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[CANCER RESEARCH 35, 3246-3253, November 1975] Nutrition in the United States, 1900 to 1974' Willis A. Gortner United States Department of Agriculture, Agricultural ResearchService, National Program Staff, Beltsville, Maryland 20705 Summary Marginal Nutritional Status Food and nutrient intakes are being examined for possi ble relationship to the occurrence or the progress of various types of cancer in man. This paper describes the state of our knowledge on the nutritional status of various population groups in the United States and on the food consumption patterns and their nutritional consequences during the 1900's. Only a few medical studies of nutritional status have been conducted on a national or even a regional basis. These extend back less than 2 decades. Dietary informa tion is available back to the 1930's, and statistical data on use of food in the United States can be found beginning with 1909. Sources of information are suggested for the use of and detailed study by the epidemiologist. During the period from 1947 to 1958 a sizeable number of regional nutritional status studies were sponsored by the USDA and summarized in a publication (12). The bio chemical, clinical, and dietary studies indicated that the average nutritional health for various population groups was good. Less than recommended dietary intakes were most frequently found for both children and adults for vitamin A, ascorbic acid, and iron. Rural, low-income families had diets containing the lowest nutritive value. Adolescent girls and especially older people tended to be overweight, and Spanish American and Indian children frequently had lower heights than average for the popula Introduction The past 4 decades have seen a dramatic turnaround in the overt nutritional health problems experienced earlier in the century (Chart 1). At the turn of the century, and again today, deaths from pellagra (a major vitamin deficiency disease) were almost unknown in this country. Yet, in the late 1920's and 1930's, there was a very high death rate, particularly in the Southern States. Large numbers also died from scurvy due to a deficiency of vitamin C. Doctors then could readily find cases of beriberi due to thiamine deficiency, cases of xerophthalmia from a deficiency of riboflavin, or cases of rickets due to a vitamin D deficiency. Today these major vitamin deficiency diseases have been eradicated so successfully in the United States that many doctors never see them and would not recognize them. Poor nutrition is now more frequently seen in the many health problems where nutrition has a more subtle involve ment but is at least implicated in playing a role. Diet, and especially the lipid components, is one of the identified factors in serum lipid levels that are listed as a major risk factor in heart disease. Diet, and particularly the caloric intake, is clearly implicated in the major health problem of obesity in our population. A number of diet interrelation ships seem to have some role in the problem of osteoporosis encountered in the elderly. The current thrust of this conference suggests that nutrition may indeed play a role in the incidence of some cancers in man. â€P̃resented at the Conference on Nutrition May 19to 22, 1975,Key Biscayne,Fla. 3246 in the Causation of Cancer, tion. 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 children at nutritional risk were mostly clustered among preschool children of lower socioeconomic status. The major nutri tional problem confronting those children appeared to be insufficient food rather than the nutritional quality of the food consumed. The authors noted the fact that a great many preschool children whose diets seemed to be quite adequate were regularly taking vitamin supplements in addition. Other surveys show the same. At about the same time, the Federal Government con ducted a nutritional status survey encompassing all age groups, using a sample drawn from the lowest average income districts in 10 states (5). One major finding in the Ten-State Survey was a high prevalence of low vitamin A values among Mexican Americans. There was a greater prevalence of unsatisfactory nutritional status among ado lescents, whereas the elderly showed evidence of general undernutrition. Obesity was very frequently observed, and in some age groups more than 50% of adult women were found to be obese. Iron deficiency anemia was identified as a widespread problem. Such nutrients as vitamin C, thia mine, and iodine did not seem to pose a major problem among any of the groups studied. In 1971 to 1972, a nationwide survey, Health and Nutni tion Examination Survey (HANES) of the nutritional status of the United States population, ages 1 through 74 years, was undertaken (1). The early, still preliminary data that have been reported gave evidence of iron deficiency 2 The abbreviations Agriculture; DHEW, used are: USDA, United States Department of Department of Health, Education and Welfare. CANCER RESEARCH VOL. 35 Downloaded from cancerres.aacrjournals.org on June 16, 2017. © 1975 American Association for Cancer Research. Nutrition in the United States food disappearance and nutrient estimates are available starting in 1909. The figures, of course, do not show which population groups were most affected by observed shifts in consumption. The other source of data is the periodic nationwide food consumption surveys conducted by the USDA's Agricul tural Research Service. The 1st such nationwide survey based on a statistical sampling of households was made in 1936 to 1937. Since then 4 large-scale studies were made in 1942, 1948, 1955, and 1965 to 1966 (4). Currently, plans are being made for the next survey, possibly in 1976 to 1977. All Chart I . Peliagradeath rates in the United States. of these surveys have included assessing food used by households, and the most recent survey also developed information on the food intake of individuals in the household (2). Data were thus provided on the total nutritive value of the diets and on the contribution of major food groups to the total of both households and individuals. The sampling allowed a breakdown into subgroups of different incomes, different regions of the United States, and rural and urban people. What have been the trends during this century in the nutrients in the United States daily food supply? The trends in food uses of protein, fat, and carbohydrate during the Some similaritiesand somedifferencesare seenas com past 60 years are shown in Table 1 and Chart 2. The pared with similar surveys in the United States. The available supply of calories shows minimal change, and the problem of overweight was evident in a large proportion of proportion of this derived from protein also has not changed adults. Moderate iron deficiency was also widespread and much. What is clear is that we have steadily been consuming was observed as a problem for men as well as for infants and more fat and less carbohydrates in the United States. women. Some biochemical evidence of a protein deficit was The declining intake of carbohydrate was also accompa seen in pregnant women. Apparently, many girls and nied by a shift in the nature of the carbohydrate (Chart 3). pregnant women had diets with inadequate calcium and Starch has dropped off at a much more rapid rate than the vitamin D, but the severity was not such as to lead to total carbohydrate during these 6 decades. The rather rickets. Moderate deficits of calcium, vitamin A, and marked rise in sugars and in refined sugar that occurred vitamin C were particularly noted in the Eskimo and Indian during the 1920's has (after a decline during World War 2) populations. By contrast, I of 5 Eskimo adult men was been maintained in the years subsequent to this. Similarly, we find that the increased amount of fat in our receiving approximately 4 times the protein intake consid ered to be adequate. food balance sheets has been accompanied by a shift in the type of fat consumed (Table 2). There has been only a small Nutrientsin the Daily FoodSupply change in saturated fatty acids in the food supply during the past several decades. A rather modest increase in polyun The major sources of data on diets of various United saturated fatty acids (linoleic acid) is seen prior to 1940, and States population groups have been the studies conducted a noticeable increase in the polyunsaturated fatty acids by the USDA and the DHEW. The DHEW data represent during the last 20 years relates to the increase in our dietary intake information taken during the 3 major nutni consumption of edible oils, margarine, and shortening. tional status surveys previously mentioned: the survey of There now are data showing who is taking this fat into the preschool children, the Ten-State Survey, and the HANES day's diet (Chart 4). Dietary fat is peaking in the age 12 to survey. For the most part, the limited dietary intake 14 group for women and falls fairly steadily thereafter information obtained in the DHEW nutritional status throughout life. By contrast, men do not reach their surveys tended to confirm more detailed and extensive data maximum fat intake until near the end of adolescence, the in the USDA statistical compilations and nationwide sur amount dropping off only after age 20. veys on food consumption. Cholesterol appears to have risen to a current level only Two different approaches have been followed by USDA. 10% above that in United States diets at the turn of the Using a food balance sheet, the Economic Research Service century (Table 2). During the past 25 years there has been a regularly makes national per capita estimates of food declining use of eggs, lard, butter, and various dairy disappearing into United States consumption. From these products but an increased intake of various meat and statistics, estimates are then made of the amount of the poultry products; thus the cholesterol level has remained various foods available for use by the civilian population (6, fairly steady during this period. Our vitamin and mineral consumption has held up well 7). Scientists in the Agricultural ResearchService can then obtain the nutritive value of the per capita food supply and during this century (Table 3). Calcium, vitamin C, and thus be able to study trends over many years (10). Annual vitamin A are at higher levels in our food supply than they at all age levels. A few population groups, especially chil dren, showed some biochemical evidence of inadequate vitamin A. For the most part, however, all age groups (and for both race and income levels) had apparently adequate intakes of protein, calcium, vitamin A, and vitamin C. Because of the close geographical location and a similar ity of eating habits and life-styles of Canadians and of population groups in the United States, it is interesting to note the recent Nutrition Canada national survey (13). NOVEMBER 1975 Downloaded from cancerres.aacrjournals.org on June 16, 2017. © 1975 American Association for Cancer Research. 3247 w.A. Gortner % OF 1909.13 Table 1 Nutrients contributing food energy available for consumption/day, J9(J9_J974a Protein Year @ @ @ Food energy Carbo hydrate Total Animal Vegetable Fat (calories) (g) (g) (g) (g) (g) 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 3530 3490 3470 3470 3460 3440 3430 3380 3330 3380 3440 3290 3200 3430 3440 3460 3450 3460 3470 3490 3460 3440 3390 3320 3280 3260 3200 3290 3260 3260 3340 3350 3410 3320 3360 3350 3300 3320 3290 3200 1949 3200 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 3260 3160 3190 3170 3150 3180 3180 3110 3120 3170 3140 3120 3120 3140 3180 3140 3170 3210 3260 3280 3300 3320 3320 3300 l974b 3350 497 495 488 490 489 483 481 470 469 464 478 457 441 480 466 474 474 478 477 482 471 474 460 448 436 429 436 438 433 433 439 429 443 425 428 426 418 412 412 397 399 402 391 389 386 380 378 378 372 375 376 375 374 373 371 374 371 371 373 378 381 380 380 381 385 388 104 102 101 102 100 98 97 96 96 97 97 93 91 54 52 52 53 52 51 50 50 50 52 52 51 50 94 96 96 51 53 53 95 94 95 94 94 93 92 91 90 91 88 91 52 52 52 51 51 51 50 50 51 52 48 51 90 90 51 51 92 93 53 54 50 50 48 49 48 47 47 46 46 45 45 43 41 42 43 43 43 43 43 43 43 42 42 41 39 39 39 127 124 126 124 125 127 126 126 122 129 130 123 122 129 135 135 134 133 134 135 137 134 135 133 133 134 127 40 133 133 133 139 143 144 140 142 142 138 143 143 140 99 60 102 102 97 94 62 63 62 60 39 40 39 39 39 41 41 39 40 39 35 34 94 60 34 140 94 93 60 59 34 34 33 32 32 32 31 31 31 31 31 31 31 31 31 30 145 139 143 142 142 146 146 141 142 147 143 142 142 145 147 145 30 147 31 31 31 30 30 30 31 31 150 154 154 157 158 158 155 158 94 55 97 100 56 59 94 61 95 94 95 62 63 64 96 65 95 64 94 63 95 95 95 64 64 64 94 96 64 65 97 96 97 98 66 65 67 68 99 69 100 100 69 70 101 71 101 71 68 70 __________________________________________________@ a Quantities of nutrients computed by USDA, Agriculatural Research Service, Consumer and Food Economics Institute, on the basis of esti mates of per capita food consumption (retail weight), including estimates of produce of home gardens, prepared by the Economic Research 5crvice. No deduction made in nutrient estimates for loss or waste of food in the home, use for pet food, or for destruction or loss of nutrients dur ing the preparation of food. Civilian per capita only, 1941 to date (6, 7. 10). b Preliminary. 3248 Ei@:: @in/: 7@I3@__@__J--@LLiLL@@IS@b9' 30 £LLLLLL .@LLLLLU @.il 190 I t@ @@&@!iII@ 1920 1930 1940 1950 1960 1970 1980 S-YEAR MOVINO AVUAGI Chart 2. Changesin per capita civilian consumption(disappearance)of food energy, protein, fat, and carbohydrate, 1909 to 1973. 0, preliminary. — Sugor. —.— Corbohydroto 150 @““-StarcI, ,.-..-- ——R.fia.d Sugar 50 1910 1920 1930 1940 1950 5-y_ *,.s 1960 1970 1980 AmaSs Chart 3. Changes in per capita civilian consumption (disappearance) of sugars, starch, and carbohydrate, 1909 to 1973. 0, preliminary. Table 2 Crudefiber andfood lipids availableper capita per day in the United Statesfood supply Fatty acidsa ________________________ Oleic Linoleic Saturated fat― acid acid (g) (g) (g) (g) Total Years nutrient Cholesterolc (mg) Crudeb fiber (g) 1909—1913 1925—1929 1935—1939 1947-1949 1957—1959 125 135 133 141 143 50.3 53.3 52.9 54.4 54.7 51.5 55.2 54.5 58.0 58.2 10.7 12.5 12.7 14.8 16.6 509 524 493 577 578 6.1 5.8 5.5 4.9 4.4 1965 1970' l974'@― 145 157 158 53.9 55.9 56.0 58.8 63.1 62.9 19.1 23.3 24.2 540 556 4.2 4.2 4.3 aRef 9. b Refs. C B. 6 and Friend, 7, Table unpublished 40; Ref. 8. data. d Preliminary. were 65 years ago (Chart 5). We also can see the very marked improvement that enrichment of cereals has made in B-vitamins and iron going into our food supply (Chart 6). In 1941, these 4 nutrients (iron, riboflavin, niacin, and thiamin) were added to enriched flour, resulting in a quite marked increase in the per capita availability of these nutrients that has held up during the past quarter century. The USDA survey on nutrient intake of individuals shows who is getting some of these minerals (Chart 7). It is quite evident that, prior to menopause, females take in substan tially less than recommended amounts of iron. On the other hand, males take in substantially larger amounts and approximate their recommended nutrient levels from teen age and on. CANCER RESEARCH VOL. 35 Downloaded from cancerres.aacrjournals.org on June 16, 2017. © 1975 American Association for Cancer Research. Nutrition in the United States marked increase in poultry. The processing and marketing innovations in the broiler industry have led to a rather dramatic increase in consumption of poultry products. The USDA survey of food intake of individuals in the United States (Ref. 2, Report I 1) gives us a picture of who is consuming these various food products. Consumption of milk and milk products (Chart 13) falls off after age 8 for females but stays quite high through age 19 for males. Consumption of animal products (Chart 14) does not change @ LPCER 1 1—2)—5 6-S 9—11 12—1k15—17 1$—192O—5@ 15—5'. 55—6465—7'. 75 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 groups from age 9 and on are substantially below recommended daily intakes. Young adult males appear to have adequate calcium, but many other age groups show less than recom mended intakes. Foods Used as Nutrient Sources The calculations for nutrients in the daily food supply are based on composition of the various foods used ( 15). Over the years, these foods have changed considerably (Chart 9). Previously mentioned data (Chart 2) indicated that per capita consumption of protein today is similar to that in 1910. Early in this century, about one-half of the protein came from animal products (Table I), whereas today 70% of protein showing up in the food balance sheets comes from meat, poultry, fish, dairy products, and eggs. The major shift in the diet is in the marked decrease in consumption of flour and cereal products. Previously mentioned data also showed a continual rise in the daily use of fat in our diet (Chart 2). Again, as can be seen in Chart 10, there have been marked shifts in the sources offat (3). During the period 1940 to 1965, there was a steady drop in the consumption of pork and milk fat. On the other hand, there was a steady and marked rise in the use of margarine and other shortenings, of various salads and cooking oils (notably soybean oil), and in the fat associated with a marked increase in consumption of beef. One can look at long-term trends in consumption of major commodities (Chart I 1). There has been a fairly steady decline in consumption of cereal products. The very marked decline in consumption of potatoes began to reverse itself some years ago as a result of innovations in processing and marketing and the introduction of dehydrated and frozen products. Note the rather marked shift over the years in the per capita consumption of eggs. These trends in the major commodities greatly for females throughout the teen-age years and most of the adult life. However, it continues to rise very markedly through age 34 for men. Grains, fruits, and vegetables may be of special interest to cancer epidemiologists because of the hypothesis that dietary fiber may play a role in cancer in man. Again, beginning at teen-age, females start consuming less grain products/day (Chart 15). Males reach their peak consump tion of grain products much later, at about age 19. A very different consumption pattern is seen for various fruits and vegetable products. For tomatoes and citrus fruit (Chart 16), males and females consume comparable quanti ties/person each day, and there is no tendency for this to change for any of the age groups after late childhood. On the other hand, while the same statement would also apply to the green and yellow vegetables (Chart 17), one may note from the quantity/person that these commodities contribute to the daily diet that they constitute a small fraction of the amount that grain products or tomatoes and citrus fruit contribute. Potato consumption shows a real difference associated with age and sex (Chart 18). For females, it remains at about 50 g daily from early childhood on. For males, the consumption rises to twice this amount by age 34 and diminishes thereafter. Unfortunately, neither the food balance sheets (disap pearance data) nor the dietary surveys of households or individuals in the United States have been used to come up with solid information on the dietary fiber consumption. B. Friend3 has estimated that the level of crude fiber in the food supply dropped from about 6 g per capita per day around 1910 to a little over 4 g in 1974 (Table 2). The decline may relate to a decreased consumption of potatoes and grain products. Although the crude fiber composition has not been tabulated for a great many foods, Watt and Merrill ( 15) include a column listing fiber for a considerable number of foods. There one can see that the fiber content of cereal products runs somewhat lower than that of many fruits and that vegetables as a class have substantially more fiber than do either cereals or fruits. Since much of the cereal consumption in the United States is of white wheat flour with perhaps only 0.3% fiber, it is obvious that an appreciable part may come from important source bles may not be, of the dietary fiber of the United States noncereal products. Potatoes may be an of fiber but the green and yellow vegeta as their relatively low daily consumption offsets the higher fiber content in vegetables. None of this can hide shifts in food consumption of the individual food items in the major groups (Chart 12). During the past 15 years, a marked increase in the consumption of meat products is largely associated with an increased intake of beef and a very NOVEMBER 1975 material 3 B. dealing Friend. Changes with “crudefiber― relates in the U. S. Diet Caused by to individual Alterations in Food Intake Patterns.Paperfor the Food and Drug Administration Conference on the Changing Food Supply in America, Arlington, Virginia, May 22, 1974. Downloaded from cancerres.aacrjournals.org on June 16, 2017. © 1975 American Association for Cancer Research. 3249 w.A. Gortner Table 3 Mineral and vitamin nutrients available for consumption/day . Year Phos Calcium 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974d phorus (g)(mg) 0.83 0.80 0.78 0.85 0.83 0.80 0.80 0.79 0.81 0.86 0.84 0.84 0.83 0.84 0.84 0.85 0.85 0.85 0.86 0.86 0.88 0.87 0.86 0.86 0.86 0.86 0.87 0.89 0.89 0.90 0.91 0.92 0.93 0.98 0.99 1.00 1.06 1.08 1.02 0.99 0.98 0.99 0.98 1.00 0.98 0.98 1.00 0.99 0.98 0.97 0.98 0.97 0.96 0.96 0.96 0.96 0.95 0.95 0.94 0.95 0.94 0.93 0.94 0.94 0.95 0.95 IronMag 1.58 1.55 1.52 1.57 1.54 1.49 1.50 1.47 1.50 1.54 1.51 1.47 1.44 1.48 1.51 1.51 1.48 1.48 1.50 1.49 1.51 1.48 1.47 1.45 1.43 1.44 1.42 1.46 1.45 1.46 1.48 1.50 1.51 1.56 1.60 1.60 1.66 1.69 1.57 1.53 1.52 1.53 1.51 1.53 1.52 1.51 1.53 1.54 1.52 1.50 1.52 1.51 1.50 1.49 1.50 1.51 1.50 1.50 1.52 1.53 1.53 1.52 1.53 1.54 1.52 15.5 15.3 15.2 15.2 14.8 14.5 14.6 14.3 14.7 15.3 15.1 14.6 14.0 14.5 14.8 14.7 14.3 14.4 14.4 14.4 14.3 14.2 14.1 13.7 13.6 14.0 13.5 13.9 13.6 13.7 14.0 14.2 14.4 15.4 16.1 17.5 17.9 18.2 17.2 16.4 16.4 16.5 16.1 16.2 16.3 16.0 16.2 16.4 16.1 16.1 16.2 16.3 16.4 16.5 16.6 16.8 16.6 16.5 17.2 17.4 17.6 17.8 17.9 18.0 17.9 1.54 18.3 A valueL@ nesium (mg)Vitamin (IU)Thiamin 7,800 7,600 7,500 7,600 7,400 7,300 7,600 7,500 7,800 7,700 8,000 7,900 7,800 8,300 8,100 7,800 7,700 8,000 8,200 7,900 8,300 8,000 8,200 8,400 8,100 8,300 8,300 8,000 8,400 8,400 8,600 8,500 8,700 9,100 9,500 9,700 10,000 9,600 9,100 8,700 8,500 8,400 8,000 8,000 8,100 8,000 8,200 8,200 8,100 8,000 8,100 8,000 7,800 7,800 7,800 7,700 7,700 7,800 7,900 8,100 8,100 8,200 8,200 8,100 8,100 343 346 346 348 8,200 l909@@I974a (mg)Riboflavin (mg)Niacin (mg)Ascorbic 1.68 1.63 1.63 1.65 1.63 1.58 1.60 1.57 1.54 1.60 1.55 1.52 1.50 1.53 1.62 1.60 1.54 1.51 1.55 1.57 1.57 1.54 1.55 1.53 1.50 1.48 1.39 1.42 1.42 1.44 1.50 1.55 1.64 1.83 2.05 2.09 2.06 2.15 1.94 1.89 1.89 1.90 1.90 1.90 1.85 1.81 1.87 1.87 1.83 1.82 1.88 1.85 1.84 1.86 1.87 1.87 1.81 1.80 1.91 1.91 1.93 1.93 1.97 1.94 1.90 1.88 1.82 1.80 1.88 1.84 1.78 1.79 1.77 1.79 1.87 1.83 1.82 1.79 1.83 1.85 1.86 1.84 1.84 1.84 1.84 1.86 1.84 1.84 1.82 1.80 1.81 1.78 1.81 1.83 1.83 1.87 1.90 1.92 2.00 2.15 2.37 2.46 2.48 2.33 2.26 2.25 2.29 2.27 2.31 2.30 2.28 2.31 2.32 2.29 2.27 2.29 2.28 2.26 2.27 2.28 2.29 2.27 2.29 2.33 2.35 2.35 2.35 2.37 2.35 2.32 9.5 19.3 18.7 19.0 18.6 18.1 18.3 17.9 18.2 18.3 18.5 17.5 17.1 17.5 18.5 18.2 17.9 17.6 17.8 17.7 17.9 17.3 17.6 17.2 17.1 17.3 16.7 17.3 16.9 17.0 17.3 17.8 18.3 18.7 20.0 22.5 22.7 23.1 21.5 20.8 20.8 20.2 19.9 20.1 20.5 20.1 20.3 20.7 20.5 20.5 20.8 20.8 20.9 21.1 21.5 21.7 21.5 21.6 22.4 22.7 22.8 23.1 23.3 23.4 22.9 2.33 23.4 1.94 acidc B1 B12 (mg)Vitamin (mg)Vitamin (mg) 105 107 99 104 103 100 105 96 98 102 100 104 104 104 109 108 106 104 105 105 III 103 109 107 105 108 112 109 110 114 116 115 115 117 115 125 125 123 119 112 109 105 107 105 106 105 106 105 107 102 106 108 107 107 101 100 101 102 108 109 Ill 114 115 115 118 119 2.18 9.5 2.29 2.24 9.8 9.5 2.28 9.7 a Quantities of nutrients computed by USDA, Agricultural Research Service, Consumer and Food Economics Institute, on the basis ofestimates of per capita food consumption (retail weight), including estimates of produce of home gardens, prepared by the Economic Research Service. No deduction has been 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 of food. Civilian per capita only, 1941 to date. Data for iron, thiamine, riboflavin, and niacin include estimates of the quantities of these nutrients added to flour and cereal products (6, 7, 10). A Includes estimates of quantities added to margarine C Includes estimates of quantities added to fruit juices and and to milk of all types. drinks. d Preliminary. 3250 CANCER RESEARCH VOL. 35 Downloaded from cancerres.aacrjournals.org on June 16, 2017. © 1975 American Association for Cancer Research. @ r @ 80 I Nutrition in the United States % OF 1909-13 125 V@onünAIThiomin( 75 50 1910 1920 1930 1940 1950 1960 1 l0 1970 5-yIAO MOVING AVISAGE Chart 5. Changes in per capita civilian consumption (disappearance) of calcium, vitamin A, thiamin, and ascorbic acid, 1909 to 1973. @, enrich ment initiated; 0, preliminary. Chart 9. Diet sources of protein, 1910 to 1972. Per capita civilian food supply, 1972, preliminary. °,total animal sources. % of 4( 3@. 150 In lION — —— @ fat a L. IIIOFLAVIN —.— NIACIN @,—‘margarine. THIAMIN @@1A_/'@ shortening ,t%_,\_,,_p_tI-. 50 fats oils Cf 1YJU P120 IY3U 1Y40 UYSU 1q60 1970 @@5Q $.nM @vu@ *wi@ Chart 6. Changesin percapitacivilian consumption(disappearance)of vitamin B and iron, 1909 to 1973. 0, preliminary. PERCENT-@ year Mali 200@ Chart , V.., @ 12 34 êl 1 i.I1 11.14 AGE is.i@ IN is.1@ sai is.m iS.ê4 *5.74 10. Diet sources of fat, 1940 to 1965. Data from Ref. 3. fl YEARS Chart 7. Iron from 1 day's diet in 1965,by age and sex of the Na tional Academy ofScience-National Research Council(l968). Chart I I . Trends in United States eating habits. Changes in per capita civilian consumption (disappearance) of major food commodities, 1909 to 1965. PERCENT-@ @ .: Mali andMale 200 @ r] 150 Female -. 1@E1960 v•oI160 ! —B... and PoulEry ———EgIE. —..-#.— 140 @ @ :LJIfflmi USEI 14 3.5 @.$ p.11 I 13.14 15.17 15.15 20.34 AGE IN YEARS 35.54 SS.@ . 120.—.—. 100 8@ZL@@ I @S.74 1960 75 Chart Research Council (1968). !Ij1970 I 1965I 1975 ‘ Chart 8. Calcium from 1 day's diet in 1965,by age and sex of Na tional Academy of Sciences-National -.-.,. 12. Changes in per capita consumption (disappearance) of selectedlivestock products, 1960to 1974. @, includes butter; A, prelimi nary. NOVEMBER 1975 Downloaded from cancerres.aacrjournals.org on June 16, 2017. © 1975 American Association for Cancer Research. 3251 w.A. Gortner GRAMS @ Mali and Mol. 100 800 80 60 40 Nil. and Nil. F...S. 20 @,1.2 2.1 @1 @.U 11.14 1517 l$.l@ M24 ‘ 1-21.1R.$•.II u.N $47 i.$ MMi.M M.MMJI 11 AGEINYEARS I Chart 13. Milk and milk products (calcium equivalent) diet in 1965, by age and sex. in I day's AGE IN YEARS ‘S@ Chart 17. Dark green and yellow vegetables in I day's diet in 1965, by age and sex. GRAMS 125- GRAMS MAI@ 100 75@[email protected]@d :@1@Illi. NNI 1.2 1.1 6.1 Rh I 21.14 2147 I$.l@ MN 11.14 S1.U 15.74 AGE IN YEARS I-, Si e.i i.a I ISN 14 *21 MM MM i.M iN 21 AGEINYEARS 71 I iMI Chart 18. White potatoes in I day's diet in 1965, by age and sex. Chart 14. Meat and poultry and fish in 1 day's diet in 1965, by age and sex. fiber components such as pectins, pentosans, cellulose, or lignin, some of which may be far more important in cancer epidemiology. @ GRAMS - @@MoI• -.-—-- Discussion There is very little basis to relate the current nutritional status of United States population an appreciable period of time. groups to changes over The food disappearance data do give useful information @s1.2 14 e.$ ,.lI liii I AGE 11.17 @$4@ M.N i.54 IN @NMU YEARS 21 ‘ Chart 15. Grain products (flour equivalent) in I day's diet in 1965,by age and sex. on changes in nutrients in our food supply during this century and on changes in the foods that provide nutrients to the population. Finally, the study of the dietary intake of individuals helps to define which age and sex groups are taking in the different foods. The data thus also tell how effective these dietary patterns are in meeting the recom mended nutrient intakes of the different population groups. In all ofthe studies I have referred to, we are talking only of averages. Usually, we do not know or are not told what the range is, what the degree of clustering may be, what the extremes encompass, and how many individuals may be near those extremes in foods or nutrients consumed or in GRAMS clinical or biochemical or anthropometric tests of “nutri tional risk.―A person with his head in the oven and his feet in the freezer may be comfortable “onthe average;― many of the data defining “NutritionUSA―are similarly com foiling 1@ :@@@uillBiHLI° NI 2 1-2 11 êA @l 1144 11.17 IS4@ *21 AGEINYEARS 21.21 21*1 11.21 11 ‘ ii. Chart 16. Tomatoes and citrus fruit in I day's diet in 1965, by age and sex. 3252 to the health scientist, on the average. An encouraging exception is the series of reports issued in the Canadian survey (Nutrition Canada, 1975; Ref. 13). Their tables show the percentage distribution of dietary intake of various nutrients and also the level for the lowest and for the highest 5% and 25% of the population. CANCER RESEARCH The same VOL. Downloaded from cancerres.aacrjournals.org on June 16, 2017. © 1975 American Association for Cancer Research. 35 Nutrition is presented for many biochemical values relating to nutri tional status. Thus, one can see that, while the lowest 5% of the Canadian teen-age males had dietary protein of only four-fifths of the recommended “adequate―intake, the upper 5% of this population group were consuming more than 4 times the amount of protein needed for good nutrition. Hopefully, the data described in this paper can at least lead the epidemiologist to sources of information dealing with food and nutrition that can be examined relative to the changes in various diseases, including the various forms of cancer. References 1. Abraham, S.. Lowenstein, F. W., and Johnson, C. 1. Preliminary Findings 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 of Health, Education and Welfare, 1974. 2. Agricultural Research Service. Household Food Consumption Survey 1965-66, Report Nos. I to 18. Washington, D.C.: United States Department of Agriculture, 1968-1974. 3. Call, D. L., and Sanchez, A. M., Trends in Fat Disappearance in the United 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 Nutrition Survey, 1968-1970. Publication Nos. (HSM) 72-8130, 72 8131, NOVEMBER in the United States 72-8132, 72-8133, 72-8134. Washington, Health, Education and Welfare, 1972. D.C.: Department of 6. EconomicResearchService.FoodConsumption, Prices,and Expendi tures. Agricultural Economic Report 138.Washington, D.C.: United States Department of Agriculture, 1968. 7. Economic Research Service. Food Consumption, Prices, and Expendi tures. Agricultural Economic Report I 38. Supplement. Washington, D.C.: UnitedStatesDepartmentof Agriculture,1974. 8. Feeley, R. M., Criner, P. E., and Watt, B. K. Cholesterol Content of Foods. J. Am. Dietet. Assoc., 61: 134-149, 1972. 9. Friend, B. Nutrients in the United States Food Supply. A Review of Trends, 1909-1913 to 1965. Am. J. Clin. Nutr., 20: 907 914, 1967. 10. Friend, B., and Marston, R. Nutritional Review. National Food Situation (USDA). 150: 26-32, 1974. II. Kelsay, J. 1. A Compendium of Nutritional Status Studies and Dietary 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. Station Bull. 769, 1959. 13. Nutrition tion Canada. Nutrition: Canada to the Department Ottawa, Canada: Information is detailed in 12 survey reports A National of Priority. National Report by Nutri Health and Welfare, Canada, 1973. (In 1975 this material covering Alberta, British Columbia, Eskimos, Indians, Manitoba, New Brunswick, Newfoundland, Nova Scotia, Ontario, Prince Edward Island, Quebec, and Saskatchewan survery 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 United States, 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. 1975 Downloaded from cancerres.aacrjournals.org on June 16, 2017. © 1975 American Association for Cancer Research. 3253 Nutrition in the United States, 1900 to 1974 Willis A. Gortner Cancer Res 1975;35:3246-3253. Updated version E-mail alerts Reprints and Subscriptions Permissions Access the most recent version of this article at: http://cancerres.aacrjournals.org/content/35/11_Part_2/3246 Sign up to receive free email-alerts related to this article or journal. To order reprints of this article or to subscribe to the journal, contact the AACR Publications Department at [email protected]. To request permission to re-use all or part of this article, contact the AACR Publications Department at [email protected]. Downloaded from cancerres.aacrjournals.org on June 16, 2017. © 1975 American Association for Cancer Research.