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'i‘HE‘. EFFECT OF A SL'PPLEMENTARY
SCHOOL LUNCH ON NUTRITIONAL
STATES AND HEMOGLOBIN LEVEL

’E'hegis :‘cr the Degree of M. 3.
MICHIGAN STATE COLLEGE
Christine C. Carlson
39-39

 

 

THE EFFECT OF A SUPPLEKENTARY SCHOOL LUNCH
ON

NUTRITIONAL STATUS AND HEMOGLOBIN LEVEL

by

Christine Charlotte girlson

A'THESIS
Submitted to the Graduate School of Michigan State College

of Agriculture and Applied Science in partial fulfilment of
the requirements for the degree of

MASTER OF SCIENCE

Department of Nutrition
Division of Home Economics

1939

THESIS

ACKN WLEDGENFNT

The writer wishes to evpress her sincere apprec-
iation to Dr. Thelma Porter, under whose supervision this
study was conducted, for the generous amount of time and
the many helpful suggestions she has given, and to Dr. flarie
Dye for her helpful criticisms.

The writer is also grateful to Drs. C. D. Barrett,
E. F. Hoffman, to Mrs. Lena M. Shermaz and Kiss hildred Card-
Well of the Ingham County Health Service, and to Mrs. Leah
Hankinson, teacher of Tonargarden s hool, for their coopera—
tion and assistance during this stud‘.

Acknow edgement is also given to Hilker and Bletsch
Company of Cincinnati, Ohio for generously donating the wafers

used in this study.

TABLE OF CONTENTS

Index to Tables . . . . . . . . . . .
Introduction . . . . . . . . . . . .
Review of Literature . . . . . . . .
Experimental Procedure . . . . . . .
Discussion and Results . . . . . . .

Part I — Hemoglobin Values . .

Part II — Nutritional Status .
Summary . . . . . . . . . . . . . . .

Bibliogapm O O O O O I O O O O O O

Table

Table

Table

Table

Table

Table

Table

INDEX TO TABLES

1. Distribution of Children According to

Sex, Grade in School and Age . . . . . . . . . .
2. Score Card for Computing Nutritional

Status Indices . . . . . . . . . . . . . . . . .
3. Average Hemoglobin Readings of Children

Four to Fifteen Years of Age . . . . . . . . . .
4. Number of Children, Average Hemoglobin
Levels of Blood and Statistical Evaluation for
Experimental and Control Groups . . . . . . . .
5. 'Trend in Gain or Loss of Weight as Shown by
Average Heights of Group . . . . . . . . .I. . .
6. Percentage of Children Varying from Erpected
Weight at the Beginning and End of the Study . .
7. Percentages of Children Who Failed to Gain
Over a Three Months Period . . . . . . . . . . .
8. Percentage Distribution of Children by

Nutritional Indices . . . . . . . . . . . . . .

ll.

14.

21.

26.

THE EFFECT OF A SJPPLFNENT FY SCHOOL LUNCH ON

NUTRITIONAL STATUS AND HENOGLOBIN LEVEL

INTRODUCTION

There have been many attempts to improve the nutritional
stetus of young school children through the feeding of lunches
supplementing the regular home diet. The presence of dental
caries, infected tonsils, mild anemia, enlarged thyroid, enlarged
lymph glands and defective vision may be in part attributed to the
lack of an optimum diet; and although these defects do not neces—
sarily impair nutrition, they are undoubtedly a factor in malnu—
trition.

When supplementary lunches for undernourished school chil-
dren were first instituted, milk was the food usually given. While
milk generally gave satisfactory results, other foods have also

been shown to be satisfactory.

REV E?! OF LITERATURE

Chaney (6) compared a mid—morning lunch of milk and
graham crackers with orange juice and graham crackers during two
eight-week periods and found slight gains in weight in both groups;
but the children in the latter group made a slightly larger gain.
This study was later continued by Morgan and her co—workers (29,
30, 31) by observations on small groups from the Deaf and Blind
school, a junior high school and a public school. As before, the
children benefited from the lunch whether it consisted of milk,
oranges, figs, crackers or wheat germ biscuit. In the first insti-
tution oranges gave the largest gain in weight, while in studies
with children from low income families the largest gains resulted
from milk or crackers. In the last study the children fed a wheat
germ roll for thirty weeks showed a gain in weight three times that
of the controls. The authors conclude that a definite superiority
for any particular food cannot be assumed, and that choice of such
lunch should be made only after careful consideration of home diets.

A Special cereal was used by Summerfeldt in a study on
twenty-one children who were patients in a hospital (49). At the end
of a ten-week period she found the group receiving the cereal had
gained 3.57 times the expected rate of gain while the control group
had gained only 1.17 times. Hemoglobin values for the special
cereal group were raised 1.5 gm. while those of the ordinary cereal
group were raised only 0.9 gm. The gain in weight was attributed to
the vitamin Bl content of the cereal and the increase in hemoglobin

to the iron content. In a continuation of this study (50) the authors

3.
‘ conclude that the rise of hemoglobin was not due, except in a minor.
degree, to the vitamins B1 and B2 present in the cereal, for inges-
tion of these factors alone was followed by only a small rise in
hemoglobin. When vitamin B1 and B2 concentrates were given (44) for
a period of six months there was an increase of 0.9 gm. in the hemo-
globin value and 1.6 times the expected gain in weight, While with
the special cereal alone there was a gain of 1.8 gm. in hemoglobin
value and 2.3 times expected gain in weight. When this was continued
(51) for twelve and eighteen months similar results were obtained.

Wait, Merriam and Coming (53) found a definit. though not
marked improvement in children Whether fed milk or tomato juice as a
supplementary lunch. This was judged by medical records, gain in
weight and improvement of the "general" nutritional condition. The
study was carried on 760 rural school children extending over a period
of four years.

Roberts et. a1. (43) made a very comprehensive study for
one year on 107 children in an institution where an accurate check on
the daily diet could be made. They compared the value of irradiated
and non—irradiated evaporated milk as a supplement to the usual diet
with a control group and found the average excess in mean gain of
weight over the control group was 2.27 pounds for the non-irradiated
mill group and 1.4 pounds for the irradiated milk group. Comprrison
of the two groups was also made by roentgenograms of the wrists and
a dental examination.

It was customary until recent years to assume that vitamin B

was Widely distributed in natural foodstuffs and that any reasonably

well-constructed diet was likely to contain enough of this vitamin.
With the discovery of the multiple nature of this vitamin, however,
this theory is not well substantiated. Since vegetables and fruits
are not excellent sources of vitamin B1 and wit the increased use
of highly milled products, the modern diet may be lacking in this
vitamin.

Recent studies have indicated an increased vitamin B1
ingestion is frequently beneficial to infants and children, and
that the amount included in ordinary diets may frequently be less
than the amount required for optimum health. Knott (20) obtained
higher retentions of vitamin B1 with higher intakes for each level
of ingestion studied and concluded the optimum requirement for young
children is 40 Chase-Sherman units per kilogram per day. This is
about six times the calculated minimal requirement. A continuation
of this study was carried on by Schlutz and Knott (47) with fifty—four
children over a thirty-two week period. The regular diet of the in-
stitution averaged 260—420 international units of vitamin Bl per day
While the supplements of wheat germ and crystalline vitamin Bl fur-
nished 120-200 additional units. The supplementary ingestion of
150 units produced from 17-25% increase in the grams of food consumed
per child per day. They conclude that since the higher levels of
vitamin Bl administered during this investigation produced no apparent
ill effects, did not force the growth, and did tend to stabilize the
appetites of the children, the higher ingestions of vitamin B1 may be
regarded as optimum.

Unless the food intake is known, a deficiency of this vitamin

is difficult to determine since no generally accepted symptom, Sign,
or diagnostic test of vitamin Bl deficiency in humans exists (60).
Hoobler (21, 22) in studying infants, found anorexia to be one of the
first signs of a lack of vitamin B1 in the diet and a loss of weight
or a period of stationary weight another symptom. The addition of
vitamin B1 to the diet caused an increase in growth not only because
the appetite was stimulated and thus increased the food intake, but
the same effect was noted even when the intake of food remained the
same. This would indicate that vitamin Bl in addition to having
stimulated the appetite may also have brought about a better assimil—
ation and utilization of the food intake. He concluded that the
quantity of vitamin Bl needed by infants differs greatly and that the
vitamin Bl in commercial products may be sufficient for certain infants
and not for others. Ishii (23) found the addition of purified vitamin B1
to the normal diet of children slightly increased the rate of growth.

With the addition of a water—soluble extract of rice—polish-
ings to an evaporated milk formula, Poole, et. al. (40) found a greater
regularity of growth in infants studied from week of birth to one year.
The average hemoglobin level for the infants receiving the vitamin B1
,supplement while not higher than the control group, did seem to be
more constant after the first customary initial drop in the first few
weeks. The authors conclude this demonstrates the possible stabiliz--
ing. effect of vitamin B1 on growth and nutrition.

Sauer (45) studied fifty—two children from a few weeks to
fourteen years of age, all in fair condition, but most of them with

some definite complaint. They received one to two teaspoons three

times a day of levurinose, a brewer's yeast powder, as a source of
vitamin B complex. Observed over varying periods, 59$ showed a

small increase in reticulocyte percentage, 27% a decrease and 15%

no change. Certain cases showed a reticulocytosis after fourteen
days, suggesting that the vitamin B complex, besides causing a mobil-

zation of pre-formed young red cells from the marrow, may also in-

Ho

duce regeneration of young cells.

A review of literature reveals a paucity of material on the
normal hemoglobin standard for children between five and fourteen
years of age. The hemoglobin value is highest at birth, then rapidly
declines until the minimum is reached at about one year. After the
second year it rises at a fairly rapid rate with sudden increases be—
tween six to ten years and from sixteen to twenty years. At this age,
it reaches the adult level and from twenty to fifty-five years the
variations in different age periods are very slight (57).

"So few are the reliable observations of the hemoglobin
content of the blood during infancy and childhood that it would seem
unwise to make a more precise statement concerning the average values
and the normal limits of variation for the different age groups.....
The important values are not the averages, but the average limits of
variation. It is just thes- which are particularly uncer ain" 55).
This quotation from the report of the White House Conference on Child
Health and Nutrition indicates clearly the need for the study of

normal hematologic standards in children.

tus,

m

This study was undertaken to show the nutritional st

Q;

and hemoglobin values of the blood of school children as aifecte

3*

by the feeding of a s1pplementary lunch of two vitamin B1 Wflfor
which each contributed 100 international units per day. The school

was divided into two groups, one receiving the supplement and the

other acting as a control group.

 

*The writer is indebted to Hilker and Bletsch Company of Cincinnati,
Ohio for contributing the wafers for this study.

 

 

 

 

 

Children Enrolled in Towargarden School

1938 -'39

EXPERIMENTAL PROCEDURE

With the assistance of the Ingham County Health Service

permission was obtained from the school board of Towsrgerden district

to conduct the experiment in their school which is located four miles

northeast of East Lansing.

There were fifty—tho children enrolled in

the sChool all of whom were distributed through a primary class and

the first three grades as shown in Table l.

of the children were included in this study.

Table

1. Distribution of Children

According to Sex, Grade in School and Age

However, only forty-eight

 

 

 

 

 

 

 

 

 

 

 

 

lst 2nd 3rd 6 7 8 9 10—
Primary Grade Grade Grade 43:. yr. g_yr. gyr. 12_yr.
BOYS 7 5 7 3 4 5 6 4 3
Girls 10 6 6 4 6 8 9 3 0
Total 17 ll 13 7 10 13 15 7 3

 

 

 

Before the study was begun, a physical examination was con-

ducted by Dr. C. D. Barrett and Dr. E. F. Hoffman from the Ingham County

Health Service. At this time a plan of the study was presented to the

parents and in all cases consent was given for the children to parti-

cipate in the problem.

The study was begun on February 13 when seven anthropometric

measurements were made on each child. Height, weight, arm girth, chest

breadth, chest depth, hip Width and subcutaneous tissue were measured.

Due to the cold weather at this time, many of the children were dressed

in heavy clothing. When the measurements were being taken, all
sweaters or jackets were removed and the measurements carried out

over as little interfering clothing as possible. Weight was taken
without shoes, on the school scales which weighed accurately to one-
half pound. Height was obtained by means of a wall measuring chart
which read accurately to within a quarter inch. In making the other
anthropometric measurements the technique as suggested by the Amer-
ican Child Health Association (2) was followed. A steel tape equip-
ped with a Gulick spring handle was used for measuring arm girth;

a large sliding wooden caliper for measuring chest depth, chest width
and hip width, and an especially devised caliper for subcutaneous
tissue. Data for all physical measurements, recorded by a second work—
er, were put down in table form (Table 2) for ease in determining nutri—
tional indices. The nutritional indices of arm girth, weight and sub-
cutaneous tissue were determined from tables published by the American
Child Health Association (2).

While the physical measurements were being made, a conversa—
tion was carried on with each child in an effort to gain information
about his dietary habits. Such general questions as, which foods he
liked and disliked, if he got up in time for breakfast and whether or
not he drank milk were asked.

Having obtained some information about the nutritional
status of the group as a whole from the doctor's examination and the
various physical measurements, an attempt was made to divide the
children into two comparable groups. Sex, age and physical status

were considered in as many instances as possible so that the experi-

Table 2. Score Card for Computing
Nutritional Status Indices

 

 

 

 

 

 

Name Sex .JAge
School Room Grade Date
MEASUREMENTS
mej‘:ed a ooooooooooooo
A.rm Girth COOOOOOOOOIOOOOOOOOI
Rela—}:ed b OOOOOOOOOOOOO
Subcutameous Tissue d .............
over the Biceps fOOOOOOOOOOOOOOODOOO
eOOOOOOOOIOOOOO
weight gOOOOOOOOOOOOOOOOOOO
Height hOOOOOOOOOOOOOOOO...

Chest Breadth

Chest Depth

Width of Hips

mpiration iOOOOOOOOOOOOOO
kOOOOQOOOOOOOOOOOIOO

InSpiration j..............
Expiration l..............
n...’...............

Inapiration m..............

OOOOOOOOOOOCOOOOIOOO

 

 

 

 

 

COMPUTATION OF INDICES
‘* '*‘_ Arm Girfi'fiw Sub. Tissue u:* Weight
1' - 4- -- + ..
Value Value Value Value Value Value

Measure
Height

Chest Breadth
Chest Depth

Hip Width

Adjustment for age

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sums

Indices
No. in 1,000 with

 

 

 

 

 

 

 

smaller indices

 

 

 

 

Copyright 1935, by the American Child Health Association

mental group would be quite comparable to the control group.

Two kinds of small wafers were fed, one to which 100
international units of vitamin B1 had been added by the incorpor-
ation of thiamin chloride, and the other similar except that no
vitamin concentrate had been added. The cookies were taken out
to the school and the teacher, Mrs. Hankinson, kindly distributed
the wafers to each group during recess time, so that each child
in the experimental group received two wafers daily during the five
school days each week or a total of 200 international units of
vitamin Bl five times a week. The control group received their
two wafers daily also but they contributed no food essential to
their diet.

Hemoglobin determinations were taken at the beginning of
the study using the Newcomer method of analysis (26). The doctors,
who were assisted by the school nurse, obtained blood samples from
the ear. It was found in many cases that very small amounts of
blood were obtained in this manner and it was necessary to massage
the ear to get a sufficient amount of blood, or in some cases the
finger was used. In later tests, after the children became more
familiar with the procedure, the finger was used entirely.

After the Samples had been obtained on the entire group
they were taken to the research laboratory at Michigan State College
for reading. All readings were completed within twenty-four hours
from the securing of the sample, a time well within the length of

time shown by Newcomer (26) to insure no change in color. Ten read-

ings were taken on each sample and averaged; this was repeated and

13.

an average of the two sets of readings was used. However, if these
two sets did not check within 0.5 mm, a third average was obtained.
Hemoglobin values were determined at intervals of approximately

a month during February, March, April and May. At the close of the
school year, May 12, the seven anthrOprometrical measurements were
made again, and a second physical examination was made by the doctors.
These data were used to calculate the three nutritional indices, arm
girth, weight and subcutaneous tissue.

The week following the closing of school, a home visit
was made to each family to tell them the results of the study, and
to secure more information about the home diet of the child whenever
possible.

The hemoglobin data were subjected to statistical analysis
andthe following measures determined: mean, median, standard devia—
tion, probable error of the mean and coefficient of variation. These
computations were made on average hemoglobin levels and a comparison
made between the children receiving the vitamin Bl wafer and those

receiving the plain wafer.

Part I:

DISCUSSION AND RESULTS

Hemoglobin Levels

From a careful survey of the literature a summary of hemo—

globin values of the blood of children in similar age groups as those

included in this study is presented in Table 3.

of Children 4 - 15 Years of Age.

Table 3.

Average Hemoglobin Readings

 

 

 

 

 

 

Age Number Number Average
Author of of of Hemoglobin Method
Subjects Subjects Determin— Level
__ _ ations (gramsl
Williamson 5~
15 yr. 105 105 14.14 Spect0po—
metric
Wilke 5-
15 yr. 200 312 13.44
Osgood & 4-
Baker 13 yr. 215 215 11.96 Osgood—
Haskins
Summerfeldt 5-
& Ross 14 1 . 66 132 11.00 Newcomer
hugrage & 5-
!ndresen 14 1 . 299 299 13.77 Osgood—
Haskins

 

 

The range of hemoglobin values in children from 4 - 15 years

old found by these workers Varies from 11.00 to 14.14 grams per 100 cc.

of blood.

In most of the cases the results are based on single read—

ings which might vary somewhat from the true value, depending upon many

factors which have been shown to cause the hemoglobin value to be in-

creased or decreased as much as 15 to 25 percent (41,54).

 

 

 

 

 

 

 

 

 

 

 

able 4. Number of Children, Average Hemoglobin Levels
and St t tical Evaluation for Experimental and Control Groups
D1v151on No. Range Median Hean S.D P.E. Coef. % of
of of child~ of of of cases be—
— Groups ren Mean Mean tar. tween
11.50-14.50
_gms.
(ng-) (ems.)(gms-) (gmso)(éms- _?%) .(%)
Children
receiving 24 11.49- E
vit. Bl 17.75 13.~ 13.97 1.40 .1893 10.4 -80
supplement
Children not
receiving 24 10.70-
vit.Bl 16.76 13.17 13.36 1.28 0.1730 9.6 80
supplement
Average of 10.70-
two groups 1 48 17.75 ~13.21 13.41 1.34 0.1293 10.0 80
A summary of the hemoglohin values found for the children in

this

study and a stati

tical analysis of the

Four readings at intervals of one month, the

data are shown in Table 4.

first begun in Februar'
L)

and continued through into May, were made but due to absences from

school four readings

readings on trentyetwo children and two readings on five

were obtained on only twenty-one children, three

chil-dren.

The table shows an average of the four monthly hemoglobin

read

the range for children of

(32), w111

children receiving the vitamin Bl it

for the cont

iamson (57)

rol group,

ings on the forty—eight chfl

this

Wilke

I; r‘ x r‘.
c on 11

mt ti sti ca ally signifies nt.

(56)-

n
191"

rrzn to 13e 1,.41 gr*ms which is
age as TCDOItE d by Pflugrage

within

and Andresen

The hemoglotin value for the

was 0.61 gr as higher

J. .. 4.1 , .L
'41:an L '~.-U

if errnce Irotably not 1 rge enough to be

Ther is no appreciably large di Wf rer Ce bet een the tto

CD

1

grou s to co ncl uCe that the sddit ion of vitgmin B1 to the diet in-
creased hemoglobin formation. This is in accord with Summerisldt's
(48) conclusion that the increased vitamin P1 pleyed little part
in the determination of the level of hemoglobin in the blood.

The figures for both boys and girls in this stucy h've been
grouped together as variations in hemoglobin due to sex, up to the
sixteenth year, have been found by T1 he (56) to be slight and may,

for all pr rac ical purposes in tlis stud;r, be ne lected. The ever-

r-
C
V

[—4

’7. ,’
.0w

(3

age value of the boys in the present study vasm1d the
3.43 grams, a difference which can be disregzrded.

Pickerd states of the routire tests used in clinical
diagnosis tie estimation of henoglobin is one of the most indefinite
(38). The methods used heve u*ide individual errors be siles those of
tecnnic, such as unnrwces :ry erroz s in the menuftcture of the instru-

ment. There is alo ficble uncertainty as to th -e n rm51 stend~

g)
C...)
E]
:1)

ard. Wintrobe (58) fee ls the kno ledge of hemoglobinometry hrs been
hampered by the inaccuracy and inadequacy of hematologic technic.
fidvences have been further impeded by lack of sufficiently well founded
standards of the normal. Elvehjem (10) and several other workers err-
advised basing the standard on grams of hemoglohin per 100 cc. f blood
instead of on a percentage basis. This was slow to come but is now al-
most universally used.

Holiday (19) feels that in Spite of the many investi.; st: ors
rhich have been made on blood, the following statements can scarcely

be disputed: {1) the cmount of hem globin in a given volume of blood

U

r7

cennot be aCCUr tely estimated (2) the percent of he.<3globin rela—

.1.

tive to a "normal" stands rd is accurate only for the apparatus em—
ployed and differs widely with different instruments. Different
results were obtained with the same instruments then read 1y two
observers. He also found differences in color shades ersy to re: d

in the lower parts of the scale but obscure in the higher parts where
a slight difference in shade represented an eyprecieble range of
hemoglobin concentration. Reading; were easier to make in daylight

Alt (1) found it ible to check with grerter accuracy

U)

08

'6

when using the Newcomer or Sehli instruments. The Newcomer was usually
reed ithin l—Z, error; however, there ere occrsi mal blood svecimens
that had variations up to 10%. The normal for mall adults using the
Newcomer instrument is 16. 92 gra ms per 100 cc. of blood lich is taken
as 100%. This is lower than Sahli and Von Fleischl—Heischer but higher
than Dare, Haldane, Oliver and Tallqvist.

In addition to the errors of the instrument and technic

there is a wide range within which a normel readinf may fall because

g
of the many factor sceusing a variation in the hemoglobin value.

The blood se mules for this study were ts wk n throughOILt the
school day thus hourly variations in hemoglohin values have not been
taken into consideration. -abinovitch (41) took blood samples every
two hours on twenty individuals end found that the hrno~lotin value
vrried as much as 26% in two cases; 15-20% in four csses and 10- 1,,

in s 3 cases. While Ward (54) found 1?? :1d 267 varicnce in hourly

tests on two normal subjects. Iiills (28) orkitr 1.ith anemic patients

U)

La la ~gv-‘d
Ut) S..O'.;";. -.

(T)

found a rrn3e off ~20? bet cen lourly values. These t

the hemoglobin value to fall during the day and rise at night since

the highest res Min as were found during 9—10 a.m. and tte lowest 6-7 p.m.
The question of the effect of season 1 vszizti on won d seem

till unsettled. Osgood (34) found no seasonal var ria t ion in hemo—

2-:-

globin values, while Platt and Freeman (39) found a definite seasonal
variation with the lowest values occuring during the winter months,
followed by a rise in L1 ay and a peek during the surmer montis. The
lowest values occurred during the time of greatest incidence of upper
respiratory infections. In this study the highest average value was
found in March. The following month showed a slight decrease in ever-

ese hemoeiobin values perhep s exolsined b the fact that there vas a
e a i

flu epidemic and also by the fact that many of the children had con—

3
(u

tracted contagious dise es.

0

Smith (48) found no variation in hemoglobin value in restonse
to rest, moderate activity or food. However, Schneider and Havens (46)
and Boothby and Berry (4) found that after subjects he lbeen s ubritted
to various forms of exercise there was an increase in the hemog lobin
value ranging from four to eleven percent. In this study it was nec-
essary in some instances to take the blood sar ples just after the
children had been playing hard at recess time or after the noon hour.
Following such conditions the hemoglobin values may have been higher
than would have been found under ordinary con oitio ons

The data may be v; titted somexhat by the manner in zdzich the
blood vas taken. Several work ers report there should be no undue manip-

ulation that involves "milking" in trying to force enough blood to the

71

A.’.

surface. Bing and Baker (3) state that this may cause surprisin»

sly
lirge errors and, contrary to that might be supposed, the errors

usua 1y lead to high rather than low values. However, since these
tests w-re made in a one room school house while school was in prog-
ress, it was necessary to take them quickly and with as little dis—
turbance to the subject as possible. Hence it was difficult to secure
blood samples without being tempted to squeeze the surrounding tissues.

In the statistical anelysis (chle 4) it will be noted that
the range in average hemoglobin levels was 7.05 erars thil,
end Baker (35) reported 5.03 and Wilke (56) 3-39 grams. Hovever,

80% of the cases fell within a range of 3 grams (11.50—14.50 gms.)
which is about the same percentage as that reported by Goldhemmer and
Fritsell (13), Wintrobe and hiller (59), Osgood (33), sgood and Has-
kins (36) and Elvehjem and co-workers (9). This shovs there were only
a few cases at either ex+reme.

The standard deviation for the group receiving the sup:
was 1.40, for the control group 1.28 and for the entire group 1.34.
The observed minima and maxima (10.79—17.75) and the calculrtcd Irinima
and maxima by 3 S. D. (9.39—-l7.43) are essentially in agreement,
so that the group as a whole may be considered homogenous.

The probable error of the mean for the experimental group
was 0.1893, for the control group 0.1730, and 0.1293 when considering
all of he cases.

The coefficient of variation for the children receiving the
supplement was 10.47, for tho e not—receiving the supplement 9.6,,

end 10.0% then both groups were included. This shows the hemoglobin

20.
levels of the two groups had about the sore anount of varleci
The values representing the children who received the vitamin B1

wafer show a slightly larger variation than was true for the control

In all the statistical analyses on the hemoglobin levels
for the group receiving the vitamin Bl valer and for the control group
there were probably no differences between the two groups large enough

..
.L

to be considered statistical y signilicant.

\

Part II: Nutritional St tus

F

The trend in change of ueight for the forty-eight children
is shown in Table 5. A record of previous monthly weights was secured

‘

from the teacher and included in the table in addition to those weight

U2

obtained during the study. Four months out of the school year were
chosen to show the variation in everece weights. The individual heights
for the children of different ages veried from thirty-taree pounds to
eighty-two pounds so this average weight does not give a picture of the
group but rather just shows the trend of the whole group.

Both the experimental group and the control group show a
practically stationary weight or slight loss in weight in the fall and
winter months and an increase in the spring months during this study.
The children in the control group showed a slightly higher average

weight for all the months which shows the children in this group as a

Whole were probably closer to normal weight.

Table 5.

Trend in Gain or Loss of

Weight as Shown by Average heights of Groups

?l.

 

 

 

No. of Children
and Kind of Average Weights of Group_
Supplementary Sept. Nov. Feb. May
Lunch Received les .1 Clbs.) Qbs .) les .1
Average weight of
24 children receiving 47.9 47-6 43.9 49.1
vitamin B1 wafer
Average weight of
24 children not re- 49.2 49.3 50-2 50.7
ceiving vit. Bl wafer
Average weight of
48 children 48.6 48.5 49.6 49.9
from both groups

 

 

 

 

 

Even though an attempt had been made to match the two

groups before the supplementary feeding was begun, it was found in

analyzing the data at the end of the study there was a distinct

difference in the make—up of the two groups.

At the beginning of the

experiment 70% of the children in the experimental group were below

their expected weight (Table 6) while in the control group only 48%

of the children were below their expected weight.

Table 6. Percentage of Children Varying

from Expected height at the Beginning and End of Study

 

 

 

24 children receiving 24 children not receiving
Period vitamin B1 wafer vitamin B1 wafer
'of Above Exp.‘ Below Exp. Above Exp. Below Exp.
Study weight weight weight weight
(<22) (it) (7:) (3-3)

Beginning

of 30 7O 52 48

study
End of 25 75 4O 60
Study

 

 

 

 

 

 

‘

At the end of the three months period the children WHO
had received the vitamin Bl' .afer shored that would seem to he a
beneficial effect from the additional vitamin B1' At any rate the
children in the supplemented group seemed to show more stabil itgr;
there were fewer failures to gain and the children seemed better able
to "hold their own". At the end of the study the control group shoued

ses losing. eigh while the

C.)

a 12% increase in the percentage of c

supplemented group showed only a 5% CT P 6-

h
f; 2

\l

There was no very striking improvement noted in either group
mainly because of the season in vhich this study res made. This ten—
dency for a stationary weight or loss in weight in the spring is in
accord with findings of other workers as to effect of seasonal ynrietion.
Emerson (11) found gs ins in v.eight to be'loxest from anusry to Hay and
highest from July to November. He states: "A Child who fa ils to gain
in veight each month, at least up to the age of ten years, is in all
probability suffering from some sort of infection or fatigue in which
diet e.nd housing plav imports nt cox tributirg rarts".

L3

Roberts (43) in summerlSln

dress the conoll:S"cn thct for the majority of children me" .um :Flrs
occur in the latter half of the year. For this reason she sug eats

v~-.r~ h h . h h ‘n ~v n -1— 3 ~ I.“ 1‘
that fihfilgllo of school dwtu be on e Cu] ncer 90m? rather tion school

ye"r bfsis. The can se of sersonal v*ria tion is not yrt determined, but
,_, L -. 1‘ . P ‘L v1 .f'" * J'A ‘
probably there are m ny con.r_hutlng factors such as sunlight and ten—

Q 1 o o _ 2
nerature, h"?i :nic factor: and tse ineld lee oi dis. .c.

“di.a““"

o . H 4‘ vv- c-‘U-J ‘P:f~' ‘
The exfccted "r3ght of a child is usually h_e.u on h icht,

A ‘P 1 ‘I- H : -— . Iv— —: N, I: ‘ ‘\ re f‘ ’1
ace and se“. Palmer (3;) helieves ,;01th 1: he pat l- .cie d.rpn —
—' w ‘-
... .- F. a g .. . 1-, N: -- . °
Lnt on Elb.o attained than chrorelcgic'l “ Th “ he “eirts out

that the gains of ten year old r”irls vary from five to fourteen pounds

ner year depending on whether the girls weigh fifty or ninety pounds
Turner and forctrom (52) tried three methods for screening

out children rho needed health imtrovenent. They founc that a record

of intermittency of grovth for a three month period gave the truest pic~

ture. Height-~ueight-fige tables have a tendency to screen out children

who are nrturally small for their age wiile the intermittency method

does not. Table 7 shows the results of subjecting the weights of the

children in this study to such an analysis.

Table 7. PercentS-es of Children Who

' . fl '2 ’ Ar- "-- ‘. A :
Failed to Gain CVer a Thr~ wrtcs Pe iod

'A' le ..-I.‘kJ—.L|'

 

 

 

 

 

 

 

Percentage of children milin~ to "sin in -
No. of children Sept.— Oct.~ Nov.~ Dec.» Jan.— Feb.~ Her.—
and kind of Dec. Jan. Feb. Ear. Arp. Moy June

aromas

 

FT (f‘i’ C7)

q
apt?

6

f)»
D

'1

f:

 

 

 

 

 

 

 

74 children
c I
not receiv1r" 23 ‘13 c 10 2? 13 4
vitamin B1
1'" per
43 children
/ h
tot"? of So 33 l7 l5 44 17 10
hoth "rours
it n _
A __ _. 4__‘__._ ‘__. .._..._.__--_._~..~ ‘é _ ‘L m

 

 

I" r

I '1‘? .
In this study in the q-rio: months t‘.;r3 Hrs a small’r
percent“:: of thorn TL; felled to said than in the ”all 5nd Tintcr
Minors thich 1: 0 nine“; n +23 r? u‘tf feted ;y T in:r (”“\ Vrm ‘7:
dzr;'to Zhgriiiffervvuoe in ifie rvffewugw ;? the iii) :ro1:r‘:x3 SL071- in

ID! ~~vrc ”1"fln +'—) th\'(‘ ff‘\/’:|‘fi +"‘.‘": V“. -'1C:J'\'-F\ ‘ffi ‘r-I-f" anx (1.331] wa‘ +‘,‘f’_r‘ 4-1-9-_+ flex-r
1 _ 5. D- . -k;‘ .'-~.. ¢ .. -- . 9‘ . "' A , v .-. --. ~.—A ’ -~‘A‘ L'-L 5' ' _’

1 ,..._ “‘1 A ”d . _-- q A' I. n- J_“ I ‘_L m‘ o I
the Cbuw ii t 2.13 2.. rr .1' m. .0 euro or u -.e 1-. u ”oer-34. his ”y
b -
‘ 1: _ - '. A -. .‘._4——~ -.-~ -. - ‘ D a .L' ° F. . 3
in”i_:“ie "1 lflCrJCL’”l foog. n-u -e (L rcrvv d . :-i Lluiltc m,‘?: r‘"= so
' ' ' . LA, ' 1- 9. m ' 1---: ‘ ,-.- It. L‘.
the Vitnrin P incornorcu d in th; diet, 1LT? snonvsis ch..: ii":.or
LL. 4. A ,1 ° ’1 1: ° 4.1 -_.., : - 4. 1 .,. L- J. _ -
,.e cons "nay ant lmFTOV€~ cone _tLon 01 one 4.1 rim nun grou, ny L_,Le~,»_.:3
‘mr‘11 Cl C'N‘A'Lfl," ‘ o fn 5-] y. r‘ J— 94":
31.1 55,5? p ‘ :k. soft; ‘ -4- 54L 0.: [J0 b‘.~-21.
T1”, newwwt-zm. +1“; -..«:.~.1-+ V“V‘°r‘~“ ...-,u,. 1%)" ..:1 ,1 .f. ..,.11 -r.
lli‘i- “gun“. - '_.I . L4H- u .--. .tu - L“..' w._ 1.. " . ._-. ‘ ..~.._... .-L)
‘ U U
I U f‘ C I 0
"1th st"t;ro rec“: lo":c l. Trcnceo (ls) egnh’714ed the importcnce of
V Q .-
1.1- 'I 1’ — - ' ‘ .L - ’ '. . ‘-.‘.t v... 1 “.L" - .' f. D '1
r' C: 4? ,... v—w q ‘4 . N - ' - - "‘ ‘ ,. H “a
”cl , l in; 1 ior- in CiJc min n. VFLLP , and e; t“; sire or KHJCloL
J-‘- n p “w?~"fi““ .tf‘ 'v‘flf‘ ‘ A o : ‘j:fi,-—J-. ~ L‘A ‘.J<. - F1
“rd ole uiot;nt 0. Su\ Luau.ous ti.s-e s inu_t tin we nquiuionii

”as much lower than what of other skeletal Measures with weight, and
pointed out that to .cse nucrit ion conclu ons on veight—height roti os
may cause erect eri ors bec use of hip and chest variations.

seven arthrooom_-i icel measurcrnents were made on the children

in this study: reisht, heieht, arm girth, chest depth, chest bre dth,

width of hips and subcutaneous tissue. Anthro ometry has grown the lost

1.. J.~

few years with the availability of new statisti l instrumc: s of re-

search. The chief fault of tlie older 8H1t 110) metry was that it friled

to take account of innate individual differences of build, exceut ”no

of height, and insisted that all persons of a given sex, nge and height
should be alilce othnrlwwe. The new ant‘mr pometry reco guises the val—
id ity of hereditary individufil differences and through the use of pronrr

structure-l an. functional necexremeits, offers a more valid In. W od of

(13

anvraising with a fcir degree of accuracy the phys icel status of the
individual.
Fven vith the improvements on the ese instruments ho. ver, tlere

of

.he

rf'

is still a great chance for error in technique because hrndl in»

L 0.

instruments necessitetes the subjective judgment of the operator. The
most comprehensive studim made on the use ofc nthropom etr ic mea sure—
ments are reported by Boynton (5) and Heredith (27). They did not use
the same measurements as were used in this study so no analogies can be
made. However the magnitude of the error in measurements due to sub-

j ctiv ve factors was shown in large standard deviations for some measure—
ments and wide ranges for all measurements at all ages.

Three nutritional indices including arm girth, weight and sub-
cutaneous tis sue were computed us ing the table of the fimsricnn Child
Health Association (2). These indices show the ind i idusl child's stand—
ing among other children of his age, sex and s‘u letel build. Since much
change in skeletal development could not be expected from such a short
study and since there is a possibility for subjective error in measuring
technique, the measurements of each child for February and for May were
averaged. The nutritional indices were based on this average. Tables are
worked out only for boys and girls between seven and twelve years of age
so only thirty-seven of the forty—eight children could be included in this

analysis. Table 8 shows the'distributi on of the children on a percenteg

basis for the three indices.

. il a . Egfi.ha§afi .. l

Table 8. Percentage Distribution of Children

by Nutritional Indices

 

 

 

Quartile Nutritional_lndicesg_
Rank Arm subcutaneous

Girth Weight fisgug‘

%) 5%) 5’3)

4 65) 43) 6)
)34 )86 )33

3 19) 43) 2'7)

2 13) ll) 56)
)16 )14 )67

1 3) 3) ll)

 

 

 

 

The distribution of the children by these indices shows
that 84% of their arm girth indices and 86% of their weight indices
were in the upper half of the distribution but only 33% of their sub—
cutaneous tissue indices fell in the upper half of the distribution.
In picturing an average child of this group from these indices he would
seem to be of average weight for his height, age, sex and build; his
muscular development would be average, but he would lack or have poor
subcutaneous tissue. This might seem to indicate that most of the
children in this community have been receiving enough calories to approxi-
mately keep up to weight but there are lacking certain food essentials
in their diet which have caused a lack of development of healthy body
tissue. However since no dietary study was made this cannot be a dogmatic
statement for there may be other unseen factors which are affecting the
nutritional status of these children.

The physician's physical examination showed the following

total number of defects in the children:

Temporary teeth 23

Permanent teeth 12

Tonsils 12
Lymph glands lO
Thyroid 8
Vision 8
Ears 4
Other 4

This examination given at the school could not of course
be as thorough as one given in a doctor's office or at a clinic.
All of the defects observed in the school examination were of the
type that undoubtedly have been accumulating over a period of years.
There is little doubt that faulty diet may have been an important
factor in their development but there may also have been other con—
tributing factors. All during the study a large number of the chil—
dren had colds and during March there was an epidemic of influenza.
On March 15 when the hemoglobin test was to be made, twenty-eight of
the forty—eight were out of school, and in April twenty-two children
were out with colds and other communicable diseases. During the study
there were several cases of measles, chicken pox, mumps and whOOping

cough. The teacher reported there had always been a high incidence of

communicable diseases each year. An “iadequate diet and poor living

L

conditions are probably contributing causes.
When home visits were made it was found mos of the children
lived in very small, crowded, tar-paper covered shacks and some in basement

houses. The sleeping conditions were very crowded and the ventilation bad.

no

.3
5 v .

.In spite of these conditions most of the houses were remarkably clean.

A description of one family will serve as an example: In a small tar-

:3)

paper covered one—room shack live two adults and two girls age nine -nd
twelve. In the one room was a double bed, cot, stove, cupboard, table
and portable closet. The house had just been sealed inside with heavy
cardboard, instead of plaster, covered with paper from a sample wall
paper book; no two pieces were alike. The floor had wide cracks in

it, but it was clean. This family was on direct relief and received
$13.30 per month for groceries and in addition one quart of milk per
day. The family received surplus commodities which vary from month

to month, but on an average this family of four received per month:
3 lbs. beans, 6 lbs. butter, 5 lbs. whole grain cereal, 10 lbs. corn
meal, 12 lbs. graham flour, 25 lbs. wheat flour, 25 lbs. grapefruit,
3 lbs. prunes or peaches, 3 lbs. raisins and 6 lbs. rice. Since most

f the families in this community are either on direct relief or on W.P.A.
they would all receive the surplus commodities. Hence the hypothesis
used at the beginning of this study that the diet of these children may
be lacking in some food essential, might not be true. This also may
account for the fact that there was not a greater difference between the
nutritional status and hemoglobin levels of the exoerimental and control
groups.

During the physical examination several mothers told the
doctor that their children had poor appetites and just didn't care to
eat. In talking to the children while weighing them it was found that
many of them did not get up in time for breakfast. Those who ate break—
fast usually had pancakes, doughnuts or fried eggs; several mentioned

oatmeal. Most of the children liked milk and drank all they could get,

which often was only one glass per day. Their food dislikes, which
were surprisingly few, included eggs, Spinach, tomatoes and liver.
The validity of this information on diet is perlaps some—
what questionable since Roberts (43) states there is a tendency for
both children and parents to "put the best foot forward". The find—
ings will therefore tend to err on the side of presenting too favor-
able a picture of the situation rather than the reverse.
When one considers all of the factors which might have
xerted an unfavorable influence on a tendency to weight gains,
such as season, infection, unfavorable environment and perhaps un-
suitability of diet, the general physical condition of all the chil—
dren was remarkably good. There is some indication that the weights
and general health of the children receiving the supplement of

vitamin B1 was more uniform since the percent of those failing to

gain was less than half that of the control group.

30.

envy: r
A study Wes made on forty-eight children ranging from five
to t elve yefrs of age for e pc“io«3 of three months from Februw rv 15

to Hay 15. The children were divided into two groups. The first

’ 1
\

group recew1red each so chool dty t o cook ie3 to which had been nd ed
300 international units of vitamin Bl in the form of thismin chloride.

The other group received similar weicrs Without added thiamin chlorit

the two groups was made by tao methods: (1) deb rHlP’+13n o” the
average hemoglobin level and (2) a judb ment of physical growth as
determined by anthroyometricel meesurements and a ohysicinn's exam
instion.

The ave ?ge hemoglobin level for th forty~eight children
stulied was found to be 13.11 L .13 grams with a sten da rd deviation
of 1.34. The average of the experimental group was 13.9 L .19 grenis
with a stxnderd deviation of 1.40, While the control group had
average of 13.361 .17 grams and a standard deviation of 1.2 . Eighty
percent of these values fell within a range of ll.50-—14.5O grams.

In the group which received the vitamin B1 wafer the.e we

only a 5% increase in the number of children below their expected

.1.

weights, while in the control group there was an .ncres.se of 12%,
during the ocriod of study.

In anal‘Zing gains in veight hy ixtc mittzn three-mouth
periods, there were onl' hel f as many in the experimental qrouo es

J‘J

riod of ohservn-

(T)

in the control group who failed to gnin during the p

31.

The anthropometrical measurements showed that 84% of the
children of this group were in the upper half of the distribution
in muscular development; 86% for weight indices but there were only
33% for subcutaneous tissue index.

The nhvsicians examination snrwed the most frewuent defects
4. J ..

nfected tonsils, enlarged lymph glands, slifhtly

to be: dental caries,

The addition of 200 internat’onal units of vitamin B1 to the
daily diet showed a slight improvement in the physical growth of the
experimental group over a control group which did not receive addition-
al vitamin. Another study carried out at a season of the year in which
the children are likely to be more free to gain in weight would seem

worthwhile.

12.

13.

14.

15.

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L?) d‘
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'. T35"
rJ
I .1
(’1
"5
(I)
"5
0.

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\o
\W

36.

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O

1..., a

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