A STUDY OF THE PHDSPHORUS REQUIREMENTS OF NORMAL FOUR YEAR OLD CHILDREN ‘I‘IIEC 11‘. FOR THE DEGREE III M. S. Rena Klooster-Potts I931 . n" .’. .. .d. I‘- '1 l -r .. 'T r ,L 4:4,; v‘.‘ _| —L '1 fr?‘ ..’ v...‘ '. .uv- ? "1.1-? til-:5“ I“ ‘Vr '_\ - - ' .' . ' . . I r I ; ".5: 6'.“7'.. ". . (“‘hl} 1 1’; .. ‘1‘.\ \I_ 1.; "1"v’t’1x a. I " o. -, I ' " ‘ ‘ | 5' .1 '0 *1yi1i‘..%—-F,-' ?..#‘ fl \ 1. ‘ .1, n. o -1? 11“} 1111‘, _ L -. ’ . 1’ +1. Jilkyi “$.31 ’ g" . 1' (w‘ v - ,' J‘.¢’?"\-‘ r' .- . z :16.- 2' A“ . “fr“ ‘6**' F‘Q‘NV’i‘ m Y???“ ‘ 99V; "64‘ ““910 fit M1 :66. 6*. P- ’ 6 ' ‘ ; {1%} 3;“ 11.xr'%“'3'“i'\a‘ U . flr‘,-?§.,¥; if” 1.11;.» My? 31;: T". F?”- 9:15;” :66"; §$;&.'-11:‘1' if k . 1, ‘2’633656’16-67‘5- 1 .fi.‘ s if» -' *1. ., .- ”MM-11» ‘ -.,;a,5.1.gx-¢,‘,z,‘-~ 115": (fix 1'". .+1'...., 11* ‘ y “fjé‘dég' ":1: a???" 'I’T‘ . RI“A.‘L {‘*(,\ ,_ 11 1-1,‘ I. ' .5"- I. ~I..-l"_’- ‘n _"':/ 1" A :11. . 't ‘1' xi. —’ 1. ‘ ‘ 6’46. 169:"; : A’Jo -‘ D. . 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I ,, . l g ‘ , ‘ l,“ .33.; h1k’t’13,‘ .136,» {I . 2-,; n .‘ - A STUDY of the PHOSPHORUS REQUIREMENTS of NORMAL FOFR YEAR OLD CHILDREN A Thesis Submitted to the Faculty of Michigan State College In Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCE by Rena filooster—Potts Department of Food and Nutrition Division of Home Economics 1951 TH 5515 ACKNOWLEDGMENTS The writer is very grateful to Dr. Marie .Eve for having suggested this problem and for her advice and encouragement during the course of the work. She also greatly appreciates the kindly advice and criticism given by Miss Whittaker. Thanks is due also to the mothers of the children who were subjects, and to Miss Miller and her assistants for their excellent co- operation. TEE PHOSPHORUS REQUTEEMENTS of NORMAL FOUR-YEAR OLD CHILDREfl The first modern endeavor to determine the food needs of human beings took the form of dietary studies in which trained observers recorded the food eaten by individuals or groups of individuals when they instinctively followed the dictates of their own appetites. These findings were usually reduced to amounts of carbohydrate, fat and protein per per- son per day and were often evaluated by comparison with the types of work these individuals did. The carrying out of balance studies was the next step in determining the food needs of human beings. In balance studies the amount of a given foodstuff in- gested minus the amount excreted in urine and feces gives the amount the body retains. From many such studies standards were finally established indica- ting in each case how much carbohydrate, fat, pro- tein and the various minerals were needed to keep the body in a state of Optimum nutrition. From these adult studies, the standards for children, as a rule, have been set more or less empirically. -2- In the literature we.find very little experimental data on the phosphorus requirements of pre-school chil— dren. There is an abundance of material on how phos— phorus is utilized by the body; as, inorganic phosphates, phospho-proteins, phospho-lipins and the phosphoric acid esters of carbohydrates. There is also a great deal of literature on the metabolism of phosphorus, especially in combination with calcium. The reason for this is that in rickets, a disease widely prevalent among both breast fed and artificially fed children, there is a lack of balance between calcium and phosphorus in the blood stream, resulting in an abnormal deposition of calcium phosphate in the bones. The emphasis has been placed upon calcium metabolism, rather than upon phos- phorus metabolism, because dietary studies have re- vealed the fact that a large percentage of American children suffer from a deficiency of calcium in their diets. There is not usually a serious lack of phos- phorus because of its close association with protein. Many studies have been made of the kind and amount of protein necessary to provide adequately for both main- tenance and growth in the body of the child. Thus, it has come about, that phosphorus, because of its associ- -3- ation with calcium and its combination with protein bearing foods, has lost its identity somewhat in the greater importance attached to a sufficient calcium supply and an adequate and complete protein ration to care for body needs. There are but three studies available on the phosphorus needs of healthy pre-school children. In the balance study done by Sherman and Hawley (l) a series of four experiments were carried out on calcium and phosphorus retention in twelve normal children, ranging in age from three to thirteen years. The first study of the series was made to determine the calcium and phosphorus retention in relation to age. The children were on a normal mixed diet which contained 750 grams of milk per day for each child. This gave an average reten- tion of .008 grams of phosphorus per kilogram of body weight per day. The second study was carried out with three of the twelve children as subjects to determine what daily allowance of milk would produce Optimum stor- age of calcium in the growing child while the third and fourth experiments were performed to learn if the calcium of vegetables is as efficiently utilized as that of milk. Of the group in the Sherman and Hawley study, there -4- are three children who in either age or weight, approx- imate that of the children who are subjects of the pres- ent study. Their balance is given in the accompanying table which is adapted from Table 5 in the article by Sherman and Hawley. Name Yrégfios. Wt.Kg. P.Intake P.0utput Balance M.0. 4 7 19.5 1.075 g .916 g +.l57 g A.B. 6 21.4 1.255 g 1.128 g +.107 g M.P. 6 19.1 .850 g .744 g +.106 g Their phosphorus storage according to weight in grams per kilogram of body weight is given in the accompanying table adapted from Table 4 in the same article. Age Grams per kilogram Name Yr.Mo. Wt.Kg. Calories Prot. P.1ntake P.0utput Bal. M.0. 4 7 19.5 78 2.8 .055 .047 +.008 A.B. 6 21.4 84 5.1 .058 .055 +.005 M.P. 6 19.1 78 2.6 .045 .059 +.006 These workers conclude from their observations that one gram each of calcium and phosphorus per day must be supplied to the growing child if he is to have sufficient retention for growth. Hughina McKay of the Ohio Experiment Station (2) reports a dietary study on fifty-five normal, healthy children ranging in age from two to five years, twenty— five of whom lived in their own homes and thirty er whom lived in an orphanage. This study, based on the individual method of determining food intake was con- ducted for four consecutive days by workers trained in the method. These young women took records of the height, weight, activity, appetite and general condition of each child, as well as weighing and computing the value of the food each child ate in terms of protein, fat, carbohydrates and mineral content. Computed anal- ysis of the amount of phosphorus these children were in— gesting gave an average of 0.9744 grams per day for both groups with an average of 1.08554 grams for the heme group and .88179 grams for the orphanage group. Dr. Chi C he hang and her associates (5) report a balance study on the "Minimum Requirement of Calcium and Phosphorus in Children". The ages of these eighteen children, with one exception, ranged between eight and twelve years. That one child is the only one in the group that belongs to the pre-school age and her phos— -5- phorus balance is given below as adapted from Table 2 in Dr. Wang's article. It is given in terms of phos- phorus rather than as phosphorus pentoxide as origin- ally given. “, . [flame Age Wt. lP.IntakelP.Intake Urine FecesJTotalfij 24 hrs. per kg 24 hr 24 hr =f24 hrs.| 1.114 A.{, 151.17;97_111-4Zg .082 .78 .596 ff [Total [Retention [Kg/24 l% I Kg/24 24 hrs. .076 .09 gms. .005 g 6.5 . These workers obtained a positive balance as long as the phosphorus ingestedvas as low as .054 grams per kilogram of body weight but found that there was a ne- gative balance when the intake fell below this. Reten- tion varied from .002 to .017 grams per kilogram of body weight. Dr. Vang and her associates conclude from their observations that an eight year old child, weighing 20 kilograms and living on a mixed diet should have a minimum of 1.58 grams of phOSphorus pentoxide, or .68 grams of phosphorus daily. Because of this lack of extensive information on -7- the phOSphorus retention of pre-school children, it was thought of value to conduct a metabolism study to learn if possible, something of their requirements for optimum retention. PROCEUEE In order to do a quantitative metabolism study on any of the essential factors in the diet, levels of food intake at which experimental work shall be done must first be decided. Usually there is a low level, just above maintenance, an average level, which per- mits of maintenance and some growth, and a high level, which may provide an excess for both maintenance and growth. Then a simple, adequate diet is planned that fulfills specifications so far as the particular food— stuff under investigation is concerned. For instance, if calcium levels were being considered, the diet planned would contain carbohydrate, fat, protein, phos— phorus, iron and vitamines in amounts accepted as ade- quate for a child of given height, age and weight. The calcium content alone would be varied at each level in order to learn by balance studies at what level best retention was obtained. Of course, these variations in -8- level influence in amount the other factors also. In— cluding a large amount of milk to supply a high level of calcium while keeping the total calorie content con- stant, might result in a diet low in iron. This de- ficieny would then have to be made up by adding a source of iron sufficient to make the diet adequate in this respect. The diet to be used must be palatable and attractive and lend itself to variations to suit each level of intake. The problem is simpler if the same basic diet is used at each level. After the diet is planned, the p eriod of feeding follows with its atten- dant collection of excreta. Composite samples of the food eaten by the subjects are also preserved so that a chem- ical analysis may be performed. The results of this analysis give the actual value of the diet, and may be used for comparison with the calculated amounts. The excreta are analyzed to determine how much of the sub- stance ingested was excreted. The difference between intake and output represents the amount retained by the body. Finally, when results from the various levels are determined, conclusions may be drawn concerning the level which supplies the optimum retention for maintenance and growth. memB pnm Cmmgofi mooneaano one meaemam ea .pnz .em 1 meanee meama paem w ceapemoomma mufleem eHHmo caemneaa 1 meanma moo; nmseaem s. ommmmHIMHmdflmo as mmsH mmHm HHH am.ma+ om omea omam HH am.ea+ ea mama babe H am.ma+ om Hmma mmme HHH aa.ma+ mm mesa mHHm HH em.ma+ mm mama smse H mm.HH+ om mama meme HHH am.ma mm mesa mHHm HH am.ma mm mmmH mmee «amnwwwmu .nm em .w: as fleece Hepoe fleece Rw.mfi+ Rw.®fi+ am.m+ Rm.m+ do a, u cw v.Hm b.0N n.0m m.om m.om ®.mH o.m¢ wee mw «we o.m¢ o.mm «mm dm HQ mew MN \1* m 03 pk 05 an 08 Mk $6) $03 fi‘r-i oa ah 08 Ah 08 ab fi'fi‘ VHO V'l‘ as a» 08 uh 08 a» VH4 #02 V‘V' HHH HH HHH HH HHH HH .h.m .mCh uzmpm paw Awesozav an H m .uMd.iwmm. 4mmm: .finfim -9- This phosphorus balance study was carried out in conjundion with a protein-calorie study reported in another paper, hence the levels, low, medium and high, were more or less arbitrarily set, since phosphorus is so closely associated with pntein in food. As the pro- tein levels chosen were 2, 5, and 4 grams of protein per kilogram of body weight, the phosphorus content more or less automatically fell into the levels of approximately .96 grams, 1.54 grams and 1.51 grams of phosphorus daily per child. Three healthy nursery school children of about the same age and size were selected for the study. They were two boys and a girl between four and five years of age. Their heights, weights, ages and caloric intake for each period are given in Table 1. Their meals for each level were carefully computed (4) and then prepared and served in a room especially set aside for the purpose. Between meals, the children attended the nursery school. A s usual, where excellent co-operation on the part of those in charge prevented any loss of excreta or any added ine take of food throughout the three experimental periods. At night, the mothers took charge of their children, being equally careful to guard against added intake of food and loss of excreta. TABLE 2. DAILY MENUS Exp. I Exp. II Exp. III Approx. 2 gms. Pro/Kg% Orange Juice Orange Juice Orange Juice Farina Cream Wheat Cream Wheat Cream Milk for Cereal Milk for Cereal Breakfast Sugar Sugar Sugar Buttered Toast Buttered Toast Buttered Toast Milk Milk Milk Orange Juice Orange Juice Orange Juice 10:50 Cod Liver Oil Cod Liver Oil Cod Liver Oil Lettuce Sandwiches Lettuce Sandwiches Lettuce and Cottage Cheese Sandwiches Buttered Potatoes Buttered Potatoes Potato Potatoes Lunch baked with Scrambled Eggs Scrambled Eggs Meat meat loaf Tomato Juice Milk Milk Milk Peaches Peaches Peaches 5:00 P.M. Milk Milk Milk Peanut Butter Sandwiches Creamed Carrots Buttered Carrots Buttered Carrots Supper Thickened Tomato Juice Liver Extract Baked Custard Tomato Juice Spinach Puree Milk Baked Custard Scrambled Eggs Spinach Milk Baked Custard -10- On each level, there was a three-day preliminary period in which the children received the weighed diet, but no excreta was gathered. This was done in order to permit the children to get into the balance for that particular period so that there might be no "lag" from their previous diet reflected in the collection period. Urine and feces were collected for the last three days. Charcoal was used as a marker for the feces. This was given in capsule form before breakfast on the morning collection was begun, and again, at the close of the last meal. On the last three days of each period, duplicate samples of the food the children ate were preserved for analysis. The purified substances such as sugar, cornstarch and filtered butter which were used in the dietary were not included in the samples for analysis for obvious reasons. The menus for the three periods appear in Table 2. On the low-protein-lowephosphorus level, liver extract was used to bring to the accepted standard an otherwise low iron content. thole wheat farina was used also, because of its increased amount of iron, but it was found that tiny particles of bran still in suspension in the feces after sulphuric acid digestion, interfered -11- with the ease of analysis, so cream of wheat was sub- stituted in the succeeding experimental periods. During the second and third periods, when the pro- tein and phosphorus content of the diets was higher, strained spinach was used instead of liver extract to bring the iron content up to normal. This proved to be a rather more desirable substitution because the chil- dren were accustomed to eating spinach and when served on their plates with potato and carrots, or potato and scrambled egg, their meal presented an attractive appearance, and the spinach was eaten quite automatically. On the high level, half skimmed milk and half whole milk was used in order not to exceed a fat content of 55% in the diet. Finely ground beef from which the connective tissue was removed, cottage cheese and pea- nut butter were used to increase the protein and phos- p horus content of this dietary. T he children's in- dividual variations in requirement during each period were provided by extra egg white and sugar. The meals were varied within themselves. Sometimes the potatoes were creamed and the carrots ‘uttered, and vice versa. Sometimes the tomato Juice and liver ex- tract were served in combination as a thickened hot soup, and at other times it was made into a cold drink, .— I ' I ! I u . o a Q C a a . u a I c . . I . . a O . n ‘ . O I O I O I u . . o D r 9 Q o . o - . . . . ¢ . a O . I a . . . u . O o o . - - . o I t I 4 I 0 g q o O I 0 A ' A . o u I O C O C I . . 0 Y ! I . O O I O c U ‘ 0 ~ . O C O O . g I c . mHMdB QOHmmm modm mom @024H4m QZ<_ZOHBHmONM mbmommmomm canan mm mao. pom. HoH.H moo. moo.H emm.m ~mm.~ mum.” mmo. nmo.a awn.» mum w N.Nm .o.m mm omo. nae. mm~.a omo. ~mo.~ moo.m ~m~.a emw.a oeo. om¢.H Hmm.¢ «mm.w m.om .q.m on ”No. «we. own.” moo. moo.” oao.m mom.a Nam.a Heo. mev.a mom.¢ up» a ~.om .m.u 83mm on as m NH oHo. Ham. mmm. woo. mmo.a mwo.m Nmm.H emw.a wmo. cam.” Nme.m mm“ m ¢.Hm .o.m em «Ho. mom. pom. m¢o. mmm. mow.m m~H.H mum.H omo. ~m~.~ mH~.m mmw w m.om .q.m mm ado. wmm. meo.a eeo. mew. mmm.~ mNH.H on.H mmo. wmm.a m-.m:.mns.o. w.mH .m.o OS rm.o moo. moo. mma. meo. mvm. mmm.m mea.~ ewm.a woo. omm. oem.m mm” m ~.om .n.m ma woo. mad. woe. meo. «mm. ~mo.m mmm. mmm.a amo. mom. mmm.~ one o m.mH .A.m oa_a NH moo. «NH. ham. Heo. mam. woe.m mun.” mm.H omo. mom. mom.~ «as a m.mH .m.e an «N ooah m pma no em an am mm Hg am ya me an we “a up an em .xoan we a: om an me new new new new new mm A: «N an up m 2% new new dupes H309 H33. moomm 05.5 new new 2% wow nofipnopom pomwso aspen moan oaapae aspen cam owe .pa mammm. and the cornstarch used elsewhere in the diet. Occasionally the custard was baked and again it was cooked with some of the day's peaches cut into it, or the custard was made into " ink ice cream" which w's always a welcome change. Weighed portions re- mained the same throughwut each period. The s ame basic menu was used in all three ex;erimental periads, but with variations to make possible increased pro- tein and phosphorus. Specific gravity, creatinine (5) and total acidity (6) determinations were made on the urine each day and the remainder made up into acid urine for further analysis. The feces were digested slowly for several days with ten percent sulphuric acid, heated over a low flame and then made up to volume for analysis. Phosphorus determinations were made on these by the Briggs' modification of the Bell-Doisy method. A ll analyses were done in triplicate. (7) Results of the fecal and urinary analyses for the three children for the three periods, appear in Table 5. The duplicate samples of food taken for analysis were weighed, dried, weighed again, and then finely ground in a food grinder. To further insure a well mixed sample, a portion for each analysis was ground to emvmé aminm wam.m whoa m .m .me wo¢¢.a mm¢¢.~ ommv.a mmm¢.H bem~.a wmmm.H momm.H oomm.a swam. pmwm.i-Mwmmwm comm. . see was .m .mam mmwo. mmwo. ammo. mmwo. empo. «mac. «one. amps. ”mac. papa. mono. «was. M madmaam m .pa m a sand aama uama eHmH mmma mmmfl mmma mmma omma owma omma omma W doom smote no .pz .95 w. as H as a 5 a . no.“ man had than no.“ ham ham hon He has hon hon i .m>a cum new pnfi .mp4 enm cam and .opfi onfi cam pea m HHH pqosanamwm HH pnmafihomunm “Emma H.435 mo mHmMAfi/Q mo magma .e fiqmde H puma: Hmmfifi HI TABLE é; COEFARISON OF CALCULATED AND fiNALYfiIS FIGUEE§_ Exp. Weight Portein . Calories teiahtwflhgsphogus gms. gms. gms. gms. Li Cale. Anal. Calc. Anal. Calc. _Anal;‘_¢_~‘ J.B. 58 41. 5 15_o_L Ham ”.9672 seal“ B.L. 58 41. 5 135: (w; .9672M_____,,,9_88_;7_________, E.J. 40 44 .8 fl 1606 H. 51 .9895 .9905 II J.B. 57.4 52.2 1805 1 1.5455 1.2577 B.L. 57.4 52.2 1605 Luna 1.5455 1.2577 E . J . 6O 50. 8 leg H9135 1 . 5477 1. 2408 III J.B. 80.6 75.4 1525 you 1. 5118 1.4458____._j B.L. 82.4 78.8 1551 11.1.5 1.5159 1,4504 ELJ. 85.5 84.4 1125 11.11 1. 5174_ 1.45._1 B.L. 5.]. J. B. -15- powder in a mortar. This food was ashed at low heat, made into solution and analyzed for phosphorus by the same method used for urine and feces. Separate analyses were made of egg wiite, liver extract and cottage cheese. No figures for phosphorus analysis of liver extract or cottage cheese were obtainable from other sources. Results of the analysis of the three diets are found in Table 4 while a comparison of the figures for the calculated and analyzed amounts for each period €,pears in Table 5. Results of the analysis of egg white, liver extract and cottage cheese are given in Table 6. DISCUSS CN The three children who were subjects in this balance study were all from business or professional homes. They had a background of good nutrition and health habits, so they were all three above height and weight for their age group. They were growing rapid- ly as will be seen by a comparison of their heights and weights at the beginning of the first experimental period with those at the beginning of the third period, three months later. (Table 1.) While B.L.‘s basal re— quirement was the low.st during the first period, he TABLE 6 AnggsIs or earns r3 FOOD gggggg -—- Grams P. in 1 gram of Food Liver Extract * .0000407 Period 1. — .OOOlO? Egg hhite Period 2. - .000104 Period 5. - .000109 Cottage Cheese .00053 * Grams Phosphorus in Extract from 1 gram Liver mm: 3238 [03H noEoHuo momH uoanodno J 2.un m.m flowpum nag av HMMWOHA shake A man . o 23.3 o aHowonm chau- ndmsu . «nan. open: mac .w om an o opanuuwwo . o- Wane opagu mwo .uaw H .n.n HmmH umanoHuo _u mwmw usaHOHao wen aofinoHao 3on 3.3 502 gm m 5395 macaw w 5395 dunno Roman 33 m wood gag . coon BEHnHa gene 3an wmo . aw H «Foam 03fi0 oz 30% ndano oz :H.m mmmH noanoHao «wmw unauOHuo mamm uoagaHmo wméw 530.5 #2:un m 5393 made H3395 annexe on anemia. 02 gene .H macaw .v .m..n 30.32364 H0535 3H m~.m~mH mo.¢omH on.¢mmH acapnon_aaaaqaa a“ uofiuono Hupoa Hmm mom hum noHnoamo danm 0 m .3de NH nonwpm 930 m madam H3 .8qu coo H m macaw we 33.3 nadnm a 35% o 3:un mm .mesm cooz 5552 3 30333 .N m~.mmmH mm.mHmH mm.>mm uooz.a=aauHa no uoHHOHmo amem as; a. . 52.3% a .22 a. H . H m.m H cannemaopnao no .paa mo. . o . pan no .p54 3de mmém madam . m madam NH. 50me no $.84 coca HazeHbHEH 5532 «swam pHmH madam mmmH sauna ommH coo“ Among no .9: Haves Ill . .H HHH anofinofim .MHF 2323mm. jufiflmaa , M Axoopuunm omom. . M1848 BHHD Huh—”4Q .mo ZOHBSDUHdo ho mB‘HDmmm -14- grew so rapidly, that during the second and third periods, J.B. who did not grow quite so rapidly represents the lowest basal need of the three children. He was a sturdy, healthy boy of very even disposition. B.L., on the other hand, was tall and more slender. He was active and of a nervous temper- ament with an appetite that needed more coaxing than the other two because his attention was more easily diverted to other things. E.J., the oldest child of the group, a girl, was probably the most active of he three. She is not of a nervous temperament, has a record of almost no illnesses and has seldom appeared tired after a day's hard play. A.n attractive, adequate dietary was planned to meet the needs of the child with the lowest basal requirement. To this was added sugar, cornstarch, butter and cod liver oil to make up sufficient cal- ories for the day's activities. The larger children's individual variations were met with added sugar or egg white. Just what these additions and variations were, are indicated in sections 2 and 5 of Table 7. Comparatively little difficulty was experienced in getting the children to eat, in spite of the fact -15- that at the high level, amounts seemed greater than they were in the habit of eating. Their meals were eaten at a nursery school table which was covered with a bright oilcloth cover. This added color and incidentally facilitated picking up any crumbs that might otherwise be lost. Pretty dishes were used and these helped to make the project lose some of its otherwise experimental atmosphere for the children. Their ini— tials pencilled on the dishes with red wax pencil, seemed to please their budding sense of ownership for they never failed to look for them, nor to miss hem if they failed to appear. Those who were conducting the study, ate with the children, using the same menu. When eating became a bit tedious for the children, a story sometimes helped to save the situation. Friendly competition in finishing the meal in order to get out to play contributed its bit also. In justice to the children themselves, it must be said that it was very much a point of honor with them not to do anything that, in their words, would "spoil the 'speriment". Nevertheless, close supervision is required night and day throughout all experimental periods in order to be sure of accurate results. In addition to careful weighing and measuring of all foods, there is the -16.. necessity of seeing that nothing is lost, that each child eats all of his allotted portion, and that no additional foods are eaten. Likes and dislikes play a part in the ease with which this is accomplished. Appetites are not always alike. The excreta must be collected with no loss if the results are to be acceptable. To be sure that there has been no added food intake and no loss of excreta, one is dependent on the co-operation of the child, his mother, his instructors and any other care-takers he may have dur- ing the course of the experimental period. In spite of the watchful care of all concerned and the fact that the children wanted to make the work a success, one child in a moment of thoughtlessness did lose a sample of urine. That day's urine was discarded and the urine analysis for the day computed from an aver— age of the other two days. Besides the problem of seeing that there are no flaW's in the technic and execution of the experiment one must be prepared to meet and deal with the slight physical difficulties such as colds, infections or digestive disturbances which sometimes develop so easily. J.B. and B.L. both had colds during the pre- -17- liminery part of the first yeriod but they were given an abundance of fluids and kept away from the other children in the nursery school so th t by the time the collection period began, they were well. Duri g the collection period of the second experiment, B.L. had a slight cold, and J.B. contracted a severe cold, which, houever, did not keep him from completing the period. During this period, also, there was s disturbing amount of constipation in Spite of the fact that strained Spinach had replaced the liver extract of the previous period. These three children were all trained in regular habits of elimination and devia- tion from that program had a bad psychic effect as well as perhaps an undesirable physical one if there can be Siid to be an relationship between the colds and the constipation of this period. It was found necessary to relieve 3.L.'s discomfort by an enema during the preliminary period of this second experi- ment. E.J. in taking what may have been too strenu- ous exercises soon after supper in order to bring about a bowel movement, lost her supper entirely. For- tunately these incidents occurred before the collection -18- period began. The difficulty was anticipated during the third period when a higher protein and phosghorus level W‘s to be fed, by giving the children mineral oil on the first two mornings of the preliminary period. This gave most satisfactory results so that no diffi- culty was experienced during the remainder of the period. Jhen results are gathered in such n study, one finds with certain expected returns, certain un Xpected deviations from what is considered normal. The analysis for phOSphorus in the food of the first period was higher then the figures given by hose. fith a calcula- ted averege per day of .9672 grams of phOSphorus, our analysis gave an average content of .9887 grams of phos- phorus per day. During the second and third periods, on the contrary, our analysis for phosphorus ran lower than the calculated amount. is egainst a calculated 1.5435 grass of phOSphorus per day in the food of the second period our analysis gave 1.2577 grams per day, and dur- ing the third period, calculated figures gave a phos- phorus content of 1.5118 grams per day while our anal- ysis gave only 1.4488 grams per day. This is disconcert- ing until it is remembered thht the published figures fiflllmm- u mac. Mbwm. mHOH.H meM: mmmo.a mbmm.m mmo. Hmm¢MH mmmm.¢ HHH bH 0H0. HHHN. wmmm. mvo. mmwo.H ommo.m mmo. mo¢N.H wmmb.m HH we moo. om¢o. omma. m¢o. wmwm. mmmm.m bwo. momm. movm.m H .h.m mm Iomo. mmflu. ommmé omo. ommoé mwmo.m ovo. womeé mamas HHH vm wao. mmom. abbmhu¢ m¢o. Hmmm. mmom.m omo. bumm.fi Hmab.m HH 7‘ n ma moo. Hmma. mmw¢. m¢o. mmmw. mbm¢.m Hmo. bmwm. Hmmm.m H .qum k on Hmo. bmww. mmmm.H awe. omoo.H mmHo.m HBO. mm¢¢.H @mwm.¢ HHH _p mm mac. whom. wmbo.a ¢¢o. warm. mmm®.m immo. bme.H Hwa.m HH . pH moo. mmba. beam. H¢o. Hmam. ¢m¢¢.m omo. bmwm. Hmmm.m H .m.m .5 d .3 w“ H: mm. Hg um em .5 mg. .3 «m. .5 em us MN R mew mew mew mam mam mam mam mam mam moansmumm. #5350 9.5039 93 QMdan usuonaénm .Hmm SEO moss mom moi/23m msmommmomm Ma Erase .m mamda -19 .- are the everege of many analyses. It is of interest to note that the analysis of egg‘vhite showed a somewhat lower content of phOSphorus, also then published figures indicate. Rose gives a phOSphorus content of .00014 grams per gran of egg white. Our analyses showed an average phOSphorus content of .OOOlO7, .000104, and .000109 reSQectiveLy for the three periods. This accounts in part at less , for the discrepancy between calculated phOSphorus content end the analyzed phOSphorus content of the diets of the last two periods. Jhile in the diet of the first period, there were only thirty grams of egg white used, in the second period, there were sixty grams used, aid in the third period, seventy grams. It will be observed from a study of Tvble 8, thet there hre variations in the rate of phOSphorus metabo- lism in the three children. They are alike in thrt the urinary phOSphorus in every case is greater then the fecal phosphorus, a fact observed with one exception by Dr. fisng and her associates (3) in their balence study on older children. The children also show an increasing retention as well as an increasing total excretion of phOSphOruS with each increase in food phosphorus. J.B. and B.L. show a more constsnt increase in retention and -20- excretion for each period and u more economical use of phOSphorus rt the low level than did E.J. However, B.L. shows an interestirg variation in the fecal phOSphorus. For the first period, it was meterirlly lower then.thst of either of the other two children and lower also cor- psratively then his can excretion at the succeeding levels. Bloom (8) finds increased fecal excretion of calcium and phOSphorus in diets high in.8pinnch and Ascham (9) reports high fecal xeretion of calcium and phosphorus in the presence of cellulose flour and agar in the diet. If the converse of this is true, thet diets low in fibre encourage greater retention of these elements, B.L.‘s comparatively low fecal phOSphorus excretion might be exglhined providing it was true also of the other periods end the other children as well. But, inasmuch as the diet in this respect was controlled and the experimental period passed off uneventfully, except for the sluggish elimination and the colds, there is no eXplanstion to offer for this except to consider it a chance variation in output.snd a further corrobor- ation of the findings of TShermen and Hayley who found \"1srge variations among the individual children" (1). They also found that the storage of phOSphorus in their -21- children avereged .008 grams per kilogrrn of body weight and thnt :t the ego of 3 - 8 years, the storege of phOSphorus Was about .01 gr ms per kilo of body weight per day, continuing at nearly this rate throughout the following years of rnpid growth and develOpment. Our results at the low level in Trble 8 beer an inter- esting similarity to the findings of Sherman and Hew- ley and to those of Lr. Hang in the tables adapted from theirs in the early part of this peper. EOJO who hrs-CL :1 weight of 130.7 kilograms “t the beginning of the first experimental period and e weight H: o 22.2 kilograms three months Inter, at the beginning of the third period was comparatively the least economi- cal of her phOSphorus intake at all levels although percentage retention increases with each level. She is a very active child and has been described as "bursting at the seams" with energy. Blatherwick, Bell and Hill (10) corroborate the findings of meden and Grefe that activity increases urinary phOSphorus excretion. Highly active children excrete more phos- phorus in the urine than do phlegmatic children. One child may run faster or plny hrrder than another child. His results will differ from those of the ouieter child of approximately the 8316 use and weight. Activity in children is h1rd to con'rol. since incrensed muscular activity increases phOSphorus excretion, prob;bly her increased mnount of metabolizing body cells and in— creased activity account for her greater excretion of phosphorus. The food of the first period with an anal- gave her '5. yzed phOSphorus value of .9887 grens per day but .002 grams of phOSphorus storage per kilogreh of body weight. It mould seen evident from the e findings th:t low levels of phOSphorus int he ere not safe for Optimum develOpment particularly of superactive children. A fUrther study of Table 8 reveals the fact that at the medium level with e phOSphorus intake of 1.2 gr ms per day, there wes e retention of .018 grams per kilogram for J.B., .014 grams per kilogram for B.L. end .010 grams per kilogrhm for 3.J. This level of phos- phorus intake evidently provides a margin for retention which is entirely safe for the average normal, healthy chidd. There is no perticuler reason why the child's retentihn and growth need to be crowded inasmuch as he has 18 - 21 years in which to attain physical maturity and physical and mental maturity need to keep pace with each other. -25- maximum retention however, was obtained at the high level of phOSphorus intrhe. Yith en snalyzed phoephorus inttke of 1.4 grmns per day, retention rose to .021 grams_per kilogram for J.B., .020 grams per kilogram for B.L. end .016 grams per kilogren for E. . From the standpoint of retention per kilogrsm alone, a high int is of phOSphorus vould seem to be recommended for active, normal children. There ere deterr nts to that conclusion, however. A daily phosphorus intrhe of 1.4 grams might be accompanied by a protein content of about four grrms per kilOgrem of body ,eight. He found this amount of protein most difficult of the three levels to feed. Apparently such a large preportion of protein, cutting down as it does the amount of fresh fruits end vegetables used, pells on the appetite of children. This large prOpor- tion of protein would also give the kidneys a maximum amount of work to do throughout the growing years end while it is not entirely proved thet a high protein content in the diet over a long period of time injures the kidneys, we know it does cause en enlergenent of the kidneys which is en end result of doubtful desira- bility. -24- In addition there is the economic phase of the Question. Protein foods are always our most expensive foods. f good retention and growth can be secured on three grams of protein and 1.2 grams of phOSQhorus daily, it would Ppp er to be poor economic judgment to increase costs for the averege householder by advising higher levels of protein and phOSphorus intake. In practical support of the theory that very high levels of protein and phOSphorus intake ere not needed by the growirg child, we recall thet the children who were subjects of his study were :11 well above the everege for their rge end none of them was accustomed to more then three grams of protein per kilogrnm. Only for the superrctive child would hijher levels of phOSphorus intake seem to be indicated. While in general, phOSphorus excretion perellels somewhat nitro- gen excretion, they may be independent of each other entirely as observed by Bodansky (11) Sumner (12) Bronson (15) end Blatherwick, Bell and Hill (10). The last named authors believe that the rate of phOSphorus excretion is influenced largely by carbohydrate metabo- lism. The formation of hexose phOSphate is 3 stage in the metabolism of glucose and these workers found on giving insulin to normal individuals that there Was a mrrked decrease in phOSphorus both in the blood and urine during the socompenying hypoglycemia. So in periods of increased muscular activity an increased amount of glucose is used, the oxidation of which results in phOSphorus being liberfited, carried to the blood and excreted in the urine as phOSphate. It would he of interest to conduct phoSphorus balence studies on children using a given dietary end vvrying the smount of exercise tahen by the children to learn to just whrt extent musculxr activity influences phOSphorus excretion. Meanwhile, since superactive children seen to be less provident of their phosphorus intvhe, higher levels of food phOSphorus might be attained by using whole grains and breads rather than the refined type, since whole grains contain a large percentage of phOSphorus. In so doing, the protein content of the diet would not be materially raised while inaddition to the increased phOSphorus content in the whole grain cereals there is an increased iron content as well as a value accruing from the ingestion of bulk forming foods which aid in maintaining regular eliminution. COICLUSIOI 1. Th*t the discrepancy between calculated and analyzed figures for food phosyhorus in ell three eXperiment:l periods m.y be accounted for on the basis of averages. 2. The standnrd of l grim of phOSphorus per day per child is conservative and allows no greet margin for retention in average, active, healthy children. 3. A medium level of phOSphorus intuke (1.2 grams daily) probably provides a sufficient mtrgin for re- tention in average, active, healthy children. 4. Children uho are growing rapidly and are p rti- cularly active probably require a high phOSphorus in- take rather then an averrge one because of the greater amount of phOSphorus used in the oxidation of glucose. 5. For children on a high phOSphorus intake, care must be taken to see thct some of the phosphorus is obtained from Whole g ains rither than permitting the diet to be too high in protein through out the long years of the growing period. The reasons for this are: a. Long continued high proteni feeding is of doubtful physiological value. -27- b. Difficulty of feeding a continued high protein diet. 0. xxpensive for the average householder. 6. Studies controlling the activity of children need to be carried out to determine if possible how greitly activity influences the excretion of phoephorus. 10. 11. 12. 13. BIBLIOGRAPHY Sherman, H.C., and Hawley E., J. Biol. Chem. 55, 375 (1922) McKay, Hughina, Bulletin Ohio Ag. Exp. Sta. No. 400 Dec. 1926 Wang, C.C., Kern, Ruth; Kaucher, Mildred A.J.D.C. 59,4,768. Rose, M.S. Laborat ory Handbook for Dietetics 5rd. Edition Hawk, P.B. Bergheim 0., Practical Physiol. Chem. p. 732. Hawk, P.B. Bergheim 0., Practical Physiol. Chem. p. 705. Bell, R.D. and Doisy E.A., J. Biol. Chem. 59, 255 (1924) Bloom, Margaret A., J. Biol. Chem. 89, 1, 221 (1950) Ascham, Leah; Jour. Nutrition 5, 411, 20 (1951) Blatherwick, Bell, Hill, J. Biol. Chem. 61, 241 (1924) Bodansky, M; Introduction to Physio. Chem. p. 299 (1927) Sumner, J.B. Textbook of Biol. Chem. p. 187 Bronson, B.S., Nutrition and Food Chemistry p. 199 (1950) . ._‘ ', K3,. , . V I . - r v we 0. ' I . ’6. 25¢: etai-‘aegv Q. .94 (I . ’{ - ' . ~ _ ' .. ’ i .‘ ' '1‘! ‘l l A. ' N “ 1 Q» o ”J ' ' ' I "_ ‘ _~ ' h a 0 O '75!“ 6%.! .' firm 'a r a .H'. . V ‘~_ 3“ ' ;-Q'# ’ 4 .' (£9 —,- n . . ' I, .1 I ‘ _ ~ ' ’l , . ' - .l ‘ l . “I" ; _ n‘l ' ‘ I\ . ' > ‘ I .7: . . . : _. .‘ ‘ - . u i i ‘ J ' '- fl ‘- 'I ' - . .' . ,. , '.' 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