Harold C. Stuart

Nutrition studies during pregnancy

T HIS paper is one of a series dealing with the importance of diet during pregnancy to both the mother and her infant. The group studied and the methods employed are described in detail in the introductory article of the series. 1 The same 216 mothers and their infants are considered here. Of the various nutritional essentials necessary for growth, protein is of great importance. During growth not only is there an increase in the amount needed, but also the quality of the protein in the diet is important in order that those amino acids essential for growth are present in necessary amounts. Despite these well-known facts and the fact that pregnancy, especially the last two trimesters, is a period of rapid growth and development, it has not been customary for many obstetricians to stress the importance of an increase in the amount of protein in the diet of the pregnant woman. Slonaker ~ studied the effect of different percentages of protein in the diets of six generations of rats in order to observe the efficiency of various levels of protein intake upon reproduction and the growth and development of the offspring. He concluded that the best results were obtained with protein constituting approximately 14 per cent of the total calories of the diet. In his conclusions he states that a study of the history of mankind convinces one that races of tall stature and most perfect physique have lived on well-balanced diets rich in protein, with meat and other animal products forming a conspicuous part. Human balance studies of Macy and her co-workers a have shown that during the latter part of pregnancy the maternal organism stores nitrogen in excess of thaZ going into the developing fetus. Coons and Blunt 4 and Macy and Hunscher G found that nitrogen retention was highest when the mothers diet was well supplied with animal protein. Coons, Macy, and others 5, ~, 7 have also studied the nitrogen retention in the fetus at each lunar month of pregnancy. From these studies it

A method of diet analysis. Application in research and pediatric practice.

Summary Balance studies are impractical as a means of studying the nutrition of groups of children living under reasonably normal circumstances. This is especially true when it is necessary to follow changes in diet over a number of years. Dietary histories can serve certain research purposes with considerable satisfaction if taken by properly qualified persons and if certain precautions are followed. A technique has been described for obtaining such histories and forevaluating them without resort to elaborate mathematical calculations. This method of approach is not new. It is believed, however, that the technique which has been developed for its application has contributed to the reliability of the data recorded and to the consistency of the ratings. The significance of this method of evaluation, as expressed in the five-point scale, is readily appreciated. More detailed assessment of the records is probably not justified by the nature of the information which they contain. This technique has been found of great assistance in the studies being conducted at the Center for research at the Harvard School of Public Health. Examples of the application of the method to the study of nutritional differences between children and between pregnant women have been presented and show that a correlation exists between the dietary ratings and the objective measures of various nutritional states. A modification of this technique of dietary study could unquestionably be applied in pediatric practice. The casual method of inquiring about a childs diet, commonly relied upon by physicians, is not sufficient to justify conclusions as to whether a diet is or is not adequate in its provision of all assentials. The adoption of a simple but sufficiently accurate method of diet analysis, such as the one described, would lead to a wider and more exact appreciation of the present knowledge of nutrition in its application to preventive medicine.

PROTEIN NEEDS OF CHILDREN: A PRELIMINARY REPORT OF STUDIES OF INDIVIDUAL DIFFERENCES

Children differ widely among themselves at any age in all aspects of health, growth, development, and adaptation. AIany of these variables are known to affect protein as well as other nutritional needs, but little is known about the extent to which these factors do so, age by age, individually or collectively. Levine‘ has reviewed the principal factors on which a child’s needs depend. I t is difficult to individualize the application of recommended allowances, The problem of recognizing those children whose protein needs are high or low because of basic attributes, or those who temporarily have such needs for special reasons, is difficult because frequent measurement of such needs in the laboratory is impracticable and because the early signs of unmet needs are nonspecific. Accurate clinical observation or measurement of those features of growth and development that are known to influence protein needs is likewise difficult. This paper deals with a limited aspect of a project that has been in progress a t the Department of Maternal and Child Health over the past 26 years under the title of “Longitudinal Studies of Child Health and Devel~prnent .”~ I n this project, individual children have been followed periodicallyt in a multidisciplinary manner from birth to 18 years of age, including limited studies of the mothers during the pregnancies and, thereafter, of the families and environments. TWO hundred and thirty-two children were followed from birth to 6 or more years, 131 of these being followed to 18 years. The staff is now involved with the analysis of the extensive data in hand and in preparing both monodisciplinary and multidisciplinary reports of the findings. Primary emphasis is being placed on the recognition of individual difference throughout entire childhoods, in patterns of growth and development on the one hand and in dietary intakes, illness experiences, and environmental circumstances on the other, as well as upon identifying interrelationships between these data. ’This paper constitutes a preliminary report on one small aspect of the research described, and it does so primarily from the standpoints of exploring * The research project from which the studies reported in this paper are derived has been supported in various aspects and in different years hy grants from many sources. The major support for the areas of research dealt with here has been provided Ijy: The General Education Fund of the Rockefeller Foundation, New York, N. Y. (1933 to 1943); The James Foundation of New York, New York, N. Y . (1944 to 1949); The Nutrition Foundation, Inc., New York, N. Y. (1945 to date); and the Research Grants Division of the I’ublic Health Service, Rethestla, Md. (1047 to date). t The routine followed provided interval histories and a series of examinations at I i r th , 2 weeks, 3, 6 , 9 , and 12 months of age, and every 6 months to 10 or 12 years, and yearly thereafter. The data regularly collected included body measurements, photographs, roentgenograms of several areas, pediatric, orthopedic, and dental evaluations, hemoglobin tleterminations, histories of illness experiences, dietary intakes, habits, activities, and psychosocial problems. Psychological tests and other special examinations also were included less regularly. Basal metabolic determinations were made only during the early years, and no biochemical or nitrogen-balance studies were included.

A Longitudinal Study of the Calcium Intake of Children from One to Eighteen Years of Age

vals and of the percentages of total protein derived from animal protein as well as of the percentages of each child’s caloric intake derived from total protein.4 The amounts of calcium consumed by the boys and girls of the Maturity Series are of interest and are reported in a manner similar to that used in the previous papers to which reference has been made. The methods used for collecting and analyzing the dietary intakes have already been described.2 The Burke Dietary History Method’ was used at each routine visit of the child to the clinic, semiannually in the early years and annually in the later years. The dietary data covering the entire childhoods of these 125 children are based on 2,707 nutrition histories, each history providing a quantitative appraisal of the average daily dietary of a child for the preced

Health problems of mothers and children.

An attempt is made by the authors to indicate certain concepts which must be utilized to bring women to and through a healthy childbearing period, to bring the greatest number of infants successfully through the period of infancy and to provide a favorable environment for healthy development of children. To accomplish these aims, proved measures must be used more widely and others must be sought out. Such measures are best used in ways which provide continuity and individualization.