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Oxford Handbook of Nutrition and Dietetics
Second edition
Edited by
Joan Webster-Gandy
Freelance Dietitian and Visiting Researcher University of Hertfordshire Herts, UK
Angela Madden
Principal Lecturer in Dietetics University of Hertfordshire Herts, UK
Michelle Holdsworth
Senior Lecturer in Public Health Public Health Section
School of Health & Related Research (ScHARR) University of Sheffield, UK
1
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Second edition published 2012
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Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.
Foreword
Both health professionals and the general public now realize that good nutrition is essential for good health. Indeed, nutrition is the health topic on which the lay public receives the most advice from popular books and magazines, but often this advice is unsound. It is therefore essential that health-care workers have readily available reliable information about all aspects of nutrition. This includes nutritional science, public health nutrition, and therapeutic nutrition.
This handbook provides, in concise format, the information about nutrition needed by those training to be dietitians (RD), nutritionists (RNutr), public health nutritionists (RPHNutr), or doctors or nurses either in all settings. It will continue to be a valuable resource after graduation, since the scope of modern nutrition is so large that a specialist in one field (say, public health nutrition) cannot hope to have instantly accessible all the necessary information about therapeutic diets, or nutritional sciences, and vice versa
The three authors of this Handbook are all registered dietitians, each of whom has a solid research record, as well as extensive experience of the nutritional problems that dietitians, hospital doctors, general practitioners, and specialist nurses will encounter. I am confident that readers will be thankful to have this book in their pocket to guide them to the correct immediate response to a nutritional problem, even if later they have to consult a senior dietitian or textbook for more detailed advice.
John Garrow MD PhD FRCP Emeritus Professor of Human Nutrition University of London
Preface
When we were approached to write this handbook the original idea was to write a book for general practice. However, we all remember being student dietitians and all created our own handbook of useful information that we carried around with us and were totally lost without. On reflection of what text books are now available in nutrition or dietetics, it became clear that, although there are now concise pocket books written for dietitians working predominantly in a clinical setting, there was a need for a user friendly handbook of nutrition and dietetics for a wider audience that included doctors, nurses, nutritionists, and other health care professionals. The available textbooks are, by necessity, large tomes or series that are unlikely to adorn the shelves of many doctors or nurses whether in primary or secondary care.
As a result, we have tried to present nutritional science, therapeutics, and community public health nutrition in a concise and integrated manner. While writing the text we have tried to identify what information would be useful to different professionals in a variety of settings. For example a doctor or nurse may want information on obesity and will find a ready reckoner for the calculation of body mass index (BMI), information on associated problems and treatment options. Dietitians working in the community or public health will have this information, but will find the sections on the measurements of obesity or nutrition interventions more informative. How well we have achieved this is for the reader to decide.
Nutrition is fascinating for many reasons, one of which is the fact that it is a very dynamic discipline. We have tried very hard to be contemporary, but there will inevitably be changes in basic science, practice and policy as the discipline continues to evolve. Major developments and changes will be posted on the relevant page of the OUP web site. For us it has been a very enjoyable, if at times rather demanding, process and we hope that this book is useful to all health care professionals.
J.W-G. A.M.M. M.H.
Acknowledgements
Special thanks go to everyone who has helped and supported us during the production of this book. We are particularly grateful to: Julie Beckerson, Gill Cuffaro, Alison Culkin, Alizon Draper, Fionna Paige, George Grimble, Michelle Harvie, Catherine Hodgson, Catherine Humphries, Tom Humphries, Jamie Hustler, Jane McClinchy, Cathy Mooney, Gail Rees, Alan Rio, Clare Soulsby, Liz Weekes, and Melissa Wilson. Finally, thanks to the medical division at OUP for all the encouragement and support.
To Beth, Didier, Catherine, Jane, Matthew, Milo, Paula, Vivienne, and Will, with much love.
Contributors
Janice Barratt
Trust Lead for Dietetics, Derbyshire Mental Health Services NHS Trust, Derby, UK
Angie Clonan
PhD Researcher, Division of Nutritional Sciences, University of Nottingham, UK
Jelena Delic
Senior Teacher Practitioner, School of Pharmacy, University of Hertfordshire, UK
Dr Francis Delpeuch
Research Director, UMR NUTRIPASS, Institut de Recherche pour le Développement- IRD, Montpellier, France
Ruby Dillon
Health Improvement Specialist Public Health Directorate NHS Birmingham East and North Aston, UK
Marjorie Dixon
Specialist Metabolic Dietitian, Great Ormond Street Hospital for Children NHS Trust, London, UK
Pauline Douglas
Senior Lecturer/ Clinical Dietetics Facilitator School of Biomedical Sciences University of Ulster, Coleraine, Coleraine Co. Londonderry, UK
Dr John Garrow
Emeritus Professor of Human Nutrition, University of London, UK
Kate Godden
Senior Lecturer, Centre for Public Health Nutrition, School of Integrated Health, University of Westminster, London, UK
Vanessa Halliday Lecturer
Division of Nutritional Sciences, University of Nottingham, Sutton Bonington, UK
Anne Holdoway Freelance Dietitian Bath UK
Dr Michelle Holdsworth
Senior Researcher, UMR NUTRIPASS, Institut de Recherche pour le Développement- IRD, Montpellier, France
Emily Kirk
Specialist Dietitian, Somerset Community Health, Bridgwater, UK
Edwige Landais
Research Associate and Public Health Nutritionist, UMR NUTRIPASS, Institut de Recherche pour le Développement- IRD, Montpellier, France
Dr Angela M. Madden
Principal Lecturer in Dietetics, University of Hertfordshire, UK
Judy Molyneux
Deputy Manager & Clinical Dietetic Lead, Broomfield Hospital, Chelmsford, UK
Dr Elizabeth Neal
Research Dietitian, Institute of Child Health, London, UK
Dympna Pearson
Freelance Dietitian, Quorn, UK
Vivian Pibram
Advanced (HIV) Dietitian, King’s College Hospital, London, UK
Dr Lisa Ryan
Senior Lecturer, School of Life Sciences, Oxford Brookes University, UK
Dr Mhairi Sigrist
Specialist Dietitian Department of Nephrology St Paul’s Hospital, Vancouver, Canada
Dr Isabel Skypala
Director of Rehabilitation and Therapies, Royal Borompton & Harefield NHS Trust, UK
Nikki Stewart
Chief Dietitian, Nutrition & Dietetic Department, Lister Hospital, UK
Helen Storer
Head of Nutrition and Dietetics, Nottingham CityCare Partnership, UK
Dr Lisa Waddell
Specialist Community Paediatric Dietitian, Nottingham CityCare Partnership, UK
Dr Joan Webster-Gandy
Freelance Dietitian, Visiting Researcher and University of Hertfordshire, UK
Dr Kevin Whelan
Lecturer in Nutritional Sciences School of Medicine, Diabetes and Nutritional Sciences Division, King’s College London UK
Symbols and abbreviations
AAD antibiotic-associated diarrhoea
i increase
d decrease
l leads to
0 caution
6 therefore
M website
5 female
4 male
X controversial topic
p primary
s secondary
5FU 5-fluorouracil
AA amino acid
abv alcohol by volume
ACE angiotensin-converting enzyme
AcP acute pancreatitis
AD Alzheimer’s disease
ADeH alcohol dehydrogenase
ADH antidiuretic hormone
ADHD attention deficit hyperactivity disorder
ADP air-displacement plethysmography
AfN Association for Nutrition
AI adequate intake
AIDS acquired immune deficiency syndrome
AKI acute kidney injury
ALA alpha-linolenic acid
ALDH aldehyde dehydrogenase
AN anorexia nervosa
AP assistant practitioners
Arg arginine
ART antiretroviral therapy
ARV antiretroviral
ASA24 automated self-administered 24-h recall
ASD autism spectrum disorders
Assoc. Nutr. associate nutritionist
ATP adenosine triphosphate
BAPEN British Association for Parenteral and Enteral Nutrition
BCS behaviour change strategies
BDA British Dietetic Association
BED binge eating disorder
BFI baby friendly initiative
BHA butylated hydroxyanisole
BHF Better Hospital Food
BHT butylated hydroxytoluene
BIA bioelectrical impedance analysis
BMA British Medical Association
BMI body mass index
BMR basal metabolic rate
BMT bone marrow transplantation
BN bulimia nervosa
BNF British National Formulary
BPD bilio-pancreatic diversion
BPD-DS bilio-pancreatic diversion with duodenal switch
CMAM community-based management of acute malnutrition
CNS central nervous system
CoD coeliac disease
COMA Committee on Medical Aspects of Food Policy
CP chronic pancreatitis
CQC Care and Quality Commission
CRP C-reactive protein
CRRT continuous renal replacement therapy
SYMBOLS AND ABBREVIATIONS
CT computed tomography
CVA cerebrovascular accident
CVD cardiovascular disease
CWT Caroline Walker Trust
DASH dietary approaches to stop hypertension
DBP diastolic blood pressure
DEFRA Department for Environment, Food and Rural Affairs
DES dietary energy supply
DfE Department for Education
DFS Defence Food Services
DH Department of Health
DHA docosahexaenoic acid
DHp dermatitis herpetiformis
DIT dietary induced thermogenesis
DM diabetes mellitus
DNA deoxyribonucleic acid
DOM Dietitians in Obesity Management
DRV dietary reference value
DS duodenal switch
DSW dietetic support worker
DXA dual-energy X-ray absorptiometry
EAR estimated average requirements
EB epidermolysis bullosa
ECF extracellular fluid
EE energy expenditure
EFA essential fatty acids
EFAD European Federation of the Associations of Dietitians
EFS Expenditure and Food Survey
EFSA European Food Safety Authority
EGRA erythrocyte glutathione reductase activity
EMA endomysial antibodies
EPA eicosapentaenoic acid
EPAFF Expert Panel on Armed Forces Feeding
ER emergency regimen
ERF established renal failure
EU European Union
EUFIC European Food Information Council
FAD flavin adenine dinucleotide
FAO Food & Agriculture Organization (UN)
FBDG food-based dietary guidelines
FBS food balance sheets
FFM fat free mass
FFQ food frequency questionnaire
FFST fat-free soft tissue
FFW food for work
FHS food hypersensitivity
FIRSSt Food Intake Recording Software System
FIVE familial isolated vitamin E
FIVR food intake visual and voice recognizer
FM fat mass
FMN flavin mononucleotide
FOS fructo-oligosaccharides
FPIES food-induced proctitis and entercolitis
FSA Food Standards Agency
FSP Food in Schools Programme
GAM global acute malnutrition
GDA guideline daily amounts
GDM gestational diabetes
GF gluten-free
GFD general food distribution
GFR glomerular filtration rate
GI gastrointestinal, also glycaemic index
GL glycaemic load
Gln glutamine
GM genetically modified
GMO genetically modified organisms
GOR gastro-oesophageal reflux
GORD gastro-oesophageal reflux disease
GOS galacto-oligosaccharides
GTF glucose tolerance factor
GTN glyceryl trinitrate
GVHD graft vs. host disease
HD haemodialysis
HDL high density lipoproteins
HFE high fat or energy
HFSS high fat, sugar or salt
HIV human immune virus
HNR Human Nutrition Research
HPC Health Professions Council
HR heart rate
HT hypertension
Ht height
IA insulin analogues
IBD irritable bowel disease
SYMBOLS AND ABBREVIATIONS
ICCID International Council for Control of Iodine Deficiency
ICF intracellular fluid
IDA iron deficiency anaemia
IDDM insulin dependent diabetes mellitus
IDL intermediate density lipoproteins
IDPN intradialytic parenteral nutrition
IF intestinal failure
IFE infant feeding in emergencies
IGD Institute of Grocery Distribution
IgE immunoglobulin E
IMD inherited metabolic diseases
IMF International Monetary Fund
INR international normalized ratio
INS International Numbering System
IOM Institute of Medicine
IOTF International Obesity Task Force
ISAK International Society for the Advancement of Kinanthropometry
IVNAA in vivo neutron activation analysis
J joule
kcal kilocalories
KD ketogenic diet
kJ kilojoules
LBW low birth weight
LCP long chain fatty acids
LCT long chain triglycerides
LDL low-density lipoprotein
LFT liver function test
LIDNS Low Income Diet and Nutrition Survey
LGIT low glycaemic index treatment
LP(a) lipoprotein (a)
LRNI lower reference nutrient intake
MAC midarm circumference
MAD modified Atkins diet
MAM moderate acute malnutrition
MAMC midarm muscle circumference
MAOI monoamine oxidase inhibitors
MAS milk alkali syndrome
MBD mineral bone disease
MCH mean cell haemoglobin
MCT medium chain triglycerides
MCV mean corpuscular volume
MDG millennium development goals
MDT multidisciplinary team
MEOS microsomal ethanol-oxidizing system
MHRA Medicines and Healthcare products Regulatory Agency
MI motivational interviewing
MIMS Monthly Index of Medical Specialties
MJ megajoules
MND motor neurone disease
MoD Ministry of Defence
MPFR mobile phone food record
MRC Medical Research Council
MRI magnetic resonance imaging
MS multiple sclerosis
MTCT mother-to-child transmission
MUAC mid-upper arm circumference
MUFA monounsaturated fatty acids
MUST malnutrition universal screening tool
Na sodium
NAD nicotinamide adenine dinucleotide
NADP nicotinamide adenine dinucleotide phosphate
NAFLD non-alcoholic fatty liver
NASH non-alcoholic steatohepatitis
NatCen National Centre for Social Research
NATO North Atlantic Treaty Organization
NCCTSL non-carious cervical tooth surface loss
NCD nutrition-related chronic diseases
NCHS National Center for Health Statistics
NDNS National Diet and Nutrition Survey
NE niacin equivalent
NFS National Food Survey
NG nasogastric
NGA non-governmental agency
SYMBOLS AND ABBREVIATIONS
NHANES National Health and Nutrition Examination Surveys
NHS National Health service
NICE National Institute for Health and Clinical Excellence
NIDDM non-insulin dependent diabetes mellitus
NIE nutrition in emergencies
NIRI near infrared interactance
NJ nasojejunal
NMES non-milk extrinsic sugars
NMN Nì-methylnicotinamide
NS nephrotic syndrome
NS-SEC National Statistics Socio-economic Classification
NSF National Service Frameworks
NSP non-starch polysaccharides
NTD neural tube defects
OA osteoarthritis
OCD obsessive compulsive disorder
OFC occipito-frontal head circumference
Ofsted Office for Standards in Education, Children’s Services and Skills
ONS Office for National Statistics
ORP operational ration packs
PA physical activity
PABA para-aminobenzoic acid
PAD peripheral arterial disease
PAL physical activity level
PAR physical activity ratios
PAYD Pay as You Dine
PCB polychlorinated biphenyl
PCHR Personal Child Health Record
PCOS polycystic ovary syndrome
PCR protein catabolic rate
PCSG Primary Care Society for Gastroenterology
PD peritoneal dialysis
PDA personal digital assistant
PDis Parkinson’s disease
PEG percutaneous endoscopic gastrostomy
PEJ percutaneous endoscopic jejunostomy
PERT pancreatic enzyme replacement therapy
PFS Pollen Food Syndrome
PHCT primary health care teams
Phe phenylalanine
PICC peripherally inserted central catheter
PKU phenylketonuria
PMTCT prevention of mother to child transmission
PN parenteral nutrition
PNI protective nutrient intake
PRG percutaneous radiological gastrostomy
PSE portal systemic encephalopathy
PUFA polyunsaturated fatty acids
PWS Prader–Willi syndrome
QUID quantitative ingredient declaration
R. Nutr. registered nutritionist
R. PHNutr. registered public health nutritionist
RD registered dietitian
RDA recommended dietary allowance
RDis Refsum’s disease
RDS rapidly digestible starch
RfS refeeding syndrome
RIG radiologically inserted gastrostomy
RMR resting metabolic rate
RNA ribonucleic acid
RNI reference nutrient intake
RQ respiratory quotient
RQIA Regulation and Quality Improvement Authority
RS resistant starch
RUTF ready to use therapeutic food
SACN Scientific Advisory Committee on Nutrition
SAM severe acute malnutrition
SAP severe acute pancreatitis
SBP systolic blood pressure
SBS short bowel syndrome
SCF Scientific Committee for Food
SCI spinal cord injury
SD standard deviation
SDC Sustainable Development Commission
SDS slowly digestible starch
SEMS self-expanding metal stent
SENr Sport and Exercise Nutrition Register
SYMBOLS AND ABBREVIATIONS
SFA saturated fatty acids
SFT School Food Trust
SGA subjective global assessment
SLE systemic lupus erythematosus
SPT skin prick test
TBK total body potassium
TBW total body water
TEE total energy expenditure
TG trigylceride/triacylglyceride
TOBEC total body electrical conductivity
TPN total parenteral nutrition
TPP thiamine pyrophosphate
TSF triceps skin-fold
TSH thyroid-stimulating hormone
tTGA IgA tissue transglutaminase
TVP textured vegetable protein
UC ulcerative colitis
UF ultrafiltration
UL upper limit
UNU United Nation University
US ultrasound
UWW under-water weight
VAD vitamin A deficiency
VLCD very low calorie diets
VLDL very low-density lipoproteins
WHO World Health Organization
WRVS Womens Royal Voluntary Services
Wt weight
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Introduction to nutrition
Definitions and titles 2
Components of the diet 6
Food composition tables 10
Digestion 14
Definitions and titles
Nutrition
‘Nutrition is the branch of science that studies the process by which living organisms take in and use food for the maintenance of life, growth, reproduction, the functioning of organs and tissues, and the production of energy.’1
Public health nutrition
Usually described as ‘the promotion of good health through nutrition and the primary prevention of nutrition-related illness in the population’. Emphasis is on maintaining the wellness of the population through applying public health principles to influence food and nutrition systems. No internationally agreed definition.
Dietitian (dietician)
The titles dietitian and dietician are protected by law in the UK; anyone using these titles must be registered with the Health Professions Council (HPC). Anyone using these titles without registration is liable to prosecution and may be prosecuted. Registered dietitians are also able to use the post-nominal letters RD (formerly SRD in the UK). The European Federation of the Associations of Dietitians (EFAD) has defined the role of the dietitian as follows.
• A dietitian is a person with a qualification in nutrition and dietetics recognized by national authorities. The dietitian applies the science of nutrition to the feeding and education of groups of people and individuals in health and disease.
• The scope of dietetic practice is such that dietitians may work in a variety of settings and have a variety of work functions.
European academic and practitioner standards for dietetics can be found on the EFAD web site (M www.efad.org).
Many dietitians work in the National Health Service (NHS) and may specialize in specific areas, e.g. oncology, renal disease. They are employed in all sectors of healthcare and are a key part of the health-care team. Dietitians also work outside the NHS in areas such as industry, sport, education, journalism, and research.
Health Professions Council
More information about Health Professions Council (HPC) is available at M www.hpc-uk.org.
British Dietetic Association
The British Dietetic Association (BDA) is the professional body representing dietitians and was established in 1936 in order to:
• advance the science and practice of dietetics and associated subjects;
1 Bender, A.E. and Bender, D.A. (1995). Oxford dictionary of food and nutrition. Oxford University Press, Oxford.
• promote training and education in the science and practice of dietetics and associated subjects;
• regulate the relations between dietitians and their employer through the BDA trade union.
Specialist groups within the BDA cover areas of specialist interest, e.g. Paediatric Group, Dietitians in Obesity Management (DOM) UK. Full membership is available to RDs; other membership categories are available for dietetic assistants, students, and affiliates. The BDA is responsible for the curriculum framework for the education and training of dietitians. More information about the BDA is available at M www.bda.uk.org. The BDA is one of the 30 member associations, representing dietitians in 24 European countries, of the European Federation of the Associations of Dietitians (EFAD) (M www.efad.org). It is also one of about 40 national dietetic associations who are members of the International Confederation of Dietetic Associations (M www.internationaldietetics.org).
Dietetic support workers and assistant practitioners2
Dietetic support workers (DSW) and assistant practitioners (AP) work under the direct supervision of a RD. Their roles may include administration and dietetic tasks as delegated by the RD. In a hospital setting these may include assisting patients requiring special diets to choose from the hospital menu, and collecting and recording information regarding the patient’s food consumption and weight. In primary care they may include providing dietary consultation, under the direction of the dietitian, and liaising with the RD regarding the patient’s progress. Within a community setting they may include assisting the dietitian to assess the food and health needs of local residents, and enabling people to eat a healthier diet to prevent disease, offering guidance in relation to food selection and preparation, planning menus, standardizing recipes, and testing new products. Individual tasks undertaken by DSWs, and even more so by APs, may be exactly the same as the level 5 dietitian with the difference being in the detail of the task/activity the level of autonomy. Unlike the dietitian a DSW or AP would have established and predetermined protocols for which referrals they are able to accept, and for which conditions, and at what point they would need to hand over to a dietitian. There would be pre agreed treatment options and a DSW or AP would not have the autonomy to move away from these options without first agreeing it with a dietitian. Again in project work, e.g. healthy eating session or diet sheet/resource development, it would be expected that the dietitian would oversee the project once delegated, and then sign off the information/project plan at the end. The level of both experience and formal education achieved will lead the difference between a DSW and an AP, and the complexity of the work expected of them. National Vocational Qualification level 3 courses are available in allied health professional support (dietetics).
2 Dietetic Support Worker and Assistant Practitioner Roles BDA 2010 Available at: M www.bda.uk.com.
4 CHAPTER 1 Introduction to nutrition
Nutritionist
The title ‘nutritionist’ has no legal standing and no educational requirements are necessary for a person to be called ‘nutritionist’. The Association for Nutrition is endeavoring to regulate the field of nutrition and protection of the title ‘nutritionist’.
The Nutrition Society
The Nutrition Society (M www.nutritionsociety.org.uk) was established in 1941 ‘to advance the scientific study of nutrition and its application to the maintenance of human and animal health’. The society covers 4 key areas:
• promotion of professional study;
• promotion of high standards in professional practice;
• promotion of professional careers;
• public protection through voluntary professional registration.
In 2010 the responsibility for the UK Voluntary Register of Nutritionists was transferred to the Association for Nutrition.
The Association for Nutrition
The Association for Nutrition (AfN) is a professional body for the regulation and registration of nutritionists (including public health nutritionists and animal nutritionists). Registrants must demonstrate high ethical and quality standards, founded on evidence-based science. The AfN sets proficiency and competency criteria, promotes continuing professional development and safe conduct, and will accredit university undergraduate and postgraduate nutrition courses. The association awards the titles associate nutritionist (Assoc. Nutr.), registered nutritionist (R. Nutr.) and registered public health nutritionist (R. PHNutr.) however this is currently under review. Further details can be obtained at M www.associationfornutrition.org
Registered public health nutritionist
Registered public health nutritionists work in health improvement on a population level to promote health, wellbeing and reduce inequalities. Based in a range of sectors, e.g. Primary Care, health improvement, government departments, non-governmental organizations, food retailer or manufacturer.
Registered Sport and Exercise Nutritionist
The Sport and Exercise Nutrition Register (SENr) (M www.senr.org.uk) is a voluntary register designed to accredit suitably qualified and experienced individuals who have the competency to work autonomously as a Sport and Exercise Nutritionist with performance orientated athletes, as well as those participating in physical activity, sport and exercise for health. The register is administered by BDA on behalf of the SENr Board.
Components of the diet
Diet
Diet is what a person habitually eats and drinks, so everyone is always on a diet. One of the most important and difficult tasks in nutritional medicine is to estimate accurately the habitual nutritional intake and diet of the patient. These difficulties arise because a person’s diet may vary widely from day to day, food processing may greatly affect the nutrient content of foods s/he eats, and hardly anyone with a nutritional problem can accurately recall what s/he has eaten.
Dietary value
Dietary value is assessed by the measured energy and nutrient content of a particular diet and often in reference to dietary reference values (see b Chapter 2 ‘Dietary reference values’, p. 20) or recommendations. Foods and diets also have many other kinds of value including political, economic, social, and cultural values (see b Chapter 14 ‘Influences on children’s food choices’, p. 293). In most societies where people live above starvation level effort is put into diversifying meals and the overall diet, e.g.:
• use of food in rituals, e.g. birthday and wedding cakes, also fasting (Ramadan and Lent);
• use of food to express values and social relationships, e.g. sharing food, preparing special foods as expression of love, etc.;
• prestige foods, e.g. champagne and caviar as symbols of wealth and privilege.
Components of the diet
Diets are composed of nutrients: macronutrients (protein, fats, carbohydrates, and alcohol) and the micronutrients (vitamins, minerals, and trace elements). Food also contains many non-nutritional, but biologically active substances. These include toxins and contaminants, such as alkaloids and aflatoxins, which are detrimental to health, as well as constituents, such as phytochemicals, that may be health-promoting. As consumers we do not eat nutrients, but meals and foods. These are the components of diet that are most meaningful to the public and usually the basis of food choice.
Food groups
Foods vary in their energy and nutrient content. Food groups are a classification of foods on the basis of the nutrient profile (see b Chapter 2 ‘The Eatwell Plate’, p. 27 and Table 1.1). Commonly used food groups are:
• high protein foods, e.g. meat, fish, eggs, dairy products, pulses/legumes;
• carbohydrate-rich foods, e.g. cereals, roots, and tubers;
• dairy foods;
• fruit and vegetables;
• foods rich in fat or oil.
Table 1.1 Nutrient profile of the main food groups
Cereals
+, This food group is a source of the nutrient(s) in most human diets; ++, this food group is an important source of the nutrient(s) in most human diets; +++, this food group is a major source of the nutrient(s) in most human diets.
Food groups are widely used in the formulation of dietary guidelines and for nutrition education messages of various kinds, such as eat five portions of fruit and vegetables a day (a UK health message). While useful, such classifications are also somewhat arbitrary; some foods can be placed in more than one food group.
Staple foods
Traditionally a staple food is one that forms the basis of the diet in terms of both quantity and frequency of consumption, and that provides the highest proportion of energy. In developed countries it is not always easy to specify one particular food as the staple. Staple foods vary with geographic region, but in global terms the most important staple foods are the following.
• Cereals: globally cereals supply approximately 51% of the world’s dietary energy supply (DES) with rice, maize, and wheat the most
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so as to form two, and they are then all laid as headers. This saves nearly half the turf, and labour. The sods should be cut from good meadow land, previously mown, and watered; but the sods should not be laid or built when wet, because they would shrink in dry weather, and all the joints would open. The sod-work is laid with the grass downwards, either alternately headers, and stretchers, or two stretchers to one header; care being taken that the joints of no two rows fall immediately over one another, which is termed breaking joint. If the layers of sods are laid perpendicular to the slope, they will answer better than if laid horizontally. Each sod should have two or three pegs driven through it, to secure it to the work beneath. When the revetment is completed, the whole should be cut off smooth to the proper slope; a pair of hedge-clippers, or a cutting knife, will answer well for this purpose.
One man can lay 19 square yards of sod-work in eight hours, when the sods are brought to the spot, and require no previous trimming.
PLATFORMS.
To facilitate the working of a gun, it must be placed on a platform of stone, or timber and plank: but, as a temporary measure, when required to fire only in one direction, timbers to take the wheels will suffice. The usual inclination given to platforms, from the rear to the front, is half an inch per foot. Platforms on barbettes should be perfectly level, and their dimensions must depend on the extent of the lateral range which may be required.
In laying a gun platform, the first thing to be done is to fix the hurter, which may be a piece of timber 7 or 8 feet long, and 7 inches square, or a strong fascine 9 feet in length may be advantageously used. The hurter is intended to take the wheels, or trucks of the carriage when the gun is run out, and to prevent their damaging the interior slope of the parapet. The position of the hurter necessarily depends therefore on the steepness of the interior slope. The hurter should be placed perpendicular to the axis, or central line of the embrazure. Three, four, or five sleepers of from 6 to 8 inches square,
are then laid, their upper surface on a level with the bottom of the hurter, and they are covered with two-inch planks, nailed down when three sleepers are used; but if there be four or five sleepers, the planks may be confined by two ribbands (which are pieces of wood of the same length, but weaker scantling than the sleepers) and the platform racked down with rack lashings at the proper intervals.
Aracklashingconsists of a piece of 2-inch rope about 9 feet long, which is fastened to a stick 15 inches long, 2 inches wide at the head, with a hole in it to receive the lashing, and tapering to a blunt point: it is passed round the timber, and sleeper beneath, then twice round itself. The end of the stick is then put into the loose gromet so formed, and twisted round until the whole is firmly secured, when the stick is turned flat on the upper piece of scantling.
The gun, and mortar platforms for sieges are now made rectangular: the dimensions of the former are 15 feet long by 10 feet 6 inches broad; those of a mortar platform are 7 feet 6 inches long by 6 feet 6 inches broad. Mortar platforms are laid exactly horizontal, the front part being placed 5 feet within the foot of the interior slope of the parapet.
Madras platforms consist of two stout planks about 12 feet long; they are supported on two sleepers, having a transom in front. The planks are secured with a moveable bolt, or pivot to the front transom, slide freely on the sleepers, and are connected together in rear by two cross pieces parallel to the rear sleeper, one in front, and the other in rear of it. To the centre of these two cross pieces is bolted another 12-feet plank, called the trail-piece, of a width equal to the distance between the cheeks of a siege-carriage, which is supported on a sleeper in the rear. When the gun is to be traversed, the whole platform is moved on the sleepers on the pivots in front. These platforms are chiefly intended for a direct fire. Two wedges are required for this platform to form inclined planes for the wheels, in running the gun on, or off the platform. Each wedge is of elm, 3 inches thick, 2½ feet long, and 1 foot wide, with a block to give the
requisite height, the block being 12 inches long, 4 thick, and 7 in extreme height.
Alderson’splatform.
The platform invented by Colonel Alderson, R.E., is 15 feet long, by 9 feet wide; and is composed of 46 similar pieces of timber (baulks) each measuring 9 feet × 5 inches × 3½ inches. Of these, ten are used as sleepers, and the remainder as planking. The weight of the platform (when 15 feet long and 9 feet wide) for guns is 15 cwt. 2 qrs. 14 lb. By addition of the small beams, this platform may easily be extended from 15 to 18 feet.
Dimensions, and weight of Platforms, for Guns, &c.
GUN, AND HOWITZER PLATFORM.
Forcarryingthisplatform, two men are required for each sleeper; one man for each plank, and ribband. The non-commissioned officer carries the rack-sticks.
Aplatform may belaiddownin an hour by expert men, and may be dismantled in three minutes.
MORTAR PLATFORM.
Detailed as above. One non-commissioned officer, and seventeen men carry the platform. Time required for laying down, and dismantling, similar to the above.
MADRAS PLATFORM.
In an elevated battery, theplatform may be laid down by expert men in half an hour, andmaybedismantledin three minutes.
BREACH.
The bestplace for making a breach, in ravelins, bastions, &c., is about thirty yards from their salient angles. The batteries should commence by marking out by their fire the extent of the breach intended to be made, first by striking out a horizontal line as near the bottom of the revetment as possible, and afterwards two others perpendicular to, and at the extremities of this line. Should the breach be required to be extensive, it will be necessary to form intermediate lines. Then, by continuing to deepen these two or more cuts, and occasionally firing salvoes at the part to be brought down, the wall will give way in a mass. The guns must, however, at first fire low, and gradually advance upwards until the breach is effected; and when the wall has given way, the firing should be continued until the slope of the breach is made practicable.
TO BURST OPEN GATES OF FORTRESSES, ETC.
A leathern bag, containing about 50 lb. of powder, should be hooked upon the gate, as near the centre as possible (or be laid on the ground, close to the bottom of the gate, and tamped with sods, &c.), and be fired by means of a piece of portfire, or match, passed through a hole in the bottom of the bag.
FORTIFICATION.
Offensivefortificationis the art of conducting a siege.
Defensive fortification comprehends military architecture, and is the art of securing, or protecting a place by works, to resist a siege.
Natural fortification consists of obstacles, such as marshes, mountain passes, &c., which are found in some countries, and should be taken advantage of to impede the approaches of an enemy.
Artificialfortificationcomprises those works which are constructed to defend a place.
Permanentfortificationis the art of putting towns, &c., into such a state as at all times to be prepared to resist the attack of an enemy.
Field fortification is the method of fortifying a camp, or position, buildings, &c., and it includes the construction of redoubts, entrenchments, &c. Works of this nature are considered as temporary.
Irregularfortificationis the art of fortifying a place of an irregular figure, situated where the country does not admit of giving to the several works their due proportion according to rule.
ACommandis the vertical elevation of one work above another, or above the country.
A Command in front is when an eminence is directly facing the work which it commands.
A Command in the rear, or reverse, is when any eminence is directly behind the work which it commands.
A Command by enfilade is when an eminence is situated in the prolongation of any line of a work, and a considerable part of it may be seen from thence; this line will be subject to enfilade, and such a command is the most dangerous.
The Rampart (A T R) is an elevation of earth, obtained from the excavation of the ditch; and is that part of the fortification which is situated between the ditch, and the town, consisting of an interior slope, terreplein, banquette, parapet, and exterior slope or escarp. (VidePlate.)
The Interior slope (A) is the inclination of earth nearest to the town.
TheTerreplein(T) is the upper part of the rampart, which remains after having constructed the parapet.
The Parapet (R) is a mass of earth elevated on the terreplein of the rampart, on the side towards the country; being from 18 to 22 feet thick, and from 6 to 8 feet high. The top is formed with a slight declivity towards the country, which is called the superiorslope.
The Banquette is an elevation of earth, or step, on which the soldiers stand to fire over the parapet.
The Revetment is the masonry which retains the earth of the rampart on its exterior side. It is about 5 feet thick at the top, and its slope is one-fifth, or one-sixth its height.
TheBermis a space, or path, sometimes left between the exterior slope of the rampart, and the ditch. It serves as a communication round the works, and prevents the earth falling into the ditch.
The Tablette is a flat coping-stone, on the exterior of the top of the escarp of whole revetment.
The Cordon is a semicircular projection of stone, whose diameter is about one foot, placed at the top of the slope of the revetment of
the escarp.
TheEscarp(a) is the exterior slope, or wall of the rampart.
TheCounterscarp(b) is the wall, or slope of the ditch, opposite to the escarp.
The Faces of a work (p q) are those parts which form a salient angle, projecting towards the country.
The Flank (q G) is the part of a work so disposed as to defend another; joining the face of a bastion to the curtain, &c.
The Bastion (M L) is a work composed of two faces, and two flanks. Bastions are joined by curtains, and are constructed salient, and with flanks, in order that the whole escarp may be seen, and that a reciprocal defence may be obtained.
Bastions are of various kinds viz., full (M), empty (L), also flat, detached, demi, and tower bastions.
A Full bastion (M) is when the terreplein occupies all the interior space of the bastion. From the description of this bastion, that of all the others may be ascertained.
TheCurtain(G R H) is that part of the rampart which lies between two bastions, and joins the flanks thereof.
AFrontoffortificationconsists of two half bastions, and a curtain.
TheDitch(B) is an excavation from 12 to 24 feet deep, and from 90 to 150 feet broad, surrounding the rampart. The side of the ditch nearest the place forms the escarp (a); and the opposite part, the counterscarp (b) is made circular opposite to the salient angles of the works.
TheCoveredway(V) is a space of about 30 feet broad, extending round the counterscarp of the ditch, being covered by a parapet from 7 to 9 feet high, with a banquette.
The Glacis (X) is the superior part of the parapet of the covered way, forming a gentle slope towards the country, and terminating at
from 120 to 180 feet; it covers the revetment of the body of the place.
ThePlacesofarmsof the covered way are spaces contrived in the salient, and re-entering angles of it; those (c) in the re-entering angles flank the branches of it, and contain troops for sallies, and its defence; and those (P) in the salient angles serve for assembling the Troops destined for the defence of the covered way.
TheSally-ports are openings cut in the glacis, at the faces of the re-entering places of arms, and at the branches of the covered way. They are used in making sallies from the covered way.
The Traverses (n) in the covered way, are parapets which cross the breadth of it at the salient, and re-entering places of arms, &c. They cover the troops who are drawn up behind the parapet of the covered way, from the enfilade fire of the enemy. There are passages cut in the parapet of the covered way, close to the traverses, in order to form a communication from one part of the covered way to another: these passages are about 6 feet wide, and are provided with gates.
A Citadel is a fortress joined to the works of a place, and is fortified both towards the town, and country. It should always be situated on the most commanding ground, serving to keep the inhabitants in awe, and, should the town be taken, it becomes a retreat for the garrison.
The Esplanade is a space of even ground, clear of buildings, situated between the town, and citadel.
TheBodyoftheplace(or Enceinte) consists of the works next to, and surrounding the town, in the form of a polygon, whether regular, or irregular.
Outworksare those works which are constructed beyond the body of the place, such as tenailles, ravelins, &c.
The Tenaille (D) consists of two faces, and a small curtain. It is constructed between the flanks of the bastions in front of the
