107 620 THS THE EFFECT OF TWELVE LESSONS 1N FOOD AND NUTRITION ON THE FOOD HABITS OF CERTAIN WOMEN PATIENTS AT INGHAM COUNTY Tb BER CULOSIS SANAI'ORIUM Thesis for the Degree of M. S. MECHIGAN STATE COLLEGE Blanche Fearing Erkel 1945 1:11:31: This is to certify that the thesis entitled The Lffect of Twelve nebsons in food and Nutrition on the E003 Habits of Certain Lomen Patients at Inghem County Tuberculosis Senatorium. presented by Elanche Bearing erel has been accepted towards fulfihnent of the requirements for m. 5. degree inFOOd and Nutrition 1 Date DOPt-leflber ‘LL L945 i { .5" .1. :f‘3‘1"‘i3é.~#““£w¥fi. vi. i'LfiLg‘fv'jT...flaw"; "33;.1,‘ . I a ’{H‘k {krillfifqm “WV; 7"" ifi'fi‘ltig‘v‘fi .. = ‘ a" '-':~3g';“';IX" ' ~t 133.6 ' 'g\\m‘”§‘ :er- .‘ 'I" 1.14}. - cw “qr“ * 4}) I)“ "w." .. 5‘th mi”. a?" w; “"A‘l": 'I’""s' "H?" g!" .‘_‘ - ' 7 1‘3 .1 L if ~. -r ‘ .} - .t‘fl‘ ’ ‘fl-".Jf‘ T‘ ‘ ‘. 3.: -. I13? . X ‘ $~ , . i ‘ 1'i .XEI-isfi. " hi" I“ '. 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' -J..' ‘1: R' I :Zé' . ‘ - "W110 H 7‘ ' ‘3 u‘, 1" ““3" ' ~ ‘ ..3 on I. r - I . . c . , ‘o § ‘ ‘tI: lt‘fi“!~-’J('T‘ ‘ol ‘\1‘V.x- :,,°._Pl‘. ‘Vf ‘ o THE EFFECT OF TWELVE LESSONS IN FOOD AND NUTRITION ON THE FOOD HABITS OF CERTAIN WOMEN PATIENTS AT INGRAM COUNTY TUBERCULOSIS SANATORIWM by BLANCHE FEARING EEKEL A THESIS Submitted to the Graduate School of Michigan State College of Agriculture and Applied Science in partial fulfilment of the requirements for the degree of MASTER OF SCIENCE Department of Foods and Nutrition School of Home Economics 1945 THESIs lI‘he writer wishes to express her appreciation to Dr. Jean Hawks, under whose direction this study has been conducted, and to Dr. Thelma Porter, Dr. Margaret Ohlson and Dr. Marie Dye for their advice and helpful suggestions. The writer is also grateful to Miss Olive Henderson, dieti- tian at Ingham County Sanatorium, for her cooperation which made this study possible. TABLE OF CONTEl-TTS I. INTRODUCTION .' . . . . . . . . . . . Purpose of the Study . . . . . . . RevieW'of the Literature . . . . . II 0 P:-JLO CEDDT-‘RE O O O O O O O O O O O O O 0 III. DISCUSSION AND RESULTS . . . . . . . Results of Test Scores . . . . . . Foods Most Liked or Disliked . . . Likes and Dislikes and the Consumption of Beets . . . . . . . . . . . . Relation of Food Likes and Dislikes Food Consumption . . . . . . . . to Changes in Food Consumption of Individual Patients . . . . . . . . . . . . Food Consumed by women Patients . . Food Consumption.of Men Patients . Adequacy of the Diets . . . . . . . IV. SUHMARY . . . . . . . . . . . . . . EPEIDE . C C O O O 0 O O O O O O O O O 0 Questions about Food and Entrition . . . A Study of the Food Likes and Dislikes of Sanatorium.Patients . . . . . . . . . . Series of Twelve Lessons . . . . . . . . Materials Used in the Foods and Nutrition Mimeographed.Material . . . . . . . . . . BIBLIOGRAPHY . . . . . . . . . . . . . . . Lessons PAGE 14 20 20 22 26 28 SO 35 58 59 59 41 46 74 79 as LIST OF TABLES TABLE I :3 I. CILIIIOISIADE as A RESULT OF IIUI’IRIIIOI: Ipoebns 13 II. SCORES on “SE TEST Tun BY PATIENTS BEFORE MID awn»: nu;- LIssOIIs n: l-TUTRITION . . . . . . 21 III . FOOD THE SMIATORIULI PaniIcrs LIKED VIII 1"EILL', Imam; IILL, on DISLZDIED . . . . . . . . 23 IV. AVILI-men areas on Inn‘s EAIIII BI“ TEE PATIENTS BEFORE, DURDIG, Ann AFTER nan IIJIIIIIIIIOII Lessons. . . . . . . . . . . . . . . . . . . . 25 V. FOOD anns 41:7.) DISLLCBS 01? iii]? PATIENES . . . . 27 VI. AMOUNT OF FOOD OOIISUMID BY SD: LIDIVIDUAL IIAIIIIIIS AT mans PERIODS . . . . . . . . . . 29 VII . TOTAL GPJLLS 035‘ F0 OD CONSUIIED BY Inn; cumm- ONE 270111-11 PATIEETS AT T 3131:”: PEE‘LIODS . . . . . 51 VIII. Gangs OF FOOD COLISUIILD BY THE CONTROL GROUP BEFORE AND AFTER Inn: LESSOl-ES than GIVIII. . . . 54 DI. ADEQUACY OF Inn DIETS smvnn we nan: BY THEPATIEI’JTS.................136 FIGURE 1. RELATIV E AMOUNTS OF CERTAIN FOODS SOLD BEFORE AND AFTER LECTURES . . . . . . . . . . '7 INTRODUCTION INTRODUCTION The results of the examination of selectees during the war showed that many of them had had.poor nutrition prac- tices and indicated that large groups of the population had been inadequately fed. Nutrition surveys have suggested the same thing; consequently, large sums of money have been spent to carry on nutrition programs in all parts of the country for the purpose Of teaching the people the importance of a balanced diet. Knowledge of nutrition has without a doubt increased, but it has been very difficult to measure the effectiveness of the program in terms of changed food habits. Some information has been obtained, however, by means of interviews or questionnaires or, better yet, by checking individual food consumption. 0 In the present study, it was possible to work with a selected group of patients in the Ingham.County Tuberculosis Sanatorium. It is especially important that these patients realize the value of proper eating habits, because adequate food is necessary not only in the treatment of the initial infection, but in the prevention of recurrences. The pa- tients received a series of lessons on food and nutrition. Since they had the food served in the institution, it was possible to make food consumption studies before, during, and after the lessons. These studies, as well as some other tests, indicated the changes in food habits. -2- There were several reasons for conducting this study; first, to find out if an increased knowledge of nutrition changed the eating habits of the sanatorium patients; second, to find the relationship of their likes and dislikes to the amount of food eaten; third, to give the patients some use- ful information that they might be prepared to guide their families' food habits when discharged from.the sanatorium; fourth, to increase the total food and kind of food consumed by the patients in the hospital; fifth, to decrease the amount of food refused or wasted; and sixth, to evaluate the available teaching materials for the purpose of developing a set of twelve popular lessons for food and nutrition. MIN OF THE LITERATIRE There have been few studies conducted for the purpose of determining the effect of nutrition teaching on food intake patterns and total food consumption. A.few studies, however, indicate the value of nutrition education. workers in the New York Public Health Department carried out a study to evaluate the effect of several different teaching techniques in diffusing nutrition knowledge. The Kips Baerorkville area of New York City was used for this study, because it contained various social, cultural, and educational groups. This area has within its boundaries Fifth and Madison Avenueu,which is the wealthiestresidential section in the city,and also a slum.district containing some of New York's most inadequate homes. The investigators -3- studied some of the problems of nutrition as related to the lowbincome portion of the urban population. The upper and middle-income groups received some information, but the re- sults of the study were based on data obtained in the lowa income group. .A community organizer, a nutritionist, and a sociolo- gist constituted the full-time staff. These three workers could not carry the entire program, if it was to be effec- tive; so it was necessary to use volunteers. These volun- teers were selected and trained to do the type of work for which they were best suited. They carried on a major part of each of the nutrition programs that were reported in this study. The investigatdrs tested several teaching devices. First, they put pesters on nutrition in the grocery stores. Second, they held nutrition lectures, and third, they of- fered a series of classes. Fourth, they organized a food information center in a public building to answer questions and give out printed.material. Fifth, they tested the abil- ity of a mobile kitchen unit to interest people in nutrition classes. Sixth, they taught nutrition through a department store promotion campaign. Seventh, they measured the effec- tiveness of volunteers as teachers of the nutrition classes. The investigators placed a poster THi Neighbor--Eat for Health" in 309 of the 520 stores in the district for one week and put exhibits in 112 additional grocery stores. They tested the effectiveness of the nutrition posters by a random.check of the food store patrons. The results were -4- controversial, but the posters were probably ineffective. Koos reports that, "They did, however, appear to have a good effect upon the merchants who displayed them." During the first six:months of the Nutrition Program, volunteers gave thirty-eight lectures to more than six thou- sand persons. They gave eighteen lectures to lowaincome groups at such organizations as Parent-Teacher Associations, Day Nursery Groups, and Settlement House Groups,and inter- viewed fifty-four people to find the effect of the lectures. Only two people remembered specific details, but many gained general information. Therefore, they concluded that al- though it was not the most impressive means for teaching nu— trition, the lecture method did have a positive effect and was worth utilizing. It was more effective if combined with motion pictures. It was difficult to get the people to attend and also to hold their interest in nutrition classes. When the in- vestigators questioned those who did not want to attend the classes, they found that 66% thought they knew enough without the course and 44% said they could not take the time. At the beginning, there were 754 persons enrolled,but at the end of the sixth lesson, only 20% of the first attendance remained. This caused the staff great concern. They ques- tioned such factors as teaching techniques, but the people who were interviewed said that their main.reason for discon- tinuing the course was the weather. They had been shut up in tenement houses all winter and were anxious to get outside when spring came. -5- The people did not respond well to the food information center which was established to provide information on the best buys on food, balanced meals, new uses of vegetables, new recipes, and so on. Although the booth was in a con- venient place, the District Health Center, few people used the facilities. When interviewed, 64% of the people who did not use the food information center, did not realize the need for additional information about food. The mobile kitchen wesadsmonstration type of procedure used to enlist the interests of women as they sat in parks, playgrounds, and the like. The nutritionist and trained volunteers gave short talks, distributed literature and took the names and addresses of those who would be interested in coming to nutrition classes. They distributed small whole- grain sandwiches and other foods high in nutritive value to arouse interest in nutrition classes. .More than ninety women expressed a desire for nutrition lectures and gave their names and addresses. The worker: mailed cards to these women, telling them the time and place of the nutri- tion lectures, and explained that their children would be taken care of during the classes. Nineteen women answered, indicating they would attend. Nine of these appeared. Four of them had had courses in nutrition and wanted more infor- mation, because they were interested. Department store promotion was more effective than other methods of teaching. Bonwitt Tellers and Saks- Fifth Avenue laintained cafeterias for their employees and wanted -5- them to know more about foods and their values. The method of approaching the problem was simple. The volunteers pre- pared and gave "minute man talks" to the cafeteria patrons. Despite the multiplicity of cultural backgrounds and of edu- cational etperience, all of the people who heard these talks 'accepted the nutrition information with enthusiasm. The volunteers measured the results by the change in food habits in the cafeteria. Figure 1 shows that people selected more balanced meals after they had received the nutrition talks. The investigators concluded that volunteer help was quite effective, because they usually had the ability to reach the people and could understand their problems. Teaching in connection with the actual eating situation was more effec- tive than any other method. Investigators in the Division of Program Surveys of the United States Department of Agridulture also realized the necessity of determining the most effective way of teaching nutrition. Two methods had been used in a number of towns: first, a general community program; and second, a more in- tensive in-plant program. This division conducted a study for the purpose of measuring the effects which had been achieved by outstanding examples of each of these two types of programs. They selected three war plants in Peoria, Illinois, and two in Evansville, Indiana, because the programs in these cities had been outstanding examples and were considered successful. -BONWITT TELLER ---- Milk i3‘l,ooo,'|'ig iii'l . Whole grain melfifl bread fi Fresh fruits , and vegetables Tomato juice b Coffee I ' ""f Wmlw.,v;'g‘l Tea Milk Whole grain , ,, bread Tomato juice hum Before - After FIGURE 1 RELATIVE AMOUNTS OF CERTAIN FOODS SOLD BEFORE AND AFTER LECTURES* *See "Food in the Lives of Our Neighbors," issued by the Kips Bay- Yorkville District Health Committee, NeW' YOrk City. -8- Peoria had had quite an extensive community program. There had been a series of six public nutrition lectures sponsored by the manufacuter's association which was com, posed of fifty-six local companies. These lectures were given wide community publicity and were well attended. The local Gas and Light Company had sponsored weekly THmme- maker's clinics" for several previous years. These were public meetings primarily concerned with cooking and meal planning and were attended by as many as a thousand persons during a single month. The Gas and Light Company also spon- sored a radio program on nutrition which was broadcast over the local station five times a week,and distributed free literature from.the downtown office. The study included a survey of three in-plant programs in Peoria. Investigators in.Plant A.used an in-plant educa- tion system. This centered around the cafeteria. They fea- tured a victory lunch containing the foods necessary for a balanced meal and displayed posters showing the basic seven foods. They also took an active part in the community pro- gram by sending notices of meetings to the workers and by advertising these meetings in the plant publications. In Plant B the investigators did nothing in connection with the cafeteria, but they did distribute pamphlets on nutrition to a large number of employees. They also cooperated with the community program by sending notices to the workers. In Plant C there was no organized attempt to influence the eat- ing habits of the workers, although occasional notices re- -9- lated to food were posted on the bulletin board. Emansville did not have a community program.oomparable to that of Peoria. The local Office of Civilian Defense and Red Cross, in cooperation with the Gas Company sponsored a series of nutrition lectures. These were similar to the series held by the Gas Company in Peoria,but there was no special campaign to obtain publicity and business support. EVansville was the home of a large company designated as Plant D, which prided itself on its in-plant program of nutrition education. This education centered around the victory lunch. which was served in the cafeteria. ‘Large posters over the serving counters displayed the values of the foods served in the victory lunch and the virtues of a balanced diet. On each table there was literature regarding a good diet. At intervals the company held special cam- paigns to increase the consumption of milk or salads. They even conducted raffles giving each worker who bought a vic- tory lunch a chance at the prize. Plant E was comparable to Plant D in size and number of workers, but it had done almost nothing to instruct workers about nutrition. The workers of both plants were equally exposed to community programs. The investigators chose a sample of 274 industrial workers at random from.the roster of these five war plants in the two cities. Then they interviewed these people to find out the effect of the community and in-plant programs. In Peoria only a few people from.the worker's families attended the community nutrition.meetings, although many had -10- heard something about them and thought they were a good idea. Very few had criticisms to make. Less than ten per cent of the workers said that they had changed their diets as a result of the program, The in-plant programs in Peoria had little effect on the workers. Very fGW'Of them felt that they had changed their food habits because of the nutrition programs. Plant A.had a little more success than the other plants; its program, however, had an effect only among those workers who ate in the plant cafeteria. Four-fifths of the Evansville workers had never heard of the community program, Thus, practically none of the workers had benefited from.the program. The workers in Plant D were highly aware of an in-plant program” Almost half of them believed that they had made some changes in their diet as a result of the teaching. Most of these changes, however, were in the worker's noon meal in the plant. Nevertheless, about one-fourth of them reported that they were eating differently in their meals at home . The community lectures were not very successful, be- cause: (1) Many people were satisfied with their present diet and cooking methods; (2) they believed that the pro- grams recommended an impractical diet for working people; (3) they lacked experience with public lectures, and hesi- tated about attending meetings with women of higher social status; and (4) the time and place was inconvenient. -11- Teaching through the cafeteria was much more satisfac- tory, because: (1) The informational stimuli were simple‘ and direct; (2) the worker received this nutrition informa- tion while he was choosing his food; (5) the cafeteria pro- gram, particularly as it involved the victory lunch, empha- sized the concept of a balanced diet rather than isolated terms about canning, cooking, or individual food elements; (4) the cafeteria utilized the important factor of social suggestion; (5) the arrangement of the food in the cafeteria counters according to the elements of a balanced diet made the selection of a nutritious meal more likely. The same government agency interviewed housewives in Bridgeport, Connecticut and Richmond, Virginia. They chose these cities for the study, since both had experienced in- tensive programs of nutrition education, conducted through the radio, newspapers, magazines, booklets, pamphlets, meet- ings, and classes. In each town they interviewed a representative sample of two hundred housewives. Ninety per cent of the women had had some contact with nutrition education, but their knowledge was often fragmentary. TWO-fifths of the women understood the concept of‘a balanced diet. Few women understood how nutrition could help them, and even war food restrictions had not aroused a feeling of need for nutrition education. Whmen got more information from.newspapers and magazines hhan from.booklets and pamphlets; however, those who really read the latter, made use of the information. -12- A radio program which combined information with enter- tainment seemed.much more likely to reach all wemen. They were not interested in a formal talk on nutrition. Although the program was not entirely effective, Table I shows that over 20%'of the housewives had made important changes in their diets as a result of the programs. women who had had some nutrition knowledge displayed more initiative than others in obtaining nutrition information and used this information in more important ways. Therefore, it can be said that a little information goes a long way, for if the housewife has taken the first step in acquiring nutrition information, she can be trusted to increase her knowledge. -13- TABLE I Changes Made as a Result of Nutrition Programs“ In In Bridgeport : Richmond 21% : 28% Have made some important food changes as a re- sult of receiv- ing nutrition information 36% have made minor changes 42% 25% have contacted programs, but made no changes 22% O. 13% : 9% have made no contact with programs * See "Housewives Discuss Nutrition Programs," May 1944, issued by the Bureau of Agricul- tural Economics. PROCEDURE PROCEDURE The Board of Control of Vocational Education and the Altrusa Club of Lansing started a series of homemaking les- sons at the Ingham County Tuberculosis Sanatorium during the spring of 1944. They felt that classes in homemaking educa- tion would be especially beneficial to this group of over fifty women, many of whom.will return to their homes when released frem the sanatoriumt Mrs. Jean.Hansen, the social worker in charge of vocational rehabilitation, interviewed the women patients to find out in which phases of homemaking they were most interested. They selected interior decoration as first choice and nutrition as second choice. Miss Grace Rinard, supervisor of homemaking education in.Lansing, taught interior decoration to the patients during May and June, 1944. . The nutrition unit, a part of the present study, fol- lowed the lessons in interior decoration. The instructor conferred with the patients before establishing the objec- tives for the course and then gave a series of twelve lessons on nutrition. The available facilities and the results of previous studies determined the teaching methods used. Since the sanatorium was equipped with a radio system having a.microphone on the main floor and head phones for each pa- tient, the instructor gave thirty-minute lessons once each ‘week. Same of the patients were able to sit up and attend -15- the lecture and take part in the discussion. The women who were on the floors in bed enjoyed hearing these discussions in which.members of their own group participated. The results of previous studies were taken into consid- eration when planning the lessons. As it had been found that the information obtained from.bulletins and pamphlets was really used, each patient received these materials and thus had time to read them, Patients frequently made such comments as, "I'm.glad I have a chance to take these classes now, because I have always wanted to take them, but have“ never had time to before." Facilities were not available for motion pictures, but other visual aids were used to sup- plement the lessons. The colored graphs published by the Dairy Council of St. Louis were particularly effective. The large colored charts that showed the nutritive value of good and poor meals also were effective. The vitapmin-go game was an entertaining way for the patients to measure their own food consumption. The effectiveness of general posters had been questioned and these were not used in teaching the lessons. As the cafeteria approach had been shown to be an effective way of improving food habits,the lessons were cor- related whenever possible with the actual food served in the sanatorium. Several methods have been used to organize nutrition material for teaching to lay groups. Hershey* reported that *Personal communication with.Miss Roberta Hershey, foods specialist in the Michigan State College Extension Service. -16- teaching nutrition from.the standpoint of meal planning and food service had proved the most satisfactory method in ex- tension classes in foods and nutrition. The Red Cross or- ganized their nutrition program around the food constituents, such as protein, calories, vitamins, and so on. many commu- nity programs utilized the basic seven foods and planned their lessons around these. There was a combination of approaches in arranging the subject matter for the lessons in this study. It was hoped that this would stimulate interest in nutrition. The studies previously reviewed showed that the people were not inter- ested in nutrition unless they felt that it was needed. The folloudng subjects were taught in the twelve lessons: Each of the first seven lessons included one of the basic seven foods as the nucleus. Each one emphasized the amount of the foods in the group needed in the daily-diet and the ways that the food could be used. The next three lessons dise cusses meal planning, breakfasts, lunches and dinners. Les- son XI summarized the work of Tisdall and Ebbs on prenatal diets. It pointed out the significance of food and its ef- fect on the outcome of pregnancy and the health of the baby. The last lesson emphasized the ways and means of controlling weight with food. The patients had asked to have this sub- ject discussed. An outline of the lessons including the objectives and the subject matter covered is presented in the Appendix, pages 4£»to 75. Although the outlines of the lessons appear -17- to be quite formal, the approach was informal throughout the entire program. The records of the cultural and educational backgrounds, which were available in the sanatorium files, were considered in adapting the lessons to the individual patient's needsand interests, in order to accomplish this type of personal teaching. The patients discussed their nu- trition problems with the instructor. They saved newspaper clippings about nutrition and wrote letters to their families emphasizing the importance of a balanced diet. The instructor selected teaching materials which would most nearly fulfill the objectives that had been set up for the course. These included booklets, pamphlets, and the like, from the United States Department of Agriculture, Michigan State College, the Michigan Department of Health, and various commercial companies. She distributed these bulletins and other materials to the patients on Wednesday of each week, so they could have time to look them over be- fore the lessons on Friday. ,A list of the materials used is in the Appendix, pages 74 to 78. The instructor took the illustrative material to the various rooms and carried on the discussion with each patient or group of patients after broadcasting each lesson. This took three or four after- noons each week. There were several methods used to determine the effec- tiveness of the nutrition lessons. The patients received a test to evaluate their basic nutrition knowledge. They were asked to check a list of foods to find out which ones they ~18- liked and which they disliked. The amount of food eaten by the women patients who were given the lessons was checked three times. The men patients served as controls. They had no lessons, but the food intake was checked at the beginning and the end of the period. The patients had the same tests before the lessons were taught and.again after the lessons were finished. In this way the results indicated the amount of knowledge gained. Since the patients were in bed and many of them were in poor physical condition, the test was a simple one-page objective type which could be filled out while the instructor waited (Appendix, page 39). It included questions concerning facts such as the deficiency diseases caused by lack of iron, iodine, and Vitamin D, the amount of milk required in the daily diet, the uses of foods in the body and foods which are good sources of specific vitamins and minerals. In order to find out how much the likes and dislikes of food influenced the food donsumption, the patients were naked to check a list of 110 foods. They indicated whether they liked each food very well, medium well, or disliked it. In a space at the side the patients added remarks stating specific reasons for their choices or told if they had not tasted the food. The three food checks, each of which was a record of the food the women patients consumed during the three consecu- tive days, were as accurate as possible. Only one floor could be checked at a time. Since almost all of the women patients were on the third floor, it was used for the food -19- checks. Moving the patients throughout different parts of the sanatorium made it difficult to have many of the same people for three months, but there were twenty-one patients who were on the third floor for the three consecutive checks. The trays were checked to determine the amount of food served to each patient and the amount of food eaten. Sample servings were weighed and a standard measure used to dish up the food. Second helpings and the amount of food returned were recorded. The trays were checked carefully when they were returned because of the danger of infection. The pa- tients had choices of afternoon and evening nourishment which consisted of orangeade, lemonade, chocolate milk, whole milk, or tomato juice. These foods were included also in the checks. In order to find out if other factors such as the time of the year and the type of food served influence the eating habits of the women patients, food checks were made on the men patients who did not receive the lessons. These were made at the beginning and end of the three-month period. DISCUSSION AND RESULTS DISCUSSION AND RESULTS Forty-five women received the complete set of twelve lessons. Of this group twenty-one patients were on the third floor for the three-month period and had their food intake measured. Result 2;,Test Scores Table II presents the scores which the twenty-one pa- tients obtained on the tests. These indicated that there ‘was a marked increase in knowledge of nutrition over the three-month period. It wdll be noted that with a total score of 20.0, the average score on the pretest was 15.9. It increased to 19.7 on the final test. The scores on the pretest showed that the amount of nutrition knowledge that the patients had at the beginning of the classes varied. One person had a score of zero and one had a perfect score. Four people had less than half of the questions right,while three had all but one correct. There was no question that everyone answered correctly, but some questions were better understood than others. Only two people missed questions number one, five, and six. Question eighteen was missed by fifteen patients and questions twelve and fifteen were missed by more than half of the women. Even those who hadLlow scores in the beginning had high scores in the end. In the final test, seventeen patients had a perfect score. No one -21... TABLE II SCORES ON THE TEST TAKEN BY PATIENTS BEFORE AND AFTER THE LESSONS 1N NUTRITION r Patient Pflt £19223: E.H. 12 19 B.T. 16 20 M.D. 17 20 V.T. O 20 J’.B. 14: 20 L.D. 12 20 M.G. 18 20 A.G. 18 20 L.F. 19 20 E.H. 16 20 Y.H. 20 20 H.M. '7 18 LR. 20 E.S. 8 20 G.S. 16 18 W.S. 19 20 C.R. 1'7 20 F.M. 14- 19 E.P. 19 20 j L.J. 14 20 ' P.P. 11 20 Total Scores 293 414 Average Score 13.9 '19.7 -23- missed more than two questions. Only six questions were missed by the entire group and no question was missed by more than one person. This test may not have been difficult enough for the most intelligent persons and could have been longer and more inclusive; however, it did indicate the trend of increase in knowledge and did not tire the patients. FoodsMost Liked g; Disliked Table III lists those food that were well liked by ten or more people, those medium.well liked by eight or more people, and those which were disliked by five or more people. .A sample of the check list used is found in the Appendix. Some foods appear in both the very well liked and disliked columns. In general, the patients liked the foods which they had been served at home and those with which they were most familiar. For example, the patients liked ham.and beef, but disliked roast mutton, variety meats, and canned fish. They liked potatoes, bread, and eggs, prepared in any way, and fruits. Grapes were the only fruit that was not well liked by ten or more people. Chicken and strawberries were the only two foods that all people liked. Five or more pa- tients disliked cold.meats. This may have been because of the frequency with which they have been served since the shortage of other meats. The vegetables which the patients disliked were those such as broccoli and parsnips, which they were not accustomed to eating. Several foods were never served in the sanatorium, because food administrators -25- TABLE III FOOD THE SANATORIUM PATIENTS LIKED VERY WELL, MEDIUM m, OR DISLIKED Foods Very Well Foods Medium Well Foods Disliked Liked by Ten or Liked by Eight by Five or More People gr Mgre Pegple Mops People Roast Beef Mashed Meat Loaf Corned Beef Pork Liver Potatoes Meat Balls *I-Ieart Sirloin Steak Creamed Corned Beef *Kidney Cureleam Potatoes Dried Beef *Tongue4 Round Steak Baked Potatoes IBeef Liver *Pork Liver Bacon French Fried. Pork Sausage *Salt Pork Beef SteW' Potatoes Cured.Ham. *Roast Mutton Roast Veal Scalloped Salt Pork Bologna Roast Pork Potatoes Roast Mutton Salmon Lamb Chops Cabbage Bologna Tuna Fish Pork Chops Lettuce ‘Wieners *Calf Liver Veal Chops .Asparagus Cold Meats *Sweetbreads Chicken Carrots Grapes *Brains Salmon Beets Sweet Rolls Sardines Calf Liver Celery Corn Bread *Oysters Tbmatoes String Beans Rice *Canned Milk Nayy Beans Peas Dry Cereal Buttermilk Lima Beans Onions Cooked Cereal *Ehdive Radishes Corn IMacaroni and *Turnips White Bread Squash Tomatoes *Rutabegas Whole Wheat Cucumbers IMacaroni and *Egg Plant : Bread Cauliflower Cheese *Broocoli Rye Bread Oranges Chili Con Carne *Brussel Sweet Rolls Grapefruit Sweet Pickles Sprouts Corn Bread Cherries Cabbage *Beet Greens Chili Con Apples Spinach Swiss Chard Carne Strawberries Beet Greens *Parsnips Chow Mein Raspberries Swiss Chard Cottage Cheese Olives Blueberries ,Asparagus Wieners Sweet Pickles Cantaloupe Beets ColeMeatl Dill Pickles watermelon Turnips Fried Eggs Peaches String Beans Boiled Eggs Pears Onions Whole Milk Pineapple Parsnips Cottage Cheese * Foods that are never served in the sanatoriwm. -24- had learned by the "trial and error method" that the pa- tients would not eat these foods. Likes and Dislikes and the Consumption g§_Beets It happened that beets appeared on the menu for all checks. Thus, table IV presents the average number of grams of beets eaten each time. There was an increase in the amount of geets consumed, even though some patients disliked them. The patients who liked beets very well ate an average of 82 grams per serving at the first check. Seven of the ten people ate the complete servings. They consumed the same amount at the second check, but at the third check they ate an average of 105 grams, and all except one person ate the total serving and two asked for second helprmgs. Those who liked beets medium well ate an average of 25 grams at the first check. Only one person ate the complete serving, and four people did not eat any. At the second check four of the people ate the complete serving and all of the pa- tients ate at least half of the beets. The average amount eaten was 81 grams at the second check and decreased to 56 grams at the third check. Two peOple ate the complete serv- ing at the third check, and two did not eat any. This shows that changes in food habits may be just transitory and the result of momentary enthusiasm.fading out as time passes. Those who disliked beets did not eat any at the first check. At the second check two of the patients ate part of their servings, making an average of 33 grams. At the third -25- TABLE IV AWE GRAMS OF BEETS EATEN BY THE PATIENTS BEFORE, DURING, AND AFTER THE NUTRITION LESSONS Checks _.4.. 3 _§_ Patients E. SEE; & Very Iell Liked 10 82 82 105 Medium Well Liked 8 25 81 56 Disliked 3 none 33 50 -25- check, one patient still did not eat any, but one had eaten the whole serving, which brought the average to 50 grams. This shows that, on the whole,all patients tried to eat more vegetables, whether they liked them or not. That the amount of food consumed was directly related to the likes and dislikes is shown in table V. This table does not include a complete list of foods, but only enough to point out this relationship. The patients ate a much larger portion of the food which they liked very well than of the food which they disliked. People who liked milk medium.well drank about three times as much (749 grams) as those who disliked it (258fgrams). Those who liked milk very well drank about four times as much (915 grams). Those who liked beets medium.well ate two times as much and those who liked beets very well ate three times as much as those who disliked them. Those who liked cabbage, cold meats, corned beef, and cooked cereal very well ate about twice as much as did the ones who disliked these foods. Grapefruit, a strong-flavored food, was an exception, with the one pa- tient who disliked grapefruit refusing it completely. Thus, in spite of the fact that increased food knowledge seemed to increase the consumption of a food such as beets, the likes or dislikes of the patients had a decided influence. -27- TABLE V FOOD LIKES AND DISLJKES OF THE PATIENTS AND THE NUMBER OF GRAMS OF FOOD CONSUMED Very Well Medium Well Liked g_‘ Liked Disliked Average Average Average Average Amount People Amount People Amount People Amount Served Eatenf Eaten Eaten gms. no. gms. no. gms. no. gms. 1000 11 915 7 749 3 253 100 10 9O 8 55 3 27 100 11 83 9 66 1 50 100 14 91 6 41 1 0 50 5 34 ll 24 5 15 75 2 75 10 54 9 32 100 4 vs 5 64 1 40 -28- Changes ig_Food Consumption 93 Individual Patients Table VI shows the total amount of food consumed by six individual patients on the three diet checks. These patients ‘were selected because of the differences in their eating habits. Those designated as patients 1, 2, and 3 had good food habits at the beginning of the study and did not show much change in food consumption during the study. Patients 4, 5, and 6 had poor food habits at the beginning and showed some increase. Patients 1, 2, and 3 could show little imr provement, for they ate almost all of the food served. Howe ever, in some instances they did show improvement. Patient 1 ate more meat and green and yellow vegetables after the lessons were taught. Patient 2 ate more cereal, less bread but more toast,and slightly more milk. Patient 3 ate more cereal and showed some increase in the consumption of cit- rous fruits and tomatoes and other vegetables. The other three patients showed marked improvement in eating some foods. Patient 4 showed an increase in the consumption of all foods except bread and milk. During the first check she ate none of the cereal, vegetables, or meat. At the final check she ate 300 grams of cereal, 120 grams of vegetables, and 120 grams of meat. Although this is still a Small amount of food to eat over a three-day period, it does Show improvement. Patient 5 ate an increased amount of cereal, other vegetables, fruit, meat, and green and yellow vegetables. Patient 6 ate more cereal, other vegetables, toast, potatoes, fruit, meat, and green and yellow vegetables. Those with Food Served Cereal Citrus or Tomatoes Other Vegetables Toast Bread Potatoes Fruit Milk Meat Green and Yellowr Vegetables -29.. TABLE VI AMOUNT OF FOOD CONSUMED BY SIX INDIVIDUAL PATIENTS AT THREE PERIODS Diet Size of Check Serving III I II III II III II III Ems- 500 300 300 400 500 350 100 250 220 90 90 90 180 180 180 600 400 400 350 350 450 5000 3000 3000 345 565 315 280 360 340 Patients , l 2 3 gms. gms. gms. 300 200 200 300 300 300 300 300 300 400 400 200 300 300 100 330 330 230 100 100 100 250 250 250 220 220 220 65 45 45 6O 75 90 '75 75 75 140 150 170 150 150 135 135 120 120 475 575 500 325 400 400 400 400 400 337 325 350 350 312 300 450 450 350 3200 1700 1300 3200 1700 1700 3200 1800 1500 295 320 270 280 340 340 315 315 315 112 280 180 275 360 360 340 340 840 Patients 4 5 6 gms. gms. gms. none none 100 250 250 300 300 250 300 250 400 350 100 200 250 330 330 330 none none 50 none none 250 120 170 170 57 65 10 7 5 45 7 5 75 6O 50 160 170 175 150 145 150 160 120 165 250 375 350 250 375 400 400 350 400 212 262 275 275 250 350 450 450 450 2200 2300 2800 1800 2200 2400 1900 2400 2600 none 170 220 65 210 340 120 315 315 70 110 155 65 305 360 140 340 340 -30- poor eating habits did improve, while those with good eating habits did not change much. The greatest improvement was shown in cereal, vegetables, and meat, which undoubtedly would improve the nutritive content of the diets. The physical condition of the patients did not seem to have any effect on their habits. Patient 1 has a far ad- vanced case of tuberculosis and has to lie flat on her back in bed all of the time, but her eating habits are much bet- ter than those of patient 4 who has only a minimal case of tuberculosis. Table VII shows the total number of grams served, the grams eaten, and the percentage eaten by the twenty-one pa- tients during the three food checks. This indicates that there was a change in the amount of food consumed as a re- sult of the lessons. The total food consumption increased from an average of 4,155 grams per person or 68$'of the food served at the first check to 4,760 grams or 85%»of the total food served at the last check. Foods showing the highest percentage of increase in consumption were the dry and cooked cereals, which increased over 35”. The consumption of butter, green and yelloW'vegetables, and other vegetables were next with increases of over 25%. Citrous fruits or tomatoes and meats showed an increased consumption of 20%. The grams of potatoes, fruits, desserts, and.milk consumed were approximately the same. The lesson on milk was, unfor- 551- TABLE VII TOTAL GRAMS OF FOOD CONSUMED BY THE TWENTY-ONE WOMEN.PATIENTS AT THREE PERIODS Check I Check II 1;_ Check III Pro- Pro- Pro- Food Amount Amount por- Amount Amount por- Amount Amount por- Served Served Eaten tion Served Eaten tion Served Eaten tion __ __ _E_z_a_1_:_e_1_1_ __ Eaten __ Eate gms. gms. % gms. gms. gms. gms. % Dry Cereal 330 140 42 300 260 83 300 245 81 Cooked Cereal 3000 1525 50 3300 2950 89 3300 2750 85 Pota- toes 12600 10250 80 8400 7450 88 8400 7095 84 Fruits 7350 6442 87 7350 6062 82 9450 8850 93 Citrus or Tb- matoes 8400 6350 75 6300 4925 78 6930 6530 94 Other Veg. 2100 1000 47 5250 3820 72 4620 3870 83 Meat 7245 4950 68 7665 6195 80 6615 6045 90 Butter 1260 865 68 1050 777 74 1050 1005 95 Dessert 3150 2913 92 6300 5550 88 6300 5559 88 Green.& Yellow Veg. 5880 3515 59 7560 6112 80 7140 6190 86 Milk 63000 45325 72 63000 45800 72 63000 47250 76 Toast 1890 1255 66 1890 1410 74 1890 1495 79 Bread 3780 2725 72 3780 2900 77 3780 3075 81 Average Amount 5709 4155 68 5816 4486 79 5846 4759 85 -52- tunately, taught before the first food check was made; so this study did not measure its consumption. The results of thesafood checks show that the patients were willing to co- Operate, if they knew the importance of food. The method of serving does influence the amount of food eaten. The lesson on citrous fruits, which was taught just before the second food check, was enthusiastically received by the patients, and it was expected that there would be a decided increase in the consumption of citrous fruits. When whole oranges were served, however, there were seven re- turned on the third floor. The patients were asked why they had not eaten the oranges, and in every case they said that they would have eaten them.if they had‘had a knife on their tray with which to cut them. When knives were placed on the tray during the next food check, all of the oranges were eaten. Shortage of kitchen help under wartime conditions made quantity food service very difficult. The patients complained that the toast was cold and that foods such as cream.and sugar were omitted from.their trays. The shortage of registered nurses and the employment of untrained nurses' aides was not conducive to good eating habits. They made comments about the food to the patients and also made unkind remarks which upset the patients emotionally during meal- time. The shortage of food no doubt made the patients real- ize the importance of eating the amount served and of pre- venting‘waste. -53- Food Consumption 9;" Men Patients Table VIII presents the data that was obtained by checking the food consumption of the men patients who had had no lessons. The total consumption of food did not in- crease as it did for the women. There was little change in the amount of food consumed, except in the case of citrous fruits and tomatoes, which increased 160/3; and cooked cereal, which decreased 16%. The percentage of vegetables consumed was higher than at the first check on the women patients; however, they showed no increase when the last check was made. ‘With the exception of toast and bread, the last check showed that the women patients were eating a.much larger per- centage of the food that was served to them.than were the men patients. Although the men were eating an average serv- ing of 4,176 grams or 76% of the food served to them.at the time of the first check, they ate 75%or an average serving of 4,079 grams compared to 85% of the food eaten by the women at the last check. This shows that the lessons did have a positive effect upon the eating habits of the women patients. It is suggested that nutrition lessons would be beneficial to the men patients, not only to improve their own eating habits, but because of the influence they might have upon the eating habits of their families when released from.the sanatorium. -54.. TABLE VIII GRAMS OF FOOD CONSUMED BY THE CONTROL GROUP BEFORE AND AFTER THE LESSONS WERE GIVEN Before Food Served Grams Grams Per Served Eaten Cent Fruit 11200 9350 82 Green and Yellow Vegetables 7840 5190 66 Desserts 10500 8730 83 Dry Cereal 650 554 83 Cooked Cereal 900 800 88 Potatoes 14500 10325 71 Other Vegetables 3920 2515 64 Citrus Fruit or Tomatoes 5600 3500 62 Milk 84000 60425 72 Meat 9660 7300 75 Butter ' 1680 1176 70 Toast 2520 2005 79 Bread 5980 5075 88 Average Amount 5676 4176 76 After rams rams Served Eaten 8400 6600 8960 5435 11760 9975 650 515 900 650 11200 8355 6160 3835 8400 .6550 84000 59035 7280 5605 1680 1215 2520 2015 5040 4435 5606 4079 78 70 77 72 80 88 75 -55- Adequacy p_f_ the Diets Table IX presents the data on the adequacy of the diets served, when compared to the dietary allowances that have been set up by the National Research Council. The amount of food served to the sanatorium patients exceeded the amounts recommended for each constituent with the exception of ribo- flavin. Although the amount of food served was adequate, the diets of many patients were inadequate, because they did not eat all of the food. At the time of the first check, the diets were adequate in calcium, vitamin A, and thiamin, and inadequate in protein, iron, riboflavin, and ascorbic acid. The amount of riboflavin probably is high; so the amount consumed may have been adequate. The consumption of iron was still not adequate, although it did increase from.8.5 to 10.9 milligrams per person per day. More emphasis should have been placed on foods containing iron. Ascorbic acid, which is important for tubercular patients, increased to 72 milli- grams. This may have been due to the increased emphasis on the consumption of citrous fruit and tomatoes. The protein consumption increased from.53.7 grams, which was inadequate, to 70.2 grams, which was adequate. The consumption of all protein foods had been emphasized in the lessons. The ade- quacy of calcium in both checks shows the effect of the gen- eral propoganda on milk consumption. The control group did not show the amount of improve- ment that was shown with the group that had the nutrition -35- TABLE II ADEQUACY OF THE DIETS SERVED AND EATEN BY THE PATIENTS Recommended .Amounts of Calo- Pro- National Do- ries tein search Council ‘Wbmen. 2100 60.00 Men 2500 70.0 Total Average Amount Served 2433 82.05 Food.Checks for womep_ Check I 1748 53.74 Check 11 1919 59.56 Check III 2040 70.18 Food Checks for Men Check I 1862 64.09 Check II 1888 58.75 1.549 1.144 1.151 1.274 1.166 1.225 8.47 10.29 10.90 9.79 10.24 Vita- Thia- min A min 5244 6459 6707 5625 6222 1.785 1.250 1.596 1.500 1.549 1.587 1.575 1.156 1.202 1.276 1.151 1.208 80.9 59.0 65.7 72.4 52.9 61.9 -37- classes. Their diet was inadequate in protein, iron, ribo- flavin, ascorbic acid, and thiamin at both checks. The lessons on food and nutrition improved the eating habits of the women patients in the sanatorium.. The amount of food which they consumed increased and their diets were more adequate. These lessons apparently were responsible for this change, because there was no similar change in the food habits of the men patients. All;patients in the sanatorium, men as well as women, should have this nutrition information and have the oppor- tunity to improve their own health, to influence the food habits of their families, and to prevent food waste. SIEILJLARY 1. 2. 5. 4. 5. 6. 7. :TEFLMTY This study presents the results of twelve lessons in nu- trition upon the eating habits of women patients with active tuberculosis. An increase in the knowledge of nutrition was shown by an objective test. The average scores increased from.l3.9 at the beginning to 19.7 at the end of the lessons. The likes and dislikes of the patients influenced the amount of food consumed. They ate larger portions of the foods that they liked well. The women patients increased their consumption of food "after they had had the nutrition classes. There was a variation in the amount of food eaten by the individual patients. Those who had poor foodhabits at the begin- ning of the study showed more increase in food consump- tion than those with good eating habits. The men patients.who did not have nutrition classes, did not increase their food consumption during the three- month period. These classes seem to have had a favorable effect on the patients who were included in the study. It is suggested that classes of this type be adopted by the sanatorium for both the men and women patients. APPENDIX -39- Name Questions about Food and Nutrition 1-4. Milk is an important source of calcium. The amount of milk required in each day's diet for a child is 1 , for an adult 2 , up on to I4 for a pregnant woman 3 , for a convales- cent 4 . 5. Michigan does not have much sunshine. For this reason.__§__ should be included in the diet for each child. 5 6. Tomatoes, oranges, grapefruit, and raw cabbage are all important sources of’__p__, 6 7. Many women are anemic. This is because of in- adequate 7 . ' 7 8-10. Of these five foods the three which are good 8 sources of phosphorus are 8 , 9 , and 9 10 .(Rice, fish, petatoes, milk,lean.meats)10 11. Whole wheat or enriched bread should be in- cluded in the diet each day. The vitamin which is most important in these foods is_llp,11 12. Michigan is in the Great Lakes region where there is little ocean food. For this region 12 should be included in the diet. '12 13-15. High calorie foods are necessary for an activel3_p_ person. Three high calorie foods are _l§_, l4 l4 , 15 . 15 16-18. Three main purposes for food in the body are for 19-20. Vegetables in the diet are the main sources 16 -49- Questions about Food and Nutrition (Confu) : .._1.7__.9 and __l§__. of two of the following: energy, vitamins, calories, minerals, or calcium -- 12 and 20 16 17 18 19 -41- Name A STUDY OF THE FOOD LIKES AND DISLILKES OF SANATORIUM PATIENTS Very Medium Food Well Well Disliked Remarks Liked Liked Roast Beef Sirloin Steak Round Steak [Meat Loaf eat Balls Corned Beef Dried Beef Beef Liver Beef Stew Heart Kidney Tongue Roast Pork Pork Chop s Pork Liver Pork Sausage Cured Ham Bacon Salt Pork Roast Mutton Roast Veal Lamb Chops Veal Chops ”\U . hia- lr.. .11! -42- A STUDY OF THE FOOD LlKES AND DISLJKES 0F SANATORIUM PATIENTS cont. Very Medium Food well well Disliked Remarks Liked Liked Roast Lamb Bologna 'Wienegpp Cold.Meats Chicken Salmon Tuna Fish Calf Liver Sweetbreads Brains Tomatoes Navy Beans Lima Beans Radishes Oranges gpgpefruit Cherries ppples Strawberries .Raspberries Blueberries Cantaloupe watermelon -43- A STUDY OF THE FOOD LIKE AND DISLIKES 0F SANATORIUI-d PATIENTS (cont.) Very Medium * Food ‘Well Well Disliked Remarks Liked Liked caches Tears Pineapple Concord Grapes ggeen Grapes Apricots runes Rhubarb Raisips White Bread Whole Wheat Bread Rye Bread Sweet Rolls Corn Bread Rice Cereal Cooked Cereal Facaroni & Cheese vlacaroni & Tomatoes Chili Con Carne Chow Mein Olives [Sweet Pickles -44... .A STUDY OF THE FOODILIKES ARD DIS%IKES‘OF SANATORIUM.PATIENTS cont. ‘Very ZMedium Food well well Disliked Remarks Liked pggxegp Dill Pickles ‘ Sardines Fresh Fish ysteru Fried Eggé crambled Eggs Boiled Eggs Whole Milk Buttermilk CannedlMilk Cheddar‘gheese F__.__L_ Cottage Cheese Mashed.Potatoes Creamed Potatoes aked Potatoes Ezench Frigdjp tatoes Scalloped Potatoes Cabbage Lettuce Endive Watercress inach eet Greens -45... A. STUDY OF THE FOOD LIKES AND DISEJIIES OF SANATORIUM PATIENTS (cont. Very Medium Food Well well Disliked Remarks Liked. Liked Swiss Chard #gpggagus germ ts Beet§_f Turnips Celery Rutabagas tring Beans Peas Onions Corn arsnips FEELPlant Squash Cucqfibers Cauliflower roccoli LB_I:LISSGB Sprouts -46.. LESSON I -- THE BASIC SEVERE AND MILK I. Objectives F. Tb know the foods required in the daily diet. Tb know the three uses of food in the body. To know hOW milk contributes to the three uses of food in the body. To know the amount of milk needed in the diets of the various members of the family. Tb know the different kinds of milk and the other dairy products that are alternates for milk. Tb knOW'how to use milk in various ways. II. Lecture and discussion (Reference Material, lppendix, p. A. 74) r1hevwheel of good health is made up of seven spokes. Each of these must be present in the daily diet if one is to have good health. These spokes include: 1. Green and yellow vegetables 2. Oranges, tomatoes, and grapefruit 3. Potatoes and other vegetables or fruits 4. Milk and milk products 5. Meat, poultry, fish, or eggs 6. Bread, flour, and cereals 7. Butter or fortified margarine These foods have three uses in the body: 1. To furnish energy. 2, To build and repair the body. 3. To regulate body processes and protect against disease. C. Milk contributes to each of these uses. 1. It supplies energy. D. -47- a. Milk contains fat and lactose or milk sugar which is burned. 2. It supplies protein to build and repair the body. a. One quart of milk furnishes the same amount of protein as 5 eggs, 5 1/2 oz. liver, 6 l/3 oz. fish, 5 oz. dried beans, 5 % oz. beef, 4 oz. peanut butter, 4 oz. cheese,or 16 slices of bread. 3. It contains minerals and vitamins to regulate body processes and protect against disease. a..milk is a good source of all minerals and an excellent source of calcium, One quart fur- nishes the same amount of calcium.as 6 i lbs. cabbage, 27 lbs. potatoes, 28 oranges, 39 eggs, 7 1/4 lbs. carrots. b. Milk has many vitamins and contains the same amount of riboflavin as 3 1/4 oz. liver, 12 eggs, 1 1/2 lbs. dried beans, 2 1/3 lbs. beef, 14 oz. cheese, or 1 l/3 lbs. greens. The amount of milk needed in the diet varieS'with' different individuals. 1. Milk supplies food material needed for growth, there- fore children need from.% to one quart a day to furnish the calcium and phosphorus for bones and teeth. 2. Milk furnishes the food material for tissue re- pair, therefore convalescents need one quart daily. 3..Adults in order to maintain normal body functions should have a pint of milk daily. Forms of milk other than whole fluid.milk may be used. 1. Skim.milk and buttermilk are the most usual forms. 2. Skim milk has the fat removed so it has a low calorie and Vitamin A.content, but is an excel- lent source of calcium and riboflavin. b. Buttermilk may or may not have the fat removed, depending upon the method of processing. 2. Milk may also be obtained as condensed, evaporated, or dried milk powder. -48- a. Evaporated milk has about 60% of the water re- moved. b. Condensed milk is a similar product which has sugar added. 0. Dried.milk powder is gaining popularity because of the convenience and conservation of shipping Space. . d. These products with the exception of condensed milk have approximately the same composition as whole milk when reconstituted by the addition of water. 3. Cheese is a product made from milk which is a good alternate. a. Cheddar cheese which is made from.whole milk and cottage cheese which is made from.skim.milk are both good milk products to include in our daily meals. F. Milk may be used in.many ways to fulfill the daily quota for the various members of the family. 1. There is an abundance of recipes that may be used to introduce milk into the daily diet. a. Cream soups, creamed vegetable dishes, des- serts, and milk drinks may all be used. -49.. LESSON II -- CEREALS IN THE DIET I. Objectives A. B. C. D. E. To know the kinds of cereals that are used for food. Tb know the parts of the cereal grains and their ims portance as food. To know the difference in refined, enriched, and whole grain cereals. Tb know attractive and palatable ways to serve cereals. To kn0W'hOW't0 cook cereals to save the nutritive value. II. Lecture and Discussion (Reference Material, Appendix, p. A. B. 74) Several kinds of cereal grains are used for food. 1. Wheat, oats, and corn are the cereals that are used most in the United States. 2. Buckwheat and rye are used in lesser amounts. 3. Rice is a very common food in the Orient. All parts of the cereal grain are used for food. 1. The endosperm is the white part of the kernel. a. This contains starch and protein. 2. The bran is the outer layer of the kernel. a. This is rich in the B vitamins, phosphorus, calcium, and iron. 3. The wheat germ or embryo constitutes a small part of the kernel. a. This is rich in the B vitamins. Cereals may be obtained in three forms. 1. Whole grain cereal is milled to contain 100% of the kernel. 2. Refined cereal contains only the endosperm or starch portion of the kernel. -50- 3. Enriched cereal is refined cereal to which signif- icant amounts of the B vitamins and minerals have been added. Cereals may be served so they are attractive and pal- atable. l. Cereals that must be cooked before eating are often referred to as "cooked cereals." a. To be most palatable these must be a smooth, semi-solid consistency and served piping hot. b. They may be whole grain, refined, or enriched. 2. Ready prepared cereals are often referred to as "dry cereals." a. These may be served with various kinds of fruits. b. They may be whole grain, refined, or enriched. 3. Whole grain or enriched cereals should be used whenever possible because of the vitamin and min- eral content. a. Oatmeal or other cereals may be added to meat loaf or:meat patties. b. Stuffing may be made with whole grain or en- riched bread. c. Cereals may be added to cookies. d. Waffles, cakes, griddle cakes, biscuits, and baked or steamed puddings may be made with whole grain or enriched flour. Cereals must be cooked cautiously to preserve the B vitamins. l. Thiamine is destroyed by heat or soda. a. Cereal should be cooked no longer than necessary. 2. Cooking makes digestiontnore rapid. -51.. 'LESSOH III -- CITRUS, FRUITS, TOMATOES AND.DRIED FRUITS I. Objectives II. .A. To knoW'why vitamin C is needed in the body. B. To know the comparative values of foods that are good sources of vitamin C. C. To knoW'hOW'tomatoes can be used in various ways. D. To know the value of dried fruits and how they may be served. E. To knOW'how'tp prepare fruits to preserve the nutri- ents. Lectmfe and discussion (Reference Material, Appendix, 3:34 - . A. Vitamin C is needed for healthy tissues -- teeth, bones, and gums. 1. A study by the New York State Health Dept. showed that although people appear to be well and healthy many of them had vitamin C deficiencies that caused lesions of the gums of which they were un- aware. 2. Mrs. Scoville, nurse supervisor at Ingham County Sanatorium, because of a shortage of vitamin C had a tendency to have tissues that bruised easily. This condition was corrected by the administration of vitamin C. B. Citrous fruits and tomatoes will best fulfill the re- quirements of vitamin C. 1. One orange will furnish the average daily require- ments of vitamin C. 2. AgglaSs of tomato Juice will furnish about two- thirds of the daily requirements of vitamin C. 3. Other fruits may furnish liberal amounts of vita- min C while they are in season. a. Strawberries b . Cantaloupe 4. Apples furnish relatively small amounts of vitamin C. a. If one has a limited amount of money to spend oranges are a better buy than apples. 5. Vitamin C as well as the other vitamins in the diet can be checked by playing the vita-min—go game. Tomatoes are an important source of vitamin C, be- cause they retain a large share of vitamin 0 even when they are cooked and canned and they are avail- able in.Michigan. 1. Tomatoes should be peeled and out just before serv- ing. 2. They may be cooked in different ways. a. Stewed d. Scalloped b . Fri ed 6. Baked c. Broiled 3. Tomatoes may be added to main dishes. a. Chili b. Macaroni 4. Salads may be made with tomatoes a. Stuffed temato salad b. Jellied salads c. Sliced tomatoes 5. Tomato juice may be used in many different ways a. Cocktail b. Soup 0. Sauces 6. Green as well as ripe tomatoes can be used a. Catsup b. Relishes c. Chili sauce 7. Desserts may be prepared with tomatoes a. Mincemeat be Sauce Dried fruits are valuable in the diet and may be used in various ways. 1. Dried fruits are a good source of iron and bulk. -53- 2. They may be used for sauce and for many other ways. a. Added to cereals b. Scalloped with meat or vegetables o. Added to muffins, cake, cookies, or plain breads d. Added to stuffings e. Candies E. Fruits should be prepared to preserve the vitamin C. 1. Vitamin C is destroyed by heat and air. a. If fruit has to stand, it should be kept cold. b. Fruit should be prepared just before serving. -54- LESSON IV -- GREEN AND YELLOW VEGETABLES I. Objectives A. B. C. D. To know the importance of green anduyellOW'vegetables in the diet. To know some of the less common green and yeIIOW'vege- tables. Tb know hOW’tO cook vegetables to preserve the nutri- tive value. To know various ways to serve green and yellow vege- tables. II. Lecture and Discussion (Ref. Mat., Appendix, pp.75)~ A. Green and yellow vegetables are a good source of vitamin A, the B vitamins, and vitamin C. 1. Spinach and other greens are a good source of vitamin A and vitamin C. 2. One serving of cabbage will furnish over one-third of the daily requirement of vitamin C. 3. Carrots and squash will give more than two-thirds of the daily requirement of vitamin.A. B. Many vegetables that are not commonly used are excel- lent sources of vitamins. 1. Brussels sprouts and broccoli contain large amounts of vitamin.A and vitamin C. 2. Many wild greens that grow in Michigan are edible and many are good sources of vitamins. C. Vegetables must be cooked properly to retain their nutritive value. 1. Vegetables should be washed quickly and not al- lowed to soak. 2. They should be kept cool and nature's covering until ready to cook. 3. They should be cooked as quickly as possible with a small amount of water. 4. Cooking liquors should be saved and used. D. 5. 6. -55.. a. Gravies, soups, and vegetable juice cocktails are ways of using the cooking water. Vegetables should not be overcooked. The water should always be boiling when vegetables are added. Vegetables may be served in appealing and attractive ways. 1. 2. 3. 4. Raw vegetables should be used as much as possible. a. A salad a day is a good rule to follow. b. Salads whould always be cold and crisp and the salad dressing should be added at the last min- Ute. Cream soups and creamed vegetables have a two-way purpose, as they also add.milk to the diet. Boiled vegetables, seasoned with butter or meat drippings, are always a favorite. Cabbage and other strong-flavored vegetables are best if cooked in a moderate amount of boiling water in an uncovered pan. u -56- LESSON V -- POTATOES AND OTHER VEGETABLES I. Objectives A. D. To know how potatoes and other vegetables contribute to the daily requirements. To know hOW to serve dried beans and peas. Tb know how to prepare root vegetables so they are most palatable. Tb know various ways to serve potatoes. II. Lecture and discussion (Ref. Mat., Appendix, p3.75)~ A. C. Potatoes and other vegetables are good sources of vi- tamins, minerals, and calories. 1. Dried beans and peas are good sources of iron, one serving furnishing more than one-third of the daily requirement of iron. 2. Potatoes in moderate amounts will furnish from.one- fourth to one-third of the daily requirements of Vitamin C o 3. The vitamin C in potatoes is lost after long stor- age. 4. One mediumasized potato has about one hundred cal- cries. 5. One serving of carrots will furnish about two-thirds of the daily requirements of vitamin A. 6. Rutabagas will furnish about one-third of the daily requirements of vitamin A. Dried beans and peas may be served as an alternate for other protein foods. 1. Iain dishes such as baked beans, stew, and chowder are favorite dishes. 2. They may be combined with other foods in salads. 3. Onion relish or catsup may be mixed'with peas or beans for sandwich fillings. Root vegetables offer appealing variety to all meals. 1. 2. 3. -57- Carrots, onions, turnips, and potatoes may be cooked and served with a pot roast. Root vegetables may be mixed in stew, soup, chow; der, or pie. Raw relishes and salads are good ways to serve all of the root vegetables. D. Potatoes may offer variety even though they are served every day. l. 2. 3. 4. Potatoes may be baked or boiled in their skins. Scalloped potatoes, mashed potatoes, and creamed potatoes are also ways to include milk in the diet. Hashed browned, fried,and French fried potatoes of- fer variety. Potato pancakeé, potato soup,and potato salad are useful variations. ~58- LESSON VI —- EGGS, CHEESE,.AND SOY PRODUCTS I. Objectives A. B. C. Tb know why butter is important in the diet. To know why eggs are important in the diet. Tb know how to tell high quality eggs and how to keep their high quality. To know how to cook eggs. To know ways to serve cheese. To know the food constituents soy beans furnish and how to use products that are made from.soy beans. III. Lecture and discussion (Ref. Mat., Appendix, pp.75-76) A. Butter is a good source of vitamin.A. 1. It is important that butter be included in each day's diet, because it has high vitamin.A content. 2. Much butter is wasted in the sanatorium, because it is not eaten but left on the trays to be de- stroyed. Eggs contain the necessary nutrients for the three functions of food. 1. Eggs are a high protein food and may be used as an alternate for meat. 2. Eggs are a good protective food, because they sup- ply liberal amounts of vitaminiA, B, and D. ‘ 3. Iron, which is deficient in many wamen's diets is abundant in egg ybkks. 4. Children should have one egg in their diets each day and adults should have not less than three or four eggs each week. Eggs of high quality, often referred to as "fresh" eggs are preferred by consumers. 1. The color of the shell has no effect upon the quality of the egg. 2. Eggs will deteriorate when.kept at room.tempera- ture. I23 0 -59.. 3. Eggs of high quality will have a firm, well- centered yolk, a small air space, and a thick white. Eggs may be cooked in many ways, but should always be cooked slowly. 1. Eggs cooked in the shell should be simmered, not boiled. 2. Eggs may be scrambled, fried, poached, baked, or creamed. 3. Many variations of omelets may be prepared. 4. Eggs with vegetables make many nutritious dishes. 5. Cereals may be prepared with eggs and served as a main dish. 6. Salads and salad dressings are made with eggs. 7. Appetizing sandwich fillings may be made with eggs. 8. Custards and other desserts contain eggs. Cheese offers interesting variety to our meals and is an alternate for meat. 1. Cheese may be added to white sauce and-served with toast and vegetables. 2. Toasted cheese sandwiches are always favorites. 3. Cheese gets tough and stringy when it is cooked at too high a temperature. Soy products are valuable foods because of their pro- tein and other nutrients. 1. Soy protein has almost the same quality as that in meat, fish, eggs, milk, and cheese. 2. Soya can take the place of twenty to twenty-five per cent of the meat in most recipes. Soy bean products may be used in different ways. 1. Soya may be used to make meat, fish, eggs, and cheese go further. 2. Vegetables and cereals are made more nutritious by the addition of soya products. -59- 3. Soya.may also be used in sandwich spreads, sauces, soups, and desserts. 4. Bread, quick breads, and cakes may be made with part soya flour. -6l- LESSON VII -- MEAT IN OUR MEALS I. Objedtives A. To know the nutritive value of various kinds of meats. B. To C. To D. To E. To know the cuts of meat that may be served. knOW'hOW to cook various meats. know hOW to cook liver and the variety meats. know the ways of extending meats. II. Lecture and discussion (Ref. Mat., Appendix, p,.76)- A, Meat is an important source of several nutrients. l. 2. 3. 4. 5. Ideat is one of the best sources of protein for body building and repair. Iron is supplied in liberal ambunts by all meats. JPcrk is high in thiamine, the "morale" vitamin. ILiver is an excellent source of iron, vitamin.A, and riboflavin. Glandular meats build red blood. B..Many cuts of meat that are good to eat are unpopular, because homemakers are not acquainted.with the methods of preparing them. 1. 2. Popular cuts of meat total thirty per cent of the beef carcass. a. Sirloin steak e. Pcrterhcuse steak b. T-bcne Steak f. Club steak c. Rolled rib roast g. Standing rib roast d 0 Round. Steak The following cuts are just as nutritious and de- licious but less popular, even though they consti- tute sixty per cent of all beef. a. Heel pot roast g. Brisket b. Flank steak h. Cross-cut shank c. Plate 1. Pinbcne shank d. Arm.pct roast j. Short ribs 6. Rump roast k. Blade pot roast f. Blade rib roast 1. Boneless neck -52- 3. There are similar cuts for lamb and pork, as well as for beef. 4. If homemakers would take advantage of the less popular meat cuts, they could reduce their meat budgets and yet have more variety in their meals. C. Meat is grouped in two main classes for cooking. 1. Tender cuts that are cooked by dry heat methods. a. Tender cuts of meat are those from.the loin, a muscle which is not exercised much by the ani- 111810 b. Dry heat methods are broiling, pan-broiling (sometimes called frying), and roasting. 2. Moist heat methods are braising or cooking in water. a. Braising is a most popular method of cooking meat, as it is used for swiss steak, pot roasts, and breaded veal and pork steak. 3. The most important thing to remember when cooking is always to cook at a low temperature. a. Meat should never be Eboiled, just simmered. b. Theocven temperature should be from 300° F. to 325 F. 4w Liver, heart, and other variety meats should be served often, because of their high nutritive value. a. nhssezmeats may be cooked by braising. (1) Heart may be stuffed with dressing and then braised. (2) Liver may be braised like swiss steak with tomatoes and onions added. (3) Sweetbreads and.kidneys:may be breaded. (4) Tongue may be cooked in water, smoked, or pickled. D. Meat extenders may be used when there is a meat shortage. -55- 1. Soy products or cereals may be added to meat loaf or meat dishes . 2. Dressings may be served'with roast pork, flank steak, and many kinds of meat. .. 64:... LESSON VIII -- BETTER BREAKFASTS I. Objectives A. B. C. D. To know why it is important to eat breakfast To know how to plan adequate breakfasts. Tb know the characteristics of a good breakfast. To know how to plan breakfast on a l w income. II. Lecture and discussion (Ref. Mat., Appendix, pp. 76-77) A. Breakfasts should supply from one-third to one-fourth of the daily food requirement. 1. Workers who miss breakfast work less efficiently during the morning hours. 2. It is difficult to have an adequate daily diet if breakfast is omitted. 3. There is a twelve to fourteen-hour stretch between supper and breakfast. Breakfast patterns may vary from light to heavy, de- pending upcn the person's physical activities. 1. Light breakfasts may include fruit, cereal, or bread and beverage. 2. Medium.breakfasts include fruit, cereal, bread, and beverage. 3. Heavy breakfasts may include fruit, bread, cereal, protein food such as sausage, bacon or eggs, pan- cakes and syrup, and beverage. C. Good breakfasts should supply foods from several of the basic food groups. 1. A sweet roll and coffee is an inadequate breakfast because it does not supply enough of the daily re- quirements. a. Many foods could be added to this menu to raise the nutritive value. 2. Two good breakfast menus are: Fruit Fruit Whole-Grain Cereal Scrambled Egg Toast and Butter Whole Wheat Toast Butter Milk Coffee Milk Coffee LESSON IX -- PLANNING LUNCHES AND SUPPERS IL Objectives A. To know how to plan food for the family on low and moderate incomes. B. Tb know how to obtain variety in lunch and supper menus. C. To knOW'hOW’tO plan well-balanced lunch and supper menus. D. To RDDW’hOW’tO plan good packed lunches. II. Lecture and discussion (Ref. Mat., Appendix, p.77) — A..Adequate meals may be planned at low or moderate costs. 1. 2. 3. 4. 5. Home-grown foods should be used whenever possible. Foods that are in season should be used. Potatoes, dry beans and grain products are used more abundantly in lOW’OOSt menu plans. Moderate cost menus include larger quantities of meat, eggs, fruits, and vegetables. Basic management principles should be considered for both low and moderate cost plans. a. Buy carefully and buy no more than you can use. b. Store foods properly so they will not spoil. c. Prepare foods so as to get the most benefit from them. d. Use all leftovers. B. Padked lunches should be planned so they contain the basic seven foods. 1. Examples of poor and good packed lunches are: Pccr’Lunch Good Lunch Jelly Sandwiches Peanut Butter Sandwich Soft Drink Cheese Sandwich Candy Bar Raw Carrots Orange Cookies Milk a. The poor lunch contains only one of the basic seven groups. C. -55- b. The good lunch includes food from most of the basic seven groups. Lunch (if served at noon) or supper (if served in the evening) should be well balanced. 1. Vegetables, milk and fruit should be included in the lunch.menu. 2. It should contain about one-third of the day's re- quirements. 3. Examples of good and poor lunch menus are: Poor Lunch Good.Lunch Rice and Tomatoes IMacarcni and Cheese Beets Stewed Tomatoes Bread and Butter Whole Wheat'Muffins and Doughnuts Coffee Butter Apples Cookies Milk Interesting lunch or supper menus may be obtained with skillful planning. 1. Supper should not be just a warmed-over edition of the dinner. ~67- LESSON X -- DINNER AND THE FAMILY MEALS I. Objectives A. To know how to plan dinner so that the day's meals wall be adequate. To know the things to consider when planning, prepar- ing, and serving meals. To know how to obtain variety in meals using Michigan foods. To know how to plan meals for low or:mcderate cost. II. Lecture and discussion (Ref. Mat., Appendix, p3.77)m A" Meals should be checked to see if they contain the basic seven foods. 1. "Guide to Modern Meals” can be hung in the kitchen and used to check the daily meals. 2. Dinner patterns may be followed to assure adequate dinners. at Meat, fish, eggs, cheese, or beans. b. Potatoes or other starchy vegetable. c. A vegetable besides potato ( a green or leafy vegetable at least three times a week). d. Bread and butter. 6. Salad (fruit or vegetable). f. Dessert (fruit and milk desserts often). 3. Examples of poor and good menus are: Poor Dinner Good Dinners Meat Patty Baked Beans IMeat Stew Mashed Potatoes Brown Bread ‘with'Vegetables Bread and Butter Butter Cole Slaw Jam ' Cabbage Salad Whole Wheat Bread Cupcake Tea Baked Apple Butter Jam Milk Coffee Ice Cremn Milk Coffee B. Many things are important for the family meals. 1. The dietary needs of the family should be given consideration. 2. Meals should be planned in advance. 3. Foods should be cooked properly. -68- 4. Mealtime should be pleasant. C. Variety may be obtained witthichigan foods. 1. Eggs, fruit, and vegetables should be used in abundance. a. Beans are plentiful and should be used whenever possible. b. Apples and cherries are abundant fruits. I. II. -69... LESSON XI -- DIET IN PREGNANCY AND CHILDREN'S DIETS Objectives .A. To know what foods are needed during pregnancy. B. To know the effect of the prenatal diet on the out- come cf pregnancy. C. To know the effect of the prenatal diet upon the con- diticn of the infant during the first few weeks of life. D. To know the important things to consider in develop- ing children's food habits. E. To knoW'where to obtain reliable advice on infant and prenatal care. Lecture and discussion (Ref. Mat., Appendix. PP. 77-78) A. Food.must be adequate for the mother and the growing baby. 1. At least one quart of milk daily. 2. Two servings of vegetable besides potato. a. One green or yellow and one raw; 3. Citrus fruit or tomatoes daily. 4. One egg each day. 5. Meat and butter in liberal amounts. 6. Two teaspoons of standard cod liver oil. 7. Whole wheat or enriched breads and cereal. 8. chized salt. 9. Wheat germ and additional iron. Studies in Toronto, Canada, show’the results of good and poor prenatal diets on the dcndition of the women during pregnancy. Poor Diet Good D'et l. Obstetricians rating Good 66% 940 during the whole course J of pregnancy. Poor 34% 6% -70- 2. There were six times more miscarriages in the poor diet group. 3..There were six times more premature births and three times more stillbirths in the poor diet group. 4. There were twice as many infections of the breast and uterus, and toxemia and anemia in the poor diet group. The babies of both diet groups were rated during the first six months of life. 1. More mothers on the good diet nursed their babies. 2. There were five times more babies of the poor diet group with frequent colds, pneumonia, bronchitis, and rickets. 3. The babies did not show much difference in birth weight, but those on the good prenatal diets showed a much greater increase in growth after birth. Food for children should be carefully planned, pre- pared, and served. 1. Children should have prcper food. 2. Meals should be served at regular times. 3. Food should not be given between meals if the child does not eat his food at mealtime. 4. Sweets should be given in small amounts and chly at the end of the meal as dessert. 5. Children's food habits are affected by several factors. a. Too much attention at mealtime. b. Attitude of other members of the family towards food. 6. Too much excitement and lack of rest. d. Too large servings. e. Ease of handling of food. -71- f. New foods which are given in too large amounts. E. Information on prenatal and infant care may be ob- tained without charge. 1. Much.material is available from the State Dept. of Health. -72- LESSON XII -- CONTROLLING WEIGHT BY DIET I. Objectives A. B. C. D. Tb know the relationship of calories to weight. Tb know what foods to eat to gain weight. Tb knOW'hOW’tO adjust diets to lose weight. To know the effect of improper dieting. II. Lecture and discussion (Ref. Mat., Appendix, p.378)»- A. The calorie is a.measure of the fuel value of foods and the energy produced by their combustion in the bOdYO 1. Calories are not a measure of body-building or protective qualities of foods. 2. Diets may be high in calories and yet inadequate. 3. High calorie foods are those containing sugars, starches, and fats. B. High calorie diets are necessary to gain weight. 1. More calories than the daily requirement should be included in the diet. 2. Foods containing large amounts of concentrated sugars, fats, and starches should.be eaten. 3. The diet must include the basic seven foods as well as high calories. C. Low calorie diets are needed to lose weight. 1. If the calorie intake is lower than the daily re- quirement, the body will draw from the fat supply stored in the body. 2. Diets that have low calorie value must contain foods that have bulk and that are satisfying, so the person will not be hungry all of the time. 3. Diets must be nutritionally adequate. Improper dieting is harmful to the body. 1. It will cause loss of strength and wrinkles. -73- 2. In severe cases it will cause deficiency diseases. 3. Improper dieting will cause a lack of resistance to disease. Lesson I II II II III III III -74- IiATERIALS USED IN THE FOODS.AND NUTRITION LESSONS Material National wartime Food Guide NEG-'4: RSV 0 Milk in Modern Meals Extension Course Notes 129 8x11 charts Protein Equivalents Riboflavin Equivalents Foods Furnishing the Same Amount of Calciun 8x12 charts American Cheese Cottage Cheese Whol e Milk Skimmilk The Wheat Kernel Breads and Cereals Help Replace Rationed Foods 8x12 charts Whole Wheat Flour Rolled.0ats White Flour Enriched Flour Tbmatces for Your Table ARI-104 Dried Fruits in Low Cost Meals 8x12 charts Apples Oranges Strawberries Tomato Juice Dried Prunes Publisher U.S. Department of Agridulture war Food Administration Office of Distribution washington, D.C. Michigan State College Extension Division East Lansing, Michigan National Dairy Council 111 NOrth Canal St. Chicago 6, Illinois Dairy Council of St. Louis St. Louis, Missouri Mimecgraphed material, p. Mimeographed.material, p. Dairy Council of St. Louis St. Louis, Missouri U.S. Department of Agriculture Bureau of Human Nutrition and Home Economics hbshington, D.C. U.S. Department of Agriculture Agricultural Marketing Adminis- tration washington, D.C. Dairy Council of St. Louis St. Louis, Missouri Lesson IV '2' VI -75.. Material Vita-Min-Go Game Vitamins from Farm to You AWI-Z Green Vegetables in War- time Meals AMI-54 8x12 charts Spinach Cabbage Get the Good from.Fruit Nutritive Values of Fruits and Vegetables Set of 10 charts Dried Beans and Peas in Wartime Meals AWI-47 Root Vegetables in wartime AMI-59 Potatoes in Popular ways AWI-BS 8X12 chart Navy Beans Egg Dishes in Any Meal AWI-BQ Publisher VitaéMin-Go, Inc. 175 Varick St. New York City, N.Y} U.S. Department of Agriculture Bureau of Human Nutrition and Home Economics washington, D.C. U.S. Department of Agriculture Bureau of Human Nutrition and Home Economics washington, D.C. Dairy Council of St; Louis St. Louis, Missouri Mimeographed material, p. Mimeographed material, p. U.S. Department of Agriculture Bureau of Home Eccnomics Washington, D.C. U.S. Department of Agriculture Bureau of Human Nutrition and Home Economics ‘ilaSIIing-bon , D o C o U.S. Department of Agriculture Bureau of Human Nutrition and Home Economics washington, D.C. U.S. Department of Agriculture Bureau of Human Nutrition and Home Economics Washington, D.C. Dairy Council of St. Louis St. Louis, Missouri U.S. Department of Agriculture Bureau of Human Nutrition and Home Economics Washington, D.C. Lesson VI VI VI VI VI VII VII VII VII VIII VIII -75- Iaiateria; Cheese in Your Meals AMI-16 Eggs a Protective Food K... Chart Eggs Retail Grades and Uses Cooking with Soya Flour and Grits 8x12 Eras IIeat and Romance Lamb or Goodness Sake All about Pork 8x12 charts Baa Butter Pork Chop Beef Chicken Fried,Liver Eat a Good Breakfast AWI-lO? Better Breakfasts Extension Course Notes 137 Publisher U.S. Department of Agriculture Bureau of Human Nutrition and Home Economics washington, D.C. Poultry and Egg National Board 508 West Washington St. Chicago, Illinois Poultry and Egg National Board 508 West Hashington St. Chicago, Illinois U.S. Department of Agriculture Bureau of Human Nutrition and Home Economics washington, D.C. Dairy Council of St. Louis St. Louis, Missouri National Livestock and'fieat Board 407 South Dearborn St. Chicago, Illinois National Livestock and Meat Board . 407 South Dearborn St. Chicago, Illinois National Livestock and.Meat Board 407 South Dearborn St. Chicago, Illinois Dairy Council of St. Louis St. Louis, Missouri U.S. Department of Agriculture Bureau of Human Nutrition and Home Economics washington, D.C. Michigan State College Extension Division East Lansing, Michigan Lesson VIII VIII VIII XI -77- Material Colored Graphs A Poor Breakfast A Good Breakfast Our Family's Breakfast lfienus Why the Nutritionally Ade- quate Breakfast is the Better Breakfast Family Food Plans AMI-'78 Streamlined Suppers Ext. Course Notes lAO Colored Graphs A.Poor'Lunch A Good Lunch A.Poor Packed Lunch A Good Packed Lunch Eat Right to Wbrk and Win Different Dinners Ext. Course Notes 141 Everyday Meals for Michi- gan Homes Ext. Course Notes 82 Guide to Modern Meals Ext. Course Notes 139 Colored Graphs A.Poor Dinner .A Good Dinner .A Good Dinner What to Eat Before the Baby Comes Publisher National Dairy Council lll North Canal St. Chicago, 6, Illinois Cereal Institute 135 South Lasalle Street Chicago, 5, Illinois Cereal Institute 135 South Lasalle Street Chicago 5, Illinois U.S. Department of Agriculture Bureau of Human Nutrition and Home Economics Washington, D.C. Michigan State College Extension Service East Lansing, Michigan National Dairy Council 111 North Canal Street Chicago 6, Illinois Swift and Company Department A Chicago, Illinois Michigan State College Extension Division East Lansing, Michigan Michigan State College Extension Division East Lansing,lflichigan Michigan State College Extension Division East Lansing,-michigan National Dairy Council lll North Canal Street Chicago 6, Illinois Michigan Department of Health Lansing, Michigan Lesson XI XI XII XII XII -78.. Material one Meal for All Exhibit of Available Mate- rials for Prenatal and Infant Care Your Food and Your Figure Calories in Food YOur weight and HOW'to Control It ‘Weight Reduction with Safety and Comfort Publisher Merrill-Palmer School 71 East Ferry Avenue Detroit, Michigan Michigan Department of Health Lansing, Michigan Michigan Department of Health Lansing, Michigan Kellogg Company Battle Creek,-michigan National Livestock and Meat Board 407 South Dearborn Street Chicago, Illinois -79- THE WHEAT KERNEL Endosperm or the white part of the kernel. Contains starch and protein. Bran Rich in all of the B Vitamins. Rich in phosphorus, calcium, and iron. Wheat Germ or embryo Rich in the B vitamins. CEREAL FOODS-~0NE OF THE BASIC SEVEN Cereals “ many breakfast foods are made from.the cereal grains, the usual ones being oats, corn, wheat, and ride. These may be ob- tained in ready-prepared forms which are usually called "dry cereals" or in forms which must be cooked before eating which are often referred to as "cooked cereals? Bread; Breads may be made from wheat, corn or rye flours. Meat breads are made from.wheat flours. These flours are of three types, whole wheat flour, white flour or enriched flour. Whole wheat flour is milled to contain 100% of the wheat kerneh. It has all the important nutritive values of the entire grain. This includes important vitamins and minerals. White flour contains only that part of the wheat kernel called the "endosperm" because the sifting processes remove the "bran" and the "wheat germ" portions. Thus, while white flour contains abundant energy and some body building material it is very low in the important "B Vitamins" and minerals. Engiched flour is white flour to which is added a signifi- cant amount of the Vitamins and.minerals. -80- BREAD AND CEREALS HELP REPLACE RATIONED FOODS (white) GRAIN If their coats are removed in milling,the vitamins and min- erals are LOST. REFINED FLGIR AND CEREALS: Wheat Rice White Flour Farina Co rnmeal Hominy The outer coats of the grains have necessary VITAMINS and IMINERALS. WHOLE GRAIN.FLOUR AND CEREALS: Oatmeal Whole Wheat Rye Buckwheat Cracked Wheat Brown Rice Graham 0. .0 O. .0 O. O. O. O. O. .0 O. O. O. O. .0 O. O. O. * * * BREAD and CEREALS give ENERGY for work and play.‘ BREAD and CEREALS contain PROTEIN for GROWTH and REBUILDING of body structure like muscles, tissues and blood. ENRICHED bread, cereal and flours contain certain‘VITNMINS and MINERALS that are necessary for life...Ordinary white Ensuriched bread, cereals and flour do not supply as much of these vitamins and.minerals. The vitamins in enriched preducts are BI and NIACIN. The mineral added to enriched products is IRON and sometimes CALCIUM and.PHOSPHORUS. BUT WHOLE GRAIN as well as whole wheat contains these and other necessary vitamins and minerals. Oatmeal, brown rice Or any cereal can be used in meat loaf or meat patties. Prepare a stuffing from.whole grain or enriched bread. 'Use with suchameats as flank steak, shoulder of lamb, veal or other meats. CEREALS can be used as thickening in gravy, together, with or in place of flour. USE whole grain or enriched flours in griddle cakes, waffles, cakes, biscuits, baked or steamed puddings, and.aookies. ’ The vitamin thiamin can be destroyed by HEAT and by SODA. Do NOT cook cereal any longer than necessary. 1. 2. 3. 4. 5. 6. '7. e. l. 2. 3. 4. 5. 6. 7. 8. 9. -81- GET THE 6001) FROM FRUIT ‘ Use fruit fresh...if it has to stand, keep covered and C01d 0 Cook in the peel if you can...if you must peel, make it 1311111 0 Spread berries and keep dry and cold; That's the way to prevent mold. Don't pinch bruise or break the skin, You'll let the enemy "rot" come in. wash and cap berries Just before using. Spread fruits to keep them from.bruising. Keep ripe fruit cold. Let under-ripe fruit ripen at room.temperature to bring out the flavor. GET THE GOOD FROM VEGETABLES wash quickly...don't soak. Keep cool...keep in nature's covering until ready to 000k. Cut Just before serving. Boiled or baked...nature's jacket holds in the good. Heat canned foods quickly...they're already cooked... use all the Juices. Start cooking frozen vegetables while still frozen... don't thaw first. wash salad green...drain...store in vegetable pan... keep cold. Trim.non-edible parts from.tender roots or cooking greens, then wash, drain, put in a covered pan and keep 001d. Keep corn, peas and lima beans cold to keep their sweet, delicate flavor. -82.. NUTRIWE VALUE OF FRUITS AND VEGETABLES ' Vitamin A One serving of the following vegetables furnish at least two- thirds of the average adult's daily requirement. Carrots Squash, Winter Greens (all cooked kinds) Sweet Potatoes One serving of the following vegetables and fruits furnish at least one-third of the average adult's daily requirement. Apricots Peaches Green Pepper Pumpkin Broccoli Ibmatoes Vitamin 9_ One serving of these vegetables and fruits furnish at least t - thirds of the average adult's requirement. Orange (at least 4 oz. of Juice) Grapefruit (at least 4 oz. of Juice) Strawberries Tomatoes (at least 8 oz. of Juice) Additional fruits and vegetables furnish at least egg-thizd of the average adult's requirements. Asparagus Greens Broccoli Kale Brussels sprouts* Green pepper Cabbage Pineapple Juice Cantaloupe or muskmelon Rutabaga Cauliflower Potatoes are a good source of Vitamin C in the amounts usually eaten. Two or three potatoes will furnish about gngrthirg of the day's requirements. None 2; these vegetables will furnish vitamin,g,;§ they are not properly cooked. It A at DROWNED BY LOTS SUFFERS FROM ' STRANGLED BY or WATER HEAT ExPOSURE TOO MUCH AIR -85— B IBL IOGRAPHY ARTICLES Ebbs, J. H., F. F. Tisdall, and W. A. Scott, "The InfluenCe of Prenatal Diet on the Mother and Child,g g, Q§_Nutr. 22:515-526. 1941. - "Housewives Discuss Nutrition Problems." U. S. Department of Agriculture, Division of Program Surveys. May, 1944. "Nutrition and the war." U. S. Department of Agriculture, Division of Program.Surveys. November, 1945. BOOKS Koos, Earl L., Food in the Lives of Our Neighbors. ‘Kips Bay-Ybrkville District HealthICommittee, All East 69th St., New York City. August, 1942. Kruse, H. D., The Gingival Manifestations of Avitaminosis C, with Special Consideration to the Detection of Early Changes by Biomicroscopy. Melbank Rem. Fund 20, 5:290. 1942. Ohlson, MargaretiA., and Goodrin Thompson, Laboratory Hand- book for Dietetics. Burgess Publishing Company, 1942. Taylor, Clara Mae, Food Values in Shares and weights. The Macmillan Company, 1942. PHISONAL COILEREIICATIO N Hershey, Roberta, Foods Specialist in the Michigan State College Extension Service, East Lansing, Michigan. I . f l I I .- I l I ' i' ' w ‘ ' ‘ ‘ -.' ( ((r . ' ”5,4. 1 0 / . . ,_ Apr 5 48 - a ' , - | v . ' -. I v - I I ‘I ' I . a I | I ' I I . . ‘ l I"! F I D 6 | ‘ I I “ I r k ' I I l I I I . I‘ ’ - l’ I ' | '- l f ‘ M" . , , ——'"-‘:'—,"““' _ ’— ., ~ ( - ' wv- -- 'f v ' 1 : . ’- \ ‘ " J I , " . . ~. ‘ ' ' I ' ‘ . 'l . I ‘ , 2 1 ‘ ' I : ' .' i (\‘ . . ‘ I . I -, I , l . ' O , I A \ 5 , ' ' v ‘! ' ' ' I ‘I ‘ l ‘. )1 ~ ‘ I ‘ -, I ‘ ‘v ,1 .l ' ’ g " ” "l . I \ , 4 ' . -. l I ‘I- l I. I I t ' l V , .. I ' I . ’ f ‘ I I. ‘ I I . I I ’r y I ' i , I I ‘| I ’ r‘ ' . I C ' I l I 7 T612.5 . _ - 'E68 Erkel . I I | l I | | l I X I ‘ I . ' l I | I y \ ‘ , . 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