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1
Chapter 1 – An Overview of Nutrition
Learning Objectives
After completing Chapter 1, the student will be able to:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Discuss the major reasons people make food choices.
List the six nutrients contained in food and a major use of each nutrient.
Identify the energy-providing nutrients and calculate the energy available from foods.
Explain nutritional genomics and its role in the science of nutrition.
List the types of research designs and the strengths and weaknesses of each.
Discuss Dietary Reference Intakes and the 4 parts of the DRI including the Estimated Average Requirements
(EAR), Recommended Dietary Allowances (RDA), Adequate Intakes (AI), and Tolerable Upper Intake Levels
(UL).
Explain the Estimated Energy Requirement (EER) and how it is used to maintain energy balance.
Discuss the Acceptable Macronutrient Distribution Ranges (AMDR) and how they relate to a healthy diet.
Utilize the DRI in the assessment of a healthy individual.
List the 4 parts of a nutritional assessment and apply them to individuals to detect malnutrition.
List the major methods used to survey the nutritional status of populations.
Identify the chronic diseases that are linked to diet or alcohol.
Identify accurate sources of nutrition information.
List the 8 red flags that identify nutrition misinformation.
Assignments and Other Instructional Materials
The following ready-to-use assignments are available in this chapter of the instructor’s manual:
 New! Case study
 Worksheet 1-1: Evaluation of Published Nutrition Information
 Worksheet 1-2: Research Project Using the Internet
 Worksheet 1-3: Influences on Food Choices1
 Worksheet 1-4: Chapter 1 Crossword Puzzle
 New! Worksheet 1-5: Choosing Party Foods and Snacks (Internet Exercise) 2
 New! Worksheet 1-6: Analyzing Foods and Meals for Nutritional Value 3
 New! Worksheet 1-7: Unit of Measurement Conversions Practice
 New! Critical thinking questions with answers
Other instructional materials in this chapter of the instructor’s manual include:
 Answer key for How To (pp. 8, 9, 29) activities
 Classroom activities
 New! Handout 1-4: Converting Metric/English Units of Measurement
 Worksheet answer keys (as appropriate)
Log in to www.cengage.com/login and access the UNCN 9e companion site to download:
 Handout 1-1: DRI Terms and Nutrients
 Handout 1-2: Parts of a Research Article
 Handout 1-3: Sources of Reliable Nutrition Information
Chapter Outline/Summary
I.
Food choices
A. Personal preference
B. Habit
A person selects foods for a variety of reasons.
Whatever those reasons may be, food choices influence
health. Individual food selections neither make nor break
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Worksheet 1-3 and Handouts 1-1, 1-2, and 1-3 contributed by Sharon Rady Rolfes.
Contributed by Daryle Wane.
3 Worksheets 1-6 and 1-7 and Handout 1-4 contributed by Kathryn Pinna, City College of San Francisco.
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© 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
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C.
D.
E.
F.
G.
H.
I.
J.
Ethnic heritage or tradition
Social interactions
Availability, convenience, & economy
Positive & negative associations
Emotions
Values
Body weight & image
Nutrition & health benefits
a diet’s healthfulness, but the balance of foods selected
over time can make an important difference to health.
For this reason, people are wise to think “nutrition”
when making their food choices.
II. The nutrients
A. Nutrients in foods & in the body
1. Nutrient composition of foods
2. Nutrient composition of the body
3. Chemical composition of nutrients
4. Essential nutrients
B. The energy-yielding nutrients: carbohydrate,
fat, & protein
1. Energy measured in kcalories
2. Energy from foods
3. Energy in the body
4. Other roles of energy-yielding nutrients
C. The vitamins
D. The minerals
E. Water
Foods provide nutrients—substances that support the
growth, maintenance, and repair of the body’s tissues.
The six classes of nutrients include: carbohydrates,
lipids (fats), proteins, vitamins, minerals, and water.
Foods rich in the energy-yielding nutrients
(carbohydrate, fat, and protein) provide the major
materials for building the body’s tissues and yield
energy for the body’s use or storage. Energy is measured
in kcalories. Vitamins, minerals, and water facilitate a
variety of activities in the body.
III. The science of nutrition
A. Conducting research
1. Controls
2. Sample size
3. Placebos
4. Double blind
B. Analyzing research findings
1. Correlations & causes
2. Cautious conclusions
C. Publishing research
Scientists learn about nutrition by conducting
experiments that follow the protocol of scientific
research. In designing their studies, researchers
randomly assign control and experimental groups, seek
large sample sizes, provide placebos, and remain blind
to treatments. Their findings must be reviewed and
replicated by other scientists before being accepted as
valid.
IV. Dietary Reference Intakes
A. Establishing nutrient recommendations
1. Estimated Average Requirements (EAR)
2. Recommended Dietary Allowances (RDA)
3. Adequate Intakes (AI)
4. Tolerable Upper Intake Levels (UL)
B. Establishing energy recommendations
1. Estimated Energy Requirement (EER)
2. Acceptable Macronutrient Distribution
Ranges (AMDR)
C. Using nutrient recommendations
D. Comparing nutrient recommendations
The Dietary Reference Intakes (DRI) are a set of nutrient
intake values that can be used to plan and evaluate diets
for healthy people. The Estimated Average Requirement
(EAR) defines the amount of a nutrient that supports a
specific function in the body for half of the population.
The Recommended Dietary Allowance (RDA) is based
on the Estimated Average Requirement and establishes a
goal for dietary intake that will meet the needs of almost
all healthy people. An Adequate Intake (AI) serves a
similar purpose when an RDA cannot be determined.
The Estimated Energy Requirement (EER) defines the
average amount of energy intake needed to maintain
energy balance, and the Acceptable Macronutrient
Distribution Ranges (AMDR) define the proportions
contributed by carbohydrate, fat, and protein to a healthy
diet. The Tolerable Upper Intake Level (UL) establishes
the highest amount that appears safe for regular
consumption.
© 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
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V. Nutrition assessment
A. Nutrition assessment of individuals
1. Historical information
2. Anthropometric measurements
3. Physical examinations
4. Laboratory tests
5. Iron, for example
B. Nutrition assessment of populations
1. National nutrition surveys
2. National health goals
3. National trends
People become malnourished when they get too little or
too much energy or nutrients. Deficiencies, excesses,
and imbalances of nutrients lead to malnutrition
diseases. To detect malnutrition in individuals,
healthcare professionals use a combination of four
nutrition assessment methods. Reviewing historical
information on diet and health may suggest a possible
nutrition problem. Laboratory tests may detect a possible
nutrition problem in its earliest stages, whereas
anthropometric measurements and physical
examinations pick up on the problem only after it causes
symptoms. National surveys use similar assessment
methods to measure people’s food consumption and to
evaluate the nutrition status of populations.
VI. Diet & health
A. Chronic diseases
B. Risk factors for chronic diseases
1. Risk factors persist
2. Risk factors cluster
3. Risk factors in perspective
Within the range set by genetics, a person’s choice of
diet influences long-term health. Diet has no influence
on some diseases but is linked closely to others. Personal
life choices, such as engaging in physical activity and
using tobacco or alcohol, also affect health for the better
or worse.
VII. Nutrition information & misinformation—on the
Net and in the news
A. Nutrition on the Net
B. Nutrition in the news
C. Identifying nutrition experts
1. Physicians & other health-care
professionals
2. Registered dietitian (RD)
3. Dietetic technician, registered (DTR)
4. Other dietary employees
D. Identifying fake credentials
E. Red flags of nutrition quackery
Much nutrition information on the Internet and in massaudience publications is false or distorted, sometimes
intentionally. Reliable sources of information include
government agencies, dietitians and other health
professionals with formal training in clinical nutrition,
and nutrition departments at universities.
Case Study4
Mary P. is a 57-year-old operating room nurse who works full-time at a local hospital. She is 65 inches tall and
weighs 160 pounds. She has a family history of diabetes and heart disease and was recently diagnosed with high
blood cholesterol. She has declined the cholesterol-lowering medication her doctor prescribed, and says she would
like to explore other methods for lowering her cholesterol first. For the past few weeks, Mary has been taking a
tablespoon of coconut oil every day after reading on the Internet that this will lower her cholesterol. She admits she
has little time or energy to exercise. Her diet history reveals she often skips breakfast or has a donut or bagel with
cream cheese at work. She drinks several cups of coffee each morning with cream and sugar. Lunch is a salad with
crackers and iced tea with sugar in the hospital cafeteria. She occasionally drinks one or two glasses of wine in the
evening, especially after a stressful day at work. She lives alone and relies on frozen dinners or other convenience
foods in the evening. An analysis of her diet reveals an average daily intake of 80 grams of fat, 200 grams of
carbohydrate, and 50 grams of protein.
1.
2.
3.
4
Taking into account her current lifestyle and personal food preferences, what eating habits might be difficult for
Mary to change?
How might her emotions contribute to her food and drink choices?
Using Table 1-2, calculate Mary’s average daily kcalorie intake.
Contributed by Barbara Quinn.
© 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
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4.
5.
6.
7.
What percentage of her daily calories is provided by fat? Carbohydrates? Protein?
Compare the composition of Mary’s diet with the Acceptable Macronutrient Distribution Ranges (AMDR).
How would you use the information above to make dietary recommendations for Mary?
How would you direct her to valid nutrition research for lowering blood cholesterol?
Answer Key:
1. Skipping breakfast, snacking on donuts at work, use of convenience foods, use of alcohol to calm emotions.
2.
Alcohol and foods high in carbohydrates tend to calm emotions in times of stress; caffeine (coffee) may help
ease her feelings of tiredness.
3.
(80 grams fat x 9 kcalories/gram = 720) + (200 grams carbohydrates x 4 kcalories/gram = 800 calories) + (50
grams protein x 4 kcalories/gram = 200 kcalories) = 1720 kcalories.
4.
Fat: 720/1720 = 42%; Carbohydrates: 800/1720 = 46%; Protein: 200/1720 = 12%
5.
Her diet is high in fat (42% versus 20-35% AMDR); adequate in carbohydrates (46% in an acceptable range of
45-65%); and adequate in protein (12% in a range of 10-35%).
6.
Help her find major sources of fat in her diet to decrease or eliminate. Help her find lower-fat choices of usual
foods such as lower-fat cream cheese and convenience foods.
7.
Explain the evidence from peer-reviewed research publications for eating a diet lower in saturated fat for
lowering blood cholesterol. Direct her to the “red flags of nutrition quackery” (Figure H1-2) and explain how to
determine if a website is reliable (Highlight 1).
Suggested Classroom Activities
A nutrition course should begin on a note of excitement. The best classes involve students and help them to see
nutrition’s importance to them. Once they are hooked on nutrition because they feel personally involved with it, they
will be motivated to learn about nutrition topics.
Classroom Activity 1-1: Students’ Burning Questions5
Objective: Introduction to nutrition
Class size: All sizes
Materials needed: Post-It notes (3 per student), 20 sheets construction paper, tape
Instructions: The first day of class, give each student three “Post-It” notes. On each note, students are to write down
a “burning” question they have about nutrition. While they are doing this, tape twenty large pieces of construction
paper around the room, each with a title that roughly corresponds to chapters of the text.
When they finish writing their questions, have them categorize their Post-It notes according to the twenty topics by
placing their Post-It on the piece of construction paper that relates to their question. When they finish, ask them to
take turns reading the questions that they have generated. Before the next class, check the categorization of their
questions and rearrange the Post-It notes if necessary. As you begin a new chapter, bring the corresponding piece of
construction paper to class, and read the questions aloud.
This activity helps reassure students, early on, that you will (or won’t) be covering some of their “burning”
questions. It also helps show students the relevance of the information you’re covering in class, and helps show
instructors the interests of the students.
Classroom Activity 1-2: “Find a Person Who” Introduction Activity
Objective: Enhancing emotional classroom environment
Class size: All sizes
Materials needed: Copy of form described below (developed by instructor) for each student
Instructions: Students sometimes enjoy classes more when they are acquainted with other students. One way to
assist this process is by providing students with a “Find a Person Who” form. Develop a form several columns wide
and several rows long that lists a variety of traits in each square such as: enjoys cooking, recycles, has a pet, is a
nutrition major, etc. Instruct students to walk around the class, introduce themselves to each other, and try to find a
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Activity provided by: Caroline Roberts, R.D., M.P.H.—Nutrition Education Specialist for California Department
of Education and Instructor at Sierra College
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license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
5
person who fits the categories described on the sheet. When they find someone who fits a category, have them write
person’s first name in that category. The goal is to complete the sheet. You may also suggest that they exchange email addresses or phone numbers and form study groups. This activity works best for small to medium size classes.
Classroom Activity 1-3: Brown-Bag Introduction Activity
Objective: Establishing positive classroom environment
Class size: Small to medium
Instructions: In the class period preceding this introduction activity, read the following list of categories: a hobby or
interest that students enjoy, something that is a favorite (color, book, music, food), future plans or goals, something
they would like to do better, a place they’d like to visit, something special about family or friends, the best part of
their last vacation, a healthy activity they like to do, and a talent or special ability they have. From this list, students
are to select one item that represents each of 3 categories and bring these 3 items to class in a small brown bag. They
should try to select items that are 3 dimensional and unique. During class they will share the contents of their brown
bags with the class. This is a good way for students to become acquainted with others. This activity works best with
small classes.
Classroom Activity 1-4: Getting Acquainted Activity
Objective: Establishing positive classroom environment
Class size: Small to medium
Instructions: This activity allows students to learn more about each other and can provide an environment in which
people practice listening skills. Instruct students to pair off with someone that they do not know very well. Give the
students 10-15 minutes to converse and ask some general questions about each other. Bring the group back together
in a large circle with each student sitting next to his or her partner. Ask each student to introduce and speak about his
or her new friend. This activity works best for small and medium sized classes.
Classroom Activity 1-5: “How Is Your Day Going?” Activity
Objective: Enhancing positive classroom environment
Class size: Small to medium
Instructor: An instructor who displays sincere caring about students is likely to be effective at gaining student trust.
At the beginning of class, tell students you want to find out how they are doing. Instruct students to individually
introduce themselves to the class by stating their name, where they are from, and what type of day they are having
(either A, B, or C day). Then they are to share why they are having that type of day. The next person repeats the
process sharing information about themselves and their day, then repeats what the other students shared. This can be
a challenging activity, especially in larger classes. This activity is most appropriate for small to medium size classes.
Classroom Activity 1-6: Who Are You? Introduction Activity
Objective: Establishing rapport
Class size: Any
Materials needed: 1 index card per student
Instructions: Instructors who know their students and can refer to them by name are better equipped to gain trust and
be effective in the classroom. Distribute index cards to each student and instruct students to record information
about themselves on each card. Write on the board the information you are interested in obtaining. Some suggestions
include: name, address, phone, e-mail, major, year in college, home town, employment, professional goals, hobbies,
what they hope to learn from the class, reason for taking the class, and something interesting and/or unique about
themselves. After students have recorded this information, you may ask them to introduce themselves to the class or
you may simply collect the cards to help you learn more about your students. Instructors may want to use the cards
to learn student names.
Classroom Activity 1-7: Chapter Opening Quiz6
Objective: Introducing new material
Class size: Any
Instructions: As a way of introducing any new chapter, give a “quiz” to the class. The students will moan initially,
but they will enjoy the activity once you get underway and they realize that it is taken as a class and does not count
towards their grade. The “quiz” asks ten true/false or multiple-choice questions projected on the overhead from a
transparency. The students are not allowed to talk during the quiz, and must show their choice of answer by raising
hands. Mark the answer chosen by the majority of hands on the transparency. Then go over the correct answers
(their curiosity is piqued!) and seize the “teachable moment.” Generally, they score about 55% and realize there is a
lot to learn.
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Activity provided by: Lin Brown, Shasta College, Redding, CA
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license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
6
This “pretest” is valuable because it creates interest in the subject matter, challenges students’ erroneously-held
beliefs, and introduces new terms and concepts. It is valuable to instructors in assessing the level of knowledge and
attitudes in the subject area and identifying the needs and the focus for the unit.
Classroom Activity 1-8: Using FAQs For Class Information7
Objective: Disseminating class information
Class size: Any
Instructions: As many people know, a Frequently Asked Questions page is worthwhile to examine. The questions
asked and answered are the type of questions a student may have about the class but may not have thought about
until reading them. These questions should be designed carefully based on questions that are often received so they
will be of high interest to students. These could be the top ten questions for surviving the nutrition class. A sample
question is: “What is the best way for a student to learn nutrition well enough to ace this course?” If you can cover
questions that students really have about the course, you’ll be showing them early on that you understand their
concerns and can also provide some good advice.
Classroom Activity 1-9: Exploration of “MyPyramid.Gov” Web Site8
Key concepts: MyPyramid diet planning tools, Internet skills
Class size: Any
Objective: The purpose of this assignment to help the student become familiar with the available resources offered
on the MyPyramid web site provided by the United States Department of Agriculture (USDA). Since the majority of
people have computer access (24/7), this activity will help the student to see what is available to both the health
professional and health consumer on a daily basis.
Instructions:
1. Divide the students in the class into 5 equal groups. This can be accomplished either through a lottery ticket
mechanism or use of a student roster list.
2.
Secure online access and have each of the student groups go to the following URL address:
http://mypyramid.gov/.
3.
Assign each group to one of the following areas: (1) My Pyramid for kids, (2) Tour My Pyramid, (3) Inside the
pyramid, (4) Tips & Resources and (5) My Pyramid Plan.
4.
For each group assignment, have the student group enter into the assigned area and ascertain the following
information:
a.
b.
c.
Describe the content area of the link.
Identify the resources available from the link.
Describe how many steps are required to get to all of the information and the length of time involved in
accessing the information.
5.
If the class is Web enhanced, post a MyPyramid Discussion Board to the course site. Have the student groups
post their critical appraisal of each of the assigned links prior to coming to the next class session. If the course is
not Web enhanced, then have the groups do a write-up of the assignment.
6.
At the next class session, review the information posted on the Web, or in the case of the course not being Web
enhanced, have the groups bring their written information to class and discuss the groups’ findings in terms of
these criteria:
a.
b.
c.
d.
Was the information easy to access? (Yes or no.)
If the information was not easy to access for you as a “college student,” then how do you think that others
who have less experience with either the subject matter or computer competency would be able to access
the information?
Do you think that the information was representative across cultural lines?
Overall, who do you think would be most likely to benefit from the information on this Web site?
Classroom Activity 1-10: Using the Internet as a Research Tool
Key concept: Research process
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8
Class size: Any
Activity provided by: Dr. Neil Allison, University of Arkansas
Contributed by Daryle Wane.
© 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
7
Instructions: The Internet can be used as a valuable research tool in nutrition. The student can become familiar with
the diversity of Internet resources and can learn to participate in online discussions about nutrition topics in classbased and listserve groups. Worksheet 1-2 provides assignments to help students acquire Internet skills.
How To “Try It” Activities Answer Key
How to Think Metric
The student should divide his or her body weight in pounds by 2.2 to determine weight in kilograms, and multiply
his or her height in inches by 2.54 to determine height in centimeters. For example, a student who weighs 115 lb.
and is 5’6” tall would convert this to 52.27 kg and 167.64 cm.
How to Calculate the Energy Available from Foods
The bean/cheese burrito would provide 388 kcal and 56.7% of kcal from carbohydrate, 15.5% from protein, and
27.8% from fat.
How to Determine Whether a Website Is Reliable
The student should provide a URL for the website chosen, and then describe the group or individual that created the
site, name the date it was most recently updated, discuss sources for the information presented, speculate on the
motivation for presenting this information, and evaluate the overall message of the site.
Critical Thinking Questions9
These questions will also be posted to the book’s website so that students can complete them online and e-mail their
answers to you.
1.
The following example was provided in your text regarding the importance of “nutrition”: “...your body uses
the nutrients from (meals eaten) to make all its components, fuel all its activities, and defend itself against
diseases....” Please expand upon this statement relative to the role of food in the lifestyle of the average
American consumer. If you were performing a dietary intake on a patient, what other questions might you be
interested in regarding the patient’s diet and activities?
Answer: In this question, students are being asked to discuss the multiple factors that influence an individual’s
food choices and eating patterns, beyond the single role of food as the body’s fuel. While the students can
respond to this question in an individual manner, their response should include some combination of the
following.
A thorough Dietary Intake should include:
1.
2.
3.
4.
5.
6.
Patient preferences – include value systems such as vegetarian, religious, environmental, or political
beliefs.
Patient dietary habits & exercise habits – use multiple methods of assessment.
Ethnic and cultural traditions & importance to the patient’s dietary preferences.
Psycho-social assessment – Body image issues, eating disorders, social eating vs. preference to eat alone.
Economic abilities – What is the patient’s ability to purchase food, what type of cooking utensils and
equipment do they have to use in cooking, where do they shop, and is the store reasonably priced?
Nutritional knowledge – What do they know about nutrition and food choices, serving sizes, and cooking
styles? Who does the cooking?
If the student makes reference to the idea that Americans often lose sight of the role of food as fuel to our
bodies because food has taken on so many other roles in the lives of Americans, the student should get
additional credit as this statement fully summarizes a complete response to the question.
2.
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Your text described six classes of nutrients and discussed the distinctions between them in several ways (i.e.
caloric density, organic/inorganic, size, and essentiality). Discuss each class of nutrient important to the body
Contributed by Kathleen Rourke.
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license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
8
and its unique distinction. Discuss your concerns for a patient that might be undernourished or over nourished in
each category. For example, in a broad sense, what problems would that cause the patient?
Answer: Water is an essential nutrient that provides no energy. It is vital to the body for metabolic reactions, to
carry waste away from the body, and to carry nutrients around the body. The body is over 65% water.
Patients that are undernourished can be dehydrated, resulting in them having a bodily environment that is
inefficient in carrying out metabolic processes, removing waste, and carrying nutrients to the various organ
systems. They might also have elevated levels of minerals and some vitamins that are stored in the body due to
the dehydration. Undernourished patients need to break down protein for energy, given that glycogen and fat
stores are not longer available. An undernourished patient’s risk for protein malnutrition, infection, and cardiac
problems increases.
Over nourished patients may have difficulty circulating the water around their bodies because their heart has to
work harder to pump the fluid around a bigger surface area.
Carbohydrate is an energy-yielding macronutrient that supplies 4 kcal/gram. Because carbohydrates contain
carbon, they are considered an organic compound.
Undernourished patients’ bodies will turn to their body fat and then their body protein for energy and metabolic
functions. Most undernourished patients have now consumed all their body glycogen from carbohydrates and
their body fat and are now using their body protein for energy and are thus in protein-energy malnutrition.
Over nourished: Excess carbohydrates are stored as fat, leading to obesity.
Protein is an energy-yielding macronutrient that supplies 4 kcal/gram. Protein is also an organic compound that
is important to the body for tissue repair, growth, and maintenance, its primary functions.
Undernourished: If the patient becomes too undernourished, protein stores (muscle) are used. If nourishment is
the only issue with this patient, one hopes that nourishment is provided. Remember that many organs, such as
the heart, are also muscle tissue; therefore, organ compromise can occur over time in situations of proteinenergy malnutrition.
Over nourished: Many athletes seek to find the optimum amount of protein to take to enhance protein building
and thus muscle mass. While research does demonstrate that protein needs are higher for athletes than sedentary
individuals, there is an upper limit of protein intake. Beyond that, excess protein beyond the needs of the
individual can be converted to fat, given there is an excess in caloric intake. High protein intake is also difficult
on the kidneys and should be discouraged.
Fat is an energy-yielding macronutrient that supplies 9 kcal/gram. This organic compound retains two times the
amount of energy as compared to other energy nutrients, given its density.
Undernourished individuals do not retain a protective layer of fat tissue, which is needed to protect the body
organs as well as to provide the body with a thermal shield. Some body fat is also required for normal hormonal
functioning. Undernourished individuals will need to be provided with a fatty acid source for hormonal
synthesis and other body protections.
Over nourished: As we well understand in this country, overconsumption of fat means excess calories and
excess weight.
Vitamins are organic compounds that facilitate release of energy and participate in many activities in the body.
Each has a different function such as vision, controlling bleeding time, making hormones, etc. Vitamins need to
be handled carefully as many environmental properties can destroy a vitamin, e.g. sunlight or heat.
Undernourished: There are two types of vitamins, fat soluble and water soluble. Fat-soluble vitamins are stored,
while most water-soluble vitamins are not stored in the body to a significant extent. Depending on the degree of
undernourishment, an individual may have some stored fat-soluble vitamins; however, he/she will probably not
absorb an appreciable amount of fat-soluble vitamins because the presence of fat is necessary in the diet to
absorb these types of vitamins. The person may be able to absorb appreciable amounts of water-soluble
vitamins, depending on the situation. If the body is lacking some of the vitamins, its ability to absorb is
enhanced. With others, there are dependent mechanisms for absorption.
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license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
9
Over nourished: This individual does run the risk of excess storage of some of the fat-soluble vitamins. Given
that most fat-soluble vitamins are found in more nutrient-dense foods, it is not likely that an over nourished
individual is at risk of an excess of fat-soluble vitamins if consuming an energy-dense, nutrient-poor diet.
Minerals are inorganic substances that do not provide energy to the body but do serve as cofactors in many
reactions in energy metabolism. Several minerals are essential. Minerals are found in fluids within the body and
thus can influence the properties of fluids (e.g., sodium, potassium). Minerals are inert, so they are not easily
destroyed; however, they can be bound to other substances such as phytates.
Undernourished: An undernourished individual does run the risk of missing many essential mineral elements in
their diet and therefore could potentially not have sufficient quantities for metabolic functions.
Over nourished: Again, while the over nourished individual may gain more minerals in their diet from excess
consumption, most minerals are found in nutrient-dense foods such as fruits and vegetables, which are not
generally foods that result in overnourishment. Therefore, this individual may also run a risk of deficiency of
some minerals.
3.
As noted in Chapter 1, the science of nutrition is a young science but growing rapidly. Without scientific
studies, nutrition could not grow and flourish as it does. It will be important for you not only to understand how
to read scientific studies but to be involved in them. Tell me about a nutrition-related topic that you are
interested in studying. Attempt to write a simple question that could be answered with a research study. How
would you differentiate between the experimental and control groups, how many subjects do you think you
would need for a good sample size, and what do you want to know before making conclusions? What other
specifics should you know or integrate into your research design to optimize its validity? What should your
readers know when it is published?
Answer: In this question, the students should select a research topic that they are interested in studying. That
will help make the topic of research more interesting to them.
A simple research question should be a succinct as possible and include the following: the type of study, the
study population, and the time period of the study. Think “measurable” when putting together a research
question. For example:
The efficacy of vitamin D in relieving pain will be studied in 50 pain management patients over a one-year
period.
The focus of the study: The efficacy of vitamin D in relieving pain
The study population: 40 pain management patients
The time period: One year
An experimental group is the group receiving the treatment; the control group is the placebo group or the group
that does not receive treatment. A control group is needed to distinguish whether the treatment participants react
differently than participants receiving no treatment.
A good sample size is determined by power statistics.
Before making any conclusions, the researcher wants to fully understand the research and how it relates to other
researchers’ work in the same field of research. The researcher needs to fully understand the statistics and what
they mean, what they don’t mean, and what the data may be “saying” relative to other work in the field.
To optimize the validity of a study, a researcher will take time to make sure that the study question is a
measurable question and the study design is consistent with the study question and achievable over the
determined study period.
A published research article should include why it was important to study the topic, information on other
researchers that have studied the topic, a brief outline on how to carry out the research to enable other
researchers to replicate it, results of the study, and why your results or findings are important to nutrition and
dietetics professionals.
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4.
What is the difference between a DRI and an RDA? Should you tell your client to take both? Does it mean that
everyone should take the same amount to achieve the same benefit from the nutrient? Are there DRI and RDA
for macronutrients?
Answer: DRI stands for Dietary Reference Intake and RDA stands for Recommended Dietary Allowance. The
RDA has been around for quite a long time (1940s) and was originally established for the military to prevent
scurvy. Since that time, significant study has been undertaken on each micronutrient and macronutrient to
establish the level of intake that is deemed appropriate for 98% of the population to prevent disease and
optimize health. Generally, every ten years new RDA research is published and changes are made if needed.
RDA are used to evaluate diets of populations.
DRI, which include the RDA, are relatively new and reflect collaborative work between the U.S. and Canada.
They are a set of standards resulting from collaboration of many research scientists, and can be used to evaluate
diets of healthy individuals. They include the Estimated Average Requirements from which RDA are derived,
Adequate Intakes for nutrients for which RDA have not been established, and Tolerable Upper Intake Levels
that identify potentially toxic levels of intake.
5.
You are about to perform a nutrition assessment on a patient. State specifically, and in detail, what types of
assessment information are you going to collect and why.
Answer: It is important to perform a historical review with the patient, in which the dietitian will ask the patient
about their health history, including details about any medical conditions, problems, or medications. The
dietitian also wants to know about the patient’s family background, cultural and ethnic background, work
history, and living conditions, including where the patient and family shop and who cooks the meals. It will also
be important to retrieve a detailed diet history and food frequency, and conduct some psychosocial assessment
of the patient.
Next, the dietitian should collect anthropometric data regarding height, weight, body fat, bone mass, and lean
body tissue.
The dietitian should compare her findings, including dietary analysis, with laboratory tests performed by the
physician as well as the results of the physical examination.
The above nutrition assessment provides the dietitian with background on the patient’s past health history,
which may have affected their present dietary intake. Medications previously and presently taken are important,
as they affect intake and can result in drug-nutrient interactions. It is also important for the dietitian to know of
any previous problems the patient has had with a practitioner, diagnosis, medication, or condition. In this
regard, the dietitian can avoid unnecessary problems for the patient. As discussed earlier, the more one knows
about a patient’s lifestyle, the more the dietitian can provide dietary advice, counseling, and recommendations
to the patient that will allow him/her to stay within close parameters to his/her normal regime.
A thorough diet analysis from multiple perspectives provides the dietitian with the best picture of the patient’s
intake. A single method of diet analysis can be unreliable; therefore, multiple methods increase the dietitian’s
ability to accurately determine what the client is really eating.
Anthropometric measures are made to establish appropriate weight-for-height measures as well as body fat
measures. These are compared with established norms and allow the dietitian to set goals for the patient.
Laboratory tests are objective measures that can be compared against some of the more subjective measures
such as medical history to provide a complete picture to the dietitian of the patient’s overall health and dietary
status.
6.
Chronic disease is a significant health problem in the United States. Billions of health care dollars are spent on
chronic disease, yet, in reality, little is done about the role of nutrition in the prevention of or recovery from
chronic disease. If you were the Surgeon General, in charge of health care spending, what might be your first
proclamation and why?
Answer: This is an open question for the students aimed at them exploring the role of nutrition in the
prevention or treatment of chronic disease. Students can direct this question either way. I would expect the
© 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
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11
student to give specific examples of a chronic disease and the nutrients and dietary habits that would prevent the
disease or help in its management. It would also be important for them to demonstrate that they understand that
research is important to making any proclamation at the federal level. Therefore, any decision that they make
must be supported by a sound evidence base.
7.
Bonus: (a) Nutrition assessment is the diagnostic tool of the registered dietitian. In performing a nutrition
assessment, an RD asks many specifics about diet—in detail. Why? (b) The RD also will ask for much detail
about an individual’s behaviors, culture, financial status, etc. Why would the RD delve into one’s personal
history in such detail, and what does this have to do with what one eats? (c) If an RD asks about the person’s
health status, would that be appropriate? Why or why not? (d) If there were questions about a disease or issue
that the RD was not familiar with, where might they go to find additional information?
Answer: (a) The RD needs a great deal of specific, detailed information about the patient’s diet because it is
important to understand servings or volume, all condiments or extraneous items a patient might use on a
specific food, cooking procedures, food preferences, and cultural or ethnic habits. Several different questions
regarding food habits also allow the RD to assess the reliability of the dietary data that is being collected.
(b) Because one’s culture and finances have much to do with their dietary habits. Culture is the basis of one’s
eating habits and one’s finances are critical to one’s ability to purchase food.
(c) Yes, as health status is the foundation for how the RD will counsel the patient. Perhaps problems with the
patient’s health status sent the patient to the RD or perhaps there are new issues. Either way, the RD should
know of the patient’s health background and medications to appropriately counsel him or her.
(d) It is important for the RD to be familiar with the medical library and professional journals where the RD can
search for information on questions s/he may have. Clearly one can turn to a colleague for a quick question, but
the RD should always follow up their inquiry with a review of the professional literature.
8.
There are a variety of health professionals in addition to the physician and the nurse. Very frequently the health
care consumer is confused as to who does what and whom to listen to. It seems like everyone is providing
nutrition information these days, and other than the physician and the RN, why should I trust anyone else? You
are an RD in a community hospital and your patient indicates when you come into his room that there have been
several individuals that have already visited him to talk about diet. You find out that the respiratory therapist,
physical therapist; speech pathologist, MD, and RN have all talked to Mr. X about his diet. Discuss the
differences among the many health care professionals with regard to their nutrition training and scope of
practice and then briefly discuss how you might approach your patient to help him understand how your skills
are unique from those of the other health care professionals.
Answer: Many health care professionals are involved in patient care; therefore, when they are accessible, the
patients will turn to them for nutrition advice, not knowing any different. It is important to understand that the
public does not always understand the difference among all the different types of health care professionals. The
majority of health science professionals do not receive any nutrition training, except for the occasional nutrition
content specific to certain content areas. The exception to this is nursing, which does require one nutrition
course in a four-year curriculum. Physicians may or may not receive a nutrition course in a four-year
curriculum, as it is presently not mandated by the accrediting body. Therefore, it is really important for the RD
to work with other health care professionals in collaboration for the best of patient care.
When talking to the patient, take a positive approach by indicating that you are glad that the patient is interested
in finding out how they can improve their diet. Then explain your role in the hospital, clinic, etc. as the RD and
health care professional that is the diet and nutrition expert, providing a business card and information for the
patient to easily contact you as the RD. Finally, help the patient to understand all details of their dietary regime
and answer all questions in full detail. Do not discuss any other health care professional negatively. This is
unprofessional!
IM Worksheet Answer Key
Worksheets 1-1, 1-2, and 1-3 – Answers will vary.
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license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
12
Worksheet 1-4: Chapter 1 Crossword Puzzle
1. foods
4. vitamins
2. organic
5. risk factors
3. nutrition
6. diet
7.
8.
9.
malnutrition
compounds
phytochemicals
10. essential nutrients
Worksheet 1-5: Choosing Party Foods and Snacks (Internet Exercise)
1. True
4. True
7. False
2. True
5. False
8. True
3. False
6. True
9. False
10. c
11. True
Worksheet 1-6: Analyzing Foods and Meals for Nutritional Value
Overview example: a; a. cheddar = 9.40 g; b. mozzarella = 6.34 g (for whole-fat); c. Swiss = 7.88 g
1.
b
2. b
Data for 1 & 2: a. oranges = 87.3 mg vitamin C, 322 mg K; b. kiwifruit = 166.9 mg vitamin C, 562 mg K;
c. strawberries = 89.4 mg vitamin C, 233 mg K; d. grapefruit = 76.6 mg vitamin C, 329 mg K; e. bananas = 13.1
mg vitamin C, 537 mg K
3.
a; vitamin C in oranges = 87.3 mg; RDA for vitamin C = 90 mg; % of RDA in oranges = 97%; K in oranges =
322 mg; AI for K = 4700 mg; % of AI in oranges = 6.85%
4.
c; a. wheat bran = 12.4 g; b. avocado = 7.8 g; c. brown rice = 1.75 g; d. black beans = 7.5 g
5.
d
Meal #1
Whopper with
cheese
French fries
Vanilla shake
Totals
Meal #2
Caesar salad
with grilled
chicken
Fruit 'n Yogurt
Parfait
Orange juice
Totals
6.
Energy
(kcal)
790
Protein (g)
Fiber (g)
35.36
Total Lipid
(fat) (g)
48.44
3.2
Calcium
(mg)
259
387
667
1844
4.09
12.66
52.11
20.36
34.70
103.50
3.4
0.0
6.6
11
413
683
Energy
(kcal)
221
Protein (g)
Fiber (g)
30.54
Total Lipid
(fat) (g)
6.34
3.4
Calcium
(mg)
199
156
4.07
1.94
1.5
224
601
3.38
37.99
0.30
8.58
1.0
5.9
e
7.
b
8.
c
Worksheet 1-7: Unit of Measurement Conversions Practice
English (U.S.) System
1 lb =
16 oz
Weight
Volume
Length
1.
2.
3.
1 gallon =
1 quart =
1 yard =
1 foot =
25,000 mg
3000 g
50,000 µg
4 quarts
4 cups
3 feet
12 inches
4.
5.
6.
48 oz
4 lb
52.73 kg
9.
70.4 lb
12.7 cm
19.7 in
6.32
Sodium
(mg)
1431
1.51
1.67
9.50
532
397
2360
Iron (mg)
1.90
Sodium
(mg)
886
128
0.67
86
45
372
0.50
3.07
5
977
d
10. a
Metric System
1 kg =
1000 g
1g=
1000 mg
1L=
1000 mL
1 meter =
1 meter =
7.
8.
9.
Iron (mg)
1000 mm
100 cm
10. 196 g
11. 0.54 oz
12. 140 g; 140,000 mg
13. 77.27 kg
14. 139,091 kcal
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license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
13
Canadian Information10
Introduction
Nutrition instructors in Canada need to provide up-to-date and accurate Canadian information to their students
about: food labelling; food, nutrition, and physical activity guidelines and recommendations; impacts of nutrition,
health, and social programs on food intake; nutrition and physical activity education resources; and current nutritionrelated research. Prior to and since the release of the first set of Dietary Reference Intakes in 1997, effort has been
taken to harmonize nutrition-related policies and standards of Canada with those in the United States. Canadian
nutrition educators and colleagues in the United States use a common research base for describing how nutrients
function in the body and for planning nutrition interventions. However, differences in food intake patterns, health
statistics, and health policies affect the content and format of national nutrition programs.
Canadian instructors and students have Internet access to Canadian information, as well as information for other
countries around the world. Although access to a vast amount of information is available, students often feel
challenged to discern unreliable from reliable and credible web-based nutrition information and resources. This
Canadian Information section identifies Canadian food regulations, standards, programs, research, and resources to
help instructors locate and use Canadian information in their introductory nutrition courses. Canadian information is
provided according to the topics discussed in each chapter or highlight in Understanding Nutrition, Twelfth Edition.
1.1 How to Calculate the Energy Available from Foods in Kilocalories
Energy values found in food composition tables and on food labels in Canada are expressed as Calories
(kilocalories). To become more familiar with kilocalories, students can calculate the energy available in foods using
the example in “How to Calculate the Energy Available from Foods” and the energy conversion factors for the
macronutrients found in the “How to” box on page 9 in Chapter 1 of the textbook.
1.2 Dietary Reference Intakes
As Chapter 1 of the textbook indicates, Canada has participated in the development and implementation of the Dietary
Reference Intakes (DRI). The DRI provide a set of nutrient and energy recommendations for both Canada and the
United States, and support harmonization of trade-related issues and freer trade of food across the Canada-U.S. border.
Health Canada provides current information about the DRI on its web site (www.hc-sc.gc.ca/fnan/nutrition/reference/index-eng.php). This link will provide access to: (a) Dietary Reference Intakes FAQs, a link that
instructors will find particularly helpful when planning lectures to explain the DRI; (b) Development of the Dietary
Reference Intakes, which provides a historical perspective to development of the current DRI; (c) Using the Dietary
Reference Intakes, a fact sheet that provides a brief introduction to appropriate uses of the DRIs for dietary assessment
and planning, and provides direct links to Applications in Dietary Assessment and Applications in Dietary Planning,
both reports providing guidelines to help instructors determine when specific uses would be inappropriate; (d) A
Consumer's Guide to the DRIs to familiarize consumers with the current recommendations for nutrient intakes; and (e)
the Dietary Reference Intake Report List, which provides a list of all DRI-related published reports. Instructors who
want to gain an in-depth understanding of DRIs and their application can take an on-line course through the member’s
side of the Dietitians of Canada web site www.dietitians.ca or at www.dieteticsatwork.com.
These two published articles explain the application of DRI to assess and plan diets.
Murphy SP, Barr SI, and Poos MI. 2002. Using the New Dietary Reference Intakes to Assess Diets: A Map to the
Maze. Nutrition Reviews, 60(9):267-275.
Murphy SP, and Barr SI. 2005. Challenges in Using the Dietary Reference Intakes to Plan Diets for Groups. Nutrition
Reviews, 63(8):267-271.
1.3 Nutrition Assessment of the Canadian Population
Canada does not have a formal, regularly cycled, systematic program of national food and nutrition surveillance,
such as HANES (Health and Nutrition Examination Survey), NFCS (Nationwide Food Consumption Survey), and
NHANES (National Health and Nutrition Examination Survey). Canada's first comprehensive national nutrition
survey, the Nutrition Canada Survey, was conducted in 1970-1972. During the 1990s, provincial surveys were
10
Contributed by Gail Hammond.
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license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
14
completed under the Canadian Heart Health Initiative. Methods of data collection varied with the different surveys;
hence, the results of these studies have not been compiled nationally or used for comparisons between regions. Refer
to Health Canada’s guide to provincial nutrition survey contacts and reports for dietary intake patterns and other
survey-specific information (www.hc-sc.gc.ca/fn-an/surveill/nutrition/prov/index-eng.php).
The Canadian food intake survey, “Food Habits of Canadians,” collected data between August 1997 and July 1998
from five regions in Canada (Atlantic, Québec, Ontario, Prairies, and British Columbia). The intake of fat showed
total fat represented 29 to 31% of energy intake, within the currently recommended Acceptable Macronutrient
Distribution Range of 20-35%.11 Adult and adolescent intake of foods compared with recommendations in Canada’s
Food Guide to Healthy Eating showed only males between the ages of 13 and 34 years met the recommended intake
for all of the four food groups, and the mean intakes of milk products were below the minimum recommended
servings for all age and gender groups.12 The other food groups showed variable intake results across age and
gender.
Improving the Health of Canadians 2005-2006 Report Series provides a broad look at the health of Canadians and
the impact of multiple determinants on health. Information from this report can be used when discussing issues of
low income or food insecurity (Chapter 20), or during the appropriate stage of the life cycle. The report series
examines what we know about factors that affect the health of Canadians, ways to improve our health, and relevant
options for evidence-based policy choices. The series is produced by the Canadian Population Health Initiative, and
is available from the Canadian Institute for Health Information web site (www.cihi.ca), an independent, not-forprofit organization that provides essential data and analysis on Canada’s health system and the health of Canadians.
Reports in the 2005-2006 series include: Improving the Health of Young Canadians, which highlights research
relevant to understanding adolescent health and development; Promoting Healthy Weights, which focuses on the
role of the environments in which we live that promote healthy weights, using a population health framework; and
the final report, An Introduction to Health in Urban Places, which explores the patterns of health within and
between Canadian cities and looks at how the social and physical aspects of urban neighbourhoods and housing may
be linked to people’s overall health. The more recent Improving the Health of Canadians 2007-2009 report series is
comprised of three reports that focus on the determinants of mental health among Canada's vulnerable populations.
During 2004, the Canadian Community Health Survey (CCHS), Cycle 2.2 on Nutrition, collected 24-hour dietary
recall data, and nutrient supplement use and related data on Canadians at a provincial level. This collaborative
initiative between Health Canada and Statistics Canada represented the first national nutrition survey conducted by
the Canadian government in over 30 years and was the largest and most comprehensive survey ever conducted of
what Canadians eat. Trained interviewers directly measured height and weight data of a nationally representative
sample of over 35,000 Canadians of all ages residing in private households in all ten provinces. The measured data
differ from self-reported data used in previous surveys. Other data collected included: physical activities, chronic
health conditions, smoking, alcohol use, food insecurity, and socio-demographic characteristics. Listed below are
publications in reverse chronological order by date of release from the CCHS, Cycle 2.2.
Date
2009
2008
2008
2007
2007
Report from CCHS Data
*Nutrient Intakes from Food, Provincial, Regional and National Summary Data Tables, Volumes
2 and 3
Nutrition – General Health (including Vitamin & Mineral Supplements) & 24-Hour Dietary
Recall Components – User’s Guide
*Nutrient Intakes from Food, Provincial, Regional and National Summary Data Tables, Volume
1 – Revised
*Income-Related Households Food Security in Canada: Supplementary Data Tables
*Income-Related Household Food Security in Canada
11
Gray-Donald K, Jacobs-Starkey L, Johnson-Down L. 2000. Food habits of Canadians: Reduction in fat intake
over a generation. Canadian Journal of Public Health, 91(5):381-385.
12 Linda Jacobs Starkey, Louise Johnson-Down, Katherine Gray-Donald. 2001. Food habits of Canadians:
Comparison of intakes in adults and adolescents to Canada's food guide to healthy eating. Canadian Journal of
Dietetic Practice and Research, 62:61-69.
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license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
15
Date
2006
2006
2005
2005
Report from CCHS Data
*A Guide to Accessing and Interpreting the Data
Overview of Canadians’ Eating Habits
Overweight Canadian children and adolescents
Adult obesity in Canada: Measured height and weight
Access to all reports labelled with an asterisk is available at www.hc-sc.gc.ca/fnan/surveill/nutrition/commun/cchs_focus-volet_escc-eng.php#p1.
Access to the Adult obesity in Canada: Measured height and weight report is available at:
www.statcan.gc.ca/pub/82-620-m/2005001/article/adults-adultes/8060-eng.htm.
Access to the Overweight Canadian children and adolescents report is available at: www.statcan.gc.ca/pub/82-620m/2005001/article/child-enfant/8061-eng.htm.
Access to the Overview of Canadians’ Eating Habits report is available at: www.statcan.gc.ca/pub/82-620-m/82620-m2006002-eng.htm.
Access to the Nutrition – General Health (including Vitamin & Mineral Supplements) & 24-Hour Dietary Recall
Components – User’s Guide is available at www.hc-sc.gc.ca/fn-an/surveill/nutrition/commun/cchs_focusvolet_escc-eng.php#2. Scroll close to the bottom of the page.
The National Population Health Survey (NPHS) is a 20-year longitudinal survey started in 1993/1994, conducted by
Statistics Canada, and designed to measure the health status of Canadians to add to the existing body of knowledge
about the determinants of health. Self-reported data are collected on the same individuals every two years for up to
20 years, with the original sample selected to be representative of the Canadian population.13 Health Canada added a
number of supplementary nutrition-related questions to the 1994-95 NPHS that focused on two key healthy eating
concerns—increasing starch and fibre consumption, and decreasing fat consumption. In 1997, the report Canadians
and Healthy Eating - how are we doing? was released. Although findings in this document were aligned to dietary
guidance tools that are no longer in use (Canada’s Guidelines for Healthy Eating, Nutrition Recommendations for
Canadians, and Canada’s Food Guide to Healthy Eating), the report does provide a snapshot of Canadians’
awareness of and action on key nutrient messages of the mid-1990s. The 1999 report, Toward a Healthy Future:
Second Report on the Health of Canadians, used findings from the NPHS and is available at the Public Health
Agency of Canada’s web site: www.statcan.gc.ca/bsolc/olc-cel/olc-cel?lang=eng&catno=82-570-X. Three recent
nutrition-related reports also used data from the NPHS: Healthy Aging (2005) (available at:
www.statcan.gc.ca/pub/82-618-m/82-618-m2005004-eng.htm), Obesity: A Growing Issue (2005) (available at:
www.statcan.gc.ca/pub/82-618-m/82-618-m2005003-eng.htm), and Trends in weight change among Canadian
adults: Evidence from the 1996/1997 to 2004/2005 National Population Health Survey (2006) (available at:
www.statcan.gc.ca/pub/82-618-m/82-618-m2006005-eng.htm).
The National Institute for Nutrition has partnered with Health Canada and other organizations to conduct the
Tracking Nutrition Trends series of surveys that assess adult Canadians’ knowledge, attitudes, and behaviour with
respect to nutrition. In 2002, three reports were generated from this series of surveys: What Do Canadians Think
About Nutrition, What Do Canadians Know About Nutrition, and What Do Canadians Do About Nutrition. Access
to these reports is available at www.hc-sc.gc.ca/fn-an/surveill/facts-faits/index-eng.php.
Health Behaviour in School-aged Children is a cross-national study of the health behaviours of young people aged
11 to 15, started in 1986 by the World Health Organization. It consists of a series of regular cycle surveys conducted
in 35 countries in Europe and North America, including Canada. The survey includes a core set of questions,
including health-related behaviours such as dietary habits. More information can be obtained at www.phacaspc.gc.ca/dca-dea/7-18yrs-ans/hbschealth-eng.php.
1.4 Leading Causes of Death in Canada
In 2004, the top 10 leading causes of death in Canada differed in rank order from those in the United States (Table
1-6 in the textbook). Causes listed as 1, 2, 3, and 6 have relationships with diet. This information is available at:
www.statcan.gc.ca/pub/84-215-x/2008000/tbl/tblg1-eng.htm.
13
Health Canada. Canadians and Healthy Eating: How Are We Doing? Nutrition Highlights, National Population
Health Survey, 1994-95. Ottawa: Health Canada, 1998.
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16
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Canada
Cancers
Diseases of the heart
Cerebrovascular diseases (stroke)
Chronic lower respiratory diseases
Accidents
Diabetes mellitus
Pneumonia and influenza
Alzheimer’s disease
Suicide
Kidney disease
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
United States
Heart disease
Cancers
Stroke
Chronic lower respiratory diseases
Accidents
Diabetes mellitus
Pneumonia and influenza
Alzheimer’s disease
Kidney disease
Blood infections
Highlight 1: Nutrition Information and Misinformation—On the Net and in the News
Dietitians’ Credentials in Canada
The qualifications for admission to Dietitians of Canada are similar to those for the American Dietetic Association.
Dietitians of Canada (www.dietitians.ca) assesses and accredits university undergraduate programs and dietetic
internship programs, which qualify dietitians to practice. There is no single designation of title or initials for
Canadian dietitians (see table below).
Provincial Regulatory Bodies
Provincial government legislation determines the professional designation for health professionals who practise in
each province. Many provinces have established colleges under their health professions legislation to ensure that the
public receives quality care from dietitians. Dietitians are registered to practice through a college or provincial
regulatory body. The public can take complaints about dietetic practice to the college or regulatory body. Provincial
colleges and regulatory bodies exist for the purpose of ensuring public safety. These regulatory bodies:
•
•
•
•
monitor the competence of members (e.g., mandatory continuing education);
protect the public from unsafe or unethical dietetic practice;
protect the use of regulated title designation and initials (e.g., RD); and
review the professional conduct of members based on complaints, and discipline members where appropriate.
All provinces include the word “dietitian” or “diététiste” in the title and protect these titles from use by unqualified
individuals. The following list provides the designation for dietitians in each of the provinces and the respective
contact information for each provincial college or regulatory body. For the most current contact information, go to
the “Find a Nutrition Professional” section of the Dietitians of Canada web site (www.dietitians.ca), select
“Qualifications of a Dietitian,” then choose “Provincial Regulatory Bodies.”
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and
Labrador
Nova Scotia
Ontario
Designation
RD (Registered Dietitian) or Registered
Nutritionist
Dietitian or RD (Registered Dietitian)
Dietitian or RD (Registered Dietitian)
RD (Registered Dietitian) or RDN
(Registered Dietitian-Nutritionist)
Dietitian or R.D. (Registered Dietitian)
Contact Information
www.collegeofdietitians.ab.ca
Dietitian or Nutritionist or P.Dt. (Professional
Dietitian)
RD (Registered Dietitian) or Dt.P. (diététiste
professionnelle)
www.nsdassoc.ca
www.collegeofdietitiansbc.org
www.manitobadietitians.ca
www.adnb-nbad.com
www.nlcd.ca
www.cdo.on.ca
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17
Province
Prince Edward Island
Designation
P.Dt. (Professional Dietitian)
Québec
Dt.P. (diététiste professionnelle) or P.Dt.
(Professional Dietitian) or R.D. (Registered
Dietitian)
P.Dt. (Professional Dietitian) or R.D.
(Registered Dietitian)
Saskatchewan
Contact Information
PEI Dietitians Registration Board
153 Spring Street
Summerside, PE
C1N 3G2
Phone: 902-436-2438
www.opdq.org
www.saskdietitians.org
Canadian Web-Based Resources
1. Most university libraries have on-line resources to help students critically assess the reliability and credibility of
information provided on web sites. Direct your students to these resources when accessing, extracting, and
utilizing web-based nutrition information.
2.
As of April 1, 2008, the Canadian Health Network ceased to exist. Instead, Canadians can turn to credible
public health information through the Public Health Agency of Canada (www.phac-aspc.gc.ca/index-eng.php).
Included at this site is the Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention,
a database of evidence-based interventions for health promotion and chronic disease prevention, available at:
http://cbpp-pcpe.phac-aspc.gc.ca/index-eng.html.
3.
The Nutrition Resource Centre (www.nutritionrc.ca) is part of the Ontario Public Health Association. The
centre provides important resources for nutrition professionals in Ontario, and many resources that can apply to
other areas of Canada.
4.
Canadian Council of Food and Nutrition (www.ccfn.ca) offers a listing of reliable food and nutrition links in its
“In Action” section.
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18
Worksheet 1-1: Evaluation of Published Nutrition Information
Literature Critique: Critical Evaluation of Published Nutrition Information—
“Should I Believe What I Just Read?”
Assignment for discussion: Carefully read a journal article and answer the following questions
on a separate sheet of paper.
1. Summarize the basic idea of the article in a short paragraph.
2. a. What are the credentials of the author(s)? What do the abbreviations after the name(s)
mean? Do they enhance the authors’ credibility? Explain.
b. Is the author affiliated with an organization or institution? Does the affiliation with the
organization or institution enhance the authors’ credibility? Briefly explain.
c. Does the periodical have an editorial board? Do the editors’ credentials enhance the
article’s credibility? Where does one look in a periodical for the editorial board?
3. a. Is scientific research being presented or discussed? Is the research current?
b. If so, what specific kinds of research or data are presented or cited to support the ideas?
c. Were references listed to allow readers to investigate the information’s original source?
Were full citations provided?
4. a. What is the underlying hypothesis (if/then, cause/effect, etc.)?
b. What are the article’s conclusions/recommendations?
c. Are the conclusions or recommendations supported by the research discussion? Explain
briefly why or why not.
5. a. Design and describe in depth additional research that could more decisively test the
hypothesis identified. Pay particular attention to details and controls.
b. Indicate what will be measured.
c. State the type of experimental design and type of experiment.
6. Identify the statements in the article that you believe and those that you do not believe, and
discuss why or why not for each.
7. What sources other than those listed in the periodical would you refer to if you were to
research the article’s topic further?
Source: Adapted with permission of: Deborah Fleurant, MOE Thesis, University of New Hampshire, 1989 (Thesis
Advisor Sam Smith)
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19
Worksheet 1-2: Research Project Using the Internet
This research project will employ the use of the Internet as a research tool. The student will be
expected to become familiar with the diversity of Internet resources. The purpose of this project
is to develop research skills using the Internet.
1. Access the world wide web. Access several search engines for locating publications in peerreviewed journals.
2. Select a topic such as vitamin A, osteoporosis prevention, or obesity among children.
Topic chosen:
3. Search for articles using key words related to your topic.
Key words you used:
4. Print out the references of articles that you found.
5. Print out abstracts from selected articles that are most interesting.
6. Obtain entire articles for selected articles.
7. Discuss your findings (1-2 pages, typed).
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20
Worksheet 1-3: Influences on Food Choices
We decide what to eat, when to eat, and even whether to eat for a variety of reasons. Examine the factors that
influence your food choices by keeping a food diary for 24 hours. Record the times and places of meals and snacks,
the types and amounts of foods eaten, and a description of your thoughts and feelings when eating. Now examine
your food record and consider your choices.
1.
Which, if any, of your food choices were influenced by emotions (happiness, boredom, or disappointment, for
example)?
2.
Was social pressure a factor in any food decisions?
3.
Which if any, of your food choices were influenced by marketing strategies or food advertisements?
4.
How large a role do availability, convenience, and economy play in your food choices?
5.
Do your age, ethnicity, or health concerns influence your food choices?
6.
How many times did you eat because you were truly hungry? How often did you think of health and nutrition
when making food choices? Were those food choices different from others made during the day?
Compare the choices you made in your 24-hour food diary to the USDA Food Guide recommendations. To obtain a
set of personalized recommendations, you can enter your age, sex and activity level under “MyPyramid Plan” at the
MyPyramid website, www.mypyramid.gov.
Food Groups
Grains
Suggested Amounts
Amounts Consumed
Vegetables
Fruit
Milk
Meat and beans
7.
Do you eat the suggested amounts from each of the five food groups daily?
8.
Do you try to vary your choices within each food group from day to day?
9.
What dietary changes could you make to improve your chances of enjoying good health?
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21
Worksheet 1-4: Chapter 1 Crossword Puzzle
1
3
2
5
4
6
7
8
9
10
Across
a substance or a molecule containing carbon-carbon
bonds or carbon-hydrogen bonds
4. organic, essential nutrients required in small
amounts by the body for health
6. the foods and beverages a person consumes
9. nonnutritive compounds found in plant-derived
foods that have biological activity in the body.
10. nutrients a person must obtain from food because
the body cannot make them for itself in sufficient
quantity to meet physiological needs
2.
1.
3.
5.
7.
8.
Down
products derived form plants or animals that can be
taken into the body to yield nutrients for the
maintenance of life and the growth and repair of
tissues
the science of foods and the nutrients and other
substances they contain, and of their actions within
the body
factors associated with an elevated frequency of a
disease but not proven to be causal
any condition caused by excess or deficient food
energy or nutrient intake or by an imbalance of
nutrients
a substance composed of two or more different
atoms; for example, H2O
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22
Worksheet 1-5: Choosing Party Foods and Snacks (Internet Exercise)
Instructions: Go to the following website to answer questions 1-11:
http://www.mypyramid.gov/podcasts/index.html. Do not close the window until you have finished answering the
questions. Watch the Holiday Parties Video Podcast to answer questions 1-6.
1.
When at a party you should only place 2 food items on your plate at any one time.
a. True
b. False
2.
When selecting snacks, fruits are always a good choice.
a. True
b. False
3.
When at a party it is better to start filling up with beverages (soda and fruit juices) first so that you will eat less.
a. True
b. False
4.
Filling up on low-calorie food choices helps to increase your sense of fullness at parties.
a. True
b. False
5.
It does not matter where you stand or sit at a party, as you are prone to eat more in order to be sociable.
a. True
b. False
6.
If you stand near the food table, you are likely to eat more at a party.
a. True
b. False
Watch the Snack Attack Video Podcast to answer questions 7-11.
7.
A good beverage selection would be one that contains fruit juice concentrate.
a. True
b. False
8.
A good snack choice would be to select baked potato chips instead or fried chips or crackers.
a. True
b. False
9.
Dried fruits would not be considered a healthy snack.
a. True
b. False
10. What comes out of the vending machine at the end of the video?
a. Candy bar
b. Potato chips
c. Pyramid
d. Bottled water
11. Products that contain whole grains are considered to be a healthy snack food choice.
a. True
b. False
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23
Worksheet 1-6: Analyzing Foods and Meals for Nutritional Value
Overview
This assignment offers tools to help you answer questions about the nutrient-dense foods in your diet and the types
of meals that are best for health.
Good resources for nutrient values in foods include the following:
• USDA Nutrient Database: http://www.nal.usda.gov/fnic/foodcomp/search/
• Another good food analysis website: www.nutritiondata.com
• Nutrition textbooks: Appendix H in Understanding Normal and Clinical Nutrition
Preview of Part Ia: Using Food Composition Tables
This first section is an exercise in using food composition tables for finding the nutrient values in foods. Because
students may have different editions of the textbook, we’ll use the online USDA website for this part of the
assignment (see the first bullet in the list of resources above).
To orient yourself to the website, start by trying to answer this question: Which cheese has the highest amount of
fat?
a. cheddar
b. mozzarella
c. Swiss cheese
To help guide you, the data sheet has spaces for you to fill in your answers. As an example:
a.
cheddar
________ g fat/oz.
b.
mozzarella
________ g fat/oz.
c.
Swiss cheese
________ g fat/oz.

To start, go to the USDA website, type in the term “cheddar” in the “Keyword” box (see below), and select
“Dairy & Egg Products” from the pull-down menu. Click “Submit.”


On the next web page, select the bullet for “Cheese, cheddar” and click “Submit.”
On the next page, place a check mark in the 5th box down (click in the box) to get information about 1 oz. of
cheese, de-select the first entry (click the first box to de-select), and click “Submit.”
The results page has a list of nutrients for an ounce of cheddar cheese; note that the 5th listing [“Total lipid
(fat)”] indicates that an ounce of cheddar cheese has 9.40 grams of fat.

Following the same procedure for the other two types of cheese will allow you to make comparisons among foods.
Preview of Part Ib: Sorting Foods by Nutrient Content
Question #5 allows an opportunity for you to check the Nutrient Lists feature, which provides reports of foods that
are sorted either by food description or in descending order by nutrient content. To use this feature, find this
sentence on the USDA web page, and click on the link for “Nutrient Lists”:
To view reports on foods by single nutrients, such as calcium or niacin, go to Nutrient Lists.
The following page shows a long list of nutrients. The links to the right of each nutrient include an “A” for lists of
foods sorted alphabetically and a “W” for lists of foods sorted in descending order by nutrient content. Select any
nutrient you like and click on each of these links to compare the two types of reports.
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24
Preview of Part II: Comparing the Energy and Nutrient Density of Meals
The questions in Part II show you how to compare the energy and nutrient contents of a meal. The first step is to list
the calories and nutrients provided by each food in the meal. After you find the exact values specified, you can
compare the totals to recommended intake levels. Use the USDA Nutrient Database for this question as you did for
Part Ia of this assignment.
Note that the food items you select in the USDA database must exactly match the items listed in the question. If the
item specified is a Burger King Whopper with cheese, don’t choose the Chicken Whopper or the Whopper without
cheese. If the serving specified is 16 fluid ounces, you must make sure to enter the correct amount.
A review of calculations needed to answer the questions:
% of recommendations = total amount consumed (kcal, g, or mg)
amount recommended (same unit)
% kcal from fat =
fat g  9 kcal/g
total kcal
Part I: Using Food Composition Tables
Using data from the USDA Nutrient Database, look up the nutrient values for foods listed in questions 1 through 4,
and fill in the appropriate blanks in the boxes to help you answer the questions (make sure you read the food
descriptions carefully and choose the exact entries indicated).
1.
Many people name oranges as a good source of vitamin C and bananas as a good source of potassium. They are
correct, but there are other good sources as well. Which fruit below has the most vitamin C per cup of the fruit?
a. oranges, raw (California, Valencia)
b. kiwifruit, raw (green)
c. strawberries, raw (halves)
d. grapefruit, raw (white, California)
e. bananas, raw (sliced)
2.
Now compare the potassium content of these fruits. Which fruit in the list is highest in potassium per cup of
fruit?
a. oranges
b. kiwifruit
c. strawberries
d. grapefruit
e. bananas
Questions 1 and 2:
Vitamin C (mg) per cup
Potassium (mg) per cup
a.
oranges
________
_______
b.
kiwifruit
________
_______
c.
strawberries
________
_______
d.
grapefruit
________
_______
e.
bananas
________
_______
3.
How do the vitamin C and potassium values in oranges compare to the DRI for these nutrients?
To answer, fill in the blanks in the table below as follows: fill in the vitamin C and potassium values for oranges
in the first line; then find the appropriate DRIs for vitamin C and potassium for 19- to 30-year-old males (see
the textbook inside cover for these values) and fill in these values on the second line. Finally, determine the
percentage of the DRI provided by the oranges (line 1 ÷ line 2 × 100).
Using this information, answer this question: What percentage of the potassium DRI is provided by a cup of
oranges?
a. 7%
b. 12%
c. 15%
d. 69%
e. 358%
Question 3: Vitamin C in oranges (1 cup) _________
Potassium in oranges (1 cup)
_________
RDA for vitamin C
_________
AI for potassium
_________
% of RDA in oranges
_________
% of AI in oranges
_________
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25
4.
Now compare the fiber content of some common produce items. Which food below supplies the lowest amount
of fiber per ½-cup portion of the food?
(To find the correct data that can answer this question, you will need to do one of the following: select a 1-cup
portion from the choices and divide by 2, select a ¼-cup portion and multiply by 2, or select “1 serving” of a ½cup portion.)
a.
wheat bran
Question 4:
b.
Fiber (g)
avocado
c.
brown rice
d.
black beans
Appropriate Listing:
a.
wheat bran ________
Use either of the two wheat bran listings
b.
avocado
________
Raw, California, pureed
c.
brown rice
________
Long-grain, cooked
d.
black beans ________
Mature, cooked, boiled, without salt
Next: What are some of the top calcium sources in our diets? Follow the directions in the “Overview” regarding Part
Ib: Sorting Foods by Nutrient Content to answer the following questions.
5.
Using the Nutrient List tool, click on the “W” next to “Calcium” and read the foods on the first page of the list.
Which green vegetable supplies 357 mg of calcium per cup?
a. broccoli
b. spinach
c. kale
d. collards
e. turnip greens
Part II: Comparing the Energy and Nutrient Density of Meals
Compare the energy (calories) and nutrient contents of two meals using data from the USDA Nutrient Database. To
do this, first find the correct nutrient values for each food listed for Meal #1 and Meal #2 and fill in the values in the
two tables below.
Meal #1: Lunch at Burger King
• Burger King Whopper with cheese
• Burger King French fries (1 medium serving)
• Burger King vanilla shake (1 medium serving; 16 fl. oz.)
Foods
Energy
(kcal)
Protein (g)
Total Lipid
(fat) (g)
Fiber (g)
Calcium
(mg)
Iron (mg)
Sodium
(mg)
Whopper with
cheese
French fries
(medium)
Vanilla shake
(medium)
Totals
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26
Meal #2: Lunch at McDonald’s
• McDonald’s Caesar salad with grilled chicken
• McDonald’s Fruit 'n Yogurt Parfait
• Orange juice, frozen concentrate, unsweetened, diluted with 3 parts water (16 oz.)
Foods
Energy
(kcal)
Protein (g)
Total Lipid
(fat) (g)
Fiber (g)
Calcium
(mg)
Iron (mg)
Sodium
(mg)
Caesar salad
with grilled
chicken
Fruit 'n Yogurt
Parfait
Orange juice
(16 oz.)
Totals
Now, answer the following questions, showing all calculations.
6.
If your caloric needs are about 2000 kcal/day, about what fraction of the day’s intake would be provided by
Meal #1?
a. 22%
b. 32%
c. 52%
d. 72%
e. 92%
Show question #6 calculations:
7.
The fiber Adequate Intake (AI) levels for college-age men and women are 38 and 25 grams, respectively.
Considering that a nutritious meal is likely to provide about 1/3 of recommended fiber intakes, how would you
rate the fiber content of Meal #1 and Meal #2?
a. Both meals provide at least one-third of the fiber AI for men and women.
b. Neither meal provides at least one-third of the fiber AI for men or women.
c. Meal #1 provides one-third of a woman’s fiber AI, but not a man’s; Meal #2 has less fiber than Meal #1.
d. Meal #2 provides one-third of a woman’s fiber AI, but not a man’s; Meal #1 has less fiber than Meal #2.
Show question #7 calculations:
8.
According to your data, which of the following statements is TRUE?
a. Meal #1 provides over twice as much protein as Meal #2.
b. Meal #2 provides over twice as much iron as Meal #1.
c. Meal #1 provides over three times as many calories as Meal #2.
d. Meal #2 provides over twice as much calcium as Meal #1.
Show question #8 calculations:
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27
9.
Recall the Acceptable Macronutrient Distribution Range (AMDR) for dietary fat (see textbook if you’ve
forgotten). Do either meal or both of these meals fall into the suggested AMDR range?
a. Yes, Meal #1 is in the correct AMDR for fat.
b. Yes, Meal #2 is in the correct AMDR for fat.
c. Yes, both meals are in the correct AMDR for fat.
d. No, neither meal is in the correct AMDR for fat.
Show question #9 calculations:
10. The Tolerable Upper Intake Level (UL) for sodium (the maximum intake without adverse effects) is 2300 mg of
sodium per day. If the person eating one of these lunches wanted to limit sodium to no more than 1/3 of the UL
per meal, how would you rate the sodium content of these meals?
a. Both meals exceed 1/3 of the sodium UL.
b. Neither meal exceeds 1/3 of the sodium UL.
c. Meal #1 exceeds 1/3 of the sodium UL, but not Meal #2.
d. Meal #2 exceeds 1/3 of the sodium UL, but not Meal #1.
Show question #10 calculations:
Assignment over! I hope you’ve learned something about the use of nutrient databases from working through these
questions!
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28
Worksheet 1-7: Unit of Measurement Conversions Practice
Common Units
English (U.S.) System
pounds (lb), ounces (oz)
Weight
gallons, quarts, pints, cups
Volume
yards, feet, inches
Length
Metric System
kilograms (kg), grams (g), milligrams (mg), micrograms (μg)
liters (L), milliliters (mL)
meters (m), centimeters (cm), millimeters (mm)
Simple Conversions
English (U.S.) System
Weight
Volume
Length
1 lb =
_______ oz
Metric System
1 kg =
_______ g
1g=
_______ mg
1L=
_______ mL
1 gallon =
_______ quarts
1 quart =
_______ cups
1 yard =
_______ feet
1 meter =
_______ mm
1 foot =
_______ inches
1 meter =
_______ cm
Conversions within Systems – Convert:
1. 25 grams to milligrams
2.
3 kilograms to grams
3.
50 milligrams to micrograms
4.
3 pounds to ounces
5.
64 ounces to pounds
Conversions between Systems – Convert:
6. 116 pounds to kilograms
7.
32 kilograms to pounds
8.
5 inches to centimeters
9.
50 centimeters to inches
10. 7 ounces to grams
11. 15 grams to ounces
Word Problems
12. How many grams are in 5 ounces? How many milligrams?
13. Express the weight of a 170-pound man in kilograms.
14. More advanced: A healthy 135-pound woman may have about 34 pounds of fat. How many kilocalories would
that fat provide? (To answer, link several conversion factors in a row until “pounds of fat” can be converted to
“kilocalories from fat.”)
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29
Handout 1-4: Converting Metric/English Units of Measurement
Metric and English Systems
Common metric units and their U.S. equivalents include:
• grams vs. ounces
• kilograms vs. pounds
• meters and centimeters vs. yards and inches
Common metric units include grams, kilograms, milligrams, and micrograms. Note: “centi-” is
less commonly used (as in meter, centimeter).
Steps in a Conversion Problem
1. Identify the weight or measure for which you want to change units. Write it down on the left
of the page, including its units.
2. Identify a conversion (equality) you can use to solve the problem; it must contain both types
of units—the original units, and the new units.
3. Make a fraction (a “conversion factor”) out of the equality that has the two units. The unit
you want in your answer should be in the numerator (top); the unit you want to eliminate
should be in the denominator (bottom).
4. Multiply the original weight or measure (step 1) times the conversion factor (step 3).
Examples: conversions between English and metric system
Pounds (lb) to kilograms (kg): 2.2 lb = 1 kg
_______ lb × 1 kg =
2.2 lb
______ kg
Inches (in) to centimeters (cm): 1 in = 2.54 cm
_______ in × 2.54 cm =
1 in
______ cm
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license distributed with a certain product or service or otherwise on a password-protected website for classroom use.