Ð424early childhood, 421Ð422fecal incontinence and, 463tin infants, 21tnutritional guidelines for, 423nutritional objectives for, 423travelerÕs diarrhea, 422types of, 421t

Diazepam (Valium), 284tDiazoside, 568Didanosine, 834tDiet

African/African American, 85Asian, 85Hispanic/Latino, 85Hmong, 85Indian/Pakistani, 86Mediterranean diet, 86Middle Eastern, 86religious food practices, 86

Eastern, 91Ð92Middle Eastern, 95Ð96Western, 93Ð95

vegetarian, 88Ð90Dietary fats, 55t

in breast milk, 13tin diet, 302tdietary guideline for, 3thealth claims, 55tin post-transplant nutrition, 495 trecommended intakes for children, 29t

Dietary Þberbone health and, 665tbreast cancer and, 784cardiovascular disease, 349in common foods, 465tconstipation and, 235health claims, 55t, 56theart disease and, 337t, 338tinsoluble, 736tmyocardial infarction and, 374recommended intakes, 49recommended intakes for children, 29tsoluble, 736tin vegetarian diet, 89t

Dietary guidelines, 3Ð5tAmerican, 3Ð4tfor athletes, 41tCanadian, 4tChinese, 4tMyPyramid, 35South African, 5t

Diethylpropion (Tenuate), 617 tDigestion, 384Digitalis, 350, 361t, 586Digoxin, 350, 356, 366Dihydrochalcones, 734tDilantin (phenytoin), 235, 239, 241 t, 376Dilated congestive cardiomyopathy, 354Ð355

Diltiazem, 345Dimenhydrinate (Dramamine), 559Diovan (valsartan), 886Diphenhydramine, 616tDipsogenic diabetes insipidus, 577Dipyridamole, 181Direct renin inhibitors, 371tDisability Rating Scale, 238Discolored teeth, 98tDisease-modifying antirheumatic drugs

(DMARDs), 680tDisopyramide (Norpace), 345Disruptive behavior, 223tDissociative disorders, 223tDissociative identity disorder, 223tDistal colitis, 434Distal muscular dystrophy, 653tDisulÞram (Antabuse), 476Diuretic-antihypertensives, 371tDiuretics, 152, 154, 329t, 356, 361t, 364t, 366,

371t, 376, 478, 486t, 496t, 498t,510t, 538t, 596, 886

Diuril (chlorothiazide), 486 tDivalproex sodium, 241tDiverticular diseases, 425Ð426Diverticulitis, 425Ð426Diverticulosis, 426Docosahexaenoic acid (DHA), 362, 378Docusate, 695Docusate sodium, 417, 420tDomperidone, 404, 559, 744tDonepezil (Aricept), 230 tDong quai, 73tDopamine, 224t, 287, 587tDopamine agonists, 255tDopamine antagonists, 404Dopamine receptor antagonists, 263Down syndrome, 166Ð167Doxazosin (Cardura), 616tDoxepin (sinequan), 284t, 616tDoxercalciferol (Hectorol), 598, 872 tDoxil, 512Doxorubicin, 512, 774, 784, 798, 835tDoxycycline, 467D-penicillamine, 217DPP-4 inhibitors, 547tDramamine (dimenhydrinate), 559Dronabinol (Marinol), 631, 836 tDroxia (hydroxyurea), 719DSM-IV, 222tDuchenne muscular dystrophy, 653tDuchenne/Becker muscular syndrome, 45tDulcolax (bisacodyl), 417Duloxetine (Cymbalta), 284t, 657Duphalac (lactulose), 491tDyrenium (triamterene), 486 tDysentery, 421t, 422Dysgeusia, 740tDyslipidemia, 347Ð351, 525t, 540, 875Dyspepsia, 397Ð399Dysphagia, 386Ð390. See alsoGastrointestinal

disorderscancer and, 740tcauses of, 387tclinical indicators, 387tdrugs and side effects, 390evaluation of, 387tnutritional guidelines for, 388

nutritional objectives for, 388patient education, 390supplements, 390

Dysthymia, 277Dysthymic disorder, 223t

Earache, 128Early childhood caries (ECC), 99Ð100Early childhood diarrhea, 421Ð422Eastern Orthodox Christian, dietary practices

of, 94Eating disorder, 223t

anorexia athletica, 274tanorexia nervosa, 266Ð268bigorexia, 274tbinge, 269Ð270body dysmorphic disorder, 274tbulimia nervosa, 270Ð273compulsive exercising, 274tcyclic vomiting syndrome, 274teating disorders not otherwise speciÞed

(ED-NOS), 274tmuscle dysmorphic disorder, 274tnight eating syndrome, 274tnocturnal sleep-related eating disorder,

274torthorexia nervosa, 274tpica, 274trumination syndrome, 274t

Eating disorders not otherwise speciÞed (ED-NOS), 274t

Echinacea, 74t, 661t, 736t, 746t, 808tEcstasy, 288tEczema, 110Ð111Edema, 740t, 880Edentulism, 99, 101Efavirenz, 834tEffexor (venlafaxine), 284tEggs

allergy to, 125t, 127theart disease and, 338t

Eicosapentaenoic acid (EPA), 362Elavil (amitriptyline), 284 t, 616t, 657Eldepryl (selegiline), 230t, 255tElderly, 58Ð66

clinical indicators, 59tdiabetes in, 523tdrug effects in, 63, 64tdrugs and side effects, 58food safety tips, 66immunocompetence of, 822tmedical nutrition therapy for, 58Ð59nutrition assessment for, 60tnutritional education for, 64Ð66nutritional guidelines for, 61nutritional objectives for, 59Ð61patient education for, 66physiological characteristics of, 58recommended intakes for, 62Ð63tstature for, 66tsupplements, 63Ð64weight table for, 65t

Elderly Dietary Index (EDI), 336Electrolytes, 63t, 806Ð807t, 915tEleuthero, 746tEllagic acid, 433, 500t, 644Ellagitannins, 500tEmery-Dreyfus muscular dystrophy, 653t


1006 INDEX

Emitasol, 559Emollient laxatives, 420tEmphysema, 300Emtricitabine, 834tEmtriva, 834tEnalapril (Vasotec), 886Enbrel (etanercept), 332t, 681tEncephalomalacia, 705Ð706Encopresis, 418Ð419Endemic goiter, 592Endocannabinoids, 225tEndocrine disorders, 519Ð527

acromegaly, 573Ð574AddisonÕs disease, 582Ð584adrenocortical insufÞciency, 582Ð584assessment factors, 519Ð520CushingÕs syndrome, 575Ð576diabetes. seeDiabetes mellitusdiabetes insipidus, 577Ð578diabetic gastroparesis, 558Ð559diabetic ketoacidosis, 560Ð563hyperaldosteronism, 585Ð586hypercalcemia, 596Ð598hyperinsulinism, 567Ð569hyperosmolar hyperglycemic state,

563Ð564hyperparathyroidism, 596Ð598hyperthyroidism, 589Ð591hypocalcemia, 595Ð596hypoglycemia, 565Ð566hypoparathyroidism, 595Ð596hypopituitarism, 571Ð573hypothyroidism, 591Ð594metabolic syndrome, 539Ð541pheochromocytoma, 586Ð588polycystic ovarian syndrome, 580Ð582prediabetes, 542Ð544pre-eclampsia, 556Ð557spontaneous hypoglycemia, 567Ð569syndrome of inappropriate antidiuretic

hormone, 579Ð580Endocrine system cancers, 732tEnd-of-life care, 900Ð901tEnd-stage renal disease, 524tEnemas, 466Energy, 3tEnergy requirements, 608t

in athletes, 38in children, 29 t, 142tin infants, 142tprotein-energy malnutrition, 626Ð631

Enfuvirtide, 835tEntacapone (Comtan), 255tEntamoeba histolytica, 845tEntecavir (baraclude), 486tEnteral nutrition, 902Ð911. See alsoParenteral

nutritionassessment factors, 897checklist, 910tclinical indicators, 904Ð905tclinical practice guidelines, 905tfor coma patients, 900Ð901tcomplications, 908tconsequences of not feeding in, 904tcontraindications, 908tdelivery methods, 908tfor dialysis patients, 877tdisadvantages of, 903drugs and side effects, 907

feeding site selection, 908tßuid needs in, 908tformula selection, 908tformulas, 906tindications and contraindications, 738t,

850issues in, 908toverview, 898Ð901patient education, 910Ð911terminology, 899t

Enteric fever, 828tEnteric nervous system stem cells (ENSSCs),

448Enterobius vermicularis, 845tEnteropathy-associated T-cell lymphoma

(EATL), 795Entocort (budesonide), 432Entry inhibitors, 835tEosinophilic esophagitis, 122, 395Eosinophilic gastroenteritis, 122Ephedra, 42t, 80t, 272, 283, 295, 302, 356, 615,

808tEphedrine, 42tEpicatechin, 499tEpidermolysis bullosa, 111, 112Epidural hemorrhages, 237Epigallocatechin, 499tEpigallocatechin gallate (ECGC), 735tEpilepsy, 240Ð242Epinephrine, 126, 224t, 296t, 570t, 587tEpithelioma, 732tEpivir (lamivudine), 486 t, 834tEplerenone, 586Epoetin, 872tEpzicom, 834tEqual (aspartame), 533tEquilactin, 420tErectile dysfunction, 52tErgocalciferol, 595Ð596Eriodictyol, 499t, 736tErlotinib (Tarceva), 779Erucic acid, 185Erythremia, 726Ð728Erythroblastosis fetalis, 692Erythrocyte sedimentation rate, 338tErythromycin, 404, 559Erythropoietin, 688, 860tErythropoietin stimulating agents (ESAs), 695Escherichia coli, 851Esidrix, 486tEskalith, 616tEsomeprazole (Nexium), 397, 398, 402, 406,

409t, 512Esophageal cancer, 763Ð766Esophageal spasm, 390Ð391Esophageal stricture, 390Ð391Esophageal trauma, 392Ð393Esophageal varices, 393Ð394Esophagitis, 395Ð397, 740tEssential fatty acids (EFAs), 9, 110Ð111, 225tEssential oils, 534tEssiac, 746tEstimated energy requirement (EER), 605tEstrogen, 5, 338t, 370, 517, 570t, 572, 784Etanercept (Enbrel), 332t, 681tEthambutol, 332t, 376Ethionamide, 332tEthopropazine, 255tEthosuximide (Zarontin), 241 t

Etoposide, 787Eucalyptus, 74tEugenol, 433, 500t, 644Eurixor, 81tEustachian tube, 202Evening primrose oil, 74t, 534t, 661t, 746tEvista (raloxifene), 670tExanta (ximelagatran), 381Exelon (rivastigmine), 230tExenatide (Byetta), 547tExercise

breastfeeding and, 17carbohydrate ingestion and, 38for diabetic patients, 536theart disease and, 338t

Expectorants, 296t, 298

Facial nerve, 221tFactitious disorder, 223tFailure to thrive (FTT), 169Ð171, 280Falcarinol, 746tFamilial adenomatous polyposis (FAP), 46tFamilial hemolytic jaundice, 705tFamily meals, 49Famotidine (Pepcid), 409tFanconi anemia, 45tFanconi-Bickel syndrome, 176tFanconiÕs anemia, 696Ð698FanconiÕs syndrome, 165Ð166Fascioscapulohumeral muscular dystrophy,

653tFasting, 95Ð96Fat malabsorption syndrome,

427Ð430Fatigue, 740tFats

in breast milk, 13tin diet, 302tdietary guideline for, 3thealth claims, 55tin post-transplant nutrition, 495 trecommended intakes for children, 29t

Fatty acid oxidation disorders, 172Ð173Fatty acid synthase, 786Fatty acids, 638Ð639Febrile conditions, 825Ð829Febuxostat (Uloric), 646Fecal incontinence, 463Ð465Felbamate, 241tFelbatol, 241tFeldene (piroxicam), 660tFeltyÕs syndrome, 677tFemale athlete triad, 38Fenßuramine-phentermine, 366FenoÞbrate, 350tFenugreek, 74t, 340t, 534tFermented foods, 247t, 492tFerritin, 689t, 707Ferulic acid, 734tFetal alcohol syndrome, 173Ð175Feverfew, 74t, 113, 247Fiber

bone health and, 665tbreast cancer and, 784cardiovascular disease, 349in common foods, 465tconstipation and, 235health claims, 55t, 56theart disease and, 337t, 338t


INDEX 1007

insoluble, 736tmyocardial infarction and, 374recommended intakes, 49recommended intakes for children, 29tsoluble, 736tin vegetarian diet, 89t

Fiberall, 420tFiberCon (calcium polycarbophil), 420 tFiber-Lax, 420tFibric acids, 350tFibromyalgia, 656Ð657Filgrastim (Neupogen), 755tFinasteride (Proscar), 52tFish, 492t

allergy to, 125t, 127tsodium content, 359t

FK506 (tacrolimus), 364t, 442, 510tFK5-6 (tacrolimus), 496t, 538t, 893tFlagyl (metronidazole), 283Flavanones, 499t, 734t, 736tFlavoglycosides, 500tFlavones, 294t, 499t, 734tFlavonoids, 294t, 338t, 349, 737t, 771Flavonolignans, 500tFlavonols, 499t, 734t, 735tFlaxseed, 74t, 746tFleet Mineral Oil, 420tFleet Phospho-Soda, 420tFlexeril (cyclobenzaprine), 657Florinef (ßudrocortisone), 583Flovent (ßuticasone), 296tFloxin (oßoxacin), 895Flu, 826tFlucytosine, 744t, 835tFludarabine, 755tFludrocortisone (Florinef), 583Fluid overload, 915tFlunisolide, 296tFluoride, 97tFluoroquinolone, 895Fluorouracil, 46t, 512, 744t, 762, 768, 784Fluoxetine, 149, 272, 279, 284t, 616tFlurazepam (Dalmane), 284tFluticasone (Flovent), 296tFluvastatin, 350t, 886Fluvoxamine (Luvox), 283t, 616tFocal segmental glomerulosclerosis, 880Focalin (dexmethylphenidate), 147tFolate

deÞciency of, 712tdementia and, 229drug interactions, 195health claims, 55tfor healthy vision, 108tfor oral tissue and dental care, 97trecommended intakes, 341trecommended intakes for children, 29tschizophrenia and, 281

Folate antagonists, 744tFolic acid, 56t, 119t, 121, 181, 226t, 229,

338t, 661t, 665t, 701Ð704, 735t, 760

Folic acid deÞciency anemia, 701Ð704Folinic acid, 149Folk remedy oils, 74tFollicle-stimulating hormone (FSH), 571Food additives, allergy to, 125tFood Allergen Labeling and Consumer

Protection Act (FALCPA), 123

Food allergies/intolerances, 122Ð127allergens, 125tclinical indicators, 124education, 131food processing concerns, 126tfood safety tips, 131tgastrointestinal, 122Ð123nutritional guidelines for, 124Ð125nutritional objectives for, 124patient education, 126Ð127prevalence of, 122supplements, 126symptoms, 122

Food labeling terms, 55tFood protein-induced enterocolitis syndrome

(FPIES), 122Ð123Food scale, 612tFoodborne illnesses, 130Ð136

clinical indicators, 130tdrugs and side effects, 134Ð135food handling/safety guidelines,

134t, 135nutritional objectives for, 131outbreaks, 130pathogens, 132Ð133trefrigerator food storage, 135tsymptoms, 132Ð133t

Food-dependent exercise-induced anaphylaxis(FDEIA), 123

Food-induced anaphylaxis, 123Foods

fruits, 54tfunctional, 50Ð51tlabeling terms, 55toxygen radical absorbance capacity

(ORAC), 503Ð505tvegetables, 54t

Foradil, 296tForbes disease, 176tForebrain, 220tFormiminoglutamic acid, 701Formula-fed infants, 20Formulation, 899tForskolin, 73t, 74tForteo, 670tFosamax (alendronate), 52t, 670tFosamprenavir, 834tFoscarnet, 835tFoscavir, 835tFosfree, 669tFosphenytoin (Cerebyx), 241tFosrenol (lanthanum carbonate), 872tFractures, 842Ð844Fragile X syndrome, 45t, 148Frankincense, 660tFrondanol A5, 762Frontal lobe, 220t, 234Frontotemporal dementia, 45tFrozen foods, 492tFructose, 532tFructose intolerance, 155Fructose-1,6-disphosphatase deÞciency, 45tFructosemia, 157Fruits

eating tips, 53tÞber content, 465theadaches and, 247thealth claims, 55tnutrients in, 54Ð55

Fumarylacetoacetate hydrolase (FAH), 212Functional foods, 49, 734Ð737tFuradantin (nitrofurantoin), 895Furosemide (Lasix), 478, 486t, 886Fusion inhibitors, 835tFuzeon, 835t

Gabapentin (Neurontin), 241 t, 616tGabitril (tiagabine), 241 tGalactosemia, 155, 156Galantamine, 230tGallate esters, 499tGallbladder cancer, 516Gallbladder disorders, 473, 516Ð518, 915tGallic acid, 500t, 735tGallocatechin, 499tGallotannins, 500tGallstones, 516Gamma aminobutyric acid, 224tGamma linolenic acid, 74t, 295, 534t, 661t,

746tGanciclovir, 835tGantrisin (sulÞsoxazole), 895Garcinia, 615Garlic, 74t, 340t, 534t, 661t, 747t, 808tGastrectomy, 399Ð401Gastric bypass surgery, 812Ð815Gastric cancer, 767Ð769Gastric mucosa, 569tGastric residual volume, 907Gastric retention, 403Ð405Gastrin, 569tGastrinoma, 511Ð512Gastritis, 401Ð403Gastroduodenostomy, 399Gastroenteritis, 401Ð403Gastroesophageal reßux disease (GERD),

395Ð397Gastrointestinal agents, 409tGastrointestinal cancers, 732tGastrointestinal disorders, 383Ð385

achalasia, 390Ð391assessment factors, 383carcinoid syndrome, 412Ð413celiac disease, 414Ð417conditions that may cause fear of eating,

384tconstipation, 418Ð420CrohnÕs disease, 430Ð433diarrhea, 421Ð424diverticular diseases, 425Ð427dysentery, 421Ð424dysphagia, 386Ð390esophageal stricture/spasm, 390Ð391esophageal trauma, 392Ð393esophageal varices, 393Ð394esophagitis, 395Ð397fat malabsorption syndrome, 427Ð430fecal incontinence, 463Ð465gastric retention, 403Ð405gastritis, 401Ð403gastroenteritis, 401Ð403gastroesophageal reßux disease, 395Ð397gastroparesis, 403Ð405giant hypertrophic gastritis, 405Ð406hemorrhoids, 466Ð467hiatal hernia, 395Ð397intestinal fuels for, 385tintestinal lymphangiectasia, 439Ð440


1008 INDEX

Gastrointestinal disorders (continued)irritable bowel syndrome, 443Ð445lactose maldigestion, 445Ð447malabsorption, 384tmalnutrition and, 384 tmechanical function, 384tmegacolon, 447Ð449MŽnŽtrierÕs disease, 405Ð406peptic ulcer disease, 407Ð410peritonitis, 454Ð455proctitis, 467Ð468short bowel syndrome, 456Ð459travelerÕs diarrhea, 421Ð424tropical sprue, 460Ð461ulcerative colitis, 434Ð436vomiting, pernicious, 410Ð412WhippleÕs disease, 461Ð462ZenkerÕs diverticulum, 390Ð391

Gastrointestinal neuropathy, 524tGastrointestinal stromal tumor (GIST), 767Gastrojejunostomy, 399Gastroparesis, 403Ð405Gaviscon, 409tGBL, 288tGelusil, 409tGemcitabine (Gemzar), 784GemÞbrozil, 350, 350tGemzar (gemcitabine), 784Generalized anxiety disorder, 223tGenetic disorders

abetalipoproteinemia, 144Ð145assessment factors, 137Ð142tattention-deÞcit disorders, 145Ð147autism spectrum disorder, 148Ð150biliary atresia, 150Ð152bronchopulmonary dysplasia, 152Ð154carbohydrate metabolic disorders,

155Ð157cerebral palsy, 158Ð160congenital heart disease, 163Ð164congenital megacolon, 175Ð177cystinosis, 165Ð166Down syndrome, 167Ð168FanconiÕs syndrome, 165Ð166fatty acid oxidation disorders, 172Ð173fetal alcohol syndrome, 173Ð175HirschsprungÕs disease, 175Ð177HIV infection, pediatric, 177Ð179homocystinuria, 180Ð182infant macrosomia, 182Ð183intrauterine growth restriction, 210Ð211leukodystrophies, 184Ð185maple syrup urine disease, 189Ð191myelomeningocele, 194Ð196necrotizing enterocolitis, 192Ð193neural-tube defects, 194Ð196orofacial clefts, 161Ð162phenylketonuria, 203Ð204Prader-Willi syndrome, 206Ð207small for gestational age, 210Ð211spina biÞda, 194Ð196tyrosinemia, 212Ð213urea cycle disorders, 214Ð216WilsonÕs disease, 216Ð218

Genetically modiÞed foods, 123Gengraf (cyclosporine), 893tGenistein, 499t, 736tGenitourinary tract disturbances, 524t

Gentamicin, 895Geodon (ziprasidone), 283tGermander, 80tGerminomas, 757tGestational diabetes, 523t, 552Ð555Gestational diabetes insipidus, 577GHB, 288tGhrelin, 206Ð207Giant cell arteritis, 346Giant hypertrophic gastritis, 405Ð406Giardia, 845tGiardia intestinalis, 460Gigantism, 573Ginger, 10t, 74t, 398, 410, 411, 644, 661t, 747tGingerol, 433, 644, 747tGingivitis, 103Ð104Gingko biloba, 74t, 229, 272, 283, 534t, 661tGinkgo, 808tGinkgo biloba, 747tGinkgolides, 735tGinseng, 42t, 75t, 229, 230t, 283, 661t, 808tGinseng, American, 534t, 747tGinseng, Asian, 747tGlandular extracts, 81tGlargine (Lantus), 533tGlasgow Coma Scale, 238, 855tGlasgow Outcome Scale, 238Glaucoma, 106Gleevec, 755t, 768, 794tGlehnia, 75tGliadins, 417Glimepiride (Amaryl), 547 tGlioblastoma multiforme, 757Gliomas, 757tGlipizide (Glucotrol), 547 tGlomerular diseases, 879Ð881Glomerular Þltration rate (GFR), 865 t, 867tGlomerulonephritis, 879Glomerulosclerosis, 879Ð880Glossopharyngeal nerve, 221tGlucagon, 566, 569tGlucarate, 747tGlucocorticoids, 570t, 583Ð584Gluconeogenesis, 565Ð566Glucosamine sulfate, 75t, 660t, 661Glucose, 532t, 860tGlucose transporter type 1 (Glut1) deÞciency

syndrome, 155, 157Glucose-6-phosphate dehydrogenase

deÞciency anemia, 705tGlucosinolates, 735tGlucotrol (glipizide), 547 tGlutamate, 224tGlutamine, 153, 458, 903Glutathione, 310t, 734tGluten, 247tGlyburide, 547tGlycemic index, 535tGlycemic load, 338t, 535tGlycine, 224tGlycitein, 499tGlycogen, 38, 622Glycogen storage disorders (GSDs), 155, 157,

176tGlycogen synthase kinase-3 (GSK-3), 227Glycogenolysis, 565Ð566Glycolax, 420tGlycomacropeptide, 204

Glycyrrhizin, 735tGlyset (miglitol), 547tGoiter, 592Gold sodium thiomalate (Ridaura), 680tGoldenseal, 80tGonadocorticoids, 570tGonadotropin-releasing hormone (GnRH),

569tGonadotropins, 569tGonads, 570tGotu kola, 75tGout, 645Ð647Graft-versus-host disease, 740tGraft-versus-host disease prophylaxis, 755tGrains, 359t, 416t, 491t, 535tGranisetron, 744tGrapefruit, 340tGravesÕ disease, 589Green coffee bean extract, 370Green tea, 75t, 370, 615, 655, 747t, 760Growth factors, 13tGrowth hormone, 58, 152, 310, 459t, 571,

841t, 872tGrowth hormone deÞciency, 45tGuar gum, 534tGuggul, 75t, 340tGugulipid, 340tGuillain-BarrŽ syndrome, 242Ð243Gum disease, 98tGut immunity, 821tGut-associated lymphoid tissue (GALT), 123Gymnema sylvestre, 534tGynecological cancer, 732t

H2-receptor antagonists, 409t, 498tHaemophilus inßuenzae, 315Halal, 95Halcion (triazolam), 284 tHaldol, 283t, 616tHaloperidol, 149, 616tHang time, 899tHaram, 95Harris-Benedict equation, 606t, 824t, 838Hartnup disorder, 887Ð888HashimotoÕs thyroiditis, 591Ð592Hawthorn, 75t, 340tHead and neck cancer, 763Ð766Health claims, 55Ð56tHealthcare-associated pneumonia, 314tHearing loss, 107, 109Heart disease, 44t

dietary recommendations for, 337tfactors in, 338Ð339therbs and botanical products for, 340t

Heart failure, 357Ð362Heart transplantation, 363Ð365Heart valve diseases, 365Ð367Heart valve replacement, 809tHeart-lung transplantation, 363Ð365Hectorol (doxercalciferol), 598, 872 tHedagenin, 734tHelicobacter pylori, 11, 18, 406, 407Ð410, 767Helper T cells, 821tHematochromatosis, 724Ð726Hematologic disorders

anemia. seeAnemiaassessment factors, 687hemochromatosis, 724Ð726


INDEX 1009

hemophilia, 722Ð724hemorrhage, 722Ð724iron overload, 724Ð726leukemia, 791Ð794myeloma, 797Ð798thalassemias, 720Ð721thrombocytopenia, 728Ð729

Hematopoietic stem-cell transplantation,753Ð756

Hemianopia, 106Hemochromatosis, 45tHemoglobin, 688, 689t, 707Hemolytic anemia, 705Ð706Hemolytic disease of the newborn, 692Hemophilia, 722Ð724Hemorrhage, 722Ð724Hemorrhagic gastritis, 401Hemorrhoidectomy, 816Hemorrhoids, 466Ð467Heparin, 318Hepatic cirrhosis, 483Ð486Hepatic coma, 488Hepatic encephalopathy, 487Ð492Hepatic failure, 487Ð490Hepatitis, 479Ð482Hepatitis A virus, 479, 480tHepatitis B virus, 479, 480tHepatitis C virus, 480, 480tHepatitis D virus, 480, 480tHepatitis E virus, 480, 480tHepatobiliary disorders, 471Ð473

alcoholic liver disease, 474Ð477ascites, 477Ð479biliary cirrhosis, 512Ð514cholestasis, 514Ð516chylous ascites, 477Ð479cirrhosis, 483Ð486gallbladder disorders, 516Ð518hepatic coma, 487Ð492hepatic encephalopathy, 487Ð492hepatic failure, 487Ð492hepatitis, 479Ð482pancreatic cancer, 777Ð779pancreatic insufÞciency, 507Ð508pancreatitis, acute, 497Ð501pancreatitis, chronic, 501Ð506Zollinger-Ellison syndrome, 511Ð512

Hepatocellular carcinoma, 769Ð771Hepatolenticular degeneration, 216Ð218Hepcidin, 688Hepsera (adefovir), 834tHerbs and supplements. SeeComplementary

nutritionHerceptin (trastuzumab), 784Hereditary hematochromatosis, 724Hereditary nonspherocytic hemolytic anemia,

705tHeroin, 288tHerpes simplex, 826tHerpes zoster, 826tHers disease, 176tHesperetin, 499t, 736tHiatal hernia, 395Ð397High-calorie diet, 302High-density lipoprotein cholesterol

(HDL-C), 338tHighly active antiretroviral therapy (HAART),

177, 179

High-protein diet, 302Hindbrain, 220 tHinduism, dietary practices of, 91Hip replacement, 810tHirschsprungÕs disease, 175Ð177HirschsprungÕs-associated enterocolitis, 171tHispanic diet, 85Histamine, 123, 224t, 247tHistidine, 701HIV infection, pediatric, 177Ð179Hivid (zalcitabine), 834 tHLA-DRgene expression, 151HMG-CoA reductase, 348Hmong food, 85HodgkinÕs lymphoma, 795Ð796Homocysteine, 338t, 513Homocystinuria, 45t, 180Ð182Honey, 532tHookworms, 845tHormonal therapy, 732tHormones, 13tHorse chestnut, 75t, 80tHorseradish, 75tHuang lian, 75tHumalog (lispro), 533 t, 559Human chorionic gonadotropin (hCG), 569 tHuman growth hormone, 569tHuman immunodeÞciency virus (HIV)

infection, 829Ð837clinical staging, 830t

Humira (adalimumab), 332 t, 681tHumulin R, 533tHuntingtonÕs disease, 45t, 244Ð245Huperzine A, 229Hydergine, 230tHydralazine, 376Hydrea (hydroxyurea), 719Hydrochlorothiazide, 486t, 591, 645Hydrocortisone, 329t, 364t, 572HydroDIURIL, 486 tHydroxychloroquine, 651, 680tHydroxycinnamic acids, 734tHydroxycitric acid, 74t4-Hydroxyphenylpyruvate dioxygenase

(HPD), 212Hydroxyurea, 719Hyperaldosteronism, 585Ð586Hyperammonemia, 214tHyperargininemia, 214tHypercalcemia, 596Ð598, 806t, 807t, 915tHypercholesterolemia, 45tHyperchromia, 689tHyperemesis, 10tHyperglycemia, 183, 193, 522t, 796, 803, 915tHyperinsulinism, 567Ð569Hyperkalemia, 806t, 807t, 915tHyperkinesis, 145Hypermagnesemia, 806t, 807t, 915tHypernatremia, 806t, 915tHyperosmolar hyperglycemic state, 563Ð564Hyperosmolar laxatives, 420tHyperoxaluria, 429Hyperparathyroidism, 596Ð598Hyperphagia, 206Ð207Hyperphosphatemia, 807t, 915tHypertension, 55t, 337t, 367Ð371, 525t,

556Ð557Hyperthyroidism, 589Ð591

Hyperuricemia, 645Hypervitaminosis, 9Hypocalcemia, 595Ð596, 806t, 807t, 915tHypochromia, 689tHypoglossal nerve, 221tHypoglycemia, 183, 522t, 565Ð566, 915tHypokalemia, 806t, 915tHypomagnesemia, 806t, 807t, 915tHyponatremia, 580, 806t, 915tHypoparathyroidism, 595Ð596Hypopharynx, 764tHypophosphatemia, 807t, 915tHypophosphatemic rickets, 887Ð888Hypopituitarism, 571Ð572Hypostatic pneumonia, 314tHypothalamic lesions, 234Hypothalamus, 220t, 569tHypothermia, 65Hypothyroidism, 591Ð594Hysterectomy, abdominal, 810tHytrin (terazosin), 616 t

Ibandronate (Boniva), 670t, 844Ibuprofen, 230t, 255t, 408, 657, 660t, 679t, 719Ice cream, 247tIdarubicin, 798Ideal body weight, 606tIleal pouch rectal anastomosis (IPRA), 467Ileoanal anastomosis, 452Ð454Ileostomy, 452Ð454Ileum, loss of, 456tImatinib, 768, 794tImdur (isosorbide), 345Imidazoquinazoline, 729Imipramine (Tofranil), 31, 284 t, 289, 616tImmobilization, 647Ð648Immune system, 820

assessment factors, 819cells of, 820Ð821tgut immunity, 821tinnate and acquired immunity, 820tnutrition and, 820

Immunity, nutritional and host factors in,823Ð824t

Immunocompromised persons, 822tImmunosuppressants, 329t, 364t, 442t, 496t,

510t, 538t, 755tImodium (loperamide), 447Impulse control disorders, 223tImuran (azathioprine), 250, 312, 329t, 364t,

486t, 496t, 510t, 651Incomplete fracture, 842Incretin mimetics, 547tInderal (propranolol), 486 t, 616tIndeterminate colitis, 434Indian diet, 86Indian snakeroot, 283Indigestion, 397Ð399Indinavir, 835tIndirect calorimetry, 824 tIndirubin, 76 tIndocin (indomethacin), 660 tIndoles, 735t, 790tIndomethacin (Indocin), 660 tInduction therapy, 442tInfant macrosomia, 182Ð183Infantile nephropathic cystinosis,

165Ð166


1010 INDEX

Infantsages 0-6 months, 19Ð21

breastfeeding, 19Ð20food and nutrition, 20food safety tips, 21nutrition education, 21nutritional objectives for, 19Ð20recommended intakes, 20solid foods, 20supplements, 21

ages 6-12 months, 22Ð26breastfeeding, 22clinical indicators, 23complementary nutrition for, 22drugs and side effects, 25feeding, 24tfood and nutrition, 23Ð24food safety tips, 26nutritional guidelines for, 25Ð26supplements, 25Ð26

anemia in, 692Ð694clinical indicators, 19energy requirements/expenditures, 142tfailure to thrive, 169Ð171feeding problems, 21formula-fed, 20growth monitoring, 19HIV infection, 177Ð179HIV infection in, 177Ð179immunocompetence of, 821tlarge for gestational age, 182Ð183low birth weight, 186Ð189normal growth rates, 164tpediatric disorders, 137Ð143

anthropometric, 138tbehavioral, 138Ð139tclinical, 139Ð140tdevelopmental disabilities, 140teating/feeding skills, 140tgenetic/metabolic, 140 tnutritional risks, 143t

premature, 186Ð189small for gestational age, 210Ð211

Infections, 825Ð829Infectious arthritis, 638Infective endocarditis, 164Infertility, 48 t, 52tInßammation, 638Ð639Inßammatory bowel diseases

CrohnÕs disease, 430Ð433ulcerative colitis, 434Ð436

Inßiximab (Remicade), 332t, 436, 674, 681tInßuenza, 44t, 826tInnate immunity, 820tInositol, 153, 734tInsomnia, 285Insulin, 9, 183, 193, 230t, 235, 356, 476, 486t,

496t, 498t, 510t, 531, 533t, 538t, 562,569t, 616t, 779, 804, 841t, 872t

Insulin-like growth factor 1 (IGF-1), 573Intal (cromolyn), 296 tIntegrase inhibitors, 835tIntegrative nutrition. SeeComplementary

nutritionInterferon, 250, 312, 481, 744t, 773Interferon-alpha, 486t, 798, 841tInterferon-gamma, 841tInterleukin-1, 838

Interleukin-1 inhibitor, 681 tInterleukin-2, 744t, 773Interstitial cystitis, 894Interstitial lung disease, 311Ð313Intestinal Þstula, 437Ð438Intestinal ßora modiÞers, 429, 461Intestinal lipodystrophy, 461Ð462Intestinal lymphangiectasia, 439Ð440Intestinal parasite infections, 845tIntestinal transplantation, 440Ð442Intracerebral hemorrhage, 237Intracranial hemorrhage, 237Intrauterine growth restriction (IUGR),

210Ð211Intravenous fat emulsion, 899tIntron A, 486tInulin, 771Invirase, 835tIodine, 8Ionamin (phentermine), 617 tIreton-Jones formula, 824t, 838Irinotecan (Camptosar), 744tIron, 706Ð709

bone health and, 665tfor brain health, 225tdeÞciency of, 712tfor dialysis patients, 872theart disease and, 339tinfection and, 829tfor oral tissue and dental care, 97toverload, 724for pregnant women, 9recommended intakes for children, 29t

Iron deÞciency, 19, 36tIron deÞciency anemia, 89tIron dextran, 695Iron sucrose (Venofer), 695Iron-deÞciency anemia, 706Ð709Irritable bowel syndrome, 443Ð445Isatis root, 747tIscador, 748tIschemia, 347Ð348Isentress, 835tIslet cell transplantation, 537Ð539Isocarboxazid (Marplan), 284t, 616tIsoßavone phytoestrogens, 499tIsoßavones, 736tIsoniazid, 332t, 376Isordil (isosurbide), 345Isorhamnetin, 499t, 734tIsosorbide dinitrate, 391Isosurbide, 345Isothiocyanates, 790tIsotretinoin, 9Isotretinoin (Accutane), 112Isoxsuprine (Vasodilan), 379

Jainism, dietary practices of, 91Januvia (sitagliptin), 547tJasmonates, 735tJejunostomy, 559Jejunum, loss of, 456tJudaism, dietary practices of, 93Ð94Juniper, 76tJuvenile rheumatic arthritis, 677t

Kaempferol, 499t, 734tKaletra, 835t

Kaolin, 413, 423Ð424Kaopectate, 401, 413, 423Ð424Karela, 76tKasai procedure, 151Kashrut, 93Kava, 76t, 80t, 283, 661t, 808tKelp, 80tKeppra (levetiracetam), 241tKetamine, 288tKetek (telithromycin), 315Ketoconazole, 835tKetones, 561Ketoprofen, 679tKidney, 860tKidney cancer, 772Ð773Kidney diseases, 44tKidney Early Evaluation Program (KEEP), 866Kidney stones, 882Ð884Kineret (anakinra), 681 tKlonopin (clonazepam), 160, 241t, 284tKock pouch, 453Kombucha tea, 80tKonsyl, 420tKosher, 93Kristalose, 420t, 486tKudzu, 76tKuvan, 205Kwashiorkor, 626Kyushin, 76t

Lactation, 12Ð18, 523t. See alsoBreastfeedingLactobacillus, 96Lactobacillus acidophilus, 193Lactose intolerance, 155Lactose maldigestion, 445Ð447Lactulose, 420t, 491tLamictal (lamotrigine), 241 tLamivudine, 486t, 834tLamotrigine, 276Lamotrigine (Lamictal), 241 tLanoxin, 350Lansoprazole (Prevacid), 397, 398, 402, 406,

409t, 512Lanthanum carbonate (Fosrenol), 872tLantus (glargine), 533tLaparoscopic Roux-en-Y gastric bypass

(LRYGB), 813Lap-band adjustable gastric banding, 813Large for gestational age (LGA), 182Ð183Large intestine, 384L-arginine, 310t, 340tLarynx, 764tLasix (furosemide), 478, 486t, 886Latino diet, 85Laxatives, 217, 230t, 235, 258, 417, 420t, 466,

486t, 491t, 804Lead poisoning, 23, 32tLearning disorders, 223tLeßunomide, 644, 680tLenalidomide, 798Lente, 533tLeucovorin, 762Leukemia, 46t, 791Ð794Leukeran (chlorambucil), 794 tLeukocytes, 820Ð821tLeukodystrophies, 184Ð185Leukotriene modiÞers, 296tLevalbuterol, 296t


INDEX 1011

Levetiracetam (Keppra), 241tLevodopa, 255tLevothyroxine, 572Lexiva, 834tLibrium (chlordiazepoxide), 284 t, 616tLicorice, 76t, 410, 476, 747tLife expectancy, 44, 58Life stage-speciÞc assessments, 2Lignan, 500t, 735tLimb-girdle muscular dystrophy, 653tLimonene, 736tLimonoids, 736tLinoleic acid, 734tLioresal, 250Liotrix, 592Lipid-lowering drugs, 872tLipids

in breast milk, 13tcardiovascular disorders and, 336

Lipitor (atorvastatin), 886Lipoic acid, 500t, 748tLisdexamfetamine dimesylate, 147tLispro (Humalog), 533 t, 559Listeria, 18Lithane, 276Lithium, 230 t, 276, 594, 616tLithobid, 276, 616tLithotabs, 276Live glycogen phosphorylase deÞciency, 176tLiver cancer, 769Ð771Liver disease, 44t

alcoholic, 474Ð477ascites, 477Ð479biliary cirrhosis, 512Ð514cholestasis, 514Ð516chylous ascites, 477Ð479cirrhosis, 483Ð486hepatic coma, 487Ð492hepatic encephalopathy, 487Ð492hepatic failure, 487Ð492hepatitis, 479Ð482liver cancer, 769Ð771

Liver phosphorylase deÞciency, 176tLiver transplantation, 493Ð496L-methylfolate, 229, 279Lobelia, 81tLomotil, 424, 451, 454Long-bone structure, 842Long-chain 3-hydroxyacyl-Coa dehydrogenase

(LCHAD) deÞciency, 172Loop diuretics, 361t, 486tLoose teeth, 99tLoperamide, 401, 447Lopid (gemÞbrozil), 350Lopinavir, 835tLopressor (metoprolol), 486 t, 616tLorazepam (Ativan), 284tLorelco (probucol), 350LorenzoÕs oil, 185Losartan (Cozaar), 886Lotensin (benazepril), 886Lou GehrigÕs disease, 232Ð234Lovastatin, 185, 350tLow birth weight (LBW), 6, 36 t, 186Ð189, 202Low vision, 106Ð108Low-density lipoprotein cholesterol (LDL-C),

30, 337t, 338tLow-sodium diet, 359t

Lubiprostone (Amitiza), 420 tLubricant laxatives, 420tLumbarradiculopathy, 683Luminal (phenobarbital), 241 tLung cancer, 774Ð776Lung transplantation, 327Ð329Lupus, 649Ð651Lutein, 108t, 109, 499t, 735t, 790tLuteinizing hormone (LH), 571Luteolin, 499t, 734tLuvox (ßuvoxamine), 283t, 616tLycium, 76tLycopene, 232, 499t, 736t, 790tLymphocytes, 821tLymphogranuloma venereum, 467Lymphomas, 795Ð796Lynch syndrome, 46tLyrica (pregabalin), 657Lysergic acid diethylamide (LSD), 288t

Ma huang, 42t, 272, 283, 295, 302, 615, 808tMaalox (aluminum hydroxide), 396Ð397Macrobiotic diet, 748tMacrocytic anemia, 689tMacrodantin (nitrofurantoin), 895Macroglossia, 405Ð406Macronutrients, 63t, 142t, 823tMacrosomia, 182Ð183Madopar, 255tMagaldrate (Riopan), 409tMagnesium, 97t, 232, 294t, 342t, 495t, 534t,

661t, 665t, 806tMagnesium carbonate, 872tMagnesium hydroxide, 409tMalabsorption, 740tMalaria, 710Ð712Malignant of fulminant multiple sclerosis,

249tMalnutrition, 601Ð608

assessment factors, 601biochemical changes in, 631tin children, 27Ð28consequences of not feeding in, 632tdrugs and side effects, 631effects on body systems, 627tgastrointestinal disorders, 384tindicators of, 628tnutritional guidelines for, 630Ð631protein-energy, 626Ð631in pulmonary disorders, 291Ð292refeeding syndrome, 633Ð635types of, 601universal screening tool, 629Ð630t

Malnutrition-inßammation complexsyndrome, 865

Maltose, 532tMaltose intolerance, 157Malvidin, 500tManganese, 665tMaple syrup urine disease, 189Ð191Marasmic kwashiorkor, 626Marasmus, 626Maraviroc, 835tMarfan syndrome, 45tMarijuana, 288tMarinol (dronabinol), 631, 744 tMarjoram, 748tMarplan (isocarboxazid), 284t, 616t

Mashbooh, 95Matairesinol, 735tMatrix extracellular phosphoglycoprotein

(MEPE), 664Maturity-onset diabetes of the young (MODY),

521tMaxamaid XPHEN, 212Maxaquin (ßuoroquinolone), 895McArdle disease, 176tMeadowsweet, 76tMeasles, 32tMeat, 303t, 359t, 492tMeat substitutes, 303tMeclizine, 411Mediterranean anemia, 720Mediterranean diet, 49, 86, 339t, 374, 640t,

784, 877tMedium0-chain triglycerides, 145Medium-chain acyl-CoA dehydrogenase

deÞciency (MCAD), 172Ð173Medium-chain triglycerides (MCTs), 429tMedrol, 296tMedroxyprogesterone acetate, 616tMedulla, 586Ð588Medullar oblongata, 220tMedullary thyroid carcinoma, 46tMedulloblastomas, 757tMegace, 52t, 631, 836tMegacolon, 448Ð449Megaloblastic anemia, 689t, 713Ð714Megestrol acetate, 52t, 631, 784, 836tMeglitinides, 547tMelatonin, 76t, 371t, 500t, 570t, 615, 748tMellaril (thioridazine HCl), 616 tMelphalan (Alkeran), 798Memantine (Namenda), 230tMŽnŽtrierÕs disease, 405Ð406MŽni•reÕs syndrome, 128Ð129Meningiomas, 757, 757tMeningitis, 827tMeningoceles, 194Menopause, 48t, 52tMental disorder, 223tMental health disorders, 222Ð224tMeperidine, 844Mephyton (phytonadione), 486 t6-Mercaptoguanine, 436Meridia (sibutramine), 617 tMesalamine, 436Metabolic bone disease, 915tMetabolic disorders, 45tMetabolic syndrome, 339t, 344t, 539Ð541.

See alsoObesityclinical indicators, 539Ð540tdiagnostic criteria for, 539drugs and side effects, 541elevated glucose, 540nutritional objectives for, 540patient education, 541proinßammatory state, 540prothrombic state, 540supplements, 541

Metadate (methylphenidate), 147tMetafolin, 703Ð704Metal chelating agents, 486tMetamucil (laxative), 235, 340t, 417, 436, 444,

451, 454, 466Metaprel (metaproterenol), 296 t


1012 INDEX

Metaproterenol, 296tMetformin, 195, 543Methadone, 793Methamphetamines, 147t, 288tMethicillin-resistant Staphylococcus aureus

(MRSA) infection, 828tMethimazole (Tapazole), 590Methionine, 339tMethotrexate, 195, 323, 644, 651, 681t, 744t,

755t, 762, 764t, 784, 787, 796Methylcellulose, 420t, 444Methylcobalamin, 1495-10-Methylene-tetrahydrofolate reductase

(MTHFR), 180Ð181, 281Ð282Methylphenidate, 31, 147tMethylprednisolone, 296t, 436, 476, 680tMethylprednisone, 154, 312Methylselenol, 760Methyltetrahydrofolate, 229, 7035-10-Methyltetrahydrofolate-homocysteine

methyltransferase (MTR), 1815-10-Methyltetrahydrofolate-homocysteine

methyltransferase reductase(MTRR), 181

Metoclopramide, 404, 559, 744t, 804, 841tMetoprolol (Lopressor), 486 t, 616tMetronidazole, 283, 436Mexiletine (Mexitil), 374Mexitil, 374Miacalcin (calcitonin), 670 tMicroalbuminuria, 524 tMicrocytic anemia, 689tMicronase (glyburide), 547tMicronutrients, 823t

dietary guideline for, 3tMicropreemies, 186Midamor (amiloride), 486 tMidazolam (Versed), 284tMidbrain, 220tMiddle Eastern food, 86Mifßin-St. Jeor equation, 838Miglitol (Glyset), 547 tMigraine, 245Ð247Milk, 536t

allergy to, 125t, 127tMilk of magnesia, 409t, 420tMilk powder, 303tMilk thistle, 76t, 476, 748tMineralocorticoids, 570tMinerals, 459t, 823t

in breast milk, 13tfor dialysis patients, 877t

Mini Nutrition Assessment (MNA), 60 tMinimal enteral feeding, 20Minipress (prazosin), 616tMinocycline, 245Minoxidil (Rogaine), 52 tMint, 76tMiralax, 420tMirapex (pramipexole), 255 tMirtazapine (Remeron), 616tMisoprostol (Cytotec), 660tMistletoe, 81t, 748tMitochondrial disorders, 46 tMitomycin C, 768Mitral stenosis, 365Mitral valve prolapse, 365Mixed connective tissue disease, 638

Moban, 616tModular enteral feeding, 899tMolasses, 532tMonoamine oxidase inhibitors (MAOIs), 283,

284t, 616tMonoclonal antibodies, 744t, 893tMononucleosis, 827tMonosodium glutamate (MSG), 85

allergy to, 125tMonounsaturated fats, 338t, 736tMood stabilizers, 230t, 276, 616tMormons, dietary practices of, 94Morphine, 374, 844Motherwort, 76tMotilium (domperidone), 559Motrin (ibuprofen), 408, 657, 660 tMouth ulcers, 99, 101Mucolytics, 310tMucositis, 740tMulberry, 748tMultichamber bag, 899tMultiple organ dysfunction syndrome

(MODS), 847Ð850Multiple pregnancy, 6Multiple sclerosis, 248Ð250Muromonab (Orthoclone OKT3), 496 tMuscle dysmorphic disorder, 274tMuscle glucagon phosphorylase deÞciency,

176tMuscle glycogen, 38Muscle relaxants, 683Muscle wasting, 741tMuscular disorders, 45tMuscular dystrophy, 652Ð655Musculoskeletal disorders

ankylosing spondylitis, 643Ð644assessment factors, 633Ð635bone disorders, 641Ð642degenerative joint disease, 658Ð661Þbromyalgia, 656Ð657gout, 645Ð647immobilization, 647Ð649lupus, 651muscular dystrophy, 652Ð655myofascial pain syndromes, 656Ð657osteoarthritis, 656Ð657osteomalacia, 664Ð666osteomyelitis, 662Ð663osteopenia, 666Ð671osteoporosis, 666Ð671PagetÕs disease, 672Ð673polyarteritis nodosa, 673Ð674polymyalgia rheumatica, 656Ð657rhabdomyolysis, 675Ð676rheumatic disorders, 638Ð640rheumatoid arthritis, 677Ð682ruptured disc, 683Ð684scleroderma, 684Ð686

Mushrooms, 76tMuslims, dietary practices of, 95Mustard, allergy to, 125tMustard seed, 748tMyambutol, 332tMyasthenia gravis, 251Ð252Mycelex (clotrimazole), 755tMycobacterium tuberculosis, 330Mycophenolate mofetil, 496tMyeloma, 797Ð798

Myelomeningocele, 194Myelosuppressive agents, 727, 729Mylanta, 409tMyocardial infarction (MI), 372Ð375Myofascial pain syndromes, 656Ð657Myotonic dystrophy, 653tMyPyramid Food Guidance System, 35, 61Myricetin, 499t, 734t, 736tMysoline (primidone), 241 tMyxedema, 592

Nabumetone (Relafen), 660tN-acetylcysteine, 229, 500tN-acetylglutamate synthetase deÞciency, 214tN-acetyl-L-cysteine, 76tNadolol, 345, 476Nadolol (Corgard), 486 tNaloxone, 289Naltrexone, 149, 289, 476Namenda (memantine), 230tNandrolone, 836tNaprosyn (naproxen), 657, 660tNaproxen (Naprosyn), 657, 660t, 679tNardil (phenelzine), 284 t, 616tNaringenin, 499t, 736tNasal cavity, 764tNasopharynx, 764tNative American diet, 86Naturacil, 417Nausea, 741tNavane (thiothixene), 283t, 616tNecator americanus, 845tNecrotizing enterocolitis, 186, 192Ð193Nedocromil (Tilade), 296 tNeevo, 9Nefazodone (Serzone), 616tNelÞnavir, 835tNeomycin, 491tNeonatal hepatitis, 150Ð152Neoplastic disorders, 46tNeoral (cyclosporine), 893tNeotame, 533tNephrogenic diabetes insipidus, 577Nephrolithiasis, 884tNephropathy, 524tNephrotic syndrome, 885Ð886Nesiritide, 164Neupogen (Þlgrastim), 755tNeural-tube defects, 55t, 194Ð196Neuroblastoma, 757tNeurogenic diabetes insipidus, 577Neurological disorders, 45t

AlzheimerÕs disease, 227Ð231amyotrophic lateral sclerosis, 232Ð234assessment factors, 219tbrain trauma, 234Ð236cerebral aneurysm, 236Ð238cerebrovascular accident, 259Ð263coma, 238Ð239dementia, 227Ð231epilepsy, 240Ð242Guillain-BarrŽ syndrome, 242Ð243HuntingtonÕs disease, 244Ð245migraine, 245Ð247multiple sclerosis, 248Ð250myasthenia gravis, 251Ð252neuromuscular junction disorders, 251Ð252ParkinsonÕs disease, 253Ð255


INDEX 1013

persistent vegetative state, 238Ð239seizure disorders, 240Ð242spinal cord injury, 256Ð259stroke, 259Ð263tardive dyskinesia, 263Ð264trigeminal neuralgia, 265Ð266

Neuromuscular junction disorders, 251Ð252Neurontin (gabapentin), 241 t, 616tNeuro-psychiatric disorders, 219Ð226Neurotransmitter, 587tNeutropenia, 740tNeutrophils, 821tNevirapine, 834tNexium (esomeprazole), 397, 398, 402, 406,

409t, 512Niacin

for brain health, 226tdeÞciency of, 119t, 121drug interactions, 262for healthy vision, 108tfor heart disease, 340theart disease and, 339tlipoprotein metabolism and, 350trecommended intakes for children, 29tsources of, 121toxicity of, 121

Nicardipine, 345Nickel dermatitis, 111, 112Nicotinamide adenine dinucleotide (NAD),

249, 566Nicotine, 280, 288tNicotinic acid. SeeNiacinNifedipine, 345, 391Night eating syndrome, 274t, 611tNilotinib (Tasigna), 794 tNimodipine, 237Nitisone (Orfadin), 212Nitoman (tetrabenazine), 263Nitrofurantoin, 895Nitroglycerin, 391Nizatidine (Axid), 409 tNocturnal sleep-related eating disorder, 274tNon-HodgkinÕs lymphoma, 795Ð796Noni juice, 748tNonsmall cell lung cancer (NSCLC), 46t, 774Non-steroidal anti-inßammatory drugs

(NSAIDs), 247, 323, 376, 638, 657,660t, 679t

Nonucleoside reverse transcriptase inhibitors(NNRTIs), 834t

Noradrenalin, 570tNoradrenaline, 224tNoraldex (tamoxifen), 784Norepinephrine, 570 t, 587tNorßoxacin (Noroxin), 895Normochromia, 689tNormocytic anemia, 689tNoroxin (norßoxacin), 895Norpace (disopyramide), 345Norpramin, 284tNortriptyline, 284 t, 616tNorvir, 835tNovolin R, 533tNovolog (aspart), 533tNPH, 533tNucleoside reverse transcriptase inhibitors

(NRTIs), 834tNummular eczematous dermatitis, 111

Nutramigen, 20NutraSweet (aspartame), 533tNutrition screening and assessment factors,

1Ð2Nutrition support process, 899tNutrition support service, 899tNutrition support teams, 904Nutritional guidelines

for acquired immunodeÞciency syndrome(AIDS), 831t, 833

for adolescents, 36Ð38for adults, 49Ð53for allergies, 124Ð125athletes, 40, 42tfor cancer, 742Ð743for childhood obesity, 200Ð201for children, 29Ð30, 31for chronic kidney disease (CKD), 869for congenital heart disease (CHD), 164for diarrhea, 423for dysphagia, 388for elderly, 61for food allergies/intolerances, 124Ð125for infants, 25Ð26for malnutrition, 630Ð631for obesity, 614Ð615for osteoporosis, 668Ð669for overweight, 614Ð615for pregnancy, 9Ð11for rheumatoid arthritis, 679sports nutrition, 40, 42tfor stroke, 261Ð262

Nuts, 337t, 339tallergy to, 125t, 127theadaches and, 247tseeds, 491t

Nydrazid (isoniazid), 376Nytol (diphenhydramine), 616 t

Obesity, 609Ð620. See alsoMetabolic syndromebody mass index and, 198colorectal cancer and, 760diet program comparisons, 620tdrugs and side effects, 615heart disease and, 339tmedications that cause weight gain, 616tnutritional guidelines for, 614Ð615nutritional objectives for, 612Ð614patient education, 615Ð619supplements, 615weight management counseling, 610

Obesity, childhood, 197Ð201clinical indicators, 198tcomplications, 198tdrugs and side effects, 200food safety tips, 201tgenetic markers, 198tnutritional guidelines for, 200Ð201nutritional objectives for, 199Ð200patient education, 200Ð201weight loss diets for, 199tweight loss program for, 201t

Obsessive-compulsive disorder, 223tObstructive jaundice, 512Ð514Obstructive sleep apnea, 324Ð325Occipital lobe, 220tOctreotide (Sandostatin), 134, 304, 437Ð438,

498t, 574

Oculomotor nerve, 221tOculopharyngeal muscular dystrophy, 653tOdoroside, 748tOßoxacin, 895Oils, 491tOlanzapine (Zyprexa), 149, 264, 283t, 616tOleandrin, 748tOleanic acid, 734tOleic acid, 185Olfactory nerve, 221tOligosaccharides, 737t, 771Oliguria, 880Olive leaf extract, 370Olive oil, 246Olsalazine, 436Omega-3 fatty acids, 56t, 89t, 108t, 126, 185,

186, 225t, 229, 230t, 246, 294t, 295,296t, 337t, 339t, 340t, 356, 413, 643,660t, 736t, 760, 794, 803, 877t

Omega-6 fatty acids, 108t, 225t, 229, 294t, 736tOmeprazole (Prilosec), 397, 398, 402, 406,

409t, 459t, 512Oncaspar (pegaspargase), 794tOncovin, 787, 796, 798Ondansetron, 744tOolong tea, 370Open fracture, 842Opiates, 498tOpioids, 657Oppositional deÞant disorder, 223tOptic nerve, 221tOral allergy syndrome, 123Oral cavity, 764tOral contraceptives, 370, 517Oral disorders, 96Ð101

dental problems, 96Ð101gingivitis, 103Ð104periodental disease, 103Ð104temporomandibular joint dysfunction,

104Ð105Oral health, 339tOrapred, 296tOrasone (prednisone), 657Oregano, 76tOregon grape root, 76tOrfadin (nitisinone), 212Organ extracts, 81tOrlistat, 429Ð430Orlistat (Xenical), 617 tOrnithine transcarbamylase (OTC), 214tOrofacial clefts, 161Ð162Oropharynx, 764tOrthoclone OKT3 (muromonab), 496 tOrthorexia nervosa, 274tOs-Cal 500, 669tOsler-Vasquez disease, 726Ð728Osmolality, 899tOsmotic laxatives, 420tOsteitis deformans, 672Ð673Osteoarthritis, 658Ð661Osteoblasts, 641Osteocalcin, 641Osteomalacia, 664Ð666Osteomyelitis, 662Ð663Osteopenia, 666Osteoporosis, 666Ð671. See also

Musculoskeletal disorderscalcium and, 55t


1014 INDEX

Osteoporosis (continued)calcium supplements for, 669tclinical indicators, 668tdrugs and side effects, 669medications for, 670tnutritional guidelines for, 668Ð669nutritional objectives for, 668pathogenesis of, 103patient education, 670Ð671prevention of, 642trelated genes, 45trisk factors, 667t

Osteoprotegerin, 673Osteosarcoma, 751Ð752Ostomy

colostomy, 450Ð452ileostomy, 452Ð454

Otitis media, 202Ð203Ovarian cancer, 46tOvaries, 570tOvernutrition, 602, 603t, 822tOverweight, 198, 609Ð620. See alsoMalnutrition;

Metabolic syndrome; Underweightdiet program comparisons, 620tdrugs and side effects, 615medications that cause weight gain, 616tnutritional guidelines for, 614Ð615nutritional objectives for, 612Ð614patient education, 615Ð619prevalence of, 609supplements, 615weight management counseling, 610t

Oxalic acid, 500tOxaliplatin, 762Oxandrin, 631, 836tOxandrolone, 258, 631, 836tOxazepam (Serax), 284tOxcarbazepine (Trileptal), 241 tOxygen radical absorbance capacity (ORAC),

503Ð505tOxymetholone, 616tOxytocin, 569t

PagetÕs disease, 672Ð673Pain, 741tPain disorder, 223tPainkillers, 498tPakistani diet, 86Pamelor, 284t, 616tPamidronate (Aredia), 673, 798Panax ginseng, 747tPancreas, 569tPancreatic cancer, 777Ð779Pancreatic disorders, 471Ð473Pancreatic enzyme, 459t, 498t, 508, 510t, 538t,

779, 836tPancreatic insufÞciency, 507Ð508Pancreatic surgery, 810tPancreatic transplantation, 509Ð510Pancreatin, 779Pancreatitis, acute, 497Ð501Pancreatitis, chronic, 501Ð506Pancrelipase, 310t, 779Panic disorder, 223tPantoprazole (Protonix), 409t, 512Pantothenic acid, 121

deÞciency of, 119ttoxicity of, 121

Papaverine, 237Para-amino benzoic acid (PABA), 701Paracicaltol (Zemplar), 872tParanasal sinuses, 764tParaplegia, 257tParasitic anemia, 710Ð712Parathyroid glands, 570t, 594Parathyroid hormone (PTH), 357, 570t, 594Parathyroidectomy, 811tParenteral nutrition, 911Ð916. See alsoEnteral

nutritionassessment factors, 897in brain trauma, 234central, 899t, 911Ð912in chylothorax patients, 304clinical indicators, 912tclinical practice guidelines, 905tfor coma patients, 900Ð901tcomplications, 915tfor dialysis patients, 875drugs and side effects, 915Ð916guidelines, 913Ð914infusion safety, 916overview, 898Ð901patient education, 916peripheral, 899t, 911of preterm infants, 188tstandardized, 899tsupplements, 915Ð916terminology, 899t

Paricalcitol (Zemplar), 598Pariet (rabeprazole), 409tParietal lobe, 220tParkinsonÕs disease, 45t, 253Ð255Parlodel (bromocriptine), 255 t, 289, 574Parnate (tranylcypromine), 284t, 616tParotid gland, 764tParoxetine (Paxil), 284t, 616tParsley, 76tPassion ßower, 81tPaxil (paroxetine), 284t, 616tPeanuts

allergy to, 125t, 127theadaches and, 247t

Peas, 491tPediatric constipation, 418Ð419Pediatric disorders, 137Ð143

abetalipoproteinemia, 144Ð145anthropometric, 138tassessment factors, 137Ð142tattention-deÞcit disorders, 145Ð147autism spectrum disorder, 148Ð150behavioral, 138Ð139tbiliary atresia, 150Ð152bronchopulmonary dysplasia, 152Ð154carbohydrate metabolic disorders, 155Ð157cerebral palsy, 158Ð160clinical, 139Ð140tcongenital heart disease, 163Ð164congenital megacolon, 175Ð177cystinosis, 165Ð166developmental disabilities, 140tDown syndrome, 167Ð168eating/feeding skills, 140tFanconiÕs syndrome, 165Ð166fatty acid oxidation disorders, 172Ð173fetal alcohol syndrome, 173Ð175genetic/metabolic, 140 t

HirschsprungÕs disease, 175Ð177HIV infection, pediatric, 177Ð179homocystinuria, 180Ð182infant macrosomia, 182Ð183intrauterine growth restriction, 210Ð211leukodystrophies, 184Ð185maple syrup urine disease, 189Ð191myelomeningocele, 194Ð196necrotizing enterocolitis, 192Ð193neural-tube defects, 194Ð196nutritional risks, 143tobesity, 197Ð201orofacial clefts, 161Ð162otitis media, 202Ð203phenylketonuria, 203Ð204Prader-Willi syndrome, 206Ð207rickets, 208Ð209small for gestational age, 210Ð211spina biÞda, 194Ð196tyrosinemia, 212Ð213urea cycle disorders, 214Ð216WilsonÕs disease, 216Ð218

Pegaspargase (Oncaspar), 794tPegasys, 481Peginterferon-alpha, 836tPegvisomant, 574Pelargonidin, 500tPelvic exenteration, 811tPelvic ßoor dysfunction, 463tPelvic inßammatory disease, 827tPenicillamine, 486tPenicillin, 895Pennyroyal oil, 81tPentoxifylline (Trental), 379, 685Peonidin, 500tPepcid (famotidine), 409 tPeppermint, 77tPeppermint oil, 444Peptic ulcer disease, 407Ð410Peptides, 459tPepto-Bismol, 408Percutaneous automated discectomy, 683Periactin, 631Periarteritis nodosa, 346Pericarditis, 375Ð377Peridex, 103Perimenopause, 48tPerimolysis, 273tPeriodontal disease, 103Ð104Periodontoclasia, 103Peripheral artery disease (PAD), 377Ð379Peripheral vascular disease (PVD), 377Ð379Peritoneal dialysis, 875Peritonitis, 454Ð455Pernicious anemia, 713Ð714Peroxisome biogenesis disorders, 184Ð185Perphenazine (Trilafon), 616 tPersistent vegetative state, 238Ð239, 900Ð901tPersonality disorders, 223tPervasive developmental disorders (PDDs),

148, 223tPetunidin, 500tPhenelzine, 284t, 616tPhenobarbital, 152, 241tPhenolic acids, 500t, 734t, 735t, 736tPhenoptin, 205Phentermine, 617tPhenylalanine, 204, 225t


INDEX 1015

Phenylalanine hydroxylase, 204Phenylketonuria, 126, 203Ð205Phenylpropanolamine, 615Phenytoin, 195, 235, 239, 241tPhenytoin (Dilantin), 376Pheochromocytoma, 586Ð588Phosphate binders, 872tPhosphatidylserine, 56tPhosphorus, 598t

for bone health, 665tfor dialysis patients, 877tin diet, 869for oral tissue and dental care, 97tin post-transplant nutrition, 495 t

Phytates, 736tPhytic acid, 500tPhytochemicals, 433, 639, 640t, 734Ð737tPhytoestrogen, 734t, 786, 790Phytonadione, 486tPhytosterols, 49, 339t, 736tPica, 10t, 148, 274t, 707Pickled foods, 492tPickwickian syndrome, 619tPilocarpine, 764tPilocarpine hydroxide (Salagen), 681tPine bark extract, 748tPineal gland, 570tPineal gland tumors, 757tPinworm, 845tPioglitazone (Actos), 547tPiroxicam (Feldene), 660tPituitary gland, 569t. See alsoEndocrine

disordersacromegaly, 573Ð574anterior, 573Ð574, 575Ð576CushingÕs syndrome, 575Ð576diabetes insipidus, 577Ð578hypopituitarism, 571Ð572posterior, 577Ð578syndrome of inappropriate antidiuretic

hormone, 579Ð580Pituitary hormone deÞciency, 45tPlacenta, 569tPlant stanols, 735tPlant sterols, 49, 56tPlaquenil (hydroxychloroquine), 651Plasma lipoprotein, 339tPlasma volume and osmolality, 860tPneumocystis cariniipneumonia, 314tPneumonia, 44t, 313Ð315Poke root, 81tPokeweed, 748tPolicosanols, 77tPoliomyelitis, 827tPolyarteritis nodosa, 673Ð674Polycillin (ampicillin), 486 tPolycystic kidney disease (PKD), 46t, 889Ð890Polycystic ovarian syndrome (PCOS), 34,

580Ð582Polycythemia vera, 726Ð728Polyendocrine deÞciency syndrome, 583Polyethylene glycol 3350, 420tPolymyalgia rheumatica, 346, 656Ð657Polyphenols, 49, 734t, 735t, 771Polyunsaturated fatty acids (PUFA), 349, 640tPompe disease, 176tPons, 220tPoplar, 77t

Porphyria cutanea tarda (PCT), 725Porphyrias, 724Ð725Portal hypertension, 483Postmenopause, 48tPostpartum depression, 277, 280Posture (calcium supplement), 669tPosture-Vitamin D, 669tPotassium, 63t

for dialysis patients, 877tin diet, 869dietary guideline for, 4timbalance, 806tfor oral tissue and dental care, 97tin post-transplant nutrition, 495 trecommended intakes, 340in salt, salt substitutes and herbal

seasonings, 370tsources of, 341t

Potassium-sparing diuretics, 486tPoultry, 492tPrader-Willi syndrome, 206Ð207, 305Pramipexole (Mirapex), 255tPrandin (repaglinide), 547 tPravachol (ßuvastatin), 886Pravastatin, 350tPrazosin (Minipress), 616tPrealbumin, 867tPrebiotics, 385t, 420t, 425, 442t, 451, 454,

459t, 491Ð492t, 736t, 771Preconception, 523tPrecose (Acrobose), 547tPrediabetes, 542Ð544Prednisone, 258, 312, 323, 329t, 364t, 376,

436, 442t, 451, 486t, 496t, 510t, 657,680t, 729, 744t, 835t, 893t

Preeclampsia, 10tPre-eclampsia, 556Ð557Pregabalin (Lyrica), 657Pregestimil, 20Pregnancy, 5Ð11

adolescent, 36tbody mass index and, 604tclinical indicators, 7tdeÞciency of micronutrients in, 6diabetes and, 523tdrugs in, 9early, 6food and nutrition in, 8Ð9food safety in, 11hypertension in, 525tintervention, 7Ð8multiple, 6, 10tnutrition care process steps, 7tnutritional guidelines for, 9Ð11prenatal risk assessments, 6tpreterm births, 11trecommendations for pregnant women, 8tspacing of, 6supplements, 9tissue growth in, 5weight gain in, 5, 17

Pregnancy-induced hypertension, 556Ð557Prehypertension, 44Prelief (calcium glycerophosphate), 397Prelone, 296tPrematurity, 186Ð189Premenstrual dysphoric disorder (PMDD),

48t, 223t

Premenstrual syndrome (PMS), 48tPrescription medications, addiction to, 288tPressure ulcers, 114Ð118

clinical indicators, 115tdrugs and side effects, 116Medicare costs, 114nutritional objectives for, 116patient education, 116Ð118skin changes with aging, 115tstages, 115tsupplements, 116

Preterm infants, nutrient needs of, 188tPrevacid (lansoprazole), 397, 398, 402, 406,

409t, 512Preveon (adefovir), 834tPrezista (darunavir), 834tPrilosec (omeprazole), 397, 398, 402, 406,

409t, 512Primary adrenal insufÞciency, 583Primary biliary cirrhosis, 513Primary hyperparathyroidism, 596Primary-progressive multiple sclerosis

(PPMS), 249tPrimidone (Mysoline), 241 tProanthocyanidins, 499t, 734tProbenecid (Benemid), 646Probiotics, 77t, 126, 193, 385t, 420t, 425, 433,

442t, 451, 454, 455, 459t, 461,491Ð492t, 737t, 748t

Probucol (Lorelco), 350Procainamide, 374, 376Procanbid, 376Procardia (nifedipine), 345Processed meats, 247tProctitis, 122, 467Ð468Proctocolitis, 122Procyanidins, 734t, 735tProduct recalls, 126tProgestational agents, 616tProgesterone, 5, 570t, 572Prograf (tacrolimus), 364t, 442t, 496t, 510t,

538t, 893tProgressive-relapsing multiple sclerosis

(PRMS), 249tProlactin, 569tPromethazine (Phenergan), 744tPromotility agents, 841tPronestyl, 376Propafenone (Rythmol), 374Propoxyphene (Darvon), 283Propranolol, 394, 476Propranolol (Inderal), 486 t, 616tPropylthiouracil, 590Proscar (Þnasteride), 52tProstaglandin, 442t, 860tProstate, 52tProstate cancer, 788Ð790Protease inhibitors, 737t, 834Ð835tProteasome inhibitors, 893tProtein-energy malnutrition, 626Ð631. See also

MalnutritionProteins

adding to diet, 303tfor athletes, 40tbody storage of, 622bone health and, 665tfor dialysis patients, 877tdietary guideline for, 3t


1016 INDEX

Proteins (continued)for healthy vision, 108tin post-transplant nutrition, 495 trecommended intakes for children, 29trequirements in infants, 20vegetarian diet and, 89t

Protestants, dietary practices of, 94Proton pump inhibitors (PPIs), 396, 397, 402,

409t, 455, 478, 512Protonix (pantoprazole), 409 t, 512Proventil (albuterol), 296 tProvera, 616tProzac (ßuoxetine), 279, 283t, 284t, 616tPsoriasis, 111, 112, 113Psychiatric disorders

addiction, 287Ð289anorexia nervosa, 266Ð269assessment factors, 219tbinge eating disorder, 269Ð270bipolar disorders, 273Ð276bulimia nervosa, 270Ð273circadian rhythm disorder, 285Ð286depression, 277Ð280DSM-IV classiÞcation of, 222Ð224tschizophrenia, 281Ð284sleep disorders, 285Ð286substance use disorders, 287Ð289

Psyllium, 77t, 283, 340t, 420t, 424, 436, 451,454, 466

Pterostilbene, 500tPublic health

achievements, 2essential services, 2

Pulmicort (budesonide), 296 tPulmonary disorders, 291Ð292

assessment factors, 291asthma, 293Ð296bronchiectasis, 297Ð298bronchitis, acute, 298Ð299chronic obstructive pulmonary disease,

300Ð303chylothorax, 304Ð305cor pulmonale, 305Ð306cystic Þbrosis, 307Ð310interstitial lung disease, 311Ð313malnutrition in, 291Ð292pneumonia, 313Ð315pulmonary embolism, 315Ð317respiratory distress syndrome, 317Ð319respiratory failure, 319Ð321sarcoidosis, 322Ð324sleep apnea, 324Ð326thoracic empyema, 324Ð326tuberculosis, 330Ð333

Pulmonary embolism (PE), 315Ð317Pulmozyme, 310tPunicalagin, 736tPycnogenol, 748tPyelonephritis, 894Ð896Pygeum, 790Pyorrhea alveolaris, 103Pyrazinamide, 332t, 376

Quadriplegia, 257tQuercetin, 49, 295, 339t, 499t, 734t, 748tQuestran (cholestyramine), 424Quetiapine (Seroquel), 264, 283tQuinolones, 895Qvar (beclomethasone HFA), 296t

Rabeprazole, 409t, 512Radiation enteritis, 741tRadiation therapy, 741tRajasic foods, 86Raloxifene (Evista), 670tRaltegravir, 835tRanitidine (Zantac), 409tRapamycin, 773Rasagiline (Azilect), 255tRaynaudÕs syndrome, 378Razadyne (galantamine), 230tReader disorder, 223tRebetol (ribavirin), 481Rebif, 250Rebound hyperglycemia, 522tRecombinant human erythropoietin, 872 tRectal cancer, 760Rectum, 384Red blood cells (RBCs), 688, 715Ð716Red clover, 77tRed yeast rice, 80tReed-SternbergÕs cells, 795Refeeding syndrome, 633Ð635Reßux, 21tRefsumÕs disease, 184Reglan, 235, 559, 744t, 804Regurgitation, 21tReishe mushroom, 748tRelafen (nabumetone), 660tRelapsing-remitting multiple sclerosis

(RRMS), 249tReligious dietary practices, 86

Eastern, 91Ð92Middle Eastern, 95Ð96Western, 93Ð95

Remeron (mirtazapine), 616tRemicade (inßiximab), 332t, 436, 681tRemifemin, 746tReminyl (galantamine), 230tRenagel (sevelamer), 872tRenal cell cancer (RCC), 772Renal disorders, 859Ð861

Alport syndrome, 862Ð864anemia of, 694Ð696assessment factors, 859autoimmune kidney diseases, 879Ð881chronic kidney disease, 864Ð873collagen-IV nephropathies, 862Ð864glomerulonephritis, 875Ð878, 879Ð881Hartnup disorder, 887Ð888hypophosphatemic rickets, 887Ð888kidney stones, 882Ð884nephrotic syndrome, 885Ð886nutritional interventions for, 860Ð861polycystic kidney disease, 889Ð890renal failure, 864Ð873symptoms, 859thin glomerular basement membrane

nephropathy, 862Ð864urinary tract infection, 894Ð896

Renal metabolic disorders, 887Ð888Renal transplantation, 891Ð893Renin, 860tRepaglinide (Prandin), 547tRepertaxin, 784Reproductive disorders, 46tRequip (ropinirole), 255 tRescriptor (delavirdine), 834tReserpine, 263

Respiratory distress syndrome (RDS), 292,317Ð319

Respiratory failure, 319Ð321Respiratory quotient, 292tResting metabolic rates (RMR), 606tRestoril (temazepam), 284tRestrictive cardiomyopathy, 354Resveratrol, 500t, 737t, 771, 790tRetacrit (epoetin zeta), 872tRetin A (retinoic acid), 112Retinitis pigmentosa, 144Retinoblastoma, 46tRetinoic acid, 112, 433Retinoids, 736tRetinopathy, 524tRetrovir, 834tRett syndrome, 45t, 148Reyataz (atazanavir), 834tRhabdomyolysis, 675Ð676, 813Rheumatic arthritis, 671tRheumatic disorders, 638Ð640Rheumatic fever, 828tRheumatoid arthritis, 677Ð682. See also

Musculoskeletal disordersclinical indicators, 678tdrugs and side effects, 679juvenile, 677tmedications for, 679Ð681tnutritional guidelines for, 679nutritional objectives for, 679patient education, 682supplements, 682variant forms of, 677t

Rheumatoid vasculitis, 677tRheumatrex (methotrexate), 651, 681t, 762Rhodiola, 77tRhubarb, 77tRibavirin, 481, 486tRiboßavin

deÞciency of, 119t, 712tfor healthy vision, 108tfor migraine headache, 247recommended intakes for children, 29tsources of, 121toxicity of, 121

Rice, 85allergy to, 125t

Rice bran oil, 77tRickets, 89t, 208Ð209Ridaura (gold sodium thiomalate), 680tRifadin, 332tRifampin, 332t, 376Rifaximin, 424, 491tRiluzole, 233, 245Rimactane, 332tRiopan (magaldrate), 409tRisedronate, 669, 670t, 673, 844Risperdal (risperidone), 264, 283t, 616tRisperidone (Risperdal), 149, 264, 283t, 616tRitalin (methylphenidate), 31, 147 tRitonavir, 835tRituxan, 744tRituximab, 681t, 719, 729, 744t, 893tRivaroxaban, 317Rivastigmine (Exelon), 230tRocaltrol (calcitriol), 872 tRofecoxib, 719Roferon-A, 486tRogaine (minoxidil), 52 t


INDEX 1017

Rohypnol, 288tRoman Catholics, dietary practices of, 94Ropinirole (Requip), 255 tRosacea, 111, 112Rosemary, 77t, 748tRosiglitazone (Avandia), 547tRosmarinic acid, 500tRosuvastatin, 676, 886Roundworms, 845tRoux-en-Y gastric bypass (RYGB), 813Royal jelly, 77tRumination disorder, 223tRumination syndrome, 274tRuptured disc, 683Ð684Rutin, 499tRythmol (propafenone), 374

S-5-adenosyl-methionine, 284tSabril (vigabatrin), 241tSaccharin, 533tS-adenosylmethionine (SAMe), 661t, 702Salagen (pilocarpine hydroxide), 681tSalbumol, 296tSalicylates, 338tSalicylic acid, 113, 500tSalivary gland, 764tS-allylcysteine, 736tSalmonella, 135Salt substitutes, 361t, 370tSandimmune (cyclosporine), 755t, 893tSandostatin (octreotide), 134, 304, 574Saponins, 78t, 734tSaquinavir, 835tSarcoidosis, 322Ð323Sarcopenia, 602tSassafras, 81tSattvic foods, 86Saturated fatty acids (SFA), 338t, 349Saw palmetto, 77t, 749t, 790Scabies, 113Schisandra, 77tSchizoaffective disorder, 224tSchizophrenia, 281Ð284SchmidtÕs syndrome, 583Schwannoma, 757tScleroderma, 684Ð686Scleroderma renal crisis, 684Sclerotherapy, 466Sea cucumber extract, 762Seasonal affective disorder, 224tSecoisolariciresinol, 735tSecondary hyperparathyroidism, 596Secondary-progressive multiple sclerosis

(SPMS), 249tSecretin, 569tSeeds, 339tSeizure disorders, 240Ð242Selective costimulation modulator, 681tSelective serotonin 5-hydroxytryptamine-3

(5-HT3), 411Selective serotonin reuptake inhibitors

(SSRIs), 279, 283t, 284t, 616t, 669Selegiline (Eldepryl), 230t, 255tSelenium, 56t, 108t, 225t, 294t, 712t, 734t,

735t, 760Self-feeding problems, 106Ð109Selzentry, 835tSenaglinide (Starlix), 547tSenna, 77t

Sensipar (cinacalcet), 598, 872tSeparation anxiety disorder, 224tSepsis, 850Ð854Septra, 486t, 836t, 895Serax (oxazepam), 284tSerevent (salmeterol xinafoate), 296tSerlect, 616tSeronegative arthritis, 638Seroquel (quetiapine), 264, 283tSerotonin, 224tSerpalan (reserpine), 263Serpasil (reserpine), 263Sertraline, 272Sertraline (Zoloft), 284 t, 616tSerum ferritin, 689tSerum iron, 689tSerutan, 420tSerzone (nefazodone), 616tSevelamer (Renagel), 872tSeventh-Day Adventists, dietary practices of,

94Sexual maturation, 34Sfforon, 749tShared psychotic disorder, 224tShark cartilage, 749tShark oil, 749tSheep sorrel, 77tShell Þsh, allergy to, 125t, 127tShepherdÕs purse, 78tShiitake mushroom, 749tShingles, 826tShort bowel syndrome, 456Ð459, 816Siberian ginseng, 746tSibutramine, 270, 617tSickle cell anemia, 719Sideroblastic anemia, 715Ð716Sikhism, dietary practices of, 91SildenaÞl, 306SildenaÞl citrate (Viagra), 52tSilicon, 665tSilymarin, 500t, 736t, 748tSimple fractures, 842Simvastatin, 886Sinemet, 245, 250, 255tSinequan (Doxepin), 284t, 616tSingle-nucleotide polymorphisms (SNPs), 44,

415tSingulair, 296tSirolimus, 755t, 893tSitagliptin (Januvia), 547tSjšgrenÕs syndrome, 677tSkeletal disorders, 45tSkin disorders, 110Ð113Skullcap, 81t, 749tSleep apnea, 324Ð325, 619tSleep disorders, 224t, 285Ð286Slippery elm, 78tSlow Food movement, 52Small bowel surgery, 816Ð818Small for gestational age (SGA), 210Ð211Small intestinal mucosa, 569tSmall intestine, 384Small-cell lung cancer (SCLC), 774Smilax, 42tSmoking, 36t, 52t, 339tSmoking cessation, 619tSnacks, 302t, 492t, 536tSnakeroot, 283SNAP, 60t

Sodiumfor asthma, 294tbone health and, 665tfor dialysis patients, 877tdietary guideline for, 4tdietary recommendations for, 63thealth claims, 55tfor healthy vision, 108timbalance, 806tlow-sodium diet, 359tin post-transplant nutrition, 495 trecommended intakes, 340reduction, 368restriction, 354, 356in salt, salt substitutes and herbal

seasonings, 370tin typical food items, 359t

Sodium bicarbonate, 103, 166Sodium ßuoride, 670tSodium levothyroxine, 592Sodium phenylbutyrate, 215Solu-Cortef, 442t, 496t, 510t, 893tSomatostatin analogs, 478Somatotropin, 572, 573Somatuline Depot, 574Somogyi effect, 522tSorbitol, 423Sour orange, 760Soy

allergy to, 125t, 127tformulas, 20isoßavones, 749tprotein, 49, 56t, 337t, 339t

Spastic constipation, 418Ð419Speech disorder, 224tSpherocytic anemia, 705tSphingomyelin, 735tSpices, 492t, 640t

allergy to, 125tSpina biÞda, 194Spina biÞda cystica, 194Spina biÞda occulta, 194Spinach, 73tSpinal accessory nerve, 221tSpinal arthritis, 643Ð644Spinal cord, 220tSpinal cord injury, 256Ð259Spinal surgery, 811tSpirulina, 78t, 749tSplenda (sucralose), 533tSplenorenal shunting, 484Ð485Spondyloarthropathies, 643Spondylosis, 638Spontaneous hypoglycemia, 567Ð569Sports nutrition, 38Ð43

children and adolescent athletes, 38drugs and side effects, 40Ð42female athletes, 38food safety tips, 43meal planning, 41tnutritional guidelines, 40, 42tobjectives, 39Ð40protein, 40tsupplements, 42, 42t

Sprycel (dasatinib), 794tSqualene, 736tSt. JohnÕs wort, 78t, 250, 272, 295, 661t, 749t,

794, 808tStains, 109


1018 INDEX

Stanols, 337t, 339t, 615, 735tStaphylococcus aureus, 662, 828tStarch, 85, 416tStarlix (senaglinide), 547tStarvation, 602tStatins, 230t, 337t, 350, 350t, 361t, 364t, 366,

379, 670t, 676, 886Stature, calculation of, 66tStavudine, 834tSteroids, 40, 288t, 616t, 660tSterol esters, 56tSterols, 337t, 339t, 615, 736tStigmasterol, 736tStilbenes, 737tStilbenoids, 500tStillingia, 78tStimulant laxatives, 420tStomach acid protector, 409tStomatitis, 740tStool softeners, 420tStrattera (atomoxetine), 31, 147tStreptococcus, 851Streptococcus mutans, 96Streptomycin, 332tStreptozotocin (Zanosar), 512Stress fractures, 842Stroke, 259Ð263

as cause of death, 44tclinical indicators, 260tdiabetes and, 525tdrugs and side effects, 262nutritional guidelines for, 261Ð262nutritional objectives for, 261prevention of, 261Ð262supplements, 262symptoms, 260t

Struvite stones, 882, 884tSubarachnoid hemorrhages, 237Subclinical hypothyroidinism, 592Subdural hemorrhages, 237Subjective Global Assessment (SGA), 60tSuboxone, 289Substance use disorders, 287Ð289Substance-related disorders, 224tSubutex, 289Sucralfate, 402, 409tSucralose, 533tSucrose, 532tSucrose intolerance, 155, 157Sudden infant death syndrome (SIDS), 172Sugar, 532tSugar alcohols, 56t, 532tSuicide, 44tSulfasalazine, 195, 436, 644, 681tSulÞnpyrazone (Anturane), 646SulÞsoxazole (Gantrisin), 895SulÞtes, 247t

allergy to, 125tSulfonylureas, 547t, 616tSulforaphane, 407, 640t, 734t, 760, 790tSulphadoxine-pyrimethamine, 712tSunburn, 113Sunette (acesulfame potassium), 533tSunitinib (Sutent), 769, 773Supertasters, 44Surfak (docusate sodium), 417Surgery, 800Ð811

amputations, 808t

assessment factors, 799bariatric, 812Ð815bowel, 816Ð818clinical indicators, 801tcolostomy, 450Ð452drugs and side effects, 804electrolyte imbalances in, 806Ð807tgastrectomy, 399Ð401gastric bypass, 812Ð815herbal medications, 808tileostomy, 452Ð454immunity concerns in, 822tnutritional objectives, 809Ð811tnutritional support in, 802Ð804patient education, 805postoperative concerns in, 802, 803Ð804postsurgical status, 799preoperative concerns in, 801Ð803presurgical status, 799small intestine after, 803ttypes of, 809Ð811tvagotomy, 399Ð401

Surmontil (trimipramine), 616 tSutent (sunitinib), 773Sweet ÕN Low (saccharin), 533tSweeteners, 126, 532Ð533tSweets, 302t, 532t, 536tSymlin (amylin), 547tSymmetrel (amantadine), 255tSynbiotics, 385t, 459tSyndrome of inappropriate antidiuretic

hormone (SIADH), 579Ð580Synthroid, 593Syprine (trientine), 486 tSystemic inßammation response syndrome

(SIRS), 848, 850Ð854, 903Systemic sclerosis, 684Ð686

T cells, 821tTachycardia, 373Tacrine (Cognex), 230tTacrolimus, 329t, 364t, 442t, 496t, 510t, 538t,

646, 755t, 893tTadalaÞl (Cialis), 52tTagamet (cimetidine), 283, 409tTakayasuÕs arteritis, 346Tamasic foods, 86Tamoxifen (Noraldex), 784Tangeritin, 499tTanner stages, 33Ð34Tannins, 78t, 735t, 771Tansy, 113Tapazole (methimazole), 590Tarceva, 774, 779Tardive dyskinesia (TD), 263Ð264Tartrazine, allergy to, 125tTarui disease, 176tTarvil, 263Tasigna (nilotinib), 794 tTasmar (tolcapone), 255tTaste, 44Tay-Sachs disease, 45tT-cell prolymphocytic leukemia, 793tTea tree oil, 78tTegaserod (Zelnorm), 420tTegretol (carbamazepine), 241t, 265, 616tTelithromycin (Ketek), 315Temazepam (Restoril), 284t

Temporal lobe, 220tTemporomandibular joint (TMJ) disorder,

104Ð105Tenofovir DF, 834tTenormin (atenolol), 486 t, 616tTenuate (diethylpropion), 617 tTerazosin (Hytrin), 616 tTeriparatide, 670tTerminally ill patients, 238tTerpenes, 734t, 735t, 736tTerpenoids, 499tTestes, 570tTestoderm, 616tTestosterone, 570t, 572, 616tTetrabenazine, 245, 263Tetracycline, 112, 461, 486tTetrahydrobiopterin, 204, 205Tetranectin, 538tTetrathiomolybdate, 217TF constipation, 418Ð419Thalamus, 220tThalassemias, 720Ð721Thalidomide, 798Theaßavin, 499tThearubigins, 499tTheo-Dur, 302Theophylline, 296t, 299Thermal injury, 838Ð841Thiamin

deÞciency of, 119tfor healthy vision, 108trecommended intakes for children, 29ttoxicity of, 121

Thiazide, 306, 350Thiazide diuretics, 361t, 370, 486t, 886Thiazolidinediones, 547t, 616tThin glomerular basement membrane

nephropathy (TBMN), 862Ð8636-Thioguanine, 436Thiols, 734t, 735tThionamides, 590Ð591Thiopurine toxicity, 46 tThioridazine HCl (Mellaril), 616 tThiothixene (Navane), 283t, 616tThitoic acid, 534tThoracic empyema, 326Ð327Thorazine (chlorpromazine), 283 tThrombocytopenia, 45t, 192Thrombocytopenia purpura, 728Ð729Thrombolytics, 381Thrombophilia, 45 tThrombophlebitis, 379Ð381Thymoglobulin, 538Thymosin, 570tThymus, 570tThyrocalcitonin, 673Thyroid cancer, 763Ð766Thyroid crisis, 589Thyroid gland, 570t

hypercalcemia, 596Ð598hyperparathyroidism, 596Ð598hyperthyroidism, 589Ð591hypocalcemia, 595Ð596hypoparathyroidism, 595Ð596hypothyroidism, 591Ð594

Thyroid hormones, 593Ð594Thyroid storm, 589Thyroid-stimulating hormone, 569 t


INDEX 1019

Thyrotoxicosis, 589Tiagabine (Gabitril), 241 tTilade (nedocromil), 296 tTimolol (Blocadren), 486 tTinnitus, 128Tipranavir, 834t, 835tTissue transglutaminase (TTG), 415Tobramycin, 310tTocolytics, 9Tofranil (imipramine), 31, 284 t, 616tTolcapone (Tasmar), 255tTongue disorders, 99, 101Tonsillectomy, 811tToothache, 99tTopamax (topiramate), 241t, 270Topical pain relievers, 660tTopiramate, 276Topiramate (Topamax), 241t, 270Total nutrient admixture, 899 tTotal-body irradiation, 755tToxic shock syndrome, 828tTramadol (Ultram), 660 tTranquilizers, 283tTrans fatty acids, 339tTransferrin, 689tTransplantation

bone marrow, 753Ð756heart-lung, 363Ð365hematopoietic stem-cell, 753Ð756intestinal, 440Ð442islet cell, 537Ð539liver, 493Ð496lung, 327Ð329pancreatic, 509Ð510renal, 891Ð893

Transtheoretical Model for Stages of Change,52

Transthyretin, 867tTranxene (clorazepate), 284tTranylcypromine (Parnate), 284t, 616tTrastuzumab (Herceptin), 784Trauma, 822t, 854Ð856Traumatic brain injury (TBI), 234Ð236TravelerÕs diarrhea, 421t, 422Trecator-SC, 332tTrental (pentoxifylline), 379, 685Triamcinolone (Azmacort), 296 tTriamterene, 195Triamterene (Dyrenium)_, 486 tTriazolam (Halcion), 284 tTribulus, 42tTribulus terrestris, 78tTrichinella spiralis, 845tTricyclic antidepressants, 284t, 616t, 657Trientine (Syprine), 486 tTrigeminal nerve, 221tTrigeminal neuralgia, 265Ð266Triglycerides, 339tTrihexyphenidyl (Artane), 255 tTrilafon (perphenazine), 616 tTrileptal (oxcarbazepine), 241tTrimethoprim (Trimpex), 895Trimethoprim-sulfamethoxazole, 486t, 836t,

895Trimipramine (Surmontil), 616 tTrimox (amoxicillin), 895Trimpex (trimetophrim), 895Trinsicon, 714

Trisenox (arsenic trioxide), 798Triterpene glycoside, 735tTrizivir, 834tTrochlear nerve, 221tTropheryma whipplei, 461Tropical sprue, 460Ð461Trovaßoxin, 895Troxerutin, 466Truvada, 834tTryptophan, 42t, 78t, 225t, 283Tube feeding, 100, 101Tuberculosis, 330Ð333Tumor necrosis factor alpha (TNF� ), 638, 643Tumor necrosis factor (TNF), 838Tumor necrosis factor (TNF) inhibitors, 681 tTums (calcium supplement), 669tTurkey tail mushroom, 749tTurmeric, 78t, 476, 534t, 644, 749tTwinrix, 481Typhoid fever, 828tTyramine, 247tTYREX, 212TYROMEX-1, 212TYROS, 212Tyrosine, 204, 212Ð213, 225tTyrosine aminotransferase (TAT), 212Tyrosinemia, 212Ð213

Ubiquinone, 340t, 736tUkrain, 78tulcerative colitis, 434Ð436Ulcerative colitis, 760Uloric (febuxostat), 646Ultralente, 533tUltram (tramadol), 660 tUndernutrition, 602Ð603t, 626Ð631, 822t.

See alsoMalnutritionUnderweight, 622Ð626. See alsoMalnutrition;

Overweightbody mass index and, 622clinical indicators, 623tdrugs and side effects, 624nutritional guidelines for, 624patient education, 624Ð625strengthening tips, 623t

Upper respiratory infections, 822tUrea cycle disorders, 213Ð216Uremia, 880Uric acid, 500t, 645Ð646Uric acid stones, 882Uricosuric drugs, 646Uridine, 226tUrinary incontinence, 894Urinary tract cancer, 772Ð773Urinary tract infection, 894Ð896Urolithiasis, 884tUrso, 517Ursodeoxycholic acid, 310t, 491t, 514, 515,

517, 755tUrsodiol, 152, 517Ursolic acid, 433, 644, 748t

Vaccines, 522tVagotomy, 399Ð401Vagus nerve, 221tValcyte, 836tValdecoxib, 679tValerian, 78t, 283, 661t, 749t, 808t

Valganciclovir, 836tValium (diazepam), 284tValproate, 241t, 268Valproic acid, 241t, 616tValsartan (Diovan), 886Vanadium, 79t, 534tVanatrip (amitriptyline), 616 tVancomycin, 424Vascular access device, 899tVasodilan (isoxsuprine), 379Vasopressin, 569tVasotec (enalapril), 886Vegan vegetarians, 10tVegetables

eating tips, 53tÞber content, 465tglycemic index, 535theadaches and, 247thealth claims, 55tnutrients in, 54Ð55

Vegetarian diet, 88Ð90Velcade (bortezomib), 798Venlafaxine (Effexor), 284tVenofer, 695Ventilator, 319Ð321Ventolin (albuterol), 296 tVerapamil, 345Versed (midazolam), 284tVery long-chain fatty acid (VLCFA), 184Ð185Very low birth weight (VLBW), 153Vestibulocochlear nerve, 221tViagra (sildenaÞl citrate), 52tVideo-assisted thorascopy (VATS), 326Videx (didanosine), 834tVigabatrin (Sabril), 241tVinblastine, 744tVinca alkaloids, 744tVincentÕs disease, 103Vincristine, 744t, 796, 835tViracept, 835tViral pneumonia, 314tViramune (nevirapine), 834 tVirazole (ribavirin), 486 tVirchow triad, 315Viread, 834tVistide, 835tVitamin A

for asthma, 294tbone health and, 665tdeÞciency of, 119t, 120, 712tin functional foods, 735tfor healthy vision, 108tfor heart disease, 337tfor oral tissue and dental care, 97tfor pregnant women, 9recommended intakes for children, 29tsources of, 499ttoxicity of, 121

Vitamin B complex, 97tVitamin B12

AlzheimerÕs disease and, 227for bone health, 665tfor brain health, 226tdeÞciency anemia, 713Ð714deÞciency of, 89t, 119t, 121for healthy vision, 108tfor homocystinuria, 181Ð182for pancreatic cancer, 779


1020 INDEX

Vitamin B12 (continued)schizophrenia and, 281sources of, 121

Vitamin B6

AlzheimerÕs disease and, 227for bone health, 665tfor brain health, 226tdeÞciency of, 119t, 121for diabetic patients, 534tin functional foods, 735tfor healthy vision, 108tmetabolic disorder, 180for sideroblastic anemia, 716sources of, 121toxicity of, 121

Vitamin Cfor asthma, 294tbone health and, 665tin cancer prevention, 736tdeÞciency of, 120t, 121, 712tin functional foods, 736tfor healthy vision, 108tfor heart disease, 337t, 339t, 340trecommended intakes for children, 29trole in brain, 226tside effects of, 423sources of, 499ttoxicity of, 121

Vitamin Dbone health and, 665tfor CrohnÕs disease, 433deÞciency of, 89t, 119t, 121, 208Ð209in diabetes management, 534tfor dialysis patients, 872tfor healthy vision, 108tfor infants, 19for oral tissue and dental care, 97trheumatic disorders and, 640trole in brain, 226tsupplementation

for asthma, 294tfor chronic obstructive pulmonary

disease, 302for dialysis patients, 876

toxicity of, 121Vitamin D 3, 208, 278, 669, 735t, 771,

850, 878tVitamin E

AlzheimerÕs disease and, 229, 230tarthritis and, 661tfor asthma, 294tfor colorectal cancer, 760deÞciency of, 120t, 712tin functional foods, 735t, 736tfor healthy vision, 108t

for heart disease, 337t, 339t, 340tside effects of, 356sources of, 499tfor stroke patients, 262toxicity of, 121

Vitamin E-sensitive hemolytic anemia, 705tVitamin K, 722Ð724

blood clotting and, 394, 804bone health and, 665tfor cirrhosis, 486tdeÞciency of, 120t, 121food sources, 723theart disease and, 339tfor oral tissue and dental care, 97ttoxicity of, 121warfarin and, 350

Vitamins, 118Ð121in breast milk, 13tdeÞciency of, 118Ð121for dialysis patients, 877timmunutrition and, 823 t

Vitex, 79tVomiting, 741tVomiting, pernicious, 410Ð412Von Gierke disease, 176tVon Willebrand disease, 722Vyvanse (lisdexamfetamine dimesylate), 147t

Warfarin, 317, 318, 356, 374, 381, 886Waste excretion, 860tWater, 340Weight, calculation of, 604tWeight gain. See alsoBody mass index (BMI)

activity level or illness, 608tmedications that cause, 616tin pregnancy, 7, 17smoking cessation and, 619t

Weight lossactivity level or illness, 608tin cancer patients, 741tin malnutrition, 602 tmedications for, 617tunintentional, 622Ð626

Wellbutrin, 284t, 835tWheat, allergy to, 125t, 127tWheat grass, 81t, 749tWhippleÕs disease, 461Ð462White birch, 749tWhite willow, 79tWild yams, 42t, 79tWillow bark, 79tWillow yam, 79tWilmÕs tumor, 46t, 772Ð773WilsonÕs disease, 216Ð218Wired jaw, 99Ð100

Witch hazel, 79tWomen

medications, 52tnutrition-related concerns for, 48 t

Wymox (amoxicillin), 895

Xanax (alprazolam), 284t, 616tXanthene oxidase inhibitors, 646Xanthones, 500tXenazine (tetrabenazine), 245Xenical (orlistat), 617 tXerostomia, 101, 178, 273t, 740tXifaxan (rifaximin), 424Ximelagatran (Exanta), 381X-linked adrenoleukodystrophy, 184X-linked hypophosphatemic rickets (XLH),

887Ð888X-linked sideroblastic anemia, 715Ð716

Yersinia enterocolitis, 851Yew, 79tYogurt, 536tYohimbe, 42t, 81t, 283

Zalcitabine, 834tZanosar (streptozotocin), 512Zantac (ranitidine), 409 tZarontin (ethosuximide), 241 tZeaxanthin, 108t, 109, 499t, 735t, 790tZeldox, 616tZellwegerÕs syndrome, 184Zelnorm (tegaserod), 420tZemplar (paricalcitol), 598, 872tZenkerÕs diverticulum, 390Ð391Zerit, 834tZiagen (abacavir), 834tZidovudine, 834tZinc, 19, 42t, 79t, 89t, 97t, 108t, 225t, 294t,

534t, 661t, 665t, 698, 712t, 736tZinc acetate, 217Ziprasidone (Geodon), 283tZocor (simvastatin), 886Zofrab, 559Zoledronic acid, 773Zoledronic acid (Zometa), 673, 798Zollinger-Ellison syndrome, 511Ð512Zoloft, 283tZoloft (sertraline), 284 t, 616t, 835tZometa (zoledronic acid), 673, 798Zonegran, 241tZonisamide, 241tZovirax, 835tZyßo, 296tZymenol, 420tZyprexa (olanzapine), 149, 264, 283t, 616t


table b-8 interpretation of lab values (continued)cholecystitis, renal insufﬁ-ciency, alcohol ......

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