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to summarize the evidence as to how far those conditions have been remedied by the enrichment program and other factors. For example, a study by the late Dr. Philip C. Jeans and his associates42 shows the contribution of cereal enrichment to the diets of some 400 pregnant women of low income in Iowa. In each of the five groups into which subjects were classified, cereals provided the major part of the daily thiamine intake and the mean intake for each group was ample. The report states: "In Iowa, practically all cereal foods and flours are enriched; therefore, the intakes of thiamine, iron, and riboflavin were all far higher than would be possible with unenriched white flour products. Bread alone supplied from 15 to 31 per cent of the thiamine; from 40 to 50 per cent was provided by cereal foods. White flour products predominated heavily in the diets; therefore, had the bread and flour been unenriched the thiamine intake would have been cut by 30 to 40 per cent and many women would have been close to actual deficiency." The conclusion of the authors is typical of the value which nutritionists have placed on the enrichment program: "The fact that the bread is enriched has certainly aided the majority of women re- ported in this study from having even greater deficiencies in iron, thiamine, and riboflavin. The usefulness of the enrich- ment program is obvious. It appears that, in addition to the present program, enrich- ment of bread with a greater amount of non-fat dry milk solids also would improve the nutrition of these women and their families by automatically increasing their intake of calcium and animal protein." From the clinics serving the poorer ele- ments of the population comes evidence that B vitamin deficiencies in the United States have largely disappeared since 1942. This evidence is confirmed by Jolliffe43, Bean, Vilter, and Blankenhorn44, the Army Medical Nutrition Laboratory45, and by Darby, Goldsmith, Sebrell, Spies, Wilder, and others by personal communication. The observations of the Medical Nutri- tion Laboratory are perhaps particularly significant. That study dealt with alcoholic derelicts of the streets of Chicago who were in no position to benefit from increased em- ployment such as would be influential in improving the diets of other low income groups. Jolliffe has also called attention to the fact that there has been no correspond- ing decrease in the incidence of scorbutic symptoms observed in these clinics. DIETARY TRENDS IN RELATION TO ENRICHMENT Dietary trends in the United States are periodically reviewed by the Department of Agriculture46. The latest (1955) of these reviews shows new trends and habits in buying and eating foods. One-fifth of the meals are now eaten outside the home. Ready-processed foods represent a large proportion of the purchased foods. There is thus a continuing responsibility for the purchaser to keep in mind the nutritional balance of the foods served in the home. A nation-wide study of diets of urban families in 194847 showed that these fam- ilies purchased about a quarter of a pound P. C. Jeans, M. B. Smith, and Genevieve Stearns. Dietary habits of pregnant women of low income in a rural state. J. Am. Dietet. Assoc. 28: 27 (1952) * N. Jolliffe. Conference on corn enrichment. Clemson College, Clemson, S. C., 1947. 4 W. B. Bean, R. W. Vilter, and M. A. Blankenhorn. J. Am. Med. Assoc. 140: 872 (1949) Army Medical Nutrition Laboratory. Report No. 71 (1950) * Nutritive value of the per capita food supply, 1909-1945. Institute of Home Economics, U.S. Dept. Agriculture, Washington, 1946. 1948 food consumption surveys. Institute of Home Economics. U.S. Dept. Agriculture, Washington, 1951. Household food consumption surveys 1955. Reports No. 1âNo. 10. Institute of Home Economics, U.S. Dept. Agriculture, Washington, 1956. Nutritive content of city diets. Special Report No. 2. U.S. Dept. Agriculture, October 1950. 17
(5 slices) of bread per individual per day, of which 86 per cent was white enriched. This amount of enriched bread contributed about 315 calories, 9.6 grams protein, 3.6 grams fat, 90 milligrams calcium, 2 milli- grams iron, 0.28 milligram thiamine, 0.18 milligram riboflavin, and 3.5 milligrams niacin. The effect of the flour and bread enrichment on the nutritive value of the family diets is shown below for the entire sample and for two income classes. The contribution is significant and is largest where most neededâamong the low income groups. Annual Income Addition to Diet Due to Enrichment Class (per cent) Iron Thiamine Riboflavin Niacin All classes 12 16 3 13 $1000 to $2000 14 20 5 15 $5000 to $7500 10 13 2 9 Bread and flour, according to Phipard48, constitute a larger share of the diets of low income groups. At 17.2 cents per pound, 5 cents invested in bread purchased the following proportions of the NRC adult daily allowances: thiamine, 20 per cent; iron, 19 per cent; niacin, 17.5 per cent; riboflavin, 12 per cent; and calcium, 13 per cent. If the bread had not been enriched, the thiamine, iron, niacin, and riboflavin contributed would have been insignificant. The summaries based on the survey of food consumption of households in the United States in 195549 point out that there has been an increase in protein and niacin consumption but a slight decrease in ascor- bic acid, due to a shift in emphasis on fruits and vegetables. Other nutrients show no great change compared with the results shown in the survey of 1948. There is a high level of food consumption in the United States, but efficient distribution has not been achieved. The enrichment of staple foods such as flour, bread, rice, and corn is a positive step toward wider distri- bution and consequently a broader base for consumption of nutrients essential to good nutrition. Long-range trends since 1909-13 are illus- trated in charts I50 and 2S1. Particularly noteworthy is the downward trend of con- sumption of cereal products as shown in chart 2. Maintenance of per capita intake of the enrichment nutrients, particularly thiamine, in spite of this decline is strik- ingly illustrated in charts 332 and 450. The enrichment program has evidently accomplished much that is constructive and beneficial to public health. However, this summary shows the need for continued edu- cation to inform people as to how to obtain good diets and how important it is to bring their food habits in line with the principles of good nutrition. " Bread facts for consumer education. U.S. Dept. Agriculture AIB 142, November 1955. " Food consumption of households in the United States. U.S. Dept. Agriculture. Household food con- sumption survey, 1955. Report No. 3. "Faith Clark. Family spending for food. Cereal Science Today 1: 155 (1956) 51 Agricultural Research Service. Neg. 58 (4)-5543, 1958. "Agricultural Research Service. Neg. 58 (4)-5542, 1958. 18
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