[CANCER RESEARCH 35, 3246-3253, November 1975]

Marginal NutritionalStatus

Food and nutrient intakes are being examined for possible relationship to the occurrence or the progress of varioustypes of cancer in man. This paper describes the state of ourknowledge on the nutritional status of various populationgroups in the United States and on the food consumptionpatterns and their nutritional consequences during the1900's. Only a few medical studies of nutritional statushave been conducted on a national or even a regional basis.These extend back less than 2 decades. Dietary information is available back to the 1930's, and statistical data onuse of food in the United States can be found beginning with1909. Sources of information are suggested for the use ofand detailed study by the epidemiologist.

Introduction

The past 4 decades have seen a dramatic turnaround inthe overt nutritional health problems experienced earlier inthe century (Chart 1). At the turn of the century, and againtoday, deaths from pellagra (a major vitamin deficiencydisease) were almost unknown in this country. Yet, in thelate 1920's and 1930's, there was a very high death rate,particularly in the Southern States. Large numbers alsodied from scurvy due to a deficiency of vitamin C. Doctorsthen could readily find cases of beriberi due to thiaminedeficiency, cases of xerophthalmia from a deficiency ofriboflavin, or cases of rickets due to a vitamin D deficiency.Today these major vitamin deficiency diseases have beeneradicated so successfully in the United States that manydoctors never see them and would not recognize them.

Poor nutrition is now more frequently seen in the manyhealth problems where nutrition has a more subtle involvement but is at least implicated in playing a role. Diet, andespecially the lipid components, is one of the identifiedfactors in serum lipid levels that are listed as a major riskfactor in heart disease. Diet, and particularly the caloricintake, is clearly implicated in the major health problem ofobesity in our population. A number of diet interrelationships seem to have some role in the problem of osteoporosisencountered in the elderly. The current thrust of thisconference suggests that nutrition may indeed play a role inthe incidence of some cancers in man.

During the period from 1947 to 1958 a sizeable number ofregional nutritional status studies were sponsored by theUSDA and summarized in a publication (12). The biochemical, clinical, and dietary studies indicated that theaverage nutritional health for various population groupswas good. Less than recommended dietary intakes weremost frequently found for both children and adults forvitamin A, ascorbic acid, and iron. Rural, low-incomefamilies had diets containing the lowest nutritive value.Adolescent girls and especially older people tended to beoverweight, and Spanish American and Indian childrenfrequently had lower heights than average for the population. The hemoglobin content of the blood in nearly all the

people examined was fair to excellent (1 1).A nationwide survey of the nutritional status of preschool

children in the United States was conducted in 1968 to 1970.A summary of this study (14) suggested that those childrenat nutritional risk were mostly clustered among preschoolchildren of lower socioeconomic status. The major nutritional problem confronting those children appeared to beinsufficient food rather than the nutritional quality of thefood consumed. The authors noted the fact that a greatmany preschool children whose diets seemed to be quiteadequate were regularly taking vitamin supplements inaddition. Other surveys show the same.

At about the same time, the Federal Government conducted a nutritional status survey encompassing all agegroups, using a sample drawn from the lowest averageincome districts in 10 states (5). One major finding in the

Ten-State Survey was a high prevalence of low vitamin Avalues among Mexican Americans. There was a greaterprevalence of unsatisfactory nutritional status among adolescents, whereas the elderly showed evidence of generalundernutrition. Obesity was very frequently observed, andin some age groups more than 50% of adult women werefound to be obese. Iron deficiency anemia was identified asa widespread problem. Such nutrients as vitamin C, thiamine, and iodine did not seem to pose a major problemamong any of the groups studied.

In 1971 to 1972, a nationwide survey, Health and Nutnition Examination Survey (HANES) of the nutritionalstatus of the United States population, ages 1 through 74years, was undertaken (1). The early, still preliminary datathat have been reported gave evidence of iron deficiency

â€P̃resented at the Conference on Nutrition in the Causation of Cancer,

May 19to 22, 1975,Key Biscayne,Fla.2 The abbreviations used are: USDA, United States Department of

Agriculture; DHEW, Department of Health, Education and Welfare.

3246 CANCER RESEARCH VOL. 35

Nutrition in the United States, 1900 to 1974'

Willis A. Gortner

United States Departmentof Agriculture, Agricultural ResearchService,National Program Staff, Beltsville, Maryland 20705

Summary

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Nutrition in the United States

food disappearance and nutrient estimates are availablestarting in 1909. The figures, of course, do not show whichpopulation groups were most affected by observed shifts inconsumption.

The other source of data is the periodic nationwide foodconsumption surveys conducted by the USDA's Agricultural Research Service. The 1st such nationwide surveybased on a statistical sampling of households was made in1936 to 1937. Since then 4 large-scale studies were made in1942, 1948, 1955, and 1965 to 1966 (4). Currently, plans are

being made for the next survey, possibly in 1976 to 1977. Allof these surveys have included assessing food used byhouseholds, and the most recent survey also developedinformation on the food intake of individuals in thehousehold (2). Data were thus provided on the total nutritivevalue of the diets and on the contribution of major foodgroups to the total of both households and individuals. Thesampling allowed a breakdown into subgroups of differentincomes, different regions of the United States, and ruraland urban people.

What have been the trends during this century in thenutrients in the United States daily food supply? The trendsin food uses of protein, fat, and carbohydrate during thepast 60 years are shown in Table 1 and Chart 2. Theavailable supply of calories shows minimal change, and theproportion of this derived from protein also has not changedmuch. What is clear is that we have steadily been consumingmore fat and less carbohydrates in the United States.

The declining intake of carbohydrate was also accompanied by a shift in the nature of the carbohydrate (Chart 3).Starch has dropped off at a much more rapid rate than thetotal carbohydrate during these 6 decades. The rathermarked rise in sugars and in refined sugar that occurredduring the 1920's has (after a decline during World War 2)been maintained in the years subsequent to this.

Similarly, we find that the increased amount of fat in ourfood balance sheets has been accompanied by a shift in thetype of fat consumed (Table 2). There has been only a smallchange in saturated fatty acids in the food supply during thepast several decades. A rather modest increase in polyunsaturated fatty acids (linoleic acid) is seen prior to 1940, anda noticeable increase in the polyunsaturated fatty acidsduring the last 20 years relates to the increase in ourconsumption of edible oils, margarine, and shortening.

There now are data showing who is taking this fat into theday's diet (Chart 4). Dietary fat is peaking in the age 12 to14 group for women and falls fairly steadily thereafterthroughout life. By contrast, men do not reach theirmaximumfat intakeuntil nearthe endof adolescence,theamount dropping off only after age 20.

Cholesterol appears to have risen to a current level only10% above that in United States diets at the turn of thecentury (Table 2). During the past 25 years there has been adeclining use of eggs, lard, butter, and various dairyproducts but an increased intake of various meat andpoultry products; thus the cholesterol level has remainedfairly steady during this period.

Our vitamin and mineral consumption has held up wellduring this century (Table 3). Calcium, vitamin C, andvitamin A are at higher levels in our food supply than they

Chart I . Peliagradeath rates in the United States.

at all age levels. A few population groups, especially children, showed some biochemical evidence of inadequatevitamin A. For the most part, however, all age groups(and for both race and income levels) had apparentlyadequate intakes of protein, calcium, vitamin A, andvitamin C.

Because of the close geographical location and a similarity of eating habits and life-styles of Canadians and ofpopulation groups in the United States, it is interesting tonote the recent Nutrition Canada national survey (13).Some similaritiesand somedifferencesare seenas compared with similar surveys in the United States. Theproblem of overweight was evident in a large proportion ofadults. Moderate iron deficiency was also widespread andwas observed as a problem for men as well as for infants andwomen. Some biochemical evidence of a protein deficit wasseen in pregnant women. Apparently, many girls andpregnant women had diets with inadequate calcium andvitamin D, but the severity was not such as to lead torickets. Moderate deficits of calcium, vitamin A, andvitamin C were particularly noted in the Eskimo and Indianpopulations. By contrast, I of 5 Eskimo adult men wasreceiving approximately 4 times the protein intake considered to be adequate.

Nutrientsin the Daily FoodSupply

The major sources of data on diets of various UnitedStates population groups have been the studies conductedby the USDA and the DHEW. The DHEW data representdietary intake information taken during the 3 major nutnitional status surveys previously mentioned: the survey ofpreschool children, the Ten-State Survey, and the HANESsurvey. For the most part, the limited dietary intakeinformation obtained in the DHEW nutritional statussurveys tended to confirm more detailed and extensive datain the USDA statistical compilations and nationwide surveys on food consumption.

Two different approaches have been followed by USDA.Using a food balance sheet, the Economic Research Serviceregularly makes national per capita estimates of fooddisappearing into United States consumption. From thesestatistics, estimates are then made of the amount of thevarious foods available for use by the civilian population (6,7). Scientists in the Agricultural ResearchServicecan thenobtain the nutritive value of the per capita food supply andthus be able to study trends over many years (10). Annual

NOVEMBER 1975 3247

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Ei@::@in/:

7@I3@__@__J--@LLiLL@@IS@b9'

£LLLLLL.@LLLLLU @.il@@@@ I@@@ @@&@!iII@t@@

Food Carboenergy hydrate Total Animal Vegetable Fat

Year (calories) (g) (g) (g) (g) (g)

w.A. Gortner% OF1909.13Table 1

Nutrients contributing food energy available for consumption/day,J9(J9_J974a

Protein

1909 35301910 34901911 34701912 34701913 34601914 34401915 34301916 33801917 33301918 33801919 34401920 32901921 32001922 34301923 34401924 34601925 34501926 34601927 34701928 34901929 34601930 34401931 33901932 33201933 32801934 32601935 32001936 32901937 32601938 32601939 33401940 33501941 34101942 33201943 33601944 33501945 33001946 33201947 32901948 32001949 32001950 32601951 31601952 31901953 31701954 31501955 31801956 31801957 31101958 31201959 31701960 31401961 31201962 31201963 31401964 31801965 31401966 31701967 32101968 32601969 32801970 33001971 33201972 33201973 3300l974b 3350

497495488490489483481470469464478457441480466474474478477482471474460448436429436438433433439429443425428426418412412397399402391389386380378378372375376375374373371374371371373378381380380381385388

104 54102 52101 52102 53100 5298 5197 5096 5096 5097 5297 5293 5191 5094 5196 5396 5395 5294 5295 5294 5194 5193 5192 5091 5090 5191 5288 4891 5190 5190 5192 5393 5494 5597 56100 5999 60102 62102 6397 6294 6094 6094 6093 5994 6195 6294 6395 6496 6595 6494 6395 6495 6495 6494 6496 6597 6696 6597 6798 6899 69100 69100 70101 71101 71

6870

50 12750 12448 12649 12448 12547 12747 12646 12646 12245 12945 13043 12341 12242 12943 13543 13543 13443 13343 13443 13543 13742 13442 13541 13339 13339 13439 12740 13339 13340 13339 13939 14339 14441 14041 14239 14240 13839 14335 14334 14034 14034 14534 13933 14332 14232 14232 14631 14631 14131 14231 14731 14331 14231 14231 14531 14730 14530 14731 15031 15431 15430 15730 15830 15831 15531 158

30190 1920 1930 1940 1950 1960 1970 1980

S-YEAR MOVINO AVUAGI

Chart 2. Changesin percapitacivilian consumption(disappearance)offood energy, protein, fat, and carbohydrate, 1909 to 1973. 0, preliminary.

— Sugor.

—.— Corbohydroto

@““-StarcI,,.-..-- ——R.fia.d Sugar@

150

50

1910 1920 1930 1940 1950 1960 1970 19805-y_ *,.s AmaSs

Chart 3. Changes in per capita civilian consumption (disappearance) ofsugars, starch, and carbohydrate, 1909 to 1973. 0, preliminary.

Table 2Crudefiber andfood lipids availableper capita per day in the United

Statesfood supply

Fatty acidsaTotal ________________________ Choles- Crudeb

Years nutrient Oleic Linoleic terolc fiberSaturated

fat― acid acid (mg) (g)(g) (g) (g) (g)

1909—1913 125 50.3 51.5 10.7 509 6.11925—1929 135 53.3 55.2 12.5 524 5.81935—1939 133 52.9 54.5 12.7 493 5.51947-1949 141 54.4 58.0 14.8 577 4.91957—1959 143 54.7 58.2 16.6 578 4.41965 145 53.9 58.8 19.1 540 4.21970' 157 55.9 63.1 23.3 556 4.2l974'@― 158 56.0 62.9 24.2 4.3

aRef 9.b Refs. 6 and 7, Table 40; Ref. 8.

C B. Friend, unpublished data.

d Preliminary.

were 65 years ago (Chart 5). We also can see the verymarked improvement that enrichment of cereals has madein B-vitamins and iron going into our food supply (Chart 6).In 1941, these 4 nutrients (iron, riboflavin, niacin, andthiamin) were added to enriched flour, resulting in a quitemarked increase in the per capita availability of thesenutrients that has held up during the past quarter century.

__________________________________________________@ The USDA survey on nutrient intake of individuals showsa Quantities of nutrients computed by USDA, Agriculatural Research who is getting some of these minerals (Chart 7). It is quite

Service, Consumer and Food Economics Institute, on the basis of estimates of per capita food consumption (retail weight), including estimates evident that, prior to menopause, females take in substanof produce of home gardens, prepared by the Economic Research 5cr- tially less than recommended amounts of iron. On the othervice. No deduction made in nutrient estimates for loss or waste of food hand, males take in substantially larger amounts andin the home, use for pet food, or for destruction or loss of nutrients during the preparation of food. Civilian per capita only, 1941 to date (6, 7. 10). approximate their recommended nutrient levels from teen

b Preliminary.

3248 CANCER RESEARCH VOL. 35

age and on.

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Nutrition in the United States

marked increase in poultry. The processing and marketinginnovations in the broiler industry have led to a ratherdramatic increase in consumption of poultry products.

The USDA survey of food intake of individuals in theUnited States (Ref. 2, Report I 1) gives us a picture of whois consuming these various food products. Consumption ofmilk and milk products (Chart 13) falls off after age 8 forfemales but stays quite high through age 19 for males.Consumption of animal products (Chart 14) does notchange greatly for females throughout the teen-ageyears and most of the adult life. However, it continues torise very markedly through age 34 for men.

Grains, fruits, and vegetables may be of special interest tocancer epidemiologists because of the hypothesis thatdietary fiber may play a role in cancer in man. Again,beginning at teen-age, females start consuming less grainproducts/day (Chart 15). Males reach their peak consumption of grain products much later, at about age 19.

A very different consumption pattern is seen for variousfruits and vegetable products. For tomatoes and citrus fruit(Chart 16), males and females consume comparable quantities/person each day, and there is no tendency for this tochange for any of the age groups after late childhood. Onthe other hand, while the same statement would also applyto the green and yellow vegetables (Chart 17), one may notefrom the quantity/person that these commodities contributeto the daily diet that they constitute a small fraction of theamount that grain products or tomatoes and citrus fruitcontribute.

Potato consumption shows a real difference associatedwith age and sex (Chart 18). For females, it remains atabout 50 g daily from early childhood on. For males, theconsumption rises to twice this amount by age 34 anddiminishes thereafter.

Unfortunately, neither the food balance sheets (disappearance data) nor the dietary surveys of households orindividuals in the United States have been used to come upwith solid information on the dietary fiber consumption. B.Friend3 has estimated that the level of crude fiber in thefood supply dropped from about 6 g per capita per dayaround 1910 to a little over 4 g in 1974 (Table 2). Thedecline may relate to a decreased consumption of potatoesand grain products. Although the crude fiber compositionhas not been tabulated for a great many foods, Watt andMerrill ( 15) include a column listing fiber for a considerablenumber of foods. There one can see that the fiber content ofcereal products runs somewhat lower than that of manyfruits and that vegetables as a class have substantially morefiber than do either cereals or fruits. Since much of thecereal consumption in the United States is of white wheatflour with perhaps only 0.3% fiber, it is obvious that anappreciable part of the dietary fiber of the United Statesmay come from noncereal products. Potatoes may be animportant source of fiber but the green and yellow vegetables may not be, as their relatively low daily consumptionoffsets the higher fiber content in vegetables. None of thismaterial dealing with “crudefiber― relates to individual

3 B. Friend. Changes in the U. S. Diet Caused by Alterations in Food

Intake Patterns.Paperfor the Food and Drug Administration Conferenceon the Changing Food Supply in America, Arlington, Virginia, May 22,1974.

LPCER 1—2)—5 6-S 9—11 12—1k15—17 1$—192O—5@ 15—5'.55—6465—7'.75@

1 AGE IN VIAlS

Chart 4. Grams of fat from I day's diet in 1965, by age and sex.

There is a different story for calcium in diets of men,women, and children (Chart 8). For females, all age groupsfrom age 9 and on are substantially below recommendeddaily intakes. Young adult males appear to have adequatecalcium, but many other age groups show less than recommended intakes.

Foods Used as Nutrient Sources

The calculations for nutrients in the daily food supply arebased on composition of the various foods used ( 15). Overthe years, these foods have changed considerably (Chart 9).Previously mentioned data (Chart 2) indicated that percapita consumption of protein today is similar to that in1910. Early in this century, about one-half of the proteincame from animal products (Table I), whereas today 70% ofprotein showing up in the food balance sheets comes frommeat, poultry, fish, dairy products, and eggs. The majorshift in the diet is in the marked decrease in consumption offlour and cereal products.

Previously mentioned data also showed a continual rise inthe daily use of fat in our diet (Chart 2). Again, as can beseen in Chart 10, there have been marked shifts in thesources offat (3). During the period 1940 to 1965, there wasa steady drop in the consumption of pork and milk fat. Onthe other hand, there was a steady and marked rise in theuse of margarine and other shortenings, of various saladsand cooking oils (notably soybean oil), and in the fatassociated with a marked increase in consumption of beef.

One can look at long-term trends in consumption ofmajor commodities (Chart I 1). There has been a fairlysteady decline in consumption of cereal products. The verymarked decline in consumption of potatoes began to reverseitself some years ago as a result of innovations in processingand marketing and the introduction of dehydrated andfrozen products. Note the rather marked shift over the yearsin the per capita consumption of eggs.

These trends in the major commodities can hide shifts infood consumption of the individual food items in the majorgroups (Chart 12). During the past 15 years, a markedincrease in the consumption of meat products is largelyassociated with an increased intake of beef and a very

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. Phos

Year Calcium phorus(g)(mg)

IronMag nesium(mg)Vitamin

AvalueL@(IU)Thiamin (mg)Riboflavin (mg)Niacin (mg)Ascorbic

acidc(mg)Vitamin

B1(mg)Vitamin

B12(mg)

w.A. GortnerTable 3

Mineral and vitamin nutrients available for consumption/day l909@@I974a

1909 0.83 1.58 15.5 7,800 1.68 1.88 9.5 1051910 0.80 1.55 15.3 7,600 1.63 1.82 19.3 1071911 0.78 1.52 15.2 7,500 1.63 1.80 18.7 991912 0.85 1.57 15.2 7,600 1.65 1.88 19.0 1041913 0.83 1.54 14.8 7,400 1.63 1.84 18.6 1031914 0.80 1.49 14.5 7,300 1.58 1.78 18.1 1001915 0.80 1.50 14.6 7,600 1.60 1.79 18.3 1051916 0.79 1.47 14.3 7,500 1.57 1.77 17.9 961917 0.81 1.50 14.7 7,800 1.54 1.79 18.2 981918 0.86 1.54 15.3 7,700 1.60 1.87 18.3 1021919 0.84 1.51 15.1 8,000 1.55 1.83 18.5 1001920 0.84 1.47 14.6 7,900 1.52 1.82 17.5 1041921 0.83 1.44 14.0 7,800 1.50 1.79 17.1 1041922 0.84 1.48 14.5 8,300 1.53 1.83 17.5 1041923 0.84 1.51 14.8 8,100 1.62 1.85 18.5 1091924 0.85 1.51 14.7 7,800 1.60 1.86 18.2 1081925 0.85 1.48 14.3 7,700 1.54 1.84 17.9 1061926 0.85 1.48 14.4 8,000 1.51 1.84 17.6 1041927 0.86 1.50 14.4 8,200 1.55 1.84 17.8 1051928 0.86 1.49 14.4 7,900 1.57 1.84 17.7 1051929 0.88 1.51 14.3 8,300 1.57 1.86 17.9 III1930 0.87 1.48 14.2 8,000 1.54 1.84 17.3 1031931 0.86 1.47 14.1 8,200 1.55 1.84 17.6 1091932 0.86 1.45 13.7 8,400 1.53 1.82 17.2 1071933 0.86 1.43 13.6 8,100 1.50 1.80 17.1 1051934 0.86 1.44 14.0 8,300 1.48 1.81 17.3 1081935 0.87 1.42 13.5 8,300 1.39 1.78 16.7 1121936 0.89 1.46 13.9 8,000 1.42 1.81 17.3 1091937 0.89 1.45 13.6 8,400 1.42 1.83 16.9 1101938 0.90 1.46 13.7 8,400 1.44 1.83 17.0 1141939 0.91 1.48 14.0 8,600 1.50 1.87 17.3 1161940 0.92 1.50 14.2 8,500 1.55 1.90 17.8 1151941 0.93 1.51 14.4 8,700 1.64 1.92 18.3 1151942 0.98 1.56 15.4 9,100 1.83 2.00 18.7 1171943 0.99 1.60 16.1 9,500 2.05 2.15 20.0 1151944 1.00 1.60 17.5 9,700 2.09 2.37 22.5 1251945 1.06 1.66 17.9 10,000 2.06 2.46 22.7 1251946 1.08 1.69 18.2 9,600 2.15 2.48 23.1 1231947 1.02 1.57 17.2 9,100 1.94 2.33 21.5 1191948 0.99 1.53 16.4 8,700 1.89 2.26 20.8 1121949 0.98 1.52 16.4 8,500 1.89 2.25 20.8 1091950 0.99 1.53 16.5 8,400 1.90 2.29 20.2 1051951 0.98 1.51 16.1 8,000 1.90 2.27 19.9 1071952 1.00 1.53 16.2 8,000 1.90 2.31 20.1 1051953 0.98 1.52 16.3 8,100 1.85 2.30 20.5 1061954 0.98 1.51 16.0 8,000 1.81 2.28 20.1 1051955 1.00 1.53 16.2 8,200 1.87 2.31 20.3 1061956 0.99 1.54 16.4 8,200 1.87 2.32 20.7 1051957 0.98 1.52 16.1 8,100 1.83 2.29 20.5 1071958 0.97 1.50 16.1 8,000 1.82 2.27 20.5 1021959 0.98 1.52 16.2 8,100 1.88 2.29 20.8 1061960 0.97 1.51 16.3 8,000 1.85 2.28 20.8 1081961 0.96 1.50 16.4 7,800 1.84 2.26 20.9 1071962 0.96 1.49 16.5 7,800 1.86 2.27 21.1 1071963 0.96 1.50 16.6 7,800 1.87 2.28 21.5 1011964 0.96 1.51 16.8 7,700 1.87 2.29 21.7 1001965 0.95 1.50 16.6 7,700 1.81 2.27 21.5 1011966 0.95 1.50 16.5 7,800 1.80 2.29 21.6 1021967 0.94 1.52 17.2 343 7,900 1.91 2.33 22.4 108 2.18 9.51968 0.95 1.53 17.4 8,100 1.91 2.35 22.7 1091969 0.94 1.53 17.6 8,100 1.93 2.35 22.8 Ill1970 0.93 1.52 17.8 8,200 1.93 2.35 23.1 1141971 0.94 1.53 17.9 8,200 1.97 2.37 23.3 1151972 0.94 1.54 18.0 346 8,100 1.94 2.35 23.4 115 2.29 9.81973 0.95 1.52 17.9 346 8,100 1.90 2.32 22.9 118 2.24 9.51974d 0.95 1.54 18.3 348 8,200 1.94 2.33 23.4 119 2.28 9.7

aQuantities of nutrients computed by USDA, Agricultural Research Service, Consumer and Food Economics Institute, on the basis ofestimates of percapita food consumption (retail weight), including estimates of produce of home gardens, prepared by the Economic Research Service. No deduction hasbeen made in nutrient estimates for loss or waste of food in the home, use for pet food, or for destruction or loss of nutrients during the preparation offood. Civilian per capita only, 1941 to date. Data for iron, thiamine, riboflavin, and niacin include estimates of the quantities of these nutrients added toflour and cereal products (6, 7, 10).

A Includes estimates of quantities added to margarine and to milk of all types.

C Includes estimates of quantities added to fruit juices and drinks.

d Preliminary.

3250 CANCER RESEARCH VOL. 35

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V@onünAIThiomin(

1@E1960—B... andv•oI160

140

120.—.—.

PoulEry

———EgIE. —..-#.—

.@

-.-.,.

Nutrition in the United States

75

501910 1920 1930 1940 1950 1960

5-yIAO MOVING AVISAGE

Chart 5. Changes in per capita civilian consumption (disappearance) ofcalcium, vitamin A, thiamin, and ascorbic acid, 1909 to 1973. @,enrichment initiated; 0, preliminary.

1970 1 l0

Chart 9. Diet sources of protein, 1910 to 1972. Per capita civilian foodsupply, 1972, preliminary. °,total animal sources.

% of

1504(3@.

InL.a

Cf

lION— IIIOFLAVIN

—.— NIACIN

—— THIAMIN

fat@,—‘margarine.

@@1A_/'@ shortening

,t%_,\_,,_p_tI-.@ fats oils50

1YJU P120 IY3U 1Y40 UYSU 1q60 1970 @@5Q

$.nM @vu@*wi@

Chart 6. Changesin percapitacivilian consumption(disappearance)ofvitamin B and iron, 1909 to 1973. 0, preliminary.

PERCENT-@

Mali

200@ ,

@ r@@@

V.., 12 34 êl i.I1 11.14 is.i@ is.1@ sai is.m iS.ê4 *5.74 fl

1 AGE IN YEARS@

Chart 7. Iron from 1 day's diet in 1965,by age and sex of the National Academy ofScience-National Research Council(l968).

year

Chart 10. Diet sources of fat, 1940 to 1965. Data from Ref. 3.

Chart I I . Trends in United States eating habits. Changes in per capitacivilian consumption (disappearance) of major food commodities, 1909 to

1965.PERCENT-@

100 8@ZL@@

80@@@@@ I@

1960 1965II I@ !Ij1970

1975

Chart 12. Changes in per capita consumption (disappearance) ofselectedlivestock products, 1960to 1974. @,includesbutter; A, preliminary.

3251

% OF 1909-13

125

200 r] -..:@ MaliandMale150@@ Female !

:LJIfflmiUSEI 14 3.5 @.$ p.11 13.14 15.17 15.15 20.34 35.54 SS.@ @S.74 75

I AGE IN YEARS ‘

Chart 8. Calcium from 1 day's diet in 1965,by age and sex of National Academy of Sciences-National Research Council (1968).

NOVEMBER 1975

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w.A. GortnerGRAMS

@ Mali and Mol.800

@,1.2 2.1 @1 @.U 11.14 1517 l$.l@ M24

‘ AGEINYEARS

Chart 13. Milk and milk products (calcium equivalent) in I day'sdiet in 1965, by age and sex.

GRAMS - @@MoI•@@@@ -.-—--

@s1.2 14 e.$ ,.lI liii 11.17 @$4@M.N i.54 @NMU 21I AGE IN YEARS ‘

Chart 15. Grain products (flour equivalent) in I day's diet in 1965,byage and sex.

GRAMS

1@ :@@@uillBiHLI°NI 1-2 11 êA @l 1144 11.17 IS4@ *21 21.21 21*1 11.21 11

2 AGEINYEARS ‘ii.

Chart 16. Tomatoes and citrus fruit in I day's diet in 1965, by ageand sex.

100

80

60

40 Nil. and Nil. F...S.

20

1-21.1R.$•.IIu.N $47 i.$ MMi.M M.MMJI 11I AGE IN YEARS â€S̃@

Chart 17. Dark green and yellow vegetables in I day's diet in 1965,by age and sex.

GRAMS

125- MAI@

100

fiber components such as pectins, pentosans, cellulose, orlignin, some of which may be far more important in cancerepidemiology.

Discussion

There is very little basis to relate the current nutritionalstatus of United States population groups to changes overan appreciable period of time.

The food disappearance data do give useful informationon changes in nutrients in our food supply during thiscentury and on changes in the foods that provide nutrientsto the population. Finally, the study of the dietary intake ofindividuals helps to define which age and sex groups aretaking in the different foods. The data thus also tell howeffective these dietary patterns are in meeting the recommended nutrient intakes of the different population groups.

In all ofthe studies I have referred to, we are talking onlyof averages. Usually, we do not know or are not told whatthe range is, what the degree of clustering may be, what theextremes encompass, and how many individuals may benear those extremes in foods or nutrients consumed or inclinical or biochemical or anthropometric tests of “nutritional risk.―A person with his head in the oven and his feetin the freezer may be comfortable “onthe average;― manyof the data defining “NutritionUSA―are similarly comfoiling to the health scientist, on the average.

An encouraging exception is the series of reports issued inthe Canadian survey (Nutrition Canada, 1975; Ref. 13).Their tables show the percentage distribution of dietaryintake of various nutrients and also the level for the lowestand for the highest 5% and 25% of the population. The same

75@M@.Iea@d

I-, Si e.i i.a ISN 14 *21 MM MM i.M iN 21

I AGEINYEARS

Chart 18. White potatoes in I day's diet in 1965, by age and sex.

GRAMS

:@1@Illi.NNI 1.2 1.1 6.1 Rh 21.14 2147 I$.l@ MN 11.14 S1.U 15.74 71

I AGE IN YEARS I iMI

Chart 14. Meat and poultry and fish in 1 day's diet in 1965, by ageand sex.

3252 CANCER RESEARCH VOL. 35

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Nutrition in the United States

is presented for many biochemical values relating to nutritional status. Thus, one can see that, while the lowest 5% ofthe Canadian teen-age males had dietary protein of onlyfour-fifths of the recommended “adequate―intake, theupper 5% of this population group were consuming morethan 4 times the amount of protein needed for goodnutrition.

Hopefully, the data described in this paper can at leastlead the epidemiologist to sources of information dealingwith food and nutrition that can be examined relative to thechanges in various diseases, including the various forms ofcancer.

References

1. Abraham, S.. Lowenstein, F. W., and Johnson, C. 1. PreliminaryFindings of the First Health and Nutrition Examination Survey,United States 1971-72: Dietary Intake and Biochemical Findings.Publication No. (HRA) 74-1219-I. Washington, D.C.: Department ofHealth, Education and Welfare, 1974.

2. Agricultural Research Service. Household Food Consumption Survey1965-66, Report Nos. I to 18. Washington, D.C.: United StatesDepartment of Agriculture, 1968-1974.

3. Call, D. L., and Sanchez, A. M., Trends in Fat Disappearance in theUnited States, 1909-65. J. Nutr., 93 (suppl.): I -28, 1967.

4. Clark, F. Recent Food Consumption Surveys and Their Uses.Federation Proc., 33: 2270-2274, 1974.

5. Department of Health, Education and Welfare. Ten-State NutritionSurvey, 1968-1970. Publication Nos. (HSM) 72-8130, 72 8131,

72-8132, 72-8133, 72-8134. Washington, D.C.: Department ofHealth, Education and Welfare, 1972.

6. EconomicResearchService.FoodConsumption, Prices,and Expenditures. Agricultural Economic Report 138.Washington, D.C.: UnitedStates Department of Agriculture, 1968.

7. Economic Research Service. Food Consumption, Prices, and Expenditures. Agricultural Economic Report I38. Supplement.Washington,D.C.:UnitedStatesDepartmentof Agriculture,1974.

8. Feeley, R. M., Criner, P. E., and Watt, B. K. Cholesterol Content ofFoods. J. Am. Dietet. Assoc., 61: 134-149, 1972.

9. Friend, B. Nutrients in the United States Food Supply. A Review ofTrends, 1909-1913 to 1965. Am. J. Clin. Nutr., 20: 907 914, 1967.

10. Friend, B., and Marston, R. Nutritional Review. National FoodSituation (USDA). 150: 26-32, 1974.

II. Kelsay, J. 1. A Compendium of Nutritional Status Studies andDietary Evaluation Studies Conducted in the United States(1957-1967).J.Nutr.,99:119-166,1969.

12. Morgan, A. F. Nutritional Status U.S.A. Calif. Agr. Exptl. StationBull. 769, 1959.

13. Nutrition Canada. Nutrition: A National Priority. Report by Nutrition Canada to the Department of National Health and Welfare,

Ottawa, Canada: Information Canada, 1973. (In 1975 this materialis detailed in 12 survey reports covering Alberta, British Columbia,

Eskimos, Indians, Manitoba, New Brunswick, Newfoundland, NovaScotia, Ontario, Prince Edward Island, Quebec, and Saskatchewansurvery areas).

14. Owen, G. M., Kram, K. M., Garry, P. J., Lowe, J. W., and Lubin, A.H. A Study of Nutritional Status of PreschoolChildren in the UnitedStates, 1968- 1970. Pediatrics, 53: 597-646, 1974.

15. Watt, B. K., and Merrill, A. L. Composition of Foods Raw,Processed, Prepared. Agriculture Handbook No. 8. Washington,D.C.:UnitedStatesDepartmentof Agriculture,1963.

NOVEMBER 1975 3253

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