PART II

CHAPTER 2. THE HUMAN

BODY

Chapter 2. The Human Body | 53

Introduction
UNIVERSITY OF HAWAI‘I AT MĀNOA FOOD SCIENCE AND HUMAN
NUTRITION PROGRAM AND HUMAN NUTRITION PROGRAM

I ola no ke kino i ka māʻona o ka ʻōpū

The body enjoys health when the stomach is full

Image by
Henrique
Felix on
[Link]
m / CC0

Learning Objectives

By the end of this chapter, you will be able to:

Introduction | 55
 • Explain the anatomy and physiology of the
digestive system and other supporting organ systems
• Describe the relationship between diet and each of
the organ systems
• Describe the process of calculating Body Mass
Index (BMI)

The Native Hawaiians believed there was a strong connection

between health and food. Around the world, other cultures had
similar views of food and its relationship with health. A famous
quote by the Greek physician Hippocrates over two thousand years
ago, “Let food be thy medicine and medicine be thy food” bear much
relevance on our food choices and their connection to our health.
Today, the scientific community echoes Hippocrates’ statement as
it recognizes some foods as functional foods. The Academy of
Nutrition and Dietetics defines functional foods as “whole foods
and fortified, enriched, or enhanced foods that have a potentially
beneficial effect on health when consumed as part of a varied diet
on a regular basis, at effective levels.”
In the latter nineteenth century, a Russian doctor of immunology,
Elie Metchnikoff, was intrigued by the healthy life spans of people
who lived in the tribes of the northern Caucasus Mountains. What
contributed to their long lifespan and their resistance to life-
threatening diseases? A possible factor lay wrapped up in a leather
satchel used to hold fermented milk. Observing the connection
between the beverage and longevity, Dr. Elie Metchnikoff began his
research on beneficial bacteria and the longevity of life that led to
his book, The Prolongation of Life. He studied the biological effects
and chemical properties of the kefir elixir whose name came from
the Turkish word “kef” or “pleasure.” To this day, kefir is one of the
most widely enjoyed beverages in Russia.
Kefir has since found its way into America, where it is marketed in

56 | Introduction
 several flavors and can be found at your local grocery store. It is one
product of the billion-dollar functional food industry marketed with
all sorts of health claims from improving digestion to preventing
cancer. What is the scientific evidence that kefir is a functional
food? Expert nutritionists agree that probiotics, such as kefir,
reduce the symptoms of lactose intolerance and can ward off virally
caused diarrhea. While some health claims remain unsubstantiated,
scientific studies are ongoing to determine the validity of other
health benefits of probiotics.
The Native Hawaiians also consumed a daily probiotic in their
diet commonly known as poi (pounded taro). In precolonial Hawai‘i,
poi was used for a wide variety of dietary and medicinal purposes.
Aside from poi’s nutrient dense composition, fermented poi has
numerous compounds created in the fermentation process that are
very beneficial to the health of the human body. As a probiotic,
evidence suggests that poi can be useful in helping diseases such
as diarrhea, gastroenteritis, irritable bowel syndrome, inflammatory
1
bowel disease, and cancer.
Another well-known probiotic to the local people of Hawai‘i is
Kimchi. Kimchi is a traditional Korean food that is manufactured by
fermenting vegetables (usually cabbage). Similar to the kefir and poi,
kimchi also has shown to have similar health benefits as a probiotic
2
food.
The Japanese also have traditional fermented foods such as natto.
Natto is made from fermented soybeans and has many health

1. Brown A, Valiere A. (2004). The Medicinal Uses of Poi.

Nutrition in Clinical Care, 7(2), 69-74.
[Link]
PMC1482315/
2. Park K, Jeong J, et al. (2014). Health Benefits of Kimchi.
Journal of Medicinal Food, 17(1), 6-20.
[Link]

Introduction | 57
 benefits as a probiotic. Along with the beneficial components, natto
is very nutrient-dense containing carbohydrates, fats, protein, fiber,
3
vitamins and minerals. Other common foods we ferment in our diet
include miso, sauerkraut, kombucha, and tempeh.
Figure 2.1 Components of Organ Systems in the Human Body

3. Sanjukta S, Rai AK. (2016). Production of bioactive

peptides during soy fermentation and their potential
health benefits. Trends in Food Science and Technology,
50, 1-10. [Link]
article/pii/S0924224415300571

58 | Introduction
 Digestive
system
without
labels by
Mariana
Ruiz / Public
Domain

Knowing how to maintain the balance of friendly bacteria in your

intestines through proper diet can promote overall health. Recent
scientific studies have shown that probiotic supplements positively
affect intestinal microbial flora, which in turn positively affect
immune system function. As good nutrition is known to influence
immunity, there is great interest in using probiotic foods and other
immune-system-friendly foods as a way to prevent illness. In this
chapter we will explore not only immune system function, but also

Introduction | 59
all other organ systems in the human body. We will learn the
process of nutrient digestion and absorption, which further
reiterates the importance of developing a healthy diet to maintain
a healthier you. The evidence abounds that food can indeed be “thy
medicine.”

Learning Activities

Technology Note: The second edition of the Human

Nutrition Open Educational Resource (OER) textbook
features interactive learning activities. These activities are
available in the web-based textbook and not available in the
downloadable versions (EPUB, Digital PDF, Print_PDF, or
Open Document).

Learning activities may be used across various mobile

devices, however, for the best user experience it is strongly
recommended that users complete these activities using a
desktop or laptop computer and in Google Chrome.

An interactive or media element has been

excluded from this version of the text. You can
view it online here:
[Link]
humannutrition2/?p=71

60 | Introduction
Introduction | 61
Basic Biology, Anatomy, and
Physiology
UNIVERSITY OF HAWAI‘I AT MĀNOA FOOD SCIENCE AND HUMAN
NUTRITION PROGRAM AND HUMAN NUTRITION PROGRAM

The Basic Structural and Functional Unit of Life:

The Cell

What distinguishes a living organism from an inanimate object? A

living organism conducts self-sustaining biological processes. A cell
is the smallest and most basic form of life.
The cell theory incorporates three principles:
Cells are the most basic building units of life. All living things
are composed of cells. New cells are made from preexisting cells,
which divide in two. Who you are has been determined because
of two cells that came together inside your mother’s womb. The
two cells containing all of your genetic information (DNA) united to
begin making new life. Cells divided and differentiated into other
cells with specific roles that led to the formation of the body’s
numerous body organs, systems, blood, blood vessels, bone, tissue,
and skin. As an adult, you are made up of trillions of cells. Each of
your individual cells is a compact and efficient form of life—self-
sufficient, yet interdependent upon the other cells within your body
to supply its needs.
Independent single-celled organisms must conduct all the basic
processes of life. The single-celled organism must take in nutrients
(energy capture), excrete wastes, detect and respond to its
environment, move, breathe, grow, and reproduce. Even a one-
celled organism must be organized to perform these essential
processes. All cells are organized from the atomic level to all its
larger forms. Oxygen and hydrogen atoms combine to make the
62 | Basic Biology, Anatomy, and
Physiology
molecule water (H2O). Molecules bond together to make bigger
macromolecules. The carbon atom is often referred to as the
backbone of life because it can readily bond with four other
elements to form long chains and more complex macromolecules.
Four macromolecules—carbohydrates, lipids, proteins, and nucleic
acids—make up all of the structural and functional units of cells.
Although we defined the cell as the “most basic” unit of life,
it is structurally and functionally complex (Figure 2.2 “The Cell
Structure”). A cell can be thought of as a mini-organism consisting
of tiny organs called organelles. The organelles are structural and
functional units constructed from several macromolecules bonded
together. A typical animal cell contains the following organelles:
the nucleus (which houses the genetic material DNA), mitochondria
(which generate energy), ribosomes (which produce protein), the
endoplasmic reticulum (which is a packaging and transport facility),
and the golgi apparatus (which distributes macromolecules). In
addition, animal cells contain little digestive pouches, called
lysosomes and peroxisomes, which break down macromolecules
and destroy foreign invaders. All of the organelles are anchored
in the cell’s cytoplasm via a cytoskeleton. The cell’s organelles are
isolated from the surrounding environment by a plasma membrane.
Figure 2.2 The Cell Structure

Basic Biology, Anatomy, and Physiology | 63

 Figure 2.2
The Cell
Structure

The cell is
structurally
and
functionally
complex.

Tissues, Organs, Organ Systems, and Organisms

Unicellular (single-celled) organisms can function independently,

but the cells of multicellular organisms are dependent upon each
other and are organized into five different levels in order to
coordinate their specific functions and carry out all of life’s
biological processes (see Figure 2.3 “Organization of Life”.

• Cells are the basic structural and functional unit of all life.
Examples include red blood cells and nerve cells. There are
hundreds of types of cells. All cells in a person contain the
same genetic information in DNA. However, each cell only
expresses the genetic codes that relate to the cell’s specific

64 | Basic Biology, Anatomy, and Physiology

 structure and function.
• Tissues are groups of cells that share a common structure and
function and work together. There are four basic types of
human tissues: connective, which connects tissues; epithelial,
which lines and protects organs; muscle, which contracts for
movement and support; and nerve, which responds and reacts
to signals in the environment.
• Organs are a group of tissues arranged in a specific manner to
support a common physiological function. Examples include
the brain, liver, and heart.
• Organ systems are two or more organs that support a specific
physiological function. Examples include the digestive system
and central nervous system. There are eleven organ systems in
the human body (see Table 2.1 “The Eleven Organ Systems in
the Human Body and Their Major Functions”).
• An organism is the complete living system capable of
conducting all of life’s biological processes.

Figure 2.3 Organization of Life

“Organizatio
n Levels of
Human
Body”
by Laia
Martinez /
CC BY-SA 4.0

Basic Biology, Anatomy, and Physiology | 65

Table 2.1 The Eleven Organ Systems in the Human Body and Their
Major Functions

Organ System Organ Components Major Function

heart, blood/lymph
Transport nutrients and waste
Cardiovascular vessels, blood,
products
lymph
mouth, esophagus,
Digestive Digestion and absorption
stomach, intestines
all glands (thyroid,
Endocrine Produce and release hormones
ovaries, pancreas)
A one-way system of vessels that
tonsils, adenoids,
Lymphatic transport lymph throughout the
spleen and thymus
body
white blood cells,
Immune lymphatic tissue, Defend against foreign invaders
marrow
skin, nails, hair, Protective, body temperature
Integumentary
sweat glands regulation

skeletal, smooth,
Muscular Body movement
and cardiac muscle
brain, spinal cord,
Nervous Interprets and responds to stimuli
nerves
Reproduction and sexual
Reproductive gonads, genitals
characteristics

lungs, nose, mouth,

Respiratory Gas exchange
throat, trachea

bones, tendons,
Skeletal Structure and support
ligaments, joints
Urinary, kidneys, bladder,
Waste excretion, water balance
Excretory ureters

66 | Basic Biology, Anatomy, and Physiology

 Learning Activities

Technology Note: The second edition of the Human

Nutrition Open Educational Resource (OER) textbook
features interactive learning activities. These activities are
available in the web-based textbook and not available in the
downloadable versions (EPUB, Digital PDF, Print_PDF, or
Open Document).

Learning activities may be used across various mobile

devices, however, for the best user experience it is strongly
recommended that users complete these activities using a
desktop or laptop computer and in Google Chrome.

An interactive or media element has been

excluded from this version of the text. You can
view it online here:
[Link]
humannutrition2/?p=75

Basic Biology, Anatomy, and Physiology | 67

The Digestive System
UNIVERSITY OF HAWAI‘I AT MĀNOA FOOD SCIENCE AND HUMAN
NUTRITION PROGRAM AND HUMAN NUTRITION PROGRAM

The process of digestion begins even before you put food into your
mouth. When you feel hungry, your body sends a message to your
brain that it is time to eat. Sights and smells influence your body’s
preparedness for food. Smelling food sends a message to your brain.
Your brain then tells the mouth to get ready, and you start to
salivate in preparation for a meal.
Once you have eaten, your digestive system (Figure 2.4 “The
Human Digestive System”) starts the process that breaks down the
components of food into smaller components that can be absorbed
and taken into the body. To do this, the digestive system functions
on two levels, mechanically to move and mix ingested food and
chemically to break down large molecules. The smaller nutrient
molecules can then be absorbed and processed by cells throughout
the body for energy or used as building blocks for new cells. The
digestive system is one of the eleven organ systems of the human
body, and it is composed of several hollow tube-shaped organs
including the mouth, pharynx, esophagus, stomach, small intestine,
large intestine (colon), rectum, and anus. It is lined with mucosal
tissue that secretes digestive juices (which aid in the breakdown of
food) and mucus (which facilitates the propulsion of food through
the tract). Smooth muscle tissue surrounds the digestive tract and
its contraction produces waves, known as peristalsis, that propel
food down the tract. Nutrients, as well as some non-nutrients, are
absorbed. Substances such as fiber get left behind and are
appropriately excreted.
Figure 2.4 Digestion Breakdown of Macronutrients

68 | The Digestive System

3 molecules of Glucose, Lipids becomes 1 molecule of fatty acids and
and one molecule of glycerol, and Proteins become 3 molecultes
of Amino Acids” class=”alignnone wp-image-77″ width=”438″
height=”234″>
Digestion converts components of the food we eat into smaller
molecules that can be absorbed into the body and utilized for
energy needs or as building blocks for making larger molecules in
cells.

Everyday Connection

Image by
Gabriel Lee /
CC
BY-NC-SA

The Digestive System | 69

 There has been significant talk about pre- and probiotic foods in
the mainstream media. The World Health Organization defines
probiotics as live bacteria that confer beneficial health effects on
their host. They are sometimes called “friendly bacteria.” The most
common bacteria labeled as probiotic is lactic acid bacteria
(lactobacilli). They are added as live cultures to certain fermented
foods such as yogurt. Prebiotics are indigestible foods, primarily
soluble fibers, that stimulate the growth of certain strains of
bacteria in the large intestine and provide health benefits to the
host. A review article in the June 2008 issue of the Journal of
Nutrition concludes that there is scientific consensus that
probiotics ward off viral-induced diarrhea and reduce the
1
symptoms of lactose intolerance.
Expert nutritionists agree that more health benefits of pre- and
probiotics will likely reach scientific consensus. As the fields of pre-
and probiotic manufacturing and their clinical study progress, more
information on proper dosing and what exact strains of bacteria are
potentially “friendly” will become available.
You may be interested in trying some of these foods in your diet.
A simple food to try is kefir. Several websites provide good recipes,
including [Link]
Kefir, a dairy product fermented with probiotic bacteria, can make a
pleasant tasting milkshake.

Figure 2.5 The Human Digestive System

1. Farnworth ER. (2008). The Evidence to Support Health

Claims for Probiotics. Journal of Nutrition, 138(6),
1250S–4S. [Link]
[Link]

70 | The Digestive System

 Image by
Allison
Calabrese /
CC BY 4.0

From the Mouth to the Stomach

There are four steps in the digestion process (Figure 2.5 “The
Human Digestive System”). The first step is ingestion, which is the
intake of food into the digestive tract. It may seem a simple process,
but ingestion involves smelling food, thinking about food, and the
involuntary release of saliva in the mouth to prepare for food entry.
In the mouth, where the second step of digestion starts, the
mechanical and chemical breakdown of food begins. The chemical
breakdown of food involves enzymes, such as salivary amylase that
starts the breakdown of large starch molecules into smaller
components.
Mechanical breakdown starts with mastication (chewing) in the
mouth. Teeth crush and grind large food particles, while saliva
provides lubrication and enables food movement downward. The
slippery mass of partially broken-down food is called a bolus, which
moves down the digestive tract as you swallow. Swallowing may
seem voluntary at first because it requires conscious effort to push
the food with the tongue back toward the throat, but after this,
swallowing proceeds involuntarily, meaning it cannot be stopped

The Digestive System | 71

once it begins. As you swallow, the bolus is pushed from the mouth
through the pharynx and into a muscular tube called the esophagus.
As the bolus travels through the pharynx, a small flap called the
epiglottis closes to prevent choking by keeping food from going
into the trachea. Peristaltic contractions also known as peristalsis in
the esophagus propel the food bolus down to the stomach (Figure
3.6 “Peristalsis in the Esophagus”). At the junction between the
esophagus and stomach there is a sphincter muscle that remains
closed until the food bolus approaches. The pressure of the food
bolus stimulates the lower esophageal sphincter to relax and open
and food then moves from the esophagus into the stomach. The
mechanical breakdown of food is accentuated by the muscular
contractions of the stomach and small intestine that mash, mix,
slosh, and propel food down the alimentary canal. Solid food takes
between four and eight seconds to travel down the esophagus, and
liquids take about one second.
Figure 2.6 Peristalsis in the Esophagus
Image by
Allison
Calabrese /
CC BY 4.0

72 | The Digestive System

From the Stomach to the Small Intestine

When food enters the stomach, a highly muscular organ, powerful

peristaltic contractions help mash, pulverize, and churn food into
chyme. Chyme is a semiliquid mass of partially digested food that
also contains gastric juices secreted by cells in the stomach. These
gastric juices contain hydrochloric acid and the enzyme pepsin, that
chemically start breakdown of the protein components of food.
The length of time food spends in the stomach varies by the
macronutrient composition of the meal. A high-fat or high-protein
meal takes longer to break down than one rich in carbohydrates.
It usually takes a few hours after a meal to empty the stomach
contents completely into the small intestine.
The small intestine is divided into three structural parts: the
duodenum, the jejunum, and the ileum. Once the chyme enters the
duodenum (the first segment of the small intestine), the pancreas
and gallbladder are stimulated and release juices that aid in
digestion. The pancreas secretes up to 1.5 liters (.4 US gallons) of
pancreatic juice through a duct into the duodenum per day. This
fluid consists mostly of water, but it also contains bicarbonate ions
that neutralize the acidity of the stomach-derived chyme and
enzymes that further break down proteins, carbohydrates, and
lipids. The gallbladder secretes a much smaller amount of a fluid
called bile that helps to digest fats. Bile passes through a duct that
joins the pancreatic ducts and is released into the duodenum. Bile
is made in the liver and stored in the gall bladder. Bile’s components
act like detergents by surrounding fats similar to the way dish soap
removes grease from a frying pan. This allows for the movement of
fats in the watery environment of the small intestine. Two different
types of muscular contractions, called peristalsis and segmentation,
control the movement and mixing of the food in various stages of
digestion through the small intestine.
Similar to what occurs in the esophagus and stomach, peristalsis
is circular waves of smooth muscle contraction that propel food

The Digestive System | 73

forward. Segmentation from circular muscle contraction slows
movement in the small intestine by forming temporary “sausage
link” type of segments that allows chyme to slosh food back and
forth in both directions to promote mixing of the chyme and
enhance absorption of nutrients (Figure 2.7 “Segmentation”). Almost
all the components of food are completely broken down to their
simplest units within the first 25 centimeters of the small intestine.
Instead of proteins, carbohydrates, and lipids, the chyme now
consists of amino acids, monosaccharides, and emulsified
components of triglycerides.
Figure 2.7 Segmentation
“Segmentatio
n” by
OpenStax
College / CC
BY 3.0

The third step of digestion (nutrient absorption) takes place mainly

in the remaining length of the small intestine, or ileum (> 5 meters).
The way the small intestine is structured gives it a huge surface

74 | The Digestive System

area to maximize nutrient absorption. The surface area is increased
by folds, villi, and microvilli. Digested nutrients are absorbed into
either capillaries or lymphatic vessels contained within each
microvillus.
The small intestine is perfectly structured for maximizing
nutrient absorption. Its surface area is greater than 200 square
meters, which is about the size of a tennis court. The large surface
area is due to the multiple levels of folding. The internal tissue
of the small intestine is covered in villi, which are tiny finger-like
projections that are covered with even smaller projections, called
microvilli (Figure 2.8 “Structure of the Small Intestine”). The
digested nutrients pass through the absorptive cells of the intestine
via diffusion or special transport proteins. Amino acids, short fatty
acids, and monosaccharides (sugars) are transported from the
intestinal cells into capillaries, but the larger fatty acids, fat-soluble
vitamins, and other lipids are transported first through lymphatic
vessels, which soon meet up with blood vessels.
Figure 2.8 Structure of the Small Intestine
“Histology
Small
Intestines” by
OpenStax
College / CC
BY 3.0

The Digestive System | 75

From the Small Intestine to the Large Intestine

The process of digestion is fairly efficient. Any food that is still

incompletely broken down (usually less than ten percent of food
consumed) and the food’s indigestible fiber content move from the
small intestine to the large intestine (colon) through a connecting
valve. A main task of the large intestine is to absorb much of the
remaining water. Remember, water is present not only in solid foods
and beverages, but also the stomach releases a few hundred
milliliters of gastric juice, and the pancreas adds approximately 500
milliliters during the digestion of the meal. For the body to conserve
water, it is important that excessive water is not lost in fecal matter.
In the large intestine, no further chemical or mechanical breakdown
of food takes place unless it is accomplished by the bacteria that
inhabit this portion of the intestinal tract. The number of bacteria
residing in the large intestine is estimated to be greater than 1014,
which is more than the total number of cells in the human body
(1013). This may seem rather unpleasant, but the great majority
of bacteria in the large intestine are harmless and many are even
beneficial.

From the Large Intestine to the Anus

After a few hours in the stomach, plus three to six hours in the
small intestine, and about sixteen hours in the large intestine, the
digestion process enters step four, which is the elimination of
indigestible food matter as feces. Feces contain indigestible food
components and gut bacteria (almost 50 percent of content). It
is stored in the rectum until it is expelled through the anus via
defecation.

76 | The Digestive System

Nutrients Are Essential for Cell and Organ
Function

When the digestive system has broken down food to its nutrient
components, the body eagerly awaits delivery. Water soluble
nutrients absorbed into the blood travel directly to the liver via a
major blood vessel called the portal vein. One of the liver’s primary
functions is to regulate metabolic homeostasis. Metabolic
homeostasis is achieved when the nutrients consumed and
absorbed match the energy required to carry out life’s biological
processes. Simply put, nutrient energy intake equals energy output.
Whereas glucose and amino acids are directly transported from
the small intestine to the liver, lipids are transported to the liver
by a more circuitous route involving the lymphatic system. The
lymphatic system is a one-way system of vessels that transports
lymph, a fluid rich in white blood cells, and lipid soluble substances
after a meal containing lipids. The lymphatic system slowly moves
its contents through the lymphatic vessels and empties into blood
vessels in the upper chest area. Now, the absorbed lipid soluble
components are in the blood where they can be distributed
throughout the body and utilized by cells (see Figure 2.9 “The
Absorption of Nutrients”).
Figure 2.9 The Absorption of Nutrients

The Digestive System | 77

 Image by
Allison
Calabrese /
CC BY 4.0

Maintaining the body’s energy status quo is crucial because when

metabolic homeostasis is disturbed by an eating disorder or disease,
bodily function suffers. This will be discussed in more depth in the
last section of this chapter. The liver is the only organ in the human
body that is capable of exporting nutrients for energy production to
other tissues. Therefore, when a person is in between meals (fasted
state) the liver exports nutrients, and when a person has just eaten
(fed state) the liver stores nutrients within itself. Nutrient levels
and the hormones that respond to their levels in the blood provide
the input so that the liver can distinguish between the fasted and
fed states and distribute nutrients appropriately. Although not
considered to be an organ, adipose tissue stores fat in the fed state
and mobilizes fat components to supply energy to other parts of the
body when energy is needed.

78 | The Digestive System

 All eleven organ systems in the human body require nutrient input
to perform their specific biological functions. Overall health and the
ability to carry out all of life’s basic processes is fueled by energy-
supplying nutrients (carbohydrate, fat, and protein). Without them,
organ systems would fail, humans would not reproduce, and the
race would disappear. In this section, we will discuss some of the
critical nutrients that support specific organ system functions.

Learning Activities

Technology Note: The second edition of the Human

Nutrition Open Educational Resource (OER) textbook
features interactive learning activities. These activities are
available in the web-based textbook and not available in the
downloadable versions (EPUB, Digital PDF, Print_PDF, or
Open Document).

Learning activities may be used across various mobile

devices, however, for the best user experience it is strongly
recommended that users complete these activities using a
desktop or laptop computer and in Google Chrome.

An interactive or media element has been

excluded from this version of the text. You can
view it online here:

The Digestive System | 79

 [Link]
humannutrition2/?p=84

80 | The Digestive System

The Cardiovascular System
UNIVERSITY OF HAWAI‘I AT MĀNOA FOOD SCIENCE AND HUMAN
NUTRITION PROGRAM AND HUMAN NUTRITION PROGRAM

Figure 2.10 The Cardiovascular system

The Cardiovascular System | 81

 “Simplified
diagram of
the human
Circulatory
system in
anterior
view” by
Mariana
Ruiz / Public
Domain

82 | The Cardiovascular System

The cardiovascular system is one of the eleven organ systems of
the human body. Its main function is to transport nutrients to cells
and wastes from cells (Figure 2.12 “Cardiovascular Transportation
of Nutrients”). This system consists of the heart, blood, and blood
vessels. The heart pumps the blood, and the blood is the
transportation fluid. The transportation route to all tissues, a highly
intricate blood-vessel network, comprises arteries, veins, and
capillaries. Nutrients absorbed in the small intestine travel mainly to
the liver through the hepatic portal vein. From the liver, nutrients
travel upward through the inferior vena cava blood vessel to the
heart. The heart forcefully pumps the nutrient-rich blood first to
the lungs to pick up some oxygen and then to all other cells in
the body. Arteries become smaller and smaller on their way to
cells, so that by the time blood reaches a cell, the artery’s diameter
is extremely small and the vessel is now called a capillary. The
reduced diameter of the blood vessel substantially slows the speed
of blood flow. This dramatic reduction in blood flow gives cells time
to harvest the nutrients in blood and exchange metabolic wastes.
Figure 2.11 The Blood Flow in the Cardiovascular System
“Blood Flow
Through the
Heart” by
OpenStax
College / CC
BY 3.0

The Cardiovascular System | 83

Blood’s Function in the Body and in Metabolism
Support

You know you cannot live without blood, and that your heart pumps
your blood over a vast network of veins and arteries within your
body, carrying oxygen to your cells. However, beyond these basic
facts, what do you know about your blood?
Blood transports absorbed nutrients to cells and waste products
from cells. It supports cellular metabolism by transporting
synthesized macromolecules from one cell type to another and
carrying waste products away from cells. Additionally, it transports
molecules, such as hormones, allowing for communication between
organs. The volume of blood coursing throughout an adult human
body is about 5 liters (1.3 US gallons) and accounts for approximately
8 percent of human body weight.

What Makes Up Blood and How Do These

Substances Support Blood Function?

Blood is about 78 percent water and 22 percent solids by volume.

The liquid part of blood is called plasma and it is mostly water (95
percent), but also contains proteins, ions, glucose, lipids, vitamins,
minerals, waste products, gases, enzymes, and hormones. We have
learned that the protein albumin is found in high concentrations
in the blood. Albumin helps maintain fluid balance between blood
and tissues, as well as helping to maintain a constant blood pH. We
have also learned that the water component of blood is essential for
its actions as a transport vehicle, and that the electrolytes carried
in blood help to maintain fluid balance and a constant pH.
Furthermore, the high water content of blood helps maintain body
temperature, and the constant flow of blood distributes heat
throughout the body. Blood is exceptionally good at temperature

84 | The Cardiovascular System

control, so much so that the many small blood vessels in your nose
are capable of warming frigid air to body temperature before it
reaches the lungs.
The cellular components of blood include red blood cells, white
blood cells, and platelets. Red blood cells are the most numerous
of the components. Each drop of blood contains millions of them.
Red blood cells are red because they each contain approximately
270 million hemoglobin proteins, which contain the mineral iron,
which turns red when bound to oxygen. The most vital duty of red
blood cells is to transport oxygen from the lungs to all cells in the
body so that cells can utilize oxygen to produce energy via aerobic
metabolism. The white blood cells that circulate in blood are part
of the immune system, and they survey the entire body looking for
foreign invaders to destroy. They make up about 1 percent of blood
volume. Platelets are fragments of cells that are always circulating in
the blood in case of an emergency. When blood vessels are injured,
platelets rush to the site of injury to plug the wound. Blood is
under a constant state of renewal and is synthesized from stem cells
residing in bone marrow. Red blood cells live for about 120 days,
white blood cells live anywhere from eighteen hours to one year, or
even longer, and platelets have a lifespan of about ten days.
Figure 2.12 Cardiovascular Transportation of Nutrients

The Cardiovascular System | 85

 The
cardiovascul
ar system
transports
nutrients to
all cells and
carries
wastes out.

Nutrients In

Once absorbed from the small intestine, all nutrients require

transport to cells in need of their support. Additionally, molecules
manufactured in other cells sometimes require delivery to other
organ systems. Blood is the conduit and blood vessels are the
highway that support nutrient and molecule transport to all cells.
Water-soluble molecules, such as some vitamins, minerals, sugars,
and many proteins, move independently in blood. Fat-soluble
vitamins, triglycerides, cholesterol, and other lipids are packaged
into lipoproteins that allow for transport in the watery milieu of
blood. Many proteins, drugs, and hormones are dependent on
transport carriers, primarily by the plasma protein albumin. In
addition to transporting all of these molecules, blood transfers
oxygen taken in by the lungs to all cells in the body. As discussed,

86 | The Cardiovascular System

the iron-containing hemoglobin molecule in red blood cells serves
as the oxygen carrier.

Wastes Out

In the metabolism of macronutrients to energy, cells produce the

waste products carbon dioxide and water. As blood travels through
smaller and smaller vessels, the rate of blood flow is dramatically
reduced, allowing for efficient exchange of nutrients and oxygen for
cellular waste products through tiny capillaries. The kidneys remove
any excess water from the blood, and blood delivers the carbon
dioxide to the lungs where it is exhaled. Also, the liver produces
the waste product urea from the breakdown of amino acids and
detoxifies many harmful substances, all of which require transport
in the blood to the kidneys for excretion.

All for One, One for All

The eleven organ systems in the body completely depend on each

other for continued survival as a complex organism. Blood allows for
transport of nutrients, wastes, water, and heat, and is also a conduit
of communication between organ systems. Blood’s importance to
the rest of the body is aptly presented in its role in glucose delivery,
especially to the brain. The brain metabolizes, on average, 6 grams
of glucose per hour. In order to avert confusion, coma, and death,
glucose must be readily available to the brain at all times. To
accomplish this task, cells in the pancreas sense glucose levels in
the blood. If glucose levels are low, the hormone glucagon is
released into the blood and is transported to the liver where it
communicates the signal to ramp-up glycogen breakdown and
glucose synthesis. The liver does just that, and glucose is released

The Cardiovascular System | 87

into the blood, which transports it to the brain. Concurrently, blood
transports oxygen to support the metabolism of glucose to provide
energy in the brain. Healthy blood conducts its duties rapidly,
avoiding hypoglycemic coma and death. This is just one example of
the body’s survival mechanisms exemplifying life’s mantra “All for
one, one for all.”

What Makes Blood Healthy?

Maintaining healthy blood, including its continuous renewal, is

essential to support its vast array of vital functions. Blood is healthy
when it contains the appropriate amount of water and cellular
components and proper concentrations of dissolved substances,
such as albumin and electrolytes. As with all other tissues, blood
needs macro- and micronutrients to optimally function. In the bone
marrow, where blood cells are made, amino acids are required to
build the massive amount of hemoglobin packed within every red
blood cell, along with all other enzymes and cellular organelles
contained in each blood cell. Red blood cells, similar to the brain,
use only glucose as fuel, and it must be in constant supply to
support red-blood-cell metabolism. As with all other cells, the cells
in the blood are surrounded by a plasma membrane, which is
composed of mainly lipids. Blood health is also acutely sensitive to
deficiencies in some vitamins and minerals more than others.

What Can Blood Tests Tell You About Your

Health?

Figure 2.13 Blood Tests

88 | The Cardiovascular System

 Blood tests
are helpful
tools in
diagnosing
disease and
provide
much
information
on overall
health. Image
by Thirteen
of Clubs /
CC BY-SA

Since blood is the conduit of metabolic products and wastes,

measuring the components of blood, and particular substances in
blood, can reveal not only the health of blood, but also the health
of other organ systems. In standard blood tests performed during
an annual physical, the typical blood tests conducted can tell your
physician about the functioning of a particular organ or about
disease risk.
A biomarker is defined as a measurable molecule or trait that
is connected with a specific disease or health condition. The
concentrations of biomarkers in blood are indicative of disease risk.
Some biomarkers are cholesterol, triglycerides, glucose, and

The Cardiovascular System | 89

prostate-specific antigen. The results of a blood test give the
concentrations of substances in a person’s blood and display the
normal ranges for a certain population group. Many factors, such as
physical activity level, diet, alcohol intake, and medicine intake can
influence a person’s blood-test levels and cause them to fall outside
the normal range, so results of blood tests outside the “normal”
range are not always indicative of health problems. The assessment
of multiple blood parameters aids in the diagnosis of disease risk
and is indicative of overall health status. See Table 2.2 “Blood Tests”
for a partial list of substances measured in a typical blood test. This
table notes only a few of the things that their levels tell us about
health.
Table 2.2 Blood Tests

90 | The Cardiovascular System

 Substance Measured Indicates

Red-blood-cell count Oxygen-carrying capacity

Hematocrit (red-blood-cell
Anemia risk
volume)
White-blood-cell count Presence of infection
Bleeding disorders, atherosclerosis
Platelet count
risk

Metabolic, kidney, respiratory

pH
abnormalities
Liver, kidney, and Crohn’s disease,
Albumin
dehydration, protein deficiency
Bilirubin Liver-function abnormality

Oxygen/Carbon Dioxide Respiratory or metabolic abnormality

Hemoglobin Oxygen-carrying capacity
Iron Anemia risk
Magnesium Magnesium deficiency
Electrolytes (calcium, chloride,
Many illnesses (kidney, metabolic, etc.)
magnesium, potassium)
Cholesterol Cardiovascular disease risk
Triglycerides Cardiovascular disease risk
Glucose Diabetes risk
Many illnesses (diabetes, reproductive
Hormones
abnormalities)

1
National Heart Lung and Blood Institute. Types of Blood Tests.

1. National Heart Lung and Blood Institute (2012, January

6). Blood Tests. [Link]
topics/topics/bdt/[Link]

The Cardiovascular System | 91

 Learning Activities

Technology Note: The second edition of the Human

Nutrition Open Educational Resource (OER) textbook
features interactive learning activities. These activities are
available in the web-based textbook and not available in the
downloadable versions (EPUB, Digital PDF, Print_PDF, or
Open Document).

Learning activities may be used across various mobile

devices, however, for the best user experience it is strongly
recommended that users complete these activities using a
desktop or laptop computer and in Google Chrome.

An interactive or media element has been

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92 | The Cardiovascular System

Central Nervous System
UNIVERSITY OF HAWAI‘I AT MĀNOA FOOD SCIENCE AND HUMAN
NUTRITION PROGRAM AND HUMAN NUTRITION PROGRAM

The human brain (which weighs only about 3 pounds, or 1,300

kilograms) is estimated to contain over one hundred billion neurons.
Neurons form the core of the central nervous system, which
consists of the brain, spinal cord, and other nerve bundles in the
body. The main function of the central nervous system is to sense
changes in the external environment and create a reaction to them.
For instance, if your finger comes into contact with a thorn on a
rose bush, a sensory neuron transmits a signal from your finger up
through the spinal cord and into the brain. Another neuron in the
brain sends a signal that travels back to the muscles in your hand
and stimulates muscles to contract and you jerk your finger away.
All of this happens within a tenth of a second. All nerve impulses
travel by the movement of charged sodium, potassium, calcium, and
chloride atoms. Nerves communicate with each other via chemicals
built from amino acids called neurotransmitters. Eating adequate
protein from a variety of sources will ensure the body gets all of the
different amino acids that are important for central nervous system
function.
Figure 2.14 The Central Nervous System

Central Nervous System | 93

 Nervous
System” by
William
Crochot /
CC BY-SA 4.0

The brain’s main fuel is glucose and only in extreme starvation will
it use anything else. For acute mental alertness and clear thinking,
glucose must be systematically delivered to the brain. This does not

94 | Central Nervous System

 mean that sucking down a can of sugary soda before your next exam
is a good thing. Just as too much glucose is bad for other organs,
such as the kidneys and pancreas, it also produces negative effects
upon the brain. Excessive glucose levels in the blood can cause a
loss of cognitive function, and chronically high blood-glucose levels
can damage brain cells. The brain’s cognitive functions include
language processing, learning, perceiving, and thinking. Recent
scientific studies demonstrate that having continuously high blood-
glucose levels substantially elevates the risk for developing
Alzheimer’s disease, which is the greatest cause of age-related
cognitive decline.
The good news is that much research is directed toward
determining the best diets and foods that slow cognitive decline and
maximize brain health. A study in the June 2010 issue of the Archives
of Neurology reports that people over age 65 who adhered to diets
that consisted of higher intakes of nuts, fish, poultry, tomatoes,
cruciferous vegetables, fruits, salad dressing, and dark green, and
leafy vegetables, as well as a lower intake of high-fat dairy products,
red meat, organ meat, and butter, had a much reduced risk for
1
Alzheimer’s disease.
Other scientific studies provide supporting evidence that foods
rich in omega-3 fatty acids and/or antioxidants provide the brain
with protection against Alzheimer’s disease. One potential “brain
food” is the blueberry. The protective effects of blueberries upon
the brain are linked to their high content of anthocyanins, which
are potent antioxidants and reduce inflammation. A small study
published in the April 2010 issue of the Journal of Agricultural and
Food Chemistry found that elderly people who consumed blueberry

1. Gu Y, Nieves JW, et al. (2010). Food Combination and

Alzheimer Disease Risk: A Protective Diet. Archives of
Neurology, 67(6), 699–706.
[Link]

Central Nervous System | 95

 juice every day for twelve weeks had improved learning and
memorization skills in comparison to other subjects given a placebo
2
drink.
However, it is important to keep in mind that this was a short-
term study. Blueberries also are high in manganese, and high intake
of manganese over time is known to have neurotoxic effects. Variety
in the diet is perhaps the most important concept in applied
nutrition. More clinical trials are evaluating the effects of
blueberries and other foods that benefit the brain and preserve its
function as we age.

Learning Activities

Technology Note: The second edition of the Human

Nutrition Open Educational Resource (OER) textbook
features interactive learning activities. These activities are
available in the web-based textbook and not available in the
downloadable versions (EPUB, Digital PDF, Print_PDF, or
Open Document).

Learning activities may be used across various mobile

devices, however, for the best user experience it is strongly

2. Krikorian R, Shidler MD, et al. (2010). Blueberry

Supplementation Improves Memory in Older Adults.
Journal of Agricultural and Food Chemistry, 58(7).
[Link]

96 | Central Nervous System

recommended that users complete these activities using a
desktop or laptop computer and in Google Chrome.

An interactive or media element has been

excluded from this version of the text. You can
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[Link]
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Central Nervous System | 97

The Respiratory System
UNIVERSITY OF HAWAI‘I AT MĀNOA FOOD SCIENCE AND HUMAN
NUTRITION PROGRAM AND HUMAN NUTRITION PROGRAM

A typical human cannot survive without breathing for more than

3 minutes, and even if you wanted to hold your breath longer,
your autonomic nervous system would take control. This is because
cells need to maintain oxidative metabolism for energy production
that continuously regenerates adenosine triphosphate (ATP). For
oxidative phosphorylation to occur, oxygen is used as a reactant and
carbon dioxide is released as a waste product. You may be surprised
to learn that although oxygen is a critical need for cells, it is actually
the accumulation of carbon dioxide that primarily drives your need
to breathe. Carbon dioxide is exhaled and oxygen is inhaled through
the respiratory system, which includes muscles to move air into
and out of the lungs, passageways through which air moves, and
microscopic gas exchange surfaces covered by capillaries. The
cardiovascular system transports gases from the lungs to tissues
throughout the body and vice versa. A variety of diseases can affect
the respiratory system, such as asthma, emphysema, chronic
obstructive pulmonary disorder (COPD), and lung cancer. All of
these conditions affect the gas exchange process and result in
labored breathing and other difficulties.
The major organs of the respiratory system function primarily
to provide oxygen to body tissues for cellular respiration, remove
the waste product carbon dioxide, and help to maintain acid-base
balance. Portions of the respiratory system are also used for non-
vital functions, such as sensing odors, producing speech, and for
straining, such as during childbirth or coughing.
Figure 2.15 Major Respiratory Structures

98 | The Respiratory System

 Major organs
of the
respiratory
system

The major respiratory structures span the nasal cavity to the

diaphragm. Functionally, the respiratory system can be divided into
a conducting zone and a respiratory zone. The conducting zone
of the respiratory system includes the organs and structures not
directly involved in gas exchange (trachea and bronchi). The gas
exchange occurs in the respiratory zone.

Conducting Zone

The major functions of the conducting zone are to provide a route

for incoming and outgoing air, remove debris and pathogens from
the incoming air, and warm and humidify the incoming air. Several
structures within the conducting zone perform other functions as
well. The epithelium of the nasal passages, for example, is essential
to sensing odors, and the bronchial epithelium that lines the lungs
can metabolize some airborne carcinogens. The conducting zone

The Respiratory System | 99

includes the nose and its adjacent structures, the pharynx, the
larynx, the trachea, and the bronchi.

Respiratory Zone

In contrast to the conducting zone, the respiratory zone includes

structures that are directly involved in gas exchange. The
respiratory zone begins where the terminal bronchioles join a
respiratory bronchiole, the smallest type of bronchiole (Figure 2.16
“Respiratory Zone”), which then leads to an alveolar duct, opening
into a cluster of alveoli.
Figure 2.16 Respiratory Zone
Bronchioles
lead to
alveolar sacs
in the
respiratory
zone, where
gas exchange
occurs.

Alveoli

An alveolar duct is a tube composed of smooth muscle and

connective tissue, which opens into a cluster of alveoli. An alveolus

100 | The Respiratory System

is one of the many small, grape-like sacs that are attached to the
alveolar ducts.
An alveolar sac is a cluster of many individual alveoli that are
responsible for gas exchange. An alveolus is approximately 200 μm
in diameter with elastic walls that allow the alveolus to stretch
during air intake, which greatly increases the surface area available
for gas exchange. Alveoli are connected to their neighbors by
alveolar pores, which help maintain equal air pressure throughout
the alveoli and lung.
Figure 2.17 Location of Respiratory System
“Human
Respiratory
System” by
United
States
National
Institute of
Health:
National
Heart, Lung
and Blood
Institute /
Public
Domain

Figure 2.17 shows the location of the respiratory structures in the

body. Figure B is an enlarged view of the airways, alveoli (air sacs),
and capillaries (tiny blood vessels). Figure C is a close-up view of gas
exchange between the capillaries and alveoli. CO2 is carbon dioxide,
and O2 is oxygen.
A major organ of the respiratory system, each lung houses
structures of both the conducting and respiratory zones. The main
function of the lungs is to perform the exchange of oxygen and
carbon dioxide with air from the atmosphere. To this end, the lungs
exchange respiratory gases across a very large epithelial surface
area—about 70 square meters—that is highly permeable to gases.

The Respiratory System | 101

Gross Anatomy of the Lungs

The lungs are pyramid-shaped, paired organs that are connected

to the trachea by the right and left bronchi; below the lungs is the
diaphragm, a flat, dome-shaped muscle located at the base of the
lungs and thoracic cavity.
Figure 2.18 Basic Anatomy of the Lungs
Bronchioles
lead to
alveolar sacs
in the
respiratory
zone, where
gas exchange
occurs.

Each lung is composed of smaller units called lobes. Fissures

separate these lobes from each other. The right lung consists of
three lobes: the superior, middle, and inferior lobes. The left lung
consists of two lobes: the superior and inferior lobes.

Blood Supply

The major function of the lungs is to perform gas exchange, which

requires blood flowing through the lung tissues (the pulmonary
circulation). This blood supply contains deoxygenated blood and
travels to the lungs where erythrocytes, also known as red blood

102 | The Respiratory System

cells, pick up oxygen to be transported to tissues throughout the
body. The pulmonary artery carries deoxygenated blood to the
lungs. The pulmonary artery branches multiple times as it follows
the bronchi, and each branch becomes progressively smaller in
diameter down to the tiny capillaries where the alveoli release
carbon dioxide from blood into the lungs to be exhaled and take up
oxygen from inhaled air to oxygenate the blood. Once the blood is
oxygenated, it drains from the alveoli by way of multiple pulmonary
veins that exit the lungs to carry oxygen to the rest of the body.

Learning Activities

Technology Note: The second edition of the Human

Nutrition Open Educational Resource (OER) textbook
features interactive learning activities. These activities are
available in the web-based textbook and not available in the
downloadable versions (EPUB, Digital PDF, Print_PDF, or
Open Document).

Learning activities may be used across various mobile

devices, however, for the best user experience it is strongly
recommended that users complete these activities using a
desktop or laptop computer and in Google Chrome.

The Respiratory System | 103

 An interactive or media element has been
excluded from this version of the text. You can
view it online here:
[Link]
humannutrition2/?p=99

104 | The Respiratory System

The Endocrine System
UNIVERSITY OF HAWAI‘I AT MĀNOA FOOD SCIENCE AND HUMAN
NUTRITION PROGRAM AND HUMAN NUTRITION PROGRAM

Figure 2.19 The Endocrine System

“Major
Endocrine
Glands” by
National
Cancer
Institute /
Public
Domain

The functions of the endocrine system are intricately connected to

the body’s nutrition. This organ system is responsible for regulating
appetite, nutrient absorption, nutrient storage, and nutrient usage,
in addition to other functions, such as reproduction. The glands

The Endocrine System | 105

in the endocrine system are the pituitary, thyroid, parathyroid,
adrenals, thymus, pineal, pancreas, ovaries, and testes. The glands
secrete hormones, which are biological molecules that regulate
cellular processes in other target tissues, so they require
transportation by the circulatory system. Adequate nutrition is
critical for the functioning of all the glands in the endocrine system.
A protein deficiency impairs gonadal-hormone release, preventing
reproduction. Athletic teenage girls with very little body fat often
do not menstruate. Children who are malnourished usually do not
produce enough growth hormone and fail to reach normal height
for their age group. Probably the most popularized connection
between nutrition and the functions of the endocrine system is
that unhealthy dietary patterns are linked to obesity and the
development of Type 2 diabetes. The Centers for Disease Control
and Prevention (CDC) estimates that twenty-six million Americans
have Type 2 diabetes as of 2011. This is 8.3 percent of the US
population. Counties with the highest incidence of obesity also have
the highest incidence of Type 2 diabetes. To see how the rise in
obesity in this country is paralleled by the rise in Type 2 diabetes,
review this report by the CDC.
[Link]
maps_diabetesobesity_trends.pdf
What is the causal relationship between overnutrition and Type
2 diabetes? The prevailing theory is that the overconsumption of
high-fat and high-sugar foods causes changes in muscle, fat, and
liver cells that leads to a diminished response from the pancreatic
hormone insulin. These cells are called “insulin-resistant.” Insulin is
released after a meal and instructs the liver and other tissues to take
up glucose and fatty acids that are circulating in the blood. When
cells are resistant to insulin they do not take up enough glucose and
fatty acids, so glucose and fatty acids remain at high concentrations
in the blood. The chronic elevation of glucose and fatty acids in the
blood also causes damage to other tissues over time, so that people
who have Type 2 diabetes are at increased risk for cardiovascular
disease, kidney disease, nerve damage, and eye disease.

106 | The Endocrine System

 Career Connection

Do your part to slow the rising tide of obesity and Type 2

diabetes in this country. On the individual level, improve
your own family’s diet; at the local community level,
support the development of more nutritious school lunch
programs; and at the national level, support your nation’s
nutrition goals. Visit the CDC Diabetes Public Health
Resource website at [Link] It
provides information on education resources, projects, and
programs, and spotlights news on diabetes. For helpful
information on obesity, visit [Link]
obesity/. The CDC also has workplace web-based
resources with the mission of designing work sites that
prevent obesity. See [Link]
workplacehealthpromotion/[Link] or more details.

Learning Activities

Technology Note: The second edition of the Human

Nutrition Open Educational Resource (OER) textbook
features interactive learning activities. These activities are
available in the web-based textbook and not available in the
downloadable versions (EPUB, Digital PDF, Print_PDF, or
Open Document).

The Endocrine System | 107

 Learning activities may be used across various mobile
devices, however, for the best user experience it is strongly
recommended that users complete these activities using a
desktop or laptop computer and in Google Chrome.

An interactive or media element has been

excluded from this version of the text. You can
view it online here:
[Link]
humannutrition2/?p=102

An interactive or media element has been

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108 | The Endocrine System

The Urinary System
UNIVERSITY OF HAWAI‘I AT MĀNOA FOOD SCIENCE AND HUMAN
NUTRITION PROGRAM AND HUMAN NUTRITION PROGRAM

The urinary system has roles you may be well aware of: cleansing
the blood and ridding the body of wastes probably come to mind.
However, there are additional, equally important functions played
by the system. Take for example, regulation of pH, a function shared
with the lungs and the buffers in the blood. Additionally, the
regulation of blood pressure is a role shared with the heart and
blood vessels. What about regulating the concentration of solutes
in the blood? Did you know that the kidney is important in
determining the concentration of red blood cells? Eighty-five
percent of the erythropoietin (EPO) produced to stimulate red blood
cell production is produced in the kidneys. The kidneys also
perform the final synthesis step of vitamin D production, converting
calcidiol to calcitriol, the active form of vitamin D.
If the kidneys fail, these functions are compromised or lost
altogether, with devastating effects on homeostasis. The affected
individual might experience weakness, lethargy, shortness of
breath, anemia, widespread edema (swelling), metabolic acidosis,
rising potassium levels, heart arrhythmias, and more. Each of these
functions is vital to your well-being and survival. The urinary
system, controlled by the nervous system, also stores urine until
a convenient time for disposal and then provides the anatomical
structures to transport this waste liquid to the outside of the body.
Failure of nervous control or the anatomical structures leading to
a loss of control of urination results in a condition called
incontinence.
Characteristics of the urine change, depending on influences
such as water intake, exercise, environmental temperature, nutrient
intake, and other factors . Some of the characteristics such as color
and odor are rough descriptors of your state of hydration. For

The Urinary System | 109

example, if you exercise or work outside, and sweat a great deal,
your urine will turn darker and produce a slight odor, even if you
drink plenty of water. Athletes are often advised to consume water
until their urine is clear. This is good advice; however, it takes
time for the kidneys to process body fluids and store it in the
bladder. Another way of looking at this is that the quality of the
urine produced is an average over the time it takes to make that
urine. Producing clear urine may take only a few minutes if you are
drinking a lot of water or several hours if you are working outside
and not drinking much.
Figure 2.20 Urine Color

110 | The Urinary System

 “Urine
Color” by
OpenStax
College / CC
BY 3.0

Urine volume varies considerably. The normal range is one to two

liters per day. The kidneys must produce a minimum urine volume
of about 500 mL/day to rid the body of wastes. Output below
this level may be caused by severe dehydration or renal disease
and is termed oliguria. The virtual absence of urine production is

The Urinary System | 111

termed anuria. Excessive urine production is polyuria, which may
occur in diabetes mellitus when blood glucose levels exceed the
filtration capacity of the kidneys and glucose appears in the urine.
The osmotic nature of glucose attracts water, leading to increased
water loss in the urine.
Urine is a fluid of variable composition that requires specialized
structures to remove it from the body safely and efficiently. Blood
is filtered, and the filtrate is transformed into urine at a relatively
constant rate throughout the day. This processed liquid is stored
until a convenient time for excretion. All structures involved in the
transport and storage of the urine are large enough to be visible to
the naked eye. This transport and storage system not only stores
the waste, but it protects the tissues from damage due to the wide
range of pH and osmolarity of the urine, prevents infection by
foreign organisms, and for the male, provides reproductive
functions. The urinary bladder collects urine from both ureters
(Figure 2.21 “Urinary System Location”).
Figure 2.21 Urinary System Location

112 | The Urinary System

 “Illu Urinary
System” by
Thstehle /
Public
Domain

Figure 2.22 The Bladder

“The
Bladder” by
OpenStax
College / CC
BY 3.0

The Urinary System | 113

The kidneys lie on either side of the spine in the retroperitoneal
space behind the main body cavity that contains the intestines. The
kidneys are well protected by muscle, fat, and the lower ribs. They
are roughly the size of your fist, and the male kidney is typically a
bit larger than the female kidney. The kidneys are well vascularized,
receiving about 25 percent of the cardiac output at rest.
Figure 2.23 The Kidneys
“Kidney
Position in
Abdomen” by
OpenStax
College / CC
BY 3.0

The kidneys (as viewed from the back of the body) are slightly
protected by the ribs and are surrounded by fat for protection (not
shown).
The effects of failure of parts of the urinary system may range
from inconvenient (incontinence) to fatal (loss of filtration and many
other functions). The kidneys catalyze the final reaction in the
synthesis of active vitamin D that in turn helps regulate Ca++. The
kidney hormone EPO stimulates erythrocyte development and
promotes adequate O2 transport. The kidneys help regulate blood
pressure through Na+ and water retention and loss. The kidneys
work with the adrenal cortex, lungs, and liver in the
renin–angiotensin–aldosterone system to regulate blood pressure.
They regulate osmolarity of the blood by regulating both solutes and

114 | The Urinary System

water. Three electrolytes are more closely regulated than others:
Na+, Ca++, and K+. The kidneys share pH regulation with the lungs
and plasma buffers, so that proteins can preserve their three-
dimensional conformation and thus their function.

Learning Activities

Technology Note: The second edition of the Human

Nutrition Open Educational Resource (OER) textbook
features interactive learning activities. These activities are
available in the web-based textbook and not available in the
downloadable versions (EPUB, Digital PDF, Print_PDF, or
Open Document).

Learning activities may be used across various mobile

devices, however, for the best user experience it is strongly
recommended that users complete these activities using a
desktop or laptop computer and in Google Chrome.

An interactive or media element has been

excluded from this version of the text. You can
view it online here:
[Link]
humannutrition2/?p=108

The Urinary System | 115

The Muscular System
UNIVERSITY OF HAWAI‘I AT MĀNOA FOOD SCIENCE AND HUMAN
NUTRITION PROGRAM AND HUMAN NUTRITION PROGRAM

The muscular system allows the body to move voluntarily, but it

also controls involuntary movements of other organ systems such
as heartbeat in the circulatory system and peristaltic waves in the
digestive system. It consists of over six hundred skeletal muscles,
as well as the heart muscle, the smooth muscles that surround
your entire alimentary canal, and all your arterial blood vessels (see
Figure 2.24 “The Muscular System in the Human Body”). Muscle
contraction relies on energy delivery to the muscle. Each movement
uses up cellular energy, and without an adequate energy supply,
muscle function suffers. Muscle, like the liver, can store the energy
from glucose in the large polymeric molecule glycogen. But unlike
the liver, muscles use up all of their own stored energy and do not
export it to other organs in the body. Muscle is not as susceptible
to low levels of blood glucose as the brain because it will readily use
alternate fuels such as fatty acids and protein to produce cellular
energy.
Figure 2.24 The Muscular System in the Human Body

116 | The Muscular System

 “Muscle
Types” by
BruceBlaus /
CC BY-SA 4.0

Learning Activities

Technology Note: The second edition of the Human

Nutrition Open Educational Resource (OER) textbook
features interactive learning activities. These activities are
available in the web-based textbook and not available in the
downloadable versions (EPUB, Digital PDF, Print_PDF, or
Open Document).

Learning activities may be used across various mobile

devices, however, for the best user experience it is strongly
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The Muscular System | 117

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118 | The Muscular System

The Skeletal System
UNIVERSITY OF HAWAI‘I AT MĀNOA FOOD SCIENCE AND HUMAN
NUTRITION PROGRAM AND HUMAN NUTRITION PROGRAM

Bone Structure and Function

Your bones are stronger than reinforced concrete. Bone tissue is

a composite of fibrous strands of collagen (a type of protein) that
resemble the steel rebar in concrete and a hardened mineralized
matrix that contains large amounts of calcium, just like concrete.
But this is where the similarities end. Bone outperforms reinforced
concrete by several orders of magnitude in compression and
tension strength tests. Why? The microarchitecture of bone is
complex and built to withstand extreme forces. Moreover, bone is
a living tissue that is continuously breaking down and forming new
bone to adapt to mechanical stresses.

Why Is the Skeletal System Important?

The human skeleton consists of 206 bones and other connective

tissues called ligaments, tendons, and cartilage. Ligaments connect
bones to other bones, tendons connect bones to muscles, and
cartilage provides bones with more flexibility and acts as a cushion
in the joints between bones. The skeleton’s many bones and
connective tissues allow for multiple types of movement such as
typing and running. The skeleton provides structural support and
protection for all the other organ systems in the body. The skull,
or cranium, is like a helmet and protects the eyes, ears, and brain.
The ribs form a cage that surrounds and protects the lungs and
heart. In addition to aiding in movement, protecting organs, and

The Skeletal System | 119

providing structural support, red and white blood cells and platelets
are synthesized in bone marrow. Another vital function of bones
is that they act as a storage depot for minerals such as calcium,
phosphorous, and magnesium. Although bone tissue may look
inactive at first glance, at the microscopic level you will find that
bones are continuously breaking down and reforming. Bones also
contain a complex network of canals, blood vessels, and nerves that
allow for nutrient transport and communication with other organ
systems.
Figure 2.25 Human Skeletal Structure
“Axial
Skeleton” by
Openstax
College / CC
BY 3.0

The human skeleton contains 206 bones. It is divided into two main
parts, the axial and appendicular.

120 | The Skeletal System

Bone Anatomy and Structure

To optimize bone health through nutrition, it is important to

understand bone anatomy. The skeleton is composed of two main
parts, the axial and the appendicular parts. The axial skeleton
consists of the skull, vertebral column, and rib cage, and is
composed of eighty bones. The appendicular skeleton consists of
the shoulder girdle, pelvic girdle, and upper and lower extremities,
and is composed of 126 bones. Bones are also categorized by size
and shape. There are four types of bone: long bones, short bones,
flat bones, and irregular bones. The longest bone in your body is the
femur (thigh bone), which extends from your hip to your knee. It is a
long bone and functions to support your weight as you stand, walk,
or run. Your wrist is composed of eight irregular-shaped bones,
which allow for the intricate movements of your hands. Your twelve
ribs on each side of your body are curved flat bones that protect
your heart and lungs. Thus, the bones’ different sizes and shapes
allow for their different functions.
Bones are composed of approximately 65 percent inorganic
material known as mineralized matrix. This mineralized matrix
consists of mostly crystallized hydroxyapatite. The bone’s hard
crystal matrix of bone tissue gives it its rigid structure. The other
35 percent of bone is organic material, most of which is the fibrous
protein collagen. The collagen fibers are networked throughout
bone tissue and provide it with flexibility and strength. The bones’
inorganic and organic materials are structured into two different
tissue types. There is spongy bone, also called trabecular or
cancellous bone, and compact bone, also called cortical bone
(Figure 2.26 “The Arrangement of Bone Tissues”). The two tissue
types differ in their microarchitecture and porosity. Trabecular
bone is 50 to 90 percent porous and appears as a lattice-like
structure under the microscope. It is found at the ends of long
bones, in the cores of vertebrae, and in the pelvis. Trabecular bone
tissue makes up about 20 percent of the adult skeleton. The more

The Skeletal System | 121

dense cortical bone is about 10 percent porous and it looks like
many concentric circles, similar to the rings in a tree trunk,
sandwiched together (Figure 2.27 “Cortical (Compact) Bone”).
Cortical bone tissue makes up approximately 80 percent of the adult
skeleton. It surrounds all trabecular tissue and is the only bone
tissue in the shafts of long bones.
Figure 2.26 The Arrangement of Bone Tissues
Image
by Gtirouflet
/ CC BY-SA
3.0

The two basic tissue types of bones are trabecular and cortical. This
photo shows normal (left) and degraded (right) trabecular (spongy)
bone.
Figure 2.27 Cortical (Compact) Bone.

122 | The Skeletal System

 “Compact
Bone with
osteons” by
Lord of
Konrad /
CC0

Bone tissue is arranged in an organized manner. A thin membrane,

called the periosteum, surrounds the bone. It contains connective
tissue with many blood vessels and nerves. Lying below the
periosteum is the cortical bone. In some bones, the cortical bone
surrounds the less-dense trabecular bone and the bone marrow lies
within the trabecular bone, but not all bones contain trabecular
tissue or marrow.

Bone Tissues and Cells, Modeling and

Remodeling

Bone tissue contains many different cell types that constantly resize
and reshape bones throughout growth and adulthood. Bone tissue
cells include osteoprogenitor cells, osteoblasts, osteoclasts, and
osteocytes. The osteoprogenitor cells are cells that have not
matured yet. Once they are stimulated, some will become
osteoblasts, the bone builders, and others will become osteoclasts,
the cells that break bone down. Osteocytes are the most abundant

The Skeletal System | 123

cells in bone tissue. Osteocytes are star-shaped cells that are
networked throughout the bone via their long cytoplasmic arms
that allow for the exchange of nutrients and other factors from
bones to the blood and lymph.

Bone Modeling and Remodeling

During infancy, childhood, and adolescence, bones are continuously

growing and changing shape through two processes called growth
(ossification) and modeling. In fact, in the first year of life, almost
100 percent of the bone tissue in the skeleton is replaced. In the
process of modeling, bone tissue is dismantled at one site and built
up at a different site. In adulthood, our bones stop growing and
modeling, but continue to go through a process of bone remodeling.
In the process of remodeling, bone tissue is degraded and built up
at the same location. About 10 percent of bone tissue is remodeled
each year in adults. Bones adapt their structure to the forces acting
upon them, even in adulthood. This phenomenon is called Wolff’s
law, which states that bones will develop a structure that is best
able to resist the forces acting upon them. This is why exercising,
especially when it involves weight-bearing activities, increases bone
strength.
The first step in bone remodeling is osteocyte activation.
Osteocytes detect changes in mechanical forces, calcium
homeostasis, or hormone levels. In the second step, osteoclasts are
recruited to the site of the degradation. Osteoclasts are large cells
with a highly irregular ruffled membrane. These cells fuse tightly
to the bone and secrete hydrogen ions, which acidify the local
environment and dissolve the minerals in the bone tissue matrix.
This process is called bone resorption and resembles pit excavation.
Our bodies excavate pits in our bone tissue because bones act as
storehouses for calcium and other minerals. Bones supply these
minerals to other body tissues as the demand arises. Bone tissue

124 | The Skeletal System

also remodels when it breaks so that it can repair itself. Moreover,
if you decide to train to run a marathon your bones will restructure
themselves by remodeling to be better able to sustain the forces of
their new function.
After a certain amount of bone is excavated, the osteoclasts begin
to die and bone resorption stops. In the third step of bone
remodeling, the site is prepared for building. In this stage, sugars
and proteins accumulate along the bone’s surface, forming a cement
line which acts to form a strong bond between the old bone and
the new bone that will be made. These first three steps take
approximately two to three weeks to complete. In the last step of
bone remodeling, osteoblasts lay down new osteoid tissue that fills
up the cavities that were excavated during the resorption process.
Osteoid is bone matrix tissue that is composed of proteins such as
collagen and is not mineralized yet. To make collagen, vitamin C is
required. A symptom of vitamin C deficiency (known as scurvy) is
bone pain, which is caused by diminished bone remodeling. After
the osteoid tissue is built up, the bone tissue begins to mineralize.
The last step of bone remodeling continues for months, and for a
much longer time afterward the mineralized bone is continuously
packed in a more dense fashion.
Thus, we can say that bone is a living tissue that continually
adapts itself to mechanical stress through the process of
remodeling. For bone tissue to remodel certain nutrients such as
calcium, phosphorus, magnesium, fluoride, vitamin D, and vitamin K
are required.

Bone Mineral Density Is an Indicator of Bone

Health

Bone mineral density (BMD) is a measurement of the amount of

calcified tissue in grams per centimeter squared of bone tissue.
BMD can be thought of as the total amount of bone mass in a

The Skeletal System | 125

defined area. When BMD is high, bone strength will be great. Similar
to measuring blood pressure to predict the risk of stroke, a BMD
measurement can help predict the risk of bone fracture. The most
common tool used to measure BMD is called dual energy X-ray
absorptiometry (DEXA). During this procedure, a person lies on
their back and a DEXA scanner passes two X-ray beams through
their body. The amount of X-ray energy that passes through the
bone is measured for both beams. The total amount of the X-ray
energy that passes through a person varies depending on their bone
thickness. Using this information and a defined area of bone, the
amount of calcified tissue in grams per unit area (cm2) is calculated.
Most often the DEXA scan focuses on measuring BMD in the hip
and the spine. These measurements are then used as indicators of
overall bone strength and health. DEXA is the cheapest and most
accurate way to measure BMD. It also uses the lowest dose of
radiation. Other methods of measuring BMD include quantitative
computed tomography (QCT) and radiographic absorptiometry.
People at risk for developing bone disease are advised to have a
DEXA scan. We will discuss the many risk factors linked to an
increased incidence of osteoporosis and the steps a person can take
to prevent the disease from developing.

Learning Activities

Technology Note: The second edition of the Human

Nutrition Open Educational Resource (OER) textbook
features interactive learning activities. These activities are
available in the web-based textbook and not available in the

126 | The Skeletal System

downloadable versions (EPUB, Digital PDF, Print_PDF, or
Open Document).

Learning activities may be used across various mobile

devices, however, for the best user experience it is strongly
recommended that users complete these activities using a
desktop or laptop computer and in Google Chrome.

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The Skeletal System | 127

The Immune System
UNIVERSITY OF HAWAI‘I AT MĀNOA FOOD SCIENCE AND HUMAN
NUTRITION PROGRAM AND HUMAN NUTRITION PROGRAM

The immune system comprises several types of white blood cells

that circulate in the blood and lymph. Their jobs are to seek, recruit,
attack, and destroy foreign invaders, such as bacteria and viruses.
Other less realized components of the immune system are the skin
(which acts as a barricade), mucus (which traps and entangles
microorganisms), and even the bacteria in the large intestine (which
prevent the colonization of bad bacteria in the gut). Immune system
functions are completely dependent on dietary nutrients. In fact,
malnutrition is the leading cause of immune-system deficiency
worldwide. When immune system functions are inadequate there is
a marked increase in the chance of getting an infection. Children
in many poor, developing countries have protein- and/or energy-
deficient diets that are causative of two different syndromes,
kwashiorkor and marasmus. These children often die from
infections that their bodies would normally have fought off, but
because their protein and/or energy intake is so low, the immune
system cannot perform its functions.
Other nutrients, such as iron, zinc, selenium, copper, folate, and
vitamins A, B6, C, D, and E, all provide benefits to immune system
function. Deficiencies in these nutrients can cause an increased risk
for infection and death. Zinc deficiency results in suppression of the
immune system’s barrier functions by damaging skin cells; it is also
associated with a decrease in the number of circulating white blood
cells. A review of several studies in the journal Pediatrics concluded
that zinc supplements administered to children under age five for

128 | The Immune System

 longer than three months significantly reduces the incidence and
1
severity of diarrhea and respiratory illnesses.
Zinc supplementation also has been found to be therapeutically
beneficial for the treatment of leprosy, tuberculosis, pneumonia,
and the common cold. Equally important to remember is that
multiple studies show that it is best to obtain your minerals and
vitamins from eating a variety of healthy foods.
Just as undernutrition compromises immune system health, so
does overnutrition. People who are obese are at increased risk for
developing immune system disorders such as asthma, rheumatoid
arthritis, and some cancers. Both the quality and quantity of fat
affect immune system function. High intakes of saturated and trans
fats negatively affect the immune system, whereas increasing your
intake of omega-3 fatty acids, found in salmon and other oily fish,
decreases inflammatory responses. High intakes of omega-3 fatty
acids are linked to a reduction in the risk of developing certain
autoimmune disorders, such as rheumatoid arthritis, and are used
as part of a comprehensive treatment for rheumatoid arthritis.

1. Aggarwal R, Sentz J, Miller MA. (2007). Role of Zinc

Administration in Prevention of Childhood Diarrhea and
Respiratory Illnesses: A Meta-Analysis. Pediatrics, 119(6),
1120–30. [Link]
17545379

The Immune System | 129

 Learning Activities

Technology Note: The second edition of the Human

Nutrition Open Educational Resource (OER) textbook
features interactive learning activities. These activities are
available in the web-based textbook and not available in the
downloadable versions (EPUB, Digital PDF, Print_PDF, or
Open Document).

Learning activities may be used across various mobile

devices, however, for the best user experience it is strongly
recommended that users complete these activities using a
desktop or laptop computer and in Google Chrome.

An interactive or media element has been

excluded from this version of the text. You can
view it online here:
[Link]
humannutrition2/?p=118

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excluded from this version of the text. You can
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The Immune System | 131

Indicators of Health: Body
Mass Index, Body Fat
Content, and Fat Distribution
UNIVERSITY OF HAWAI‘I AT MĀNOA FOOD SCIENCE AND HUMAN
NUTRITION PROGRAM AND HUMAN NUTRITION PROGRAM

Although the terms overweight and obese are often used

interchangeably and considered as gradations of the same thing,
they denote different things. The major physical factors
contributing to body weight are water weight, muscle tissue mass,
bone tissue mass, and fat tissue mass. Overweight refers to having
more weight than normal for a particular height and may be the
result of water weight, muscle weight, or fat mass. Obese refers
specifically to having excess body fat. In most cases people who are
overweight also have excessive body fat and therefore body weight
is an indicator of obesity in much of the population.
The “ideal” healthy body weight for a particular person is
dependent on many things, such as frame size, sex, muscle mass,
bone density, age, and height. The perception of the “ideal” body
weight is additionally dependent on cultural factors and the
mainstream societal advertisement of beauty.
To standardize the “ideal” body weight and relate it to health,
scientists have devised mathematical formulas to better define a
healthy weight. These mathematically derived measurements are
used by health professionals to correlate disease risk with
populations of people and at the individual level. A clinician will take
two measurements, one of weight and one of fat mass, in order to
diagnose obesity. Some measurements of weight and body fat that
do not require using technical equipment can easily be calculated
and help provide an individual with information on weight, fat mass,
and distribution, and their relative risk of some chronic diseases.

132 | Indicators of Health: Body Mass

Index, Body Fat Content, and Fat
 Figure 2.28 Body Composition
Image by
Allison
Calabrese /
CC BY 4.0

Body Mass Index: How to Measure It and Its

Limitations

Body mass index (BMI) is calculated using height and weight

measurements and is more predictive of body fatness than weight
alone. BMI measurements are used to indicate whether an
individual may be underweight (with a BMI less than 18.5),
overweight (with a BMI over 25), or obese (with a BMI over 30).
High BMI measurements can be warning signs of health hazards
ahead, such as cardiovascular disease, Type 2 diabetes, and other
chronic diseases. BMI-associated health risks vary by race. Asians
face greater health risks for the same BMI than Caucasians, and

Indicators of Health: Body Mass Index, Body Fat Content, and Fat
Distribution | 133
Caucasians face greater health risks for the same BMI than African
Americans.

Calculating BMI

To calculate your BMI, multiply your weight in pounds by 703

(conversion factor for converting to metric units) and then divide
the product by your height in inches, squared.
BMI = [weight (lb) x 703] ÷ height (in)2
or
BMI = [weight (kg)] ÷ height (m)2

More Ways to Calculate

The National Heart, Lung, and Blood Institute and the CDC have
automatic BMI calculators on their websites:

• [Link]
• [Link]
adult_bmi/english_bmi_calculator/bmi_calculator.html

To see how your BMI indicates the weight category you are in, see
Table 2.3 “BMI Categories”.
Table 2.3 BMI Categories

Categories BMI

Underweight < 18.5

Healthy or Normal weight 18.5–24.9

Overweight 25–29.9
Obese > 30.0

134 | Indicators of Health: Body Mass Index, Body Fat Content, and Fat
Distribution
Source: National Heart, Lung, and Blood Institute. Accessed
November 4, 2012. [Link]

BMI Limitations

A BMI is a fairly simple measurement and does not take into account
fat mass or fat distribution in the body, both of which are additional
predictors of disease risk. Body fat weighs less than muscle mass.
Therefore, BMI can sometimes underestimate the amount of body
fat in overweight or obese people and overestimate it in more
muscular people. For instance, a muscular athlete will have more
muscle mass (which is heavier than fat mass) than a sedentary
individual of the same height. Based on their BMIs the muscular
athlete would be less “ideal” and may be categorized as more
overweight or obese than the sedentary individual; however this is
an infrequent problem with BMI calculation. Additionally, an older
person with osteoporosis (decreased bone mass) will have a lower
BMI than an older person of the same height without osteoporosis,
even though the person with osteoporosis may have more fat mass.
BMI is a useful inexpensive tool to categorize people and is highly
correlative with disease risk, but other measurements are needed to
diagnose obesity and more accurately assess disease risk.

Body Fat and Its Distribution

Next we’ll discuss how to measure body fat, and why distribution of
body fat is also important to consider when determining health.

Indicators of Health: Body Mass Index, Body Fat Content, and Fat
Distribution | 135
Measuring Body Fat Content

Water, organs, bone tissue, fat, and muscle tissue make up a

person’s weight. Having more fat mass may be indicative of disease
risk, but fat mass also varies with sex, age, and physical activity
level. Females have more fat mass, which is needed for reproduction
and, in part, is a consequence of different levels of hormones. The
optimal fat content of a female is between 20 and 30 percent of
her total weight and for a male is between 12 and 20 percent. Fat
mass can be measured in a variety of ways. The simplest and lowest-
cost way is the skin-fold test. A health professional uses a caliper to
measure the thickness of skin on the back, arm, and other parts of
the body and compares it to standards to assess body fatness. It is
a noninvasive and fairly accurate method of measuring fat mass, but
similar to BMI, is compared to standards of mostly young to middle-
aged adults.
Figure 2.29 Measuring Skinfold Thickness Using Calipers
Image by
Shutterstock.
All Rights
Reserved.

Other methods of measuring fat mass are more expensive and more
technically challenging. They include:

• Underwater weighing. This technique requires a chamber full

136 | Indicators of Health: Body Mass Index, Body Fat Content, and Fat
Distribution
 of water big enough for the whole body to fit in. First, a person
is weighed outside the chamber and then weighed again while
immersed in water. Bone and muscle weigh more than water,
but fat does not—therefore a person with a higher muscle and
bone mass will weigh more when in water than a person with
less bone and muscle mass.
• Bioelectric Impedance Analysis (BIA). This device is based on
the fact that fat slows down the passage of electricity through
the body. When a small amount of electricity is passed through
the body, the rate at which it travels is used to determine body
composition. These devices are also sold for home use and
commonly called body composition scales.

Figure 2.30 BIA Hand Device

Image by
United
States
Marine
Corps /
Public
Domain

• Dual-energy X-ray absorptiometry (DEXA). This can be used to

measure bone density. It also can determine fat content via the
same method, which directs two low-dose X-ray beams
through the body and determines the amount of the energy
absorbed from the beams. The amount of energy absorbed is
dependent on the body’s content of bone, lean tissue mass, and
fat mass. Using standard mathematical formulas, fat content

Indicators of Health: Body Mass Index, Body Fat Content, and Fat
Distribution | 137
 can be accurately estimated.

Figure 2.31 Dual-Energy X-ray Absorptiometry (DEXA)

“A
Dual-energy
X-ray
absorptiomet
ry (DEXA)
scan” by Nick
Smith / CC
BY-SA 3.0

Measuring Fat Distribution

Total body-fat mass is one predictor of health; another is how the

fat is distributed in the body. You may have heard that fat on the
hips is better than fat in the belly—this is true. Fat can be found
in different areas in the body and it does not all act the same,
meaning it differs physiologically based on location. Fat deposited in
the abdominal cavity is called visceral fat and it is a better predictor
of disease risk than total fat mass. Visceral fat releases hormones
and inflammatory factors that contribute to disease risk. The only
tool required for measuring visceral fat is a measuring tape. The
measurement (of waist circumference) is taken just above the belly
button. Men with a waist circumference greater than 40 inches

138 | Indicators of Health: Body Mass Index, Body Fat Content, and Fat
Distribution
and women with a waist circumference greater than 35 inches are
predicted to face greater health risks.
Figure 2.32 Fat Distribution
Image by
Allison
Calabrese /
CC BY 4.0

The waist-to-hip ratio is often considered a better measurement

than waist circumference alone in predicting disease risk. To
calculate your waist-to-hip ratio, use a measuring tape to measure
your waist circumference and then measure your hip circumference
at its widest part. Next, divide the waist circumference by the hip
circumference to arrive at the waist-to-hip ratio. Observational
studies have demonstrated that people with “apple-shaped” bodies,
(who carry more weight around the waist) have greater risks for
chronic disease than those with “pear-shaped” bodies, (who carry
more weight around the hips). A study published in the November
2005 issue of Lancet with more than twenty-seven thousand

Indicators of Health: Body Mass Index, Body Fat Content, and Fat
Distribution | 139
 participants from fifty-two countries concluded that the waist-to-
hip ratio is highly correlated with heart attack risk worldwide and is
1
a better predictor of heart attacks than BMI. . Abdominal obesity is
defined by the World Health Organization (WHO) as having a waist-
to-hip ratio above 0.90 for males and above 0.85 for females.

Learning Activities

Technology Note: The second edition of the Human

Nutrition Open Educational Resource (OER) textbook
features interactive learning activities. These activities are
available in the web-based textbook and not available in the
downloadable versions (EPUB, Digital PDF, Print_PDF, or
Open Document).

Learning activities may be used across various mobile

devices, however, for the best user experience it is strongly
recommended that users complete these activities using a
desktop or laptop computer and in Google Chrome.

1. Yusuf S, Hawken S, et al. (2005). Obesity and the Risk of

Myocardial Infarction in 27,000 Participants from 52
Countries: A Case-Control Study. Lancet, 366(9497),
1640–9. [Link]
140 | Indicators of Health: Body Mass Index, Body Fat Content, and Fat
Distribution
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