75.
CURRENT N U T R I T I O N A L PROBLEMS I N AMERICA
W.
0 . CASTER
UNLVERSITY
OF GEORGIA
...........................................................................
I want t o thank t h e American Meat Science I n s t i t u t e f o r t h e
opportunity t o address t h i s group today. The t o p i c t h a t has been chosen
f o r me, "Current N u t r i t i o n a l Problems i n America," i s c o n t r o v e r s i a l , t o say
t h e l e a s t . If you were t o ask any t e n p r o f e s s i o n a l n u t r i t i o n i s t s t o speak
on t h i s t o p i c , I suspect t h a t you would f i n d a t l e a s t six d i f f e r e n t answers
and e v a l u a t i o n s . The Food and D r u g Administration and s e v e r a l o t h e r groups
a r e c u r r e n t l y holding h e a r i n g s i n Washington on c e r t a i n a s p e c t s of t h i s
q u e s t i o n . Much of what I w i l l say today, t h e r e f o r e , I must l a b e l as
opinion.
The comments w i l l , however, be centered on t h e d a t a of r e c e n t
s u b s t a n t i a l r e p o r t s . There a r e a number of t h e s e , b u t t h e r e z r e t h r e e
major r e p o r t s t h a t have been i s s u e d w i t h i n t h e l a s t few months. One of
t h e s e i s t h e Nationwide Food Consumption Survey of t h e U. S. Department of
A g r i c u l t u r e . The second i s e n t i t l e d , "Hunger, U. S. A.", and i s i s s u e d by
t h e C i t i z e n s ' Board of I n q u i r y i n t o Hunger and M a l n u t r t t i o n i n t h e U. S. A.
The t h i r d i s t h e r e p o r t of t h e "World Food Problem" i s s u e d by t h e P r e s i d e n t ' s
Science Advisory Committee. These t h r e e r e p o r t s c o n t a i n an abundance of
provocative d a t a .
The U. S. Department of A g r i c u l t u r e r e p o r t says i n e f f e c t t h a t
50% of t h e American families have d i e t s which a r e ''not good" ( d o not meet
t h e NRC recommended allowances over t h e period of one week as measured i n
t h e Spring of 1965). The s i t u a t i o n now i s r e p o r t e d l y worse t h a n it w a s 1 0
y e a r s ago, a t which time o n l y 40% of t h e American d i e t a r i e s were judged t o
The c l e a r i m p l i c a t i o n i s t h a t t h e American d i e t has been
g e t t i n g p r o g r e s s i v e l y worse f o r t h e l a s t 1 0 y e a r s .
be "not good".
If one r e a d s f u r t h e r i n t o t h e r e p o r t , he w i l l f i n d a d e s c r i p t i o n
of t h e changes i n d i e t which have occ>a-red i n t h e p a s t 1 0 y e a r s and which
presumably have l e d to t h i s d e t e r i o r a t i o n i n n u t r i t i o n a l a c c e p t a b i l i t y of
t h e n a t i o n a l d i e t . Among t h e major t h i n g s t h a t one w i l l note i s t h a t we
a r e now e a t i n g more beef and p o u l t r y . W
e are e a t i n g p r o p o r t i o n a t e l y more
e are consuming s l i g h t l y l e s s milk,
cake and perhaps a l i t t l e l e s s bread. W
and we are consuming much more f r o z e n f r u i t j u i c e s and v e g e t a b l e s . Taken
all t o g e t h e r , t h i s i s presumably bad. I must concede t h a t if I w e r e g i v e n
a choice between t h e 1965 d i e t and t h e one r e p o r t e d 1 0 y e a r s e a r l i e r , I
would probably be s t u p i d enough t o choose, f o r myself, t h e 1965 d i e t .
The r e p o r t goes on t o d e t a i l t h e n a t u r e of t h e n u t r i t i o n a l
d e f i c i e n c i e s which occur most commonly i n t h i s country today, and t o
i n d i c a t e t h e r e a s o n s why h a l f of t h e f a m i l y d i e t a r i e s were c l a s s e d as b e i n g
"not good". Most f r e q u e n t l y , t h e r e w a s d e f i c i e n c y i n Vitamin C, Vitamin A
and calcium. These axe t h e conclusions of t h i s survey, and on t h i s b a s i s
we a r e asked t o b e l i e v e t h a t t h e American d i e t a r y h a s become worse i n t h e
l a s t 1 0 years, and t h a t h a l f of t h e American f a m i l i e s a r e consuming d i e t s
which a r e "not good".
76.
.
Now I ask you t , o s t o p and t h i n k a morrent
How nany c a s e s of f r a n k
scurvy, x e r o p h t h d m i a , n i g h t b l i n d n e s s , o r o t h e r c r i t l c a i evidences of
Vitamin A or Vitamin C d e f i c i e n c y have you seen i n t h e p a s t week? C e r t a i n l y
i f a h i g h p e r c e n t of t h e American d i e t a r i e s are g r o s s l y inedequate w i t h
r e g a r d t o t h e s e n u t r i e n t s , s t a t i s t i c s would g r a n t t h a t t h e r e n u s t a l s o be a
v e r y l a r g e number of c r i t i c a l l y d e f i c i e n t i n d i v i d u a l s i n t h i s country. I
have not seen them, and I d a r e say y o i ~have not seen them. I n f a c t , t h e y are
c l i n i c a l l y r a r e i n any developed a r e s of t h i s e a r t h .
P a r e n t h e t i c a l l y , I suspect t h a t one problem w i t h t h e USDA conc l u s i o n s s t e m s f r o m a r a t h e r simple s t a t i s t i c a l e r r o r -- r e l a t e d t o t h e f a c t
t h a t d i e t a r y i n t a k e d a t a f o r Vitamin C and Vitamin A have unusually l a r g e
day-to-day v a r i a t i o n s . I d i s c u s s e d t h i s m a t t e r s e v e r a l y e a r s ago, and I
would hope t h a t , b e f o r e p u b l i s h i n g f - x t h e r p a r t s of t h i s survey, t h e s e
workers might t a k e t h e o p p o r t u n i t y t o confer w i t h a s t a t i s t i c i a n concernlng
t h i s point.
Now, t h e o t h e r c r i t i c a l d e f i c i e n c y i n t h e American d i e t a r y w a s
r e p o r t e d t o be t h a t of calcium. I do not claim t o be an e x p e r t on t h e
m i n e r a l s . I do note t h a t t h e P r e s i d e n t ' s Science Advisory Committee goes
i n t o some d e t a i l concerning t h e n . J t r i t i o n a 1 d e f i c i e n c i e s t h a t o c c w i n
c e r t a i n of t h e underdeveloped n a t i o n s of t h i s e a r t h , and concludes by
s t a t i n g t h a t ' ' t h e r e i s no good evidence t h a t calcium d e f i c i e n c y c o n s t i t u t e s
a s e r i o u s h e a l t h problem" i n any p o r t i o n of t h i s e a r t h -- and it f u r t h e r
p o i n t s out t h a t t h e r e are many areas of t h e e a r t h i n which t h e calcium consumption i s c o n s i d e r a b l y l e s s t h a n t h e average i n t h e U. s. A.
I n summary t h e n , t h e most generous t h i n g t h a t I can say about t h e
o v e r a l l c o n c l u s i o n s of t h e USDA survey i s t h a t t h e y are i n a c c u r a t e , m i s l e a d i n g and d e t r a c t a t t e n t i o n from t h e t r u e problem.
They should not have r e c e i v e d t h e widespread p u b l i c i t y t h a t t h e y
have been given. The i n t e l l i g e n t layman l o o k i n g a t t h e s e c o n c l u s i o n s , and
t h e n l o o k i n g a t t h e people i n h i s i m e d i a t e environmeat, can only conclude
t h a t n u t r i t i o n a l allowances and probably all o f f i c i a l s t a t e m e n t s on n ? t r i t i o n
are g r o s s l y unimportant or misleading. The s c i e n t i f i c c o r n u n i t y l o o k i n g c a r e f u l l y a t t h e s e c o n c l u s i o n s can o n l y view t h e f i e l d of n u t r i t i o n w i t h e i t h e r
contempt or p i t y .
Now I ' d l i k e t o t u r n t o t h e second r e p o r t , "Hunger, U. S. A." It
d e a l s with poverty. It d e a l s w i t h t h e i n v i s i b l e poor. It i s important t o
couple t h e word " i n v i s i b l e " w i t h t h e word "poverty". Data concerning t h e
poor are extremely d i f f i c u l t t o o b t a i n , and I must concede t h a t t h i s r e p o r t ,
though v e r y eloquent i n i t s p r e s e n t a t i o n , i s l e c k i n g i n some of t h e hard
f a c t t h a t I would l i k e t o s e e . The d i f f i c u l t y , of course, i s t h a t of
l o c a t i n g and studying t h e poor. T h e i r names are not l i s t e d i n t h e tele-ahone
book. Many of them l i v e on s t r e e t s t h a t a r e not paved and have no water
o r sewage.
I s u s p e c t t h a t , by and l a r g e t h e y are not adequately covered i n
USDA
food
consumption survey. True, t h a t survey included i n d i v i d u d s
the
w i t h low f a m i l y incomes, b u t a l a r g e p o r t i o n of t h e s e w e r e o l d e r people o r
p e n s i o n e r s w i t h l i t t l e or no t a x a b l e income. T h i s i s a v e r y d i f f e r e n t
s o c i o l o g i c a l groap. I ' m speaking now of l o n g term, hard core p o v e r t y -- t h e
i n v i s i b l e poor. They a r e not "consumers" ( i n t h e m e r c a n t i l e sense) and
77.
hence, one who i s i n t e r e s t e d i n s e l l i n g food or any o t h e r commodity h a s no
r e a l i n t e r e s t i n sampling t h i s group. T h e i r d o l l a r s a r e t o o few t o be
important i n t h e market p l a c e .
They do e x i s t and t h e y a r e hungry. They are i n a l l p a r t s of t h i s
country, i n c l u d i n g Georgia. They a r e b l a c k and white. There a r e an i n c r e a s ing number of Negroes. One evidence of t h i s i n c r e a s e i n numbers can be seen
i n t h e p r o g r e s s i v e i n c r e a s e i n t h e rate of premature b i r t h weight among t h e
Negro p o p u l a t i o n of t h i s s t a t e . P r e m a t u r i t y i s a l e a d i n g cause of i n f a n t
m o r t a l i t y i n t h i s area. I f you w i l l t r a c e t h e s e d a t a back t o t h e 1940's,
j u s t a f t e r t h e war-time (when jobs were r e l a t i v e l y e a s y t o o b t a i n ) , you w i l l
f i n d t h a t t h e p r e m a t u r i t y r a t e i n both t h e white and Negro p o p u l a t i o n s w a s
s u b s t a n t i a l l y i d e n t i c a l a t t h a t p e r i o d . Since t h e n , however, t h e r e has been
a p r o g r e s s i v e i n c r e a s e i n p r e m a t u r i t y among t h e Negro, b u t no change i n t h e
white p o p u l a t i o n . P r e m a t u r i t y i s known t o be c o r r e l a t e d with poor maternal
n u t r i t i o n , and I am t o l d by s o c i o l o g i s t s t h a t t h e s e d a t a r e f l e c t i n a t r u e
way t h e d i f f e r e n c e i n r e l a t i v e economic s t a t u s of t h e s e two r a c i a l groups i n
our s t a t e over t h e course of t h e l a s t 15 y e a r s .
There i s one l a r g e group of hungry people t h a t i s e a s i l y v i s i b l e .
We have 100,000 school c h i l d r e n i n t h e s t a t e of Georgia t h a t go t o t h e lunchroom e v e r y noon and watch t h e o t h e r c h i l d r e n eat, while t h e y s i t t h e r e with
no food. There a r e about 200,000 of them i n t h i s one s t a t e d o n e t h a t cann o t pay f o r t h e i r school lunch. Some 70,000 of t h e s e are covered by funds
from l o c a l and c i v i c groups and another 30,000 a r e covered by F e d e r a l funds,
b u t each day t h e r e are an a d d i t i o n a l 100,000 t h a t do not e a t . They s i t
t h e r e and watch t h e o t h e r s e a t , while t h e y themselves go hungry. You can
be e q u a l l y c e r t a i n t h a t many of t h e s e same c h i l d r e n have l i t t l e or nothing
f o r b r e a k f a s t and r e t u r n home t o a supper which i s meager a t b e s t .
There i s another group t h a t i s a l i t t l e more d i f f i c u l t t o f i n d ,
b u t we are coming t o b e l i e v e may be t h e most c r i t i c a l of all. I refer t o
t h e malnourished i n f a n t and h i s mother. There are s t u d i e s i n v a r i o u s p a r t s
o f t h e world t o d a y t h a t confirm t h a t t h e l a c k of proper food d u r i n g pregnancy and d u r i n g t h e e a r l y months of i n f a n t l i f e l e a d t o a permanent p h y s i c a l
and mental s t u n t i n g of t h e c h i l d . Most s t u d i e s suggest t h a t t h e r e s u l t i s
a p o p u l a t i o n whose average I.&. i s 85 r a t h e r t h a n 100 -- a p o p u l a t i o n which
i s almost t o t a l l y l a c k i n g i n i n d i v i d u a l s with high l e v e l s of i n t e l l i g e n c e .
Many of t h e s e c h i l d r e n a r e i n e v i t a b l y f a i l u r e s i n school and many more w i l l
i n e v i t a b l y end up as wards or p a r t i a l dependents of t h e s t a t e .
Anlong t h e working adult p o p u l a t i o n a l a c k of food does not, have
as dramatic or as permanent an e f f e c t . C a r e f u l p h y s i o l o g i c a l s t u d i e s i n w a r time Germany i n d i c a t e v e r y c l e a r l y t h a t one of t h e major e f f e c t s of hunger
i s t o make t h e i n d i v i d u a l l e t h a r g i c . If you do not have an adequate c a l o r i c
i n t a k e , it i s mathematically impossible t o s u s t a i n a high l e v e l of c a l o r i c
output f o r any prolonged p e r i o d . A t f i r s t glance t h e person may appear t o
be languid or even l a z y . Among t h e poor, however, it may be much more
a p p r o p r i a t e t o ask t h e q u e s t i o n f i r s t , "has t h i s person had an adequate
amount of food t o eat?"
I s t h e r e a n u t r i t i o n a l problem i n t h e United S t a t e s ? Many d i f f e r e n t answers can and have been given. A s I s a i d , t h i s i s a matter of opinion.
If you are t h e t y p i c a l a f f l u e n t American, and judge by t h e people coming
through your home and through your a i r - c o n d i t i o n e d o f f i c e and are c a r e f u l
78.
t o look n e i t h e r t o t h e r i g h t nor l e f t a s you go through l i f e , you w i l l
probably r e p l y t o t h i s q u e s t i o n by p o i n t i n g t o t h e problems of o b e s i t y
and say t h a t we a r e e a t i n g t o o much. You may even p o i n t t o t h e l a r g e meat
i n t a k e , and t a l k about s a t u r a t e d f a t , c h o l e s t e r o l and high blood p r e s s u r e .
You may even p o i n t t o t h e USDA survey as evidence t h a t w e are e a t i n g t h e
wrong t h i n g s (cake i n s t e a d of bread) and conclude t h a t we should be t a k i n g
v i t a m i n p i l l s , o r probably both v i t a m i n p i l l s and mineral p i l l s t o balance
our d i e t .
I a m a f r a i d t h a t I do not see any of t h e s e as an adequate or
r e s p o n s i b l e answer today. If one w i l l b u t look, he must conclude t h a t t h e r e
are hundreds of thousands of hungry and malnourished people i n t h i s country.
The hungry school c h i l d r e n are e a s y t o f i n d . There a r e many thousands of
c h i l d r e n and adults t h a t a r e permanently p h y s i c a l l y and mentally s t u n t e d
from inadequate e a r l y n u t r i t i o n . The most c r i t i c a l n u t r i t i o n a l problem i n
America today i s a l a c k of food, a l a c k of c a l o r i e s , a l a c k of p r o t e i n and
probably a l a c k of c e r t a i n o t h e r s p e c i f i c n u t r i e n t s -- j u s t what n u t r i e n t s ,
I do not know. The i n v i s i b l e poor a r e t h e r e . They have not been adequately
s t u d i e d , and t h e i r s p e c i f i c n u t r i t i o n a l problems a r e not p r e c i s e l y known.
F i n a l l y , l e t me say a f e w words about t h e t h i r d of t h e s e o f f i c i a l
reports
"The World Food Problem", prepared by t h e P r e s i d e n t ' s Science
Advisory Committee. Much of t h i s a p p l i e s more s p e c i f i c a l l y t o t h e n u t r i t i o n a l problems of C e n t r a l and South America.
--
The world food problem i s c r i t i c a l . It i s i n t i m a t e l y r e l a t e d t o
t h e r a p i d r i s e i n world population. T h i s w i l l r e q u i r e a 50% i n c r e a s e i n food
production by 1985, and a doubling by t h e t u r n of t h e c e n t u r y - - i f we a r e
t o f e e d t h e world of t h e f u t u r e as w e l l as it i s b e i n g f e d t o d a y . It i s
only f a i r t o add t h a t we a r e not doing t o o w e l l t o d a y . There a r e over 10,OOC
persons each day who d i e of s t a r v a t i o n . (Over 400 persons have d i e d of
and many of them were i n C e n t r a l and
s t a r v a t i o n w i t h i n t h e p a s t hour
South America.)
--
T h i s i s t o o b i g a problem t o d i s c u s s or solve i n t h e next few
minutes, b u t what it does mean i s t h a t t h e r e must be a major r e v o l u t i o n i n
15 y e a r s . Some of t h e
a g r i c u l t u r e and t h e food i n d u s t r i e s w i t h i n t h e next 1 0
p r e s e n t p r e d i c t i o n s undoubtedly are i n a c c u r a t e , b u t one can w e l l imagine
t h a t , w i t h i n t h e next decade o r so:
-
1) every a c r e of t i l l a b l e farm l a n d i n t h e world w i l l be pressed
i n t o maximum production
2) g r a z i n g may be l a r g e l y confined t o t h e savannah l a n d s of A f r i c a
and South America, and similar a r e a s u n s u i t e d t o more i n t e n s i v e
c u l t i v a t i o n , and
3) f a r m animals w i l l no longer be f e d g r a i n o r o t h e r products
s u i t a b l e f o r human food consumption.
I n f i n a l summary, hunger and c a l o r i e - p r o t e i n u n d e r n u t r i t i o n c o n s t i t u t e t h e g r e a t e s t n u t r i t i o n a l problem both i n t h i s country and i n t h e l e s s
developed c o u n t r i e s of t h e world. Some people a r e a c t u a l l y s t a r v i n g . Large
numbers a r e hungry, and more mouths a r e a r r i v i n g t o be f e d every day. T h i s ,
i n a word, I s t h e c u r r e n t n u t r i t i o n a l problem of America, and of t h e World.
There i s a need f o r food -- not vitamin p i l l s , but FOOD.
79.
DR. SJBRMAN: Thank you f o r an extremely f i n e paper and very well
p r e s e n t e d . I t h i n k it w i l l s t i m u l a t e some thought i n all of us. NOW I
would l i k e t o t u r n t h e d i s c u s s i o n cver t o D r . O l d Kolari, of t h e American
Meat I n s t i t u t e Foilndation. He w a s , i n c i d e n t a l l y , t h e Chairman of t h i s
N u t r i t i o n Committee, and d i d a v e r y e x c e l l e n t job and a l o t of work on it.
DR KOLARI: Thank you, B i l l . Members of t h e A m e r i c a Meat Science
Association, I might say t h a t I am v e r y happy t o be on your program. I
would l i k e t o commend our speakers for s e t t i n g t h e r e c o r d s t r a i g h t on t h e
recommended d i e t a r y allowances and t h e n t o D r . C a s t e r f o r s e t t i n g us
s t r a i g h t on t h e n u t r i t i o n a l problems t h a t we have i n t h i s c o u n t r y . I agree
w i t h B I l l - - I t h i n k t h a t what he h a s s a i d w i l l c e r t a i n l y stimulate a l o t of
discussion.
I w a s also very happy t o n o t i c e t h a t D r . V o r i s s a i d t h a t t h e r e
were no recommended allowances f o r a l c o h o l , b u t I would just l i k e t o p o i n t
out from t h e n u t r i t i o n a l p o i n t of view t h a t one gram of a l c o h o l y i e l d s 7
c a l o r i e s , and i f you l i k e t h i s i n a l i q u i d measure--one m i l l i l i t e r y i e l d s
5.6 c a l o r i e s .
I t h i n k t h a t our time i s running a l i t t l e s h o r t , so a t t h i s t i m e I
t h i n k I w i l l j u s t ask for questioiis, and t h e s e young gentlemen here w i l l
provide t h e r i g h t answers i f you have t h e r i g h t q u e s t i o n s . Are -there any
q u e s t i o n s on t h e two papers t h a t were presented?
QUESTION: You h e a r a g r e a t d e a l about v i t a m i n E, and I wonder i f
you would cme t o t e l l u s i f t h e r e i s a requirement and what r e l a t i o n t h i s
may have t o m u s c u l a dystrophy.
question.
problems.
0. KOLARI: Dr. Voris, I wonder if you would l i k e t o handle t h a t
P l e a s e come t o t h e microphone i n case we have some r e c o r d i n g
DR. VORIS: There i s a recommendation i n t h e 1968 r e v i s i o n of t h e
recommended allowances f o r v i t a m i n E f o r t h e f i r s t t i m e . This i s a t t h e
l e v e l of I t h i n k 3 G micrograms or 30 I n t e r n a t i o n a l U n i t s p e r day f o r adults,
b u t t h e r e h a s been no symptomatology f o r v i t a m i n E d e f i c i e n c y among people
i n t h e United S t a t e s t h a t h a s been r e a l l y i d e n t i f i e d , so t h a t t h e r e h a s been
no r e l a t i o n s h i p observed as f a r as I know t o muscular dystrophy. I t h i n k
t h a t t h e v a r i o u s a t t e m p t s t o t r e a t t h e c a s e s of muscular dystrophy w i t h
v i t a m i n E have been l a r g e l y d i s a p p o i n t i n g . A t l e a s t f o r t h e f i r s t t i m e ,
t h e r e w i l l be t a b u l a t e d a recommended allowance of v i t a m i n E and t h i s
l a r g e l y came about because of t h e p e r s i s t e n t i n c r e a s e i n t h e consumption of
v e g e t a b l e o i l s w i t h polyunsaturated f a t . T h i s i s where v i t a m i n E a p p a r e n t l y
s e r v e s t h e main purpose i n human n u t r i t i o n , i n t h e p r o t e c t i o n of t h a t t y p e
of c a l o r i e s .
FROM THF) FLOOR:
Occasionally we h e a r laymen speak of t h e r e l a t i o n s h i p of vitamin E to h e a r t d i s e a s e . Vould you c a r e t o speak on t h i s ?
DR. VORIS: I d o n ' t t h i n k t h e r e h a s been any r e a l f a c t o r r e l a t e d
t o h e a r t d i s e a s e , and cer-bainly as f a r as I know not with v i t a m i n E .
KOLARI:
Thank you, Dr. V o r i s .
Are t h e r e any o t h e r q u e s t i o n s ?
FROM THE FLOOR:
creasing f o r adults?
Why a r e t h e recommended c a l o r i c requirements de-
DR. VORIS: Because t h e i r g a s o l i n e consumption i s i n c r e a s i n g . It
may be based on t h e apparent decrease i n p h y s i c a l a c t i v i t y mong t h e e l d e r l y
i n t h e United S t a t e s .
0. E. KOLARI: Any o t h e r questions? If t h e r e a r e no o t h e r q-dest i o n s , I w i l l t u r n t h e program back over t o D r . S l e e t h . Thank you v e r y
much.
DR. SLEETH: Thanks t o yo^, B i l l , Oley, and t h e two guest speaker:
we have had t h i s morning. Because of t h e t h i n g s t h a t t h e y had t c t e l l . us-about c a l o r i e s and d i e t m y allowances and so forth--we have t a k e n t h e przr o g a t i v e of c a n c e l i n g lunch and have t h e t r a c k opened up over a t the fieLd
house.
######if#####