:Lw.‘ '.trflk‘PQQ‘.1‘l‘_eTI.'1"'C'I-‘."'.‘l'2",'3 WWW“! THE FOOD HABITS AND NUTRIENT INTAKE 0F ELEMENTARY SCHOOL CHILDREN: A LONGITUDINAL APPROACH Thesis for the Degree of M. S. MICHIGAN STATE UNIVERSITY NANCY REGINA BEYER 1972 ........ MSU LIBRARIES £32525— RETURNING MATERIALS: PIace in book drop to remove this checkout from your record. FINES wiTT be charged if book is returned after the date stamped beTow. ABSTRACT THE FOOD HABITS AND NUTRIENT INTAKE OF ELEMENTARY SCHOOL CHILDREN: A LONGITUDINAL APPROACH By Nancy Regina Beyer The nutritional status of preschool children has been studied intensively, but very seldom have researchers looked at these same children in later years. The present study is a longitudinal one. It looks at the nutrient intake of a group of healthy elementary school children, and compares these data with data obtained on the same children during their preschool years. Forty-four children participated in the current study. A home interview relating to family and health characteristics, food habits, and dietary history was conducted with the mother. In addition, two 24-hour food intake records were kept for each child, and height and weight measurements were taken by the investigator. Preschool food intake records and height and weight data were available from earlier studies. Interview results for the elementary school children were compared to those obtained as preschoolers, in order to determine changes in physical and environmental characteristics. The nutrient intake data for both preschool and elementary school was analyzed by computer, and presented as percent of the recommended dietary allowance (RDA). Height Nancy Regina Beyer and weight data were compared with the Stuart and Meredith percentile tables to evaluate increments of growth. These children appeared to be adequately nourished. The mean intake of all nutrients was above the RDA, with the exception of the preschool iron intake and the elementary school caloric intake. The most limiting nutrients for the elementary school children were vitamin A and ascorbic acid. Iron was also limiting for the preschool children. There was a remarkable consistency in food habits from one period to the next. Most mothers thought that their child's diet was nutritionally adequate. Mealtime patterns had been slightly altered since the preschool years as a result of the school routine. All children ate breakfast and dinner at home, while approximately half ate lunch at school. Children of both ages liked meat, but the older children also liked mixed dishes. Vegetables were overwhelmingly disliked by both age groups. Snacking was important in the overall nutrient intake of both groups, but was at a slightly higher level for the preschoolers. Growth rate was also fairly constant between the two age groups. This study has shown that the preschool years are important for establishing good food habits for later life. Since young children copy what the rest of their family does, it is necessary that parents provide their children with a good example from birth. THE FOOD HABITS AND NUTRIENT INTAKE OF ELEMENTARY SCHOOL CHILDREN: A LONGITUDINAL APPROACH BY Nancy Regina Beyer A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE Department of Food Science and Human Nutrition 1972 ACKNOWLEDGEMENTS I would like to thank each of the families who participated in this project. Without their help, there would have been no study. Thanks are also expressed to my committee members, Dr. Olaf Mickelsen and Dr. Dorice Narins, for their interest in this project. A special word of thanks and appreciation is due to my thesis advisor, Dr. Portia Morris, for her patient understanding and encouragement through— out the entire study. I would also like to thank my aunt, Ruth Beyer, for typing this manuscript. And finally, I would like to eXpress my appreciation and love to my parents, whose guidance and example have inspired me to strive for excellence. ii TABLE OF CONTENTS Chapter I INTRODUCTION Objectives II LITERATURE REVIEW III EXPERIMENTAL PROCEDURES Selection and Description of the Sample Data Collection Data Analyses IV FINDINGS Results of Home Interview Family Characteristics Health Characteristics Food Habits Nutrition Education Evaluation of Dietary Data Results of Height and Weight Measurements V DISCUSSION AND CONCLUSIONS Limitations of the Present Research Summary and Conclusions Suggestions for Future Research BIBLIOGRAPHY APPENDICES A Correspondence 1. Initial letter to parents 2. Letter of thanks and appreciation B Instruments 1. Food intake recording form 2. Home interview schedule iii Page to ocooooo 11 11 13 15 22 23 26 28 31 32 34 37 38 39 45 4.12 4.13 4.14 LIST OF TABLES Sex distribution Racial distribution Age distribution Grade distribution Household size Education of parents Employment of parents Type and frequency of vitamin supplementation Frequency of medical and dental visits Reasons for the most recent medical and dental visits Number of filled teeth as a function of grade Mothers' evaluation of child's activity and attitude toward food Frequency of home responsibilities Family's attitude toward new food or recipes Meals eaten together as a family Importance of eating all that is served Usual mealtimes Frequency of snacking Time when most hungry for snacks and meals Mothers' assessment of appetite Most favorite food iv Page 11 12 12 13 14 14 15 16 17 17 17 18 18 19 19 19 20 Table 4.18 4.19 4.20 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 Frequency of foods listed as disliked Influences on family meal planning Mothers' assessment of child's feeding problems Comparison of mothers' perception of child vs. Stuart and Meredith percentile tables Most valuable sources of food information Mean intake as percentage of RDA Percentage of the sample meeting specified pr0portions of the RDA Percentage of calories supplied by carbohydrate, protein, and fat Mean percentage of calories and protein consumed as meals and as snacks Frequency of various types of snacks Growth data Changes in growth patterns Page 21 21 22 22 23 24 25 25 26 26 27 27 CHAPTER I INTRODUCTION Many people are interested in the study of why people eat what they do, and how this affects their physical growth and health. While much of this work has involved adults, there have been a number of studies involving children, particularly the preschool child. Kallen (1971) has stated that a child is most susceptible to diseases of malnutrition ' between the ages of one and four-—hence, the intensive interest which has been focussed on this age group. Less attention has been given to the elementary school child. Most of these studies have been cross-sectional, short—term projects. They have assessed the nutritional status of a given population at a given time, with little consideration for the history or subsequent development of each subject. It has been proposed that longitudinal studies give a better understanding of the relationship between dietary intake and growth during childhood, as well as the effect of dietary habits on the health of the individual as an adult (Beal, 1961). Although children during the elementary school years show a steady, gradual increase in growth as compared to the growth spurts of infancy and adolescence, they are important years for building up body stores of nutrients for the later period of rapid growth, as well as for developing sound nutrition habits (McWilliams, 1967). As children progress through the elementary school grades, however, more dietary deficiencies are reported to occur (Morgan, 1959). 2 During the school years 1967-68, 1968-69, and 1969-70, children attending the Michigan State University Laboratory Preschool were involved in studies which assessed their eating habits, nutrient intake, and physical growth. The first study (Lanz, unpublished) involved approximately 50 children. It consisted of a home interview on food habits and health characteristics, and a single 24—hour food intake record. Height and weight data were available from preschool records. The second study (Sims, 1971) involved 163 children. In addition to the 64 children from the Michigan State University Laboratory Preschool, 91 children from the Spartan Nursery School and eight children from the Ingham County Public Health Clinic were included in the sample. This study included a more detailed home interview schedule, involving both socioeconomic and nutritional parameters. It also consisted of three 24-hour food intake records, three sets of height and weight measures, a series of anthropometric measurements, and biochemical data of blood and urine samples. It was decided to resurvey those children from the Michigan State University Laboratory Preschool who were now attending elementary school. This research describes the current food habits and nutrient intake of these children, and tries to define the underlying influences which affect growth and eating habits. Objectives The resurvey had as a primary objective to determine whether there were changes in eating habits from preschool to school age, and if so, whether these affected growth. A second objective was to determine the food preferences of children in this age group. CHAPTER 11 ' LITERATURE REVIEW Nutritional status has been defined as the degree of well-being of a population as it is affected by food intake (Morgan and Odlund, 1959). One of the ways that has been proposed for determining the nutritional status of a pOpulation is by some type of food intake record (U. S. Department of Health, Education, and Welfare, 1971). By this method, the investigator attempts to learn the types and quantities of food eaten during a given period of time. Means of collecting food intake data include the weighed intake, the dietary history, the food record, and the 24-hour recall (Pike and Brown, 1967). Some workers feel that weighing is the only accurate method of determining food intake (Huenemann and Turner, 1942; Whiting and Leverton, 1960). Many workers in this field have admitted that the weighed intake requires considerable time, effort, and cooperation on the part of the subject. Others have stated that questioning or recall may closely approximate weighing (Bransby E£.El'v 1948; Mickelsen, 1963). It has been mentioned by several authors that no one method is without flaw (Trulson and McCann, 1959; Wiehl and Reed, 1960; Beal, 1969). Real (1969) recommended using a three~month dietary history with a concurrent 24—hour intake record to check validity. Several studies have been done to determine whether children can accurately report what they have eaten. Results show that children younger than nine years of age have difficulty (Eads and Meredith, 1948; 3 4 Young gt_al., 1951). In a study by Meredith et 31. (1951), the school children forgot both how much and what they had eaten. They also had difficulty in identifying some of the foods served in the school lunch. Although there have been few longitudinal studies on the nutrient intake of children, one important contribution to this field is the work of Beal (1953, 1954, 1955, 1956) at the Child Research Council in Denver, Colorado. These papers report the changes in nutrient intake of a single group of healthy children from birth to five years of age. The general trend is a rapid increase in intake during the first year, concurrent with the infant's growth spurt. There is then a decline in intake which plateaus during the second and third years, and is followed by a gradual increase to the fifth year. Beal (1953) found that intakes of calories, carbohydrates, and fat did not show a decline, but rather a slower increase in consumption during the second and third years. Protein, however, plateaued between eighteen months and three years. In evaluating mineral intake, Beal (1954) observed that calcium and phosphorus followed the general pattern of intake. Calcium needs are low- est between two and four years because skeletal growth rate has decreased. For the first three months, milk was the essential source of calcium. After that time, other dietary sources supplied significant amounts of this mineral. Iron intake also peaked at one year, and then declined.u This was attributed to the iron fortification of commercially-prepared infant formulas and cereals. As the infant foods were replaced with home- prepared foods, the child's iron intake dropped and stayed at a low level throughout the preschool years. Beal (1955) also looked at the dietary levels of B vitamins. Although an average of 40% of the children at each age level received supplementary 5 vitamins, these were not included in the calculations. She found that the pattern of dietary thiamine consumption was similar to that for protein. Riboflavin paralleled calcium intake, both of which reflected a decrease in milk consumption between the second and third year. Niacin levels were low compared to the RDA, but they did not include that niacin which could be converted from tryptophan. Lastly, Beal (1956) looked at intake patterns for vitamins A and D, and ascorbic acid. The intake of vitamin A from animal sources (mainly milk) showed relatively little variation. In contrast, the intake of vitamin A from plant sources showed a high degree of variability. A rise in intake occurred when commercially-prepared infant vegetables were introduced. The majority of these have a high carotene content. After one year, however, there was a decrease in intake as infant foods were replaced by a wider variety of home-prepared vegetables. This was compounded by the samll quantity of vegetables eaten by most preschool children. After three years, the intake of vitamin A increased slightly. Dietary sources provided adequate amounts of vitamin A, although some children received additional supplements. Vitamin D showed a high intake level in the first year as a result of using irradiated milk plus supple— mental vitamin D. The consumption then slowly decreased to the fifth year. Ascorbic acid showed no decrease in intake during the preschool years. As infants, these children received ascorbic acid supplements, switching to dietary sources by one year of age. After the first few months, dietary sources provided adequate amounts of ascorbic acid. In summary, Beal (1955) described the factors which lead to changes in dietary intake as being physiologic demand and environmental/emotional changes. The first nine months are characterized by rapid growth, a good appetite, a steady increase in food consumption, and few feeding problems. 6 However, after the first year the growth rate and appetite decline, and the child cXperiences independence in the form of self—feeding and expression of choice. She concluded that: ...there are changes in the level of intake as the individual progresses from birth to maturity; the significance of these changes in regard to both cause and effect presents a challenging field of study. No matter how nourishing the food served to a child may be, his growth and freedom from malnutrition are dependent only on the food which enters his stomach and is absorbed into his body. Several studies have tried to determine what influences the food attitudes of children. Breckenridge (1959) has said that food attitudes (1) contribute to the quality of the relationship with parents and other adults, (2) may determine whether the child is well-fed or poorly—fed, (3) may be an expression of covert feel- ings about self or'dthers, and (4) reflect tradition and culture. She further states that: ...an understanding of children's food preferences and prejudices, and of their dynamics can be of value both to those who plan and supervise the feeding of children, and to those who are engaged in promoting sound food habits through nutrition education. According to Clark (1969), food habits are a result of education, sociological background, and present situations. In looking at the eating habits of preschool children, Kerrey 33 El. (1968) suggested that: ...food practices and attitudes established during the early years are believed to affect choice and consequently nutritional status throughout life. The necessity of longitudinal nutritional surveys of normal popula— tions has been stated by Krehl and Hodges (1965). More effort needs to be expended on evaluating the nutritional status of populations with an 7 abundant food supply, and on gaining more information on the late effects of early nutrition. CHAPTER III EXPERIMENTAL PROCEDURES Selection and Description of the Sample Letters were sent to the parents of 83 of the children who had previ— ously participated in a nutrition survey at the Michigan State University Laboratory Preschool, asking them to participate in this current study (see Appendix A). Many families had moved out of the area, some could not be located, and others preferred not to participate. Forty-four parents replied that they would be willing to let their children be resurveyed. The criteria for the children involved in this study were that: (l) (2) (3) (4) they had participated in an earlier study, they could be located, they were currently attending an elementary school, and their mothers were willing to keep two 24-hour food intake records and participate in an interview of the child's dietary history. The sex and racial distribution of these children are described in Tables 3.1 and 3.2. The distribution by age and grade is shown in Tables 3.3 and 3.4. The mean age in December 1971 was 7 years and 2 months. Table 3.1. Sex Distribution Number Percentage Males 18 40.9 Females 26 59.1 9 Table 3.2. Racial Distribution Number Percentage White 36 81.8 Negro 6 13.6 Oriental 2 4.5 Table 3.3. Age Distribution Age in Years Number Percentage as of 12/71 5;-6 2 4.5 6-6; 4 9.1 62-7 12 27.3 7-7; 8 18.2 7g—8 7 15.9 8-8g 5 11.3 8.3-9 6 13.6 Table 3.4. Grade Distribution Grade as of Number Percentage Fall 1971 K 2 4.5 l 19 43.2 2 13 29.6 3 10 22.7 Data Collection The interviews took place in the late fall of 1971. The mothers of the sample children were phoned by the investigator, and a home interview appointment was made for the following week. At the time the appointment was made, the mother was mailed two forms on which to record her child's 24-hour intake of food on any two days prior to the interview (see Appendix B). Both weekdays and weekends were allowed for recording, but none of the families kept a record on Thanksgiving, the only holiday during the study period. These forms were then collected at the time of the interview. 10 All interviews were conducted by the investigator, and required approxi- mately forty-five minutes to complete. A copy of the interview schedule may be found in Appendix B. If the child was at home during the interview, height and weight measurements were gathered at that time. However, if the child was in school at the time of the interview, arrangements were made to return at a suitable time to collect these measurements. Height was measured with a steel tape and a right—angled wooden triangle (U. S. Department of Health, Education, and Welfare, 1971). The children were measured without shoes, with heels and scapula in contact with a flat vertical surface, such as a wall. Weight was determined by using a portable bathroom scale, which had previously been checked against a standard thirty-pound weight. Data Analyses The information from the two 24-hour intake records was transformed by the procedure described by Sims (1971), and transferred to data process— ing cards. This method follows the guidelines set up by Davenport (1964) for machine tabulation of diets. Nutritive values for the first 512 food items were taken from the U. S. Department of Agriculture Home and Garden Bulletin No. 72 (1964). For the additional 300 food items, nutritive values were taken from Agriculture Handbook No. 8 (Watt and Merrill, 1963), Bowes and Church (Church and Church, 1970), and information supplied by food manufacturers. Nutrient intake values were compared with the recom- mended dietary allowance (RDA) for 6 to 8 year old children (Food and Nutrition Board, 1968). Analyses were performed on the Control Data Corporation (CDC) 3600 model computer, utilizing a program written by a Michigan State University computer consultant (Sims, 1971). CHAPTER IV FINDINGS Results of Home Interview Characteristics of families and information about the child's health and his food habits were obtained by a home interview with the parents of the sample children. Family Characteristics The largest number of children came from two-parent, four—member families (Table 4.1). Almost as many families had three children. Half of the participating children were first-born. Only two children came from single-parent families. Table 4.1. Household Size A. Number of Number Percentage Persons in Home 3 5 11.3 4 17 38.6 5 9 20.5 6 7 15.9 7-10 6 13.7 B. Number of Number Percentage Children in Home l 4 9.1 2 16 36.3 3 12 27.3 4 7 15.9 5—8 5 11.3 11 12 The educational level of the parents in the sample is considerably higher than average (Table 4.2). The average father had completed 18.5 years of school, equivalent to 2.5 years of post-graduate education. The average mother had completed 16.2 years of school, approximately equivalent to the bachelor's degree. Twenty-two fathers and four mothers had earned the Ph. D. or M. D. degrees. Table 4.2. Education of Parents Number of School Father Mother Years Completed % % <16 years 11.3 29.6 16 years 15.9 31.8 >16 years 72.7 38.6 MEAN 18.5 years 16.2 years All of the fathers were employed full-time (Table 4.3). Only 11.3% of the mothers had full-time jobs. The remainder listed "homemaker" as their foremost occupation. However, 11.3% were part-time students and 27.3% had a variety of part-time jobs. Table 4.3. Employment of Parents Father Mother % % University faculty 52.4 2.3 Other profession 14.3 2.3 Retailing 9.5 -— Other full-time job 23.8 6.8 Homemaker -- 88.7 13 Health Characteristics Only four children were currently allergic to some food item, whereas seven of the observed children had had an allergy while in the preschool. Two children were now allergic to foods containing mold, one child was allergic to meat, and one to chocolate. Only two of these children were on special diets for their allergies. No child was on a special diet for weight gain or loss, although several mothers said they felt their child should reduce his caloric intake. Mothers were asked whether their child had ever been anemic. It was assumed that those who were anemic had been diagnosed as such by a physician. However, it was not known whether the diagnoses were made on the basis of observation, hemoglobin level, or serum iron level. Three children were reported to have been anemic since starting school. Two others had been anemic as infants. All five received iron supplements to alleviate this condition. None of the mothers had recently consulted a physician about feeding problems with her child, although 31% had done so during the preschool years. As preschoolers, 71% of the children received vitamin supplements. As grade school children, only 50% received vitamins. Table 4.4 shows the type and frequency of supplementation. Table 4.4. Type and Frequency of Vitamin Supplementation Type Percentage :Frequency Percentage None 50.0 Never 50.0 Multivitamins 29.5 Daily 36.5 Multivitamins plus iron 18.2 3-6 times/week 13.7 Vitamin-mineral mix Once/week 2.3 with fluoride 2.3 Winter only 4.5 14 Most children took the chewable children's multivitamins of their own preference. Only one child received wheat germ several times a week as an additional supplement, while there had been three children who took wheat germ as preschoolers. In one-fourth of the sample, there was someone in the immediate family who was on a special diet. Most frequently mentioned was a gastrointestinal problem of one of the parents. Over 80% of the children had been seen by a doctor within the last year (Table 4.5). Most of the others were older children who last saw the doctor for their physical exam before entering school. Reasons for the last doctor's visit are listed in Table 4.6. Table 4.5. Frequency of Medical and Dental Visits Time since Doctor Dentist last visit % % 0-6 months 54.5 81.8 7-12 months 27.3 13.6 >1 year 18.2 4.5 Table 4.6. Reasons for the Most Recent Medical and Dental Visits Doctor Dentist % % Routine checkup 70.5 77.3 Illness 22.7 —- Tooth filled -- 13.6 Orthodontia -- 4.5 Other 6.8 4.5 Over 80% of the children had been to the dentist within the previous six months (Table 4.5). There were many mothers who mentioned that their children went to the dentist twice a year. Reasons for dental visits are also listed in Table 4.6. The frequency of filled teeth as a function of grade level is presented in Table 4.7. Only 12% of the children had fill- ings as preschoolers. This suggests that the occurrence of dental caries increases with age. Table 4.7. Number of Filled Teeth as a Function of Grade (expressed as %) Number of Fillings K 1 2 3 Total 0 O 25.0 6.8 6.8 38.6 1 2.3 0 4.5 0 6.8 2-4 2.3 9.1 9.1 4.5 25.0 4-8 9.1 6.8 4.5 20.4 >8 2.3 6.8 9.1 86.4% of the children got between 10 and 12 hours of sleep on the average each night. The remainder (13.6%) slept for 8 to 9 hours. Food Habits Most mothers (88.6%) thought that their child's diet was nutritionally adequate, although many of these could suggest ways for improvement. The most frequently mentioned food group lacking in the children's diets was vegetables. 36.3% of the children received no special attention at mealtime. None of the children was forced to eat, but 22.7% (mainly the younger children) had to be coaxed to eat at times. Nearly 30% received a variety of types of attention——praise, scolding, coaxing--depending on their behavior. Several parents mentioned the need to restrict amounts of food eaten, and others placed an emphasis on table manners, rather than on quantity of food consumed. Over 80% of the children had no snacks at school, except for occasional birthday or holiday celebrations. Those who regularly snacked at school were the younger children, and this was limited to once a day. 16 Table 4.8 is a summary of the mothers' evaluation of her child's level of activity, and of his attitude toward food. Table 4.8. Mothers' Evaluation of Child's Activity and Attitude Toward Food A. Activity Percentage B. Attitude Toward Food Percentage Very active 38.6 Enjoys eating 59.1 Moderately active 54.5 Attitude varies 31.8 Quiet 6.8 Indifferent 6.8 Has to be urged to eat 2.3 84.1% of the children helped their mothers in the preparation of food. Three children helped almost every day, but the majority helped only occa- sionally, usually when they felt like it. The most frequently mentioned types of help included baking cookies, making sandwiches, preparing salads and raw vegetables, and making gelatin. The boys provided as much help in the kitchen as the girls did. Over 40% of the children prepared their own meals at some time or other. This was limited to breakfast and lunch—-none of the children prepared his own dinner. The need to prepare their own breakfast occurred most frequently on weekend mornings when their parents were sleeping in. Several children got breakfast for younger siblings, as well as for them— selves. Only one child had to prepare lunch for herself every day. The remainder of the children fixing their own meals did it much less frequently. Nearly 30% of the children had no responsibilities around the home. The frequency of various types of home responsibilities is listed in Table 4.9 for the thirty-two children who did help out. The attitudes of families toward new recipes or new foods are summarized in Table 4.10. Over half of the families had a positive attitude about trying new foods. 17 Table 4.9. Frequency of Home Responsibilities Number Set table 18 Clear table 9 Make bed 17 Keep room neat 15 Care for pet 5 Take out garbage 6 Table 4.10. Family's Attitude Toward New Foods or Recipes Percentage Enthusiastic 9.1 Willing 47.7 Cautious 20.5 Reluctant 15.9 Refuse 6.8 Most of the families ate dinner together. This was also true as preschoolers. However, breakfast and lunch were usually eaten together only on weekends. Most of the families never or rarely snacked together (Table 4.11). One child did not eat with his parents because of a very flexible meal schedule. Table 4.11. Meals Eaten Together as a Family (eXpressed as %) Meal Never <§ the time S} the time Almost always Breakfast 18.2 52.3 9.1 20.4 Lunch 36.3 61.3 0 2.3 Dinner 2.3 6.8 4.5 86.3 Snack 40.9 43.2 4.5 11.3 The mother's opinion of the importance of her child eating everything he had been served is shown in Table 4.12. Over half of the mothers felt that this was not very important. 18 Table 4.12. Importance of Eating All That is Served Percentage Not important 34.1 Slightly important 29.6 Moderately important 25.0 Considerably important 11.3 All of the children ate their breakfast and dinner at home. However, during the school week, 43.2% ate lunch at school, the remainder going home for lunch. The majority of the children ate breakfast between 7:30 and 8:30 a.m. (Table 4.13). In many cases this was earlier than their preschool pattern (Sims, 1971), and was a result of their need to be at school by approxi- mately 9:00 a.m. Lunch was also on a more rigid schedule as a result of the school routine. Nearly three-fourths of the children ate between 11:30 and 12:00 noon. Over 80% of the families ate dinner between 5:30 and 6:30 p.m. Table 4.13. Usual Mealtimes Breakfast % Lunch % Dinner % 7:00-7:30 13.6 11:00-11:30 6.8 5:00—5.30 4.5 7:30-8:00 45.5 11:30—12:00 72.7 5:30-6:00 31.8 8:00—8:30 38.6 12:00—12:30 20.5 6:00-6.30 50 0 8:30-9:00 2.3 6:30—7:00 13.6 The frequency of snacking is summarized in Table 4.14. Snacks are most frequently consumed after school. Four of the preschool children skipped meals at times. Three of these were still skipping meals in elementary school. Two of the children missed dinner most often; one because of illness due to an allergy, and the other because he became too involved in his play. One child missed breakfast most often because she was nervous and afraid of missing the school bus. 19 ’Table 4.14. Frequency of Snacking (expressed as %) {Time of Snack Never Occasionally Almost always Before breakfast 93.2 2.3 4.5 IBetween breakfast and lunch 72.7 18.2 9.1 Between lunch and dinner 0 13.7 86.3 After dinner 31.8 25.0 43.2 The mothers' impression of when her child was hungriest for snacks, as well as for what meal he had his best appetite are summarized in Table 4.15. Table 4.15. Time When Most Hungry for Snacks and Meals Snacks % Meals % Morning 4.5 Breakfast 4.5 Afternoon 90.9 Lunch 22.7 Evening 2.3 Dinner 68.2 Combination 2.3 Combination 4.5 Over one-third of the mothers described their child's appetite during the previous three months as excellent. Nearly one-half reported good appetites. Only one-fifth said that their child's appetite was fair. Table 4.16 compares this to the preschool data. Table 4.16. Mothers' Assessment of Appetite Preschool Elementary school % % Excellent 28.6 34.1 Good 52.4 45.5 Fair 16.7 20.4 Poor 2.3 0 A little more than one-half of the children said that their favorite :food was meat. One-fourth of these Specifically mentioned chicken. Next 111 popularity were mixed dishes, such as spaghetti and pizza. This is <3100% P* E* P E P E Calories 4.9 2.3 34.1 65.1 61.0 32.6 Protein 0 0 9.8 0 90.2 100.0 Vitamin A 17.1 20.9 19.5 27.9 63.4 51.2 Ascorbic Acid 12.1 11.7 2.5 4.6 85.4 83.7 Niacin 2.5 0 2.5 2.3 95.0 97.7 Riboflavin 4.9 0 4.9 4.6 90.2 95.4 Thiamine 4.9 6.9 17.1 28.0 78.0 65.1 Calcium 9.8 4.6 26.8 34.9 63.4 60.5 Iron 41.5 6.9 31.7 48.9 26.8 44.2 *P=preschool children E-elementary school children of the calories came from carbohydrate. Fat supplied a little over one- third of the calories with protein providing the remainder. This level of dietary fat intake is in accord with the recommendations of the American Heart Association (1961) for reducing the incidence of heart attacks in adults. Table 4.25. Percentage of Calories Supplied by Carbohydrate, Protein, and Fat Mean % Range P E P E Carbohydrate 50.7 50.5 36.3-68.6 39.1-62.8 Protein 13.9 14.3 5.7-25.8 10.8-19.6 Fat 35.4 35.2 18.1-49.6 26.2-44.5 In order to determine the importance of snacking, the mean percentage 0f calories and protein consumed as a meal or as a snack was computed (Table 4.26). The results show that snacks contain a larger amount of calories than protein. In other words, a larger percentage of protein is consumed at mealtime. The data also show that the mean percentage 26 of calories and protein consumed as snacks is lower for the child in elementary school than for the preschooler. Table 4.26. Mean Percentage of Calories and Protein Consumed as Meals and as Snacks Preschool Elementary school Meal Snack Meal Snack Calories 78.2 21.8 82.6 17.4 Protein 87.8 12.2 90.6 9.4 The frequency of various types of snacks is shown in Table 4.27. Elementary school children consumed more fruits and juices, and less breads and cereals, popcorn, and potato chips than they did several years earlier. Table 4.27. Frequency of Various Types of Snacks P E Breads, cookies, cereals 73 62 Fruits, juices 42 50 Vegetables 6 3 Milk 29 33 Koolaid-type drinks 22 14 Sweets (candy, pop, dessert) 50 44 Nuts, popcorn, chips 14 5 Results of Height and Weight Measurements Height and weight data were gathered on the children at one or more times in the preschool, and again as a part of the present research. These data were evaluated in terms of the Stuart and Meredith height and weight percentile tables (Watson and Lowrey, 1967) (Table 4.28). Trends in total growth were determined by visual inspection, and the results are shown in 'Table 4.29. An increase in height or weight increments means moving from