Nutrition, Health and Disease

Simon Langley-Evans is Head of the School of Biosciences and Professor of Human Nutrition in the Faculty of Science at the University of Nottingham, UK. He obtained his first degree in Biochemistry with Microbiology from Royal Holloway and Bedford New College; his PhD from the University of Southampton, and a DSc from the University of Nottingham. He is the author of over 200 peer-reviewed research papers and book chapters in the area of lifespan nutrition.

• Preface ixAcknowledgements xAbbreviations xiGlossary of terms used in this book xiiAbout the companion website xxiii1 Introduction to lifespan nutrition 11.1 The lifespan approach to nutrition 11.2 The concept of balance 21.2.1 A supply and demand model 21.2.2 Overnutrition 31.2.3 Undernutrition 41.2.3.1 Increased demand 41.2.3.2 The metabolic response to trauma 41.2.3.3 Compromised supply and deficiency  61.2.3.4 Malnutrition 71.2.4 Classical balance studies 111.2.5 Overall nutritional status 121.3 The individual response to nutrition 121.3.1 Stage of the lifespan 131.3.2 Genetics 141.4 Personalized nutrition 171.5 Assessment of nutritional status 191.5.1 Anthropometric measures 191.5.2 Estimating dietary intakes 201.5.2.1 Indirect measures 201.5.2.2 Direct measures 211.5.3 Biomarkers of nutritional status 241.5.4 Clinical examination 251.6 Nutritional epidemiology: understanding diet–disease relationships 261.6.1 The importance of the evidence base 261.6.2 Nutritional epidemiology 261.6.3 Cause and effect 271.6.4 Bias and confounding 271.6.5 Quantifying the relationship between diet and disease 281.6.6 Study designs in nutritional epidemiology 291.6.6.1 Ecological studies 311.6.6.2 Cross‐sectional studies 321.6.6.3 Case–control studies 331.6.6.4 Cohort studies 331.6.6.5 Randomized controlled trials 331.6.6.6 Systematic review and metaanalysis 341.6.6.7 Scoping reviews 341.7 Dietary reference values 351.7.1 The UK dietary reference values system 361.7.2 Dietary reference values in other countries 392 Before life begins 452.1 Introduction 452.2 Nutrition and female fertility 462.2.1 Determinants of fertility and infertility 462.2.1.1 The endocrine control of female reproduction 472.2.1.2 Disordered reproductive cycling 482.2.1.3 Polycystic ovary syndrome 482.2.2 Importance of body fat 502.2.3 Role of leptin 512.2.4 Antioxidant nutrients 532.2.5 Caffeine and alcohol 552.3 Nutrition and male fertility 562.3.1 Determinants of fertility and infertility 562.3.2 Obesity 602.3.3 Alcohol 612.3.4 Zinc 612.3.5 Antioxidant nutrients 622.3.6 Selenium 632.3.7 Phytoestrogens and environmental oestrogens 632.3.7.1 Phthalates 642.3.7.2 Phytoestrogens 642.3.7.3 Pesticides 652.4 Preparation for pregnancy 662.4.1 Why prepare for pregnancy? 662.4.2 Maternal weight management 662.4.3 Vitamin A and liver 662.4.4 Folic acid and neural tube defects 692.4.4.1 Supplementation with folic acid 712.4.4.2 Fortification with folic acid 713 Pregnancy 793.1 Introduction 793.2 Physiological demands of pregnancy 813.2.1 Maternal weight gain and body composition changes 813.2.2 Blood volume expansion and cardiovascular changes 823.2.3 Renal changes 833.2.4 Respiratory changes 833.2.5 Gastrointestinal changes 843.2.6 Metabolic adaptations 843.3 Nutrient requirements in pregnancy 853.3.1 Energy protein and lipids 853.3.2 Micronutrients 873.3.2.1 Iron 873.3.2.2 Calcium and other minerals 893.3.2.3 Vitamin D 903.4 Diet in relation to pregnancy outcomes 913.4.1 Miscarriage and stillbirth 913.4.2 Premature labour 923.4.2.1 Prepregnancy body mass index and pregnancy weight gain 923.4.2.2 Alcohol and caffeine consumption 943.4.2.3 Oral health 963.4.3 Hypertensive disorders of pregnancy 973.4.3.1 The aetiology of pre‐eclampsia 983.4.3.2 Nutrition‐related factors and pre‐eclampsia 993.4.4 Abnormal labour 1013.5 Nausea and vomiting of pregnancy 1023.5.1 Nausea and vomiting of pregnancy as a normal physiological process 1023.5.2 Hyperemesis gravidarum 1043.6 Cravings and aversions 1063.6.1 Pica 1073.7 Gastrointestinal disturbances in pregnancy 1083.8 High‐risk pregnancies 1083.8.1 Gestational diabetes 1083.8.2 Adolescent and older mothers 1103.8.3 Multiple pregnancies 1113.8.4 Fetal alcohol spectrum disorders 1134 Fetal nutrition and disease in later life 1234.1 Introduction 1234.2 The developmental origins of adult disease 1234.2.1 The concept of programming 1234.2.2 Fetal programming and human disease 1254.2.2.1 Fetal growth 1254.2.2.2 Nutrition and the constraint of growth 1264.2.2.3 Fetal growth health and disease 1274.3 Evidence linking maternal nutrition to disease in later life 1294.3.1 Epidemiology 1294.3.1.1 Association of disease with birth anthropometry 1294.3.1.2 Maternal nutrition and later disease 1314.3.1.3 Maternal obesity and later disease 1324.3.2 Criticisms of the programming hypothesis 1334.3.3 Experimental studies 1344.3.3.1 Global undernutrition 1364.3.3.2 Micronutrients 1364.3.3.3 Macronutrients 1374.4 Mechanistic basis of fetal programming 1384.4.1 Thrifty phenotypes and genotypes 1384.4.2 Mismatched environments 1394.4.3 Tissue remodelling 1394.4.4 Endocrine imbalance 1414.4.5 Nutrient–gene interactions 1444.4.5.1 Polymorphisms in humans 1444.4.5.2 Gene expression in animals 1454.4.6 Epigenetic regulation 1454.5 Implications of the developmental origins hypothesis 1484.5.1 Public health interventions 1484.5.2 Transgenerational transmission of disease risk 1495 Lactation and infant feeding 1575.1 Introduction 1575.2 The physiology of lactation 1575.2.1 Anatomy of the breast 1575.2.1.1 The nipple and areola 1575.2.1.2 The lactiferous ducts 1585.2.1.3 The lactiferous sinuses 1585.2.1.4 The alveolar cells 1585.2.1.5 The rooting reflex 1585.2.2 Synthesis of milk 1585.2.2.1 Foremilk and hindmilk 1595.2.2.2 Time of day 1595.2.2.3 Course of lactation 1605.2.2.4 Synthesis of carbohydrates 1605.2.2.5 Origins of milk fats 1605.2.2.6 Milk proteins 1615.2.3 Endocrine control of lactation 1625.2.3.1 The breast during pregnancy 1625.2.3.2 Established lactation 1625.2.3.3 The breast after weaning 1635.2.4 Maintenance of lactation 1645.2.5 Nutritional demands of lactation 1645.3 The advantages of breastfeeding 1655.3.1 Advantages for the mother 1655.3.1.1 Convenience and cost 1655.3.1.2 Bond with infant 1665.3.1.3 Recovery from pregnancy 1665.3.1.4 Long‐term health 1675.3.2 Advantages for the infant 1685.3.2.1 Immunoprotection 1685.3.2.2 Sudden infant death 1695.3.2.3 Cognitive development 1695.3.2.4 Obesity 1715.3.2.5 Atopy 1715.3.2.6 Milk contaminants 1725.3.3 Recommendation to breastfeed for six months 1735.4 Trends in breastfeeding behaviour 1745.4.1 Reasons why women do not breastfeed 1765.4.1.1 Cultural factors 1765.4.1.2 Technique infection and stress 1775.4.2 Promoting breastfeeding 1785.5 Situations in which breastfeeding is not advised 1795.6 Alternatives to breastfeeding 1815.6.1 Cow’s milk formulas 1825.6.1.1 Milk stages and follow‐on milk 1835.6.2 Preterm formulas 1845.6.3 Soy formulas 1855.6.4 Hydrolysed protein and amino acid‐based formulas 1855.6.5 Other formulas 1856 Nutrition and childhood 1916.1 Introduction 1916.2 Infancy (birth to five) 1926.2.1 The key developmental milestones 1926.2.2 Nutrient requirements 1936.2.2.1 Macronutrients and energy 1936.2.2.2 Micronutrients 1966.2.3 Nutrient intakes and infants 1976.2.4 Transition to an adult pattern of food intake 1986.2.4.1 Complementary feeding 1986.2.4.2 Nutrition‐related problems 2016.2.4.3 Barriers to healthy nutrition 2066.3 Childhood (5–13) 2126.3.1 Nutrient requirements of the older child 2126.3.2 School meals and the promotion of healthy eating 2136.3.3 The importance of breakfast 2146.4 Obesity in children 2156.4.1 The rising prevalence of obesity 2156.4.2 The causes of obesity in childhood 2176.4.2.1 Physical activity 2176.4.2.2 Food intake 2186.4.2.3 Genetic disorders 2216.4.3 The consequences of childhood obesity 2226.4.3.1 Immediate health consequences 2226.4.3.2 Tracking of obesity: consequences for the future 2226.4.4 Treatment of childhood obesity 2246.4.5 Prevention of childhood obesity 2267 Nutrition and adolescence 2377.1 Introduction 2377.2 Physical development 2377.2.1 Growth rate 2377.2.2 Body composition 2387.2.3 Puberty and sexual maturation 2397.2.4 Bone growth 2417.3 Psychosocial development 2447.4 Nutritional requirements in adolescence 2457.4.1 Macronutrients and energy 2457.4.2 Micronutrients 2467.5 Nutritional intakes in adolescence 2477.5.1 Factors that influence food choice 2487.5.2 Food consumed out of the home 2497.5.3 Meal skipping and snacking 2507.6 Potential problems with nutrition 2517.6.1 Dieting and weight control 2517.6.2 The teenage vegetarian 2537.6.3 Sport and physical activity 2547.6.4 Eating disorders 2557.6.4.1 Anorexia nervosa 2567.6.4.2 Bulimia nervosa 2577.6.5 The pregnant teenager 2587.6.6 The transgender teenager 2607.6.7 Alcohol 2627.6.8 Tobacco smoking 2647.6.9 Drug abuse 2668 The adult years 2748.1 Introduction 2748.2 Changing needs for nutrients 2748.3 Guidelines for healthy nutrition 2768.4 Disease states associated with unhealthy nutrition and lifestyle 2798.4.1 Obesity 2798.4.1.1 Classification of overweight and obesity 2798.4.1.2 Prevalence and trends in obesity 2808.4.1.3 Causes of obesity in adulthood 2818.4.1.4 Treatment of obesity 2818.4.2 Type 2 diabetes 2848.4.3 The metabolic syndrome 2878.4.4 Cardiovascular disease 2888.4.4.1 What is cardiovascular disease? 2888.4.4.2 Risk factors for cardiovascular disease 2908.4.4.3 Nutrition‐related factors and risk of cardiovascular disease 2918.4.5 Cancer 3028.4.5.1 What is cancer? 3028.4.5.2 Diet is a modifiable determinant of cancer risk 3038.4.5.3 Nutritional epidemiology and cancer 3058.4.5.4 Dietary factors that may promote cancer 3098.4.5.5 Dietary factors that may reduce cancer risk 3169 Nutrition ageing and older adults 3309.1 Introduction 3309.2 The ageing population 3309.3 The ageing process 3319.3.1 Impact on physiological systems 3319.3.2 Mechanisms of cellular senescence 3329.3.2.1 Oxidative senescence 3329.3.2.2 The role of p53 activation 3349.3.2.3 Telomere shortening 3349.3.2.4 The Ink4a/ARF axis 3359.3.3 Nutritional modulation of the ageing process 3369.3.3.1 Caloric restriction and lifespan 3369.3.3.2 Fetal programming of lifespan 3389.3.3.3 Supplementary antioxidants 3389.4 Nutrient requirements of the elderly 3399.4.1 Macronutrients and energy 3399.4.2 Micronutrients 3399.4.3 Specific guidelines for the elderly 3399.5 Barriers to healthy nutrition in the elderly 3409.5.1 Malnutrition and the elderly 3409.5.2 Poverty 3419.5.3 Social isolation 3429.5.4 Education 3429.5.5 Physical changes 3439.5.6 Combating malnutrition in the elderly 3439.6 Common nutrition‐related health problems 3459.6.1 Bone disorders 3459.6.1.1 Bone mineralization and remodelling 3459.6.1.2 Osteoporosis pathology and prevalence 3469.6.1.3 Risk factors for osteoporosis 3479.6.1.4 Dietary interventions for osteoporosis prevention 3479.6.1.5 Paget’s disease of bone 3509.6.2 Immunity and infection 3509.6.3 Digestive tract disorders 3549.6.3.1 Mouth and oesophagus 3549.6.3.2 Stomach 3549.6.3.3 Small intestine 3549.6.3.4 Large intestine 3549.6.4 Anaemia 3559.6.4.1 Iron deficiency anaemia 3579.6.4.2 Vitamin B12 deficiency 3579.6.4.3 Folate deficiency 3589.6.4.4 Cognitive impairment and anaemia 359Appendix An introduction to the nutrients 368Index 379

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