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IIWWIIWW 3 1293 00992 6134 PLACE IN RETURN BOX to remove this checkout from your record. TO AVOID FINES return on or before date due. AN EVALUATION OF THE SCHOOL LUNCH PROGRAM FOR GRAMMAR SCHOOL CHILDREN AT VISITATION SCHOOL, DETROIT MICHIGAN BY Sister Joanne Marie Sullivan, 0. P. A Thesis Submitted to the School of Graduate Studies of Michigan State College of Agriculture and Applied Science in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE 7 Department of Food and Nutrition School of Home Economics 1952 THES‘S /O'/‘./‘::‘>- (1') /, ACKN WLEDGEMENTS The author wishes to express her sincere thanks to Dr. Dena C. Cederquist, under whose supervision and unfailing interest this thesis was written. She is also greatly indebted to Dr. margaret A. Ohlson for her valuable guidance and kind help in laying the foun- dation for this investigation and in collecting and analyzing the blood samples which were taken. Grateful acknowledgement is also due to Dr. Wilma D. Brewer, Mrs. Ruth Marin Beagle, and Lois M. Jackson for their help in the collection and analysis of the blood samples. The investigator extends her sincere thanks to the children who took part in the study and to their parents for their persevering and kind cooperation. 28.313353 TABLE OF CONTENTS PAGE INTRODUCTIONOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO 1 REVIEW OF THE LITERATUREoooooooooooooocooooo00{00000000 3 FOOd Intake RecorGSooooooooooooococoooocoooooooooo 3 PhYSiOlogical Flu1d StUdieSooooocooooooooooooooooo 7 Clinical Observat10n300000oooooooooOQQOooooooooooo 12 FOOd HabitSoo00.000000000009000ooooooooooooooooooo 15 SChOOl LunCh Studies..o..............o............ 16 ECPERIIJJMTAL PROCEWRE...OOOOOOOOOOOOOOOOOOOOOOO0...... 21 subJOCtSOOOOOI.0.000000.0.0000000000000000...000.0 21 FOOd Acceptance.........oo.......o...........o.... 23 Diet Records...................................... 24 Height and Weight Records.....o................... 25 Plasma Ascorbic ACid DeterminationS...o........... 26 RESULTS AND DISCUSSION................................. 28 SUMMfiRY AND CONCLUSIONOOOQOooccoooowuunu00000000000000 46 LITERAWRE CITED.................O.....C............... 48 APPEIDIXOOOOOOOOOOOOOO0..0.00.000.00.00...OOOGOOOOOOOOO 52 LIST OF TABLES TABLES I II III IV VII VIII IX XII XIII Description of the Subjects..................... Thirteen Pairs of Third and ChildrenCOOOOOOOOOO0.00.00.00.00. Heights of the Fourth Grade Weights of the Thirteen Pairs of Third and Fourth Grade Children......................... Estimated Economic Status of the Thirteen Pairs of Third and Fourth Grade Children............ Estimated Mean Daily Intake of Calories of the Thirteen Pairs of Third and Fourth Grade ChildrenOOOO0......OOOOOOOOOOOOOOOOOOOOO0.000. Estimated Mean Daily Intake of Protein of the Thirteen Pairs of Third and Fourth Grade ChildrenOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOODOOO0.. Estimated Mean Daily Intake of Calcium of the Thirteen Pairs of Third and Fourth Grade ChildrBDOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO Estimated Mean Daily Intake of Vitamin A of the Thirteen Pairs of Third and Fourth Grade ChildrenOCOOOCOOOOOOOOOO..0.000000000000000000 Estimated Mean Daily Intake of Ascorbic Acid of the Thirteen Pairs of Third and Fourth Grade ChildrenOOO0.000000000000000000000000000000000 Plasma Ascorbic Acid Concentrations of the Thirteen Pairs of Third and Fourth Grade Children.OOOOOOOOOOOOOOOOOCCOOOOOOOOOOOOOOOOOO Comparison of the Estimated Mean Ascorbic Acid Intake and Plasma Concentrations of the Control and Experimental Groups............... Food Acceptance Data for the Control Group...... Food Acceptance Data for the Experimental Group. PAGE 29 31 32 35 56 37 38 39 40 42 43 44 INTRODUCTION 1. INTRODUCTION In 1942 Wiehl, and in 1943, Hardy and associates, re- ported surveys which suggested that a considerable propor- tion of the American peOple did not consume Optimum or even minimum amounts of the essential food nutrients. Before World War II, concern for the health and well-being of American children had resulted in a school lunch program which was originally instituted to supplement the diets of the poor. The interest in nutrition which developed during the second world war furnished an impetus for the expansion of this program. It is assumed by many nutritionists, educators, and parents that great nutritional benefits are derived by children from participation in the school lunch program. However, few actual experimental studies to support this thesis have been reported in nutrition literature. There appear to be many possibilities for improving the nutri- tional status of the children of America through this program. Thus, carefully designed studies should be planned and carried out to ascertain possible benefits so that improvement in feeding techniques and methods of food prepa- ration may be developed. Moreover, carefully designed studies should be planned and carried out to obtain a clearer picture I. of the areas in which the American children need to have their diets improved. The present investigation had for~its purpose a study of the hot lunch served at Visitation School, Detroit, Michigan, in the hepe of improving the future program there. This study was planned to compare the nutritive value of the diets, the plasma ascorbic acid concentrations, and the degree of food acceptance of two groups of children; one group of children participated in the regular school lunch program; the second grbup of children brought their lunches from home but could purchase milk at school. REVIEW OF THE LITERATURE 3. REVIEW OF THE LITERATURE The use of food-intake records as a basis for a quali- tative estimation of nutritional status is based upon the prem- ise that a person who regularly consumes a balanced diet enjoys better health than a person who is malnourished. Various methods have been used to estimate the food intakes of individuals and pepulation groups. The dietary history, twenty-four 2222.2229 recall, and estimated and weighed 2229’ intake records are four types of diet records which have been used to obtain an estimate of food consumption. The de- gree of accuracy of the estimate obtained depends upon the method used and the circumstances under which it is used. According to Tedhunter (1942) and Stiebeling (1949) diet records must be kept over a sufficiently long period of time to be truly representative of the over-all dietary pattern of a subject. Darby (1947) pointed out that week-by-week variations in eating habits should be taken into considera- tion as well as day-by-day variations. Stiebeling (1949) expressed the opinion that if food records were kept as long as two weeks, they would be less accurate during the second 'week than during the first. Burke (1947) stated that dietary history studies have been introduced to obtain an over-all, long range picture of ersubject's dietary pattern. In carefully planned studies, a trained nutritionist has interviewed each subject and, through tact and a thorough knowledge of food-value, has obtained the information necessary to secure a representative picture of the subject's normal dietary pattern. Burke (1947), however, pointed out the importance of recognizing the qualitative nature of information obtained in this way. Twenty-four hour recall.digt records are obtained by having the individuals being studied list all food eaten during the past twenty-four hours. This method has recently been used by Eppright (1950) and Storvick and associates (1951) as an economical means of obtaining a qualitative pic- ture of the food-intake of large groups of subjects. It has the advantage of presenting a record of the food ordinarily eaten when the subjects are not under the strain of knowing that their diets are going to be recorded. I Darby (1947) found that many subjects have been able and willing to keep estimated food-intake records for a per- iod of time such as three or seven days. According to Burke (1947) many estimated food-intake reports have required the recording of all the food consumed by the subjects as well as the recording of the approximate measure eaten and the pro- cedures used in the preparation of each item. Since the re- sults of chemical analyses of representative dietaries used in several experiments and the calculated vitamin content of the same dietaries agreed satisfactorily, Darby (1947) con- cluded that the estimated food-intake method yields useful e I . 1 g. . . . r . . ‘ r A . . .. . l I o l._ I , . l' ’ . . ' r . . ; . n. - . . .,. .. I , J . . r \_r 0 .4 I ~ . — »r - n -l . _. . _ 1 o. \ I. \ . ’ I I r“ 5. information about the mean intakes of a population, but has less value for assessing the intake of an individual than for assessing the intake of a population. Weighed food-intake studies have been designed to give a quantitative picture of the amounts of particular foods ingested by the subject. According to Hunscher and Macy (1951), weighed food-intake studies require that records be kept of the weight and method of preparation of all food consumed by the subject. If aliquots of food are obtained and analyzed for the nutrients being studied, the procedure becomes more quantitative than the procedure in which the in- dividual portions are weighed only. The weighing of the food may be carried out by someone else or by the subject himself. According to Burke (1947) few individuals are suf- ficiently cOOperative to carry out the weighing of all their food over any extended period of time. On the other hand she also pointed out that when the food consumed by the subject has been weighed and recorded by someone else, an artificial situation has been created which.may have caused the subject to change his ordinary dietary pattern. If an artificial situation has resulted where the weighings have been carried out by someone other than the subject, the results may not have been representative of the normal amounts of the partic- ular foods or nutrients ingested by the subject. The balance £2221 combines the results of a weighed food-intake study in which aliquots are analyzed for the c c u- - . \I ll. I‘-' up- nutrients under consideration and the chemical analysis of the urinary and fecal outputs of these same nutrients. According to Burke (1947) the balance study has offered the most accurate method of calculating the actual food utiliza- tion of an individual. Burke (1947) also pointed out, how- ever, that this method is time consuming and costly. The re- sults obtained seldom have lent themselves to interpretation of the nutritional status of a population because the number of subjects who have been observed at one time rarely has been great enough to permit such interpretation. After a record of food intake has been obtained, the nutritive value of the diet may be estimated in one of several ways. Separate computations for each food item may be car- ried out; the food items may be classified into groups com- posed of foods which make similar nutritional centributions to the dietary and average figures used for the computations of the food groups; or a combination of the afore-mentioned methods may be employed. According to Donelson and Leichsenring (1945) the estimation of the nutritive value of a diet, following the procedure in which separate computa- tions are made for each food item, assumes a greater degree of accuracy than is justified when the wide variation in com- position of any given food is taken into consideration. Therefore, these workers grouped together foods of similar composition and, for each food group, established mean values for the nutrients which are generally included in food e o‘x‘ . . ~ . r . u. - s s ' r e \ I. 7. tables. Certain foods deviated sufficiently in composition from the means of any food group to require that they be listed as separate items. Donelson and Leichsenring (1945) tested the accuracy of the values in the grouped-food composition table. A series of 30 three day diet records were computed first by separate computations for each food and then using the food groups. Comparison of the results obtained by the two methods showed a high degree of accuracy for the values in the grouped-food composition table. When tested statistically, the observed differences were shown to be due to errors in random sampling and not to real differences between the two methods. Physiological glgid Studies: It has been widely recog- nized that malnutrition results from dietary deficiency or deficiency due to abnormal physiological conditions. Cooperstock and associates (1948) stated that nutritional inadequacy may result from a deficiency attributable to fac- tors which interfere with the ingestion, absorption, or utilization of essential nutrients, or from factors such as growth and destruction of nutrients in the body, which result in increased requirements. For this reason, any method which measures nutritional status in terms of food intake is sub- ject to error in cases where the food requirements of the in- dividual are greater or less than those which are considered normal. Therefore, the relation of nutritional status to food intake has been studied by noting the changes in clini- cal signs and in blood and urine concentrations of the various nutrients which have resulted from changes in diet. moyer and her associates (1948) reported that the greatest difficulty encountered in using physiological fluid concen- trations as indices of nutritional status has been inadequate knowledge of the concentrations which define the zones of nutritional adequacy and inadequacy. Kaucher and associates (1948) pointed out that hemoglo- bin concentrations have been useful in assessing the adequacy of the diets of groups of individuals, but, because such a variety of factors Operate to influence hemoglobin levels no satisfactory standard for all individuals in a mixed group has been found. Serum protein concentrations were formerly believed to be a reliable index of protein nutrition. Beach (1948), how- ever, reported the total blood volume of subjects whose diets had been deficient in protein. These total volumes had under- gone a compensatory reduction which had left the unit con- centration of blood protein unaltered. This would indicate, therefore, that a dietary deficiency of protein was masked by a corresponding reduction of the total blood volume. Interpretation of the data with regard to vitamin A has been complicated by the capacity of the body for storage of this vitamin. Both Callison and associates (1947) and Robinson and associates (1948) showed that this capacity has 9. made it possible for the diet to change from an abundant supply of this vitamin to a marked lack of it for a period of months without having changed appreciably the blood con- centration of vitamin A. Chemical and microbiological methods for the determina- tion of thiamin, riboflavin, and niacin have been developed. According to Goldsmith (1949), fluorometric methods for the determination of riboflavin check well with the.microbiologi- cal procedure when interfering fluorescent substances can be removed, but the numerous chemical tests for the appraisal of niacin nutrition have been far from satisfactory. Kerk and associates (1947) demonstrated a correlation between the intake of riboflavin and the fasting one-hour excretion of this vitamin. According to Suvarnakich and associates (1952) the study of the serum riboflavin concentrations obtained from one-hundred-forty-one normal individuals indicated that human serum flavin-adenine-dinucleotide indicates riboflavin nutriture and is of diagnostic value in detecting riboflavin deficiency. Mickelsen, Caster and Keys (1947) showed that the excretion of thiamin is characteristic of the individual as well as of the intake. Thus far vitamin C studies have yielded promising results as to the blood concentrations defining adequacy and inade- quacy of nutritional status with respect to this vitamin and to the interrelationship among dietary intake, blood concen- trations, and related physiological conditions of the body 10. tissues. Moyer (1948) pointed out that the great amount of research conducted on blood vitamin c has resulted in a more definite knowledge of the desirable blood levels of this constituent than is available for any of the other vitamins. However, the Committee on.Nutrition Surveys of the National Research Council (1949) pointed out that the significance of findings concerning vitamin C blood concentrations has been controversial and, for any one individual, temporary fluctua- tions in plasma ascorbic acid concentrations may be frequent, showing a wide range of values at any given level of intake. Minot (1940) and Johnson (1945) considered serum ascorbic acid concentrations below 0.3 milligrams percent as indici- tive of serious deficiency. Minot also regarded a serum ascorbic acid concentration of over 0.7 milligrams percent as indicative of satisfactory vitamin 0 nutrition. Gold- smith (1949) reported that many of those who had studied the problem most carefully considered plasma ascorbic acid con- centrations below 0.6 milligrams percent less than desir- able. Johnson and associates (1945) and Johnstone and associ- ates (1946) found that in order to maintain blood ascorbic acid at a high concentration its frequent ingestion is neces- sary. Consequently, tests for ascorbic acid levels in the blood have appeared to give better correlation with the cur- rent diet than is found in some other measures of nutritional status. Putnam and associates (1949), in studying the (I ll. relationship between the ascorbic acid intakes of two large groups of subjects and their corresponding blood concentra- tions, reported that the correlation ocefficients were in- dicative of a significant relationship. When the data were assembled, the coefficients were:'P0.595 andi-0.4l6 Meyer and associates (1948) stated that while a single blood sample from an individual has furnished a poor pic— ture of the person's state of vitamin C nutrition, the over- all picture of the population which is obtained by taking a single sample from each of a large group of subjects has been of much greater reliability. The ascorbic acid content of the white cells of the blood has been shown by Crandon, Lund, and Dill (1940) to be more indicative of actual tissue concentration than the ascorbic acid content of the plasma. These workers found that plasma was lacking in ascorbic acid thirteen weeks be- fore clinical scurvy became evident in their patients. ‘Whereas clinical signs of scurvy deve10ped soon after the ascorbic acid values in the leukocytes approached zero. Ac- cording to Peters and associates (1948) the plasma ascorbic acid values reflect the immediate dietary intake, but the white cell ascorbic acid values give a better picture of the tissue store. These authors found that on a vitamin C-free diet about one-hundred days elapsed between the virtual disappearance of vitamin C from the plasma and the occurance of the first clinical signs of scurvy in their subjects. On I‘ 12. the other hand, the concentration of vitamin C in the white cells reached its lowest value three to six weeks before clinical scurvy appeared. In this same study it was found that, in general, the vitamin 0 concentration in the white cells was about twenty-five times that in the plasma. Johnson-and associates (1945) showed that the excretion of ascorbic acid for three and six hours after giving one gram of the vitamin orally reflected the previous dietary intake. Youmans (1942) pointed out that the results follow- ing load tests paralleled plasma ascorbic acid values ob- tained during fasting. Clinical Observations: According to Burke (1947) diet records become more meaningful and reliable when the intake of essential nutrients is related to the appearance or lack of appearance of certain clinical or laboratory findings in the subjects studied. For many years anthropometric measurements were used to evaluate nutritional status. Sevringhaus (1949) found that anthrOpometry as a detached and academic scientific approach has provided many contributions, but these often have been stated as correlations with racial or geographic background, seldom with any nutritionally useful correlates. Darby (1947) found physical signs of deficiency states which may have had several causes. These physical signs are not specific. For example, oral lesions, which upon examina- tion cannot be distinguished with certainty one from the 13. other, may be caused by deficiencies of niacin, riboflavin, or possibly pyridoxine or pantothenic acid. 0n the other hand, Todhunter (1942) stated that some gross deficiencies such as scurvy, rickets, xerophthalmia, and night blindness are readily recognized and, therefore, aid in the evaluation of extremely poor nutritional status with regard to the par- ticular nutrients concerned. According to Kruse and associates (1945) clinical.mani- festations of nutritional deficiencies severe enough to re- sult in the classical symptoms of avitaminosis seldom have been encountered in the United States but there has been a widespread prevalence of moderately deficient diets which have evidenced themselves in vague and indefinite feelings of fatigue and "lack of pep". Clinicians and research workers, therefore, have been limited in the degree to which clinical findings could be used to estimate the nutritional status of the population, although occasionally such findings have been used to help estimate the nutritional status of an individual. gpggflggpggg: In 1945 Guthe and mead stated that enough scientific knowledge had been amassed in the field of nutri- tion to enhance enormously the well-being of mankind by its application. They pointed out that one of the major problems in nutrition work is the attainment of widespread application of this scientific knowledge to everyday living. 14. With regard to attempts to improve the nutritional status of an entire nation by the use of this knowledge, two general procedures have been followed: (a) enrichment, restoration, or reinforcement of common foods, and (b) nutrition education for the peeple. The genetic alteration of hereditary strains' of plants and animals, enrichment of flour, and the addition of iodine to salt illustrate the first procedure. These methods havemade no attempt to change the food habits of the population, but has been valuable when used to remedy deficiencies which could not be checked by a reasonable increased intake of readily available foods which were within the purchasing power of the population. The second procedure was followed in the wide publication of the basic food chart which was introduced in 1941 in the national nutrition movement. Food-habit studies laid the foundation for the effective application of both of these procedures for the improvement of the nutritional status of the nation. Unless the foods to be enriched, restored, or reinforced were readily accepted by the peeple who needed to have their diets improved, the results obtained would have been almost worthless. In addition, food- habit studies have provided information which has been useful in planning a psychological approach to nutrition education. Guthe and Head (1945) stated that the study of food habits might be defined as the study of the manner in which individual subjects, in response to social and cultural pressures, select, consume, and utilize parts of the available food supply. In 1950 Grant reported the results which a nine week period of nutrition education given to fifty fifth grade school children had on the number of times they included fruits and vegetables, other than potatoes, on their lunch trays. Before the nutrition unit began, fifteen percent of the children took a vegetable and thirty percent took a fruit. Five weeks after the unit was completed, forty-nine percent took a vegetable on their trays and thirty-nine percent took a fruit. The parents of the majority of these children were professional people in a fortunate socio- economic group. The nutrition unit had been concerned with the nutritional requirements of hamsters which the children observed in their class rooms. A study of the food habits and preferences of Iowa adults was reported by Eppright in 1950. A large number of subjects were asked to make out what they considered an ideal menu for an entire day if they could have any foods that they wanted. They were also asked to record their actual dietary intake for one day. It was found that the preferred menus did not differ markedly from the actual. In the Southern Pasture area of Iowa, which rates lower economically but higher educationally than the other two areas studied, people used milk and green and yellow vegetables more frequently than the other two areas. The frequency of use of fruits and vegetables, other than the green and yellow, tended to increase with an increase of income. The frequency of use of 15. 16. the green and yellow vegetables, however, appeared to be un- affected by economic level. Satiety value and a pleasant taste were given most frequently as the reasons why peeple liked particular foods. Odor was mentioned as an unfavorable quality but seldom as a favorable one. In 1951 Storvick and associates reported a study of the food habits of fourteen, fifteen, and sixteen year old school children. A twenty-four hour food-intake record and a diet- ary history based on a check list of foods were used to ob- tain information about the food habits of the children. The twenty-four hour food-intake-records were used to check the validity of the dietary histories. The results indicated that almost all of the children had high intakes of protein and vitamin A and quite high intakes of calcium, but con- sumption of vitamin C was low. School Lungh Studies: In 1956 the school lunch pro- gram, as a nationwide Works Progress Administration project, was instituted to provide free lunches for children from re- lief families. By 1937 (Woodward, 1937), it had become the policy in.many communities to serve all the school children who cared to partake in the program. At that time an aver- age of 500,000 were participating daily in 10,000 schools throughout the country. According to Ratcliff (1941), it was stated that on October 1, 1945, the number of public school children who obtained their lunch at school totalled 17. 6,060,500. Although more recent figures are not available, the number who benefited from this program during 1950 may be estimated from the data published in The National Educa- tion Association Journal (1950) which showed the total ap- propriation of funds for the operation of the National School Lunch Program to have been $83,500,000. As was also pointed out, each dollar of federal funds had to be matched by one and one-half dollars from the state. From the onset of the program many nutritionists agreed with Pendergast (1938) when he stated that this plan pre- sented unlimited possibilities for an important contribution to a long term effort to improve the food habits of the American People. However, very few actual studies conducted with the purpose of evaluating the nutritional benefits de- rived from the school lunch program by the children who par- ticipate in it have been published. Mack (1947) reported the school lunch fed to a large number of children in Pennsylvania produced no improvement in their general condi- tion. Velat and associates (1951) studied children who were divided into two groups: those who partook of the school lunch four or more days a week and those who did so one day a week or less often. The second group included those who carried their lunch as well as those who went home to eat. During each of two successive years, these children were ex- amined. In regard to several physical signs of nutritional 18. inadequacy, the school lunch group showed a higher percent- age of children with signs suggestive of nutritional dis- turbance than the group without school-lunches. There were more underweight children in the school lunch group and more overweight children in the group without school lunches. In all cases, however, only the mildest symptoms of nutri- tional deficiency were present, and clinical signs of defi- ciency proved insignificant as a means of evaluating the program. The blood concentrations of hemoglobin, carotene, and ascorbic acid of this group of children were determined. The hemoglobin levels gave no evidence of advantage for the children who received the school meal. Ascorbic acid con- centrations of non-fasting blood samples showed that in the group of children who did not take part in the school lunch, 53% were below 0.35 milligrams percent and 70% were below 0.75 milligrams percent. Of those who participated, 15% were below 0.55 milligrams percent and 49% were below 0.75 milligrams percent. With regard to the serum carotene con- centrations, about the same percentage of children in both groups were in the intermediate category (between 70 and 129 micrograms per 100 milliliters of blood). The percentage of children with serum carotene concentrations in the lowest category (below 70 micrograms per 100 milliliters of blood), however, was less in the group which partook in the school lunch program than in the group without school lunches. 19. The data presented indicated that fewer children who ate the school lunch had very poor diets than those who ate at home or carried their lunch. In the group which purchased their lunch at school, 29% consumed fewer calories than the recommended daily allowances of the National Research Council, 15% ate less protein, 68% less calcium, 54% less vitamin A, and 18% less vitamin C. In the group which carried their lunch, 50% consumed fewer calories than the recommended daily allowances, 25% ate less protein, 76% less calcium, 58% less vitamin A, and 49% less vitamin C. A study reported by Abbott (1946) made in a part of Florida where nutritional disturbances were common, indicated that a school lunch which furnished more than liberal amounts of all the nutrients as well as supplements of vitamins and minerals when needed resulted in considerable improvement in the well-being of the children. In a study in a rural county in South Carolina where the dietary patterns were particularly poor, Meser (1945) found that the physical and biochemical findings which are used to estimate nutritional status indi- cated a greater improvement in the health of the children who ate a complete lunch served in one school than in the health of the children who ate a ”partial" lunch served in a second school. The results of the eXperiment performed by Velat and as- sociates (1951) indicated that an ordinary school lunch de- creased the percentage of children who consumed extremely 20. poor dietaries and produced a well-defined increase in serum carotene and plasma ascorbic acid concentrations. It appears that the more than liberal lunch reported by Abbott (1946) produced a very marked improvement in the well-being of a group of poor children who partook of it. Another study reported by Augustine and associates (1950) indicated that the lunch served in an Iowa school furnished one-third of the recommended daily allowances only twenty-two percent of the time. The fact that the primary school chil- dren etc before the intermediate and high school children was believed to be partially reSponsible for the deficiency since less food was available for the older children whose re- quirements were greater. EXPERIMENTAL PRO CEDURE 21. EXPERIMENTAL PROCEDURE Subjects: A group of third and fourth grade children who carried their lunch but who were able to buy milk were matched according to height, weight, age, and economic status ‘with a second group of children who participated in the school hot lunch program. In September, 1950, all the third and fourth grade chil- dren of Visitation School, Detroit, Michigan, who carried their lunch or who took part in the school hot lunch program were weighed and measured. Weights were taken with their clothes on but without any heavy articles such as coats and books. Heights were taken with their shoes on, since all the children, without exception, wore shoes with one-half inch heels and ordinary soles. In order to obtain some idea of which children would be used as subjects in this study, the second and third grade teachers estimated roughly the economic status of the family of each of the aboveementioned children. On the basis of this information, those who carried their lunches were ten- tatively paired with those who partook of the hot lunch at school. This obviated the necessity of having to make out economic status reports for all of the children who were weighed and measured. Thirty pairs of children were obtained who were matched according to height (within one inch), weight 22. (within two and one-fourth pounds), age (within six.months), and approximate economic status. The children who regularly brought their lunches from home but were free to purchase milk at school if they wished made up the controllggggp. Those who regularly partook of the hot lunch at school made up the experimental 53232. The parents of the children in the control group were contacted and asked if it would be possible to have the children carry their lunches continuously from.the last part of September, 1950, through February,l951. The parents of the pupils in the experimental group were also contacted and asked if their children might take part in the school hot lunch program con- tinuously from the last part of September,l950, through December, 1950; bring their lunch from home during January, 1951, and take part in the school lunch program during February,1951. The.mother of one of the pupils in the control group found it impossible to take part because of family circumstances. At the time the parents were contacted, inquiry was .made concerning the health of the children, and those pupils who were suffering from.heart trouble, asthma, or other seri- ous diseases were dropped from the study. Pupils who were receiving supplements of vitamin C were eliminated also. At the time the parents were first contacted, the economic sta- tus records, designed by F.S.Chapin (1947) were filled out. This method uses the type, size, quality, and condition of the household furnishings as well as the overall condition of the home and the presence of books, magazines, and news- papers as measures of the economic status of the family. After the economic rating of each child was computed, it was necessary to re-pair the control and experimental pupils. Twenty-seven pairs were available for study after the preliminary preparations were completed. Food Acceptance: During the first ten days of October, 1950, the sixty original subjects were interviewed, in groups of five or six, to determine their food likes and dislikes. An original form listing seventy-six foods was used. The foods included in this list were divided equally into two groups: those which could readily be used in a packed lunch, and those which could readily be served in the cafeteria. In addition to this, the foods which ordinarily are disliked by grammar school children were divided equally between the two aboveementioned groups. Each food listed on the form was described to the subjects. They then placed a "Y”, "N", or ”-", after each food item. "Y" indicated that they liked the food, "N” that they did not, and "-" that they were not familiar with it. Care was" taken to maintain a quiet and reserved atmosphere in the room so that the children would not influence each other's answers. The decision to question the children in groups of five or six was made after the first two subjects were interviewed 24. privately and attempts to check their answers led to the conclusion that they were incorrect because responses which should have been similar were not. It was obvious to the investigator that her personal contact with these small children stimulated their imaginations and their answers were biased by their desire to say that they liked what was good for them. On the other hand, the composite picture of the food likes and dislikes of the subjects, which was ob- tained from the analysis of the questionnaires after the children were interviewed in groups of five or six, was more in accord with the likes and dislikes which the interviewer had noted when she served these children in the cafeteria and when she watched them eat or fail to eat the food which their mothers had prepared for their lunches.) The diet records kept one week in January and one week in February were studied and the number of times each child ate foods listed as disliked or unknown were tabulated. The average difference between the acceptance of disliked or un- familiar foods by the two groups of children was taken as a measure of the increase or decrease in the food acceptance which had been developed in the subjects. A copy of the form used may be found in the Appendix. Diet Records: One and one-half to two weeks before the blood samples were taken on January 27, 1951, forms to be used to record the diets of the children were mailed to each 25. home. The parents were asked to record the foods eaten by their children, the method of preparation, and the number and size of the servings. Two weeks before the second series of blood samples was taken on February 23, 1951, duplicate forms were mailed to the home of each child. During both periods the diet records were kept for the seven consecutive days immediately preceding the taking of the blood samples. Subjects were on unrestricted diets. Pupils participating in the school lunch program were encouraged to set everything on the menu, just as they were during the entire school year. However, they were not required to do so. Copies of the form used to record food intake.may be found in the Appendix. Intakes of calories, protein, calcium, vitamin A, and vitamin C for the two week periods were estimated by the use of the short method of Donelson and Leichsenring (1945). Average daily intakes.for each of these nutrients were then computed. The menus served in the school cafeteria during the week in February when diet records were kept.may be found in the Appendix. Height and‘Weight Records: The height and weight of each subject were taken at the beginning of the study and again at the time the first blood samples were obtained on January 27, 1951. The scale was of the balance type, and the sliding rule on it was employed in the measurement of height. 26. Plasma Ascorbic Acid geterminations: The blood plasma concentration of reduced ascorbic acid was determined on January 27, and February 25, for each control and experimen- tal subject who showed no signs of being ill. The finger-tip blood samples were taken at school from 7:30 Add. to 11:30 A.M. on January 27, and from 7:50 A.M. to 10:50 Ash; on February 25. The day before the samples were taken, the children were reminded not to eat fruit, fruit juice, vegetable, or vegetable juice for breakfast. Subjects whose diet records indicated failure to carry out this in- struction were eliminated from the study. Analysis for ascorbic acid was carried out according to the micromethod of Farmer and Abt (1936). Approximately 1.0 milliliter of capillary blood from a finger cut was collected into a vial containing the dried lithium oxalate from two drops of a two percent solution. The oxalated blood samples then were centrifuged for five minutes to separate the plasma from the corpuscles. An aliquot of 0.2 milliliter of plasma was transferred to a centrifuge tube and 0.2 milliliter of glass distilled water and 0.4 milliliter of five percent metaphosphoric acid were added after which the samples were frozen. The samples were thawed and centrifuged and two 0.2 .milliliter portions of the deproteinized plasma were titrated immediately with a standard solution of sodium 2, 6 dichlorobenzenone-indophenol to an end-point of the first 27. faint pink which persisted for twenty seconds. Two reagent blanks were titrated to the same end-point. The Farmer and Abt.microburette was used. Calculations were based on the formula: m1. of dye m1. of dye micrograms of mg. of ascorbic to titrate - to titrate x ascoruc acid x 2 nacid per 100 m1. sample blank required to plasma reduce one ml of dye. All solutions were prepared with glass-distilled water. RESULTS AND DISCUSSION 28. RESULTS AND DISCUSSION Twenty-two pairs of subjects were studied at the first blood sampling on January 29, 1951. During February, 1951, many of the children.were stricken with influenza. There- fore, only thirteen pairs were studied at the time of the second blood sampling on February 23. The figures for these thirteen pairs will be reported. The description of the children may be found in Table I. According to the data (Tables II and III) the control group gained an average of 7.7 pounds and 1.2 inches from September to January while the experimental group gained an average of 7.5 pounds and 1.1 inches. The differences of 0.2 pound and 0.1 inch are within the margin of experimental error. The economic status record for each child, as determined in October, 1950, is shown in Table IV. The ranges and av- erage economic ratings for the two groups were similar. The average rating of the control group was 142.5, and the average rating of the experimental group was 140.0. Scores ranging from 100 to 199 indicate lower middle class to upper middle class economic status. Only one child in each group was in the upper economic status class (200 and over). Three children in the control group were in the lower economic- class (100 and under), but one of these three children had a score (99.4) only a fraction of a point below the middle 29. mm #m mm AM OH nH dd HH OH a b menace GNOO #00 Dam n.am n.mn n.m a ma m.mn n.om o.m w n.mn n.on m.a H ma m.om o.an o.m a n.as m.nn n.a M ed o.nm o.ae m.m a o.mn m.an n.o a ma n.5s o.nn n.o w o.mm 0.0m o.a a ma n.nn n.on n.a a o.os_ n.sm n.oa H a o.nn o.an o.a w m.ma n.nn o.a n n o.mo o.en o.a a n.no o.mn o.a a a o.as n.am n.m a o.mn o.ae o.a a n o.ma 8.0m m.a a o.sa «.mm m.o H m o.na n.em o.a w n.ns m.nm n.oa a a 0.0m n.nn n.o a Hones: .aH .em .ns oeoo .uma .mu .na .rr 23.: season owal 23 Rm Boreas»... pads: 23 am new) 23 mom 93.3 Henson—«Henna 96.8 flamenco meofihmbm mm? ho ZOHBmHmome H mAde 30. a.ma s.mn e.a m.aa a.mm m.m omaaaaa o.am o.an o.a a an 0.90 m.mm n.m N am n.0s n.nm n.a H om m.an o.mn m.m w an nomads Menage .DH .nH .Hh o oo 4MH .nH .9» o co enema; season «we Heme mam poauaam passes enemas sea Hens aom poafiaam Adena Hendeaanommm macaw Hospmoo QHDZHBZOO H qudfi HEIGHTS OF THE THIRTEEN PAIRS OF THIRD AND FOURTH GRADE CHILDREN TABLE II Control Group Experimental Group Subject September January Gain Subject September January Gain Height Height Height Height code in. in. in. code In. in. in. number number 7 52.0 53.3 1.3 2 51.0 52.4 1.4 9 54.0 54.5 0.5 17 53.0 53.8 0.8 10 54.0 56.0 2.0 6 56.0 57.5 1.5 11 50.3 51.3 1.0 4 51.5 52.0 0.5 14 53.0 54.0 1.0 5 54.8 55.5 0.7 15 49.5 51.0 1.5 5 48.0 49.0 1.0 16 49.0 50.5 1.5 19 51.0 ' 52.3 1.3 21. 55.0 55.0 2.0 20 54.0 55.5 1.3 22 48.0 49.0 1.0 23 49.5 51.0 1.5 24 49.5 51.0 1.5 1 55.0 55.2 0.2 25 50.0 50.5 0.5 18 49.0 50.5 1.5 26 51.0 52.0 1.0 13 50.0 51.8 1.8 27 51.5 52.8 1.3 12 49.0 50.0 1.0 Averag 51.1‘i' 52.4- 1.2+ 51.5 + 52.7- 1.1+ 31. TABLE III WEIGHTS or THE THIRTEEN PAIRS 0F THIRD AND FOURTH GRADE CHILDREN Control Group Experimental Group Subject September January Gain SubJec September January Gain Weight Weight Weight Weight code 1b. 1b. 1b. code "1b. 1b. *1b. number number 7 58.0 80.5 22.5 2 66.0 77.0 11.0 9 64.0 75.0 9.0 17 64.0 71.5 7.5 10 68.0 75.0 7.0 6 66.0 76.0 10.0 11 61.0 71.0 10.0 4 58.0 65.5 7.5 14 64.0 62.0 -2.0 5 69.0 75.5 6.5 15 49.0 55.0 4.0 5 48.0 55.0 7.0 16 52.0 55.5 5.5 19 51.0. 57.5 6.5 21 71.0 76.5 5.5 20 p 64.0 75.5 11.5 22 48.0 55.0 7.0 25 47.0 54.0 7.0 24 67.5 80.5 15.0 1 70.0 75.5 5.5 25 49.0 55.5 6.5 18 48.0 55.5 7.5 26 54.0 59.5 5.5 13 52.0 58.0 6.0 27 55.0 65.0 8.0 12 52.0 58.0 6.0 Average 58.5 66.2 7.7 58.1 65.6 7.5 32. 33. TABLE IV ESTIMATED ECONOMIC STATUS OF THE THIRTEEN PAIRS OF THIRD AND FOURTH GRADE CHILDREN Control Group A EXperimental Group ""'§%gg:ct Rating. Sggggct Rating number number 19 252.2 16 218.8 1 191.4 15 179.6 5 191.4 24 172.5 12 186.7 27 163.7 5 159.2 9 150.5 17 149.0 21 147.0 20 143.4 25 135.9 18 123.6 14 133.5 2 106.5 10 124.5 4 102.4. 11 124.5 13 99.4 7 112.9 25 81.6 22 104.8 6 65.4 26 52.4 Average 142.5 140.0 34. class scores. One child in the experimental group was in the lower class. From.the diet records obtained at the time the blood samples were taken, the calorie, protein, calcium, vitamin A and ascorbic acid intakes of each subject were estimated by means of the short method of Donelson and Leichsenring (1945). The results obtained may be found in Tables‘v through IX. With regard to the diet records, the only differences in the estimated intakes of the nutrients studied which proved to be significant at the ninety-five percent confidence level were those of ascorbic acid. ‘When the estimated aver- age intakes were compared to the daily allowances recommended by the National Research Council (Tables V through Ix), it was found that ascorbic acid was the only one of the nutrients studied, except calories, which was not well above the recwm- mended allowances. This is in agreement with the findings of Storvick and associates (1951) that fourteen, fifteen, and sixteen year old children generally have high intakes of pro- tein and vitamin A, quite high intakes of calcium, and low intakes of vitamin c. Velat and associates (1951), in study- ing two grade school lunch programs found that the children partaking of the school lunch consumed fewer calories but more vitamin C than did the children who carried their lunches or ate at home. With regard to the plasma ascorbic acid concentrations presented in Table X, the average of the control group fell TABLE'V ESTIMATED MEAN DAILY INTAKE 0F CALORIES OF THE THIRTEEN PAIRS 0F THIRD AND FOURTH GRADE CHILDREN Control Group Experimental Group Subject January February Subject January February Calorie Calorie Calorie Calorie Intake Intake Intake Intake 7 2,542.9 1,780.8 2 2,130.7 2,197.9 9 3,006.4 2,558.1 l7 2,888.6 2,043.0 10 2,906.8 2,665.0 6 2,094.5 1,962.7 11 2,772.5 2,755.1 4 2,538.9 2,289.4 14 2,268.9 2,053.1 5 2,914.8 1,852.8 15 2,547.9 2,685.4 5 1,989.1 2,087.2 16 2,655.9 2,481.9 l9 1,798.2 1,825.3 21 2,250.7 1,884.5 20 2,784.1 2,564.9 22 2,528.6 1,685.9 23 1,865.6 1,833.3 24 2,828.8 2,568.5 1 1,998.9 2,204.4 25 1,967.4 1,951.6 18 1,717.9 1,559.5 26 1,957.8 2,444.8 15 2,176.9 2,417.1 27 2,248.6 1,774.6 12 21304.0 1,885.4 Average 2,464.8 2,257.5 2,231.0 2,052.4 Recommended Daily Allowance: 2,000 35. -7... --, - w-.. r. I. ..‘_ -.—-o—-. a __., ”4. b 4-.. 1 a. r co . .. . n. . x I. I. I. l‘ --..-- ‘ . ._._-........ . . .. - o C o - \ _. .-...- _..—‘.-.' a. 'I'I v--- TABLE VI ESTIMATED MEAN DAILY INTAKE OF PROTEIN OF THE THIRTEEN PAIRS 0F THIRD AND FOURTH GRADE CHILDREN Control Group Experimental Group Subject January February Subject January February Protein Protein Protein Protein Intake Intake Intake Intake codé’ gm. gm. code gm. gm. number number 7 102.29 71.82 2 80.79 80.49 9 101.29 74.90 17 92.82 74.50 10 87.11 88.70 6 85.18 72.49 11 83.20 97.10 4 82.39 91.95 14 70.60 64.00 93.79 72.70 15 79.60 91.80 3 77.11 74.99 16 97.50 85.80 19 64.79 70.70 21 92.50 76.60 20 112.96 101.98 22 96.87 66.00 23 71.98 70.32 24 114.54 105.00 1 83.20 78.49 25 72.91 69.27 18 79.25 65.98 26 68.58 70.96 15 79.92 100.45 27 87.11 76.54 12 84.38 82.38 Average 88.75 _ 79.88 83.58 79.80 Recommended Daily Allowance: 60.00 gm. 36. TABLE VII ESTIMATED MEAN DAILY INTAKE OF CALCIUM OF THE THIRTEEN PAIRS 0F THIRD AND FOURTH GRADE CHILDREN Control Group Experimental Group Subject January February Subject January rebruary Calcium Calcium Calcium Calcium __Intake Intake ;;ntake Intake code gm. gm. code gm. gm. number number 7 1.37 1.14 2 0.79 1.15 9 1.47 1.26 17 1.03 1.39 10 1.50 1.41 6 0.82 0.88 11 1.58 1.59 4 1.21 1.56 14 1.02 1.04 5 1.22 0.87 15 1.08 1.33 3 0.71 0.74 16 1.55 1.15 19 1.04 1.00 21 1.16 1.24 20 1.78 1.67 22 1.21 0.97 23 1.14 0.99 24 1.48 V 1.47 1 0.55 0.69 25 1.14 1.02 18 1.17 1.25 26 1.02 0.99 13 1.11 1.15 27 1.54 1.13 12 1.24 1.18 Average 1.29 1.21 1.06 1.10 Recommended DailygAllowance: 1.00 gm. 37. ** w" A... u. ‘ _ - . - _ _.- .1- ..-. ~- -- . .v ~ - -.. c _ ¢_-—.- ‘.- » A- . c, ‘ .. .- - 4 - 1 o - .- 4-.....- , - _ . 4 .0"- .. . . . -1. ,u- -. — ' ' 1 t‘”‘-'-- .n-.---- h— ' 4 ._n A - -'- h ‘— 9 . O . o .4... _. .. 1.1 — - _. - . . -ofl--m -- —-.. . v 2 - _‘ ”m*- TABLE VIII ESTIMATED MEAN DAILY INTAKE OF VITAMIN A OF THE THIRTEEN PAIRS OF THIRD AND FOURTH GRADE CHILDREN Control Group Experimental Group Subject January February Subject January February ‘Vitamin Vitamin Vitamin Vitamin A A A A Intake Intake Intake Intake code I: U. I. C) code I. U. . . number number 7 9,657.1 12,487.5 2 5,265.0 5,099.7 9 6,745.0 12,81709 1'7 19,11406 7,594.8 10 16,505.9 8,584.6 6 7,362.5 4,999.0 ll 14,121.8 9,501.8 4 8,357.9 11,653.4 l4 7,305.4 5,612.9 5 14,15200 3,829.4 15 5,613.8 9,164.4 5 4,749.0 5,082.5 16 4,582.9 3,444.6 l9 10,212.9 6,933.0 21 12,969.6 18,778.6 20 15,381.4 16,478.7 22 7,127.1 8,603.9 23 2,351.7 5,749.0 24 12,225.9 6,907.1 1 2,192.9 4,351.4 25 2,197.4 7,581.6 18 9,111.8 4,659.0 26 5,155.7 3,955.8 13 6,548.9 8,572.0 27 9,304.3 4,670.4 12 25,474.7 17,517.0 Average 8,577.7 8,593.2 9,865.9 7,716.8 Recommended Daily Allowances: 5,500 I. U. 38. . - .4 . I. 1.. 4 ----o -.7- .. -._..--_ >¢¢ - - n . m-—.—- ‘9 .— _.. -.-.... ._ ,_.—-o ——. .~_—- -..m— —..._.- _ . c . .4.....41-.— .. - 1 ._ ”-9-5- . o... - . — , .~..a w- .o a -v— .. w- o... val-I. . «cl-~‘o *~-~.—w-~ . o .— l ‘ I 1 . . I 5 _ a. w .. . .- -A- _. a _ «m- -1. u-—- -- - o ~ . - _.__. ~. -.- o- 1 ‘0 : ° ( O ’ 0‘ O a. — O : e g 0 g 0 't 1‘. *'r; . -' {I . g _ e '= .o . ‘ ..1» ,. 0 ‘t ' ' -' t ' Q ,.n. t I. O : ° '1 . ~‘ 1 1 o 7'-- - . .' e -': ~o Q I. - t' . 1;. - . - _ o —1- Q ‘. .2 ‘. Q g t o t . e ' g _ g __t - - . ,, _ o a. _-_ _ ..-__.' - ‘ . '-.-.-..< .. .. ‘1- .1.-_--...--..'.- .1-.--- -- ’ ___-_ J.-.- .‘...-. , : ‘ ' ‘ TABLE IX ESTIMATED MEAN DAILY INTAKE OF ASCORBIC ACID OF THE THIRTEEN PAIRS OF THIRD AND FOURTH GRADE CHILDREN Control Group Experimental Group Subject January February Subject January February Ascorbic Ascorbic Ascorbic Ascorbic Acid Acid Acid Acid Igtake Intake Intake Intake code mg. mg. code mg. mg. number number 7 77.7 58.5 2 54.0 59.1 9 142.1 27.2 17 99.2 51.7 10 107.6 86.2 6 57.4 59.9 11 126.8 74.7 4 72.8 72.2 14 42.6 53.3 5 95.7 88.9 15 74.0 77.6 5 45.6 83.1 16 47.8 47.3 19 91.2 78.1 21 76.6 73.8 20 109.0 95.0 22 65.3 50.7 23 54.3 45.7 24 63.9 74.4 1 57.9 66.6 25 134.6 94.0 18 26.3 49.3 26 26.9 29.7 13 86.1 98.0 27 47.0 44.9 12 140.9 154.4 Average 79.5 6009 73.1 75.4 Recommended Daily Allowance: 601118- 39. .vv. 4... .- 6.1. TABLE X PLASMA ASCORBIC ACID CONCENTRATIONS OF THE THIRTEEN PAIRS 0F THIRD AND FOURTH GRADE CHILDREN f Control Group Experimental Group Subject January1 February1 Subject January1 February2 Plasma Plasma Plasma Plasma Ascorbic Ascorbic Ascorbic Ascorbic Acid Acid Acid Acid Concen- Concen- Concen- Concen- trations trations trations trations code mg. % mg.’%g¥ code mg. % mg. % number number 7 0.37 0.59 2 0.37 0.25 9 1.18 0.66 17 0.93 1.22 10 0.50 0.49 6 0.07 0.12 11 0.48 0.55 4 0.22 0.27 14 0.26 0.24 5 0.58 0.56 15 0.16 0.28 3 0.16 0.74 16 0.07 0.12 19 0.65 0.59 21 0.54 0.69 20 0.12 0.25 22 0.91 0.55 23 0.15 0.63 24 0.21 0.15 1 0.52 0.94 25 1.11 0.41 18 0.50 0.99 26 0.11 0.03 15 0.89 0.17 27 0.62 0.78 12 1.18 1.59 Average fif0.50 0.41 0.49 0.62 l 2 Period when lunches from home were eaten Period when lunches were purchased at school 40. ...~. 41. 0.09 milligrams percent from January to February while that of the experimental group rose 0.15 milligrams percent. At the ninety-five percent confidence level, this difference of 0.22 milligrams percent is significant. A relationship be- tween ascorbic acid intake and blood concentration was evi- dent (Table XI). The results also indicate that the average plasma concentrations of vitamin C were above those consid- ered indicative of a deficiency state but below those be- 1ieved to support Optimum nutrition. The correlation coefficient between the fifty-two ascorbic acid intakes (Table IX) and the corresponding fifty- two plasma ascorbic acid concentrations (Table'x) was calcu- lated to be«+0.6. According to Dixon and Massey Jr. (1951) this is equivalent to a-+0.4 population correlation coeffi- cient. This is in close agreement with Putnam and associates (1949) who obtained coefficients of'+0.395 and*t0.4l6 when they studied the ascorbic acid intakes and blood concentra- tions of large groups of peOple. The food acceptance records obtained in October, 1950, were examined and the data summarized in Tables XII and XIII. It will be noted that in the majority of cases the number of foods disliked by the children was considerably greater than the number of foods which the subjects checked as unknown. Eighteen of the twenty-six subjects disliked more than twice as many of the listed foods as those with which they were unfamiliar. Fourteen of the children 42o 1.1 25.85 noapenpneonoo 32 «5.8 . 3.8 3.6 8.0 63.384 seamen 793 oxuvflH fionb H.95 0.0@ 0.05 cdod adenoeuq unasnnoh humaneh huusnnoh Shannen macaw Hepqeednemnn macaw flamenco mmbomc A 4 _ _ -' .‘I' '_ . - .. ‘ . ...: ‘1 ... u ‘ . . I . ‘ - ‘7 J I v... - i a . - n C” .' r . ‘3 - .V N“ ‘.-H .9- --. . . A A “-—‘ - r. . e\‘ U .. I .‘-‘ .5» w . Vt. . ‘F \>, 6 .x’ - h-‘lfl- -I-_-‘ .- ~ mn‘me—fv 1‘ ... . *- . -“ . '- \-' ‘ “ ' .. . . . . i. ‘ I.--1I-v —h-“ I . - . 7‘ - “‘— n-vn‘ Ob . A» "D‘ 45. disliked four times as many of the listed foods as those with which they were unfamiliar. In January and February, 1951, diet records were ob- tained for the seven day periods immediately preceding the blood samplings. These records were studied to determine how often each child ate foods which he had listed in Octo- ber as unknown or disliked (Tables III and XIII). The chil- dren in the control group (those who carried their lunches from home both in January and in February) showed little acceptance of unknown or disliked foods. This may have been due to the efforts of the mothers of the children to include in the lunches the foods which the children liked. The ex- perimental group (those who carried their lunches in Janu- ary and participated in the school hot lunch program during February) showed three times as great an acceptance of foods which they had listed as disliked or unknown as did the children in the control group. These data suggest a broad- ening of food acceptance in the experimental group. It is recognized that changes in food habits take place slowly. Therefore, no great change in eating habits would be expected in a five month period. SUMalARY AND CONCLUSION SUMMARY AND CONCLUSION In October, 1950, thirteen pairs of children in the third and fourth grades of Visitation School in Detroit, Michigan,were matched according to age, height, weight, and economic status. One of each of the pairs was requested to bring his lunch to school from.00tober, 1950, through Febru- ary, 1951, while the other thirteen children were asked to partake of the hot lunch at school from October, 1950, through December, 1950; to carry their lunches from January 3, to January 27, and to partake of the hot lunch at school from January 29, 1951, through.February, 1951. Fasting finger-tip blood samples of each subject in both groups were taken on January 27, and on February 23. Approximately two weeks before each blood sample was col- lected, forms to be used to record each subject's daily food consumption were sent to the homes of the children. The blood samples which were analyzed for plasma ascorbic acid yielded results which indicated that the lunch program had a significant beneficial effect on the vitamin 0 nutrition of the subjects in the experimental group. The food records were analyzed by use of the short method of Donelson and Leichsenring (1945) and the calorie, protein, calcium, vitamin A. and vitamin c intakes were estimated. The results indicated that the children who partook of the 47. school lunch consumed a significantly higher amount of ascorbic acid than did the children who brought their lunches from home. In regard to the four other nutrients studied, the comparative estimated increases or decreases of the diet— ary nutrient levels were statistically insignificant. The height, weight, and age records indicated no appre- ciable difference in the average gains for the two groups. In October, 1950, each child in both groups was questioned concerning his food likes and dislikes. Using the results recorded on this questionnaire, the diet records were studied to ascertain how often the subjects ate foods they disliked or with which they were unfamiliar. The results suggest a broadening of the food acceptance of the children partak- ing of the school lunch. LITERATURE CITED 48. LITERATURE CITED Abbott, 0. D., R. O. Townsend, R. B. French, and C. F. Ahmann 1946 Effectiveness of the school lunch in improving the nutritional status of school children. Fla. Agr. Expt. Sta. Bul. 426. Anon. 1950 Net. Educ. Assn. Jour., 39:720. Augustine, G., M. McKinley, S. L. Laughlin, E. L. James, and E. Eppright 1950 Nutritional adequacy, cost, and ac- ceptability of lunches in an Iowa school lunch program. J. A. D. A., 26:654. Beach, E. F., A. P. Harrison, M5 Lesher, I. Kaucher, C. Roderuck, W. Lameck, and E.Z. Noyer 1948 Nutritional status of children: V blood serum protein. J. A. D. A., 24:405. Burke, B. 1947 The dietary history as a tool in research. Je Ae De Ae, 25:10410 ' Callison, E. C. and E. 0rent-Keiles 1947 Availability of carotene from carrots and further observations on human requirements for vitamin A and carotene.~ J. Nutr.,34: 153. Chapin, F. S. 1947 Experimental Designs in Sociological Research, Harper, New'York, 206 pp. Committee on Nutrition Surveys, Food and Nutrition Board, Division of Biology and Agriculture. 1949 Nutrition Sur- veys: their techniques and value. Nat. Res. Coun. Bul. 117. Cooperstock, M., E. Morse, E. 2. Meyer, 1. G. Macy 1948 Nutri- tional status of children : IV nutritional conditioning in a health camp. J. A. D. A., 24:205. Crandon, J. H., C. C. Lund, and D. B. Dill 1940 Experimental human scurvy. New Eng. J. Med. 223:559. Darby, W. J. 1947 The influence of some recent studies on the interpretation of the findings of nutrition surveys. J. A. D. A., 23:204. Dixon, W. J. and F. J. Massey Jr. 1951 Introduction to Statis- tical Analysis. MCGraw-Hill, New York. 49. Donelson, E. G. and J. M. Leichsenring 1945 The food com- position table for short method of dietary analysis. J. A. Do A., 21:440. ' Eppright, E. S. 1950 Food habits and preferences-a study of Iowa people of two age groups. Iowa Agr. Exp. Sta. Res. Bul. N0. 376. Farmer, C. F. and A. F. Abt 1936 Determination of reduced ascorbic acid in small amounts of blood. Proc. Soc. EXPe BiOIe and Made, 34:146e Goldsmith, G., Food and Nutrition Board, Division of Biology and Agriculture 1949 Nutrition surveys : their tech- niques and value. Nat. Res. Coun. Bul. 117, Section III. Grant, F.‘W. 1950 Effect on eating habits of nutrition edu- cation in the fifth grade. J. A. D. A., 26:413. Guthe, C. E. and M. Mead, Committee on Food Habits 1945 Manual for the study of food habits. Nat. Res. Coun. 111. ' Hardy, M., A. Spohn, G. Austin, S. MCGiffert, E. Mohr, and A. Peterson 1943 Nutritional and dietary inadequacies among city children from different socio-economic groups. J. A. D. A., 19:173. Hunscher, H. A. and I. G. Macy 1951 Dietary study methods: I uses and abuses of dietary study methods. J. A. D. A., 27:558. Johnson, R. E., R. C. Darling, F. Sargent, and P. Robinson 1945 Effects of variations in dietary vitamin C on the physical well being of manual workers. J. Nutr., 29:155. Johnstone, W. M., R. T. Drake, T. G. H. Drake, F. F. Tisdall, and F. H. Harvie 1946 A study of ascorbic acid metabolism of healthy young Canadians. Canad. Med. Assoc. J., 55:581. Kerk, R. M., H. F. Aiton, E. D. Pease, W. B. Bean, C. R. Hen- derson, R. E. Johnson and L. M. Richardson 1947 Tropical deterioration and nutrition; clinical and biochemical observations on troops. Medicine, 26:1. Kaucher, M., E. Z. Moyer, A. P. Harrison, R. U. Thomas, M. M. Rutledge, W. Lameck, and E. F. Beach 1948 Nutritional status of children: VII hemoglobin. J. A. D. A., 24:496. Kruse, H. D., 0. A. Bessey, J. S. McLester, N. Jolliffe, F. F. Tisdall, and R. M. Wilder, Committee on Diagnosis and Pathology of Nutritional Deficiencies, Food and Nutrition 50. Board. 1943 Inadequate diets and nutritional deficiencies in the United States. Nat. Res. Coun. Bul. 109. Mack, F. B. 1947 Nine-year study of the school lunch. J. of Home Ec., 39:73. Mickelsen, 0., W. O. Caster, and A. Keys 1947 Statistical evaluation of thiamine and pyramine excretions of normal young men on controlled intakes of thiamine. J. Biol. Chem., 168:415. Minot, A. 3., K. Dodd, R. Frank 1940 A survey of the state of nutrition with respect to vitamin C in a Southern pediatric clinic. J. Pediatrics, 16:717. Moser, A. M. 1945 Nutritional condition of children in rela- tion to school lunches in two South Carolina rural com- munities. S. C. Agr. Exp. Sta. Bul. 359. Moyer, E. Z., A. P. Harrison, M. Lesher, and O. N. Miller. 1948 Nutritional status of children III : blood serum vitamin C. J. A. D. A., 24:199. Pendergast, W. S. 1938 Prerequisite training and internship for the school 1unchroom.manager. J. of Home Ec., 30:684. Peters, R. A., and the Vitamin C Sub-committee, Medical Research Council 1948 Vitamin C requirement of human adults. Lancet, 1:254:853. Putnam, P., D. F. Milam, R. K. Anderson, W. J. Darby, and P. A. Mead 1949 The statistical association between the diet record of ascorbic acid intake and the blood content of the vitamin in surveyed populations. Milbank Memorial Fund Quarterly, 27:355. Ratcliff, J. D. F 1941 Eating their way to health and learn- ing. Reader's Digest, 38:93. Robinson, A., M. Lesher, A. P. Harrison, E. Z. Moyer, M. C. Gresock, and C. Saunders 1948 Nutritional status of children VI : blood serum vitamin A and carotenoids. J. A. D. A., 24:410. Sevringhaus, E. L., Committee on Nutrition Surveys, Food and Nutrition Board, Division of Biology and Agriculture 1949 Nutrition surveys : their techniques and value. Nat. Res. Coun. Bul. 117, Section I. Stiebeling, H. E., Committee on Nutrition Surveys, Food and Nutrition Board, Division of Biology and Agriculture 51. 1949 Nutrition surveys : Their techniques and value. Nat. Res. Coun. Bul. 117, Section II. Storvick, C. A., B. Schoad, R. E. Coffey, and M. B. Dear- dorff 1951 Nutritional status of selected population groups in Oregon. Milbank Memorial Fund Quarterly, 29:165. Suvarnakich, K., G. V. Mann, and F. J. Stare 1952 Ribo- flavin in human serum. J. of Nutr., 47:105. Todhunter, E. N. 1942 The evaluation of nutritional status. J. A. D. A., 18:79. Velat, G., 0. Mickelsen, M. L. Hathaway, S. F. Adelson, F. L. Meyer, and B. B. Peterkin 1951 Evaluating school lunches and nutritional status of children. United States Department of Agriculture in cooperation with the Federal Security Agency, Wash., D. 0., Cir. 859. Wiehl, D. 1942 Diets of a group of aircraft workers in Southern California.‘ Milbank Memorial Fund Quarterly, 20: 3290 Woodward, E. S. 1937 80,000,000 meals : Hygeia, 15:1015. Youmans, J. B. and E. W. Patton 1942 Laboratory diagnosis of nutritional deficiencies. Clinics, 1:303. APPENDIX FORM FOR THE ESTIMATION OF ECONOMIC STATUS 1 Part I Material Equipment and Cultural EXpression of the Living Room of the Home 1. Floor, softwood - 8.4 , hardwood (usually narrow boards) 13.9 2. Large rug 5.6 3. Windows with drapes 3.6 each 4. Fireplace with three or more utensils 34.3 5. Artificial light, electric 12.0 , kerosine -3.0 6. Library table -1.0 7. Arm chairs 4.1 each 8. Piano bench 5.2 9. Desk: personal, social 2.3 10. Bookcases with books 3.4 each 11. Sewing machine 2.0 12. Couch pillows 0.7 each 13. Alarm clock -5.3 14. Periodicals 1.6 each 15. Newspapers 7.7 each 16. Telephone 24.4 170 Radio 8.0 Part II Conditions of Articles in the Living Room 18. Cleanliness of room and furnishings a. Spotted or stained -19.4 be DuSty , -907 c. Spotless and dustless 9.7 19. Orderliness of room and furnishings a. Articles strewn about in disorder -l9.7 b. Articles in place or in usable order 19.7 20. Condition of repair of articles and furnishings a. Broken, scratched, frayed, ripped, or torn -16.3 b. Articles or furnishings patched up -8.1 0. Articles or furnishings in good repair and well kept 8.1 21. Record your general impression of good taste. a. Bizarre, clashing, inharmonious, or offensive -5.4 b. Drab, monotonous, neutral, inoffensive -2.7 c. Attractive in a positive way, harmonious, quiet and restful 2.7 52. 53. Penalties: 1. Use of the living room also as a dining room. -6.0 2. Use of the living room also as a kitchen -9.0 3. Use of the living room.also as a bedroom or as a dining room and kitchen combined -12.0 4. Use of the living room also as a bedroom, dining room, and kitchen combined ~15.0 Ranges in Scores Classes Examples 250 and over Upper 1. upper part Professional, physician 200---249 2. lower part Small town banker 150---199 Middlel. upper part Factory manager 100---l49 2. lower part Skilled trades 50--- 99 Lower 1. upper part Unemployed semi-skilled 0--- 49 2. lower part Unemployed unskilled lChapin, F. S. Experimental Designs in Sociological Research. New'York:_Harper, 1947, pp.‘191-194. CAFETERIA.MENU FEBRUARY 21, THROUGH FEBRUARY 27, 1951 February 21 Noodle and tuna fish cas- serole and/or Toasted cheese sandwiches Fruit cup Milk Stewed tomatoes French fried potatoes February 22 Chili con Carne mashed potatoes Green beans Bread and butter Milk Canned peaches February 27 February 23 Hard boiled eggs and/or Toasted cheese sandwiches French fried potatoes Peas and carrots milk Cherries and/or orange Juice February 26 Spaghetti and.meat balls American fried potatoes Stewed tomatoes Bread and butter Fruited Jello Milk Frankfurters and relish Mashed potatoes Bread and butter Green beans Milk Orange or tomato Juice FOOD ACCEPTANCE QUESTIONNAIRE Vegetables: Potatoes-mashed 4French fried -Ameiican fried -chips Peas -plain -soup String beans Carrots -raw -cooked Cabbage -slaw -boiled Lettuce olarge peices otossed Corn -cobbed -canned Tbmatoes-fresh ~canned -Juice Beets Turnips Parsnips Fruits: Peaches -canned ~fresh Pears -canned -fresh Oranges -Juice ~fresh Cherries-canned -fresh Plums -canned ~fresh Grapes ~white -b1ue Raisins Apples -sauce -fresh Meat and Protein Dishes: Cold meat-liver -boloney Hamburger . Frankfurters Roast beef Steak Chicken Turkey Liver Stew Boston baked beans ____ Ham -cold -hot Roast pork Bacon Pork chops Lamb chOps Pork sausage Tuna fish salad Tuna fish and noodle casserole ____Dairy Products: ____ Eggs ~salad sandwiches -scrambled with bacon -hard boiled Milk -white -chocolate Butter Cheese -grated -sticks -sandwiches -toasted Miscellaneous: Bread -white ~brown Jello -p1ain -whipped -fruited Pudding -chocolate ~butter- scotch -raisin Split pea and bacon casserole Spaghetti and meat balls 55. _.. “.9. u 56. FORM FOR FOOD-INTAKE RECORDS Dear parents, 0n the morning of Tuesday, January 23, trained personnel will be at school to take a small blood sample from.the finger tip of each child whom I have asked to help me with my thesis. These sam- ples will be analyzed for their vitamin C content. Since the amount present in the blood is affected by the food eaten at break- fast, it is necessary that I ask the children not to eat any fruit, fruit juice, vegetable, or vegetable Juice for breakfast on the .morning of the test. Cereal, toast, butter,.milk, cocoa, and sugar may be eaten, however, since they do not effect the test. The chil- dren will attend school as usual, and I will send to their rooms for them when we are ready. It would help me very much if you would have bring the inclosed record of his diet for the week of January 16-23, with him when he comes for his test on the morning of January 23. I would be grateful, too, if you would fulfill the following directions in completing the daily record of his diet. Please list the food eaten with the approximate measure consumed (for example: 1 small orange, 1 large glass of milk, 3 tablespoons of peas, or 2 slices of bread and butter). Under "How prepared," please list: baked,boiled,.mashed, or whatever the method might be. Thank you for your kind cooperation, Gratefully yours, Janl 1951 Amount Food How He pared Jan. 17 1951 Amount Food How Prepared rea as: EreEEIasE Lunch: Lunch: Dinner: Dinner: In between meals: In between meals: 311.18 1951 Amount Fbod How Fepered Mlgfil Amount How Prepared EreEEI t 88: Lunch: Dinner: In between MEETS: Juuzgggd Bre ash Dinner: In between meals: re asg Dinner: In between-meals? Jun 121 Brea ash Lunch: Dinner: Inlbetween‘meals: 57. 58. Jan. 22, Amount Food How Jan. 23, Amount Food How 1951 Prepared 1951 Prepared Ereakfest: . Breakfast: Lunch: Dinner: In between meals: .... . 41...... vi. ’1 ~ .I. l. 1 . §.I.\t. o . .111: )u\'.‘. ..4 ...fkn.\ . 5. ... f a .. .c. .. 5‘ . . 13.1.]. 7? .. 7,. .r. ...; . -. . rib? ."r \uycv... . J 1. ....u..:. . . .....,..-1v1.w.. ages...“ .. .....e... . ...; fr, -. s 1".A(Y..:v .W'Iflb‘ .F-‘