L' NETRITION AND HUMAN NEEDS—1971

 

 

 

HEARINGS

BEFORE THE

SELECT COMMITTEE ON
NUTRITION AND HUMAN NEEDS

OF THE

UNITED STATES SENATE

NINETY-SECON D CONGRESS

FIRST SESSION
ON

NUTRITION AND HUMAN NEEDS

 

PART 10—MICRONUTRIENT SUPPLEMENTS FOR
SCHOOL LUNCH PROGRAM

 

WASHINGTON, D.C., DECEMBER 7, 1971 Q!“ a I I

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NUTRITION AND HUMAN NEEDS—1971

 

 

HEARINGS

BEFORE THE

SELECT COMMITTEE ON
, NUTRITION AND HUMAN NEEDS

OF THE

UNITED STATES SENATE
NINETY-SECOND CONGRESS

FIRST SESSION
ON

NUTRITION AND HUMAN NEEDS

PART 10—MICRONUTRIENT SUPPLEMENTS FOR
SCHOOL LUNCH PROGRAM

WASHINGTON, D.C., DECEMBER 7, 1971

%

Printed for the use of the Select Committee on Nutrition and Human Needs

U.S. GOVERNMENT PRINTING OFFICE
58—854 WASHINGTON : 1972

 

For sale by the Superintendent of Documents. U.S. Government Printing Office
Washington, DC. 20402 - Price 45 cents

SELECT COMMITTEE ON NUTRITION AND HUMAN NEEDS

GEORGE MCGOVERN, South Dakota, Chairman
ALLEN J. ELLENDER, Louisiana CHARLES H. PERCY. Illinois
HERMAN E. TALMADGE, Georgia MARLOW W. COOK, Kentucky
PHILIP A. HART, Michigan ROBERT DOLE, Kansas
WALTER F. MONDALE, Minnesota HENRY BELLMON, Oklahoma
EDWARD M. KENNEDY, Massachusetts RICHARD SCHWEIKER, Pennsylvania
GAYLORD NELSON, Wisconsin ROBERT TAF‘T, .13., Ohio
ALAN CRANSTON, California

KENNETH Sanossnmno, Stan Director

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MICRONUTRIENT SUPPLEMENTS FOR
SCHOOL LUNCH PROGRAM

TUESDAY, DECEMBER 7, 1971

 

Page
Opening statement by Senator Robert Taft, Jr __________________________ 2539
CHRONOLOGICAL LIST OF WITNESSES
Young, Alan, Research Administrator, Research and Development Division,
A. H. Robins Co.: chairman, board of directors, Vitamin Information
Bureau ___________________________________________________________ 2540
White, Dr. Joseph M., nutritional and medical consultant, Miles Labora-
tories _____________________________________________________________ 2541
Briggs, Dr. George, professor of nutrition, University of California at
Berkeley:
Prepared statement of ____________________________________________ 2545
Graham, Dr. George G., professor of nutrition and associate professor of
pediatrics, The Johns Hopkins University __________________________ 2549
O'Donovan, Dr. Cornelius J., vice president and chief scientific officer,
Miles Laboratories _________________________________________________ 2555

 

APPENDIXES

Appendix 1. Material submitted by the witnesses 2
From Dr. Joseph M. White:
Table on composite of dietary intake surveys published 1950—68-- 2579
Appendix A—Joint industry findings on the nutrition status of

the US population _________________________________________ 2579
Appendix B—Analysis of the need for dietary supplements among

children based on the latest report on the nutrition survey _____ 2008
Opinion from the law firm of Kirkland-Ellis, Washington, D.C____ 2010

Appendix 2. Material from other than witnesses:
From Paul A. Lachance, associate professor of nutritional physiology,
Rutgers University, letter of December 17, 1971 ___________________ 2615
Appendix 3. Articles of interest:
Previous to the hearing:
The Des Moines Tribune, November 17, 1971:
School Goal: No “Candy Lunch" ___________________________ 2617
Subsequent to the hearing:
The Baltimore Sun, December 8, 1971:

Nutrition Wafers Get Senate Test _________________________ 2619
The Montgomery ( Ala.) Advertiser, December 8, 1971 :

Universay Malnutrition in America ________________________ 2620
The Washington Post, December 8, 1971:

Vitamins As Candy Wafers? ______________________________ 2620

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MICRONUTRIENT SUPPLEMENTS FOR
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TUESDAY, DECEMBER 7, 1971

US. SENATE
SELECT COMMITrEE 0N
NUTRITION AND HUMAN NEEDS
Washington, 0.0.

The Select Committee met at 10 :08 a.m., pursuant to call, in room
1318, of the New Senate Oflice Building, the Honorable Robert Taft,
J r., presidin .

Present: enator Robert Taft, Jr.

Staff members present: Gerald S. J. Cassidy, general counsel; and
Elizabeth P. Hottell, minority professional staff.

Senator TAFI‘. The meeting Wlll come to order.

OPENING STATEMENT BY SENATOR TAFT

Senator TAF’I‘. The purpose of today’s hearing is to explore the nu-
tritional needs of Americans, especially of our young people, and to
look at the addition of vitamin and mineral supplements to our
School Lunch Program as a possible solution in terms of both effec-
tiveness and economy.

The committee is interested in discovering the extent of micro-
nutrient deficiencies and changes in dietary trends across the Nation.
It is important to look at vitamin and mineral deficiencies in terms of
economic as well as nutritional costs. I believe that some of the testi-
mony to be presented this morning will address itself to those impor—
tant questions.

There are 25 million students now participating in School Lunch
Programs. The possibility of expanding the Type A, basic lunch, to
include a dieta supplement. containing 100 percent of the recom-
mended daily al owances of vitamins and minerals certainly deserves
the careful attention of this committee. I look forward to hearing the
panel describe in detail the progress that has been made in developing
such a dietary supplement.

I would like to take this 0 portunity to welcome our four dis—
tinguished witnesses this morning. Dr. George Graham, MD. of the
School of Hygiene of Johns Hopkins University; and the anel rep-
resenting the Vitamin Information Bureau: Alan Young, a ministra-
tor of the Research and Development Division, A. H. Robins Com-
pany; Dr. Cornelius O’Donovan, vice-president, Scientific Afl'airs,
Miles Laboratories; and Dr. Joseph White, consultant to Miles
Laboratories, Inc.

I believe Mr. Young is going to begin this testimony.

(2539)

2540

STATEMENT OF ALAN YOUNG, RESEARCH ADMINISTRATOR, RE-
SEARCH AND DEVELOPMENT DIVISION, A. H. ROBINS COMPANY;
CHAIRMAN, BOARD OF DIRECTORS, VITAMIN INFORMATION
BUREAU

Mr. YOUNG. I am Alan Young, chairman of the board of directors
of the Vitamin Information Bureau. This morning I am accompanied
by Dr. Joseph M. \Vhite, nutritional and medical consultant to Miles
Laboratories, Dr. George G. Graham, professor of Nutrition and As-
sociate professor of Pediatrics. The Johns Hopkins University, Dr.
Cornelius J. O’Donovan, vice president and chief scientific officer of
Miles Laboratories, Daniel Johnson, associate counsel, Miles Labora-
tories, and Mrs. Margaret Markham, executive director of the Vitamin
Information Bureau.

VITAMIN INFORMATION BUREAU

Since its establishment in 1967, the Vitamin Information Bureau
has worked to obtain, collect and disseminate to members of the gen-
eral public, industry, professions, public health authorities and educa-
tional institutions information as to the quality, purposes. uses and
effects of vitamins and minerals and their relation to nutrition and
health. The members of the Vitamin Information Bureau are manu-
facturers of dietary supplements, and foods for special dietary uses
as well as their components.

EXPAND PROGRAM TIIROUGII VITAMIN SUPPLEMENTS

On behalf of the Bureau, I was pleased to accept the committee’s
invitation to appear here today as a coordinator of this panel of ex-
perts to explore with you the potential for expanding the benefits of
the national School Lunch Program through addition of dietary sup-
plements of vitamins and minerals. We are convinced that dietary
supplements offer a practical and immediate solution to the serious
public health problem of malnutrition which our country’s children
presently face.

During the past quarter century the national School Lunch Program
has evolved to become an important. force in providing adequate nu-
trition for America’s children. Today, by furnishing nutritious meals
to some 25-million youngsters, the School Lunch Program not only
contributes importantly to the health of America’s youth but also
through good example does much to teach sound eating habits. None-
theless, it is recognized by advocates of the now-pending Child Nutri-
tion Act of 1971 that the full potential for the School Lunch Program
has not yet been fully realized.

There is no question that the School Lunch Program as it presently
exists and operates, has been an immense value in bringing about nu-
tritional improvement of children in economic need. However, it is be—
coming more and more evident that even in the affluent segments of
society large numbers of people—including children—remain in nutri-
tional need. This is particularly true with respect to vitamins and
minerals.

2541

Since this nutritional need is not confined to the economically un-
derprivileged, we believe that the School Lunch Program could and
should be expanded. The potential of additional legislative authorlty
notwithstanding, we are convinced that there can be importatnt pro-
gram growth within the existing statutory framework.

V ITAMIN AND MIXERAL INCREASES NEEDED

This morning we would like to develop for the Committee the evi-
dence demonstrating the need for increased amounts of vitamins and
minerals in the diets of our children. Then we will present testimony
on the changing American diets which will help to explain the facts
revealed by nutrition status surveys. Finally, we will explain how
vitamin and mineral supplements can provide an immediate and eco-
nomical effective solution to the problem of providing all children at
once with the proper balance of vitamins and minerals.

At this point, I’d like to call on Dr. White, who will summarize the
statististical evidence which demonstrates the compelling need for an
immediate mechanism for providing additional vitamins and minerals
in the diets of the children of our country. Dr. thite?

lSenator TAFT. Thank you. We will be pleased to hear from Dr.
lV lite.

STATEMENT ‘OF DR. JOSEPH M. WHITE, NUTRITIONAL AND
MEDICAL CONSULTANT, MILES LABORATORIES

Dr. WHITE. Thank you, Mr. Young. Thank you, Senator Taft. Mr.
Chairman and members of the committee; in my capacity as consult-
ant on nutrition to Miles Laboratories, together with my colleagues at
Miles, I maintain a thorough and continuous survey of the published
literature concerning the nutritional status of American population
groups. This morning I Would like to summarize the available infor-
mation on nutritional status as it applies to children in order to pro-
vide you with a basis for judging the need for additional sources of
vitamins and minerals in children’s diets.

NU'I‘R [T10 NAL STATUS OF C IIILDRE N

Nutritionists are in general accord that the optimum manner for
evaluating the nutritional status of any particular child is to take a
dietary intake history, make biochemical analyses of numerous body
substances. and conduct a clinical investigation of the child’s health.
Unfortunately, performing such an investigation involves a tremen-
dous expenditure of time, talent and money and perhaps most im-
portantly. it can validly represent the status of a particular individual
for only a brief period of time. Consequently, most nutritional status
investigations must he performed on an epidemiological basis wherein
a statistical blend of dietary histories and limited laboratory and clini-
cal analyses are used to give an indication of population or group
nutritional status or risk. “Then such data drawn from sufficiently
large population segments are considered as a Whole. they provide
reliable evidence as to nutritional status. Thus, from a public health

2542

standpoint, such evidence is highly significant and especially so when
the same data are collected and analyzed at repeated intervals.

The most comprehensive survey of dietary intake in the United
States was conducted by the Department of Agriculture in 1965. The
Department of Agriculture has published a report of household food
purchases based on a sample which was both large and re resentative
of all United States housekeeping families. This survey investigated
purchases of calories, protein, calcium, iron, vitamin A, thiamine,
rlboflavin and ascorbic acid.

.The standard for comparison used by USDA is the Recommended
Dletary Allowances established by the National Academy of Sciences
National Research Council Food and Nutrition Board. The Board
states that, “These allowances are intended to serve as goals for plan-
ning food supplies and as guides for the interpretation of food con-
sumption records of groups of people.’H The Recommended Dietary
Allowances (RDA) are “those that, in the opinion of the Food and
Nutrition Board. will maintain good nutrition in practically all
healthy persons in the United States.” ‘ Within the limits of scientific
knowledge. these allowances generally include a “margin of safety.” 3

The USDA found that half of the households surveyed failed to
purchase diets sufiicient to provide the Recommended Dietary Allow-
ances for each of eight nutrients surveyed, as listed above. which, of
course. are but a few of the nutrients essential to health. Fully one—
fifth of the households purchased diets that provided less than two—
thirds of these allowances for one or more of the nutrients‘ in the
survey.

The USDA household survey found that there were few differences
in results among the various geographic regions of the country. Simi-
larly, the overall results did not vary greatly between urban and rural
households. At each successively higher level of income a greater per-
centage of the households purchased diets that fully met the allow—
ances. However. high income itself did not insure good diets. because
more than one-third of the households with incomes of $10.000 and
over had diets that were below the Recommended Dietary Allowances
for one or more of the nutrients that were surveyed.5

PERCENTAGE or INADEQUATE DIETS RISE

Perhaps the most alarming finding of the 1965 USDA household
survey was that the percentage of diets which failed to meet the allow-
ances had increased since 1955. when a similar survey had been con-
ducted. While the 1965 survey found that 50 percent of the households
surveyed failed to meet the allowances for all nutrients considered, in
1955 this percentage was 40 percent. Thus. during the decade between
these surveys there had been a 25 percent increase in the percentage of
families which purchased diets that failed to provide the Recom-
mended Dietary Allowances.6

1WAS—NRC Food and Nutrition Board. Recommended Dietary Allowances. “Purposes
aanLriiéended Uses", NAS Pub. No. 1694 (1968).

3 Ibid.

(1;;LS‘DA, “Dietary Levels of Households in the United States, Spring 1965", ARS 62—17
aUSDA Household Survey. supra note 4. p. 3.
0 USDA Household Survey, supra. note 4, p. 4.

2543

This is also a very significant finding. All of the problems of estab-
lishing and validating standards notwithstanding, if one performs the
same analysis at two periods in time and observes a deterloratlon 1n
the quality of diet, then he must conclude that the observed downward
trend is a real one.

The above information, of course, applies to the purchases of the
family group and does not tell us specific information about the 1ntake
of children in these families. Also, during 1965, however, the Depart-
ment of Agriculture conducted a survey of the food intake of 1n-
dividuals. This also was based on large and representative samples of
the United States’ population. This survey furnished evidence showmg
which groups of individuals within households and within the popula-
tion as a whole are most likely to fail to consume diets which prov1de
the Recommended Dietary Allowances.

The Department of Agriculture report indicated that for some age
groups of children the average daily intake among the group was less
than the Recommended Dietary Allowances for calcium, iron, vitamin
A, and thiamine.7 When an average intake level among a group is
below the Recommended Dietary Allowances it is inevitable that a
large number of children fail to get sufficient amounts of the vitamin
or mineral in question. Even in those cases where group averages are
above the allowances, it does not mean, however, that each individual
systematically receives all of these micronutrients he may need. We
hypothesized that in all probability even where averages are above
those allowances, many individuals would still fail to meet them.

To test this hypothesis Miles Laboratories, using the technical ex-
pertise of Arthur D. Little Company, commissioned a review of the
results of nearly all of the dietary intake surveys ublished in the
United States between 1950 and 1968. The results 0 this review are
consistent with our theory on the implications of the USDA average
intake figures; namely, that even where average group intake was
above the allowances a substantial percentage of the group failed to
achieve them.

LACKS RECOMMENDED DIETARY ALLOWANCES

The data resulting from this analysis that applied to children are
summarized in the table that is included in the testimony that will be
submitted for the record.8 We can see by lancing at the table that in
all the age groups we are interested in to ay, that is those who would
participate in the School Lunch Program, there are significant num-
bers of children who fail to get the Recommended Dietary Allowances
of the nutrients for which data are available; namely, vitamin A, thia-
mine, riboflavin, iron and calcium.

This statistical conclusion is also supported by the concensus of pro-
fessional nutritional opinion. Over a period of 2 years, the Food and
Drug Administration conducted extensive hearings on foods for spe-
cial dietary uses which include all foods offered for the specific pur-
pose of providing vitamins and minerals.”

7USDA, “Food Intake and Nutritive Value of Diets of Men, Women, and Children in the
United States, Spring 1965,” ARS 62—18, table 2A (1969).

9 See Appendix 1. Table 1, p. 2579.

9 Hearing on Foods for Special Dietary Uses, Dkt. No. FDC—78 (1968—1970).

58—854—72—pt. 10—2

2544

During the course of these hearings the nutritional status of the
United States’ population was given a more complete and systematic
public examination than at any previous time in our Nation’s history.
Based on evidence such as that outlined above and on the Opinions ex—
pressed by their colleagues. 27 of our country’s leading nutritionists
and physicians concluded that substantial segments of the United
States’ population, including,r children, consumed diets which did not
provide them with adequate amounts of vitamins and minerals. Ap-
pendix A10 presents a detailed discussion of this disturbing picture
developed during the course of these hearings before the Food and
Drug Administration.

The above information demonstrates that on a qualitative basis, the
children of our country would benefit from an additional source of
vitamins and minerals in their diets. As in all cases. there is difficulty
in quantifying the percentage of children who would benefit directly
from such an addition. However, I can provide a conservative estimate
based on the preliminary biochemical data which have been published
by the National Nutrition Survey}1 These results reflect nutritional
status in respect to only four of the many vital vitamins and minerals;
namely. iron. vitamin A. vitamin C, and riboflavin.

The fact that some inadequacies were found with respect to each of
these four nutrients does not imply adequacy in all other cases. As
you know, the National Nutrition Survey has not yet reported results
for all of the nutrients examined and, of course, the budgetary and
technological limitations with which the survey had to deal prevented
the evaluation of many other nutrients.

CHILDREN WOULD BENEFIT FROM NUTRIENT SUI’PLEMENT

The above limitations notwithstanding, I feel that I have been able,
based on these data, to estimate the percentage of children which
would benefit from a dietary supplement of iron, vitamin A, vitamin
C and riboflavin. In making these calculations, a complete examination
of which is included as Appendix B,12 I have assumed that the bio-
chemical inadequacies found were of dietary origin and I believe this is
a reasonable assumption to make. Based on this assumption, I have
computed the following which shows the percentage of three age
groups which would benefit from the routine consumption of dietary
supplements containing these four vitamins and minerals: in the age
group zero to 5, 49 percent; in the age group 6 to 9, 42 percent; in the
age group 10 to 16, 39 percent.

Now, when I say that as much as one-half of the children would
benefit from a supplement containing these four nutrients, I must
make some further commentary. There is a substantial difference be-
tween a biochemical inadequacy such as that reported by the National
Nutrition Survey and a frank nutritional deficiency disease such as
scurvy. Populations exhibiting numerous biochemical deficiencies but
not clinical signs are customarily described as being “at risk.” which
means that any dietary worsening or other stress could result in the
rapid appearance of frank clinical signs and symptoms.

W See Appendix 1, p. 2579.
11 HEW. “Ten-State Nutrition Survey in the United States. 1908—1970". April 197].
12 See Appendix 1, p. 2008.

2545

IMPROVED NUTRITION AIDS SCHOOL PERFORMANCE

The nature of the effects on children resulting from what some call
“subclinical” inadequacies of vitamins and minerals is a subject which
is now being studied in a number of quarters. At the present time it
is certainly fair to say that conclusive results have not been obtained.
However, there have been a number of reports indicating direct im-
provement in school performance as a consequence of improved nu-
trition.13 I am sure it will be a number of years before the full implica-
tions of such deficiencies are completely understood.

However, in the meantime it seems obvious to me that we must not
wait to act until the entire picture is made clear when we have the
ability to remove the problem so readily and so completely. lVe would
certainly hate to learn at a later date that we had permanently harmed
many of our children due to a failure to act. With the indications and
knowledge we have today we have the responsibility to act and remove
them. This responsibility is all the more clear when the solution is as
modest in cost and as effective in result as that which Dr. O’Donovan
will propose here today. Thank you, sir.

Senator TAFT. Thank you very much and I note, Dr. thite, that
you have a rather extensive appendix attached to the material that
you have presented here this morning. Without objection, that will
be included into the record.” Thank you.

Dr. “7111112. Thank you.

Mr. YOUNG. We would have liked, Mr. Chairman, to have with us
this morning Dr. George Briggs, Professor of Nutrition, University
of California at Berkeley. As you are doubtless aware, Dr. Briggs is
one of the country’s leading nutrition educators and a leading propo-
nent of the concept of expanded School Lunch Programs. Unfortu-
nately, Dr. Briggs was unable to appear before you today but he (lid
prepare a written statement which I would like to offer for the record
at this time.

Senator TAF’I‘. Without objection, Dr. Briggs’ statement will he in-
cluded in the record at this point.

PREPARED STATEMENT OF GEORGE ll. BRIGGS

I would like to express my appreciation to the committee for allowing me to
place on the record my thoughts concerning the proposed expansion of the
National School Lunch Program to include dietary supplements of vitamins and
minerals. Since this is a matter about which I feel very strongly, I deeply regret
that prior commitments rendered it impossible for me to appear before you
personally.

As the members of the committee are only too aware. we are unfortunately
faced at the present time with rather widespread malnutrition in our country.
This committee has done a great deal to bring this problem to the attention of
the general public and to stimulate the government to provide the type of over—
all leadership that is essential if all Americans are to enjoy good nutrition.

Whereas people are beginning to become aware that we have a significant
malnutrition problem in this country, few understand its vast economic impact.
I use malnutrition in this sense to mean the repeated failure to consume a proper
balance. neither too little nor too much, of all the micronutrients—vitamins and
minerals and the macronutrients—proteins, carbohydrates and fats which are
known to be essential for human life.

 

1“ Fart. Latham et 111.. “The Effects of Malnutrition on Intellectual Development and
Learning". J. Pub. Health 61, pp. 1307—24 (1971) : Tndhunter, “School Feeding from a
Nutritionist's Point of View", Am. J. Pub. Health 60 :2302—2306 (1970). ‘

14 See Appendix 1, pp. 2519—2610.

2546

Speaking qualitatively, some of the ways in which such malnutrition appears
include: nutrient deficiencies, high incidences of anemia, increased frequency
of infection, underweight, overweight, severe dental problems, retarded growth,
fetal problems in pregnancy, and problems with infants, shorter life spans, and
behavioral and even mental problems. Other diseases such as diabetes and heart
disease have a close association with malnutrition. These are not problems which
are limited to any one particular social or economic stratum but rather have
been shown by reliable data to affect the rich and poor alike.

I have attempted to compute a preliminary estimate of exactly what mal-
nutrition and related diseases cost our society per year. My estimate is that the
cost to society associated with these nutrition related problems approximates
$30 billion a year. This includes not only the cost of treating the manifest prob-
lems but also reflects the cost of absenteeism from work and school and the
cost of managing behavioral and mental problems.

At a level of $30 billion a year, nutrition related costs equal about 14 of our
total annual food bill and nearly 1/2 of our total health care costs. This figure
is also more than 6 times the cost of providing all of our children a good school
lunch. Clearly malnutrition is a problem of tremendous significance in our
society.

To answer the question of why so much malnutrition occurs, we must look
at what people eat and do not eat. To facilitate this I have performed an analysis
of the United States Department of Agriculture data on food consumption
which are published in the Department’s pamphlet, “National Food Situation.”

I made calculations which reveal how much of various types of foods, on a dry
weight basis, the average American ate during 1970. Dry weight basis was used
so that all foods could be compared without the interfering factor of their vary-
ing water content. To help make my point about the good and bad aspects of the
American diet I have divided the foods into two groups of commodities. One of
these I have termed “Poor Value Foods” and the other, “High Value Foods.”
Poor Value Foods are those which are high in calories and contain relatively
little protein and few, if any, vitamins and minerals. Those which I call High
Value Foods may be rich in protein but do carry either a wide variety or goodly
quantities of vitamins and minerals.

The following table shows the average consumption per person of Poor Value
Foods during 1970.

Poor Value Foods: Pound-9 in 1970
Table sugar ________________________________________________________ 102
Fats and oils‘ _____________________________________________________ 53

‘This includes margarine, shortening, lard, butter, and cooking and salad oils—not the
fat normally present in natural foods.

 

White flour _______________ - ________________________________________ 88
Corn sugar (dextrose) ______________________________________________ 14
Milled rice _________________________________________________________ 7

Total pounds ____________________________________________________ 264

One way of characterizing these data is to say that the average person in the
United States this past year consumed more than his weight in white flour and
table sugar.

The next table shows the average per person consumption during 1970 of those
commodities which I have termed High Value Foods:

High Value Foods: Pounds m 1970
Meat (beef, pork, sheep) ____________________________________________ 74
Poultry ___________________________________________________________ 15
Fish ______________________________________________________________ 3
Eggs ______________________________________________________________ 14
Milk ______________________________________________________________ 34
Cheese ____________________________________________________________ 7
Ice cream __________________________________________________________ 5
All fruits __________________________________________________________ 18
Potatoes __________________________________________________________ 25
Vegetables (all others) _____________________________________________ 24
Whole cereals ______________________________________________________ 21
Peanuts, beans, others _______________________________________________ 18

Total pounds ___________________________ - -- - - _____________________ 259

2547

Note that there is no category of High Value Foods whose average intake even
approaches the 116 pound average intake of sucrose plus dextrose.

The average total annual consumption per person of the Low Value Foods is
264 pounds—slightly more than the average consumption of High Value Foods—
which is 259 pounds. Thus, on the average more than half of what we eat is
severely inadequate in terms of its vitamin and mineral content. Of special con-
cern is the fact that the situation seems to be getting worse rather than better.

I am a firm believer that the School Lunch Program can play an important
role in minimizing the risk of malnutrition. As you may be aware, I am among
those who endorse the concept of the Universal School Lunch Program. How-
ever, there are other types of expansion within the School Lunch Program which
can be of value also.

For quite some time now I have held the opinion that it is vital that the
School Lunch Program provide vitamins and minerals at the level of the Food
and Nutrition Board’s Recommended Dietary Allowances, and with supplements
the program can be extended to insure this. In fact, I would like to place on
the record an abstract from my direct testimony before the Food and Drug Ad-
ministration’s hearings on foods for special dietary uses which were concluded
this past year:

I think that if you have a group of school children to whom you are
giving a nutritious school lunch designed to provide one-third of the
RDA, but you have no control over what, if anything, these children
eat for breakfast and supper, it would make good nutritional sense to
give them an RDA-level vitamin and mineral supplement with their
lunch to make sure that they got at least recommended levels of vita-
mins and minerals every day. WD—46-Briggs, pp. 28—29 (March 25,
1970).

I am very pleased to see that the food industry has taken the initiative
and followed through on this suggestion to the point Where at least one of its
members is now prepared to offer a feasible program to provide supplements for
the school lunch. I think this is a good example of industry‘s ability and willing-
ness to respond to the demonstrated need of our citizens for improved nutritional
status. I urge the committee to support this concept for expanding the School
Lunch Program and to use its influence to facilitate rapid implementation of
this beneficial proposal.

Mr. YOUNG. And with your permission, I would like to summarize
certain portions of Dr. Brlggs’ statement for It contains data which
are an integral part of the picture whlch we seek to develop tlus
morning.

Senator TAFT. We would be glad to have you do so, Mr. Young.

PROBLEM or MALNUTRITION

Mr. YOUNG. In his statement, Dr. Briggs has observed that there
is a growing awareness that we have a significant malnutrition prob—
lem in this country and few understand its vast economic impact. Dr.
Briggs defines malnutrition as the repeated failure to consume a pro er
balance, neither too much nor too little, of all the micronutrients; t at
is, the vitamins and minerals and the macronutrients; that is, the
proteins, carbohydrates and fats which are known to be essential for

uman life.

Speaking qualitatively, some of the ways in which such malnutri-
tion appears include: nutrient deficiencies, high incidences of anemia,
increased frequency of infection, underweight, overweight, severe den-
tal problems, retarded growth, fetal problems in pregnancy, and prob—
lems with infants, shorter life spans and behavioral and even mental
problems. Other diseases such as d1abetes and heart disease have a
close association with malnutrition. These are not problems which are

2548

limited to any one particular social or economic stratum but rather
have been shown by reliable data to affect the r1ch and poor alike.

COST OF NU'I'RITION-RELA'I‘ED DISEASES

Dr. Briggs has attempted to compute a preliminary estimate of ex-
actly what malnutrition and related diseases cost our society per year.
He estimates that the cost to society associated with these nutrition-
related problems approximates $30 billion a year. This includes not
only the cost of treating the manifest problems but also reflects the
cost of absenteeism from work and school and the cost of managing
behavioral and mental problems.

At a level of $30 billion a year, nutrition-related costs equal about
one fourth of our total annual food bill and nearly one half of our
total health care costs. Dr. Briggs estimates further that this figure is
also more than six times the cost of providing all of our children a good
school lunch. Therefore, malnutrition is a problem of tremendous sig-
nificance in our society.

To answer the question of why so much malnutrition occurs, we
must look at what people eat and do not eat. To facilitate this, Dr.
Briggs performed an analysis of the United States Department of
Agriculture data on food consumption which are published in the
Department’s pamphlet, “National Food Situation.”

His calculations reveal how much of various types of foods, on a
dry-weight basis, the average American ate during 1970. I must em-
phasize that these are dry—weight values—all water having been re-
moved. Dry weight basis was used so that all foods could be compared
without the interferring factor of their varying water content. To
help make this point about the good and bad aspects of the American
diet, Dr. Briggs divided the foods into two groups of commodities.
One of these he termed “Poor Value Foods” and the other, “High
Value Foods.” Poor Value Foods are those which are high in calories
and contain relatively little protein and few, if any, vitamins and
minerals. Those which he calls High Value Foods may be rich in pro-
tein but also includes those that carry either a wide variety or goodly
quantities of vitamins and minerals.

The following table shows the average consumption per person of
Poor Value Foods during 1970. He lists table sugar, 102 pounds; fats
and oils, 53 pounds; white flour, 88 pounds; corn sugar, 14 pounds;
and milled rice, 7 pounds, for a total of 264 pounds.

One way of characterizing these data is to say that the average per-
son in the United States this past year—that is, 1970—consumed more
than his weight in white flour and table sugar.

The next list summarizes the average per—person consumption dur-
ing 1970 of those commodities which Dr. Briggs terms High Value
Foods: Meat, including beef, pork and lamb, 74 pounds; poultry, 15
pounds; fish, 3 pounds; eggs, 14 pounds; milk, 34 pounds; cheese, 7
pounds; ice cream, 5 pounds; all fruits, 18 pounds: potatoes, 25

ounds; vegetables, 24 pounds; whole cereals, 21 pounds; peanuts,
eans, others, 18 pounds for a total of 259 pounds.

Note that there is no category of High Value Foods whose average
intake even approaches the 116—pound average intake of sugar.

2549

Dr. Briggs concluded his statement by expressing his support for
extendmcr the School Lunch Program’s effectiveness through the in-
clusmn of dietary supplements of vitamins and minerals.

SOCIETAL PATTERNS OF FOOD CONSUMPTION

It’s not enough to measure the fact that the nutritional status of
people is less than optimum or to explain in competent terms the
reason why. Before we can address ourselves strictly to the resolution
of present nutrition problems, we must discover why people eat the
way they do. To help us in this regard, I would like to yield the floor
to Dr. Graham, who will explain the societal factors leading to the
pattern of food consumption outlined by Dr. Briggs and the implica-
tions which these factors left for our food supply during the coming
decades.

Senator TAFT. We would be glad to hear from Dr. Graham.

STATEMENT ‘OF DR. GEORGE G. GRAHAM, PROFESSOR OF NUTRI-
TION AND ASSOCIATE PROFESSOR OF PEDIATRICS, THE JOHNS
HOPKINS UNIVERSITY

Dr. GRAHAM. Mr. Chairman, ladies and gentlemen; the present day
concern over the nutritional status of our childhood population is
based on some well documented evidence and unfortunately, on some
inflated statements. Three major classes of documentation exist : dietary
surveys, laboratory determinations, and clinical and anthropometric
examinations.

The dietary surveys attempt to determine what foods groups of in-
dividuals are consuming, the amounts and their content of essential
nutrients. This last is compared with the Recommended Dietary Al—
lowances of the Food and Nutrition Board of the National Research
Council. These allowances, with the sole exception of that for calories,
have a considerable safety margin. Thus, an individual might be con—
suming considerably less than the RDA of one or more nutrients and
still be in excellent health.

Another type of evaluation of the diet data from such surveys, but
of considerably less reliability, is an assessment of their content of cer-
tain foods or groups of foods; for example, the basic four foods. Even
when carried out by the most competent professionals, dietary surveys
have many sources of possible error.

Biochemical determinations, when carried out properly are generally
a reliable indicator of the state of nutrition. Some, such as serum al-
bumin or hemoglobin, actually measure an important constituent of
the body with a well—known normal range and a clear understanding of
the significance of deviations. Most of the other determinations, how-
ever, are measuring the concentration in blood or the amount excreted
in urine of a particular nutrient at a given moment. The. significance
of deviations from the normal range is less well understood, lending
itself frequently to erroneous interpretation.

Measurements of height, weight and other body dimensions must be
related to proper standards and must take into account genetiddifl'er-
ences. When applied to groups of children, these anthropometrlc data
are of great usefulness. Clinical examinations for evidence of a spe-

2550

cific nutrient deficiency yield significant data in populations where mal-
nutrition is rampant. They are disappointing when used in populations
where malnutrition is only marginally present.

The PROBLEM IN THE UNITED STATES

Surveys carried out in the United States during the past decade do
show a deterioration in the micronutrient content of the diets of many
groups, particularly the poor, the adolescent, the pregnant and the
elderly. This is particularly notable for iron, calcium, vitamin A and
ascorbic acid. If this trend is to be checked, attention must first be given
to its causes.

ETHNIC GROUPS

For certain groups, especially the American Indian, the Mexican-
American and the Puerto Rican, a most important factor is the dis-
ruption of traditional patterns of food consumption caused by incom-
plete adaptation to a new way of life. Time and, to a certain extent,
nutrition education might correct the deficiencies encountered but
this is doubtful at best. Fortification of traditional foods, or supple-
mentary items would almost certainly prove of greater value until
necessary improvements in social and economic status make possible
a more permanent solution.

THE ELDERLY

For the elderly, the problem is usually of a more tragic origin.
Forced by our social mores to live by themselves they are no longer
motivated to buy, prepare and serve the traditional foods they know
or to clean up afterwards. In many cases, they are unable to chew
these foods. As a result, they turn to the consumption of baby and
junior foods, pastries and beverages. No amount of nutrition education
will solve their problem. They know what the classic concept of a
balanced meal is. They need a whole new generation of fully fortified
convenience foods tailored to their likes and capabilities, both physical
and economical. Better still, we should take them back into our homes
where they belong.

PREGNANT WOMEN

The poor diets of many pregnant women are causing considerable
preoccupation today because of the possible ill effects on their unborn
children. To a very great extent, this is a problem of teenage mothers
who are themselves not yet fully grown. Forty percent of first born
infants in this country are delivered by girls 19 years-of-age and

ounger. Poor eating habits are not corrected during pregnancy, some
because of poverty and ignorance, others because of medical restric-
tions and many more because of deeply entrenched habit.

INFANTILE MALNUTRITION

Infantile malnutrition is not an uncommon problem in this country
but is almost invariably the result of profound social problems, with a
major deficiency being one of adequate mothering.

2551
ADOLESCENTS

Elementary school children and adolescents are our concern here to-
day. Numerous surveys have shown a significant percentage of these
children are consuming diets which are considered anywhere from mar-
ginally deficient to atrociously so, depending on the point of View.
‘thn compared to the traditional pattern of foods and meals as most
of us know them, the species is faced with extinction. \Vhen compared
to the Recommended Dietary Allowances of nutrients, most of these
diets are adequate, but many of them barely so, and quite a few are
deficient, particularly in ascorbic acid, vitamin A, calcium, and iron.

Laboratory determinations of nutrient levels frequently correlate
poorly with the results of dietary surveys. In one important study
from Nebraska, it was shown that the regular consumption of vitamin
supplements was making up for the dietary deficiencies and correcting
the biochemical indices. Other studies have suggested that the blood
level of many nutrients is dependent on factors other than the con—
sumption of those very same nutrients. Important is the fact that
the RDA’s are set high and that the great majority of the deficient
levels of intake are still adequate to maintain normal or near normal
biochemical indices and apparent, good health. Still, many of these
people may be at risk.

Thus, there is no biochemical or clinical evidence of calcium defi-
ciency to match the dietary figures. The problem of iron deficiency and
hypochromie anemia in late infancy is a special one whose causes are
not well appreciated. In fact, the majority of these anemias disappear
spontaneously by school age and only surface again in the teenage girl,
particularly when she becomes pregnant, since she most likely has not
developed adequate iron stores. Biochemical indices do confirm the
low levels of vitamin C intake and, to a certain extent, those of vitamin
A and some vitamins of the B group. In some surveys moderately low
levels of serum albumin confirm the low figures for protein intake.

Anthropometric studies among the poorer sections of our society re-
veal a significant percentage of school age children to be growing at
a rate below the expected norm. Although some of this poor growth
may represent genetic differences, it is almost certain that it represents
inadequacies in the total intake or utilization of calories and protein.

Clinical examinations in school age children are usually nonpro-
ductive. High rates of dental caries are often found, in part the result
of low-fluoride intake, to a greater extent the result of a high consump-
tion of refined sugar. In scattered areas, enlarged thyroid glands re-
sult from inadequate intakes of iodine. The endemic area for this used
to be northern Ohio.

“lith all due respect to some opinion, there is no clinical evidence of
vitamin C deficiency to match the dietary and biochemical evidence,
most probabl because our RDA and our standard of normalcy are set
much too big . Almost exactly the same is true for vitamin A. Signifi-
cant clinical deficiency of any of the B vitamins in school-age children
is a rarity in this country.

59—834—72—~pt. 10—77::

2552

NUTRITIONAL QUALITY or DIETS DETERIORATES

There is little doubt about the deterioration in the nutritional quality
of the diets consumed by a gradually but steadily increasing percent-
age of children from all classes. The great majority consume enough
or too much protein and total calories but a significant number are
growing at rates which suggest inadequacies in total amount of food,
at least by our present standards. In the case of certain nutrients, these
inadequacies are being reflected in biochemical indices but thus far
there is little or no clinical evidence of deficiency.

If the trend continues, we may in the not too distant future begin
to see such clini tal manifestations. It is also probably true that the
regular consumption of vitamin and mineral Supplements by many
children corrects the deficiencies apparent in the diet and normalizes
the biochemical indices.

TREND TO\VARD CONVENIENCE FOODS

Underlying most of the changes being seen in the nature of the diet
is a growing trend toward the consumption of convenience foods. Most
young people, and with good reason, do not see why we make such a

ig production of our meals. They want something that they like, re-
gardless of how monotonous it may seem to us, something that is easy
to consume without a whole arsenal of utensils that must then be
washed. They want something that can be consumed in a few minutes
and that does not keep them from other more interesting activities.
They are most receptive to the idea of consuming their vitamins in a
concentrated form without having to bolt down the entire unattractive
package in which nature chose to put them, such as spinach, broccoli,
Brussel sprouts and the like. We are shocked when we find that items
which we like, or were forced to like because of their nutrient content,
are turned down with a “yukk l” even when we know full well that they
are not really necessary anymore. My youngest daughter describes
Orange juice as “hairy.” If it wasn’t for the fact that it was as repulsive
to the giver as to the receiver we might still be forcing cod liver oil into
our children.

This overwhelming trend toward convenience foods is not just a
decision of the children but to a very great extent that of their harried
mothers, glad to be freed from the increasing cost of traditional foods
and the burden of their preparation and serving. This begins with the
complete infant formulas of today, which are nutritionally superior
and yet immeasurably simpler to prepare than the formulas we were
brought up on.

COST or AGRICULTURAL COMMODITIES INCREASES

Let me pause at this point to discuss some of the reasons for the
increasing cost of many agricultural commodities which we think of
as traditional foods. If you look at the individual traditional food
items, you will see that most of them are high-cost items in terms of
production. Some of them, such as meat, involve a high cost in terms
of grazing land. As our population grows, there will be pressure to use

2553

land for other purposes and it will cost more _to keep land available
for cattle grazing. Inevitably, we will see an increased tendency to-
ward moving land from agriculture into “urban” uses.

Secondly, when one looks at traditional foods _he sees that a great
number require large amounts of human labor In their productlon.
This is most evident in the case of fruits and vegetables, where gen-
erally the product must be picked by human hands: For a number of
years, we have relied on having this produce picked by mlgrant
laborers. _

Apparently the maintenance of such a labor force is now incon51stent
with our national conscience. Consequently, we are seeing a movement
toward unionization of farm workers. Inevitably the attaining of this
goal will result in an increasing expense associated with production
of fruits and vegetables. This will mean that persons in the lower-
income strata will find it increasingly more burdensome to purchase
these commodities, and if they have some alternative they will prob-
ably take it.

I might add that as evidence of the trend toward increased cost of
vegetable production in the United States, that at the present time a
substantial fraction of our fresh produce is actually grown in countries
where labor is cheaper than in the United States.

The increased cost of vegetables and other traditional produce may
not be a bad thing. It may be simply that our country has to make
the choice between whether it is going to obtain its vitamins and
minerals from fruits and vegetables or whether it is going to permit
all men to enjoy a higher standard of living than that of the agricul-
tural migrant.

POOR GROWTH RATES AND ANEMIA

There has been little or no scientific evaluation of the nutritional
value of School Lunch Programs. What little has been done thus far
reveals no evidence of improvement in poor growth rates and anemia,
where these are important. Until proper evaluations are carried out
we can only speculate about the possible causes :

1. The total amount of nutrients consumed, being only one-
third of the estimated needs for the day, 5-days a week when
school is in session, may not be enough to correct existing
deficiencies ;

2. Consciously or subconsciously, many of the children who are
fed in school may receive less at home. lVe have seen this in other
countries ;

3. Actual consumption of the food ofl'ered may be very low,
particularly by some of those most in need. This may be because
the meals are made up of unfamiliar and unappealing constituents
dictated on the basis of traditional concepts by individuals of
another age, another race, or another cultural background. There
may be physiologically-based rejection of important items such
as milk by certain racial groups. Last but not least, poor prepara—
tion and presentation may cause rejection;

4. The cause of the 001- growth may not be an inadequate in-
take but incomplete utilization because of extraneous factors such
as infection; and

2554

5. The items chosen or their preparation might result in the
unavallablllty of micronutrlents needed for optimum utilization.

.POSSIBLE SOLUTIONS

The sincere hope of most of our community of nutritionists is that
this increasing problem can be solved by going back to the good old
days of natural foods. bought fresh, carefully prepared and served
with careful attention to the basic food groups, the colors of our vege-
tables and other articles of faith. There are those who yearn for the
general practitioner and the pediatrician who made housecalls, pref-
erably in his horse and buggy. Some would also like to go back to
the. live-in maid, the handyman, the trolley car and other gracious sym-
bols of the past era. They see the School Lunch Program as an impor—
tant. vehicle. for nutrition education, an education based on traditional
foods. This is an impossible dream.

It you will allow me. I‘d like to show you just a few slides. These
photographs were taken, not too professionally. at. the doctors
dining room in the Johns Hopkins Hospital. “'e have a very fine
cafeteria oll'ering a choice of cold foods. ‘

As you see here in the next slide, hot foods, a variety, and generally
well prepared. .

May we have the next slide? This is a typical tray of hot foods, quite
attractive. and you notice in this case, it’s a lady who’s choosing it.

Next slide. This tray is more typical of what we see in the doctors’
dining room. despite the availability of a whole variety of other foods.
It’s a hamburger. a bag of potato chips and a cola drink.

Next slide. This is a group of young interns and residents consum-
ing their hamburgers, potato chips and cola drinks.

Next slide. This is another one. He has a piece of pie and coffee, but
still the hamburger and the potato chips.

Next slide. The tray on the right, which is a hot meal, is being con-
sumed by one of the senior members of the staff who’s in the picture.

Next slide. This is another group. In this case, hot dogs and cola
drinks.

Next slide. That’s it.

This is one of the most highly educated group of young people in
this country. None of them were from less than the upper 2‘percent of
their college class. They all attended top medical schools. most of them
Johns Hopkins. They all know about nutrients and yet they choose the
same monotonous diet day in and day out hamburger, bag of potato
chips. sometimes two bags of potato chips, and cola drinks.

The reasons for this? Part of this is economic. It costs a little less
than the hot meal but to a great extent, it’s a matter of habit and con-
venience. This they eat in a hurry, they are used to it. I am not saying
they eat this way all day. The ones who are married usually go home
to a good dinner, but this trend is a very powerful one. I might add,
we didn’t see a single one of those interns and residents smoking. Not
one in ten smokes cigarettes. They are not dumb.

There should be nutritional education. and it should deal With nu-
trient requirements and the many ways in which they can be met. It
should talk of the hazards of obesity, diabetes. and degenerative

 

2555

vascular disease. It should cover the hazards to the unborn child of
being carried by a mother who is too young, still growing and poorly
nourished for such an im ortant undertaking.

I firmly believe that t e trend to convenience foods is a relentless
one and almost certainly a desirable one, if we recognize its causes
and make certain that these foods are all properly fortified in a bal-
anced manner and take into account the rapidly expanding knowledge
about overnutrition and its consequences. There is much to be done
in the way of nutrition research, technology and regulation. Until all
the existing problems are worked out, we must recognize that we are
in an era of rapid transition. We will have to use temporizing solu-
tions which will hopefully prevent further deterioration of the pres-
ent situation.

Vitamin and mineral supplements added to the school lunch might
be one such expediency and deserves serious consideration. At the
present moment. it may make possible an improvement in the overall
dietary pattern, bringing it closer to being within the Recommended
Dietary Allowances, and an improvement of the biochemical indices
for most nutrients. It might also serve as a temporary protection
against the appearance of clinical deficiencies until such time as more
definitive solutions appropriate to our society and the level of develop—
ment are reached. It should be undertaken only with definite plans
for development of methods of suflicient sophistication which can be
used on a scale large enough to provide meaningful scientific evalua-
tion of its results.

Thank you. Mr. Young?

DEVELOPMENT or DIETARY SUPPLEMENTS

Mr. YOUNG. Several of the companies which are members of the
Vitamin Information Bureau have been investing large amounts of
ingenuity and research resources to develop products which would
provide solutions of the type indicated by Dr. Graham’s presentation
as being needed.

One of these solutions, which offers the advantage of effectiveness.
economy, and immediate availability, is the dietary supplement. At
this time, I would like to ask Dr. O’Donovan. Vice President of Miles
Laboratories, and Mr. Johnson to outline for the committee the rea-
soning of Miles Laboratories in support of using dietary supplements
in the School Lunch Program and the work that Miles has done to
develop an appropriately suited product.

Dr. O’Donovan will also describe various aspects of the prototype
product itself.

Senator TAF'I‘. Dr. O’Donovan.

STATEMENT OF DR. CORNELIUS J. O’DONOVAN, VICE PRESIDENT
AND CHIEF SCIENTIFIC OFFICER, MILES LABORATORY

Dr. O’DONOVAN. Mr. Chairman. ladies and gentlemen; this morn-
ing the previous speakers have discussed scientific data and under—
lying reasons explaining the need for additional sources of vitamins
and minerals in the diets of America’s children. They have also recom-

2556

mended in general terms the addition of dietary supplements to the
National School Lunch Program as being a solution to this end.

Now, I would like to describe for you the analysis of the school
lunch performed by Miles and the product which we have developed
to expand its capability to meet a child’s complete vitamin and mm-
era] needs.

The Type A school lunch is designed to provide approximately one-
third of the Recommended Dietary Allowances for children 10
through 12 years of age. Though there is significant variation, com-
prehensive studies have shown that indeed the Type A school lunch
is widely successful in achieving this objective?“ Although the lunch
successfully meets the objective of providing one-third of the Recom-
mended Dietary Allowances, it does not attempt to make provision for
the total daily micronutrient needs of children.

SUPPLEMENT To PROVIDE DAILY NUTRIENT NEED

This does not represent any shortcoming on the part of the meal
planners; it is a restriction inherent in the use of agricultural food
items as a source of vitamins and minerals. Micronutrients in such
food are tied to calories and bulk. Bulk and satiation limit the amount
of food which can be consumed during any one sitting. Consequently,
there is a limit to the amount of micronutrients which can be supplied
through agricultural foods. Only supplements permit the school lunch
to furnish an umbrella of vitamins and minerals which will meet the
full day’s needs, because they contain little bulk and virtually no
calories.

Another complicating factor facing the administrator of a School
Lunch Program is that of unavoidable micronutrient losses, such as
those pointed out by Dr. Henry Schroeder.“ Losses can occur between
the time food is harvested and when it is delivered to consumers
through delays in transportation and handling. Many foods once proc-
essed are held in storage for long periods of time causing additional
losses. In an institution situation Where food is prepared in a central
kitchen and taken to remote points for consumption, the time and
inethods used in making the food distribution frequently result in

osses.

Finally, there are losses due to plate waste. As we move in the direc-
tion of expanded school feeding programs some of these problems may
increase. However, the use of supplements can prevent any danger that
the children will suffer as a consequence.

Children customarily receive the school lunch during approximately
one-half of the days of the year. Consequently, the School Lunch
Program as now constituted meets only about one-sixth of a child’s
total annual vitamin and mineral needs. Present technology could
enable the program to provide, through dietary supplements, the
Recommended Dietary Allowances of most vitamins and minerals.

There is limited knowledge and virtually no control over what
children eat when not at school. From the data that have been dis—

‘Murphy, “Vitamin Content of Tvpe A School Lunches." J. Am. Dictet Assoc 55 '372
(1969): Murphy, “Major Mineral Elements in T e A S h I L h "I . I
4852!;- 157125139 ”$70). v1 yp c 00 mm es. J Am. Dietet.

i c1roe< er, “ losses of taming and Trace Mineral. R sulti Fr P .~
the Preservation of Foods,” Am. J. Clin. Nut. 241562 (imi). ng om rocessing and

2557

cussed here today, it is known that frequently diets that are selected
by children themselves or furnished to them, lack sufficient amounts
of vitamins and minerals. Dietary supplements of vitamins and min-
erals are intended to insure that the useis obtain recommended
amounts of micronutrients. The reason that vitamin and mineral
supplementation on an insurance basis is useful for all children is
that one cannot with practicality ascertain which children are fail-
ing to meet all their micronutrient needs. There is no specific hunger
for vitamins and minerals as there is for bulk and calories. The hun-
ger for vitamins and minerals is a hidden one.

Miles Laboratories first became interested in the concept of a dietary
supplement for the National School Lunch Program several years ago
through discussions with Dr. George Briggs of the earlier mention,
Professor of Nutrition, University of California at Berkeley and Dr.
Jean Mayer, Professor of Nutrition at Harvard. These gentlemen
suggested that dietary supplements could provide an effective and
highly economical source of micronutrients for use in the School
Lunch Program. Dr. Mayer reiterated his support in testimony be-
fore this committee on October 14* last.

Since that time, Drs. Briggs and Mayer, together with Dr. George
Gr. Graham, who’s with us today, Professor of Human Nutrition and
Associate Professor of Pediatrics, Johns Hopkins University; Dr. Wil—
liam J. Darby, Professor of Nutrition in Medicine, Vanderbilt Uni-
versity School of Medicine; and Dr. David B. Coursin, Director at
Research Institute, St. Joseph’s Hospital, Lancaster, Pennsylvania,
have provided continuing and valuable assistance to us in developing
the concept of supplements for the School Lunch Program.

As I mentioned above, the basic objective of our proposed pro-
gram is to provide a product which would assure that the children
received the Recommended Dietary Allowances for as many vitamins
and minerals as feasible.

The formula which we used as a starting point for our prototype
products was suggested during the Food and Drug Administration’s
hearings on special dietary foods by Dr. W. Henry Sebrell. J r., Past
Chairman of the NAS/NRC Food and Nutrition Board Committee
on Recommended Dietary Allowances. Dr. Sebrell recommended this
formula as being appropriate for use in children’s dietary supple-
ments generally. Its objective would be to provide the Recommended
Dietary Allowances established for children between the ages of 8
and 10.

After consultation with the experts listed above, we arrived at an
adjusted formula which contains the RDA for each of the micronutri-
ents suggested by Dr. Sebrell, with the exception of calcium which we
have not been able to include at more than one-fourth of its Recom-
mended Dietary Allowance level because of the extreme bulk of this
ingredient. Nor has magnesium been included because of its extremely
unpleasant taste characteristics; characteristics which cannot yet be
masked in chewable supplements. Research on this problem is continu—
ing. Finally, vitamin D is provided at one-half of the RDA level in
view of our expectation that most School Lunch Programs would con-

'See Part 9—Unlversal School Lunch Program, hearing of Thursday, October 14, 1971.

2558

tain milk which is usually fortified with this vitamin, and it’s my un-
derstanding that 85 percent of all commercially available milk is forti-
fied with vitamin D. The complete Vitamin/mineral content of our
product will be as set forth in the following table:

Vitamin A ________________________ 3, 500. 0 Units.
Vitamin D _________________________ 200. 0 Units.
Vitamin C _________________________ 40. 0 mg.
B—l Thiamine _____________________ 1. 1 mg.
B—2 Riboflavin _____________________ 1. 2 mg.
Niacinamide ______________________ 15. 0 mg.
B—G Pyridoxine ____________________ 1.20 mg.
Folic Acid _________________________ 0. 1 mg.
d-Calciuln Pantothenate ____________ 5. 0 mg.
Vitamin 13—12 ______________________ 5. 0 mcg.
Elemental Iron ____________________ 10. 0 mg.
Iodine ____________________________ 0. 11 mg.
Calcium __________________________ 250. 0 mg.

No DANGER IN EXCESSIVE CONSUMPTION

A product which provides on a daily basis the nutrients listed above
is a very nutritious one indeed and this, like the commercial supple-
mentswe market for children, is completely safe for routine con—
sumption on a one-nnit-per-day basis. which is what we intend. I am
sure you have heard a number of stories about the hazards resulting
from ingestion of vitamins and minerals in inappropriate amounts and
I can assure you that this product does not present any of those
hazards.

A supplement can contain all the Vitamins and minerals that a child
should have during the course of his daily diet but it will do the child
no good unless the child will consume the product. “’0 have expended
considerable degree of effort to develop a product which will be ac-
ceptable to children and which will reliably provide the mieronutri-
ents which we have listed.

A chewable form has been selected which is palatable to children
and allows us to be very certain that the amount of vitamins and min-
erals contained in this supplement is in fact delivered to the child.
Further, this form emphasizes the food status of the supplement and
its dietary role.

To mask the rather unpleasant taste of some of the nutrient ingredi-
ents, a number of flavors, fruit flavors, were tested and the best of
these are represented in the five product flavors we have here today
to show you. I would like to invite you to try one at this time. Here is
one, Senator Taft. Now, these are not packaged in their finished and
final form. This is just a recommended mock-up type of carton wr-
have been using for the present and you may have a little difficulty
tearing that cellophane wrapper.

As you can see, we have packaged each supplement individually in
a cellophane strip wrapper. And these could be distributed to schools
on a bulk basis with approximately 400 of these wafers to a carton.

2559

ADVANTAGEOUS PRODUCT COST

One of the very strong advantages of using a supplement product
such as the one I have just described. to provide on an immediate
basis the vitamin and mineral needs of children, is its extremely low
cost. Our calculations indicate that we can provide a product in the
form described above at a cost of about a penny per child per day.

Thank you, Senator.

Senator T AFT. Thank you, Dr. O’Donovan.

Mr. YOUNG. Mr. Chairman

Senator T AFT. Yes.

Mr. YOUNG. I hope that we have been successful this morning in
showing the committee that there is a need for increased amounts of
vitamins and minerals in the diets of our children; the reasons why
this need exists; and the value of dietary supplements as an immedi-
ate and appropriate solution to this problem.

Further, I would like to thank you, the committee, for affording
us the opportunity to appear here today. This hearing constitutes
another example of this committee’s outstanding service to the public
in its role as the country’s nutrition conscience. If any of the mem-
bers of the committee would like to ask questions of our panelists, I’m
sure they would be happy to respond at this time and to furnish
any additional information for the record which would be of service
to you.

Senator TAFT. Thank you very much, Mr. Young. Let me first thank
you and all of the Witnesses for their appearances here this morning.
I think it has been most interesting and most helpful in at least get-
ting us started on what might be a rather important basic question
as to whether this type of supplement should be included in the School
Lunch Program.

I have a number of questions for various members of the panel.
Let me begin with Mr. Young.

Mr. Young. could you expand somewhat on the operation of the
Vitamin Information Bureau as to how many members you have:
whether you have a regular publication; what type of research staff
you may have.

Mr. YOUNG. Yes, sir. The Vitamin Information Bureau is a nonprofit
educational organization in nutrition education. As I mentioned earlier,
it was established in 1967. It is supported by eight companies, manu-
facturers of vitamin and mineral products. We have an executive
director, Mrs. Margaret Markham, who is here today. The purpose of
the Vitamin Information Bureau is to provide authoritative informa-
tion on nutrition, which is distributed to the general public or to other
individuals who write in and request the information.

Other individuals include professional people in the field of nutri-
tion; school teachers, public health people. and others. We have re-
ceived requests from just about all walks of life for some of the ma-
terials that we provide.

The medical director is Dr. Elmer L. Severinghaus, who reviews
the materials that we publish, and also there are other consultants who
review the publications for medical accuracy.

Senator TAFT. Thank you very much.

 

3S—854—7277pt. 10 4

 

2560

All of the members of the panel are invited to answer or expand
upon any of the questions. In many instances you may know among
yourselves more appropriately than I which member may best be able
to answer the questions.

This first one is perhaps for Mr. Young. . ' . _

On page 2 of your testimony, you mentlon certain constraints Within
the present program. Would you elaborate on what those constraints
are?

You say, “We are convinced there can be an important program
Within the constraints of the existing statutory framework.”

Mr. YOUNG. I do not believe I said constraints, sir, I have that
struck in my copy and I said, “It is important within the ex1st1ng
statutory framework.” .

Senator TAFT. Then you do not think there are constralnts on
reflection?

Mr. YOUNG. I felt that it would be possible to provide this through
the present, existing statutory framework as a food supplement.

Senator TAFT. That would have been my opinion; that is Why I
asked the question.

Are there any other members of the panel who would like to com-
ment on that?

No RESTRAINTS ON FUNDING PRODUCT

Dr. WHITE. Miles asked the law firm of Kirkland-Ellis here in
Washington to look at this issue and it was the opinion of that firm
that there was no restraint in the law as it now ex1sts to funding this
type of supplement.

Senator TAFT. If you have an opinion to that effect, I think it would
be most welcome for inclusion in the record.*

Dr. WHITE. We would be happy to supply that, Senator.

Senator TAFI‘. Thank you.

Mr. YOUNG. Are those words included in the record '3

Senator TAFT. N o, the are not. I a ologize. I was reading your
statement, I did not note t e correction, i you made it.

Mr. YOUNG. I think possibly this could be an optional item in the
School Lunch Program to be adopted by the States or districts as the
need exists or as they recognize it as a need.

Senator TAFT. Another question, to what extent is there a necessity
for continuous sup lementation of diets in this direction?

In other words, ow frequent] can deficiencies occur in articular
situations? I am not familiar an I am not sure the record 8 ows how
quickly deficiencies in particular vitamins occur. I imagine they vary,
but I would welcome an opinion.

FREQUENCY or VITAMIN DEFICIENCY

Dr. WHITE. All vitamins are classified as to their solubility, those
that are oil soluble tend to build up long—term deposits in the body and
if these deposits are full, the defiCIency will occur only after consider-
able time will have passed.

'See Appendix 1, p. 2610.

2561

On the other hand, there are vitamins which are water soluble. The
reserves of these are more readily eliminated from the body. Among
these would be substances like vitamin C. The history of the discovery
of scurvy and treatment of it with lime juice in the British Navy, tells
us that it was not until man moved off land into a closed system as on
shipboard, where he had extremely limited intake for periods of 6
weeks or more, did the problem develop.

So this gives us some idea of the parameter of time. Of course, to
get an accurate time factor we would have to know where we start.
If the individual were completely saturated with Vitamin C at time
zero, it would take longer than if a person were in a border—line
condition.

This is our concern the biochemical data suggests to us that a lot of
people are in the border—line situation, therefore, the outbreak of frank
clinical signs might be relatively rapid for some persons.

Senator TAF'I‘. It has been pictured as a deteriorating situation in
respect to the surveys and reports that have been commented on here
this morning.

How do you relate those to the apparent continued growth size fac—
tors in articular?

In other words, in View of this situatiOn, how do you fellows explain
the basketball teams and professional football teams and the like?

Dr. GRAHAM. I think I was very careful to point out in my presenta—
tion that the deterioration is not clinical evidence in terms of micro-
nutrients. It is evidence in the composition of the diets and some of
the biochemical indices.

What is alarming is the fact that it is deteriorating and getting
close to the level Where clinical deficiencies might become apparent.

PROBLEM or OVERNUTRITION

I might hasten to add that the biggest nutrition problem in this
country is still overnutrition and that there is good reason to wonder
whether we are doing right in pushing the growth of our children
to its maximum such as in the football player and basketball player.

It may be very desirable in those sports to be big, but almost cer-
tainly for man as a race, it is not des1rable. This must be taken into
account in our nutrition education. Unfortunately, we have been ush-
ing the idea that more is better, and this is not necessarily so. rob-
ably, some degree of balanced undernutrition would be desirable for
most people.

As someone said, I think that two-thirds of the people in this coun-
try should go to bed hungry every night.

N ow, we establish the pattern of eating that leads to obesity and
its complications in later life. We establish that pattern in early child-
hood, and certainly we must take this into account when we are plan-
ning things such as a School Lunch Program.

The idea of balance diets rather than just amounts.

Senator TAF'I‘. Thank you.

Dr. Graham, would you explain h0w the recommended dietary al-
lowances of essential nutrients are arrived at b the National Research
Council and particularly the importance of t e safety margins.

2562

Dr. GRAHAM. In arriving at these, the minimum daily requirement
is established on the basis of scientific balance studies: the smallest
amount that will keep a person in balance and free of clinical de-
ficiency. In making the recommendation, allowance was made for in-
dividual variation, because two individuals of exactly the same age
and size may have slightly different requirements for individual
nutrients.

Then another allowance is made for waste by the body: losses in the
stool, losses in the urine, losses through the skin. A safety margin is
added, which is roughly 30 percent.

Then. variations in size among people is taken into account, so that
for most of the nutrients with the exception of calories, Where it would
not be desirable to put in a safety margin, you end up with figures
that are probably twice the minimum daily requirement.

In answer to your earlier question, we now have a new type of expe-
rience telling us how quickly people become deficient in vitamins. “7e
are doing more and more total intravenous feeding of people. This has
been made possible by new techniques.

BERIBERI FnoM LACK or THIAMINE

If a vitamin is omitted from this mixture, then its deficiency will
become obvious rather quickly. We are dealing with a pure situation
which we know about. Usually the first vitamin deficiency—the first
deficiency to become apparent is thiamine. starting in about 2 weeks.

You give all the calories and proteins he needs and not any thia-
mine. and he will develop beriberi in about 2 weeks. This is usually
the first one.

Senator TAFT. Could you give us a brief explanation of the differ-
ence between macronutrients and micronutrients?

MACRONUTRIENTS AND MICRONUTRIENTS

Dr. GRAHAM. Macronutrients are the building blocks of the diet, pro-
tein being the most important. All cells require protein to be formed
constantly and to be regenerated constantly. Most of the cells in our
body. with the exception of the central nervous system, are broken
down and reformed. This is a key element.

The other major element is calories. It can come from carbohydrates
or fat. It does not make too much difierence to the body which of the
two it comes from. Fat has the ad 'antage of greater calorie density:
you can consume more calories in a smaller amount of food. These are
the primary sources of energy. Even at total rest the. body is consum-
ing. roughly, in the case of an adult, one-third of our calories, just to
stay still. The body’s needs to keep vital systems going require that.

There are requirements for activity and for losses through the skin,
stool and urine; and in children, of course very important, the require-
ments are added for growth.

Senator TAFT. On page 9 of your statement. you made the obser 1 —
tiou that the limited evaluation of the School Lunch Program reveals
no evidence of improvement in growth rates and anemia.

“'hat in your opinion would be the value of vitamin and mineral
supplements in this connection?

2563

VALUE or SUPPLEMENTS

Dr. GRAHAM. I think this is an important deficiency in the School
Lunch Program. We are relying to a great extent on impressionistic
statements about children doing better in school when the school break-
fast or lunch is taken. There has been little measurin of the effect of
the School Lunch Program particular] in those popu ations in which
we do encounter deficiencies in size and hemoglobin.

Senator TAFT. How about the breakfast program ?

Dr. GRAHAM. Again there have been no scientific evaluations that
I am aware of, of the actual nutritional state of the individual. There
are, studies showing the eti'ect of correcting the anemia of the child:
it has effects on his learning potential and attention span in school.
This has not been through the School Lunch Program. This is study-
ing the effect of a child with anemia and one without anemia.

“70. have done a small study in Baltimore in a number of schools
we compared growth throughout the whole school year of children
who were receiving the school lunch and those who were not.

In this population there was a significant number of children that
were below par in size and hemoglobin. lVe could show no effect of
the School Lunch Program in one year.

I enumerated some of the possible causes. One that disturbs me. con-
siderably is how well is it consumed? Food that is not consumed has
no nutritional valne-l1as a nutritional value of zero.

l think it is practically impossible to guarantee an appetizing attrac—
tive school lunch in every school in the country. There is a great deal
of variation. Some are very successful and ut high quality food which
they consume. In others there is a great ( ‘al of wastage.

I think there should be built into the program an evaluation of how
effectively it is consumed, otherwise we are just feeding our consciences.
It may be that this is a factor in why we have not shown the etl’cct
on the growth of the children.

,1 think the most important factor is that elementary-school age is
a period of slow growth anyway, and that spurts, catch—up growth, is
not likely to be impressive at that age as it is in infancy and adoles‘
cence.

()ur evaluation did not include a significant number of adolescents
where we might show better effect.

I expect that the number one factor is probabl poor consumption
and the other is that of course also mentioned y Dr. “'hite—that
the school lunch is 5 days a week, during the days of school, which
is about half the year. And it provides one-third of the recommended
intake for that day.

We have no control over what happens to the rest of the days diet.

In our experience overseas in dealing with the poor, the degree of
poverty is much greater than we ever see in this country. \Vc have
verified the fact that when we provide food for children in any con-
trolled situation, consciously or subconsciously the family withholds
food from that particular child at home on the assumption that he is
getting food elsewhere.

I doubt that that is a big factor, but it is something we must look
into. When we deal with 25—million children, the least we could do
is try to measure how effective we are and what the deficiencies are.

 

 

2564

Senator TAFT. Perhaps more so as we move into the child develop-
ment program and expanding on the day care.

Dr. GRAHAM. Yes, where food may be even a good deal more im-
portant because this is a period of rapid growth, rapid development,
in which food may be more vital.

Senator TAFT. In that connection, is nutrition education then a de-
sirable or vital complement to the use of supplements?

NU'mITIoNAL EDUCATION

Dr. GRAHAM. People look at nutrition education in two different
ways: the traditionalist, the home economist, the dietitian brought
up on the. concept, well founded. of the basic food groups, feels that the
school lunch program is an opportunity to inculcate these ideas into
children.

The children perhaps if given a chance to speak, might say that
under the circumstances the school lunch is used as an opportunity to
force the eating habits of the adults on the children. Very often it
creates rejection.

A poorly prepared traditional meal will often cause permanent
dislike of a particular food item.

NEED FOR “NUTRIENT VOCABULARY”

Nutrition education should be teaching children what nutrients
are, not foods which are sometimes dictated by pressure groups. The
inclusion of certain foods in the “basic four” concept sometimes can
be. seriously questioned as to whether it is nutritionally desirable and
yet we continue to include them and there is a great deal of pressure
to include them.

We should not be teaching foods; meat, vegetables, fruits; we should
be teaching nutrients, proteins, calories, vitamins, minerals and that
these can be obtained in a variety of ways, rather than pushing cer-
tain food groups.

Senator TAF’l‘. Dr. O’Donovan, have you concluded that the sup-
plement is completely safe and if a child is getting 100 percent of the
recommended allowances, would he be harmed in any way by taking
the supplement?

Dr. O’DONoVAN. Senator Taft, we are completely sure of the lack
of harm to the youngster taking these products or these wafers as
planned, i.e. one each school day. _ ' _ . _ .

When one talks about potential for toxmity 1n Vitamins, we are
concerned primarily with vitamins A and D, and then we are con—
cerned only when there is excessive ingestion for protracted periods
of time. of'the order of months. As a matter of fact, in the instance of
vitamin A. toxicity results only after daily dosage of the order of 20
to 30 times the recommended dietary allowances and for periods of 6
to 15 months before symptoms would become manifest. .

The idea of intoxication from an isolated overingestlon seems 1m-
probable. Similarly with respect to vitamin D, While the margin for
toxicity or the therapeutic to tox1c ratio 1s somewhat narrower, 1t

2565

would again be a matter of chronic protracted ingestion over a period
of months, large doses of the order of five or more times the require—
ment, before manifestations would show. These are entirely safe when
used as directed. It was with

Senator TAFI‘. I wonder about your qualification that they must be
“used as directed.” How about excessive use above—maybe a child
can become addicted to it.

 

Eer‘ENCE INDICATES SAFE FORMULA

Dr. O’DONOVAN. I think the problem with Vitamin overdosage A
and D has resulted from overzealous dosing of a child by a misin—
formed or neurotic parent. When in fact, hypervitaminosis A and D
have on occasion been seen in adults, and once again, there were in-
stances of neurotic individuals who were misusing or misunderstood
vitamins and were taking more than they should have, in every in-
stance using horrendously large doses of these vitamins.

Now, iron is an item, that we should give thought to. Certainly it
has been appreciated since a report by Dr. Forbes in the British Medi-
cal Journal in 1947, that the result of ingestion of large amounts of
iron by small children can have adverse consequences and there have
been fatalities.

Every reported case of serious or fatal acute iron poisoning in chil-
dren has resulted from access to adult dose iron formulations such as
those recommended for the mother in the pre- and post-natal period.
These have been, exclusively, medically recommended preparations in
the form of tablets freely available to the public without prescription.
These tablets, for the most part, contain 65 milligrams of elemental
iron per tablet.

Now, the iron content of the therapeutic formulations that we are
talking about here, for instance, and those which are commercially
available, stand in contrast to the 10 milligrams of elemental iron con-
tained in children’s food supplements. This is the level as has already
been mentioned which the NAS/NRC Food and Nutrition Board rec—
ommended as the daily allowance for children.

That level had been set as we mentioned for the children’s Supple-
ments on the basis of a proposal put forth in the FDA hearings on
foods for special dietary uses by lV. Henry Sebrell who had been
Chairman of the Committee on Revision of the Recommended Dietary
Allowances, 1968.

This recommendation was supported by many leading nutritionists
who testified at this hearing. A somewhat higher level, as a matter of

fact, had been supported by the FDA.
Excnssrvn IRON COMPOUND INGESTION

Now, fairly recently, as a matter of fact, within the past month,
Dr. David Fisher and Stuart Finch, of Yale, have just reported on 27
children who were seen for excessive ingestion of iron compounds as
single entity preparations at therapeutic dose levels. These were seen
at the New Haven hospitals over the last 10 years.

2566

These children were estimated to have ingested acutely between
400 and 3,000 milligrams of elemental iron. Only three of the” 5 chil—
dren who were admitted to the hospital—there were two just seen
in the out- -patient department and dismissed—three demonstrated,
three of these 25 who were admitted were symptomatic. These three
demonstrated irritability, nausea, diarrhea, 11nd vomiting. None had
evidence of systemic intoxication or evidence of circulatory collapse.
All these patients recovered essentially with conservative therapy as
opposed to the use of more drastic measures such as the intravenous
administration of various chelating agents.

Now, all the children included in bFisher s rep01t ingested i1 011 prep-
arations that had been given to mothers during or immediately after
pregnancy. Dr. Fisher states:

Our experience suggests that the literature overemphasizes the toxicity of
acute iron ingestion, probably because of the tendency to report fatalities and
not recoveries.

Meanwhile, we have made an intensive examination of the records
of the National Clearing House for Poison Control Centers for the
years 1969 and 1970 with respect to reported overingestion by children
under age5 years of all vitamin and 1ron pr eparations.

Now,b'pa1enthetically, it should be made very clear that the Poison
Control Center data are reports of overingestion of a wide range of
household substances. The National Clearing House does not consider
vitamins or vitamin plus iron food supplements as “poisons.”

Examination of these records has confirmed that the deaths associ—
ated with iron toxicity in small childlen have been associated excluv
sively with therapeutic 11011 p1ep11111t10ns

Further, our examination confirmed there \1 as no case of serious
harm associated with supplemental level vitamin- iron preparations in
these records. Further, an examination was recently made by Dr. John
Crotty of the National Clearing House of more than 90 pen ent of the
Nation’ s death certificates which identify poisonings fox the yea1
1968, certificates which identify poisonmgs as the cause of death. ’I heie
w ere 10 deaths involving over ingestion of 11011.

Again, adult therapeutic preparations were involved in every case.
So I think that we have good evidence that we are dealing with a safe
formulation.

Senator TAFT. Thank you very much.

Senator Bellmon has arrived and I would be glad to make the wit—
nesses available for questions.

Senator BELLMON. Thank you, Mr. Chairman.

I regret I had to be away at one other 111eeting this morning. I
would like to ask Dr. O‘Donovan a question. perhaps he covered it,
but I have just eaten one of the tablets that you prepared and I would
like to say they are very tasty and I find them entirely palatable.

Suppose a child got into these and thought they were candy 11nd ate
100 of them; would this hurt him ?

Dr. O’DONOVAN. No, sir, in this age bracket there would he no prob—
lem at all.

Senator BELLMON. \Vhich age bracket ?

Dr. 0’ DONOVAN. School- -age children 11nd I would expmt that they
couldnt possibly eat 100 of them. if only because of the 1r calcium
content. I have no feais about that at all s1r.

2567

Senator BELLMON. Well, let’s assume we have a group of students
who use these tablets all through the school year, perhaps for many
years and then leave school for one reason or another and no longer
get this supplement—~will there be a dependency developed, or will
the body lose its ability to synthesize vitamins?

No POSSIBILITY or DEPENDENCY SYNDROME

Dr. O’DONOVAN. Oh, no, Senator, there is no possibility of develop-
ing a dependency syndrome to vitamins. Certainly one would have
expected that by virtue of takin the vitamins as a part of the School
Lunch Proo'ram that an educational effect will have come about on
that individual.

The individual would be more conscious of nutrition and see to it
in his older years, more adult years, that he take appropriate care of
his diet nutrition-wise.

Senator BELLMON. Do you feel it is necessary to have some—I guess
I can say—synthetic supplement like this necessary? Couldn't a child
be taught to eat foods that would give him the necessary balanced
diet in the micronutrients that he needs.

Dr. O’DONOVAN. As was brought out earlier, Senator Bellmon, one
of the great—there are several difliculties.

Sienator BELLMON. I read your statement, yes. I know what you
sa1 .

Dr. O’DONOVAN. There are several difficulties: bulk of food and
satiation limit, the amount of vitamin or micronutrient intake. There
are losses of vitamins from the time of the cleaning of the foods

Senator BELLMON. You have that in your statement, yes, but the
point is that for everybody—our food is as good as it was 100-years
ago before we knew what vitamins were.

Perhaps the problem lies with TV advertising and a lot of the
pressures that are on the children. They eat a lot of potato chips and
soda pop, rather than eat apples and drink milk and the good foods
that are available.

It seems to me the approach may be to educate the children in nu-
trition, teach them to choose the right foods so they won’t eat the
wrong foods.

Dr. O’DONOVAN. Would you like to address that Dr. White?

Dr. WHITE. I would like to comment first of all that vitamins by
definition are not the things synthesized in the body.

Senator BELLMON. You mean to say we cannot live without vitamin

ills?
p Dr. VVIIITE. We cannot live without swallowing vitamins from some
source.

Senator BELLMON. But there are natural Vitamins.

 

MORE CALORIES—LESS VITAMINS

Dr. WHITE. In some foods, yes. The comment our food is as good
today as it has ever been may not be true. We are consuming more
and more calories that do not carry their weight in vitamins and
minerals.

58—854—72—pt. 10~———— 5

2568

Senator BELLMON. Why is this?

Dr. “’iIITE. Because there is so much sugar.

. Sugar by occupying so much of the calorie space, to whatever extent
it does, limits the calorie space that you have left for foods which
will give the vitamins and minerals you need.

400 years ago, sugar as a commodity practically did not exist.
Today, sugar as a commodity is a food additive in almost everything
we eat to the point that it now represents a tremendous amount of our
bulk and caloric intake per year.

Senator BELLMON. So we should teach the children not to eat sugar?

Dr. VVHITE. Yes.

Mr. YOUNG. Could I comment, sir?

Senator BELLMON. Yes.

Mr. YOUNG. You asked about a nutrition education program to go
along with the Schools. Many school systems do have nutrition educa-
tion programs to go along With the school lunch and hopefully to tie in
the School Lunch Program with nutrition education, teaching the
children to eat the traditional foods.

BUREAU Paovmns INFORMATION MATERIAL

“7e in the Vitamin Information Bureau provide materials for edu-
cation purposes. ‘Ve sell them. especially in quantity, but we also give
away a lot of materials free which describe the role of Vitamins in the
body. sources of vitamins. and particularly the food sources of vita—
mins.

We have charts for use in schools which they have ordered. I have
here a packet of copies of about 30 orders from various school systems.
Individuals within the school systems have ordered materials from us.

As I mentioned, we in addition have given single copies of many of
our materials free to teachers. If I may read this letter, it is very brief:

I recently received some educational materials from you and wish to thank you
for them. I find your wall chart entitled “Vitamins and Your Body" to he espe-
cially good. Would it be possible to get 14 of these charts so I can put them in
each of my schools for the teachers to use ‘3

Signed by the director of the school food service for that particular
School system.

I think that. as I said and I would like to reiterate, there are many
educational programs in the schools to tie in sources of nutrients with
the School Lunch Program. It is not only in the classroom but in some
of the schools that are able to have educational programs in the cafe-
terias or through the cafeteria service.

Dr. VVIIITE. Senator. I would like to comment in regard to nutrition
education. Just as our food supply is changing, the problem of nutri-
tion education is changing. Today about 50 percent of the food that is
consumed in this country is in some way manipulated, processed or
otherwise prepared before it is made available to the consumer. It 'as
relatively easy at one time when we dealt with simple agricultural
commodities to say you consume some of this and some of the other
and a good mixture, the chances are you will get all the micronutricnts
hidden among those foods at the same time you get your calorie and
protein needs.

2569

NEED FOR NUTRITION INFORMATION

But I defy anyone to know today what is the micronutrient content
of a pizza. Now, pizza is perfectly good food, but it is a real problem
to put that into a food group to do traditional nutrition education. We
have to change somehow; first, to have the information available
through labeling so it is possible to know what is in the food, and then
to teach people that they have nutrients. They can’t deal with the over-
simplistic approach that has been used in the past, that is, of just say-
ing you need food from food groups whatever number of groups you
care to deal with. Some people say four, some five, and some seven and
so on.

So in this period of transition when our food eating habits are chang-
ing rapidly, nutrition education will have to change, not only the
amount of it but the whole concept which is presented.

Senator TAFT. At this time I am going to have to go to another com-
mittee meeting for a few minutes. I will turn over the Chair to Senator
Bellmon.

I thank you all very much for your help in testifying.

Mr. YOUNG. Thank you, Senator.

Dr. O’DONOVAN. Senator Bellmon, if I may, I want to make very,
very clear that we see no hazard to the overingestion, accidental or de-
liberate overingestion of this vitamin-iron formulation.

Dr. WHITE. One of the things we were considering in the problem
here is the arithmetic that may be involved.

As Dr. O’Donovan suggested, the fat soluble vitamins like A and D
will accumulate.

W'e were wondering what quantities would be involved. Well, it is
possible, perhaps, that if somebody ate 2,000 or 3,000 of these in a period
of about 4 or 5 months, that there might begin to be a problem of
accumulating too much.

I think it is very unlikely that anybody would persist so as to con-
sume that number.

Senator BELLMON. I don’t want to give a wrong impression here,
I don’t want to go over the ground you have been over before, because,
as you know, I wasn’t here when you testified, but I mlght tell you that
I believe strongly in taking food supplements, particularly when they
are prescribed. . _ _ .

I might say, for many years I have taken v1tam1n pills and I think
my health has been much better as a result, but they have been pre-
scribed by a physician and they were taken according to his prescrip-
tion.

I don't know if you can take these on a shotgun basis, if you can
prescribe a pill needed by every child, regardless of the diet in school
and away from school. But you have the feeling. and programs, you
agree it is possible to produce such a supplement, is that right?

Dr. O’DONOVAN. Yes, Senator.

VITAMIN FORTIFICATION

Dr. GRAHAM. Senator Bellmon, perhaps I can speak to your con-
cern, which I apprec1ate, by givmg you an example.

Rickets used to be rampant in this country—not in Oklahoma, be-
cause they have more sunlight, but in the northeastern United States,
big cities particularly, until the early 1930’s, when we discovered that
vitamin D would prevent rickets, and we discovered fish oil was an
excellent source of vitamin D.

The introduction of cod liver oil and other fish oils resulted in a
significant reduction in the incidence of rickets.

But there was still a lot of rickets because mothers would forget
to give the cod liver oil, children would spit it back at their mothers
for a variety of reasons.

Senator BELLMON. I don’t blame them.

Dr. GRAHAM. Yes, it is a rather repulsive product.

Then, vitamin D was synthesized and we could dispense it in little
drops that had no flavor.

Still there was rickets because this required someone remembering
to give the vitamins—many times doctors forgot to prescribe it, or
the mother to give it.

Finally, we put vitamin D in all milk and certainly in all infant
formulas and vitamin D deficiency rickets, disappeared in this country.

The same is true of nutritional education. For us it is difficult to un-
derstand why some people don’t like the things we like and which
we treasure and appreciate.

We are used to eating almost subconsciously, now, a balanced diet.
lVe drink orange juice for breakfast. I can’t start the day without
orange juice.

My youngest children don’t, they find it tastes horrible and they
prefer one of these orange drinks which has vitamin C in it.

The other fact related to this is that not everybody can afford orange
juice, fresh oranges are very expensive. Orange juice concentrates re-
quire that you have a freezer to keep them in and require a certain
amount of time to prepare.

As a result, many of the people who we are most concerned with
don’t consume it.

MODERN Foons NEED BALANCED FORTIFICATION

The same can be said for a variety of natural sources of vitamins
which we have no trouble consuming but we are dealing with a society
that is in a rapid state of transition. who are turning more and more
to engineered foods, convenience foods.

Until such day as all those foods are properly fortified in a balanced
way by law, we are going to have an increasing problem. For instance.
the potato is an excellent source of vitamin C. I doubt that the potato
chip is. But children eat potato chips and young adults do. It is an
entrenched habit and it has become an important part of their diet.

There is a vast difference between what we would like things to be
and what they are. I think we have to recognize this, that this trend
is inevitable, that a very significant percentage and a growing per-
centage of our population is depending more and more on these con-
venience foods which require much less time to prepare, which often
are and always should be less costly in time and equipment and 1all
things that go with our concept of the traditional meal.

2571

This is a reality today, for the majority of the people in this coun-
try. It would be ideal from the esthetic point of VleW, looked at from
our point of view, that people should get their vitamins and minerals
from natural sources. The facts are different, unfortunately.

Senator BELLMON. This is in the nature of an observation, but one
of the great problems we have for Government and for citizens of our
country is the high cost of medical care, hospitalization and doctor
bills and the like.

Do you, as a roup, feel that if we could succeed somehow in causing
our citizens to ave better diets that we might somehow cut down on
the cost of medical care for the population?

Dr. GRAHAM. Quite honestly, no.

The present high cost has little to do with nutrient deficiencies.

“'hat we are attempting to do now is prevent the development of
deficiencies as this transitlon goes on and as we see a deterioration in
quality of diet.

_ Left unchecked, this would result in appearance of clinical deficien-
c1es.

But the high cost of hospitals today, which is a disgrace, would not
be remedied by that—no more than would be the traffic problem in
lVashington.

Senator BELLMON. VVouldn’t utilization of a better diet keep people
out of the hospital?

DIETARY HABITS CAN ALLEVIATE ILLNESS

Dr. O’DONOVAN. Certainly, I think so, sir, in terms of those of us
who are prone to overeat, get overweight, ingest too much in the way
of saturated fats, and so forth. _ _

It is interesting to note that December of last year the Commlsslon
on Heart Disease Resources. which is a consortium of some 30 medical
and scientific bodies in this country, issued a report which was pub-
lished in “Circulation,” the official journal of the American Heart
Association, making specific recommendation about modifications 1n
the diet of American men.

The recommendations went so far as to urge that we develop strains
of beef cattle that are lean, rather than fat-laden; that we modify the
fat content of our dairy products, and so on. ‘

So in this sense one feels that a tremendous preventive medicine
program can be launched with respect to the control of coronary heart
disease in our population.

Probably one day we might reduce the load on the medical profes—
sion and on the hospitals in part through such measures.

Dr. VVIIrrE. I think the apparent difference here is that Dr. Graham
was speaking to undernutrition—that is people failing to get certain
nutrients and thus develop deficiency diseases.

Dr. O’Donovan is speaking to overnutrition. They are both malnu-
trition, poorly balanced nutrition. Most of the degenerative diseases.
particularly of the cardiovascular system, sum to have a relationship
to the over-consumption of fats and so on.

Senator BELLMON. Is there any relationship between nutrition and.
say, respiratory diseases like pneumonia? If a person has a right bal-

ance of vitamins in his food, will he be less susceptible to the diseases
that frequently put people in hospitals?

Dr. \VHITE. Pneumonia is an infectious disease and most likely the
one reason people contract it is that they are overwhelmingly exposed
to the causative organism.

On the other hand, an individual who is well fed, and in good physi—
cal condition otherwise, is certainly more likely to survive that a per-
son who is underfed and otherwise in poor physical condition.

Now, that is, however, complicated by the fact that today we have
antibiotics that can completely alter the course of the pneumonia pro-
vided that it is a pneumonia responsive to an antibiotic.

Senator BELLMON. It strikes me that people who do have good
dietary habits and do have good food seem generally not to be ill.

Am I mistaken about that ?

Dr. GRAHAM. Senator Bellmon, I think in the case of the elderly,
a good many of the very old people that we admit to hospitals and
institutions on the assumption they are deteriorating are found to be
malnourished. There is no question about that.

This is an immense social problem being discussed now, the failure
to eat proper foods because they are no longer motivated to prepare
them.

In my presentation, 1 emphasized we need to develop a whole variety
of foods that are appropriate for these people and to their state in
life. There is experimental evidence that vitamin A deficiency in-
creases the susceptibility to certain respiratory infections and severity.

I do not think we can say there is evidence for such a situation in
this country leading to such, but this is some of the things that could
happen undoubtedly.

Senator BELLMUN. I suppose theideal situation would be to have a
condition in which a person could live without illness or disease for
a. long time and not have to go to the hospital, but I doubt this is a
practical possibility.

Dr. leTn. I am sure that is the dream of every physician because
he knows intimately how bad it is to be terminally hospitalized and
does not look forward to being in that position himself.

Senator BELLMON. To get back on the subject, how (lid you re-
searchers arrive at the decision that a fruit-flavored wafer would be
ideal. or should we have one that tastes like potato chips ?

FL \vons MAKE PRODUCT Mom: ACCEPTABLE

Dr. O’Doxovax. A number of considerations were brought to bear,
Senator Bellmon. Number one, we certainly wanted to remove from
the formulation the image of a medicine, a drug, or a pill-type product.

011 the other hand, we wanted to eschew the impression that we
were formulating a confection. We wanted as neutral a formulation,
appearance-wise, as possible.

But in the effort to render the several bitter or ill tasting ingredients
of vitamins and so forth! and iron necessary to make up this formula-
tion, we had to do something about the masking of flavor and make it
sufficiently palatable that it would indeed be acceptable in a positive
way.

2573

We found that fruit flavors are generally well suited to all’ording
the type of flavor that will mask the undesirable tastes of the ingre-
dients.

But primarly, we wanted to stay away from something that would
leave the impression that the end product was a candy or a medicine.

Senator BELLMON. Well, are there any other possibilities as to the
form or flavor that the tablets might take? Ilave you checked into
others and discarded them?

Dr. O’DoXUVAN. I am not fully aware as to how much has been
done in that regard.

Do you know ”.3

Mr. YOUNG. In one of the discussions we considered a wafer.

l)r. O’Doxovax. “'0”. you have a wafer here.

Mr. YoUNG. I mean a cookie—like water that would have a con-
sistency, perhaps. of a cookie. but I do not know of any developmental
work on that.

Dr. \Vm'rn. There are all sorts of possibilities. Senator. Sometimes
the reason is for other than acceptability that one selects a particular
form. This form as we show it today has the advantage of being able
to be manufactured at low cost and in very, very high numbers and
with very good specifications on it, so it is a very dependable way to
produce the product.

There are some flavors that will not mask well. will not cover well.
On the other hand. there are an infinite variety available—I guess one
could go to pepperoni. any number of flavors which are available which
may have some potential if that were desirable.

Senator BELLMUN. Are there other companies or competing prod-
ucts. or is there just one available or what is the situation? I should
know. but do you all come from the Miles Laboratories?

Mr. YOUNG. No. sir.

Senator BEmeX. Is Miles the only company doing the work?

Mr. YoUNG. They have the prototype of the product; they have done
the developmental work. This may not be the finished product. but it
is an attempt to have a product that can be looked at.

RESEARCH Is CONTINUING

Dr. lVIIrrn. Other companies are looking at this area. and have
variations as possible ways to accomplish the goal of supplying micro-
nutrients.

Senator BELLMOX. Go ahead.

Dr. GRAHAM. I might add. Senator. that in my estimation this is
certainly not the only solution; it may not be the ideal one. It is a
solution to the problem as it stands today.

Actually. our Department of Agriculture. CEO. and the Statebf
New Jersey. are supporting rather extensive research on the possibility
of replacing the School Lunch Program with a series of engineered
foods—with a variety of alternates. All of these would be fortified
making unnecessary—in other words. they would contain the vitamins
and minerals. . _

There is a great deal of work to be done. and I expect-this Wlll be
the eventual Solution. It will be a simple thing like a fortified peanut

2574

butter and jelly sandwich which would be an excellent food, better
tlllan a poorly prepared bean salad that children often leave on the
ate.

I think this is the direction in which we are going, but it will be some
years before we can make such solutions effective.

Senator BELLMON. I served for a time on Senator Hughes’ committee
on dru abuse and I remember more than one witness who came in and
testifie that apparently a desire for drugs was associated at least
in some cases with deficiencies in the diet. .

I am sure this is totally outside your field, but do you have any evi-
dence that a child who is receiving proper nutrients has any less
tendency to use drugs?

Dr. GRAHAM. There is one very important example in the world, and
this is the consumption of cocaine by Indians in the Andes. They chew
the coca leaf itself and not the extract. They do this to satisfy hunger
and as such, it is a rather Vicious habit in that it replaces food.

I have not seen any evidence of a scientific nature su gesting that
this might be the case in this country, none at all. I thini the hunger
there is often of another nature.

Senator BELLMON. No, I do not think it is nutrition.

Assuming a child, though, has eaten a meal and suppose it has the
amount of calories he needs and the amount of bulk he needs, but it is
deficient in some of the micronutrients, does there remain a hunger,
desire for something further?

Dr. GRAHAM. Unfortunately, not, sir. The only nutrient that man
and other mammals have a specific craving for is salt. Other than that,
they eat to satisfy hunger without recognizing deficiencies of micro-
nutrients in the food.

Neither man nor animals will recognize deficiencies of other
elements.

Senator BELLMON. You mean to say if a person has not had any
green leafy vegetable or fresh fruit for several months, he will not
have a hunger for this in his diet ?

Damon-moms or MICRONUTRIENTS NOT RECOGNIZABLE

Dr. GRAHAM. Definitely not. The outstanding example is the al-
coholic. Thousands of them are admitted to our hospitals with acute
deficiency of protein and deficiency of the amino acid, tryptophan, or
niacin, the vitamin. They cannot recognize this. They do not develop
a specific craving.

enator BELLMON. Are you all in agreement on this?

Dr. O’DONOVAN. Oh, yes, sir.

Dr. IVIIITE. I think you have to distinguish though, that you may
dream of your mother’s apple pie and wish you could have another
piece of it, but that is not a hunger in the sense it would direct one to
a food source where there is a specific nutrient need. There is no evi-
dence that such exists.

Senator BELLMON. So unless we are trained otherwise, we might go
through a cafeteria line and take only one item that you might partic—
ularly like, maybe nothing but potatoes.

2575

Dr. IVHITE. That is true. As man evolved on this planet and ate the
things that 11 ere a' ailable to him and around him, in ample supply,
he used those things that 11' e1 e present.

It is interesting to note, for ex \aInple—you were mentioning vitamins
were not synthesi/ed within the body, but would have to be taken in.

There is an interestiinr example 11 ith vitamin (7. in that most other
ani111al1-‘11111 make vitamin C so that 1' itamin ( is a necessary nutrient
only in man and the guinea pig and ()llIOI minor species. It is not a
universal vitamin as most of the other vitamins 111e,

This ability to synthesize a1 needed (hemical within the body was
lost sometime in evolution, and it made no ditterence as long as man
was eatin<r enough berlies and f1uits so that he never was bshort of
vitamin C as supplied by his food.

Ithn he was put 111 an isolated situation on shipboard, and couldn’t
wet the vitamin (‘, suddenlv it became appa1ent that he did not have
the ability to ma ke it and he had to ingest 1t.

WOULD TABLETS ALTER DEFICIENCY TREND?

Senator BELLMON. Dr. IVhite, in the. table that appeals 011 page 5 of
your statement, you show that as the age of the individual goes up
from 1 year to 21 years that the dietary deficiency tends to bbecome
mOIe plonounced; if I understand it. Is that correct? I am (unions to
know if you have any evidence, that this would happen if you were
using the tablet th. 1t you a1e1'e1 ommending?

Do you have any evidence that the tablets would change this t1end
toward dietary deficiencies as their age advances?

Dr. WHITE. Well, these are dietary intake figures and if I deter-
mine that this is an individual’s diet
Senator BELLMON. This table says percent who failed to ingest.

Dr. IVHITE. Yes. if I fail to ingest the RDA. and I add needed
quantities of vitamin and mineral to what I do ingest. then I ingest
the RDA.

Senator Bnmmox. But you show in the age. bracket 15—21 that 71)
percent are not getting the niacin as opposed to 4 percent in ages 10
through 12.

Now. if we were to use the tablet in the School Lunch Program.
would you expect this to change some way ?

Dr. \VHITE. lmnpletely.

Senator BELLMON. In what way 2

Dr. IVIIITE. You would abolish this dietary deficiency.

Senator BELLMoN. 0f eourse 21—year-olds are not ordinarilyin
school.

Dr. IVHI' rE. That IS t1 ue. If we cannot reach them we cannot help
them But based on what people 11 me recorded as eating on a given
day —see, this IS dietary intake history.

If I look at the food that somebodv cats in a day and know what 1s
contained 111 the various cmnponents of it then I can determine that
there is not enough of this or that. and so fo1th

So what this table is sa1ing. is that 70 percent of the people seen
between 15 and 21 yeai sol age. did not have. in what they ate in the

 

58—854—72—pt. 10—»6

2576

course of that day in which they happened to be looked at. that 70 per—
cent of them did not have the recommended dietary allowance of
thiamine. _

If I add thiamine to that diet. I obliterate this data and bring every-
body up to the reconnnended dietary allowances.

Senator BELLMUX. If you extended your table to age 50, what per—
cent at that age would you feel would have failed to ingest the RDA?

Dr. \Vm'rn. At age 50?

Senator Bmaawox. If we put t he tablet in the School Lunch Program
and when the individuals finish school. then what can we expect. ‘Will
they go back to this situation or will there be something to cause them
to continue getting a better diet?

I)r. lVIirrii. l‘nless we teach them about nutrients and unless we
get busy at labeling our foods properly, and t'ortifying them properly.
we would not have solved that problem.

Senator BELLMON. I see. “’ell then. why. from the scientific stand—
point. is the record better in the age bracket 1 through 12 than it is in
the 15 to 21 age bracket? Is there some reason for that? Is it because
they \ utteh more television when they get to be 15 or 21?

(‘irwmcs 1.\' EATING lIAm'rs

l)r. \VJH'rn. There are changes in eating habits at these. ages and Dr.
Graham. who is a pediatrician. maybe ought to speak to that.

Dr. GHANA M. 1 think this younger age group is more under the con-
trol of its parents. as to what they eat.

“'hen they become teen-agers even at home—J have a 21—year—old
daughter whose dieting is against my will and a 14-year-old who is
learning from her and it is a constant battle to keep them eating
adequately. because they are more concerned with their tigure than
they are with their nutrition.

1 think this is a for a variety ol’ r\asons-this is what they all
ma-ountcr. The other factor is the teen-agers of today and children
in colleges who honestly think we make a big production over eating
and we \‘aste a lot of time sitting down at a table and eating food.
They are in a hurry. They have more interesting things to do. even
it it is watching television.

I’mt they are changing. and it is. 1 think. an irresistible trend. to
the extent that they make less of a production over eating than we
do: they may be laying the ground for not over—eating in later life
as we do. and not having the constant battle against weight. which
we all have. and against degenerative vascular disease and obesity
based on our eating habits. high contents of dairy products, meat. and
other foods which are considered good. but which have been identified
as contributing to the high incidence of degenerative vascular diSease.

I disagree with part of Dr. Brigg‘s statement that listed wheat flour
as a poor t'ood. That happens to be man’s most important food and
in many ways much healthier than meat. milk. and eggs.

Senator lhiuarox. You do not know how much 1 appreciate that
comment from you.

Dr. \Vitrrn. I would like to say. Senator. that as individuals get
older. they can consume fewer calories because they are less activ ._ and

 

2577

we all tight. that battle as we slow down a bit so that it is more ditlieult
to get mieronutrients.

l)r. Graham mentioned the diet problem. this is a partieular problem
with young females particularly in regard to iron. The American
diet. on average. contains about (3 milligrams of iron per thousand
ealories. And it is reeonnnended that the adult female of ehildbearing
age get, 18 milligrams of iron per day. \Vell. this is simple arithmetic.
she needs 3.000 calories unless she skews her diet toward iron-rieh
foods in some extreme way. .

If one deals with this aritlnnetie on the basis that she will maintain
her weight on about 9.000 calories. then she has to eat about 1.000
ealories too many per day to get 18 milligrams of iron. .\t that rate
she will gain about a pound a week. Nobody will put up with that.

There are all sorts of resistant-es to that. Our food is short of iron
and as it, is short: of other mieronutrients. They need to be put in and
there need to be deeisious made as to where eaeh should be put.

How much should be, put. is it available. is it stable where you are
putting it. and all that will have to be worked out for eaeh kind of
food with which we must deal.

SUPPLEMEX'I‘ ()l"l~‘l-‘.]l.\' STABILITY

()ne of th\ ad 'antages ot the supplement is that the supplement is
put all together and you know these nutrients are in there and they
will stay there until they are (-onsumed.

The stability is well known. and well understood.

Senator BELLM’HN. “Vell. gentlemen. let me say this testimony is
extremely interesting and I think highly important and I assure you
the eommittee and staff will give it every emisideration as we draw
up our future plans and any rm-ommendation that we make to the
l'ull committee and to the Congress.

If you have anything further you would like to say. the reeord will
be open and you ean submit statements. or it you hay . anything you
would like to say now you may. but l have no further questions.

.\lr. Yotrxo. Thank you very mueh.

Senator BELT/MUN. Thank you.

The committee is in reeess. subject to the eall of the (‘hair.

(’Whereupon. at: 12:17 p.m.. the Seleet (‘ommittee was reeessed. to
reeonveue at the ('all of the Chair.)

l
mm.
\M

I I
\’ 'n.J I
-...,:,..._r, _

 

APPENDIXES

 

Appendix 1.
MATERIAL SUBMITTED BY THE WITNESSES

FROM DR. JOSEPH M. \VHITE

TABLE l.~ COMPOSITE 0F DIETARY INTAKE SURVEYS PUBLISHED 1950768
PERCENT WHO FAILED T0 INGEST THE RDA

 

 

 

Age Vitamin A Thiamine Riboflavin Niacin Vitamin C “on Calcium
Ho 12 ,,,,,,,,,,,,, 30 34 24 43 53 45 43
12(015__,_.. _ 40 55 40 49 64 68 58
15 to 21 ________ ,, . 44 70 53 52 67 67 63

PERCENT WHO FAILED T0 INGEST % RDA o

no 12 ,,,,,,,,,,,,,,, 12 5 ‘ s 7 24 e 18
12t015_.__., ,_ 17 15 13 10 34 22 30
15t021._._ __________ 19 l5 17 11 37 23 3i

 

Note: Number of subjects included in data vaiies from 2,000 to 5,000 depending on standard, age group, and nuiiien'.

APPENDIX A

JOINT INDUSTRY FINDINGS ON THE NUTRITIONAL STATUS OF THE UNITED STATES
POPULATION

From June 24, 1968 until May 14, 1970 the US. Food and Drug Administration
held a rulemaking hearing on Foods for Special Dietary Uses, which foods include
dietary supplements of vitamins and minerals. The major question in this hearing
was the nutritional status of the American public, and the weight of the evidence
presented indicated that problems are widespread. This evidence is summarized
in the following pages.

In the succeeding discussion testimony and exhibits are identified by symbols
used in the FDA hearings. To assist the reader, the names and titles of the wit-
nesses whose testimony is cited have been set forth in full :

William H. Allaway, PhD—Director of the Plant, Soil & Nutrition Laboratory,
lf.S.D.A., Ithaca, New York.

Zoe E. Anderson, PhD—Associate Professor of Foods & Nutrition, San Diego
State College.

Samuel G. Barton—Chairman of the Board, Market Research Corporation.

George M. Briggs, PhD—Professor of Nutrition, School of Public Health,
University of California at Berkeley, editor of The Journal of Nutrition Edu-
cation.

Myron Brin, PhD. Assistant Director of Clinical Nutrition, Hoffman—La
Roche, Nutley, New Jersey.

 

(2579)

2580

Raymond H. Bunnell, Ph.D.—Section Chief & Biochemist, Food and Agriculture
Products Development, Hoifman—La Roche, Inc. _

Bacon I“. Chow. PhD—Professor, John Hopkins l‘niversity. School of Hygiene
& Public Health, Department of Biochemistry. _

Robert E. Cooke, M.D.—-Department of Pediatrics, Johns Hopkins Hospital,
Baltimore, Maryland. _

David B. Coursin, M.D.—Director of Research at Research Institute, St.
Joseph’s Hospital, Lancaster, Pennsylvania.

Thomas R. A. Davis, M.D.—Research Physician, Arthur D. Little, Inc.

Gladys A. Emerson, Ph.D.—Professor of Nutrition, School of Public Health,
University of California, Los Angeles, California.

Lloyd J. Filer, M.D., PhD—Professor of Pediatrics & Pediatric Nutrition,
University of Iowa, College of Medicine, member of NAS/NRC Food and Nutri-
tion Board.

Stanley Gershofi’, PhD—Professor, Department of Nutrition, Harvard Univer—
sity, School of Public Health.

Robert S. Goodhart, M.D.——Secretary, Committee on Medical Education, New
York City: Adjunct, Professor of (‘ommunity Medicine. Mt. Sinai School of
Medicine.

George G. Graham, M.D.—Associate Professor of Pediatrics, Professor of
Human Nutrition, Johns Hopkins University.

Arthur Grollman, M.D., PhD—Professor of Experimental Medicine, South-
western Medical School. University of Texas.

Robert H. Harris, PhD—Emeritus Professor of Nutritional Biochemistry and
Full Professor of Department of Nutrition & Food Sciences, Massachusetts In-
stitute of Technology.

Robert E. Hodges, M.D.———I’rofessor of Medicine, University of Iowa.

M. K. Horwitt, Ph.D.—Professor of Biochemistry at St. Louis University
Hospital.

Frank L. Iber, M.D.—Professor of Medicine at Tufts University.

Thomas H. Jukes, PhD—Associate Director of Space Sciences Laboratory,
I'niversity of California at Berkeley.

Harry G. Kimpel, Ph.D.—Director Bio-Med Technical Service, Carnation Re-
search Laboratories, Van Nuys, California.

“'illard A. Krehl, M.D.. 1’h.D.—Professor & Chairman of the Department of
Preventative Medicine. Jefferson Medical College. Thomas Jefferson University.

Sheldon Margen. M.D.—Prot‘essor of Human Nutrition, Department: of Nu-
tritional Sciences. University of (‘alifornia at. Berkeley.

Jean Mayer. Ph.D.. l).Sc.——-Professor of Nutrition at, the School of Public
Health of Harvard University. Chairman of the ‘Vhitt‘ House Conference on
Food. Nutrition and Health 12/69; special consultant. to the President on
nutrition.

Olaf Mickelscn. l’h.ll—«Professor of I’dochemistry and Nutrition. Michigan
State I'niversity.

Robert ()lson. Ph.l).. M.l).-Doisy Professor and Chairman of the Department
of Biochemistry. Associate Professor of Medicine, St. Louis University School of
Medicine.

Margaret Ross. Ph.l)_—-Prot’essor of Nutrition at. Simmons College.

Arnold It}. Schaet‘er. PhD—Director of the National Nutrition Survey. Chief
of Nutrition Program of Division of (‘hronic Disease Programs in Regional
Medicine Programs Service. Health Services & Mental Health Administration
of U.S. Department of Health. Education and \Velfare.

Herman A. Schwartz. M.D.—Professor of Medicine. University of (‘alifornia
Medical School. Special Advisor on Committee of Regional Medicine Programs.

Bernard Schweitzert. PhD—Professor of Department of Food Sciences. Mich-
igan State I'niversity.

Nevin S. Scrimshaw. M.D.. Pl'l.1).—Pl‘0f(’SSOl' of Health of Department of
Nutrition and Food Sciences. Massachusetts Institute of 'l‘echnology.

“'illiam ll. Sebrell. M.D.—-Director of Columbia University's Institute of
Nutritional Sciences: Chairman. NAS/NRC Food and Nutrition Board (‘our
mittee on Recommended Dietary Allowances (19653—1908).

Elmer l'l. Severinghaus. I\I.D_—-—Professor of Nutrition at (‘olumbia University
Home 19(35): Medical (‘ousultant to the Vitamin Information Bureau.

Frederick J. Stare. Ph.D.. M.D.~v(‘thairman. Department of Nutrition. School
of Public Health at Harvard University.

2581

E.L.1t. Stoltstad, Phil—Professor of Nutrition & Biochemistry Department
of Nutritional Sciences, University of California at Berkeley.

Reinhardt ’J‘hiessen, B.S.—Nutrition Research Area Manager, General Foods
Corporation.

Walter G. Unglaub, Alli—Professor of Nutrition and Director of the N11-
trition Section, School of Public Health & Tropical Medicine, Tulane I.'niversity :
Louisiana Director of the National Nutrition Survey (deceased).

Joseph J. Vitale, M.]).—I’rot‘essor of Nutrition at Tufts University.

Ralph D. Wallerstein, M.]).———Clinical Professor of Medicine, University of
California. t‘hief of Staff at Children's Hospital in San Francisco.

Joseph M. White, M.I). Nutritional (.Ionsultants to Miles Lalmratories, Inc.

Also cited in the following pages are several documentary exhibits. The fol-
lowing list shows the identifying numbers of these together with their biblio-
graphical information :

P—Bfil—Recommended Dietary Allowances, 7th edition (1968).

O—587—46—Ilavis, et 111., “Review of Studies of Vitamin and Mineral Nutri-
tion in the United States (1950—1968)”, Journal of Nutrition Education, Vol.
I, p. 41 (1969).

0—924—33—Statement of Arnold 1‘1. Schaefer before the Senate Select (‘onnnit-
tee on Nutrition and Human Needs (4/27/70).

O—Ilti—19—llodg99, et al., “Nutritional Status of 'l‘eenagers in Iowa." American
Journal of Clinical Nutrition 17 :200 (1965).

P—764—IISDA. Nutritive Value of Food Available for Consumption in the
United States, 19094964, ARS 62—14 (January 1966).

I'—765—USI)A. National Food Situation, NB‘S—126 (Nov. 1968).

0—606—46—Gamble and \Vhite. “Vitamins and Minerals in 'l‘raditional Foods
& Dietary Supplements—Report to Miles Laboratories. Inc. (10/21/69).

0—544—33—Bunnell. et al., Alpha Tocopherol Content of Foods," American
Journal of Clinical Nutrition 17 :1 (1965).

P—568—“Dietary Levels of Households in the United States, Spring 1965, ABS
62—17 (.Iune 1968).

P-762—USI)A. "Food Intake and Nutritional Value of Diets of Men, Women
and Children in the United States. Spring 1967». ABS 62—18 (March 1969).

0—164—28~“An Analysis of Daily Food Consumption to Assess Whether Nu-
trient Intake Meets Dietary Standards,“ General Foods Marketing Research
Services (September 1967) .

0—168—33~June L. Kelsay, “A Compendium of Nutritional Status Studies
Conducted in the United States, 1957—1967," Journal of Nutrition, Supp. 1, Part
II, Vol. 99. No. 1 (9—69).

O-619—6Fr-‘National Vitamin Foundation, How Well Nourished Are Ameri-
c:111s'3. (1961).

0—599—46-«National Vitamin Foundation, How Well Nourished Are Ameri—
cans?, (1963).

0-609—46—National Vitamin Foundation, How \Vell Nourished Are Ameri-
c:1ns?, (1966).

0—461—28—Reinhardt ’J‘hicssen, “Research ReportH—A Literature Survey of
the Nutritional Adequacy of the American Diet 1956—1966." November 17, 1966.

H.l<}.~—13—Stateinent of Arnold E. Schaefer before the Senate Select (.,lommittec
on Nutrition and Human Needs (January 22. 1969).

 

2582

Pnorosnn FINDINGS OF FACT CONCERNING THE NUTRITIONAL STATUS on THE
UNITED STATES POPULATlON

Whether many of the sections of the Stayed Regulations before this hearing:
are reasonable depends to a great extent on the nutritional status of the United
States population. Both Proponents and Opponents of the Stayed Regulations
shared this view and offered testimonial and documentary evidence bearing on
the subject. The facts disclosed by this evidence, since they affect many sections
of the Stayed Regulations, are assembled at the beginning of the findings and
are referenced as appropriate in the portions of the findings devoted to specific
sections. The findings on the nutritional status of the population are divided into
the following groups:

(a) Standards of Nutritional Adequacy, Consequences of Failure to Attain
These Standards, and Techniques Used in Measuring the Degree to Which These
Standards Are. Attained.

(b) Vitamin and Mineral Content of the U.S. Food Supply and Factors Lim—
iting lts Availability for Consumption.

(0) Existence and Identity of Groups of Persons Who Are Not Receiving Ade
quate Amounts of Vitamins and Minerals From the Diets They Consume.

A. STANDARDS OF NUTRITIONAL ADEQUACY, CONSEQUENCES OF FAILURE TO A’l‘TAIN
THESE STANDARDS, AND TECHNIQUES USED IN MEASURING THE DEGREE T0 \VIIICH
THESE STANDARDS ABE ATTAINED

1. The Recommended Dietary Allowances established by the NAS-NRC Food
and Nutrition Board represent a consensus, based on the best scientific evidence
available, as to the amounts of vitamins and minerals that should be ingested
daily by healthy people. (WI)~3A—Sebrell, p. U: Wll—lU—Ulson, p. ‘o‘; \Vl')—-i(i—
Briggs, p. 12; WU—G—Ross, p. 5; \VD—2S—Thiessen, p. 91) These allowances rep-
resent levels of consumption of vitamins, minerals and other nutrients which
“will maintain good nutrition in practically all healthy persons in the United
States." (P—tifil. l’urposes and Intended I'ses)

2. These Recommended Dietary Allowances as revised in 1968 are as follows:

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2584

3. The optimum level of human nutrition is the point where body tissues are
saturated with the vitamins and minerals which are essential to life. The Recom—
mended Dietary Allowances are set at this point for healthy persons in the case
of most micronutrients. (WD-46—Olson, p. 13; WD—46—Severinghaus, p. 18)

4. Regular consumption of the Recommended Dietary Allowances of vitamins,
minerals, and other nutrients will insure that tissue saturation is maintained
in healthy persons. (Tr. 2989—90, Hodges; WD—46FMayer, p. 29) Routine con-
sumption of the RDA by all healthy individuals in the United States is a reason-
able public health goal. (WD—46—Margen, p. 9; 28694, Jukes; WD—46—Severing-
haus, p. 16)

5. It is sometimes said that the Recommended Dietary Allowances contain a
“safety factor.” By this it is meant that the allowances are set at a level suf-
ficiently above the average requirement for a particular nutrient so as to cover
the requirements of between 95% and 99% of the normal healthy population.
(Tr. 7083, Hodges; WD—46-Olson, p. 7; Tr. 29466—67, Olson; Tr. 28688, Jukes:
'I‘r. 28761, Briggs: Tr. 28865—66. Mayer: Tr. 20742, Stokstad: Tr. 30169—70. Good—
hart; Tr. 29280. Stare; WD—G—Ross, p.5).

6. The current RDA for iron for women age 10-45 is 18 milligrams. (IL-(131,
last page) Qualified nutritionists and hematologists are of the opinion that this
figure is at or near the average requirement for this population group. and
therefore the usual “safety factor” does not exist in the case of iron. (Tr. 29512,
Olson: ’l‘r. 28584, White: Tr. 29280, Stare: Tr. 28761. Briggs). Some experts
are of the opinion that this figure is actually below the average requirement for
this population group. (Tr. 28941, Tr. 28945—46, Unglaub; WD—46—Schwartz,
p. 12; 0—612—46, Table 2, p. 120; WD—46—Briggs, p. 16).

7. The absence of overt, acute deficiency diseases in a population does not
demonstrate optimal vitamin and mineral nutrition. Malnutrition is of gradient
nature. having three discrete stages. The first stage. caused by a diet which is
deficient in one or more nutrients, involves the chemical desaturation of tissues.
If a diet is less than adequate over a long period of time, stage two malnutri-
tion, which involves physiological or metabolic aberrations, will occur. Continued
dietary deficiencies can result in stage three malnutrition in which clinical mani-
festations, including symptoms and anatomical signs, appear. Eventually full
blown diseases like scurvy, beri beri and pellagra will develop. and these can
ultimately lead to death. (Tr. 3044. 3087—9, Hodges; 0—600—46, p. S; WD—46—
Olson, p. 13, p. 24—25; WD—33—Brin, p. 4—7: VVD—GS—Goodhart. p. 7—8; WD-65—
Stare, p. 6; Tr. 29474, Olson; WD—46—Margen, p. 9: WD—46—Severinghaus, p. 18;
WD—46—Wallerstein, p. 7 ; WD—46—Unglaub, p. 20—21: WD—46—Schwartz, p. 3—4).

8. The presence of Stage 1 and Stage 2 malnutrition can have a detrimental
effect on human behavior. Irritability, apathy, and loss of physical and mental
efliciency can result. (WD—33—Emerson, p. 16—17; WD—46—Unglaub, p. 21: WD—
33—Brin, p. 4—5, p. 8. p. 19—20: W'D-46—Severinhaus. p. 17; WD—33—Coursin. p.
21—22 : WD—65—Goodhart. p. 8; WD-65—Chow, p. 3—4, p. 9).

9. The nutritional status of population groups can be measured by reference
to dietary intake information, biochemical tests which measure circulating
levels of nutrients in blood or urine, by anthropometric measurements, and
through clinical examinations. (WD—46—Olson, p. 16—17; Tr. 29010—12. Tr. 29041—
42, Margen: Tr. 29475. Olson; WD—G—Schaefer, p. 5: \VD—65—Chow. p. 5) Ideally,
a nutritional status study of whole population should include all of these investi-
gations. (Tr. 29475, Olson: Tr. 29041—45, Margen; Tr. 28919, Unglaub).

10. Information concerning dietary intakes of vitamins and minerals is com—
monly evaluated against the RDA or some lower standard either related to the
RDA or stated by those evaluating the intake data. (WD—46—Davis, p. 11;
0—587—46. p. 42: 0—46843. p. 137: 0—924—32. Attach. IV).

11. Since the Recommended Dietary Allowances are established to meet the
needs of from 95% to 99% of the healthy population, it follows. at least theo-
retically, that a small percentage of this population will not meet its individual
requirements by consumption of the RDA. An increasing perecntage of the popu-
lation will fail to meet its requirements as consumption drops below the RDA
by greater amounts. (WD—49—Stare, p. 23; Tr. 29466—67, Olson: Tr. 30170, Good-
hart). If failure to ingest the RDA is found to exist within a significant seg-
ment of the population over a prolonged period. it, is reliable evidence of malnu-
trition within this segment. (Tr. 29475, Olson; Tr. 28922—25. Unglaub; Tr.
28733—35, Briggs).

2585

12. Information concerning circulating tissue levels of vitamins and minerals
is commonly evaluated against standard criteria such as those published by
the Intergovernmental Committee on Nutrition for National Defense (ICNND)
or other researchers (e.g. Pearson’s standards for interpreting urinary thiamine
data). In general, such standards class particular ranges as “High,” “Accept-
able," “Fair,” and “Low” or “Deficient.” (0—587—46, p. 55).

13. The ICNND and other biochemical standards used in analyzing the nutri-
tion survey data in the record are generally accepted and constitute the best
standards now available for evaluating this data. In general, the “below accept-
able” levels are known to be associated with poor diets and to be improved by
the consumption of good diets. (WD-46—Gershoff, p. 11—12; 0—587—16, p. 42;
W D—G—Schaefer, p. 7, p. 21).

14. More complicated biochemical tests, such as the “TPP eifect of transketo-
lase” assay development by Dr. Brin, measure whether or not vitamins are pres-
ent in the body in sufficient amounts to perform metabolic functions at proper
levels. (Tr. 6747, Hodges; WD—33—Brin, p. 10) The transketolase test has been
used in survey work. (WD—33—Brin, p. 10—16) Failure to meet the criteria for
these tests demonstrates metabolic derangement as a result of vitamin inade-
quacy. (WD—33—Brin, p. 10).

15. Anthropometric tests and clinical observation are also used to evaluate
nutritional status. Evidence from anthropometric measurements that a particu-
lar population group failed to achieve heights and weights comparable to those
found in presumably well nourished groups used to set standards would indi-
cate that the below standard group may not be adequately fed. (WD—G—Schaefer,
p. 6—7; Tr. 29012, Margen) Clinical observation can detect a number of signs
thought to be associated with vitamin deficiency, for example, nasolabial seb-
orrhea, angular lesions, cheilosis, swollen red papillae of the gums, and enlarged
thyroid. (0—36—19, Table 2B, p. 204; Tr. 30157—60. Goodhart) In addition,
through clinical examinations one can elicit symptoms and observe the anatom-
ical signs of overt, acute deficiency diseases. such as scurvy, pellegra, or beri
beri. (Tr. 2994, Hodges; WD—GS—Goodhart. p. 7—8).

16. The successful use of the testing techniques listed in the previous findings
requires that the investigators be highly trained and have at their disposal
sophisticated laboratory facilities. This is especially true in the case of the bio-
chemical and metabolic tests. All of these examinations are time consuming.
As a consequence these tests are quite expensive. It has been estimated that if
a person were to purchase a report of his nutritional status. it would cost
between $150 and $300. The cost and time consumption, when coupled with
the fact that such a report would remain valid for only a short time, con-
stitute an effective barrier to the individual’s being able to ascertain his personal
nutritional status. These tests become practical only when used on an epidemio-
logical basis. (WD—46—Margen, p. 10—13; WD—46-Schvvartz. p. 5, p. 13—14: WD—
46—Olson. p. 15—17; Tr. 3089—90, Tr. 6746—48. Tr. 6781—82, Hodges; WD—46—
Wallerstein, p. 8—9; WD—33—Brin, p. 22; WD—33—Horwitt, p. 21—22).

B. VITAMIN AND MINERAL CONTENT OF THE U.S. FOOD SUPPLY AND FACTORS
LIMITING ITS AVAILABILITY FOR CONSUMPTION

17. Evidence of record concerning the vitamin and mineral content of the
United States food supply ranges from anectodotal testimony by an FDA witness
about the wide variety of food available in supermarkets to detailed estimates
of per capita nutrient availability developed by the Department of Agriculture.
(Tr. 2996—3005, Hodges; Tr. 1843—45. Grollman; P—764; P—765).

18. The Department of Agriculture estimates of per capita nutrient avail-
ability in the United States food supply are, known as “disappearance data.”
The official USDA publication containing the data, which is in evidence, states:
“Estimates of per capita consumption of foods made by commodity specialists
of Economic Research Service are sometimes referred to as ‘disappearance data’
because of the method by which they are derived. To estimate civilian consump-
tion, these specialists use statistics on the Nation’s food production. imports and
exports, net changes in stocks, military takings, and amounts used for feed,
seed, and nonfood products. Remaining food is considered to have ‘disappeared’
into civilian consumption.” (P—764, p. 3. p. 8—9).

19. Nutrient content of the civilian food supply is calculated by the use of
standard reference tables contained in USDA Statistical Bulletin No. 364 and

2586

Agricultural Handbook No. 8. The estimated per capita nutrients available for
consumption are maximum values, because “no deduction has been made in
nutrient estimates for loss or waste of food in the home, use for pet food, or for
destruction or loss of nutrients during the preparation of food.” (P—764, p. 5, p. 9,
Rt. Nt. 1 to Table 1, p. 4; WD—16—Briggs, p. 17; Tr. 11595, Schweigert) In addi-
tion, although modern processing techniques contribute much to stabilizing micro-
nutrient content, the levels of certain micronutrients actually present in foods
when they are consumed can be quite variable due to the combined effects of
transportation, storage, and preparation. (Tr. 8197—200, Schweigert; Tr. 29036—
38, Margen; WD—46—Mayer, p. 30; Tr. 29385—86, Stare; Tr. 30198-99, Goodhart;
WD—33—Harris, p. 4—54).

20. The nutrients available per capita in 1968, the latest year for which there
are data of record, were as follows:

Food Energy 3,200 cal. : Protein, 98 gm. ; Fat, 150 gm. ; Carbohydrate, 381 gm. ;
Calcium, 93 gm. ; and Phosphorus, 1.51 gm.

Iron, 1.69 mg.; Vitamin A, 7,700 IU; Thiamin, 1.82 mg.; Riboflavin, 2.24 mg.;
Niacin. 22.1 mg. ; and Ascorbic Acid, 107 mg. (P—T65, Table 12, p. 27).

21. The calorie content of the diet is an important limiting factor in the attain-
ment of adequate vitamin and mineral intake. Department of Agriculture data
showing per capita nutrient availability (P465) show that calories are avail-
able at levels in excess of the RDA (P—651, last page). If an individual’s diet
contains not more than the RDA for calories, or, as in the case of reducing diets,
less than the RDA for calories. it becomes more difficult to select foods which
will furnish the RDA for micronutrients yet keep the diet within recommended
caloric limits. This is a particular problem for women, whose calorie allowance is
low, and becomes more aggravated if a substantial amount of calories in the diet
are in the form of such foods as sugar or alcohol. which contain no vitamins or
minerals. (WD—46—White. p. 10—13: WD—ifl—Olson. p. 14—15; 04306—46. Section V:
Tr. 28582—84, Tr. 28606-07, White; WD—46—Severinghaus, p. 16—17; Tr. 28645,
Severinghaus: WD—iG-Briggs, p. 16—17, p. 20).

22. The consensus of qualified nutritionists and physicians who appeared in
this proceeding is that the food supply of the United States does not contain
adequate amounts of iron. (Tr. 3068—69, Hodges; WD—BA—Sebrell, p. 17: Tr.
26088449. Sebrell; “’D—46—Olson. p. 10—11: WD—46—Wallerstein. p. 12—13: WI)—
46—White. p. 13—14; WD—46—Schwartz, p. 6—7: Tr. 28713—14, Margen: WD~46—
Margen. p. 7) In addition. the NAS—NRC Food and Nutrition Board states, “It is
impractical to supply these needs [of adult women for iron] with ordinary foods,
and iron supplementation is required.” (P—651, p. 59).

23. The Department of Agriculture’s annual disappearance estimates indicate
that for most nutrients the peak per capita availability occurred during and
immediately after \Vorld War II. The per capita availability of all the nutrients
shown in he table set forth in Finding 20 has decreased since that time. (P—764,
Table 1. p. 4: Table 12, p. 27).

24. No attempt was made by USDA in P—764 or P-765 to estimate the avail-
ability in the US. food supply of vitamin D, vitamin E, folacin, vitamin Ba, iodine,
or magnesium although all are essential micronutrients for which the NAS—NRC
Food and Nutrition Board has established Recommended Dietary Allowances.
(P—651. last page.) However. expert testimony indicates that in some regions
adequate amounts of iodine are not present in the food supply because of the soil
in which it is grown. (Tr. 2616—17, Mickelsen: Tr. 247779. Ross: Tr. 11768-69.
Schweigert: WD—46-01son, p. 22: WD-48—Briggs, p. 35: Tr. 31900, Vitale: Tr.
12046. Allaway) Some witnesses questioned the adequacy of the levels of folacin,
vitamin Ba. and magnesium available in the food supply. (WD—46—Olson. p. 10:
WD—46—White. p. 8: Tr. 28575. White: WD—46—Briggs, p. 18: WD—33—Krehl, p.
9—10.) The evidence of record is not sufficient to establish the actual numerical
levels at which these micronntrients occur in the US. food supply. Raymond H.
Bunnel. l’h.D.. a qualified nutritionist who appeared in this proceeding, conducted
an analysis which showed that the vitamin E content of a variety of typical break-
fast. lunch and dinner menus would average 11 TU. per day, which is approxi-
mately 1/3 of the RDA for adult males and less than the RDA for everyone over
the age of six. (0—544—33: WD—Pfi-Runnell, p. 3—5.) It was Dr. Bunnell’s opinion
that it would be difficult to achieve the adult RDA for vitamin E unless the diet
contains reasonable amounts of fresh vegetable oils. (WD—33—‘Bunnell. p. 10.)

25. “Availability" of micronutrients in the food supply does not guarantee that
individuals. or even large population groups. will in fact obtain the micronutrients

2587

they need. A variety of foods must be selected and purchased, prepared properly,
and actually consumed to insure adequate vitamin and mineral nutrition. (WD—
33gl?merson, p. 14; WD—46—Mayer, p. 24; WD—46—Olson, p. 11; WD—46—Margen,
p. .

26. Actual food choices by consumers are primarily determined by taste, Tradi—
tion, ethnic or regional habits, economic circumstances, and other factors unrelated
to the nutritional value of food. (Tr. 29460—61. Olson : WD—46—Briggs, p. 22—23:
Tr. 26103, Sebell; WD—ll—Graham, p. 20; WD—33—Horwitt, p. 18—19.) The
appearance in today’s marketplace of numerous new processed foods has com—
plicated the problem of selecting a diet adequate in vitamins and minerals. (WD—
33—Emerson, p. 16; Tr. 29037, Margen; WD—46—Mayer, p. 25—27; Tr. 28908—09,
Mayer.) Particularly today, with such a wide variety of foods of varying micro-
nutrient content available, it cannot be assumed that people generally can or will
automatically select a diet adequate in vitamins and minerals. (WD4&lIargen,
p. 18; WD—46—Briggs, p. 22—23; WD—46—Jukes, p. 5.)

C. EXISTENCE AND IDENTITY 0F GROUPS OF PERSONS \VHO ARE NOT RECEIVING ADEQUATE
AMOUNTS 0F VITAMINS AND MINERALS FROM THE DIETS THEY CONSUME

27. There is no reliable record evidence which confirms or even suggests that
all members of the United States population (a) regularly consume the Recom-
mended Dietary Allowances of vitamins and minerals, or (b) are free of evidence
of malnutrition as defined in Findings 7 and 8. As is further detailed below,
record evidence concerning food purchases, food intake, and biochemical testing
of groups Within the US. population overwhelmingly points to the conclusion that
there are substantial numbers of people in this country who, despite whatever vita-
mins or minerals are theoretically “available” in the food supply. (a) fail to
consume adequate levels of vitamins and minerals, and (b) exhibit biochemical
evidence of malnutrition. (Finding 95 infra.)

28. The United States Department of Agriculture has conducted periodic surveys
of household food purchases. The two most recent of these surveys were con-
ducted in 1955 and 1965. They surveyed 7,500 households selected so as to be repre-
sentative of the United States population as a whole. (P—568, p. 5.) The survey
report concluded that. “Half of the households had diets that furnished the recom-
mended allowances for the nutrients studied, and the other half had diets that
failed to meet the allowance for one or more nutrients.” (P—568, p.4.) The survey
also found that one-fifth of the households purchased diets that furnished less
than two-thirds of the 1964 version of the NAS—NRC Food and Nutrition Board’s
Recommended Dietary Allowances for one or more nutrients. which version is
in most cases not greatly different from the current one. (P—568, p. 5: Tr. 2917,
Hodges.) The record does not contain the underlying data from the USDA survey
which would have to be analyzed in order to determine the precise effect of the
RDA changes on the findings reported by USDA.

29. The 1965 Household Survey revealed that the following percentages of
households failed to purchase the RDA or 2/3 of the RDA per “nutrition unit”
for the following micronutrieuts:

 

Calcium lrnn Vitamin A Thiamine Riboflavin Ascorbic acid
Percent of household diet: providing
less than RDA ,,,,,,,,,,,,,,,,,, 30 10 26 8 G 27
Percent of household diets providing

less than%RDA __________________ 8 2 10 1 1 13

 

30. Despite the absence of precise data. it is clear that the Department of
Agriculture figures on household purchases set forth above understate the ex-
tent to which households fail to purchase the RDA for iron. The Department
used as its standard the 1964 RDA for iron for men. which was 10 milligrams. The
1964 RDA for iron for women of childbearing age was 15 milligrams. and the
present RDA is .18 milligrams. The 1968 RDA for iron for young children is 15
milligrams, and for males 12—18 years of age it is 18 milligrams. Only the RDA
for infants 0—2 months of age is less than 10 milligrams. Thus the standard of
adeouacy used in the report is lower than the 1968 RDA for many members of
the households surveyed. (P—568. Ft. Nt. 12. p. 34: P—651. last page: WD—46—
Briggs, p. 23—24).

2588

31. The Department of Agriculture figures on household food purchases also
tend to understate the failures to attain the RDA for each nutrient considered.
because “no deductions have been made for discard of edible food.” (P—568,
Ft. Nt. 13, p. 34).

32. The report of the 1965 Household Survey made a comparison with the
findings of the 1955 survey which revealed that there is a trend toward the
purchase of less adequate diets. The report summarized this finding as follows,
“Good diets, those meeting allowances for all seven nutrients, were found in 5
of every 10 households surveyed in 1965 and 6 of every 10 households in 1955."

p—568, .11 .

( 33. DIE.) Gla)dys Emerson, a qualified nutritionist, testified that consumption of
whole grain cereals, potatoes, milk, butter and eggs had decreased. (WD—33—
Emerson, p. 14) The changing patterns of consumption affect nutrient intake.
As a result of the decrease in consumption of whole grain cereals, there has been
:1 decrease in consumption of vitamin Be, E, and thiamin. The decrease in con-
sumption of dairy products means that there has been a decrease in consumption
of riboflavin and vitamin A. (WD—33—Emerson, p. 15) Dr. George Briggs, a
qualified nutritionist, agreed that people today are eating far less whole grains,
potatoes and vegetables. He observed that presently 20% of the total U.S. diet
is in the form of sucrose. (Tr. 28721. Briggs).

34. In its 1965 nationwide survey, the Department of Agriculture collected
data on individual vitamin and mineral intakes, as well as household food pur-
chases. The intakes of 14,500 women, men, and children were reported. (P—762).

35. These data on individual vitamin and mineral intakes indicate that the
average diet consumed by many sex-age groups was not suificient to provide the
RDA of one or more nutrients. The following table summarizes these findings:

NUTRIENTS FOR WHICH 1968 RDA WAS NOT PROVIDED BY THE AVERAGE DIET

 

Age group Calcium Iron Vitamin A Thiamine Riboflavin Ascorbic acid

 

 

Male and female:

 

   

X ........... X
X X X
X ........... X
X X X
X X
X . X
........................ X
X X X
X X X

 

 

36. The study drew the following conclusion: “With averages for several
minerals and vitamins below the recommended allowances for some sex-age
groups, it is safe to conclude that some persons within those age groups had
diets in need of improvement. Where averages fell more than 30 percent below
recommendations, as in calcium and iron for some sex-groups, the proportions of
persons in those groups with diets in need of improvement were almost cer-
tainly high." (P—762, p. 10).

37. Dr. Thomas R. A. Davis, et al, made a “Review of Studies of Vitamin and
Mineral Nutrition in the United States (1950—1968),” which combined and ana-
lyzed the dietary intake data from a number of studies, involving some 20,000
subjects. that had been conducted using compatible standards. The review con-
cluded that from 31 to 57 percent of the individuals examined in the studies had
diets which were not sufficient to furnish the RDA for the micro-nutrients con-
sidered—calcium, iron. vitamin A. thiamine. riboflavin, niacin, and vitamin C.

2589

31 percent did not achieve the RDA for vitamin A, while 57 percent failed to
achieve the RDA for iron. The percentages of failure for the other nutrients
lay between these two bounds. Between 8 and 28 percent of the subjects investi-
gated failed to consume diets which would furnish % of the RDA for the micro-
nutrients considered. 8 percent failed to achieve % of the RDA for niacin,
while 28 percent failed to achieve % of the RDA for calcium and for vitamin C.
The percentages of failure for the other nutrients lay between these two bounds.
Between 2 and 12 percent of the subjects investigated failed to consume diets
which would furnish even 1A of the RDA for the micronutrients considered. 2
percent failed to achieve 1/2 of the RDA for thiamine and niacin. 12 percent
failed to achieve 1/2 of the RDA for vitamin C. The percentages of failure for the
other nutrients lay between these two bounds. (0—587—46, Table 1, p. 42, Figure
2, p. 43, text p. 43 ; WD—46—Davis, p. 12).

38. The Davis review examined studies published during the period from 1950
to 1968. It was noted that the percentages of failures to achieve the RDA, 2/3
RDA, and 1A; RDA were higher in the more recent studies, leading the reviewers
to conclude that “between approximately 1960 and 1968 a change for the worse
occurred in the dietary intakes of all nutrients studied.” (0—587—46, p. 43, Figure
4, 46; WD—46—Davis, p. 13).

39. The studies reviewed by Davis et 211 included the results of many bio-
chemical investigations, involving approximately 10,000 subjects. The review
found that significant numbers of the subjects included in the studies reviewed
rated “below average” according to standard biochemical criteria. The biochemi-
cal information reviewed included data on hemoglobin, hematocrit, vitamin A,
carotene, thiamine. riboflavin, and vitamin C. The studies evaluated these data
in terms of ICNND standards or the Bessey and Lowry standards. Based on
these, the review found that between 24 and 50 percent of the subjects had bio-
chemical levels depending on the test considered that were “below acceptable.”
24 percent had levels that were “below acceptable" in respect to vitamin A, while
50 percent had carotene levels that were “below acceptable.” Percentages below
acceptable for the other tests listed above fell between these two bounds. Be-
tween 13 and 38 percent had biochemical levels depending on the test considered
that were “low." 13 percent had “low” levels for riboflavin, and 38 percent had
“low” levels for carotene. Percentages that had “low" values for the other tests
above fell between these two bounds. Between 3 and 24 percent of the subjects
had biochemical levels that, depending on the test considered, were “deficient." 3
percent were “deficient” in regard to hemoglobin and hematocrit, and 24 per-
cent were “deficient” in respect to riboflavin. Percentages that had “deficient”
values for the other tests listed above fell between these two bounds. (0—
587—46, p. 42, p. 45—46, Figure 7, p. 53; WD—46—Davis. p. 13).

40. A document entitled, “An Analysis of Daily Food Consumption to Assess
Whether Nutrient Intake Meets Dietary Standards," was received in evidence
as 0—464—28. This report analyzed the dietary intake of vitamin A, vitamin C,
and thiamine in comparison with the 1964 Recommended Dietary Allowances.
The sample population included some 6700 individuals who were members of
2000 families selected to provide a cross section on all dimensions of the United
States population. Because the methodology of the survey required that records
be kept by subjects, illiterate households were not included in the sample. The
intake of each individual was examined for 14 days, yielding data on consump-
tion for approximately 94,000 “individual-days.” (0—464-28, p. 2—3. app. B;
WD—28—Barton, p. 11—20) The percentage of these individual-days which failed
to achieve the RDA was then computed for the three vitamins being considered.
It was found that daily intake was below the 1964 Recommended Dietary Allow-
ances for vitamin A 60.7% of the time. Dietary intake of vitamin C was found to
be less than the RDA 62.8% of the time, and daily intake of thiamine was below
the RDA 37.2% of time. (0—464—28, p. 1 ; WD—28-Thiessen, p. 84—88).

41. A document entitled, “A Compendium of Nutritional Status Studies Con-
ducted in the United States, 1957—1967," prepared by June L. Kelsay of the
Nutrition Research Division, US Department of Agriculture, was received in
evidence as 0—468—33. This compendium reviewed approximately 60 published
studies, involving over 30,000 people, which included dietary intake investiga-
tions. “The numbers studied in the different age groups were 8,756 infants and
preschool children; 2,871 children, 4,568 adolescents; 1,240 pregnant women,
3,685 adults; 1,379 older people; 5,721 families, and children in eight Indian
boarding schools.” (0—468—33, p. 124).

2590

42. In 0—468—33, diets of studied groups were categorized as “low” in a nu-
trient if 1) more than 50% of the subjects consumed less than the Recom-
mended Dietary Allowances, or 2) if more than 30% consumed less than three-
fourths RDA, or 3) if more than 20% had less than two-thirds RDA, or 4) if
more than 10% had less than one-half RDA, or 5) if the average nutrient intake
was below the Recommended Dietary Allowance. On this basis, studies in which
subjects had “low” intakes of none, one or two, or three or more nutrients were
categorized and their location identified as follows:

 

 

  

 

 

 

 

 

’ - Children Adulls
Pueuo Rizo (Screas) O D Solisfoclcry liglrienl Intake 0 0
Virgin Islands 6 El 6 Dials lcw in 'l or 2 Nulrienls Q E
Diels low In 3 at mcre Nutrients o a

The review states that, “In the majority of the studies there was a low intake
of three or more nutrients." (0—468—33, p. 136—37).

43. The Kelsay “Compendium,” (0—468—33), also reviewed some 50 published
nutritional surveys, involving approximately 30,000 people in the United States,
the Virgin Islands and Puerto Rico, which included clinical or biochemical
evaluations of vitamin and mineral nutrition. The numbers studied in different
age groups were: 4,625 infants and preschool children; 2,985 children; 8,114
adolescents; 5,948 pregnant women; 1,476 adults; 1,587 older people; 5,301 indi-
viduals in families; 35 families; and children in eight Indiana boarding schools.
(0-468—33, p. 124) The results reported in the studies tended to confirm the
intake inadequacies indicated by the dietary studies. (0—468—33, p. 135—136).

44. Myron Brin, Ph.D., a qualified nutritionist, appeared in this proceeding
and summarized a number of surveys of nutritional status in which he had par-
ticipted. (WD—33—Brm, p. 11—18. He concluded that the significance of the re-
sults of these studies was that, “At least with the populations that we surveyed,
adolescents, senior citizens, and migrant workers, large portions of these groups
were below adequate according to the best criteria in at least three of four nu-
trients—iron, thiamine, ascorbic acid, or riboflavin. In many cases up to 1A; of
the population studied was below adequate in at least one nutrient with smaller
proportions in others, indicating that large groups of our population are essen-
tially below adequate in nutrition.” (WD-33—Brin, p. 18). He added that, "I
consider findings in excess of 5% of the population being below adequacy in a
particular nutrient as very significant from the standpoint of public health."
(WD—33—Brin, p. 19).

45. W. A. Krehl, M.D., Ph.D., a qualified physician and nutritionist, appeared
as a witness in this proceeding. In connection with the preparation of his testi-
mony, Dr. Krehl undertook an extensive review of nutrition surveys that have
been reported in the literature to determine “whether segments of the popula-
tion are suffering from malnutrition or vitamin deficiencies.” (WD—33—Krehl, p.
18). Dr. Krehl discussed the many studies he reviewed and concluded that

2591

“taken as a group they show substantial reason for concern regarding the nu—
tritional adequacy of the diets that people are actually consuming and regard-
ing the capabilities of many individuals to select wisely and appropriately from
the abundance of foods that surrounds them. In short, there is nothing to assure
us in a search through the literature of nutritional surveys that all is well in
regard to the nutritional status of the people in the United Saes.” (WD—33—
Krehl, p. 47—48).

46. Robert S. Goodhart, M.D., and Elmer L. Severinghaus, M.D., qualified nu-
tritionists who appeared in this proceeding, sponsored in evidence a series of
three documents entitled, “How Well Nourished Are Americans?" (0—619-65: 0—
599—46; 0—600-46). These documents, which were authored by Dr. Goodhart,
summarize, analyze, and comment on the significance of a number of surveys of
nutritional status made in the United States. (WD-65—Goodhart, p. 5—6; WD—
46—Severinghaus, p. 12, p. 14). It was Dr. Goodhart’s conclusion that the studies
examined “provide incontrovertible proof that a great many Americans of all
ages and socio-economic brackets are subsisting on diets which fall substantially
short of the Recommended Dietary Allowances in respect to one or more es-
sential nutrients.” (0—599—46. p. 25).

47. Mr. Reinhardt Thiessen appeared in this proceeding and summarized a
review of 53 reports of nutrition surveys which he had conducted. in 1966, as
one of his duties as Nutrition Research Area Manager at General Foods, Inc.
(WD—28~Thiesscn, p. 17—19, p. 74—75; 0—461—28). On the basis of this review
Mr. Thiessen reached the following conclusion: “the findings in a few of the
reports did not disclose evidence of any appreciable nutritional deficiencies.
However, these were the exception and in the aggregate, this study confirmed our
earlier views including those found in a similar survey which we had made in
1955, that there are a considerable number of individuals in the United States
receiving inadequate intakes of nutrients. Many of these individuals obtain less
than the Recommended Dietary Allowances as set forth by the Food and N11—
trition Board of the National Research Council. In particular, low intakes were
often noted for vitamin 0, calcium, and iron. There were numerous incidents
of other nutrient deficiencies. As a matter of fact, we noted deficiencies at times
for some individuals for protein, calcium, iron, vitamin A, thiamin, riboflavin.
niacin, vitamin C, folic acid and even calories. Now, I want to emphasize that all
of the individuals did not have all of these dietary deficiencies nor probably did
any single individual have all of these deficiencies, but taking everything as a
whole, we found at some time a deficiency of one or more of these nutrients
which I have just recounted.

“It seemed obvious to us, from these data that the teenage girl seemed to be
the poorest fed member of the family in respect to her intake of nutrients in
relationship to her requirement for them. Another class of individuals which
stood out is the age group over 50. The incidents of deficiencies in his group
was also outstanding. Adults between the ages of 21 and 50 years was the next
group in line as far as incidents of nutritional deficiencies was concerned. We
found that the teenage boy was probably the best fed member of the family
and this is probably because of the sheer mass of food which boys eat. They are
very active athletically and they require a lot of calories and even though they
snack a lot, just by their sheer volume of food intake, their diet is fairly well
balanced.” (WD—28—Thiessen, p. 75—76).

48. The Committee on Iron Deficiency of the American Medical Association‘s
(‘ouncil on Foods and Nutrition conducted a review of literature on iron de-
ficiency in the United States. which has been published and received in evidence
as 0-612—46. The Committee investigated the adequacy of the iron supply ordi—
narily available from dietary sources in relation to the requirements of several
groups. (0—612—46, p. 120) On the basis of the information available. it was con-
cluded that “many adolescent girls and menstruating women have a borderline
iron intake of 10 mg. or less each day. This value is consistent with the, 1,500 to
2.000 calorie diet of sedentary women.” (0—612—46. p. 121) In addition. it found
that, “The requirements of infancy and of the latter half of pregnancy are
clearly in excess of what may be obtained from an unfortified diet." (0—012—16.

. 121 .

p 49. The Committee concluded that within certain groups the prevalence of
iron deficiency and iron deficiency anemia is high. (0—612—46. p. 121—22, p. 124)
These groups included women of childbearing age. infants and pregnant women.

2592

Although the data reviewed did not permit the committee to fix percentages
applicable to these populations on a nationwide basis, it did observe that a study
of the hemoglobin levels of 73,783 women blood donors had found 12.6% of them
to have levels below 12.3 gm/lOO ml. blood. (0—612—46, p. 121) The studies of
infants which were reviewed found in supposedly normal children incidences
of anemia ranging from 8% to 64% (0—612—46, p. 122). Studies of pregnant
women showed anemia in from 10% to 60%, depending on the study. (0—612—46,
p. 121) The committee concluded that studies are “urgently needed to define more
clearly the incidence of iron deficiency in the United States.” (0—612—46, p. 124).

50. Robert E. Hodges, M.D., a qualified physician and nutritionist who ap-
peared in this proceeding, and W. A. Krehl, M.D., Ph.D., (Finding 45), con-
ducted a nutritional survey of a statistically randomized sample of the Iowa
teenage population. (0—36—19) Preliminary findings, based on a survey of 2,015
students are reported in 0-36—19 (p. 201) The survey was designed to run for
five years, with approximately 2,000 students being examined each year; the
results reported being those of the first year. (0—36—19, p. 200) Physical ex-
aminations were performed on each subject, biochemical tests were run, and
dietary histories recorded. (0—36—19, p. 202).

51. The mean values for physical examinations and for biochemical deter-
minations fell within the normal range, but a minority of the students was
found to have values which were less than desirable. (Tr. 3020, Hodges; 0—36—19,
p. 203) Among the 2,015 students there were found 1,272 positive clinical signs.
(0—36-19, table 2B, 1). 201) The authors reported that “the findings in this sample
are a little bit more reassuring than the actual facts justify.” (0—36—19, p. 208)
“The average values presented here conceal the abnormal values at each end
of the biochemical curve. In addition, they may omit children from impoverished
families.” (0—63—19, p. 208) It is probable that the incidence of malnutrition
within this latter group is higher than among the surveyed population. (Tr.
3127—28, Hodges).

52. Dr. Hodges believes that poor eating habits constituted a major problem
among the teenagers in the sample. (Tr. 3150 Hodges) The survey reported
that, “Dietary faddism is not infrequent and restriction of food intake to a
relatively small number of familiar and favorite items is common. A sizeable
number of students. especially those who skip breakfast have less than the
optimal intake of ascorbic acid.” (0—36-19, p. 208) .

53. Dr. Walter linglaub, a qualified physician and nutritionist, who served
as the Louisiana Field Director for the National Nutrition Survey, described
in this proceeding a study of 3.000 Louisiana school-age children which he had
conducted. (WD—lG—Unglaub. p. 21—27) This study, which involved children
between 10 and 16 years of age, was begun some eight years ago and continued
over several years. The study was undertaken as a consequence of the ICNND
surveys begin made in developing countries throughout the world, and was
originally intended to develop data relating dietary intake to clinical and bio-
chemical parameters in an apparently well nourished population. (WD—46—
Unglaub, p. 21—22) Each child received a clinical examination employing the
procedures and criteria of ICNND. Dietary intake information, blood samples,
and urine samples were taken from children selected at random from the survey
group. Altogether dietary intake data and blood biochemical data were obtained
for over 600 subjects. (WD—46—Unglaub, p. 22—23).

54. The study found that the pattern and quality of meals consumed were
poor. Many meals were skipped, particularly breakfast. Meal patterns in the
home were often poor. as demonstrated by the comparison of the school-lunch
and supper meal eaten at home. Consumption of green and yellow vegetables
and of fruits and milk was approximately twice as great at the controlled
school-lunch meal as at home. The consumption of carbonated beverages was
M; less at lunch than at home. (WD—46—Unglaub, p. 23).

55. Nearly all children reported dietary intakes deficient in calories when
compared with the 1964 version of the NAS-NRC Food and Nutrtion Board‘s
Recommended Dietary Allowances. A large portion of the caloric intake was
derived from carbonated beverages, candies and pastries. Vending machines
present in the schools tended to encourage such consumption patterns.

2593

56. Average intakes of calcium, iron, vitamin A, and ascorbic acid in the
population sampled were well below recommended levels. The results in terms of
the 1964 RDA’s are illustrated in the following graph :

‘70
I20-
3
9.
g [00-
.2
F
v 80—
33’:
2D
2.5.
60—
s:
x“:
33
g:- 40—
II
5
3 20—
o\°

 

   

g

Results of Dietary'lnloke Studies
Survey of Louisono School Children

 

 

 

 

\‘i‘ \'\K\\ \\\\\\\\W

\

 

 

 

\ \\\*\" WW

 

 

Non-While Mole
Non-While Female
[3 White Male

While Female

  

 

 

 

Calories

 

n

Calcium

 

Vitamin A Vitamin c-

Some relatively high vitamin A intakes, chiefly in the non—white groups, were
attributable to frequent consumption of sweet potatoes, a major Louisiana

agricultural product. (\VD—4t'r—Unglaub, p. 23—25)

57. The survey also reported the percentage of intakes which failed to meet
80% of the recommended level. The results are shown in the following graph :

59'
.70-
.50-

50_-

4o-

% of Subiecls

Pcrcenlcge of Subjects in Dietary Study Failing to meet 80% of' National
Research Ccunciificcommendcd Dictcry Allowances - [964 RDA's

 

 

 

 

 

 

 

 

 

 

 

  

 

 

    

 

 

    

 

 

        

 

 

 

 

 

 

 

Calories

Protein

Calcium

tron

Vitamin

A

Thiamine Riboflavin .lnacxn Ascorbic
Equiv. Acid

2594

58. Biochemical data in this survey in general confirmed the dietary intake
data. Anemia was a common finding. In some areas not a single subject met the
ICNND criteria for “acceptable” or “high” categories as to hemoglobin levels.
The hemoglobin results and the ICNND standards are shown in the following
graph:

   

 

 

70 '-
Hemolologic Findings_

6°- ICNND Standards
2 50-
U
:5: 40.. Elli Deficient <l2.0 gm. °,’o
m m Low l2.0-l3.9 gm.l°/:,
.6 30- -. Azcepfcble 14.0—15.0 gm.°,’3
°\° m Hig. >l5.0 gm. °/o

20-

IO- (WD-46-Unglaub, p. 2:3)

0...

 

 

 

 

 

 

5!). Low plasma ascorbic acid levels, defined as a concentration of less than
20 mg%, were encountered in approximately 12% of the sample, (WD—46—
l'nglaub, p. 27).

(:0. Serum carotene was classified as “deficient” or "low” in approximately
30% of the subjects, confirming the finding of low vitamin A intake in the di-
etary studies. “Low” is defined in the ICNND standard as less than .40 mk%,
and “deficient” is defined as being less than .20 mg%. (WD—lG—Unglaub, p. 27).

(ii. The record permits no definitive overall finding as to the economic level
of the subjects of the various dietary and biochemical studies summarized in
the foregoing findings. The record does contain a number of statements on this
subject by the authors of studies which are in evidence.

62. The Department of Agriculture survey referred to in Findings 2&32 and
Findings 34—36 sought to and did in fact report on a sample which included all
income levels of the population. (P—568, p. 5, p. 8-9; P—762, p. 2) "Poor" diets
were found at all income levels. (P—568, p. 3. p. 28).

(i3. Precise data on the income levels of populations in the individual studies
underlying the literature reviews of record are not available. These studies did
not, in general, report economic data in a precise or systematic fashion. How-
ever, Dr. Gershoff, one of the authors of the review by Davis et al. 0487—46
(Findings 37—39), testified regarding the studies reviewed that “they are mostly
on groups of people from small urban communities within easy traveling
distance of land grant colleges. For example, the ghetto areas of large cities,
Appalachia, or the Mississippi delta, were not studied.” (WD—46—Gershoff,
p. 8).

64. Dr. Robert Olson supported Dr. Gershoff in this respect, testifying that he
knew from personal experience that some of the studies reviewed by Davis
et a1. were of middle class families. He summarized the situation as follows,
“My view of the total data so far is that it is probably in the middle. and we
do not know the, real unemployed, hard core ghetto population who do not semi
their children to school, who are not employed: we don‘t have a really good idea
of this group and we don’t have perhaps the best idea of the upperclasses and
the upper middleclasses.

But I think the data we have turned out to he accidentally quite representa-
tive. Because we miss the top segment, and really are missing the bottom seg-
ment.” (Tr. 29473, Olson).

65. On the. basis of his literature review (Finding 45'»), Dr. Krehl concluded
that, “In every segment of the population, and even in the affluent segment one
may find evidence of nutritional inadequacy, if only in latent form." (WD—33—
Krehl, p. 48).

2595

60. The Hodges and Krehl survey reported in Findings 50—52 investigated the
health of Iowa teenagers. The authors reported that, "We selected Iowa as the
location for this survey because it has a stable population, an agricultural
heritage, an abundance of food and a high socioeconomic level. Poverty, as it
exists in the slums of a large city, is virtually unknown in the state of Iowa
although, of course, as in any community, there are a few underprivileged fami-
lies." (0—30—19, p. 200.) The study used volunteers. and there was some evidence
that those students from the lowest socioeconomic groups were disinclined to
volunteer. (0—36—19, p. 208).

67. In reporting his survey of 3,000 Louisiana adolescents (Findings 53450),
Dr. Unglaub testified that these students were “generally from low income back-
grounds." (WD—4G—Unglaub, p. 23).

68. The Department of Health, Education and Welfare was authorized by the
Partnership for Health Amendments of 1967 to conduct a comprehensive nutri-
tional status survey “designed to determine the location and magnitude of mal-
nutrition in the United States.” (WD—G—Schaefer, p. 2). This survey, conducted
under the direction of Dr. Arnold Schaefer, has been referred to in this proceed-
ing as the National Nutrition Survey. (0—924—33, Attach. I; WD—G—Schaefer,
p. 2).

(if). The National Nutrition Survey is gathering data from 10 states : California,
Kentucky, Louisiana, Massachusetts, Michigan, New York. South Carolina,
Texas, Washington, and West Virginia. (H.E.—]3, p. 3). However, the record in
this proceeding contains data and conclusions for only two of these states,
Louisiana and Texas. (0—924-33, p. 1—2) .

70. The National Nutrition Survey collected data on some 13,373 individuals
in Louisiana and Texas. (0—924—33, p. 2).

71. The sample examined was drawn by making a random selection among
census enumeration districts in proportion to the number of families reported
in the 1960 Census in the lowest one-fourth income group. Within each enumera-
tion district :1 segment with an average of about 60 housing units was randomly
selected. Finally, on the basis of a random start, an average of about 20 house-
holds in each enumeration district was chosen to be invited to participate in the
survey. (H.E.—13, p. 11—12; 0—924~33, Attach. I, p. 3). Although the sample was
chosen from areas indicated by the 1960 Census as being poor, not all of the
individuals surveyed were poor. Family incomes ranged as high as $42,000 per
annum. (HE—13, p. 12 ; WD—46-Unglaub, p. 3).

72. Testing was carried out using the protocol and procedures with some
modifications, which Dr. Schaefer’s group had developed while conducting nu-
trition surveys in undeveloped countries for the Interdepartmental Committee
on Nutrition for National Defense (ICNND). A household questionnaire was
used to gather data on family members including their name, age, sex, marital
status. race, ethnic group, relation to family head, education, and work experi-
ence. Information on the size and construction of the home, type of sanitary
facilities, and family income was also gathered. All members of each family were
given physical and dental examinations, had their medical histories recorded,
and had anthropometric measurements taken. In the case of those persons under
17 years of age, wrist x-rays were made to determine bone density and bone
age in relation to chronological age. Subjects gave blood and urine samples for
use in hematological and biochemical evaluations. Blood was analyzed for
hemoglobin, hematocrit, total serum protein, serum albumin, plasma vitamin A,
serum carotene, and serum vitamin C. In the case of those individuals having a
hemoglobin level under 10 gins/100 ml., serum folic acid, serum vitamin B12.
total serum iron, and iron binding capacity analyses were subsequently per—
formed. Urine was analyzed for creatinine. thiamine, riboflavin, and iodine.
Dietary intake data were collected for each of the individuals (WD—46—Unglaub,
p. 3—5) These dietary data were secured through a review of the previous day‘s
food consumption.” (0—924—33, p. 6)

73. Income data were important to the survey insofar as they indicated the
ability of subjects to purchase nutritious diets. This ability was dependent not
only on family income but also on such factors as geographic area, family size,
sex, and age of head of household. To take these factors into account 3. “Poverty
Index Ratio" was employed. A subject’s income places him at the poverty line
if his Poverty Index Ratio (PIR) equals 1.00. A PIR smaller than 1.00 indicates
that he is below the poverty line, and a PIR greater than 1.00 means he is above
it. (0—924—33. Attach. II) On the basis of the Poverty Index Ratio. in Texas (56

2596

percent of the households were below poverty level while in Louisiana 53 percent
were below poverty level. (0-924—33, p. 3)

74. The racial, ethnic, sex, and age characteristics of the Texas and Louisiana
survey samples are as follows:

RACE AND ETHNIC DISTRIBUTION OF SURVEY POPULATION

 

 

 

 

 

 

 

 
   

Texas Louisiana
ToIaI number ___________________________________________________________________ 7, 306 6, 067
Percent:
White ______________________________________________________________________ 12 23
Spanish speaking._.. _ . 52 ______________
Negro ..................................................................... 36 77
(04324—33, p. 2, table I.)
AGE AND SEX DISTRIBUTION OF SURVEY POPULATION
Texas Louisiana
Number Percent Number Percent
Sex:
Male __________________________________________________ 3, M7 47 2, 810 46
A Female ________________________________________________ 3, 859 53 3, 257 54
go:
Less than 6 years. . 1,148 16 856 14
6 to 9 years ....... 915 12 729 12
10 to 16 years... .. 1, 454 20 1,436 20
17 to 49 years .......................................... 2, 516 35 2,071 34
59 to 59 years __________________________________________ 481 7 507 8
60 years and over ....................................... 792 10 668 12

 

75. Data from the National Nutrition Survey indicate that substantial propor-
tions of the surveyed populations in the states of Louisiana and Texas had diets
which failed to provide amounts of one or more vitamins and minerals which
the survey considered adequate. The standards of adequacy used in the evalua-
tion of nutrient intake were developed by an ad hoc committee utilizing standards
from the World Health Organization ICNND Manual and the Recommended Die-
tary Allowances from the NAS-NRC Food and Nutrition Board. Those used to
evaluate micronutrient intake are as follows :

 

Calcium

Age: 1110/ "MI
0 to 1 month _____________________________________________________ 550
2 to 5 months ____________________________________________________ 550
6 to 11 months ___________________________________________________ 550
12 to 23 months __________________________________________________ 450
24 to 47 months __________________________________________________ 450
48 to 71 months __________________________________________________ 450
6 to 7 years ______________________________________________________ 450
8 to 9 years ______________________________________________________ 450

10 to 12 years:
Male ________________________________________________________ 650
Female _____________________________________________________ 650

13 to 16 years:
Male _______________________________________________________ 650
Female _____________________________________________________ 650

17 to 19 years:
Male _______________________________________________________ 550
Female _________________ ____ _ 550
Adults ________________ 400

 

Pregnant—3rd trimester 400/mg/day plus basic requirements _________
Lactating-500 mg/day plus basic requirements ______________________

2597

 

 

 

Iron
Age 1 lily/Day
0 to 1 month _____________________________________________________ 10
2 to 5 months ____________________________________________________ 10
6 to 11 months ___________________________________________________ 10
12 to 23 months __________________________________________________ 15
24 to 47 months __________________________________________________ 15
48 to 71 months __________________________________________________ 10
6 to 7 years months ______________________________________________ 10
8 to 9 years ______________________________________________________ 10
10 to 12 years:
Male _______________________________________________________ 10
Female _____________________________________________________ 18
13 to 16 years :
Male _______________________________________________________ 18
Female _____________________________________________________ 18
17 to 19 years :
Male ____________________ _- ______ __ _____ 18
Female _____________________________________________________ 18
Adults
Male (20 years and over) _____________________________________ 10
Female (to 55) ______________________________________________ 18
Female (55 on) ______________________________________________ 10
Pregnant and Lactating—No special allowance ____________________ —
VITAMINS B
Age Thiamine Riboflavin Niacin
For all age groups including 0.4 mg./1003 calories _____ 0.55 mg./1000 calories... including equivalent from
adults. Tr ptophane 6.6 mg./1000

ca ONES.

 

a Ntlilgi Calories for each of above groups to be computed on average weights shown, except when actual weights are
van a e.

Asconmc ACID—FOR ALL: 30 MG/DAY

 

 

 

VitaminA
Age 2 International units
0 to 1 month -_ 1,500
2 to 5 months--- ___________________ 1, 500
6 to 11 months ___________________________________________________ 1, 500
12 to 23 months _________________________ 2,000
24 to 47 months __________________________________________________ 2, 000
48 to 71 months __________________________________________________ 2, 000
6 to 7 years _____________________________________________________ 2,500
8 to 9 years _____________________________________________________ 2,500
10 to 12 years --------------------------------------------------- 2, 500
>12 years _______________________________________________________ 3,500

76. Under the above standards, intake amounts for some nutrient that are
lower than the RDA are regarded as acceptable. This is true in the case of
calcium, ascorbic acid, and vitamin A. (Finding 2 ; Finding 75).

77. The results of the National Nutritional Survey are presented in the evidence
of record for “households" and for groups of individuals which the investigators
anticipated to be vulnerable, including infants 0—3 years, adolescents 10—16
years, pregnant and lactating women, and persons 60 years of age and older.
( 0—924—33, Tables IV—VI ; WD—46—Unglaub, p. 6).

78. With a few exceptions, the mean micronutrient intakes for these groups
in each state were found to exceed 100% of the standards. The exceptions were
iron, for which average consumption fell below the standard for all analyzed
groups in Louisiana and for children 0-3 years, 10—16 years, and for pregnant
and lactating women in Texas, and niacin, for which average intakes of children

2598

10—16 years and pregnant and lactating women fell below the standards in
Louisiana. (0-924—33, p. 7. Table V).

79. The report on this phase of the National Nutrition Survey stated, “average
of adequacy for intakes of individuals do not reveal the proportion of those indi-
viduals who consume low and high amounts so the usefulness of such data is
limited in delineating the problems of malnutrition. Group means may meet or
exceed the mean reference standard considered to be adequate, while significant
proportions of the group may be consuming diets falling considerably below the
reference standard. With this in mind, it is cause for concern that several group
means actually fell below the reference standard. This was especially true for
iron intakes. where every group mean in Louisiana and those for 0—3 year old
children, 10—16 year olds, and pregnant/lactating women in the Texas sample
failed to meet the reference standard. An average of only 50 and ’73 percent of
the reference standard for iron was consumed by 0—3 year old children in Texas
and Louisiana. respectively. This most widespread occurrence of inadequate
dietary intakes is consistent with the biochemical findings in all age groups."
( 0—924-33, p. 7).

80. The National Nutrition Survey also summarized intake data from Texas
and Louisiana on a county by county basis. The average intake for each cate-
gory of individuals or households in each county was expressed as a percent
of reference standards. with the results shown in the following table:

TABLE V|.—PERCENT 0F COUNTIES IN TEXAS AND LOUISIANA HAVING MEAN NUTRIENT INTAKES FALLING
BELOW REFERENCE STANDARDS

 

 

 

 

Age groups
0 to 3 10 to 16 60 and over Households
Texas Louisiana Texas Louisiana Texas Louisiana Texas Louisiana
Nutrient:

Iron ................. .. 100 71 50 100 20 57 31 61
Vitamin A ______________ 30 0 29 21 20 41 16 11
Vitamin C _______________ 60 28 A 7 0 8 0 6
Niacin _________________ 60 35 50 63 10 24 4 6
Thiamine ______________ 10 7 21 21 20 57 23 10
Riboflavin ______________ 0 0 8 0 10 8 0 5
Calcium ________________ 10 o 53 14 o 4 10
Protein ________________ 0 4 7 30 73 8 5

 

The large percentage of counties with group means below these standards sup-
ports the evidence for dietary deficiencies of iron among all groups, In addition.
there is evidence for low intakes of vitamin A and thiamine in all age groups and
for vitamin C in infants in numerous counties. (0—924—33, p. 7-8, Table VI).

81. The percentage of people in the Texas and Louisiana samples that consumed
diets that supplied less than 70 percent, from 70 to 100 percent and over 100 per-
cent of the reference standards for iron, vitamin A, vitamin C, thiamine, and
riboflavin was also computed and reported by the National Nutrition Survey as
follows:

FOOD INTAKES PROVIDING SPECIFIED PERCENTAGES OF IRON

 

Percent of subiects consuming

 

 
  
 
 

70—100
<70 percent percent >100 percent
standard standard standard
Texas

Infants. ___________________ 75 14 1t
Adolescents 45 19 3S
Aged" . 32 20 48
Pregnant tactatin 49 17 34
Households. 30 24 46

Louisiana:
Infants... 78 5 l7
Adolescen . 66 l7 l7
Aged. _. 46 19 35
Pregnant. Iactat 81 15 4
Households...._._.__ _ 42 24 34

 

2599

FOOD INTAKES PROVIDING SPECIFIED PERCENTAGES OF VITAMIN A

 

Percent 01 subiects consuming

 

 

 
  

 

 

 

 

 

 

 

  
 
 
  
 
 
 

 

 

 

 
 

 

 

 

 

 
  

70—100
<70 percent percent >100 percent
standard standard standard
Texas:
Infants ______________________________________________________ 33 9 58
Adolescents._ 52 15 35
89 ........ r. 47 10 43
Pregnant lactating 53 6 32
.Households ___________________________________________________ 41 14 45
Loursrana:
Infants ______________________________________________________ 26 17 57
Adolescents._ __ 53 15 32
ge _________ ., ,. 54 11 35
Pregnant lactating . . 54 15 31
Households ___________________________________________________ 44 15 41
FOOD INTAKES PROVIDING SPECIFIED PERCENTAGES 0F VITAMIN 0
Percent of subjects consuming
70-100
<70 percent percent >100 percent
standard standard standard
Texasc
lnfants____ ______________________________ 56 11 33
Adolescents 35 9 56
Aged... 32 10 58
Pregnant 37 6 57
Households ________________________ 27 10 63
Louisrana:
lnfants____ ________________ 53 11 36
Adolescents 45 9 46
Aged... 46 8 45
Pregnant cta 27 23 50
Households... 29 9 62
FOOD INTAKES PROVIDING SPECIFIED PERCENTAGES 0F RIBOFLAVIN
Percent of subjects consuming
70—100
<70 percent percent >100 percent
standard standard standard
Texas:
Infants ______________________________________________________ 15 5 79
Adolescents. _ 27 17 56
__________ 32 19 49
Pregnant lactating 20 17 63
Households ___________________________________________________ 19 21 60
Louisiana:
Infants ______________________________________________________ 3 4 88
Adolescents__ 16 17 67
Aged _____ 25 19 57
PregnanL. 12 19 G9

 

2600

FOOD INTAKES PROVIDING SPECIFIED PERCENTAGES 0F THIAMINE

 

Percent of subjects consuming

 

 

 
 
 
  

70—100
<70 percent percent >100 percent
standard standard standard
Texas:

Infants ______________________________________________________ 18 12 70
Adolescents._ __ . ., 28 19 53
Aged ________ 37 19 44
Pregnant Iacta. g. 34 17 49
Households...,___ 25 21 54

Louisiana:
Infants ______ 17 12 71
Adolescents. _ 37 22 41
ge ............ 44 26 30
Pregnant lactating. _ , _ _ _ _ 19 27 54
Households ___________________________________________________ 29 21 50

 

The data in these tables reveal that from 30 to 81 percent of all daily intakes,
depending on the group considered, were low in iron. More than three-fourths
of the children under age three in Texas and Louisiana ate diets providing less
than 70 percent of the standard for iron. In Louisiana, 81 percent of the pregnant
women reported diets that provided less than 70 percent of the standard for this
nutrient. 42 percent of Louisiana households and 30 percent of Texas households
reported food intakes inadequate in iron. From 26 to 63 percent of all intakes
were low in vitamin A. Among the 10—16 year old age group and the pregnant
women, more than half consumed diets which provided less than 70 percent
of the standard for vitamin A. Between 27 and 56 percent of all intakes were
low in vitamin C. More than one-fourth of the households in Louisiana and
Texas were eating foods providing less than 70 percent of the standard for
vitamin C. Reported food intakes show that 27 percent of the adolescents and
32 percent of the aged group in Texas were consuming less than the standard
for riboflavin. Thiamin intake did not meet 70 percent of the standard in diets
of 37 percent of the adolescents and 44 percent of the aged in Louisiana.
( 0—924—33, p. 8—9, Tables VII—XI).

82. The investigators were of the opinion that one day's food intake cannot
be used to appraise the adequacy of an individual diet. since any particular
day may not be representative of the usual food intake. Nevertheless, when daily
food consumption of a large proportion of any population group fails to meet
the standards required for adequacy. it is almost certain that many individuals
within the group will consume poor diets regularly. (0—924—33, p. 8).

83. Biochemical tests for hemoglobin, plasma vitamin A, serum vitamin C,
urinary thiamine excretion and urinary riboflavin excretion have been evaluated
in the Texas/Louisiana phase of the National Nutrition Survey and these results
tend to confirm the findings of widespread inadequate dietary intakes. (0—924433,
p. 10—15).

84. The standards used in evaluating biochemical data are an ad hoc modifica-
tion of the guidelines contained in the ICNND Manual for Nutrition Surveys.
These standards are as follows :

TABLE I.—GU|DEL|NES FOR CLASSIFICATION AND INTERPRETATION OF GROUP BLOOD AND URINE DATA COL-
LECTED AS PART OF THE NATIONAL NUTRITION SURVEY

 

Classification category

 

Less than acceptable

Determination Deficient Low Acceptable

 

Hemoglobin, g./100 ml.:

  
   

 

6 to 23 months ________________________________________________ <9.0 9. 0— 9.9 210.0
2to5years _____ .. _ <10 10.0—10.9 alto
Mo 12 years ______ <10 10.0—11.4 g11.5
13 to 16 years, male ________ <12 12. 0—119 213.0
13 to 16 years, female <10 10.0-11.4 g11.5
>16 years, male" <12 12. 0—119 gm. 0
>16 years, female. <10 10. 0—11.9 g12.o
Pregnant 2d trimes <9. 5 9. 5-10. 9 an. 0
Pregnant, 3d trimeste <9. 0 9. 0-10. 4 B10. 5

2601

TABLE l.—GU|DEL|NES FOR CLASSIFICATION AND INTERPRETATION OF GROUP BLOOD AND URINE DATA COL-
LECTED AS PART OF THE NATIONAL NUTRITION SURVEY—Continued

 

Classification category

 

Less than acceptable

 

 

    
 
 

  
  
 
 
 
  
 
 

 

 
 

  

 
 

 

     
 

 

Determination Deficient Low Acceptable
Hematocrit, percent:

6 to 23 months ________________________________________________ <28 28-30 :31

2 to 5 years... _________________________ <30 30-33 :34

6 to 12 years _______________________________ <30 30—35 :36

13 to 16 years, male. . ___________________________ <37 37-39 :40

13 to 16 yea rs, female _______________________________ <31 31-35 :36

>16 years male ______________________________________ <37 37—43 :44

>16 years. female _________________________________________ <31 31—37 :38

Pregnant. 2d trimester.. ................................... <30 30-34 235

Pregnant. 3d trimester ___________ . _____________________________ <30 30-32 233
Hemoglobin cone, MCHC. g./100 ml. REC:

A {ages ____________________________________________________________________ . 30 :30
Serum Iron, rug/100 ml:

0 to 5 months _________________________________________________ _ _ ..............

6 to 23 months <30 g30

2 to 5 years-.. <t0 E40

Ste 12 years__._ <50 gso

>12 years, male... <60 gGO

>12 years, female ..... <40 E40
Transferrin saturation. percent

0105months __________ .... ..............

6 to 23 months <15 g15

Zto 12 years.... <20 g20

>12 years, male... .. _ <20 g2!)

>12 years. female ____________________________________________ <15 215
Red cell tolacin, ng/ml:

All ages ................................................. . . . _ _ (140 140—159 g 160—650
Serum iolacin. ng/ml .............................................. 3 3. 0—5. 9 :6. 0
Serum protein, g./100 ml.:

0 to 11 months ______________________________________________________________ <5.0 :50

ltoSyears ______________________________________________________ <5.5 g5.5

6 to 17 years.. ................................................... <6.0 g6.0

dull ........................................................ <6.0 6.0—6.4 $6.5

Pregnant, 2d and 3r! trimester .................................. <5. 5 5. 5—5. 9 :6. 0
Serum albumin, g./100 ml.:

0 to 11 months. ____________________________________________________________ <2. 5 22. 5

l to 5 years ................................................................ (3.0 23. 0

6 to 17 years ............................................................... <3. 5 23. 5

Adult ________________________________________________________ <2. 8 2. 8—3. 4 :3. 5

Pregnant, lst trimester ........................................ <3. 0 3. 0—3. 9 :4. 0

Pre nant, 2d and 3d trimester .................................. <3. 0 3. 0—3. 4 :15
Scrum Vitamin C. mg./100 ml.:

0 to 11 months .........................................................................................

; year ..................................................... <01 0. 1—0. 19 20. 2
Plasma carotene, ILL/100:

0 to 5 months ............................................................... <10 :10

6 to 11 months" ............................................ <30 _Z_30

l to 17 years. . ......................................................... <40 :40

Adult ............................................. 20—39 :40

Pregnant. 2d trimester ........................................... 0—79 £80

Pregnant, 3d trimester ....................................................... 40—79 £80
Plasma vitamin A, rig/100 ml.:

0 to 5 months ................................................. <10 10—19 220

0.5 to 17 years. . <20 20—29 2.30

Adult .................................................. <10 10-19 gzo
Urinary thiamine, pg./g creatinine.

1 to 3 years .................................................. <120 120~l75 g176

4 tot; years .................................................. <85 85-120 g121

7 to 9 years .................................................. <70 70-180 g 181

10 to 12 years ................................................ <60 60~180 :18!

13 to 15 years ................................................ <50 50~150 2151

Adult ........................................................ <27 27-65 :66

Pregnant, 2d trimester.. <23 23—54 g5?)

Pregnant. 3d trimester ......................................... <21 2149 §50
Urinary riboflavin, rug/g creatinine:

0 years .................................................. <150 150—499 g500

4 to 6 years- ........................................... (100 100-299 g 300

7 to 9 years.. . ................................... <85 85—269 :270

10 to 15 years. ........ <20 70—199 :200

Adult ................. <27 27—79 g80

Pregnant, 2d trimester.. <39 39—119 :120

Pregnant, 3d trimester.-.. <30 30—89 :90
Urinary iodine,ug./g creatinine ..................................... <25 25—49 gso

 

l Excessively high levels may indicate abnormal cinical status or toxicity.
2 May Indicate unusual diet or malabsorptlon.

2602

85. The following table contains the results of the tests of hemoglobin levels:
HEMOGLOBIN LEVELS

 

Texas Louisiana

 

Total number ________________________________________________ 3, 265
Percent unacceptable:

    

22

Female 18

 

Male 7 7 Female?
Poverty status:
Above poverty ____________ , ____________________________________ 20 14 40 39
Below poverty __________________________________________________ 22 20 46 42
Ethnic group:

  

 

White _________________________________________________________ 10 7 46 32
Spanish speaking. _ 23 19 ____________________
A Negro _________________________________________________________ 19 19 46 39
22:
Less than 6 years _______________________________________________ 13 9 40 35
6109 years____ , 12 9 50 48
10 to 16 years. _ 16 13 46 34
17 to 49 years. _ 29 25 42 42
50 to 59 years. , A 30 19 45 21
60 years and over _______________________________________________ 44 19 59 34

 

Anemia is one of the major problems encountered in the National Nutrition
Survey. The hemoglobin level in the blood is a commonly used test to diagnose
anemia. Low hemoglobin levels indicating anemia were found to be a major
nutritional problem at all income levels in both Louisiana and Texas. No differ-
ences in the prevalence of anemia were observed between ethnic or racial groups
in Louisiana. In Texas, Spanish-speaking and Negro groups, both male and fe-
male, had a prevalence of unacceptable hemoglobin levels approximately twice
that of the white groups. All age groups in both states had high prevalence rates
of unacceptable hemoglobin levels. (0—924—33, p. 11—12, Table XV) In Louisiana,
investigators are sure the major cause of anemia is iron deficiency. (WD—46—
U nglaub, p. 16).

86. The following results were found for plasma vitamin A:

PLASMA VlTAMlN A LEVELS

 

 

 

 

 

 

 

 

 

 
 

Texas Loursiana
Total number._, . ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 2. 960 3,743
Percent unacceptable:
_____________ 41 15
____________ 48 18
. .......... 35 12
Male Female Male Female
Poverty status: —————————————————————
Above poverty __ , ,,,,,,,,,,,,,,,,,,,,,,,,,,,, 37 26 15 12
Below poverty__ _. _ 52 37 18 10
Ethnic group:
White.,.,_,,,,,_ _ ,. _ ,,,,,,,,,,,,,,,,,,,,,,,,, 32 20 19 10
Spanish speaking. ,,,,,,,, , ,,,,,,,,,,,,,,,,, 50 40 ....................
Negro ......... . .__ , A, __ ,,,,,,,,,,,,,, 51 34 18 13
Age:
Less than 6 years _________________ , ,, ,, ,,,,,,,,,,,,,,, 79 80 40 45
6 to 9 years ,,,,,,,,,,,,,,,,,,,,,,,,,,, , ,,,,,,,,,,,, 82 78 33 33
10 to 16 years ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 68 66 19 16
17 to 49 years ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 9 12 l l
50 to 59 years _________________________________________ l 8 0 1
60 years and over ,,,,,,,,,,,,,,,,,,,,,,,,,, , ,,,,,,,,,,,,, 7 3 l 1

 

41 percent of the subjects in Texas and 15 percent of the subjects in Louisi-
ana were found to have unacceptable levels of plasma vitamin A. The prevalence
of unacceptable levels of plasma vitamin A decreased as income increased, but
was not confined to those below the “poverty level." For example, in Texas the
prevalence of unacceptable levels in individuals living in households with a Pov-

2603

erty Income Ratio (PIR) less than 0.75 was 45 percent while for those with PIR
of 1.50 and over it was 26 percent. A subject’s income places him at the poverty
line if his PIR equals 1.00. A PIR smaller than 1.00 indicates that he is below the
poverty line, and a PIR greater than 1.00 means he is above it. (0—924—33, p. 12,
Table XVI, Attach. II).

87. The following results were found for serum vitamin C :

SERUM VITAMIN C LEVELS

 

 

 

 

 

  
  

Texas Louisiana
Total number ....................................................... 2, 577 3, 793
Percent unacceptable:
Total .......................................................... 12 14
_ 12 15
Female .................................................... 12 13
Male Female Male Female
Poverty status: ————————————————————
Above poverty ................... , .............................. 12 10 16 16
Below poverty .................................................. 11 12 ll 8
Ethnic group:
White .......................................................... 19 17 15 18
Spanish speaking ................................ 7 ........... 10 8 ____________________
Negro ...................................................... 13 17 15 12
Age:
Less than 6 years ............................................... 9 11 10 12
6to9years... ........... ll 10 8 10
10 to 16 years. . ......... 13 13 12 10
17m 49 years._ 12 13 24 16
50 to 59 years_. 11 11 24 12
60 years and over ............................................... 14 7 25 13

 

Twelve percent of the total population surveyed in Texas and 14 percent in
Louisiana had unacceptable serum levels of vitamin C. In Texas, no income in-
fluence was observed, while in Louisiana the prevalence of unacceptable values
was higher in the above poverty groups. (0—924—33, p. 13, table XVII).

88. The data from the urinary thiamine tests reveal the following:

URINARY THIAMINE EXCRETION LEVELS

 

 

   

 

   

   
  
  

 

 

 

Texas Louisiana
Total number _______________________________________________ 2,984 505
Percent unacceptable:
Total, ........................................................ 10 10
Male ,,,,,,,,,,, l3 8
Female .................................................... 9 10
Male Female Male Female
Poverty status:
Above poverty ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ll 8 8 10
Below poverty __________________________________________________ 13 10 __________ 3
Ethnic group:
White ......................................................... 12 7 18 8
Spanish speaking .. .: 19 5 ____________________
Negro ,,,,,,,,,,,,,,,, , ........................................ 18 13 5 11
Age:
Less than 6 years .............................................. 6
6 to 9 years ............ 9
10 to 16 years .......... 22
17 to 49 years ____________ 8
50 to 59 years ...... 9
60 years and over ________________________ . ...................... 11

 

 

Ten percent of the overall sample had unacceptable urinary thiamine levels.
No consistent relationship to income was found. The highest prevalence of
unacceptable levels is clustered in the individuals 10—16 years of age. (0—924—33,
p. 13—14, table XVIII).

2604

89. The final biochemical test for vitamin adequacy for which data have been
analyzed is the urinary riboflavin test. The results of this are as follows:

URINARY RIBOFLAVIN EXCRETION LEVELS

 

 

   

Texas Louisiana
Total number _______________________________________________________ 3, 040 516
Percent unacceptable:
Total __________________________________________________________ 21 16
Male ______________________________________________________ 22 20
Female ____________________________________________________ 21 13
Male Female Male Female
Poverty status:
Above poverty. . . _______ 17 18 25 17
Below poverty. 22 22 24 15
Ethnic group:
White... 12 13 24 15
Spanish speaki 19 19 ....................
egro _________________ 28 25 18 13
Age:
Less than 6 years. . ___________________________ 28
6 to 9 years ________________________________ 24
10 to 16 years. .. ___________________________ 29
17 to 49 years... ......................................... 12
50 to 59 years... _________________________________________ 12
60 years and over _______________________________________________ 9

 

 

The survey reported that in Texas there are slightly higher rates of unaccept-
able riboflavin in the population below poverty. One—fifth of the total population
in Texas had unacceptable levels. (0—924—33, p. 14, Table XIX).

90. The number of persons with multiple unacceptable values has also been
determined in the Texas phase of the National Nutrition Survey. Using the six
basic determinations. hemoglobin, serum albumin, serum vitamin A, and vitamin
C, and urinary riboflavin and thiamine, over one-third (35 percent) of the survey
population in Texas was observed to have two or more of these six biochemical
levels in the unacceptable range. Other results are as follows:

PATTERN 0F BIOCHEMICAL FINDINGS IN TEXAS SURVEY POPULATION (AGE)

 

Percent with 2 or more
unacceptable biochemical

 

   

 

values
Age group Number Both sexes Male Female
1 to 9 years ________________________________________ 206 49 31 46
10 to 12 years... _______________________ 185 40 43 36
13 to 16 years... _____________________ 314 54 54 55
17 to 59 years .......................... 562 25 23 24
60 years and over ................................... 201 27 37 18
Total (all ages) _______________________________ l, 368 35 40 32

 

91. The following table shows a distribution of the multiple unacceptable bio-
chemical findings by poverty status of the survey subjects. A subject’s income
places him at the poverty line if his Poverty Index Ratio equals 1.00. A PIR
smaller than 1.00 indicates that he is below the poverty line, and a PIR greater
than 1.00 means he is above it.

PATTERN OF BIOCHEMICAL FINDINGS IN TEXAS SURVEY: ETHNIC AND POVERTY STATUS

 

Percent with 0-3 or more unacceptable

 

 

 

 

Poverty income ratio biochemical values1
All ethnic group Number 0 1 2 3 or more
319 20. 1 35. 4 28.4 16 3
564 22. 7 42. 9 23. 9 10 4
375 25. 5 42.1 22. 6 9 8
109 30.0 45 9 18.3 2 8
All incomes .......................... 1,368 23. 7 41. 2 24.1 11.0

 

'1 Only ersons with all 6'determinations completed are included; hemoglobin, serum alumen, plasma vitamin A. serum
Vitamin , urinary rtboflavm and urinary thiamine.

2605 '

The table shows that findings of multiple unacceptable values were approxi-
mately twice as frequent among subjects having a PIR of less than .50 as among
subjects having a PIR of 2.00 or larger. However, even among this latter group,
21.1 percent of the subjects had multiple unacceptable values. (0—924—33, p. 10,
Table XIII. Attach. II).

92. The data have not been analyzed to determine the significance of observed
relationships between dietary intake and pertinent biochemical observations.
However, consistent trends appear. As an example, comparisons between the in-
takes of several nutrients with the percent of the appropriate biochemical values
which fall in the unacceptable range are given in the following tables for
households:

COMPARISON OF DIETARY DATA FROM HOUSEHOLDS AND BIOCHEMICAL OBSERVATIONS: LOUISIANA

____-“E__

 

 

 

  
 
  

 

 
 

 

Dietary
Percent
of diets
Mean providing Biochemical
Average percent <50 percent percent
Nutrient intake adequacy of standard unacceptable
Hemoglobin (iron). . . l12. 6 97 32 41
Vitamin A _________ 2 4, 948 155 37 15
Vitamin C ___________ 168 202 25 14
Serum protein (protein). ________ 3 80 146 18 ______________
Thiamine ____________________ l1.45 136 22 10
Riboflavin _________ 12. 81 210 13 16
Niacin __________ . .. .. 118.0 132 21 ______________
Calcium _ .......................................... 1 738 158 20 ______________
l Milligrams.
1 international units.
3 Grams.

COMPARISON OF DIETARY DATA FROM HOUSEHOLDS AND BIOCHEMICAL OBSERVATIONS: TEXAS

 

 

 

 
 
 
   

 

 

Dietary
Percent
of diets
Mean providing Biochemical
Average percent <50 percent percent
Nutrient Intake adequacy of standard unacceptable
Hemoglobin (iron). _________________________________ '14. 0 109 21 20
Vitamin A _____ 15, 178 171 35 41
Vitamin C ..... I59 214 24 12
Serum protein( 3 84 150 13 10
Thiamine _____ I1. 33 146 18 10
Riboflavin... ll. 77 149 15 21
Niacin.,.. _ I 18.9 137 16 ..............
Calcium ................................. l 597 132 20 ..............
l Milligrams.
2 International units.
3 Grams.

These comparisons show that a substantial percentage of the people may con-
sume diets which do not meet even 60 percent of the reference intake standards,
although the mean intake for the total group may be considerably above the ref-
erence standard level. The occurrence of low biochemical levels among a sub-
stantial percentage of the subjects supports the premise that many of the indi-
viduals in the sample fail to meet their nutrient needs day after day. (0—924—33,
p. 15, Tables XXV, XXVI).

93. The National Nutrition Survey looked for approximately forty different
lesions as part of physical examination which subjects were given. Clinical lesions
appear only after prolonged periods of poor food intake or after a shorter period
of extremely limited food intake. In Louisiana, approximately one in three adults
and one in ten children under the age of six had one or more clinical lesions.
In Texas the Spanish-speaking and Negro populations had a slightly higher
prevalence of individuals with one or more clinical lesions than did white popu-

' 2606

lations. A part of the pediatric examinations was a series of body measurements
and a hand-wrist x-ray to determine growth and development. Heights of Texas
and Louisiana children between 6 and 71 months of age were compared with
heights of a similar age group of Iowa children. The average height of the cliil-
dren in the sample was less than that of the Iowa children of a similar age. For
example, in Texas 41 percent of the males and 40 percent of the females were
shorter by more than one standard deviation below the Iowa mean. If growth of
these children had been comparable to the Iowa children, one would have ex-
pected this percentage to be 16. There appears to be an ethnic and racial variation
in growth with the Spanish~speaking and Negro accounting for the largest per-
cent of those persons deviating from the mean. The trend of growth retardation
as reflected in the height data was also observed in the bone growth as determined
from the hand-wrist X-ray. (0—924—33, p. 16-17).

94. The results of the National Nutrition Survey which are reported in the
above findings demonstrate the presence of malnutrition in a large portion of the
sample population. A high prevalence of signs associated with inadequate nutri-
tion, including growth retardation, was found. Anemia and unacceptable levels of
plasma vitamin A, serum vitamin C, urinary thiamine excretion and urinary
riboflavin excretion were common. These findings demonstrate the existence of a
serious nutrition problem in Louisiana and Texas. Analysis of data from other
states is not sufficiently advanced to permit a statement as to whether the same
degree of prevalence of malnutrition exists in those areas. (0—924—33. p. 1—2:
\VD—All‘y—lliiglMib, p. 7—21).

95. The combined effect of the. survey results reported in Findings 28 through
94 is to demonstrate that there are substantial segments of the US. population
who consume diets which do not provide them with adequate amounts of vita-
mins and minerals. Twenty-seven qualified physicians and nutritionists testifying
in this hearing agree that this is an accurate portrayal of the nutritional status
of the US. population.

(’l‘r. 2955, Hodges; WD—46—Olson, p. 12—13: Tr. 29470—73, Olson; WD—46—
Wallerstein, p. 9: WD—46—Margen, p. 8, p. 16; WD—46—Unglaub, p. 35; WD—46—
Davis. p. 14 : WD—46—Gershoff, p. 9; WD~46—Jukes, p. 8—9; VVD—46—Severinghaus,
p. 11—13. p. 19: WD—46—Schwartz, p. 5—6; WD-46—Mayer, p. 6—7: WD—46—Briggs,
p. 23: WDAD—Kimpel, p. 4; WD—33—Coursin, p. 3; Tr. 27485—6, Coursin; WD—
11—(1‘rl'flllfllll. p. 14. p. 20: Tr. 26519, Tr. 26528, Graham: WD—ll—Stokstad, p. 11:
\Vl)—33~Brin. p. 19—20; Tr. 27369—70, Brin; WD—33—Krehl, p. 18. p. 47—48: Tr.
26093—94, Tr. 26115. Sebrell: WD—GS—Goodhart. p. 19: WDafifi—Stare. p. (i: Tr.
29291—93. Stare: WD—65—Vitale, p. 8: Tr. 31864, Tr. 31907, Vitale; Tr. 11712—13.
Sehweigert: 'I‘r. 1131, Tr. 25194. Filer; WD—65—Chow, p. 8: WD—49—Anderson,
p. 13—14: WD—13—Scrimshaw, p. 3.)

These include: . .

(u) (Icorgc M. Briggs. Ph. D., Professor of Nutrition and Chairman of the
Department of Nutritional Sciences. School of Public Health, UniverSIty of Cali-
fornia at Berkeley; and Editor of the Journal of Nutrition Education (0—588—
46 :

)(b) David B. Coursin, M.D., Director of Research at the Research Institute.
St. Joseph’s Hospital, Lancaster, Pa., Director of Research at the Lancaster Cleft
Palate Clinic, and Member of the Editorial Boards of the International Journal
for Vitamin Research, Clinical Pediatrics, Child Development, and the Cleft
I'lllflft‘ Journal (0—526—33) : . ‘

(0) Lloyd J. Filer. Jr., M.D., Ph. D.. Professor of Pediatrics and Professor of
Pediatric Nutrition. University of Iowa College of Medicine, Member of the NAS<
NRC Food and Nutrition Board and Chairman, of the Committee on Nutrition of
the American Academy of Pediatrics (1969) (0—385—1):

(4i) Willard A. Krehl, Ph. D., M.D., Professor and Chairman of the Depart-
ment of Preventive Medicine at Jefferson Medical College, Thomas Jefferson
University (WD—33—Krehl, p. 1) 1 . . .

t 0) Jean. Mayer, Ph. D., D.Sc.. Professor of Nutrition at the School of Public
Health, Harvard University, Chairman of the White House Conference on Food.
Nutrition and Health. December, 1969, and Special Consultant to the President
on Nutrition (0—585—46) : .

(f) Robert E. Olson, Ph. D.. M.D., Doisy Professor and Chairman of the pe-
partment of Biochemistry, and Associate Professor of Medicme. St. Louis Illll-
versi‘ty School of Medicine (0—586—46) :

2607

(9) William H. Scbrell, J72, M.D., Director of Columbia University’s Institute
of Nutritional Sciences, and Chairman of the Committee on Recommended
Dietary Allowances of the NAS—NRC Food and Nutrition Board (1965—1968)
(0—390—3A) ;

(h) Frederick J. Stare, Ph. D., M.D., Chairman of the Department of Nutrition
of the School of Public Health at Harvard University and author of the nationally
syndicated column entitled, “Food and Your Health” (0—630—65);

(«5) Walter G. Unglaub, M.D., Professor of Nutrition and Director of the N11-
trition Section, School of Public Health and Tropical Medicine, and Professor of
Nutrition, School of Medicine of Tulane University, and Louisiana Director of
the National Nutrition Survey (0—582—46) ; and

(1') Ralph O. Wallcrstein, M.D., Clinical Professor of Medicine at the Univer-
sity of California, Chief of Clinical Hematology at the San Francisco General
Hospital, and Chief of Staff at Children’s Hospital in San Francisco (0—610—46).

96. Most of the survey evidence which forms the basis for the opinions ex-
pressed by the physicans and nutritionists cited in Finding 95 is of recent origin,
much of it having been developed or organized and widely disseminated during
the period since 1966. (H.E.—13; 0—924—33; P—568; P—762; 0—464—28; H.E.—12;
0—468—33; 0—612—46; 0—587—46; Tr. 31885, Vitale).

97. Some of the documentary exhibits or record offered explanations account-
ing for the dietary inadequacies which were observed. (0—612—46; 0—36—19;
0—587—46; 0—599—46) In addition, numerous qualified nutritionists and physicians
who appeared in this proceeding offered opinions concerning why people con-
sume diets which furnish inadequate amounts of vitamins and minerals. (Find-
ing 98—109, infra) The causes and vulnerable groups disclosed by this record
evidence are set forth in the following findings.

98. It is the consensus of qualified physicians and nutritionists that many
people of low socioeconomic status frequently do not consume diets which pro-
vide adequate amounts of vitamins and minerals simply because they lack the
financial resources needed to purchase sufficient quantities of vitamin and min-
eral rich foods. (WD—46—Olson, p. 14; WD—46—Mayer, p. 9; Tr. 28853—4, Mayer;
WD—33—Coursin, p. 6; Tr. 26504, Graham; WD—65—Goodhart, p. 10; WD—65—
Vitale, p. 5).

99. It is the consensus of qualified nutritionists and physicians that there
are many people who for ethnic, cultural or faddist reasons do not consume
certain broad classes of food, with the result that they do not ingest adequate
amounts of vitamins and minerals. (WD—46—Olson, p. 14; Tr. 29460—62. Olson;
WD—46—Margen, p. 10, p. 16: WD—65—Goodhart, p. 10; WD—46—Unglaub, p.
31—32; WD—46—Mayer, p. 10—12; Tr. 28854, Tr. 28880—81, Mayer).

100. It is the consensus of qualified physicians and nutritionists that infants
and young children because of the limited variety of foods contained in their
diets and their rapid rate of growth frequently do not consume adequate amounts
of vitamins and minerals. (WD—46—Wallerstein, p. 9. p. 12; Tr. 28976, Waller-
stein; Tr. 29016, Margen: WD~46—Unglaub, p. 30; WD—46—Cooke, p. 1: WD—
46—Schwartz, p. 6; WD—65—Stare, p. 4; Tr. 29290—91, Stare; WD-G—Harrison,
p. 15 ; WD—49—Anderson, p. 14).

101. It is the consensus of qualified physicians and nutritionists that many
teenagers deliberately shun good eating habits and limit the variety of foods
which they consume, with the result that they do not ingest the amounts of
vitamins and minerals regarded as adequate during this period of life. (WD—
46—Margen. p. 10: WD—46—Unglaub, p. 6. p. 23: Tr. 28926—27. Unglaub: WD—46—
Briggs. p. 27; WD—33—Kreh1, p. 52—53; WD—65—Stare, p. 4; Tr. 29290—91, Stare:
WD—65-Vitale, p. 5).

102. It is the consensus of qualified nutritionists and physicians that many
teenagers and adults who are on weight reducing or weight maintenance diets
restrict caloric intake to the point where the vitamins and minerals contained
in the food that is consumed are not sufficient to meet the needs of these per-
sons. (WD—46—Olson, p. 14; Tr. 29483, Olson: WD—46—Margen, p. 10: Tr. 29018.
Margen: WD—46—White. p. 11—14: WD—46—Mayer. p. 14. p. 18—19: Tr. 28854. Tr.
28883—4. Mayer: WD—46—Briggs, p. 27; Tr. 26503—04, Graham; Tr. 26704, Stok-
stad : Tr. 29187, Stare).

103. It is the consensus of qualified nutritionists and physicians that many
women of childbearing age. including those who are not pregnant. do not, and
cannot as a practical matter, because of their high requirement, secure adequate
amounts of iron from the diets they consume. (Tr. 6738. Hodges. WD—46—Olson.
p. 11: WD—46—Wallerstein. p. 9, 11—12: Tr. 28976, Wallerstein: WD—46—Margen.
p. 10; WD—46—White, p. 12—14; WD—46—Briggs, p. 27; Tr. 30179, Goodhart; Tr.

2608

27218—19, Krehl; WD—33—Krehl, p. 14—15; WD—46—Unglaub, p. 30; WD—46—
Schwartz, 1). 6—10; WD—46—Mayer, p. 14—17; WD~65—Vitale, p. 5; Tr. 3191-1,
Vitale ; P—651, p. 58—59).

104. In addition, uncontradicted expert testimony indicates that women tak—
ing oral contraceptives often do not obtain the folacin they need, because the
chemicals they ingest render the body less capable of absorbing folacin in the
forms in which it appears in food. (WD—GS—Vitale, p. 5; Tr. 31885—86, Vitale).

105. It is the consensus Of qualified physicians and nutritionists that preg-
nant and lactating women, because of their increased need for vitamins and
minerals and their low caloric allowances, often do not consume all of the vita-
mins and minerals they require. (Tr. 29016, Margen; Tr. 28926—7, Unglaub; Tr.
26705. Stokstad: WD—33—Kreh1, p. 13—14; Tr. 30179, Goodhart, WD—65-Stare,
p. 4, Tr. 29290—91, Stare; WD—64-Vitale, p. 5).

106. Uncontradicted record evidence indicates that blood donors lose 250 mil-
ligrams of iron per 500 ml. of blood given. If this amount is to be replaced in one
year the body must absorb approximately .7 milligrams per day. Approximately 10
percent of dietary iron is absorbed. (Tr. 6739, Hodges) Thus the blood donor’s
requirement is increased by approximately 7 milligrams per day, an additional
amount which his diet frequently will not provide. If more than one pint of
blood is given per year, inadequate intake is even more likely to occur. (0—612—46,
1). 120—21 ; WD—46—Wallerstein, p. 7).

107. Uncontradicted expert testimony indicates that those who consume mod-
erate amounts of alcohol (more than three drinks per day) have increased re-
quirements for folates, thiamine and magnesium which are not always met by
the diets they consume. (WD—65—Vitale, p. 5; Tr. 31889—90, Vitale; WD-65—Iber
{1. 5—6) .

108. It is the consensus of qualified nutritionists and physicians that many
older people, especially those living alone, lack the physical ability or the desire
to prepare and consume meals containing the variety of foods needed to furnish
them with adequate amounts of vitamins and minerals. (WD—46—Olson, p. 14;
Tr. 29484—85, Olson; WD—46—Unglaub, p. 6: Tr. 28926—27 Unglaub; WD—46—
Mayer, p. 9: WD—46—Briggs, p. 27: Tr. 26600—02. Graham; Tr. 26704—05, Stok-
stad: WD—65—Stare, p. 4; WD-65-Vitale, p. 5; WD—49—Anderson, p. 14).

109. It is the consensus of qualified nutritionists and physicians that, in ad-
dition to the groups noted in the above findings, many people of all types fail to
consume diets which provide adequate amounts of vitamins and minerals either
because they lack knowledge of proper food selection, storage and preparation
practices, or because they act in careless disregard of this knowledge. (Tr. 2955,
Tr. 3055, Hodges; WD—46—Olson, p. 11: WD—46—Unglaub, p. 29—30: WD—46—Sev—
eringhaus. p. 13: WD—46—Mayer, p. 10—12, p. 14; Tr. 28854, Mayer; WD—46—Briggs,
o. 27—28: WD—65—Goodhart, p. 10; Tr. 29187, Stare; WD—65—Vitale, p. 5; Tr.
31980, Vitale).

110. The above findings of fact taken together demonstrate that there are
large numbers of people among the population of the United States who are not
obtaining sufficient amounts of vitamins and minerals from the diets they con-
sume. The groups within which these individuals are most likely to be found
include the poor, those who avoid certain classes of foods, infants and young
children. teenagers, weight watchers, women of childbearing age including
but not limited to those who take oral contraceptives, those who are preg-
nant and those who are lactating, blood donors, moderate drinkers, older people
who live alone, and those people who are ignorant or careless of good eating
habits.

APPENDIX B

ANALYSIS or THE NEED FOR DIETARY SUPPLEMENTS AMONG CHILDREN BASED
ON THE LATEST REPORT ON THE NATIONAL NUTRITION SURVEY

As you know, a comprehensive investigation of nutritional status was performed
in 10 states by the National Nutrition Survey. The most recent publication of the
results of this study is entitled “Ten-State Nutrition Survey in the United States,
1069—1970,” which the, Department of Health, Education and Welfare describes as
a “preliminary" report to Congress.

This report presents tabulated results of biochemical analyses for four micro-
nutrients: iron, vitamin A, vitamin C and riboflavin. The following table shows

2609

the frequency (expressed as percentages of all children tested) of unacceptable
values among children :

 

 

  

Hemoglobin
(iron) Vitamin A Vitamin C Riboflavin
20.0 15.5 6 5 19.9
6 09 15.5 15.3 48 14.2
10 to 16 ________________________________________ 14.3 9.6 4 7 17.1

 

Source: Tables 8D,9D,10D,llD.

Multivitamin and mineral supplements would benefit anyone whose diet fails
to provide sufficient amounts of at least one of the micronutrients they contain.
Consequently, the percentage of Children in the National Nutrition Survey who
would benefit from use of a supplement containing: iron, vitamin A, vitamin C
and riboflavin is that percentage whose diet habitually provides inadequate
amounts of at least one of these.

Subject to stated assumptions, the range within which this percentage must
fall can be determined using the figures in the above table. The first, and key,
assumption which must be made, is that the reported low and deficient hi0chemi~
cal levels arise from insufficient amounts of micronutrients in the diet.

The bounds of the range are based on the assumption of dependence among
the four variables, i.e., the four types of inadequacy. If two variables are de-
pendent, it means that their occurrence is in some way related, which relation-
ship can take several forms. For example, if event “X” occurs, it may be the
case that dependent event “y” can never occur or will always occur. A third
possibility is that “y” may or may not occur when “x” occurs, but “y" never
occurs unless “X" does occur.

The third possibility is usable in establishing the lower bound of the range
in terms of the statement, “Individuals who are biochemically inadequate in
one micronutrient are frequently inadequate in several." There is some survey
support for this statement. In the face of the present data, for children 0—5 where
hemoglobin inadequacy is the most frequent, the lower bound of the range may
be stated, “Vitamin A, C or riboflavin inadequacy may or may not occur when
hemoglobin inadequacy occurs, but they will not occur unless hemoglobin in-
adequacy does occur.” This means that the percentage of these children who
would benefit from a supplement of iron, vitamin A, vitamin C, and riboflavin
would equal the percentage low in hemoglobin, namely, 20.0%. In the case of
6—9 year olds the lower bound would also be determined by hemoglobin and
would equal 15.5%. For 10—16 year olds it would be determined by riboflavin
and would equal 17.1%.

The upper bound of the range, the maximum percentage of children who would
benefit from a supplement containing iron, vitamin A, vitamin C, and riboflavin.
is representable in terms of the following statement, “No person is inadequate
in more than one micronutrient.” The total who would be inadequate in one
micronutrient would thus equal the sum of the four percentages of inadequacy:

Upper bound equals:

(percent inadequate in hemoglobin) +
(percent inadequate in vitamin A) +
(percent inadequate in vitamin C) +
(percent inadequate in riboflavin).

In the case of 0—5 year olds this would total 61.9%. The total for 6—9 year
olds would be 49.8%, and for 10-16 year olds it would be 45.7%.

The following table summarizes the lower and upper bounds computed above:

 

Lower bound Upper bound

 

    

(percent) (percent)

A e rcup:
g 5105. 20.0 61.9
15.5 49.8

17. l 45. 7

 

2610

The most likely percentage of children who would benefit from the supplement
discussed above is probably neither the lower nor upper bound of the range. The
reason is that experience with nutrition surveys shows that the conditions as-
sumed to establish these bounds are not frequently observed in practice.

One method for estimating the most likely percentage of beneficiaries follows
from assuming a condition of stochastic independence, i.e., the occurrence of
vitamin A. C, or riboflavin inadequacy is completely unrelated to the occurrence
of hemoglobin inadequacy. Under this assumption the probability of a child
having a low level of at least one of the four micronutrients (P) is determined
by the following formula :

P equals: 1—(pr0babi1ity of iron adequacy) (probability of vitamin A ade-
quacy) (probability of vitamin C adequacy) (probability of riboflavin adequacy)

From the above table the following probabilities are derived :

 

0 to 5 years 6 to 9 years 10 to 16 years

 

 
 

Probability of iron adequacy ________________________________________ 1—. 200:. 800 1—-. 155:. 845 1—. 143:. 857
Probability of Vitamin A adequacy... _______ 1—. 155:. 845 1—. 153:. 847 1—.096:. 904
Probability of vitamin C adequacy... ................... 1—. 065:. 935 1—. 048:. 952 1—. 047:. 953
Probability of riboflavin adequacy ................................... 1—. 199:. 801 l—. 142:.858 1—.171=.829

 

Inserting these values in the formula one finds that the most likely per-
centages for the three age groups are as follows:

P (0 to 5 years) equals:

1—(.800) (.845) (.935) (.801).
1—-.500.
.494 or 49.4%.

P (6 to 9 years) equals:

1—-(.845) (.847) (.952) (.858).
1—.585.
.415 or 41.5 %.

P (10 to 16 years) equals:

1—(.857) (.904) (.953) (.829).
1—.613.
.387 or 38.7%.

Thus we estimate the percentage of children surveyed who would benefit
from use of a supplement containing these four micronutrients as being 49.4%
in the case of 0—5 year olds, 41.5% in the case of 6—9 year olds, and 38.7%
in the case of 10-16 year olds.

These figures are offered subject to the caveat that, while presented in terms
of three significant digits, they probably do not merit this degree of precision.
Both the basic data and the assumption 0f independence could introduce errors
making this level of precision inappropriate.

The latest report of the National Nutrition Survey also contains some results
of height and weight measurements. Insufficient information is presented to
allow analysis of these and the report itself contains none. Very preliminary
and incomplete dietary intake results for five states are also included. These
are totally beyond analysis since the standards used by HEW in judging
adequacy are not contained in the report. Thus the anthropomorphic and dietary
data cannot be used meaningfully to corroborate 0r impeach the estimates
computed above.

MILES LABORATORIES, INC..
Washington, D.C'., February 16, 1972.
Mr. GERALD CASSIDY,
Counsel, Sen/rte Select Committee on Nutrition and Human Needs, U.S. Senate,
Washington, D.O.

DEAR MR. CASSIDY: I am pleased to provide for the Committee’s use the legal
opinion of Kirkland Ellis & Rowe that dietary supplements may be added to
the National School Lunch Program under existing law and regulations. This
submission is made pursuant to the request of Senator Taft during the testi-
mony of Dr. White on December 7, 1971.

Please advise if we can be of any further assistance.

Very truly yours,
CHARLES N. Jor.r.Y.
Legislative Representative.
[ENCLOSURE]

2611

KIRKLAND, ELLIS & Rows.
Washington, D.U., February 15, 1972.

Re Dietary Supplements in the National School Lunch Program.

CHARLES N. JOLLY, ESQ.,
M ties Laboratories, Inc.,
Washington, DC.

DEAR MR. JOLLY: Enclosed pursuant to your request is a copy of our mem-
orandum summarizing how federal statutory provisions and Department of
Agriculture regulations would enable the inclusion of dietary food supplements
of vitamins and minerals in the National School Lunch Program.

As you will recall the analysis contained in the memorandum was prepared in
anticipation of the appearance of Miles’ president, Walter A. Compton, M.D.
before the Senate Select Committee on Nutrition and Human Needs on Feb-
ruary 24, 1971. However, I am aware of no changes in statutory authority or in
Department of Agriculture regulations which would alter the conclusions set
forth in the memorandum.

Thus, it is our opinion that the statutory framework provided by Congress
and the regulations promulgated by the Department of Agriculture would per-
mit the inclusion of dietary supplements of vitamins and minerals in the Na-
tional School Lunch Program.

Sincerely yours,
JAMES M. JOHNSTON.
[ENCLOSURE]

MEMORANDUM

EXPANDING THE NATIONAL SCHOOL LUNCH PROGRAM TO INCLUDE DIETARY
SUPPLEMENTS, AN ANALYSIS or EXISTING AUTHORITY

SUMMARY
Questions presented
Can dietary supplements of vitamins and minerals be incorporated in the
National School Lunch Program within the framework established by existing
federal statutes and Department of Agriculture regulations?

Conclusion

Dietary Supplements can be added to the National School Lunch Program

under existing law.
DISCUSSION

Dietary supplements

In performing our analysis it has been assumed that the dietary supplements
of vitamins and minerals desired to be incorporated in the school lunch program
are formulated with reference to the Recommended Dietary Allowances estab-
lished by the National Academy of Sciences’ Food and Nutrition Board, as set
forth in Recommended Dietary Allowances, NAS Pub. 1694 (1968). It is further
assumed that such dietary supplements, offered for the purpose of assuring that
the diet contains recommended amounts of the vitamins and minerals they con-
tain, would meet the requirements of U.S. Food and Drug Administration regu-
lations governing “foods for special dietary uses.” 21 C.F.R. Part 125.

The N attonol School Lunch Program

The statutory authority governing the National School Lunch Program and
related child nutrition activities is found in 42 U.S.C. §§ 1751—1779. The school
lunch program was initiated by the National School Lunch Act which was en-
acted in 1946. Subsequently, the statutory authority has been amended and sup-
plemented several times as Congress has refined and further expanded the scope
of the school lunch program and associated child feeding activities.

There are two basic methods under these statutory provisions by which schools
may be provided with food for their lunch programs. Under the first of these
procedures, the federal government purchases foods and then donates them to
schools. The second procedure involves school systems purchasing food for their
programs and then being reimbursed by the federal government under a match-
ing grant formula.

2612

Federal purchase of food

The statutory authority for the direct purchase of food by the Secretary of
Agriculture is contained in 42 U.S.C. §1755, which took its present form pur-
suant to a 1970 amendment. Pub. L. 91—248, §3, 84 Stat. 209. This is commonly
referred to as “Section 6” authority since it originated as Section G of the 1946
National School Lunch Act. The language of this section which applies to the
present discussion reads as follows:

The funds provided by appropriation or transfer from other accounts
for any fiscal year . . . shall be available to the Secretary during such
year for direct expenditure by him for agricultural commodities and
other foods to be distributed among the States and schools and service
institutions participating in the food service programs under this chap-
ter and under the Child Nutrition Act of 1966 in accordance with the

needs as determined by the local school and service institution
authorities . . . .

It is our understanding that up to the present time procurement under this
section has been limited primarily to fresh fruits and vegetables. processed flours.
canned fruits or vegetables and frozen meats and poultry. However, it is plain
from the language of the statute that the Secretary is free to purchase “other
foods” when to do so would be “in accordance with the needs as determined by
the local school and service institution authorities.”

Thus. the Secretary of Agriculture’s direct procurement authority leaves com—
plete freedom to respond to the needs of the program, and in fact we understand
that the Department is presently engaging in a series of investigations through
Rutgers University to determine various types of “other foods" which might
enhance the program’s ability to provide improved nutrition within the limits of
its resources. Since the proposed supplement would by definition be a food. it
also could be purchased under the Secretary’s authority to procure “other foods.”

Specific regulations governing the procedures to be used in the purchase of
foods by the Department of Agriculture are contained in 7 C.F.R. Part 250. None
of these limits the scope of the purchasing power contained in the statutory
language quoted above.

Cash payments to States

The other basic means of supporting the school lunch program provided by
federal law is through cash payments authorized by 42 U.S.C. § 1756, which is an
amended version of Section 7 of the National School Lunch Act. See Pub. L. 91—
2-18. § 4. S4 Sta t. 209 (1970). Pursuant to the authority of this section. the Secre—
tary has the following power:

Funds apportioned to any State . . . shall be available for payment to
such State for disbursement by the State educational agency . . . for the

purpose of assisting schools of that State during such fiscal year. in
supplying (1) agricultural commodities and other foods for consump-
tion by children. . . .

Here again. this section affords the Secretary great latitude in the use of cash
payments by allowing him. subject to matching fund requirements. to assist
schools in supplying “agricultural commodities and other foods for consumption
by children." As in the case of foods purchased for donation. the Secretary’s
authority to provide cash payments for “other foods” would allow him to reim-
burse states using the proposed supplements in their school lunches.

Requirements placed on school lunches

There is a further statutory requirement for school lunch programs supported
pursuant to the National School Lunch Act. This is contained in 42 USO. § 1758.
In pertinent pa rt it reads as follows :

Lunches served by schools participating in the school—lunch program
under this chapter shall meet minimum nutritional requirements pre-
scribed by the Secretary on the basis of tested nutritional research:
except that such minimum nutritional requirements shall not be con-
strued to prohibit the substitution of foods to accommodate the medical
or other special dietary needs of individual students.

This provision provides that lunches served in the school lunch program
must meet “minimum nutritional requirements,” but it in no way limits the

2613

program from attempting to meet more than minimum requirements. There-
fore the requirement that lunches meet minimum standards does not bar ex-
panding the program through the addition of dietary supplements to provide
improved vitamin and mineral nutrition.

The Department of Agriculture’s regulations governing the National School
Lunch Program are contained in 7 C.F.R. Part 210. These regulations further
specify the requirements placed on lunches funded under the program.

Some schools receive donated commodities from the federal government but
no cash payments. These are termed “commodity-only schools” and are tech-
nically not participants in the National School Lunch Program. 7 C.F.R. §210.2
(c—l). The “commodities” they receive may be any “foods donated, or available
for donation, by the Department” including those purchased under the “Section
6” authority discussed above. 7 C.F.R. § 250.3(a).

Commodity-only schools must meet the standards for lunches prescribed by
Section 210.1551 (b) of the regulations :

(b) The school-fund authority of a commodity-only school desiring
to receive commodities donated under Part 250 of this chapter shall
enter into agreement with the State Agency, or FNSRO where applica-
ble. The agreements with commodity-only schools shall. . . require
such schools to serve well-balanced nutritious lunches, priced as a unit,
that contain, as a minimum, food components from the four basic food
groups as defined in the Department’s Daily Food Guide (Leaflet No.
424 USDA).

Thus, the administrators could donate supplements to commodity-only schools
so long as these schools serve lunches containing “components from the four
basic food groups” and which otherwise meet the above broad standards.

Section 210.8 of the regulations requires that for schools to qualify to receive
cash reimbursement from the federal government, they must serve lunches which
comply with 7 C.F.R. §210.10. Section 210.10 outlines the specific requirements
for lunches in some detail. It is this section of the Department of Agriculture’s
regulations which defines the “Type A lunch” and the “Type C lunch” which
are the two basic lunch units used by the National School Lunch Program.

In addition to specifying the contents of the Type A and Type C lunches,
Section 210.10 makes provision for varying the Type A lunch when such action
will serve to achieve the objectives of the program. Specifically, subsection
210.10(g) reads as follows:

The 0ND [Child Nutrition Division, Food and Nutrition Service of
the Department] may approve variations in the food components of
the Type A lunch on an experimental or on a continuing basis in any
school Where there is evidence that such variations are nutritionally
sound and are necessary to meet ethnic, religious, economic or physical
needs.

This subsection appears expressly to enable the administrators of the pro—
gram to vary the Type A school lunch through the inclusion of dietary supple-
ments of vitamins and minerals. That is, based on the information which we
have been furnished, it would be completely appropriate to include dietary
supplements in the program since they “are nutritionally sound and are neces-
sary to meet . . . economic or physical needs.”

Thus, the statutory authority and existing regulations discussed herein would
not appear to bar the school lunch program administrators from incorporating
dietary supplements in the program should they so desire.

.‘. ’
"$.56"-

 

Appendix 2
MATERIAL FROM OTHER THAN WITNESSES

 

RUTGERS UNIVERSITY,
New Brunswick, N.J., December 17, 1971.
Hon. GEORGE MCGOVERN,
Chairman, Select Committee on Nutrition and Human Needs, Senate omce
Building, Washington, D.0.

DEAR SENATOR MCGOVERN: A press release in the Newark Star Ledger of
December 8th, provides short excerpts of the testimony of Drs. Graham, Briggs,
White and others suggesting that vitamin pills or wafers be a part of the school
feeding programs etc.

As the Director of the USDA/0E0 School Feeding Effectiveness Research
Project at Rutgers let me say that I agree that the diets of Americans and
school children is imbalanced with too few or poor levels of micronutrients
(vitamins and minerals) and too many calories; however, the provisioning of
pills is not the answer because:

1(1) The consumption of pills does not need to be fostered in our pill taking
on ture.

(2) The probability of toxic efl’ects is greater (the second largest cause
of poisoning in U.S. children is excess vitamins).

(3) It is estimated that nearly 100 million Americans now take daily
vitamin supplements and the quality of nutritional health has not reflected
this.

(4) Most water soluble vitamins are excreted within 4—6 hours and so
one shot pills are an inefficient means of providing necessary micronutrients.

(5) The metabolism of micronutrients is most intimately associated with
the metabolism of protein and/or the synthesis of protein tissues such as
hemoglobin. It stands to reason therefore, that inicronutrients should be
titrated to protein levels in food products not to calories only or foods with
no protein content.

(6) The use of vitamin pills or wafers only in school or institutional
feeding has an impact on the dietary of a limited number of Americans in
an irregular manner (e.g. we feed children in school 180 days a year and
the other 185 days they are on their own).

(7) The nutrified engineered foods now available or under development
in increasing numbers for the Rutgers School Feeding Effectiveness Project
have the potential of responsible nutrition as well as responsive nutrition
because the products are balanced for RDA nutrients in themselves or as
combined with nutrient rich commodity foods. Further all the companies
involved have agreed to make their products available commercially and
they are critically reexamining their product lines.

I trust the committee will view the problem in perspective before supporting
a partial answer rather than a full answer to the problem.

Since your office rarely acknowledges letters, I am taking the liberty of pro-
viding copies of this letter to other members of the committee and other selected
Senators.

Sincerely yours,

PAUL A. LACHANCE. Ph. D..
Associate Professor of Nutritional Physiology,

(2615)

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Appendix 3
ARTICLES OF INTEREST

Previous to the Hearing

[The Des Moines Tribune, Nov. 17, 1971]
SCHOOL GOAL: NO “CANDY LUNCH”
(By William O’Keefe)

Most Iowa school districts—With an eye on their bank accounts—are com-
plying with a U.S. Department of Agriculture (USDA) regulation that soft
drinks, candy and other confections not be sold during regular school lunch
and breakfast periods.

Des Moines and Saydel school oflicials told The Tribune the proscribed items
are still being sold, but that they hope to be in compliance with the federal di—
rective by the end of this week.

The State Department of Public Instruction, which is enforcing the rule, has
warned school administrators that violation of the lunch rule could cost the
districts their annual federal reimbursement of six cents a regular meal and
40 cents for each free or reduced-price meal served.

In Des Moines, that amounts to more than $300,000 a year.

According to the federal requirement, candy, soft drinks, potato chips and
popcorn may not be sold in the schools from a half hour before to a half hour
after the breakfast and lunch periods.

The ban on sales from vending machines and snack bars is designed to force
students to eat the balanced school lunch instead of eating snacks, which may
not provide proper nutrition.

“Too MUCH TO LOSE”

Mrs. Janice Dudley, Des Moines public schools director of food services, said
principals and administrators have been meeting to resolve the situation because
“we don’t want to lose our federal reimbursement. It’s much too much to lose."

Mrs. Dudley said the food services department does not sell soft drinks, candy.
potato chips or popcorn during the lunch and breakfast periods but that student
centers and snack bars in some of the Schools do.

Saydel Supt. Richard Branstrator said he learned just this week that candy
and soft-drink machines still were open at his district’s schools during the lunch
hour. He said he planned to close them down by the end of the week.

Other school officials in Polk County and central Iowa contacted by The
Tribune said they have stopped the sale of the items during lunch and breakfast
periods. Several also reported the action was unpopular with students.

Profits from the candy and soft-drink sales in many schools are channeled
into student activity treasuries.

Loss ann

The newly enforced rules have prompted some student bodies to complain about
possible loss in revenue as well as the students not being able to buy the con-
fections of their choice.

(2617)

2618

Urbandale Supt. Lyle Kehm pointed out that snack machines are “very popu-
lar among our students” and it is only natural that they would be unhappy if they
could not buy the snacks during lunch.

“But we really have no choice in the matter. We have to comply with it (federal
regulation) ,” he added.

Donald Butcher, Southeast Polk School District food services director, agreed,
saying: “We do get flak (from students) because there are some who bring their
own lunch and others—especially girls on diets—who just want to buy (diet) pop
instead of a regular lunch,” he said.

DISPLEASED

West Des Moines Supt. Charles J oss said students are displeased because they
contend that some other school districts are violating the rule.

But students at some schools apparently are taking the curtailed candy and
beverage sales in stride.

Johnston Supt. Louis Friestad and Marshalltown Supt. Robert McFarland said
the students have not raised any hue and cry about the absence of candy or soft
drinks at lunch.

“We have discussed this with the student council and nobody is shaken up
about it,” said Friestad.

McFarland said there has been no problem in his school because of a wide
variety of food offered for sale, including a la carte lunches.

The rationale underlying the federal regulation was explained by Vern Carpen-
ter, food services chief for the State Department of Public Instruction.

“The idea is to improve the nutrition and health of the students. Carbonated
beverages, candy, chips and popcorn are not a component part of a Grade A
lunch,” he said.

WELL-BALANCED MEAL

Carpenter said a Grade A lunch contains the basic nutritional ingredients of
protein, vegetables and fruits, bread, butter and milk.

“We want to avoid the situation of a kid coming to the lunch room and buying
the other things and not eating the well-balanced meal after his parents have
already paid for it,” he said.

Carpenter said response to the federal regulation throughout Iowa “has been
all on the positive side.” He added:

“We’re not using this as a club and hope that all schools will voluntarily
comply.

“I feel encouraged that all school districts in the state will comply."

Subsequent to the Hearing

 

[The Baltimore Sun, Dec. 8, 1971]
NUTRITION WAFERS GET SENATE TEST

(By Naomi S. Rovner)

Washington—Candy-like wafers designed to transform a hot dog and a bag
of potato chips into a nutritionally balanced meal got a lenatorial taste test
here yesterday at a hearing into ways to assure the nutritional value of school
lunch programs.

And to underscore the necessity for this kind of food supplement, 9. Johns
Hopkins University nutrition professor showed a dozen slides taken at the Johns
Hopkins Medical School staff cafeteria to members of a special Senate subcom-
mittee on food and nutrition.

The slides first showed appetizing and nutritionally balanced meat-and-vege-
table meals on the cafeteria shelves; then they showed interns and residents by
the score eating hamburgers and potato chips and hot dogs and potato chips.

Dr. George 0. Graham, the Hopkins nutritionist, noting that the young doctors
were thoroughly aware of the nutritional value of spinach and broccoli and passed
it up anyway, speculated that school youngsters were doing the same.

“Uneaten food,” he noted, “has a nutritional value of zero.”

No EFFECT ON GROWTH

He questioned the nutritional usefulness of school lunches as they are now
served, and cited a “small study” done by the Hopkins at several Baltimore
schools where lunches were served.

The study, admittedly not a conclusive one, showed that the school lunch pro-
gram appeared to have no effect on the growth or blood count of the participating
youngsters.

The wafers, which come in several different colors, were developed by Miles
Laboratories to be distributed with school lunches.

They contain, in candy form. the recommended daily dosages of 13 vitamins
and minerals and were especially designed to be attractive enough in taste, shape
and color to assure that they will be eaten.

(Reporters who tasted the chewable wafers yesterday found them pleasantly
tart and fruity, but with a bitter aftertaste.)

Spokesmen for the laboratory and for the Vitamin Information Bureau—the
trade association for vitamin manufactures—said they could be distributed with
the lunches for about a cent a day for each child.

“GROWING TREND”

Dr. Graham confirmed that dietary habits, even among higher-income groups,
are changing radically, and supplements appear to be needed particularly by
“the poor, the adolescent, the pregnant and the elderly.”

Underlying this, he. said, is “a growing trend toward the consumption of con-
venience foods. . . . We are shocked when we find that items which we like or
were forced to like because of their nutrient content are turned down [by
young people] with a ‘yukk.’ ”

He called this trend “a relentless one,” and said that a yearning to “go back to
the good old days of natural foods, bought fresh, prepared carefully and served
with careful attention to the basic food groups . . . is an impossible dream.”

He suggested that a food supplement such as the wafer might at least serve
as a temporary protection until “more definitive solutions” are reached.

(2619)

2620

[From the Montgomery (Aln.) Advertiser, Dec. 8, 1971]
UNIVERSAL MALNUTRITION IN AMERICA

A panel of nutritionists told the Senate that the diets of many children are
"marginally deficient or atrociously so.”

And it’s getting worse, according to one witness, Dr. George Graham, pro-
fessor of nutrition and associate professor of pediatrics at Johns Hopkins
University :

"There is little doubt now about the deterioration in the nutritional quality of
the diets consumed by a steadily increasing percentage of children from all
classes.”

More than half of what children (and adults as well) eat is severely in-
adequate in terms of vitamin and mineral content, the panel said. In a year,
the average American consumes 264 pounds of “poor value foods" and only
259 pounds of “high value foods."

Poor value foods are high in calories but low in protein, vitamins and minerals.
The reverse is true in the case of high value foods. ranging from meat to peanuts.

Well over half of children under 12 don‘t get enough iron; and that rises to
two-thirds of those from 12 to 21.

The most undernourished member of the American family is, typically, the
teen-age girl. The best nourished, surprisingly enough, is the teen-age boy,
probably because he eats everything—good food along with junk.

Much of the food eaten in the country is not as nutritious as sawdust, al-
though some of it, particularly the pre-processed foods, taste like that.

The panel recommended that vitamin wafers be added to school lunches to
provide the Recommended Dietary Allowance (RDA) of various vitamins and
minerals, including calcium, iron, etc., to make up for deficiencies of meals at
school and at home.

What to do about adults, who don’t eat much better but at least have their
growth behind them, is still a puzzle.

But it's no small problem. One witness told the Senate that Americans spend
$30 billion a year on nutrition-related problems.

That is one-half the total health care cost in the country.

[The Washington Post, Dec. 8, 1971]
VITAMINS AS CANDY WAFERS?

(By United Press International)

Can a child’s view of vitamins be changed from “yuk” to “yum" if they come
packaged as candy wafers instead of in such things as spinach, broccoli and
brussels sprouts?

Miles Laboratories thinks so—and today urged Congress to provide such a
dietary supplement for the 25 million youngsters who participate in government
school lunch programs.

A panel of nutritionists, some of whom worked on developing a new Miles
candy—type tablet containing 13 vital vitamins and minerals, told a Senate
Hunger Committee such a supplement is badly needed to combat widespread
malnutrition among school children.

“Numerous surveys have shown a significant percentage of these children are
consuming diets which are considered anywhere from marginally deficient to
atrociously so,” said Dr. George G. Graham, a nutritionist and pediatrician at
Johns Hopkins University.

Graham, one of those who worked on the Miles project, warned that “in the
not too distant future” doctors would begin seeing children made seriously sick
by their deficient diets and said supplements could provide them “temporary
protection” until better long—term nutrition solutions are found.

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