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Food habits and nutritional status of East Indian Hindu children in British Columbia Pi, Clara Ming Lee 1978

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FOOD HABITS AND NUTRITIONAL STATUS OF EAST INDIAN HINDU CHILDREN IN BRITISH COLUMBIA by CLARA MING LEE£1 B.Sc.(Food Science), McGill University, 1975 A THESIS.: SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE in the Division of HUMAN NUTRITION SCHOOL OF HOME ECONOMICS We accept this thesis as confirming to the required standard. THE UNIVERSITY OF BRITISH COLUMBIA September, 1977 fcT) CLARA MING LEE PI, 1978 In presenting th i s thes is in pa r t i a l fu l f i lment of the requirements for an advanced degree at the Un ivers i ty of B r i t i s h Columbia, I agree that the L ibrary sha l l make it f ree ly ava i l ab le for reference and study. I fur ther agree that permission for extensive copying of th is thesis for scho lar ly purposes may be granted by the Head of my Department or by his representat ives. It is understood that copying or pub l i ca t ion of th is thes i s fo r f i nanc ia l gain sha l l not be allowed without my wr i t ten permission. Department of HOME ECONOMICS The Univers i ty of B r i t i s h Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1WS FEB 8 , 1978 i ABSTRACT A cross-sectional study was carried out to assess the nutr i t ional stutus of a sample of East Indian children in the Vancouver area. The study sample consisted of 132 children from 3 months to 1$ years of age, whose parents belonged to the congregation of the Vishwa Hindu Parished Temple in Bur-naby, B.C. In the dietary assessment of nutr i t ional status, a 24-hour diet reca l l and a food habits questionnaire were em-ployed on the 132 chi ldren. The Canadian Dietary Standard (revised 1975) and Nutrition Canada categories were used for an evaluation of the i r dietary intake. In the anthropometric assessment of the i r nutr i t ional status, the standing height, weight, arm circumference, tr iceps skinfold, and head c i r -cumference of 127 children were measured according to the re -commendation of. the International Biological Program (Weiner and Lourie, 1 9 6 9 ) . Individual findings were plotted as scat-ter diagrams against both East India and American standard reference curves. Methods used in the biochemical assessment of nutr i t ional status were mostly those described in the In-terdepartmental Committee on Nutrition for National Defence (ICNND) Manual for Nutrition Surveys ( 1 9 6 3 ) . Hemoglobin, he-matocrit, plasma levels of vitamin C, vitamin A, carotene, vitamin E, iron and iron binding capacity were determined in i i the blood of 51 children. Results were evaluated according to the categories defined by Nutrition Canada (1973). Anthropometric results indicated satisfactory growth, with the male subjects performing better than the female sub-jects. Both the dietary and biochemical results did not indi-cate gross deficiencies. However, intakes of certain nutrients such as the B vitamins, iron and calcium were low. Recommen-dations were made to the parents on how to improve nutrient intake for such children. i i i ACKNOWLEDGEMENTS To my research director Dr. Indrajit D. Desai, I extend my sincere thanks for his guidance and encouragement so generously offered throughout the course of this project. In addition, I would like to express my appreciation to Dr. H. Kuhnlein and to Dr. B. Beck for their help in the pre-paration of this thesis. I would also like to thank Mr. Lewis James for his very kind help in developing computer programs for the data analysis. I am grateful to the congregation of the Vishwa Hindu Parishad Temple for their assistance and cooperation in the data collection. Finally, I would like to thank the children who participated in this study; without their enthusiathsm and cheerful cooperation, my thesis could not have been accomplished. iv TABLE OF CONTENTS Page ABSTRACT i ACKNOWLEDGEMENTS i i i LIST OF FIGURES v i LIST OF TABLES v i i i INTRODUCTION 1 Chapter I REVIEW OF LITERATURE 3 Food Habits of East Indians Abroad 3 Anthropometric Measurements and Indices for the Assessment of Nutritional Status 9 Biochemical Indices for the Assessment of Nutri-tional Status 11 II MATERIALS AND METHODS 14 Collection of Dietary Data and Food Habit Infor-mation 14 Collection of Anthropometric Data ............ 19 Biochemical Assessment of Nutritional Status • 21 III RESULTS I. Dietary Results 1. Dietary Intake Survey 32 2. Individual Nutrients •• 32 3. Nutrition Canada Categories • • 3# 4. Food Group Contributions 44 5. Food Habits (Questionnaire) 62 II. Anthropometric Results 65 III. Biochemical Results 95 IV DISCUSSION o 102 I. Dietary Assessment of Nutritional Status •• 102 II. Social and Cultural Factors Affecting Nu-trient Intake • , 103 Page Chapter IV DISCUSSION III. Anthropometric Assessment of the Nutrition-?', a l Status of Vancouver East Indian Children 107 IV. Biochemical Assessment of Nutritional Status 108 V SUMMARY AND CONCLUSION 113 BIBLIOGRAPHY 115 APPENDICES Legends to Appendices 119 1-1 Food Habits Questionnaire 123 1-2 24-Hour Recall Form 135 1-3 Nutritional Status; Investigation Form for Anthro-pometric Measurements • 137 1-4 Nutritional Status Investigation Form for Bio-chemical Data • • • 13 8 II Nutrient Intake (24-Hour Recall Data) 141 III Anthropometric Measurements 145 IV Biochemical Data 149 V. Thank You Letter 151 v i LIST OF FIGURES Page Figure 1-1 Standard Curve for Hemoglobin 23 1-2 Standard Curve for Vitamin C 25 1-3 Standard Curve for Vitamin A 27 1-4 Standard Curve for Carotene • 2$ 1-5 Standard Curve for Vitamin E 29 I I - l Standing Height;.-of Males vs. East Indian Standards • 66 II-2 Standing -Height: of Females vs. East Indian Standards 67 II-3 Standing Height' of Males vs. East Indian Well-to-do Standards 68 II-4 Standing Height . of Females vs. East Indian Well-to-do Standards 69 II-5 Standing Height of Males vs. Western II-6 Standards 70,71 II-7 Standing Height of Females vs. Western Il-g Stanadards 72,73 I I I - l Sitting Height of Males vs. Western Standards 74 III-2 Sitting Height of Females vs. Western Standards 75 IV-1 Body Weight of Males vs 0 East Indian- .. Standards 76 IV-2 Body Weight of Females vs. East Indian Standards ••••••••• 77 IV-3 Body Weight of Males vs. East Indian Well-to-do Standards • • 78 IV-4 'iBDdy Weight of Females vs. East Indian Well-to-do Standards • • •••• 79 v i i Page Figure IV-5 Body Weight of Males vs. Western Standards •. 80 IV-6 Body Weight of Males vs. Western Standards .. 81 IV-7 Body Weight of Females vs. Western Standards IV-8 82,83 V-1-; Triceps ^Skinfold Thickness of Males vs. x Western Standards 84 V-2 Triceps Skinfold Thickness of Females vs. Western Standards 85 VI-1 Arm Circumference of Males vs. Western Standards 36 VI-2 Arm Circumference of Females vs. Western Standards 87 VII-1 Head Circumference of Males vs. Western Standards y 88 VII-2 Head Circumference of Females vs. Western Standards 89 v i i i LIST OF TABLES Page Table 1-1 Canadian Dietary Standard 33 1-2 Distribution of Subjects with Nutrient Intake Less than 2/3 CDS 34 1-3 Distribution of Subjects in Age Groups with Nutrient Intake Less than 2/3 CDS 35 1-4 Nutrition Canada Interpretive Standard .... 4£) 1-5 Distribution of Subjects According to Nutri-tion Canada Category 41 1-6 Percentage Distribution of Subjects with In-adequate or Less than Adequate Nutrient In-takes in Addition to Calcium 42 1-7 Percentage Distribution of Subjects with In-adequate or Less than Adequate Nutrient In-takes in Addition to Iron 43 1-8 Percent Contribution of Food Groups to Nu-trient Intake of East Indian Children 1-4 Yrs 45 I-8A Percent Contribution of Food Groups to Nu-trient Intake of Canadian Children 1-4 Irs. 46 1-9 Percent Contribution of Food Groups to Nu-trient Intake of East Indian Children 5-11 Yrs 47 I-9A Percent Contribution of Food Groups to Nu-trient Intake of Canadian Children 5-11 Yrs 48 1-10' Percent Contribution of Food Groups to Nu-trient Intake of East Indian Males 12-19 Yrs 49 I-?10A Percent Contribution of Food Groups to Nu-trient Intake of Canadian Males 12-19 Yrs . 50 1-11 Percent Contribution of Food Groups to Nu-trient Intake of East Indian Females 12-19 Yrs 51 ix Table Page I-11A Percent Contribution of Food Groups to Nu-trient Intake of Canadian Females 12-19 Irs • 52 1-12 Primary and Secondary Sources for Major Nu-trients in Foods of East Indian and Canadian Children 1-4 Irs 58 1-13 Primary and Secondary Sources for Major Nu-trients in Foods of East Indian and Canadian Children 5-11 Yrs 59 1-14 Primary and Secondary Sources for Major Nu-trients in Foods of East Indian and Canadian Females 12-19 Irs 60 1-15 Primary and Secondary Sources for Major Nu-trients in Foods of East Indian and Canadian Males 12-19 Irs 61 II-1 • Distribution of Subjects in Risk Categories Defined by Nutrition Canada 96 II -2 Nutrition Canada Interpretative Standard .... 97 II-3 Distribution of Subjects* Plasma Vitamin E and Carotene Levels 100 I I I - l Summary of Dietary Practices 105 . p 1 INTRODUCTION People's food habits have been found to be moulded by c u l t u r a l patterns, n a t i o n a l i t y , race, regional l o c a l i t y , a g r i -c u l t u r a l resources, t e c h n i c a l progress and buying power. Cul-t u r a l influences have been shown to determine meal patterns, the number of meals per day, the method of preparation and u t e n s i l s used (Livingstone, 1971). Economic conditions are often also r e f l e c t e d i n people's food habits (Devadas, 1970). People sub-s i s t on what i s immediately available to them and i n doing so, t h e i r habits become a part of t h e i r culture and environment. Food habits have been found to be one of the most deeply rooted aspects of culture. This may account f o r the great conservatism often encountered i n accepting dietary change (Fathauer, I960). Since there are many new Canadians of East Indian o r i g i n l i v i n g i n Canada. We were interested i n studying t h e i r food ha-b i t s and asking about t h e i r adaptation to t h e i r new environment. Commonly used foods i n India may be l e s s p l e n t i f u l and more ex-pensive i n Canada. Food preparation and cooking methods may va-ry considerably and cooking equipment may be quite d i f f e r e n t . R e l a t i v e l y l i t t l e information i s available on the food habits and n u t r i t i o n a l status of migrant East Indians. No study 2 known.to us has yet been conducted on this particular ethnic group in North America. Hence i t was the objective of this research project to assess the nutritional status of East Indians, and in particular, on the growth and development of East Indian children in Vancouver, since children are one of the most vulnerable group to malnutrition. Measurements of their growth and development of a sample of children in Vancouver were thus compared with peer groups in North America and India. Furthermore, this project was designed to correlate diet and nutrient intakes with measurements of growth and development. A biochemical assessment of these children*s nutritional status was also attempted. The study sample consisted of 132 children aged 0.25 to 18.91 years taken from the congregation of the Vishwa Hindu Pari-shad Temple in Burnaby, B.C.; they were chosen because of acces-s i b i l i t y . These children are mainly from the middle class and professional families; they cover a f a i r l y good spectrum of East Indian Hindu immigrants residing in Vancouver. There i s a large and relatively separate community of Sikhs in the city; data collected in this study did not include members of that group. Therefore, subjects participated in this study did not represent the Sikhs, instead they represented East Indian Hindu children residing in the area of Vancouver and the lower mainland. 3 CHAPTER 1 REVIEW OF LITERATURE Food Habits of East Indians Abroad Since no food habit studies have been made of East Indians in Canada or the United States, the available literature on food habits of East Indians settled in England i s presented below. a) Food Traditions Associated With Hindu Religion Hinduism i s a religion which i s largely practiced in the home. It has strong links to caste and to the joint family sys-tem. Together these social institutions act to impose social sanctions on the family controlling everything from eating habits to marriage (Rose, 1 9 6 9 ) . Hindus believe that i f they behave incorrectly in this l i f e , they may be reincarnated as some form of animal; hence they regard a l l l i f e as being distantly related. Most Hindus refuse either to k i l l or eat animals and animal products. The cow i s a particularly sacred animal to the Hindu and since the 7 t h century i t s slaughter in India has been restricted(Simoons, 1 9 6 1 ) . In 1 9 5 4 » Gandhi explained that the cow i s the supreme symbol of the animal world and that by saving i t from death a Hindu i s able to achieve penance and self purification (Hunt, 1 9 7 6 ) . Milk and i t s products may be eaten, because they do not involve taking the 4 animal's l i f e , indeed they are highly prized, particularly ghee (clarified butter). Fish i s not eaten by most Hindus, both because they be-lieve they should not k i l l and because i t is considered dirty (Hunt, 1976). If they do eat fi s h , they prefer to select varie-ties with white flesh wich bear least resemblance to meat. This means that i f a Hindu i s eating f i s h , i t is unlikely to be any of the vitamin D-rich o i l y f i s h . Eggs may be taken by less orthodox Hindus; however, the more ri g i d l y Hindus adhere to a vegetarian diet the more they feel they are l i k e l y to better themselves. Abstention from eating food i s a much praised v i r -ture among Hindus, and most Hindus spend two or three days "fasting". This "fast" entails taking only "pure" foods such as milk, f r u i t , nuts and starchy root vegetables like cassava and potatoes. Of these they may eat as much as they want. b) Food Traditions Not Associated with Hindu Religion East Indians in general believe there are two catego-ries of foods, one category having a heating effect and the other a cooling effect. Foods are categorized by wether they produce a hot or cold feeling in the body when eat.en. ( Aman,1969) • Many illnesses and symptoms are treated by altering the balan-ce of "hot" and "cold" foods. For example, a fever i s treated with "cold" foods like rice, green peas and buttermilk. It has been found that eating a diet consisting solely of "hot" or "cold" foods can influence the pH and sulphur content of the urine and alter nitrogen retention (Hunt, 1976). 5 In India, 35$ of a l l wowen were found to believe in the concept of "hot" and "cold" foods (Hunt, 1976). It i s doubtful i f as many follow these beliefs in Canada, although the practice may continue without i t s origin being recognised. The staple foods of East Indians are chapatti flour and rice. In Britain and here in Canada the specialized wheat flour used for chapatties i s manufactured by taking enriched white flour and replacing some of the millings (bran); the quantities of millings added is varied according to the type of chapatti flour required. Because the flour i s already enriched before the addition of the millings, both the calcium and iron content of chapatti flour are at least as much as that in the flour supplied to the indigenous population. When most East Indians make chapatties, they mix the flour with warm water; other ingredients may also be added de-pending on the area of origin of the family and the type of cha-patti being made - thus o i l , spices and gram flour may be inclu-ded in the mix. The dough is often l e f t to stand for some time to improve i t s quality before rolled out; this practice, together with the use of warm water, provides suitable conditions for the enzyme phytase which is able to sp l i t the phytic acid present in the flour (Peers, 1953). It has long been thought that high con-tretations of phytic acid can prevent calcium absorption; more recently i t has been suggested that the high phytic acid content of the Asian diet may be responsible for the rickets and osteoma-lacia found in the British East Indian community (Wills et a l , 6 1972; Ford et a l , 1972). The phytic acid intake in India i s abqut 100 mg/day (Vaishnava and Rizvi, 1973) but in India wholewheat flour i s used; in Britain the highest reported intake i s only 314 mg/day (Holmes et a l , 1973) because of the lower extraction rate. Removal of chapatties from an Indian boy's diet did not affect his calcium balance (Dent et a l , 1973). Pulses either whole or sp l i t are eaten almost daily by Hindus; they are only used in small quantities because the dish frequently prepared (dhal) i s mainly water with very l i t t l e pulse; Sometimes a curry is made of whole pulses instead of using vegetables in which case their comsumption is increased. Green and Yellow vegetables are eaten in small quantities; they are frequently used to flavour curries of which potatoes usually make up the bulk. For cooking purposes, East Indians prefer to use ghee, which i s prepared at home from butter. They heat the butter to about 115°C for one hour by which time the moisture contact w i l l be reduced to approximately one per cent (Tannous and Merat, 1969). Although vitamin D is considered to be heat stable, in 1922 McCollum commented, "Mellanby found butter fat of l i t t l e va-lue for protecting against rickets after i t had been oxidized" (Hunt, 1976). Therefore i t i s possible that some of the vitamin D originally present in the butter is destroyed during ghee ma-king. Some East Indians make ghee from margarine which has a guaranteed high vitamin D content, (unlike butter in which the level of the vitamin fluctuates considerably) (Hunt, 1976). 7 Yogurt i s frequently eaten by most East Indians, particu-l a r l y Hindus. The East Indians are, of course, famous for their spices which are valuable sources of calcium, phosphorus and fluorine (Nanda, 1 9 7 2 ) . However, spices have been implicated in causing urinary cal c u l i in F i j i Indians (Holmes, 1 9 7 1 ) . c) Beliefs and Practices During Pregnancy and Weaning During pregnancy there is a general belief among East Indian women that foods with heating qualities should not be eaten as these can cause miscarriage. Certain foods like eggs, buffalo milk and bengal gram are also avoided in the later part of pregnancy in the belief that they produce a large baby which might cause a d i f f i c u l t delivery (Hunt, 1 9 7 6 ) . In India, i t was found that, as a result of such changes in the diet, by the third trimester women were receiving only 345 mg calcium/day (Matter and Wakefield, 1 9 7 1 ) . Even wealthy Asians in Uganda gained only 7 . 3 Kg during pregnancy as compared with 1 2 . 3 Kg normally gained in Britain by a pregnant British woman (Shaper et a l , 1 9 6 9 ) . In India and Pakistan the f i r s t given to a newborn baby is usually sweetened water, because the mother's colostrum i s often considered harmful as i t i s thick and seemingly indigesti-ble. In Pakistan, they believe i t to be poisonous because i t is thought to have been in the breast since conception (Hunt, 1 9 7 6 ) . Breast i s commenced on the second or third day after delivery and continues for up to eighteen months. About 75f° of mothers are s t i l l breast feeding at twelve months (Hunt, 1 9 7 6 ) . 8 d) Nutritional Deficiencies Among East Indians Iron deficiency anameia, common even among Canadian women, must almost certainly be more common among vegetarian Hindus whose diet i s devoid of the easily assimilated iron from animal sources. Although iron i s added to chapatti; flour, only about 3 $ of i t i s absorbed when eaten as part of an East Indian diet (Elwood et a l , 1 9 7 0 ) . East Indian babies born in England were found to have l o -wer Hemoglobin levels than British babies and the disparity in hemoglobin levels increased through the f i r s t year of l i f e . This was attributed to the late introduction of solid food into the diet (Warnes, 1 9 6 2 ) and to the immigrant habit of weaning onto cow»s milk (Stroud, 1 9 7 1 ) . In India, megaloblastic anaemia due to deficiency of f o l i c acid or vitamin B ^ content these babies might develop a severe deficiency (Roberts et a l , 1 9 7 3 ) . Much of the f o l i c acid i n i t i a l l y present in the Asian diet i s destroyed during cooking because of prolonged gentle heating of finely cut up foods. Pulses which are reported to be a good sour-ce of f o l i c acid for East Indians are unfortunately boiled for about an hour during which most of the f o l i c acid activity i s no doubt lost (Hunt, 1 9 7 6 ) . The habit East Indians have of boiling their milk, tea leaves and water together for five minutes when making tea i s thought to destroy much of the vitamin B^2 present in the milk. This i s particularly important to Hindus who have no other source of vitamin B-^ in their vegetarian diet. It i s unlikely that their daily requirement of about 3 ug of vitamin 9 B 1 2 c a n b e m e - b from their diet alone (Chanarin, 1 9 6 9 ) . The plas-ma vitamin B 1 2 of vegetarians in India was found to be only 117 pg/ml which compared unfavorably with that of 359 pg/ml found in non-vegetarians (Jathar et a l , 1 9 7 0 ) . Among the East Indian Hindu subjects that participated in this study, one might expect to find certain nutritional deficien-cies. These include iron, since their vegetarian diets do not include the easily assimilated iron from animal sources, and v i -tamin A, vitamin C and the B vitamins, since their diets contain l i t t l e green or yellow vegetables and f r u i t s . In addition, the prolonged gentle heating of pulses and fine cutting of vegetables usually destroy the activities of vitamin C and the B vitamins. Anthropometric Measurements and Indices for the Assessment  of Nutritional Status A child's growth and later adult's physique result from the interaction between heredity and environment. There i s am-ple evidence that significant improvement in physical characte-r i s t i c s follows from changes in environmental factors including nutrition and there i s general agreement that anthropometrical measurements properly taken and properly evaluated represent a useful basis for the assessment of nutitional status (Buzina, 1 9 7 4 ) . A number of anthropometric measurements have been used for the purpose of measuring nutritional status. Among them are those that are more under the influence of genetic factors such as the indices of the skeletal frame, and others that are 10 largely influenced by environmental factors such as the measure-ment: ©f skin-fold thickness as an indicator of body fatness. The selection of proper indices depends therefore on the degree to which a measurement reflects envitonmental changes and on their r e l i a b i l i t y in practice. The tendency has been, particu-l a r l y in epidemiological and general public health ac t i v i t i e s , to use the minimum number of measurements which would s t i l l ade-quately characterize the changes in man's physique due to chan-ges in food intake. The most widely used manuals for the assessment of nu-t r i t i o n a l status are by the Interdepartmental Committee on Nu-t r i t i o n for National Defense (ICNND,1963) and World Health Or-ganization (WHO, 1963), as well as J e l l i f f e ' s monograph which-was also published by WHO (1966). A number of anthropometric measurements have been adopted for assessing nutritional status. The mose commonly used are the measurements of body weight, body height, thickness of the skinfolds and limb circumferences. In principle a l l these measurements are rather easy to take and can be carried out on a large number of individuals in a rela-t i v e l y short time with simple equipment* In practice, however, there i s a great hazard when the technique of anthropometrical measurements i s not adequately standardized, and rather inaccu-rate or possibly useless results are obtained (Buzina, 1974). The selection of c r i t e r i a for the interpretation of an-thropometric information represents another important point. Some of the measurements, notably the indices of the skeletal frames are influenced by environmental and heredity factors and 11 therefore ethnic differences between the populations should be observed when the standards of reference are proposed (Buzina, 1974). No data are available on the anthropometric measurements of East Indian children in North America. The data shown below were obtained on East Indian children in India based on the re-sults of country-wide surveys conducted under the auspices of Indian Council of Medical Research (ICMR) (Gopalan and Vijaya Raghavan, 1971). Gopalan and Vijaya Raghavan (1971) reported that 90 per-cent of Indian children were found to be shorter and lighter than their American counterparts. Data with regard to growth and development in a large number of healthy normal children in India in whom constraints imposed by malnutrition and infection did not operate, would provide important data which could be used as standards to be achieved. A comparison between well-to-do Indian children and American children of corresponding ages re-vealed that Indian boys were as t a l l and as heavy as American up to 14 years: old. As in the case of boys, well-to-do Indian g i r l s were found to be as t a l l and as heavy as American g i r l s corresponding ages up to the age of 12 years (Vijaya Raghavan et a l , 1971). Biochemical Indices for the Assessment of Nutritional Status Variations in quantity and composition of the diet are reflected by changes in the concentration of chemical substances in tissues and body fluids, and/or by the appearance or disap-12 pearance of specific metabolites (WHO, 1963). Most available bio-chemical tests can be divided into those which measure changes that directly reflect the supply of nutrients and those which de-tect biochemical changes that reflect metabolite alterations brought about by nutrient deficiencies or imbalances. Levels of essential dietary constituents in the body-fluids are indicators of nutrient supply. The concentration of essential nutrients in body fluids may be reduced as a result of dietary deficiency, poor absorption, impaired transport or abnor-mal u t i l i z a t i o n . Tests suggested by WHO(1963) for the measurement of nutrient concentration are those which have been most exten-sively applied in nutrition surveys and have had their usefulness demonstrated. For nutritional deficiencies in vitamin A, serum vitamin A and serum B-carotene were the recommended tests. Serum vitamin A levels of a population are more closely related to the intake over a period of several months and do not necessarily re-flect recent intake. Numerous factors, other than dietary intake per se, and l i v e r stores may also have a profound influence on serum vitamin A levels (Pearson, 1962). Since most of the world's population relies upon B-carotene as a source of vitamin A, a more reliable index of the vitamin A status under some circumstances may be obtained from the serum B-carotene level. However, serum B-carotene levels do not necessa-r i l y correlate with the overall vitamin A status; but when a low vitamin A level i s accompanied by a low B-carotene level, i t i s strongly suggestive evidence for the existence of inadequate vitamin A stores (Pearson, 1962). 13 The method of choice for the determination of vitamin C status in human populations has usually been the plasma or se-rum ascorbic acid concentration. This method has the limita-tion that serum levels show a linear relationship with intake only within a narrow range. The white blood cell-blood platelet vitamin C concentration i s more closely related to tissue sto-rage. Unfortunately, determination of white blood cell-blood platelet vitamin C concentration i s technically d i f f i c u l t and thus is ;not readily adapted to routine use on nutrition surveys (Pearson, 1962). Biochemical methods used for assessing nutritional ane-mia in a population are hemoglobin and hematocrit, while for assessing the iron nutritional status of human populations, ad-ditional tests such as plasma iron and percentage saturation of transferrin are recommended by WHO (1963). Since plasma vitamin E concentration usually reflects dietary intake of this vitamin (Desai, 196c>), the determination of plasma vitamin E i s the method of choice for assessing the nutritional status of this vitamin. 14 CHAPTER II MATERIALS AND METHODS Field Clinic A f i e l d c l i n i c was set up on the third floor of the Vishwa Hindu Parishad Temple in Burnaby, B.C. The c l i n i c consis-ted of two rooms in which interviews and anthropometric measure-ments were conducted separately, as shown by the photos on the following pages. Population Total sample size was 63 boys aged 0.67-13.91 years, and 69 g i r l s aged 0.25-17.58 years. Anthropometric measurements were carried out on 63 boys and 64 g i r l s . Twenty-four hour recalls were obtained from 63 boys and 69 g i r l s . Biochemical blood ana-lyses were done on 20 boys and 31 g i r l s . Collection of Dietary Data and Food Habit Information In order to assess and evaluate the dietary competence of the East Indian children, dietary information was collected at the Hindu Temple. Because of the limited time available (children were i n -terviewed during a 2-hour period in which the congregation gather-ed for religious services at the Hindu Temple), i t was decided Collection of Dietary Data Through Interviews 16 Collection of Anthropometric Data C o l l e c t i o n o f Blood f o r B i o c h e m i c a l A n a l y s i s 18 that the 24-hour recall would be the method of choice of the col-lection of dietary information. The relative lack of accuracy of (the 24-hour r e c a l l , as well as the particular limitations inherent in the method, were recognized. That i s , the results can only be interpreted in terms of groups, and not of individuals, further-more, such cross-sectional dietary and nutritional patterns may not be typical of either seasonal or long term patterns (Linusson et a l , 1974)• Nevertheless, for purposes of comparison the me-thod was considered to be adequate, particularly as other measu-rements (anthropometric and biochemical) were carried out at the same time and represented cross-sectional rather than longitudi-nal evaluations. 1. Food Habits Questionnaire Questionnaires were developed for the parents to f i l l out in order to assess general food habits, shopping practices, cook-ing practices at home, and the family background of the subjects. A sample questionnaire i s presented in Appendix 1-1. 2. Twenty-Four-Hour Recall In essentially a l l cases, each child was interviewed and asked to rec a l l a l l foods consumed by himself (herself) during the preceding 24-hour period. In cases where the child was too young to answer questions, his (her) parents were asked to re-c a l l foods eaten by that child during the preceding 24-hour pe-19 riod. During the interview, sample measuring cups, glasses, ce-real bowls and measuring spoons were used as aids in estimating portion sizes. A l i s t of common East Indian food items was available for quick reference. Information from the 24-hour recall forms (a sample form i s presented in Appendix 1-2) (expressed as servings of each food eaten) was transferred to coding sheets in which each food was identified by a 6-digit code. International Business Machine (IBM) cards were punched from the information in the coding sheets, with each card containing the code number, sex and age of the subject. Using programs developed at the University of British Columbia, the daily intake of 13 nutrients (Calories, Protein, Calcium, Iron, Vitamin A, Thiamine, Riboflavin, Niacin, Ascorbic Acid, Total Fat, Polyunsaturated Fat, Carbohydrate and Vitamin E) was computed for each individual. Questionnaires were coded and key punched. Additional data analysis of the 24-hour reca l l and questionnaires was carried out with the IBM 370/163 computer at the University of British Columbia. Collection of Anthropometric Data A l l anthropometric measurements were done according to the recommendations of the International Biological Program (Handbook No. 9, 1969). The children were clothed in light summer clothing, and a l l anthropometric measurements were done at the c l i n i c set up in the Hindu Temple. The measurements in-20 eluded standing height, sitting height, body weight, triceps skin-fold, midupper arm circumference and head circumference. 1, Standing and Sitting Height Standing height was measured to the nearest 0.1 cm with a portable stadiometer; the measuring board was equipped with a d i -g i t a l readout in order to eliminate parallax. Sitting height was similarly measured to the mearest 0.1 cm; a stool of known height was used and actual sitting height subsequently (obtained by sub-traction. 2. Body Weight Body weight was measured to the nearest 0.05 Kg with a por-table beam-type platform balance. Heavy outdoor clothing, as well as foot wear, w&s removed, 3• Triceps Skinfold Thickness Triceps skinfold was measured with Harpenden Skinfold C a l i -per (Skin Fold Calipers, Holtain Ltd., Pembrokeshire, Wales), which read to 0.1 mm accuracy. These calipers exert a constant preassure of 10 g/mm through the whole range of skinfold thicknesses at a l l distances of caliper jaw separation. This was verified by the me- " thod described by WHO (1968). Triceps skinfold measurement was ta-ken on the l e f t side of the body, and the accuracy of the measure-ment was such that duplicate readings agreed to within •+ 5$ in two or more of a l l repeated measurements. 4. Arm Circumference Arm curcumference was measured to the mearest 0.1 cm, using a steel tape measure, with the arm in a relaxed position. Com-pression of soft tissue was avoided. The measurement was:$aken on 21 the l e f t arm, at the point midway between the acromion process of the scapula and the olecranon process of the ulna. 5. Head Circumference Head circumference was measured by placing the tape firmly around the frontal bones, just superior to the supraorbital r i d -ges, passing i t around the head at the same level on each side, and over the maximum occipital prominence at the back. 6. Computer Analysis Data were recorded on the "Nutritional Status Investiga-tion Form" of the School of Home Economics. (Appendix 1-3) The coded sheets were read by the IBM 1232 Optical Mark reader at Simon Fraser University and key punched onto cards. Bata analy-sis was carried out with the IBM 370/168 computer at the Univer-sity of British Columbia. Scatter diagrams of individual findings were prepared with the CALCOMP plotter together with standard reference curves. Biochemical assessment of Nutritional Status 1. Collection of Blood Samples for Biochemical Analyses At the c l i n i c set up in the Vishwa Hindu Parishad Temple, approximately 20 ml of blood were collected from each subject, into heparinized vacutainer tubes. The tubes were gently shaken and placed in ice u n t i l the i n i t i a l processing could be carried out on the same day at the Nutrition Laboratory of the University of British Columbia. Aliquots of whole blood were taken for hemoglobin and hematocrit determinations and the remaining samples were centrifuged 22 immediately for the separation of the plasma. Aliquots of plasma were divided into several screw-cap tubes for the determination of ascrobic acid, vitamin A and carotene, vitamin E, plasma iron and iron binding capacity. Numbered aliquots of plasma samples were frozen immediately and were stored frozen at -20°C u n t i l further analyses could be carried out. 2. Methods for Biochemical Analyses Unless otherwise noted, the methods used for biochemical analyses were those described in the ICNND Manual for Nutrition Surveys (1963). a) Hemoglobin The hemoglobin content of each sample was determined on fresh whole blood, using the cyanmethemoglobin method. A 0.02 ml aliquot of well-mixed blood was added to 5.0 ml of potassium fer-ricyanide solution using Adams disposable Sahli A/l hemoglobin pipet. The pipet was rinsed several times with the solution in the same test tube. After proper mixing, tubes were allowed to stand for 10 minutes and the chromophore which developed was read in the Turner Spectrophotometer at 540 mu using the mixed f e r r i -cyanide solution as the blank. Cyanmethemoglobin was used to pre-pare the standard curve (Fig. 1-1) and the f i n a l values were ex-pressed as g of hemoglobin per 100 ml of blood. Figure 1-1.Standard curve for hemoglobin 24 b) Hematocrit A small amount of fresh blood was introduced into a Micro-Hematocrit capillary tube (Fisher Brand), care being taken to avoid air bubbles. The tube was sealed at one end with plastic clay (Critaseal) and centrifuged in a Micro-Capillary Centrifuge (IEC Model MB) at 3.000 rpm for five minutes or u n t i l complete packing of the cells was obtained. Red c e l l volume in percent was read directly from the Micro-Capillary Reader. c) Plasma Vitamin C The micro-dinitrophenylhydrazine technique for plasma v i -tamin C as described in the ICNND Manual for Nutrition Surveys (1963) was used. Analysis on the plasma samples was carried out within a week after freezing to prevent loss of ascorbic acid. After thawing, 0.4 ml of plasma was added to 1.6 ml of 5 per cent trichloroacetic acid and the precipitated protein was separated by centrifugation for 10 minutes at 3»000 rpm. to 1.2 ml aliquot of the clear supernatant f l u i d , 0.4 ml of the 2.4 dinitrophenyl-hydrazine—thiourea-copper sulfate + 20 volume of 2.2$ dinitrophe-.nylhydrazine) was added and incubation was carried out at 60°C for 1 hour. The tubes were removed from the ice bath and the red-orange chromophore was measured spectrophotometrically at 515 mu. Appropriate blanks and standards were run and correction factor was derived from the standard curve (Fig. 1-2) for expressing vitamin C values in mg per 100 ml of plasma. Figure 1-2. Standard curve for vitamin G VJ-I 26 d) Plasma Vitamin A and Carotene Plasma vitamin A was determined by a modification of the Carr-Price colourimetric macro-procedure of Nee Id and Pearson |v. (1963)using trifluoroacetic acid. The carotene concentration was determined by measuring the absorption of the petroleum eth-er extract at 45Q;;mu. The vitamin A concentration was determined ; by measuring the absorption of the trifluoroacetic acid ex-tract at 620 mu. A correction was made for the amount of caro-tene present, since carotene contributes to the total colour in the Carr-Price reaction. Plasma vitamin A and carotene values were calculated from the standard curves (Fig 1-3• Fig 1-4) and expressed as ug per 100 ml of plasma. e) Plasma Vitamin E Plasma vitamin E was determined by a slight modification of the micromethod described by Fabinek et a l (1968). The me-thod essentially consisted of extracting 0.6 ml of plasma with xylene, followed by the addition of 0.4$ bathophenanthroline, 0#,6 •fo f e r r i c chloride and 85$ orthophosphoric acid. Tocopherol i s oxidized by fe r r i c chloride and also reduces interference of ca-rotene to a minimum. Plasma vitamin E concentrations were cal-culated from a standard curve (Fig. 1-5) made with pure tocophe-r o l . The results were expressed as, mg of vitamin E per 100 ml of plasma. 28 ug B-carotene /ml Figure 1-4. Standard curve f o r carotene 1 2 3 4 5 6 ug v i t . E / tube (0.4 ml) Figure 1-3... Standard curve for vitamin E 30 f) Plasma Iron The Ferro-Check II Test Kit (Hyland) was used to determine plasma iron. In the Ferro-Check II Test, Acid Dissociating Rea-gent (11$ acetic acid plus a non-ionic surfactant) was added to plasma to dissociate the f e r r i c i©n from the iron-transferrin com-plex. Ascorbic acid (1.81$) was used to reduce the f e r r i c ion to i t s ferrous state, which was then available to complex with the chromagen (FerroZine colour reagent, containing 1.8$ FerroZine). An i n i t i a l absorbance (O.D.) of the mixture before addition of the chromagen was read at 560 'nm to provide a blank for correcting the native colour and any residual turbidity of the plasma. FerroZine was added to the ferrous ion to form a stable magenta complex; and a second absorbance (O.D.) was read at 560, nm. The difference in absorbance ( O.D.) was obtained and the calculation for plasma iron was calculated as follows: A O.D. of specimen . Iron content of ,, plasma iron x = &0.D. of standard standard (ug/dl) (ug/dl) g) Iron Binding Capacity The Ferro-Check II Test Kit (Hyland) was used to determine iron-binding capacity. The capacity of transferrin to bind iron may be expressed in either of two ways: 1) unsatureated iron-binding capacity (UI BC), a measure of the additional iron which transferrin i s capable of binding, over and above that already present in the specimen; and 2) total iron-binding capacity (TIBC), a measure of the total amount of iron, including that already bound, which transferrin i s capable of binding. Therefore, total iron-binding capacity (TIBC) 31 i s the sum of serum i r o n and unsaturated iron-binding capacity. Excess ferrous ion (Iron Reagent Solution containing 400 ug iron/dl) and ascorbic acid (l,$lfo)f which maintains the iro n i n i t s ferrous state, were added to the specimen to satu-rate the t r a n s f e r r i n . Binding Buffer Reagent (3$ acetic acid plus a buffering agent) was added to produce the proper pH f o r saturation of the unoccupied iron-binding s i t e s of the trans-f e r r i n . The excess iron added was calculated i n the same way as f o r plasma iron , then UIBC (ug/dl) was obtained by subtracting excess iron added (ug/dl) from t o t a l i r o n added (400 ug/dl). F i n a l l y , t o t a l iron-binding capacity (ug/dl) was obtained by the addition fo plasma i r o n to UIBC. 3• Data Analyses Data were recorded on the " N u t r i t i o n a l Status Investiga-t i o n Form" of the School of Home Economics. (Appendix 1-4) The coded sheets were read by the IBM 1232 Optical Mark Reader at the Simon Fraser University and key punched onto IBM cards. Da-t a analyses were carried out with the IBM 370/163 computer at the University of B r i t i s h Columbia. 32 CHAPTER III RESULTS I. Dietary Results 1. Dietary Intake Survey Nutrient intakes derived from the 24-hour reca l l are listed in Appendix II. The nutrient intake data of the subjects was analysed and compared with 2/3 of the Canadian Dietary Stan-dards revised 1975 (CDS) (Table 1-1), i t was f e l t that this i s more meaningful and significant than comparison with 100$ of the CDS. Since intakes of less than 2/3 of the CDS are clearly un-desirable and where this i s found to occur in a large proportion of the population, some attention should definitely be given to improving or correcting the situation. Table 1-2 shows the num-ber of subjects with nutrient intake less than 2/3 of CDS; and the percentage distribution of these subjects, while Table 1-3 shows the distribution of the subjects in age groups with nu-trient intake less than 2/3 of the Canadian Dietary Standards. (CDS). 2. Individual Nutrients A. Calories Twenty-two percent of the male subjects had intakes be-low 2/3 of CDS, and 29.8 percent of the female subjects had i n -take levels less than 2/3 of CDS. In males, 25 percent of the Table 1-1 Canadian D i e t a r y Standard (Revised 1975) I i ' NUTRIENTS ' Age Sex Weight Height Energy Prote in Thiamin Niacin Riboflavin Vitamin C Vitamin A Vitamin E Calcium 1 ron (kg) (cm) (kcal) (g) (mg) (NE) a (mg) (mg) (RE)t> (mg-°<-to (mg) (mg) copherol) 0-6 mo Both 6 - kg x 117 kg x 2.2(2.0) 0.3 5 0.4 20 400 3 500 7 7-11 mo Both 9 - kg x 108 kg x 1.4 0.5 6 0.6 20 400 3 500 7 1-3 yrs Both 13 90 1400 22 0.7 9 0.8 20 400 4 500 8 4-6 yrs Both 19 110 1800 27 0.9 12 1.1 20 500 5 500 9 7-9 yrs M 27 129 2200 33 1.1 14 1.3 30 700 6 700 10 F 27 128 2000 33 1.0 13 1.2 30 700 6 700 10 10-12 yrs M 36 2500 41 1.2 17 1.5 30 800 7 900 11 F 38 145 2300 40 1.1 15 1.4 30 800 7 1000 11 13-15 yrs M 51 162 2800 52 1.4 19 1.7 30 1000 9 1200 13 F 49 159 2200 43 - 1.1 15 1.4 30 800 7 800 14 16-18 yrs M 64 172 3200 54 1.6 21 2.0 30 1000 10 1000 14 F 54 161 2100 43 1.1 14 1.3 30 800 6 700 14 19-35 yrs M 70 176 2700 56 1.5 20 1.8 30 1000 9 800 10 F 56 161 2100 41 1.1 14 1.3 30 800 6 700 14 81NE (niacin equivalent) Is equal to 1 mg of niacin or 60 mg of tryptophan b1RE (retlnol equivalent) corresponds to a biological activity In humans equal to 1 ug retlnol (3-33 IU) or 6 ug B-carotene (10 IU) Table 1-2 Distribution of Subjects with Nut rient Intake Less than 2/3 CDS NUTRIENTS No. o f Males % No. o f Females i Both 1 C a l o r i e s 14 22 20 29.8 34 26 P r o t e i n 1 1.6 0 0 1 0.76 Thiamine 12 19 15 22 27 20.8 N i a c i n 31 , 49 26 38.8 57 43.8 R i b o f l a v i n 14 22 15 22 29 22.3 Vitamin C 5 . 7.9 8 11.9 13 10 Vitamin A 8 12.7 13 19 21 16.2 V i t a m i n E 0 0 0 0 0 0 Calcium 7 11 9 13 16 12.3 1 ron 17 26.9 26 38.8 43 33.1 Number o f s u b j e c t s : Males = 63 Females = 69-2 (who were l e s s than 6 months old) = 67 Table 1-3 Distribution of Subjects in Ap;e Groups with Nutrient Intake Less than 2/3 CDS Age Groups Sex Calories Protein No. 1 No. I 7-11 mos M(1)* 0 0 0 0 F(2) 0 0 0 0 1-3 yrs M(8) 2 25 0 0 F(2) 3 37.5 0 0 4-6 yrs M(10) 4 10 0 0 F(13) 5 38.5 0 0 7-9 yrs M(18) 3 16 0 0 F(16) 9 56 0 0 10-12 yrs M(12) 2 16 0 0 F(14) 2 14 0 0 13-15 yrs M(10) 1 10 0 0 F(10) 1 10 0 0 16-18 yrs M(4) 2 50 1 25 F(4) 0 0 0 0 ( )* No. of subjects In each age group Total Males - 63 Thiamine Niacin Riboflavin Vitamin C No. 1 No. 1 No. i No. % 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 12.5 6 75 1 12.5 1 12.5 1 12.5 4 50 0 0 1 12.5 1 10 4 40 2 . 20 0 0 3 23 5 38.5 3 23 1 7-7 4 22 8 kk 2 11 0 0 3 18.8 . 5 31 5 31 2 12.5 1 8 6 50 4 33 2 16.6 1 7 4 28.5 2 14 1 7 3 30 4 40 2 20 1 40 6 60 6 60 3 30 3 30 2 50 3 75 3 75 1 25 0 0 1 25 1 25 0 0 VitarnIn A Vitamin E Calcium Iron No. i No. 1 No. 1 No. % 0 0 0 0 0 0 1 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 62 0 0 0 0 0 0 6 75 2 20 0 0 0 0 4 40 2 15 0 0 2 15 5 38 1 5.5 0 0 2 11 3 16 5 31 0 0 4 25 4 25 2 16 0 0 1 8 1 8 2 14 0 0 2 14 3 21 3 30 0 0 2 20 2 20 3 30 0 0 1 10 7 70 0 0 0 0 2 50 1 25 1 25 0 0 0 0 1 25 Total Females - 69 -2 ( < 6mo.) - 67 36 1 to 3 years old, 10 percent of the 4 to 6 years old, 16 percent of the 7 to 12 years old, 10 percent of the 13-15 years old and 50 percent of the 16-18 years old had intakes of calories less than 2/3 of CDS. In females, 37.5 percent of the 1 to 3 years old, 38.5 percent of the 4 to 6 years old, 56 percent of the 7 to 9 uears old, 14 percent of the 10 to 12 years old and 10 per-cent of the 13 to 15 years old had intakes of calories less than 2/3 of CDS. B. Protein A l l except one male subject (1.6 percent of the male po-pulation) had protein intakes more than 2/3 of CDS. C '. Thiamine Nineteen percent of male subjects and 22 percent of female "• subjects had intakes of thiamine less than 2/3 of CDS. In males, subjects with inadequate thiamine intake f a l l mainly in the 7-9 years, 13-15 years and 16-18 years age groups, compri-sing about 75 percent of the male subjects with inadequate inta-kes. In females, subjects withinadequate thiamine intake f a l l mainly in the 4-6 years, 7-9 years and 13r-15 years age groups, comprising about 80 percent of the female subjects with inade-quate thiamine intake. D. Niacin Forty-nine percent of the male subjects and 38.8 percent of the female subjects had intakes of niacin less than 2/3 of CDS. In males, subjects with inadequate niacin intake seem to be quite evenly spreaded out through ages 1-18, with slightly higher percentage in the 1-3 years age group and 16-18 years age 37 group, with 75 percent of each age group not meeting 2/3 of CDS. Similarily in females, subjects with inadequate niacin intake are evenly spreaded out through ages 1 to 1 8 , with slight higher percentage in the 1-3 years and 13-15 years age groups with 50 percent and 60 percent of each age group respectively not meeting 2/3 of CDS. E. Riblflavin Twenty-two percent of both male and female subjects had intakes of riboflavin below 2/3 of CDS. Among males, subjects with inadequate riboflavin intake occur more frequently in higher age groups; 33 percent of the 10-12 years age group and 75 percent of the 16-18 years age group making up 50 percent of a l l the male subjects with inadequate intakes of riboflavin. Among females, the 10-12 years age group had less subjects with inadequate inta-ke (14 percent) than other age groups rangeing from 4 - 1 8 years of age. F. Vitamin C Among male subjects, 7 . 9 percent had intakes of vitamin C less than 2/3 of CDS, while the percentage i s 1 1 . 9 in female sub-jects. In males, subjects in the 4 - 6 years and 7-9 years old had intakes higher than 2/3 of CDS; while 1 2 . 5 percent of 1-3 years old, 1 6 . 6 percent of the 10-12 years old, 10 percent of the 13-15 years old and 25 percent of the 16-18 years old had intakes less than 2/3 of CDS. In females, 1 2 . 5 percent of the 1-3 and 7-9 years of age, 7 . 7 percent of the 4 - 6 years old, 7 percent of the 10-12 years of age and 30 percent of the 13-15 years of age did not meet 2/3 of CDS. G. Vitamin A Nineteen percent of the female subjects and 1 2 . 7 percent 38 of the male subjects had intakes less than 2/3 of CDS. In males, 20 percent of the 4-6 years old, 5.5 percent of the 7-9 years old and 30 percent of the 13-15 years old had inadequate vitamin A intake. In females, 15 percent of the 4-6 years old, 31 percent of the 7-9 years of age, 14 percent of the 10-12 years of age, 30 percent of the 13-15 years of age and 25 percent of the 16-18 years old had intakes of vitamin A less than 2/3 of CDS. H. Vitamin E A l l subjects had intakes greater than 2/3 of CDS, and thus were adequate in the vitamin E intake. I. Calcium Eleven percent of the male subjects and 13 percent of the female subjects had calcium intakes less than 2/3 of CDS. In-'-males, ;Vr. inadequate intake occurs from ages 7 to 18 while in females, this occurs from ages 4 to 15. J. Iron Among male subjects, 26.9 percent had iron intake less than 2/3 of CDS. In males, the highest percentage of inadequate iron intake occurs in the 1 to 3 years of age and 4 to 6 years of age with percentage of 62.5 and 40 respectively. In females, the highest percentage of iron intake occurs in the 1 to 3 years old and 13 to 15 years old with percentage of 75 and 70 respectively. O. Nutrition Canada Categories Subjects were further classified into categories defined by the standard developed in 1969 by the Nutrition Canada Commit-•tee on Standards and Data Interpretation which classified the 39 nutrient intakes of individuals within an age group into three l e -vels, with corresponding cut-off points, designated as inadequate, less-than-adequate and adequate (Table 1-4)• Inadequate intakes are considered to be below the desirable amount of a nutrient. Less-than-adequate intakes are those above the minimum requirement but below the desirable amount of a nutrient. Adequate intakes are those providing a desirable margin of safety in meeting the bo-dy's needs of a nutrient. It should be noted that the recommended nutrient intakes set out in the Canadian Dietary Standard (CDS) used for comparison in the previous section are higher than those for thiamine, ribo-flavin, and niacin for a l l age groups and are lower for adolescents for iron than those or the Nutrition Canada Interpretive standard. Table 1-5 shows the percentage distribution of male and female subjects according to the Nutrition Canada Interpretive standard. Intakes of iron and calcium of the subjects were further examined, and the percentage distributions of subjects eith inade-quate or less than adequate nutrient intake in addition to calcium or iron are shown in Tables 1 - 6 and 1-7 respectively. Of those subjects with inadequate or* less than adequate calcium intake, 5 6 . 7 percent had inadequate or less than adequate iron intake, 1 0 . 8 percent had inadequate or less than adequate protein intake, 5 percent had inadequate or less than adequate vitamin A intake, 8 percent had inadequate or less than adequate vitamin C intake, 1 0 . 8 percent had inadequate or less than ade-quate thiamine intake, 27 percent and 4 0 . 5 percent had inadequate or less than adequate intake in riboflavin and niacin respectively. T a b l e 1-4 NUTRIENT INTAKES VITAMIN A (retinol equivalent /kg body wt/day)' 0- 5 mos M & F 6-11 mos M & F 1- 3 yrs M 4 F 4-12 yrs M & F Nutrition Canada Interpretative Standard (1973) CLASSIFICATION OF INTAKES INADEQUATE LESS-THAN-ADEQUATE ADEQUATE CLASSIFICATION OF INTAKES INADEQUATE LESS-THAN-ADEQUATE ADEQUATE NIACIN -(Niacin equivalent PROTEIN 0-11 mos M 4 F (equiv./day) below 4.4 4.4 6 6 above 6.6 (g/kg body weight/day) t-12 yrs M & F (equiv. n000 Cal/day) below 4.4 4.4 6.6 above 6.6 0-5 mos M 4 F below 2.0 2.0 - 2.5 above 2.5 13 + yrs M 4 F (equiv. /day) below 8.8 8.8 13.2 above 13.2 6-11 mos M & F below 1.2 1.2 - 1.6 above 1.8 or, il calorie intake is above 2000 1-2 yrs M & F below 0.9 0.9 - 1.6 above 1.6 (equiv. /1000 Cal/day) below' 4.4i 4.4 6.6 above 6.6 3-8 yrs M & F below 0.7 0.7 - 1.3 above 1.3 THIAMIN ' 9-16 yrs M 4 F below 0.6 0.6 - 1.0 above 1.0 0- 11 mos M 4 F (mg/day) 1- 12 yrs M 4 F below below 0.25 0.25 0.25 -0,25 -0.4 0.4 above above 0.4 0.4 17+ yrs M 4 F - below 0.5 0.5 - 0.7 above 0.7 (mg/1000 Cal/day) 13+ yrs M 4 F (mg/day) below 0.5 0.5 - O.B above 0.6 below below below below 40 25 15 12 40 25 15 12 60 35 25 20 above above above above 60 35 25 20 or, if calorie intake is above 2000 (mg/1000 Cal/day) RIBOFLAVIN 0- 11 mos M 4 F (mg/day) 1- 12 yrs M 4 F (mg/1000 Cal/day) 13+ yrs M 4 F (mg/day) below below 0.25 0.30 0 30 0.25 0.30 -0.30 -0.55 0.55 1.10 above above 0.55 0.55 1.10 (retinol equivalent/day) 13+ yrs M 4 F VITAMIN C (mg/day) 0-5 yrs M 4 F 6+ yrs M 4 F IRON (mg/day) below 500 below below 10 10 500 10 10 - 750 20 30 above 750 above above 20 30 0-8 yrs M 4 F below 6 6 8 above 8 9-16 yrs M & F below 10 10 - 15 above 15 17+ yrs M below 6 6 - 10 above 10 or. il calorie intake is above 2000 (mg/1000 Cal/day) CALCIUM (mg/day) 0.30 0.30 0.55 0.55 0-11 mos M 4 F below 400 400 - 500 above 500 1-5 yrs M 4 F below 500 500 - 700 above 700 6-8 yrs M 4 F below 500 500 - 1000 above 1000 9-16 yrs M 4 F below 700 700 - 1200 above 1200 17-21 yrs M 4 F below 600 600 - 900 above 900 o Table 1-5 Distribution of Subjects According to Nutrition Canada Category Nutrients (No.of Sex Subjects) Inadequate No. % Less than Adequate No. % Adequate No. % Protein M (63) 0 0 4 6.3 59 93.7 F (63) 0 0 4 6.3 59 93.7 Both (126) 0 0 8 6.3 118 93.7 1 ron M (63) 23 36.5 16 25.4 2k 38.1 F (67) 33 49.3 15 22.4 19 28.4 Both (130) 56 43 31 23.8 43 33 Calcium M (63) 9 14.3 10 15.9 44 69.8 F (67) 9 13.4 9 13.4 49 73.1 Both (130) 18 13.8 19 14.6 93 71.5 Vitamin A M (63) 4 6.3 4 6.3 55 87.3 F (63) 7 11.1 10 15.9 46 73 Both (126) 11 8.7 14 11 101 80 Vitamin C M (63) 4 6.3 5 7.9 54 85.7 F (67) 5 7.5 8 11.9 54 80.6 Both (130) 9 6.9 13 10 108 83 Thiamine M (63) 5 7.9 9 14.3 49 77 F (67) 7 10. 4 7 10.4 53 79.1 Both (130) 12 9.2 16 12.3 . 102 78.5 Riboflavin M (63) 3 A.8 19 30.2 41 65.1 F (67) 5 7.5 17 14.9 45 67.2 Both (130) 8 6.2 36 27.7 86 66.1 Niacin M (63) 21 33.3 21 33.3 21 33.3 F (67) 21 31.3 16 23-9 30 44.8 Both (130) 42 32.3 37 28.5 51 39.2 42 Table 1-6 Percentage Distribution of Subjects with Inadequate or Less than Adequate Nutrient Intakes in Addition to Calcium Nutrients Percentage of Subjects Iron 56.7 Protein 10.8 Vitamin A 5 Vitamin C 8 Thiamine 10.8 Riboflavin 27 Niacin 40.5 Table 1-7 Percentage Distribution of Subjects with Inadequate or Less than Adequate NutrientIntakes in Addition to Iron Nutrients Protein Calcium Vitamin A Vitamin C Thiamine Riboflavin Niacin Percentage of Subjects 7 31 16.3 14.9 13.8 > 27.6 44* 8 44 Of those subjects with inadequate or less than adequate iron intake, 31 percent had inadequate or less than adequate calcium intake, 16.3 percent had inadequate or less than ade-quate vitamin A intake, 14.9 percent had inadequate or less than adequate vitamin C intake, 13.3 percent, 17.6 percent and 44.3 percent had inadequate or less than adequate intakes in thiamine riboflavin and niacin respectively. These results indicate that in subjects with low calcium intake, the next most lacking nutrients are iron and niacin. For subjects with low iron intake, the next most lacking nu-trients are niacin, calcium and riboflavin. 4. Food Group Contribution Food items recorded in the dietary recalls were catago-rized into food groups and compared with those found by the Nu-t r i t i o n Canada (1973). Tables 1-3, 1-9, 1-10 and 1-11 show the percent contribution of food groups to nutrient intake for c h i l -dren 1-4 years old, children 5-11 years old, males 12-19 years old and females 12-19 years old respectively. Findings of Nu-t r i t i o n Canada on children across Canada are lis t e d in Tables I-3A, I-9A, I-10A and I-11A in the same age group order as above. a) Milk and Dairy Products For the East Indian children 1-4 years old, this food group was a primary source of calories, protein, fat, calcium, vitamin A, thiamine and riboflavin; and a secondary source of Table 1-8 Percent C o n t r i b u t i o n of Food Groups to Nutrient Intake of Vancouver East Indian Children Sampled (1-4 years) Meat, P o u l t r y , F r u i t & Fats N u t r i e r | t Dairy F i s h , Eggs, Cereal F r u i t Vegetables and Sugars S Miscellaneous Products Legumes Products Products O i l s Sweets C a l o r i e s 41.10 4.25 25.44 12.81 6.55 6.22 3.29 0.34 P r o t e i n 63.59 10.15 17.19 3.99 4.12 0.0 0.40 0.56 Fat 57.06 7.11 11.44 0.19 2.34 18.47 0.0 0.06 Carbohydrate 25.46 0.37 36.22 23.66 7.66 0.0 6.20 0.43 Calcium 89.47 0.73 5.00 2.63 1.32 0.13 0.05 0.66 1 ron 8.19 8.38 45.16 22.98 12.58 0.0 0.59 2.11 Vitamin A 36.93 3.54 1.23 24.03 24.93 7.67 0.0 1.67 Thiamine 33.05 2.76 30.36 21.17 10.34 0.0 0.0 2.31 R i b o f l a v i n 75.88 3.39 11.61 4.74 2.56 0.0 0.11 1.70 N i a c i n 5.66 18.75 40.63 14.48 17.51 0.0 0.11 2.85 Vitamin C 6.25 0.04 0.48 79.94 12.67 0.0 0.0 0.62 Vitamin E 16.51 5.00 17.91 10.75 5.38 kh.kk 0.0 0.02 T a b l e I-8A Percent C o n t r i b u t i o n of Food Groups to N u t r i e n t Intake o f C h i l d r e n (1-4 y e a r s ) ( N u t r i t i o n Canada 1973 b) Meat, N u t r i e n t Dai ry Products P o u l t r y , F i s h , Eggs Cereal Products F r u i t 6 F r u i t Products Vegetables & Potatoes Fat and O i l s Othei C a l o r i e s 28 14 24 9 8 5 12 P r o t e i n 42 29 15 1 5 . _ 7 Fat 33 25 14 1 6 13 8 Carbohydrate 19 - 34 18 10 • - 17 F i b r e - - 21 27 37 - 14 C a l c i u m 80 2 9 2 2 - 4 1 ron 2 21 47 9 9 - 10 V i t a m i n A 34 22 2 3 16 12 9 Thiamine 23 14 36 8 11 6 Ri b o f l a v l n 58 11 22 2 3 - 3 N i a c i n 29 32 21 3 8 - 7 V i t a m i n C 10 - - 66 22 - 2 Free F o l a t e 37 8 13 24 13 • - • - 4 ^Includes Nuts and D r i e d Legumes, Foods P r i m a r i l y Sugar, Beverages and Soft Drinks , Mixed D i s h e s , Soup, M i s c . O N Table 1-9 Percent C o n t r i b u t i o n of Food Groups to Nutrient Intake of Vancouver East Indian Children Sampled (5-11 years) Meat, F r u i t £ Fats P o u l t r y , F r u i t Vegetables and Sugars & Miscellaneous N u t r i e n t Dairy F i s h , Eggs, Cereal Products O i l s Sweets Products Legumes Products C a l o r i e s 23.85 10.44 30.84 P r o t e i n 39.29 23.69 24.81 Fat 32.93 17.72 17.61 Carbohydrate 14.69 1.84 41.69 Ca 1c i urn 77.42 2.23 10.36 1 ron 4.06 16.75 39.65 Vitamin A 24.55 4.06 2.50 Thiamine 18.85 9.38 33.97 R i b o f l a v i n 61.67 8.53 14.72 N i a c i n 2.49 30.23 32.89 Vitamin C 3.73 1.21 0.27 Vitamin E 19.73 6.33 15.29 11.37 9.52 8.09 5.22 0.58 4.31 6.39 0.0 0.74 0.78 0.69 8.04 22.65 0.22 0.13 20.47 10.83 0.04 9.64 0.80 4.94 3.05 0.30 0.15 1.56 17.61 15.87 0.09 1.07 4.91 23.95 31.64 10.66 0.0 2.64 20.06 14.11 0.0 0.0 3.62 6.32 4.92 0.02 0.14 3.68 9.86 21.15 0.0 0.02 4.36 72.90 20.78 0.0 0.0 1.10 7.29 8.14 42.94 0.0 0.30 Table I-9A Percent C o n t r i b u t i o n of Food Groups to N u t r i e n t Intake of C h i l d r e n (5-11 years) ( N u t r i t i o n Canada, 1973b ) Meat, P o u l t r y , F r u i t & Fat Nut r i e n t Dairy F i s h , Cereal F r u i t Vegetables and Products Eggs Products Products & Potatoes O i l s Other * C a l o r i e s 19 14 29 8 8 6 15 P r o t e i n 32 32 20 1 5 - 9 Fat 23 25 17 - 7 17 10 Carbohydrate 13 - 40 16 10 - 20 Fi bre - - 21 26 36 - 16 Ca 1 c i urn 72 2 12 3 3 - 7 1 ron 1 24 39 9 12 - 14 Vitamin A 26 24 3 4 15 17 • 10 Thiamine 17 15 40 8 13 - 7 R i b o f l a v i n 48 14 26 2 4 - 5 N i ac i n 21 35 23 2 9 - 10 Vitamin C 7 - 1 61 28 - 3 Free Folate 29 9 18 20 17 - 6 "Includes Nuts and Dried Legumes, Foods P r i m a r i l y Sugar, Beverages and Soft Drinks , Mixed Dishes, Soup, Misc. Table 1-10 Percent C o n t r i b u t i o n of Food Groups to N u t r i e n t Intake of Vancouver East Indian Children (Males sampled 12-19 years) Meat, P o u l t r y , F r u i t & Fats Nutrient Dairy F i s h , Eggs, Cereal F r u i t Vegetables and Sugars & Miscellaneous Products Legumes Products Products O i l s Sweets C a l o r i e s 17 . 66 16.78 30.11 6.01 6.06 11.71 11.13 0.54 P r o t e i n 28.78 36.74 23.87 2 . 46 5.88 0.0 1 .14 1 .14 Fat 23.90 26.25 15.50 0.18 3.68 30 .04 0.35 0.09 Carbohydrate 11 .14 5.07 42 . 3 0 11.59 7.92 0.0 21.28 0.70 Ca1c i urn 69.63 7.29 12.00 4.37 3 . 24 0.54 0.73 2.20 1 ron 3.43 30.20 37.67 7 . 64 13.56 0.19 3.61 3-71 Vitamin A 2 4 . 9 6 7 . 48 2.90 11.23 30.88 18.83 0.0 3.71 Th iami ne 14 . 28 17.05 33.68 16.36 14 .02 0.0 0.08 4.53 R i b o f l a v i n 53.96 15.95 13.04 4 . 46 5.88 0.11 0.59 6.03 N i a c i n 1.49 50.41 25 .16 5.19 13.40 0.0 0.05 4.30 Vitamin C 3.35 2.70 1.38 67.56 23.63 0.0 0.0 1.38 Vitamin E 7.±5 23.98 12.96 2.98 4.33 4 8 . 1 6 0 . 2 4 0.19 vO Table I-10A Percent C o n t r i b u t i o n of Food Groups to N u t r i e n t Intake of Males (12-19 years) ( N u t r i t i o n Canada, 1973 b) N u t r i e n t D a i r y Products Meat, P o u l t r y , F i s h , Eggs Cereal Products F r u i t and F r u i t Products Vegetables & Potatoes Fats and O i l s Othei C a l o r i e s 16 18 29 4 9 7 16 P r o t e i n 26 38 19 1 6 - 9 Fat 18 30 17 -' 7 18 9 Carbohydrate 12 - 42 9 12 - 24 F i b r e - - 22 15 42 - 19 Calcium 70 3 14 2 4 - 6 1 ron 2 31 36 4 12 - 15 Vitamin A 23 26 3 2 13 21 10 Thiamine 14 22 37 4 15 - 7 R i b o f l a v i n 44 26 1 5 - 6 N i a c i n 16 41 21 1 9 - 11 Vitamin C 8 - - 47 39 - 5 Free F o l a t e 27 12 21 !3 19 - 7 ^ I n c l u d e s Nuts and D r i e d Legumes, Foods P r i m a r i l y Sugar, Beverages and S o f t Drinks , Mixed Di s h e s , Soup, M i s c . Table 1-11 Percent C o n t r i b u t i o n Food Groups to Nutrient Intake of Vancouver East Indian ChiIdren(Females sampled 12-19) Meat, P o u l t r y , F r u i t S Nut r i e n t Dairy Eggs, F i s h , Cereal F r u i t Vegetables Fats S Sugar & Miscellaneous Products Legumes Products Products O i l s Sweets C a l o r i e s 15.23 5.41 31.93 9.28 15.84 13.13 9.17 0.0 Prot e i n 35.35 16.70 31.67 4.22 12.00 0.0 0.05 0.0 Fat 20.83 7.73 18.27 0.37 16.17 36.49 0.13 0.0 Carbohydrate 8.32 1.39 41.16 16.39 15.72 0.05 16.95 0.0 Ca 1 c i urn 71.70 2.06 14.13 4.27 6.96 0.44 0.45 0.0 1 ron 3.88 13.57 38.24 14.94 26.97 0.09 2.32 0.0 Vitamin A 15.21 0.84 3.00 28.13 39.92 12.87 0.02 0.0 Th i ami ne 14.60 6.76 37.94 19.04 21.63 0.0 0.03 0.0 R i b o f l a v i n 49.47 4.55 30.58 5.54 9.09 0.0 0.36 0.41 Ni a c i n 1.87 16.24 34.69 9.62 36.37 0.0 0.01 1.19 Vitamin C 2.43 0.25 0.76 61.60 34.96 0.0 0.0 0.0 Vitamin E 3.84 5.53 8.29 3.62 10.65 67.92 0.01 0.13 h-1 Table 1-11 A Percent C o n t r i b u t i o n of Food Groups to N u t r i e n t Intake of Females (12-19 years) ( N u t r i t i o n Canada, 1973 b) Meat, F r u i t and Nutrient Dairy P o u l t r y , Cereal F r u i t Vegetables Fats and Other-Products F i s h , Eggs Products Products & Potatoes O i l s C a l o r i e s 16 17 29 6 9 7 17 Pr o t e i n 25 37- 19 1 6 - 10 Fat 17 28 18 - 7 18 10 Carbohydrate 11 - 40 13 12 - 24 F i bre - 19 20 42 - 18 Calcium 66 3 14 3 4 - 9 I ron 2 30 30 6 14 - 18 Vitamin A 21 22 4 3 17 19 12 Thiamine 14 21 32 8 16 - 9 R i b o f l a v i n 45 18 21 2 5 - 8 N i a c i n 16 42 20 2 10 - 10 Vitamin C 6 - - 56 33 - 4 Free F o l a t e 24 10 17 21 20 - 7 "Includes Nuts and Dired Legumes, Foods P r i m a r i l y Sugar, Beverages and Soft Drinks, Mixed Dishes, Soup, Mi sc. 53 carbohydrate. This pattern i s similar to that found by Nutri-tion Canada, however, niacin was contributed mainly by dairy products in Canadian children while i t was contributed mainly be cereal products in East Indian children. For the East Indian children 5-H years old, this food group was a primary source of protein, fat, calcium, and riboflavin and a secondary source of calories. This pattern is similar to those of Canadian children except for thiamine and niacin which were contributed mainly by cereal products in East Indian children. For the East Indian male subjects 12-19 years old, this food group was a primary source for calcium and riboflavin, and a secondary source for fat, vitamin A, pritein and calories. This i s quite similar in surveyed Canadian males of the same age group. In female subjects 12-19 years old, this food group was a primary source for protein, fat, calcium and riboflavin, and a secondary source for calories. While in Canadian females of the same age group these foods were the primary source of cal-cium, vitamin A, riboflavin and a secondary source of calories, protein and fat. The difference i s in vitamin A, which was contributed mainly by vegetables in East Indian subjects, b) Meat, Poultry, Fish, Eggs and Legumes For East Indian subjects 1-4 years old, these foods were neither the primary nor the secondary source of any nutrients. For Canadian children this food group was a primauy source of niacin and a secondary source of protein, fat, iron and vitamin A. 54 For subjects 5-11 years old, th i s food group was a prima-ry source of niacin and a secondary source of protein, fat, and iron. This differs from the Canadian counterparts in that this food group was also a primary source of vitamin A. For East Indian adolescents 12-19 years old, this food group was a primary source of protein, fat and niacin for males, but not a primary source of any nutrients for females. It was a secondary source of calories, iron, thiamine and riboflavin for males, and of protein and niacin for females. The Nutrition Canada findings indicated that this food group was a primary source of protein, fat, vitamin A and niacin for both sexes, and of iron for the females. It was a secondary source of calories and thiamine for both sexes, of iron for the males and of ribo-fl a v i n for the females, c) Cereals and Cereal Products Among East Indian children 1-4 years of age, this food group was a primary source for carbohydrate, iron, thiamine, and niacin, and a secondary source for calories, protein, riboflavin and vitamin E. For Canadian children of the same age, this food group was the primary source of iron, thiamine and carbohydrate, and a secondary source of calories, riboflavin and niacin. Among East Indian children 5-11 years of age, this food group was a primary source of calories, carbohydrate, iron, thiamine and niacin, and a secondary source of protein, calcium and riboflavin. For Canadian children of this age, this food 55 group was a primary source of calories, carbohydrate, iron and thiamine, and a secondary source of protein, fat, calcium, r i b l f l a v i n and niacin, very similar to those patterns found in East Indian children. For East Indian adolescents 12-19 years df age, this food group was a primary source of calories, carbohydrate, iron and thiamine for both sexes, and of protein and niacin for males. For both sexes, in Canadian counterparts, this food group was a primary source of calories, carbohydrate, thiamine and iron and a secondary source of fat, calcium, riboflavin and niacin. The difference l i e s in this food group as a secondary source of fat for Canadian adolescents but not for East Indians, d) Fruits and Fruit Product In both the 1-4 years and 5-H years age groups, these foods were the primary source of vitamin C and a secondary source of carbohydrate, iron, vitamin A and thiamine. These foods were a secondary source of carbohydrate, but not of iron, vitamin A and thiamine in Canadian children. In adolescents, these foods were the primary source of vitamin C for both sexes, a secondary source of thiamine for both sexes, and of carbohydrate and vitamin A for females. In Canadian adolescents, these foods were the primary source of v i -tamin D for both sexes, but not a secondary source of thiamine, carbohydrate nor vitamin A. a j Vegetables This food group was a secondary source of vitamin A; niacin and vitamin C in East Indian children 1-4 years old; but i t i s a secondary source only of vitamin C in Canadian children. 56 This food group was a primary source of vitamin A and a secondary source of iron, niacin and vitamin C in East Indian children 5-H years old; i t was a secondary source of vitamin A and vitamin C in Canadian children. This food group was a primary source of vitamin A for both sexes 12-19 years old, and of niacin for females. It was a secondary source of thiamine and vitamin C for both sexes, and of carbohydrate, iron, and calories for females. For Canadian adolescents, this food group was a secondary source of vitamin C for both sexes and of iron and vitamin A for females, f) Fats and Oils This food group was the primary source of fat and v i t a -min E in East Indian children 1-4 years old, but not in Canadian children. Fats and oil s were found to be the primary source of vitamin E and secondary source of fat for East Indian children 5-11 years old, but not a secondary source of vitamin A as in Canadian children. This food group was a primary source of vitamin E and fat for both sexes adolescents 12-19 years old and a secondary source of vitamin A for males.; In Canadian adolescents this food group was a secondary source of fat and vitamin A for both sexes. 57 g) Sugar and Sweets The results of the East Indian survey show that sugar and sweets make the following contributions to total carbo-hydrate intake: 6.2 percent in children 1-4 years old, 9.64 percent in children 5-H years old, 21.23 percent in males 12-19 years old and 16.95 percent in females 12-19 years old. Calories supplied by sugar and sweets were 3.29 percent in children 1-4 years old, 5.22 percent in children 5-11 years old, 11.13 percent in males 12-19 years old and 9.17 percent in females 12-19 years old. Hence the consumption of this food group increased with age. In the Nutrition Canada findings, foods primarily made of sugar, beverages and soft drinks supplied 13 percent of the carbohydrate and 7 percent of the calories in children 1-4 years old, 16 percent carbohydrate and 3 percent calories in children 5-11 years old, 13-19 percent carbohydrate and 10 percent calories in adolescents 12-19 years old. It i s interesting to note that Canadian children 1-11 years old consumed more sugar and sweets than their East Indian counterparts, while the amount of sugar and sweets consumed by adolescents of these two cultural groups were quite similar. In summary, the primary and secondary source of major nutrients in foods consumed by East Indian subjects versus those of Canadian children are liste d in Tables 1-12 to %-15» It i s interesting to note that for iron, vitamin A, thiamine and niacin, the major sources for East Indian children are cereals, f r u i t s and vegetables, whereas dairy products, meats 58 Table 1-12 Primary and Secondary Sources for Major Nutrients in Foods of East Indian and Canadian Children 1-4 Years Old*-Vancouver Standard East Indian Canadian Nutrients Sources Sources Iron *1. Cereals 1. Cereals **2. Fruits 2. Meats Calcium 1. Dairy products 1. Dairy products 2.. ...Cereals 2. Cereals Vitamin A 1. Dairy products 1. Dairy products 2. Fruits, Vegetables 2. Meats Protein 1. Dairy products 1. Dairy products 2. Cereals 2. Meats Thiamine 1. Dairy products, 1. Cereals Cereals 2. Fruits 2. Dairy products Niacin 1. Cereals 1. Meats, Dairy products 2. Meats, Vegetables 2. Cereals *1. Primary source **2. Secondary source 59 Table 1-13 Primary and Secondary Sources of Major Nutrients in Foods of  East Indian and Canadian Children 5-H Years Old Vancouver East Indian Standard Canadian Nutrients Sources Sources Iron Calcium Vitamin A Protein Thiamine Riboflavin Niacin *1. Cereals **2. Fruits, Meats, Vegetables 1. Dairy products 2. Cereals 1. Vegetables 2. Dairy products, Fruits 1. Dairy products 2. Cereals, Meats 1. Cereals 2. Fruits, Dairy products 1. Dairy products 2. Cereals 1. Cereals, Meats 2. Vegetables 1. Cereals 2. Meats 1. Dairy products 2. Cereals 1. Dairy products, Meats 2. Vegetables 1. Dairy products, Meats 2. Cereals 1. Cereals 2. Dairy products, Meats 1. Dairy products 2. Cereals 1. Meats 2. Cereals, Dairy products *1, Primary source **2. Secondary source 60 Table 1-14 Primary and Secondary Sources of Major Nutrients in Foods of  East Indian and Canadian Females 12-19 Years Old Vancouver Standard East Indian Canadian Nutrients Sources Sources ..Iron *1. Cereals 1. Meats,Cereals **2. Vegetables 2. Vegetables Calcium 1. Dairy products 1. Dairy products 2. Cereals 2. Cereals Vitamin A 1. Vegetables 1. Meats, Dairy products 2. Fruits 2. Vegetables Protein 1. Dairy products, 1. Meats Cereals 2. Meats 2. Dairy products '(Thiamine 1. Cereals 1. Cereals 2. Vegetables 2. Meats Riboflavin 1. Dairy products 1. Dairy products 2. Cereals 2. Cereals, Meats Niacin 1. Vegetables, 1. Meats Cereals 2. Meats 2. Cereals *1. Primary source m2. Secondary source 61 Table 1-15 Primary and Secondary Sources of Major Nutrients in Foods of East Indian and Canadian Males 12-19 Years Old Nutrients Vancouver East Indian Sources Standard Canadian Sources Iron Calcium Vitamin A Protein Thiamine Riboflavin Niacin * 1. Cereals x^2. Meat group 1. Dairy products 2. Cereals 1. Vegetables 2. Dairy products 1. Meat 2, Dairy- products 1. 2. 1. 2. 1. 2. 1. 2. 1. 1. Cereals 2. Fruits,Vegetables,2. Dairy products 1. Dairy products 1. 2. Meat, Cereals 2. 1. Meat 1. 2. Cereals 2. Cereals Meat, Poultry, Fish & Eggs Dairy products Cereals Meat group Dairy products. Meat Dairy products Cereals Meats Dairy products Cereals Meat Cereals, Dairy products *1. Primary source **2. Secondary source 62 and cereals are the major sources for Canadian children in general. 5. Food Habits (Questionnaire) Twenty-seven questionnaires were f i l l e d out and returned. This represented 27 families and 52 of the 132 infants and children who participated in the study. A brief summary of the responses to the questionnaire i s provided below under the same headings as they appeared on the questionnaire. a) Shopping Practices Most families do their grocery shopping in supermarkets and East Indian specialty food stores, and they usually buy spi-ces, pulses and flours in the latter. The amount of money spent on groceries per week ranged from 21 to over 80 dollars per family. b) Dietary Practices About 2/3 of the families are non-vegetarians while 1/3 of the families are lacto-vegetarians. They usually eat 3 meals per day and generally the families eat breakfast and/or supper together. They eat rice and western bread quite often, although ninety-three percent of them also eat East Indian bread which they made mostly from whole wheat flour and water. Fresh f r u i t s are eaten almost every day and raw vegetables are served quite 63 often. They often have a dessert at the end of a meal, such as ice cream, cakes, cookies or pies, and f r u i t s , three families have meat, f i s h or poultry at the main meal every day, 11 families have meat more than twice a week, and 5 families have meat once a week. Most of them eat pulses and legumes very frequently. One to 2 glasses of milk are drunk by children per day. Whole and 2$ milk i s usually used. Snacks for children i n -clude f r u i t s , some vegetables, desserts or sweets, candies or chocolate bars and potato chips. Beverages served to children are usually pops, milk, tea or coffee. A typical daily menu i s as follows: Breakfast Tea Cereal Toast Lunch Sandwich Fruit Supper Snacks Dahl Cookies Rice Pops Roti Chips Vegetable curry c) Cooking Practices The families sampled generally wash their rice before cooking i t , some of them would remove the cooking water in rice. When they b o i l milk before serving i t . d) Nutrition Practices Foods avoided during pregnancy or breast feeding include f r u i t s and vegetables, spices, meat and i t s alternates, breads and cerals. Foods considered to be good during breast feeding include dairy products, f r u i t s and vegetables. 64 One-quarter of the mothers sampled breast-feed their babies, one-quarter bottle-feed their babies and one-half of them supplied alternate feedings of these two types. Infants are usually introduced to cereals by 3 months, at around 4-6 months they are introduced to f r u i t s , vegetables and eggs; and at the age of 7-3 months meat is introduced. Two-thirds of them believe in the concept of "hot" or "cool" foods. About one-half of them practice 24-hour fasting. This i s done usually either once' per month, once per week or once per year. Sources of information on food and nutrition are p r i -marily cook books, magazine articles, newspaper, labels on food items, television programs, doctors, friends or neighbours and mother. e) BackgroundInformation The language spoken at home amongest the families sam-pled i s generally English and/or Hindi. The total annual income of these families ranged from $6,000 to over $25,000. Most of the people interviewed were born in India, although some were horn in Africa or F i j i . The age of the head of the household ranged from 30-49 years, while the age for the housewives was always under 49. The length of residency in Canada ranged from . 1 year to more than 10 years. Husbands were mostly professionals, although some were in c l e r i c a l , sales, technical, mechanical or managerial work. The degree of education for these men ranged from pre-high school to university. Thw wives were mostly home-makers, although some worked at professional, technical, c l e r i - . cal or selling jobs. The degree of education for theses wives 65 also ranged/ from pre-high school to u n i v e r s i t y . Most l i v e d i n India before they moved to Canada. However, some had l i v e d i n A f r i c a , F i j i or England. A l l of them except one was a Hindu. I I . Anthropometric Results A l l anthropometric measurements are l i s t e d i n Appendix III and are displayed graphically (Pages 6 6 — 89 ), against the chronological age. 1. Standing Height Figures I I - l and II-2 show standing heights f o r males and females respectively. Standard curves are those of Gopalan and Vijaya Raghayan (1971), based on the r e s u l t s of country-wide surveys i n India conducted under the auspices of Indian Council of Medical research. Throughout the age range studied, most individuals f a l l above the 50th and 90th percentile. In males, 85 percent of the sample studied f a l l above the 90th percentile, 15 percent f a l l between the 50th and 90th percentile, while none f a l l below the 50th percentile. In females, 52 percent of the sample stiadied f a l l be-tween the 90th and 50th percentile, 43 percent f a l l above the 90th percentile, and 5 percent f a l l below the 50th perc e n t i l e . Figures II - 3 and I.I-4 show standing heights f o r males and females of ages 5 to 17 respectively. Standard curves are those of Gopalan and Vijaya Raghavan (1971) based on well-to-do children i n India. 66 HEIGHT DF EAST INDIRN HflLE CHILOREN CD HGE IN YERR5 Figure I I - l . Standing height of males. Standard percentile curves are those of Gopalan and Vijaya Raghavan (1971). 67 Figure II - 2 . Standing height of females. Standard percentile curves are from Gopalan and Vijaya Raghavan (1971). 68 Figure II-3. Standing height of males. Standard percentile curves are from Gopalan and Vijaya (1971) on well-to-do children in India. 69 - HEIGHT OF EAST INDIAN FEflRLE CHILDREN o Figure II - 4 . Standing height of females. Standard percentile curves are from Gopalan and Vijaya Raghavan (1971) on well-to-do children in India. 70 HEIGHT OF ER5T INDIRN WRLE CHILDREN Figure II-5* Standing height of males. Standard curves are from Jackson and Kelly (1945) on Caucasian children. HEIGHT OF EHST INOIFSN flflLE CHILDRQt Figure 11-6. Standing height of males. Standard curves are from Jackson and Kelly (1945) on Caucasian children. 72 Figure II-7. Standing height of females. Standard curves are from Jackson and Kelly (1945) on Caucasian children. 73 Figure I1-8. Standing height of females. Standard curves are from Jackson and Kelly"(1945) on Caucasian children. 74 Figure I I I - l . Sitting height of males. Standard curves are from Simmons (1944) on Caucasian children. 75 SITTING HEIGHT. EAST INDIAN FEMRLX CHILDREN a . Xo. L9|£> UJ X to 5H o T — r 6 B 10 AGE IN YEHR5 T" 14 "T" 16 ~1 2D T 12 Figure III-2. Sitting height of females. Standard curves are from Simmons (1944) on Caucasian children. WEIGHT OF Efl5T INDIAN HALE CHILDREN Figure IV-1. Body weight of males. Standard percentile curves are from Gopalan and Vijaya Raghavan (l>9f71). 77 Figure IV-2. Body weight of females. Standard percentile curves are from Gopalan and Vijaya Raghavan (1971). Figure IV-3. Body weight of males. Standard percentile curves are from Gopalan and Vijaya Raghavan (1971) on well-to-do children in India. Figure IV-4. Body weight of females. Standard percentile curves are from Gopalan and Vijaya Raghavan (1971) On well-to-do children in India. so Figure IV-5. Body weight of males. Standard iperGentile curves are from Jackson and Kelly (1945) on Caucasian children. 81 Figure IV-6. Body weight of males. Standard percentile curves are from Jackson and Kelly (1945) on Caucasian children. WEIGHT OF EAST INQIRN FFHRLE CHILDREN Figure IV-7. Body weight of females. Standard percentile curves are from Jackson and Kelly(1945) on Caucasian children. 33 WEIGHT OF ERST INDIAN FEMALE CHILDREN a AGE IN YEARS Figure IV-3. Body weight of. females. Standard percentile curves are from Jackson and Kelly (1945) on Caucasian children. TRICEPS SKIN-FOLD THICKNESS. ER5T INDIAN MALE CHILDREN Figure V - l . Triceps skinfold thickness of males Standard percentile curves are from Tanner and Whitehouse (1962) on Caucasian children. 85 TRICEPS SKIN-FOLD THICKNESS. EAST INDIAN FEMALE CHILDREN tn - 1 Figure V-2. Triceps skinfold thickness of females. Standard percentile curves are from Tanner and Whitehouse ( 1962) on Caucasian children. 86 ARM CIRCUMFERENCE. EAST INDIAN MALE CHILDREN Figure VI-1. Arm circumference of males. Standard percentile curves are from Frisancho (1974) on Caucasian children. 67 RRH CIRCUMFERENCE. EAST INDIAN FEMALE CHILCSEN T —~>— r 6 B 10 AGE IN YEAR5 Figure VI-2. Arm circumference of females. Standard percentile curves are from Frisancho (1974) on Caucasian children. \ 88 Figure VII - 1 . Head circumference of males. Standard percentile curves are from Watson and Lokry (1967) on Caucasian children. 89 HERD CIRCUMFERENCE. EAST INDIAN FEMALE CHILDREN 2-1 Figure VI1-2. Head circumference of females. Standard percentile curves are from Watson and Lowry (1967) on Caucasian children. 90 Most subjects in this age group f a l l between the 75th and 25th percentile. In males, 60 percent f a l l in this range. Ten percent are above the 75th percentile and 26 percent f a l l below the 25th percentile. In females, 56 percent f a l l between the 75th and 25th percentile. Thirteen percent are above the 75$h percentile and 52 percent f a l l below the 25th percentile. Those subjects which f a l l below the 25th percentile are not evenly distributed throughout the age range studied. For males between 6 and 10 years of age, 30 percent f a l l below the 25th percentile, while for older males, between 10 and 17 years of age, this percentage has decreased to 19. For females between 6 and 10 years old, 43 percent f a l l below the 25th percentile, while for older females, between 10 and 17 years old, this per-centage has decreased to 17. Thus the proportion of the subjects studied who have low height for age, as compared with reference children, decreases with increasing age. Figures II-5 and II-6 show standing heights for males; figures II-7 and II-8 show standing heights for females. Standard curves are those of Jackson and Kelly (1945)» derived from the Iowa growth: data, measurements taken several decades ago on Caucasian children predominately from the higher socio-economic group. In using standards derived from a group both culturally and genetically distinct from the study sample, i t i s recognized that interpretation of results i s somewhat limited. Standard curves are therefore presented for reference only. 91 . Throughout the age range studied, most indivi d u a l s f a l l between 1 standard deviation above and 1 standard devia-t i o n below the mean. In males, 82.5 percent of the samples f a l l i n t h i s range; 7.9 percent are more than 1 standard deviation above the mean, and 9.5 percent are more than 1 standard devia-t i o n below the mean. In females, 71.8 percent f a l l between 1 standard de-v i a t i o n above and below the mean. Fourteen percent are more than 1 standard deviation above and below the mean. 2. S i t t i n g Height S i t t i n g height/standing height r a t i o s were computed and i n d i v i d u a l findings are l i s t e d i n Appendix I I I , since stan-dards are not available f o r t h i s parameter. Only s i t t i n g height i s displayed g r a p h i c a l l y (Figures I I I - l and III-2). The standards of Simmons (1944) are used (mean - 2 standard deviations). These standards are based upon measurements taken several decades ago on Caucasian children. This parameter indicates growth of the head and trunk. In general, most indivi d u a l s f a l l between the mean and 2 standard deviations below the mean. Among males, 61 percent are i n t h i s range, only 13 percant are above the mean. While none ar^ more than 2 standard deviations above the mean, 20 per-cent of males are more than 2 standard deviations below the mean. Among females, 65 percent are between the mean and 2 standard deviations below the mean. Eleven percent of the females are above the mean; with only one i n d i v i d u a l more than 2 standard deviations above the mean. Twenty percent of the females are more 92 than 2 standard deviations below the mean; s i m i l a r to the f i n d -ings i n male subjects. 3• Body Weight Figures IV-1 and IV-2 show body weight of the children plotted against chronological age. Standard curves are those of Gopalan and Vijaya Raghavan (1971) obtained i n India, 10th, 50th and 90th percentiles are presented. Most indivi d u a l s are above the 50th pe r c e n t i l e . In males, 40 percent f a l l above the 90th percentile, 53 percent f a l l above the 50th percentile and only 6 percent f a l l between the 50th and 10th perce n t i l e . In females, 50.8 per-cent are above the 90$h percentile, 44 percent are above the 50th percentile and only 4.9 percent f a l l between the 50th and the 10th p e r c e n t i l e . Figures IV-3 and IV-4 show body weight f o r males and females ages 5 to 17 respectively. Standard curves are those of Gopalan and Vijaya Raghavan (1971) on well-to-do Indian children i n India. Most subjects are between the 75th and 25th perc e n t i l e . Among males, 58 percent f a l l between the 75th and 25th percentile, 20 percent are above the 75th percentile and 22 per-cent are below the 25th perc e n t i l e . Among females, 50 percent f a l l between the 75th and 25th percentile, 12.5 percent f a l l above the 75th percentile and 37.5 percent f a l l below the 25th p e r c e n t i l e . Figures IV-5 and IV-6 show body weight of males from 0 to 19 years of age. Figures IV-7 and IV-8 show body weight of f e -males from 0 to 19 years of age. Standard curves are those of 93 Jackson and Kelly (1945) based on Iowa data. Median, 16th and 84th percentiles are presented. Most individuals f a l l between the 16th and 84th percentile. Thus, 69.8 percent and 60.9 per-cent of males and females respectively are in this range. Among: males, 9.5 percent are above the 84th percentile, and 20.6 per-cent are below the 16th percentile. Among females, 10.9 percent are above the 84th percentile and 28 percent are below the 16th percentile. Children below the 16th percentile are not evenly dis-tributed throughout the age range studied. For males between 0 to 5 years of age, only one individual (7.6 percent of males in that age range) f a l l below the 16th percentile; while for older males, between 5 and 19 years of age, this percentage has i n -creased to 24. For females between 0 and 5 years old, 25 percent f a l l below the 16th percentile, while for older females, between 5 and 19 years old, this percentage has increased to 28.8 per-cent. Thus, the proportion of the subjects who have low weight for age as compared with reference children, increased with age. 4. Skinfold Thickness Figures V-l and V-2 display trceps skinfold thicknesses for males and females. Percentile curves are those of Tanner and Whitehouse (1962). Since values obtained by skinfold measurements give a non-gaussian frequency distribution, the appropriate loga^, rithmic transformation, as described by these authors, has been employed for triceps skinfold measurements and transformed values plotted against age« 94 Most individuals, both male and female, are between the 3rd and 97th percentile. Ninty-five percent of both the males and females are in this range, with 4.7 percent (3 in-dividuals) of the males and 1.5 percent (1 individual) of the females above the 97th percentile; and 3 percent (2 i n d i v i -duals) of the females below the 3rd percentile. 5. Arm Circumference Figures VI-1 and VI-2 show arm circumference measure-ments of males and females respectively. Standard percentile curves are those of Frisancho (1974), and are based on a cross-sectional sample of white subjects derived from the United States. Ten State Nutrition Survey of 1968-1970. Most individuals are between the 95th and 5th percen-t i l e ; 90 percent of the males and 89 percent of the females are in this range. Eight percent of the males and 9 percent of the females are below the 5th percentile, 1 male (1.58 percent) and 1 female (1.56 percent) are above the 95th percentile. Among males, 36.5 percent are between the 95th and 50th percentile, and 39.6 percent are between 50th and 5th < percentile. Among females, 35.9 percent are between 95th and . 50th percentile, and 37.5 percent are between 50th and 5th percentile. 6. Head Circumference Figures VII-1 and VII-2 display measurements of head circumference against chronological age: of males and females respectively. Standard curves are those of Watson and Lowry (1967). These standards present the mean.> 2 standard devia-tions and are not sex-specific. They are derived from measure-95 merits on Caucasian children. Most males are within + 2 standard deviations of the mean, only 6 percent are more than 2 standard deviations below the mean. There are more children below the mean than above the mean, thus 25.8 percent are above the mean and 67.7 percent are below the mean; but s t i l l within the + 2 standard deviation limits. Females display a similar growth pattern in head c i r -cumference. Sixteen percent are more than 2 standard deviations below the mean; 11 percent are above the mean and 72 percent are below the mean but above the -2 standard deviation l i m i t . III. Biochemical Results The biochemical data presented in this section represent blood samples collected from 51 subjects (32 females and 20 males). 1. Hematological Data The most commonly used biochemical c r i t e r i a for asses-sing nutritional anemia in a population are hemoglobin and hema-tocrit or red blood c e l l volume measurements. In the past decade additional tests, such as plasma iron and transferrin saturation have been used as sensitive indicators for assessing the iron nutritional status of human populations, a) Hemoglobin Hemoglobin values of the subjects are listed in Appen-dix IV. The percentage distribution of subjects with hemoglobin levels are summarized in Table I I - l . The subjects were classified Table II-l Distribution of Subjects in Risk Categories Hemoglobin (g/100 ml) MCHC($) Plasma Transferrin (% Saturation) Plasma Vitamin A (ug/lOO'ml) Plasma Vitamin C (ug/100 ml) Sex High Risk No. & M 0 0 F 0 0 Both 0 0 M 0 0 F - 0 0 Both 0 0 M 4 20 F 8 2 5 . 8 Both 12 2 3 . 5 M 0 0 F 0 0 Both 0 0 M 0 0 F 0 0 Both 0 0 Defined by Nutrition Canada (1973) Moderate Risk Low Risk No. t No. 1 5 19 95 1 3 . 2 30 9 6 . 8 2 3 . 9 49. 96 1 5 19 95 1 3 . 2 30 9 6 . 8 2 3 . 9 49 96 4 20 12 60 6 1 9 . 4 17 5 4 . 8 10 1 9 . 6 29 5 6 . 9 1 5 18 90 4 1 2 . 9 27 8 7 . 1 5 16 45 88 1 5 19 95 3 9 . 6 28 90.3 4 7 . 8 47 92.1 ON 97 Table I1-2 Nutrition Canada Interpretive Standard (Nutrition Canada, 1973) High Hemoglobin (g/100 mi; 0-1 M & F 9 . 0 2 - 5 yrs M & F 1 0 . 0 6-12 yrs M & F 1 2 . 0 13-16 yrs M ~j 1 2 . 0 13-16 yrs F 1 0 . 0 17+ yrs M 1 2 . 0 17+ yrs F 1 0 . 0 MCHC(fl) A l l ages M & F 30 Serum Transferrin ( fo Saturation) ', A l l ages M & F 16 Serum Vitamin A tug/100 ml) A l l ages M & F 10 Serum Vitamin C (mg/100 ml) 0-19 yrs M & F 0 . 2 Risk Categories Moderate Low 9 . 0 - 1 0 . 0 1 0 . 0 1 0 . 0 - 1 1 . 0 1 1 . 0 1 2 . 0 - 1 3 . 0 1 3 . 0 1 2 . 0 - 1 3 . 0 1 3 . 0 1 0 . 0 - 1 1 . 5 1 1 . 5 1 2 . 0 - 1 4 . 0 1 4 . 0 1 0 . 0 - 1 2 . 0 1 2 . 0 30 - 32 32 16 - 20 20 10 £ ' . 3 0 30 0 . 2 - 0 . 6 0 . 6 98 into "High Risk", "Moderate Risk" and "Low Risk" according to the suggested Nutrition Canada guideline appearing in Table II-2. One male and one female were found to be in the moderate risk category while the rest of the subjects were in the low risk category. b) Hematocrit Hematocrit values for the subjects are listed in Appendix IV. These values were used for the calculation of mean corpuscular hemoglobin concentration (MCHC) index shown below. c) MCHC (#) MCHC (fo) of the subjects was calculated using the for-mula: Hemoglobin (g/100 ml) x 100. Hematocrit One male and one female were found to be in the mode-rate risk category while the rest of the subjects were in the low risk category. d) Plasma Iron and Transferrin Saturation Plasma iron and total iron-binding capacity of the sub-jects were determined and listed in Appendix IV. Transferrin sa---tureation was calculated for each subject using the formula:. Plasma iron (ug/100 ml) x 100 Total plasma iron binding capacity and categorized into risk categories in Table I I - l , according to the Nutrition Canada guideline. Four males and eight females were found to be in the high risk category, four males and six females were found to be in the moderate risk category with the rest of the subjects in the low risk category. 99 2. Plasma Vitamin A and Carotene Fi f t y instead of fifty-one plasma samples were availa-ble for this determination. Plasma vitamin A and carotene levels were determined and their values are listed in Appendix IV. Vitamin A levels of the subjects were divided into risk categories provided by Nutrition Canada and shown in Table I I - l . No subjects were found in the high risk category, one male and four females were found in the moderate risk category with the rest of the subjects in the low risk category. Plasma carotene values were evaluated using the ICNND reference standard (ICNND, Manual for Nutrition Surveys, 1963) shown in Table II-3. Two females and one male were found to be in the "De-fic i e n t " category, one male in the "Low" category, one female and three males in the "Acceptable" category and the rest of the subjects were found to be in the "High" category. Whereas levels of plasma carotene below 20 ug per 100 ml were considered to be "Deficient", levels between 20 an 39.4 ug per 100 ml were considered to be "Low"; levels between 39.5 and 99.9 ug per 100 ml to be "Acceptable" and levels greater than 100 ug per 100 ml to be "High". 3. Plasma Vitamin C Subjects' plasma vitamin C levels were determined and listed in Appendix IV. Table I I - l shows the classification into risk categories as determined by Nutrition Canada (Table II-2). No subjects were found in the high risk category. One male and three females were found in the moderate risk category while the rest of the subjects were in the low risk category. Table II-3 Distribution of Subjects' Plasma Vitamin E and Carotene Levels in Categories Defined by Desai (1968) and ICNND (Manual for Nutrition Surveys, 1963) Respectively Deficient Low Sex No. No. No. No. Plasma ' •;; V Vitamin E F 5 16 9 29 15 48 2 (mg/100 ml) M 0 0 8 40 12 60 0 Both 5 9.a 17 33 27 53 2 Plasma Carotene F 2 6.5 0 0 1 3.2 28 (ug/100 ml) M 1 5 1 5 3 15 14 Both 3 6 1 2 4 7.8 42 High 1o 6.5 0 3.9 90 70 82 101 4. Plasma Vitamin E Subjects* plasma vitamin E levels were determined and list e d in Appendix IV. Since risk categories of this vitamin were not defined by Nutrition Canada, the distribution of subjects into "Defi-cient", "Low", "Acceptable", and "High" categories (Table II-3) wgs based on information from population surveys (Bieri et a l , 1964; Rahman et a l , 1964; Desai, 1968). The classification into three categories should be considered as expressions of nutri-tional levels and as guidelines to be modified as better eviden-ce j u s t i f i e s . Plasma vitamin E levels below 0.5 mg per 100 ml were considered to be "Deficient"; between 0.5 mg and O.69 mg per 100 ml were considered to be "Low"; between 0.7 and 1.09 mg per 100 ml were considered to be "Acceptable"; and levels greater or equal to 1.1 mg per 100 ml were considered to be "High". Five subjects ( a l l females) were found to be in the "De-fi c i e n t " category, seventeen subjects (nine females and eight males) were found to be in the "Low" category, twenty-seven sub-jects (fifteen females and twelve males) were found to be in the "Acceptable" category and two female subjects were found to be in the "High" category. 102 CHAPTER IV DISCUSSION I. Dietary Assessment of Nutritional Status In general, the results of the dietary study did not indicate gross inadequacies in the nutritional status in our sample of Vancouver children of East Indian origin. From the 24 hour reca l l data, i t appears that most of these children consumed adequate amounts of protein rich foods. Only one male failed to obtain 2/3 of Canadian Dietary Standards for protein. However, some children failed to obtain 2/3 of Cana-dian Dietary Standards for other nutrients, such as calories, vitamin A, calcium, iron and the B vitamins (especially niacin). The food intake data relating to the contribution of various specific food groups to personal nutrition show that these East Indian children obtained most of their intake of iron, vitamin A and the B vitamins from cereals and vegetables. Their Canadian counterparts obtained these nutrients mostly from dairy products and meats. This suggests that these Vancouver East Indian children who did not meet 2/3rds of the CDS in iron, vitamin A and the B vitamins, did not get enough of these nutrients from their cereal and vegetable sources; and that they should perhaps increase their intake of dairy products. 103 Dairy products were found to be the primary source for calcium in both the East Indians sampled and in a general sam-ple of Canadian children. Twelve percent of the East Indian children did not meet 2/3 of the CDS for calcium. This implies that these children did not consume enough dairy products. Cereals and f r u i t s were the primary source for calories and vitamin C respectively in both the East Indian sample and for the sample of Canadian children. Twenty-six percent of East .• Indian children failed to meet 2/3 of CDS for calories, and 10 percent failed the same test for vitamin C. This suggests that these children did not consume enough cereal and/or f r u i t s . The results reported in Table 1-8 further support the above interpretations by'pointing out the co-existing nutrient inadequacies inB'ivitamins .and' in"''Iron.1 Since cereals are the major source of iron for the subjects, not eating enough cereals to meet their iron requirement probably also resulted in not meeting their needs for the B vitamins. Table 1-7 shows the co-existing nutrient inadequacies in the B vitamins with low cal-cium intake. Not consuming enough dairy products would result in a low calcium intake as well as low intake of the B vitamins. II. Social and Cultural Factors Affecting Nutrient Intake To new immigrants in a foreign land the use of tradition-a l foods and customs can provide a sense of security and familiar r i t y . Hence such families usually gather together for a tradition-a l meal at dinner time thus strengthening that "back at home" 104 feeling. This may seem fine to the adults, but children who have grown up in this new country, learning new habits from their Canadian friends may prefer to eat more Canadian foods such as the hamburger rather than r o t i and curry. Since Hindus refrain from eating beef because of their religion, their children may rebel against them by refusing what is being served on the dinner table. During the interviews, several children mentioned disliking varius kinds of East Indian foods served at home and described how they prefer Western foods. Some even mentioned deliberately flouting their parents' religion by eating beef at hamburger stands. This may be the reason for the low calorie intake for some children indicated by our analysis of the 24-hour reca l l data. Small serving sizes were also noted during the interview. The impression was that the children did not eat more because they did not like the foods. Parents' knowledge of nutrition i s another factor af-fecting the nutrient intake of their children. Soft drinks and • water were served with meals instead of juices and milk. Very often children were served tea which contained only a l i t t l e milk, instead of large servings of milk at breakfast. Hence i t is important that nutrition information be made available to these parents. This might encourage them to provide more whole-some foods to their children. From the completed questionnaires, we have provided sum-maries of the dietary practices of the group studied. These sum-maries have been divided into "Beneficial", "Neutral", "Harmful" and "Unclassified" categories (Table I I I - l ) . From these tables 105 Table :XII-1 Summary of Dietary Practices BENEFICIAL Using milk, whole wheat flour and margarine to make bread dough. Mixing of green leafy vegetables with dhals in cooking. NEUTRAL Heating or boiling milk before serving. Fasting. HARMFUL Serving sweets, candies, gum and potato chips as snacks. Serving pops as beverages. Washing rice before cooking. Throwing away the water in boiled/canned vegetables. Avoiding f r u i t s , vegetables, and meat or a l l i t s alternates during pregnancy. Avoiding cereals, breads, f r u i t s and vegetables during breast-feeding. UNCLASSFIED Serving tea or coffee as beverages. Believing in the "Hot" and "Cool" c l a s s i f i c a -tion of foods. 106 several recommendations and suggestions f o r change have been proposed. Recommendations; 1. Use milk, whole wheat or enriched white f l o u r and margarine to make bread dough. (85$ of the f a m i l i e s used water instead - of milk). 2. Stuff parathas (pastry sh e l l s ) with paneer (cottage cheese) with/or instead of vegetables. 3. Discourage use of sweets, candies, gum and potato chips as snacks. 4. Use milk and juices as beverages instead of pop, tea and coffee. 5. Discourage the washing of r i c e and the throwing away of cookin water. 6. Encourage the use of water i n canned/boiled vegetables f o r soups and sauce. 7. Encourage good n u t r i t i o n f o r females during pregnancy and the subsequent breast feeding period. 107 II I . Anthropometric Assessment of the Nu t r i t i o n a l Status of  Vancouver's East Indian Children The height and weight measurements of the East Indian subjects i n t h i s study were compared with those of well-to-do East Indian children i n India. Most subjects f e l l between the 75th and 25th percentile of the well-to-do Indian growth curves. When compared with ordinary East Indian standards f o r weight and height, most subjects f e l l above the 50th and 90th percentile. Throughout the age range studied, most individuals f e l l between 1 standard deviation above the mean and 1 standard devia-t i o n below the mean f o r height and between the 84th and 16th percentile f o r weight when compared with the Iowa standards f o r Caucasion children. There was a f a i r percentage of females who f e l l below the 16th percentile of the Iowa standard f o r weight, and below the 25th percentile of the well-to-do East Indian standard f o r weight. A les s e r percentage was found to f a l l be-low these two standards f o r weight among males. Similar findings occurred with height measurements. This implies that the East Indian females studied were not as up-to-standard f o r height and weight as the male subjects were. For skinfold thickness and arm circumference measure-ments, no Indian standards were available, and so those of Tanner and Whitehouse (1962) and Frisancho (1974) were used as the point of reference. Most of the subjects studied f e l l be-tween the 3rd and 97th percentile f o r skinf o l d thickness and be-tween the 5th and 95th percentile f o r arm circumference. The 1 0 8 results also showed that there was a greater percentage of males than females distributed in the upper range on the standard curves, thus confirming the previous finding that in general males f a l l closer to general standard for weight than do females. Skinfolds and arm circumferences are indices for fat and muscle mass. For head circumference, male subjects seem again to be better off than females. There was a greater percentage of male; located above the mean and lesser percentage below the mean than the females when: the standard curves of Watson and Lowry .', (1967) on Caucasian children were used as a standard. It is interesting to pause here and look back at the dietary data. A greater percentage of female subjects consumed less than 2/3 of the CDS for calories and other nutrients than the males. This may be a causative factor helping to explain the above mentioned anthropometric findings. In general, the physical status of the children in t h i study is (reasonably satisfactory. They are t a l l e r and heavier than their counterparts in India, and the majority are about 'the same size as well-to-do children in India, or as Caucasian children in the Iowa study. IV. Biochemical Assessment of Nutritional Status Only a limited number of subjects were used for the collection of biochemical data. The)results obtained indicated a high risk i n plasma transferrin saturation, and a moderate risk in MCHC, and hemoglobin. These latter are indices for iron intake and transport. Moderate, deficient or low risks were 109 found in plasma vitamin A, carotene, plasma vitamin C and plas-ma vitamin E. This may reflect inadequacies in intakes of foods rich in these vitamins. An attempt has been made to correlate subjects in bio-chemical risk categories with the' same subjects who had less than adequate or inadequate intakes of nutrients. No correlation was found. This could be due to the small sample size or to the -inade-quacy of the recal l technique to assess dietary intake of an indi-vidual. Hence, any interpretations or conclusions made here must be s t r i c t l y observational and not s t a t i s t i c a l . 1. Evaluation of the Hematological Data Hemoglobin and hematocrit are the most commonly used biochemical c r i t e r i a for assessing nutritional anemia in a popu-lation. The results of the hemoglobin and mean corpuscular hemo-globin concentration (MCHC) measurements indicate that only two subjects were in the mod©rate risk range for both indices, while the majority of the subjects were in the low risk range. It appears therefore, that the hematologic status of these subjects was satisfactory. Plasma iron levels provide a relatively objective index of iron deficiency. Plasma iron i s transported in the form of a complex with Bl-globulin called transferrin. The measurement of transferrin i s usually achieved indirectly by assessing the amount of iron bound when the transferrin has been saturated; this i s known as the total iron binding capacity (TIBC). Low dietary intake or a deficiency of iron may lead to low plasma 110 iron and low transferrin saturation i n normal subjects. Among members of the group studied, 20 percent of the males and 25.8 percent of the females were in the high risk ca-tegory for plasma transferrin percent saturation according to Nutrition Canada (1973); 20 percent of the males and 19 percent of the females were in the moderate risk category. The rest of the subjects f e l l in the low risk category. Among the biochemi-cal indices, this i s the only one in which subjects were found in the high risk category. It i s clear that the members of our East Indian group did not hane as good a nutritional status with respect to iron as in regard to other nutrients. Furthermore, females were generally at higher risk than males. 2. Plasma Vitamin C The plasma vitamin C concentrations indicate that the level of dietary intake of this vitamin i s that of normal heal-thy subjects. In scurvy, the plasma vitamin C level may drop to 0.1 mg per 100 ml or less (ICNND, Manul for Nutrition Surveys, 1963)• There has been no clear evidence of malnutrition due to lack of vitamin C in subjects with plasma levels of vitamin C above 0.2 mg per 100 ml. Our results showed that only 1 male and 3 females were in this moderate risk category (0.2-0.6 mg/100 ml) as defined by Nutrition Canada (1973)> and that none were in the high risk category. Hence, the overall status of plasma vitamin C of these subjects who participated in the biochemical study was satisfactory. 3. Plasma Vitamin A and Carotene Plasma levels of vitamin A dod not necessarily indicate recent dietary intake, but reflect intake over a long period of I l l time (Pearson, 1963). Any excess of this vitamin i s deposited in the l i v e r and the level of plasma vitamin A i s then maintain-ed at the expense of this reserve. Therefore, low plasma v i t a -min A levels can only be caused by inadequate intake over an ex-tended period of time or by interference with the absorption and storage of the nutrient. On a deficient diet, these reserves become depleted in about four months in children. Only then do c l i n i c a l signs of deficiency shows up. The distribution of subjects in risk categories as shown in Table I I - l indicated that the incidence of plasma vita— min A deficiency was of no great consequence. No subjects were found in the high risk range, 1 male and 4 females were found in the moderate risk category, and the rest of the subjects f e l l in the low risk range. Therefore, the plasma vitamin A status of these subjects was satisfactory. The plasma carotene concentration i s considered to re-flec t recent dietary intake of this provitamin (ICNND, Manual for Nutrition ,,: Surveys, 1963). The distribution of subjects according to the ICNND standard (ICNND, Manual for Nutrition Surveys, 1963) i s presented in Table I I - l . Most subjects f a l l within the "High" or "Acceptable" range, with 3 subjects in the "Deficient" range and 1 subject in the "Low" range. The nutri-tional status with regard to plasma carotene among these East Indian subjects i s not as satisfactory, therefore, as their plasma vitamin A status. This may be due to inadequate intake of fresh f r u i t s and green leafy vegetables rich in carotene. 112 4. Plasma Vitamin E There i s extensive evidence now that vitamin E i s an e s s e n t i a l nutrient f o r humans. It i s e s s e n t i a l as a b i o l o g i c a l antioxidant and i t s requirement increases with increased dietary intake of unsaturated f a t and f a t t y acids (Horwitt, 1962). The plasma vitamin E concentration i s considered to r e f l e c t d ietary intake of t h i s vitamin (Desai, 1968). The d i s t r i b u t i o n of subjects into "Deficient", "Low", "Acceptable" and "High" categories i s shown i n Tablt II-3. Six-teen percent of the females were found i n the "Deficient" range, 29 percent of the females and 40 percent of the males were found i n the "Low" range with the majority of the subjects i n the "Acceptable" and "High" range. Whether t h i s small incidence of vitamin E "Deficiency" (plasma concentrations below 0.5 mg per lOOrinl), has any r e l a t i o n s h i p to hematological findings remains to be investigated. It i s i n t e r e s t i n g to note that varying degree of plasma vitamin E deficiency have also been observed i n c e r t a i n segments of the populations studied i n East Pakistan (Rahman et a l , 1964). These findings c l e a r l y point to the importance of extensive popu-l a t i o n surveys to e s t a b l i s h more accurately the actual intake of both vitamin E and polyunsaturated f a t t y acids among sub-groups of the Canadian population exhibiting diverse eating habits. 113 CHAPTER V SUMMARY AND CONCLUSION The food habits and nutritional status of a sample of East Indian children in Vancouver were studied u t i l i z i n g a dietary interview, plus anthropometric and biochemical tech-niques. The sample consisted of 132 children aged 0.25 to 18.91 years attending the Vishwa Hindu Parishad Temple in Burnaby, B.C. The study was cross-sectional in design. The results have been compared with standard reference data. The objective of the study was to assess the nutritional status of these East Indian children dietarily, anthropometrically and biochemically. Thr results of the study do not indicate any gross de-ficiencies in nutrient intake for these East Indian subjects. However, some of the subjects did evidence an inadequate intake for certain nutrients. It has been suggested that they increase their consumption of dairy products and foods high in iron and calcium. Anthropometric test results showed that these East Indian children were comparable both in height and weight with well-to-do children in India and with Caucasian children used in an Iowa study. The male subjects in the study sample were found to be more up to standard for physical growth status than the 114 females. This might be explained by a correlated finding that . females did not eat as adequately as males. Biochemical analy-ses indicated a high risk in plasma transferrin saturation, and moderate risks for some other nutrients. This may be a re-fleti o n of inadequacies in intake of foods rich in these nutria ents, especially in iron. Hence the importance of obtaining an adequate amount of iron from dietary sources should be stressed. A thank-you letter was drafted and sent to the parents of the subjects in this study. The results of the study, recom-mendations and suggestions for improvements, together with a copy of the Canada Food Guide, were included in the letter (Appendix V). 115 BIBLIOGRAPHY Aman. Medical Secrets of Your Food. 1 s t ed. Mysore. India. 1 9 6 9 . Bieri, J.G., Teets, L., B. Belavady and Andrews, E.L. Serum Vitamin E Levels in a Normal Adult Population in the Washington, D.C. Area. Proc. Soc. Exptl. Biol. Med. 117: 1 3 1 - 1 3 3 , 1 9 6 4 . Buzina, A. Assessment of Nutritional Status and Food Consumption Surveys: Anthropometric Measurements and Indices., in Somogyi, J.C. and Szczygiel, A. Assessment of Nutrition-al Status and Food Consumption Surveys. S. Karger, Basel, 1 9 7 4 . pp 2 4 - 3 0 . Chanarir, I. The Megaloblastic Anaemias. 1 s t ed. Oxford. 1 9 6 9 . Dent, C.E., Rowe, D.J.F., J.M. Round and Stamp, T.C.B. Effect of Chapattis and Ultraviolet Irradiation on Nutrition-al Rickets in an Indian Immigrant. Lancet I: 1282-1284, 1 9 7 3 . Desai, I.D. Plasma Tocopherol Levels in Normal Adults. Canad. J. Physiol. Pharmacol. 4 6 : 8 1 9 - 8 2 2 , 1 9 6 8 . Devedas, R.P. Social and Cultural Factors Influencing Malnutri-tion. J. Home. Econ. 6 2 ( 3 ) : 1 6 4 - 1 7 1 , 1 9 7 0 . Elwood, P.C., Banjamin, I.J., Fry, F.A., Eakins, J.D., Brown, D.A., P.C. deKock and Shah, J.U. Absorption of Iron from Chapatti Made from Wheat Flour. Am. J. Clin. Nutr. 2 3 : 1 2 6 7 - 1 2 7 1 , 1 9 7 0 . Fabianek, J., J. DeFilippi., T. Richards and Herp, A. Micromethod for Tocopherol Determination in Blood Serum. Clin. Chem. 1 4 ( 5 ) : 4 5 6 - 4 6 2 , 1 9 6 8 . Fathauer, G.H. Food Habits - an Anthropologist's View. J. Amer. Diet. A. 3 7 ( 4 ) : 3 3 5 - 3 3 8 , I 9 6 0 . Ford, J.A., Colhoun, E.M., W.B. Mcintosh and Dunnigan, M.G. Biochemical Response of Late Rickets and Osteomalacia to a Chupatty-free Diet. Br. Med. J. 3 : 4 4 6 - 4 4 7 , 1 9 7 2 . 116 Friancho, A.R. Triceps Skinfold and Upper Arm Muscle Size Norms for Assessment of Nutritional Status. Am. J. Clin. Nutr. 27: 1052-1058, 1974. Gopalan, C. and Vijaya Raghavan, K. Nutrition Atlas of India. National Institute of Nutrition. Indian Council of Medical Research. Hyderabad, India. 1971. Herbert, V. Symposium. Folic Acid Deficiency. Am. J. Clin. Nutr. 23: 841-842, 1970. Holmes, G. Urinary Calculi in F i j i Indians, The Curry Kidney. Med. J. Aust. 2: 755-756, 1971. Horwitt, MK.K. Interrelations between Vitamin E and Polyunsatu-rated Fatty Acids in Adult Men. Vitamins and Hormones 20: 541-558, 1962. Hunt, S. The Food Habits of Asian Immigrants. Getting the Most out of Food. 11th Series. Van den Berghs and Jergens Ltd. 1976. Interdepartmental Committee on Nutrition for National Defense. Manual for Nutrition Surveys. Washington. 1963. Jackson, R.L. and Kelly, H.G. Growth Charts for Use in Pediatric Practice. J. Pediat. 27: 215-229, 1945. Jathar, V.S., Patrawalla, S.P., Doongaji, D.R., D.V. Rege and Satoskar, R.S. Serum Vitamin B12 Levels in Indian Psychiatric Patients. Br. J. Psychiat. 117: 669-704* 1970. J e l l i f f e , D.B. The Assessment of Nutritional Status of the Community. Monogr. Ser. Wld. Hlth. Org. 53, 1966. Linusson, E.E.I..,;.D. Sanjur and Erickson, E.C. Validating the 24-hour Recall Method as a Dietary Survey Tool. Arch. Latinoamericanos de Nutr. 24: 277-293, 1974. Livingstone, S.K. What Influences Malnutrition? J. Nutr. Ediic. 3 ( 1 ) : 18-27, 1971. McGanity, W.J. C l i n i c a l Assessment of Nutritional Status, in Assessment of Nutritional Status. Proc. Nutr. Soc. Canada. 1973. pp 47-64. Nanda, R.S. Flouride Content of North Indian Foods. Indian Med. Res. 60: 1470-1482, 1972. 117 Neeld, J.B.Jr. and Pearson, W.N. Macro- and Micromethods for the Determination of Serum Vitamin A Using Trifluoro-acetic Acid. J. Nutr. 19: 454-462, 1963. Nutrition Canada. National Survey. Nutrition: A National Prio-r i t y . A Report by Nutrition Canada to the Department of National Health and Welfare. Ottawa, 1973. Nutrition Canada. Food Consumption Patterns Report. A Report , from Nutrition Canada by the Bureau of Nutritional Sciences, Health Protection Branch, Department of National Health anf Welfare. Ottawa, 1973b. Pearson, W.N. Biochemical Appraisal of Nutritional Status in Man. Am.'J. Clin. Nutr. 11: 462-474, 1962. Peers, F.G. The Phytase of Wheat. Biochem. J. 53: 102-110, 1953. Rahman, M.M., Hossain, S., Talukdar, S.A., K. Ahmad and Bieri, J.G. Serum Vitamin E Levels in the Rural Population of East Pakistan. Proc. Soc. Expt. Biol. Med. 117: 133-135, 1964. Roberts, P.D., James, H., Petrie, A., J.O. Morgan and Hoffbrand, A.V. Vitamin B12 Status in Pregnancy Among Immigrants to Britain. Br. Med. J. 3: 67-72x, 1973. Rose, E.J.B. Colour and Citizenship. 1st ed. London, 1969. Sharper, A.G., Leonard, P.J., K.W. Jones and Jones, M. Biochemi-cal Changes, Blood Pressure and~ Body Build During Preg-nancy in African and Indian Primigravidae in East Africa. E. Afr. Med. J. 46: 290-308, 1969. Simmons, K. This' Brush. Foundation Study of Child Growth "and Deve-• lopment II. Physical Growth' arid Development. Monogr. Soc. Res. Child. Devel. 9: 1-87^ 1944. Simoons, F.J. Eat Not This Flesh. 1st ed. Madison, 1961. Stroud, C.E. Nutrition and the Immigrant. Br. J. Hosp. Med. 5: 629-634, 1971. Tanner, J.M. and Whitehouse, R.H. Standards for Subcutaneous Fat in British Children. Percentiles for Thickness of Skin-*• folds Over Triceps and Below Scapula. Br. Med. J. I: 446-450, I96.2. 118 /it-.-. -i Tannous, R.I. and Merat, A. Chemical, Physical and Biologic Properties of Butter and Ghee. J . Amer. Diet. A. 55: 267-272, 1969. Vijaya Raghavan, K., Darhan singh and swaminathan, M.C. Heights and Weights of Well-Nourished Indian School Children. Indian J. Med. Res. 59: 648-654, 1971. Vaishnava, H and R i z v i , S.N.A. Vitamin D Deficiency Osteomalacia i n Asians. Lancet I I : 621-622, 1973. Warnes, G.A. Comparative Study of Infant Feeding Habits of f i f t y Asian and f i f t y European Mothers i n Bradford with re-ference to the infants* state of n u t r i t i o n . Braford, 1962. Watson, E.H. and Lowry, G.H. Growth and Development of Children. Year Book, 5th, Chicago, 1967. Weiner, J.S. and Lowrie, J.A. Human Biology: A guide to f i e l d methods. IBP Handbook No. 9 . Blackwell S c i e n t i f i c Publishers. Oxford, 1969. WHO. Expert Committee on Medical Assessment of N u t r i t i o n a l Status. Tech. Rep. Ser. Wld. Hlth. Org. 258, 1963. WHO. N u t r i t i o n a l Status of Populations: A. Manual on Anthropo-metric Appraisal of Trends. WHO/Nutr. 70. 129. 1968.- -pp. 12. Wells, M.R., P h i l l i p s , J.B., R.C. Day and Bateman, E.C. Phytic Acid and N u t r i t i o n a l Rickets i n Immigrants. Lancet I: 771-773, 1972. 119 APPENDICES Legends to Appendices Page Legend to Nutrient Intake (24-hour reca l l data) 120 Legend to Anthropometric Measurements . . . . . . . o 121 Legend to Biochemical Data 122 120 LEGEND TO NUTRIENT INTAKE (24 HOUR RECALL DATA) SN Survey number CAL Calories PROT Protein VIT-A Vitamin A VIT-E Vitamin E THIA Thiamine RIBO Riboflavin ASCORB Ascorbic acid T-FAT Total fat SAT Saturated fat MONO Mono-saturated fat POLY Poly-saturated fat CARB Carbohydrate LEGEND TO ANTHROPOMETRIC MEASUREMENTS ID Country of birth 1. Canada 2. India 3. U.S.A. 4. Ugenda 5. F i j i ' 6. England 7. Africa SX Sex STHT Standing height SITHT Sitting height SIT/ST Sitting height/standing height rat WT Body weight SKIN Triceps skin fold thickness HC Head circumference AC Arm circumference LEGEND TO BIOCHEMICAL DATA HB Hemoglobin HCT Hematocrit CAROT Plasma B-carotene VIT A Plasma vitamin A VIT C Plasma vitamin C VIT E Plasma vitamin E io SAT Plasma transferrin (ft saturation) PLFE Plasma iron TIBC Total iron binding capacity APPENDIX 1-1 FOOD HABITS QUESTIONNAIRE This questionnaire is designed to obtain background information on your family as well as your individual dietary practices that affect your child's nutrient intake. For each cuestion, please put one or more checks ( v-) beside the statement of your choice or where appropriate, f i l l in the. blanks. SHOPPING PRACTICES 1. What type of store do you do most of your grocery shopping in? supermarket neighbourhood department health food specialty food (East Indian) other (please specify) 2. If you shop at health food stores, what do you usually buy there? spices and/or condiments pulses (dhals) flours other (please specify) 3. If you shop at East Indian food stores, what do you usuaVLly buy there? spices and/or condiments pulses (dhals) flours other (please specify) 4. How much do you usually spend in a week for groceries? up to $20 $21 - $40 $41 - $60 $61 - $80 over $80 DIETARY PRACTICES 1. Some people eat only vegetables with no eggs, milk, cheese or meat but some people eat begetables and include one or more of eggs, milk, cheese or meat. How would you best describe the diet that you follow? vegetables only vegetables,eggs, milk and vegetables plus eggs cheese vegetables plus milk and cheese vegetables, meat, nilk, vegetables plus milk eggs and cheese Disregard this column How many meals does your f a m i l y eat per day? one t wo three four over four What meals does your f a m i l y g e n e r a l l y eat together? break f a s t lunch supper snacks How f r e q u e n t l y do you cat r i c e ? never seldom (once a month) sometimes (once a week) o f t e n (more than twice a wool;) e'erv dav What type of r i c e do you u s u a l l y eat? brown quick-cooking white converted Jo you eat western bread? yes no If yes, which type of bread? whole wheat white brown enriched other (please s p e c i f y ) Do you eat Indian bread? yes no What i n g r e d i e n t s do you u s u a l l y use to make bread dcugh ( a t t a ) ? water b u t t e r m i l k margarine whole w'leat f l o u r ghee white f l o u r (maida) enriched white f l o u r l a r d 125 Disregard t h i s column . 10 11 13 1 4 15 1-'. 17 1? l f 20 21, 22 23 24 9. How often are the following eaten? never seldom sometimes often every day a) R o t t i b) P u r i c) Paraatha - p l a i n d) Paraatha - stuffed 10. What do you usually s t u f f your paraatha with? potatoes and/or c a u l i f l o w e r c a r r o t s and/or peas cottage cheese (panneer) other (please specify) 11. How often do you eat fresh f r u i t s ? never seldom (once a month) sometimes (once a week) often (more than twice a week) every day 12. How often do you eat raw vegetables? never seldom (once a month) sometimes (once a week) often (more than twice a week) every day 13. How often do you eat potatoes? never seldom (once a month) sometimes (once a week) often (more than twice a week) every day 14. How often do you have a dessert at the end of a meal? never seldom (once a month) sometimes (once a week) often (more than twice a week) every day 126 Disregard t h i s colun 26 27 28 29 30 33 34 I f you do eat d e s s e r t , what do you u s u a l l y have? i c e cream cakes, cookies or pies f r u i t puddings r i c e pudding (Kheer) Halwa Indian Sweets (e.g. Gulab Jamboo or Ras Goola) J e l l o other (please s p e c i f y ) How o f t e n do you eat eggs? never seldom (once a month) sometimes (once a week) of t e n (more than twice a week) every day How o f t e n do you eat meat, f i s h or p o u l t r y at the main meal? never seldom (once a month) sometimes (once a week) o f t e n (more than twice a week) every day Which type of animal products do you p r e f e r ? mutton p o u l t r y lamb f i s h pork. none beef How f r e q u e n t l y do you eat pulses and legumes (dhals)? never seldom (once a month) sometimes (once a week) o f t e n (more than twice a week) every day Do you mix some green l e a f y vegetables such as spinach (palak) w i t h dhals? yes no How much m i l k do the c h i l d r e n u s u a l l y d r i n k per day? (answer f o r any c h i l d ) none 1-2 g l a s s e s 3-4 glasses over 4 g l a s s e s 22. What type of milk do you usually give your children to drink? whole milk chocolate milk skim milk 21 milk canned milk buttermilk (lassi) other (please specify) powdered skim milk vitamin 1) enriched milk 23. What types of snacks do you usually have for children? frui t vegetables desserts or sweets candies or chocolate bars meats or cheeses salty finger foods such as potato chips gum beverages such as pop milk tea or coffee other (please specify) 24. Please give an example of a typical day's menu for your family by li s t i n g the member of the family down the l e f t hand column, and stating what that member usually has for the meals listed in the right hand column. 128 Disregard this column r — — — — — — MEMBER OF THE FAMILY WHAT EACH MEMBER USUALLY HAS FOR THIS MEAL BREAKFAST LUNCH SUPPER SNACKS 56 57 58 59 60 61 62 63 64 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 6 129 I COOKING PRACTICES 1. How often do you cook western style neals? never seldom (once a month) sometimes (once a week) often (more than twice a week) every day 2. Do you wash your r i c e before cooking i t ? yes no 3. What do you do with the cooking water in rice? leave i t i n remove i t 4. How do you cook your vegetables? boiled fried steamed other (please specify) 5. What type of fats and o i l s do you use for cooking' ghee ( c l a r i f i e d butter) vegetable shortening (e.g. Crisco) ? I* vegetable o i l s (e.g. Mazola, Wesson) lard margarine butter 6. If you b o i l your vegetables or use canned vegetables, what do you do 1 with the water? I throw i t away | use i t for sauce, stock or soup F drink i t other (please specify) 7. Do you mix panneer with some vegetables (e.g. matar-panneer)? yes no 8. Do you heat or b o i l milk before serving? yes no NUTRITION PRACTICES 1. Are there any foods that you eat only when you are pregnant? yes no Please specify 2. Are there any food that you avoid eating during pregnancy? yes no Please specify Are there any foods that you consider good for a mother who is breast feeding her infant? yes no Please specify Are there foods that you avoid eating during breast feeding? yes no Please specify 5. How do you usually feed your babies? breast feed bottle feed both 6. For what length of time do you feed them this way? up to 3 months 4-6 months 7-12 months over 12 months 7. At what age was the child introduced to other foods besides milk? Please check the most representable age group for each food. up to 3 months 4-6 months 7-8 months 9-12months a) pablum and cereals b) fruits c) vegetables ' d) meat e) eggs 8. At what age did the baby eat meals from the table? before 4 months 4-6 months 7-12 months 13-18 months over 18 months 130 Disregard this c o l u 18 19 20 21 i o 23 24 25 26 27 28 29 30 31 32 33 Do you p r a c t i c e f a s t i n g ? If yes, how long 8 Do you b e l i e v e some foods are "hot", n e u t r a l or " c o o l " to your body? yes no *" ' " yes no and how o f t e n ? Are there any foods or ap p l i a n c e s that you wish were a v a i l a b l e but that you are unable to o b t a i n here i n Canada? yes no Please s p e c i f y What sources of i n f o r m a t i o n on food and n u t r i t i o n do you use f o r y o u r s e l f and your f a m i l y ? Please check. nothing books magazine a r t i c l e s . magazine advertisements newspaper cookbooks other (please s p e c i f y ) t e l e v i s i o n programs t e l e v i s i o n advertisements b u l l e t i n s r a d i o l a b e l s on food items Some people o b t a i n food and n u t r i t i o n i n f o r m a t i o n from a v a r i e t y of sources. I f you use any of these, please check which you use. . mother other f a m i l y member doctor . d e n t i s t nurse f r i e n d s or neighbors home economist, d i e t i t i a n or n u t r i t i o n i s t teacher s a l e s person i n grocery s t o r e s a l e s person i n drug s t o r e s a l e s person i n h e a l t h food s t o r e Disregard t h i s c o l uir 34 37 38 39 40 41 42 4 3 44 45 46 47 48 49 50 52 53 54 55 56 57 58 59 60 61 BACKGROUND INFORMATION:FAMILY 1. Check the number of children i n your family. one c h i l d two children three children four or more children 2. Besides yourself and your children, who else l i v e s i n your home? 3. What language i s usually spoken at home? Disregard t h i s column 62 63 64 Check what your t o t a l annual income of the family i s from a l l sources, under $5,999 $6,000 - $9,999 $10,000 - $14,999 $15,000 - $19,999 $20,000 - $24,999 over $25,000 What does your family do i n their spare time? East Indian c u l t u r a l and s o c i a l a c t i v i t i e s l o c a l community programmes and a c t i v i t i e s other (please specify) BACKGROUND INFORMATION:HUSBAND What i s your place of birth? Canada India other (please specify) _____ How old are you? up to 29 3 0 - 3 9 4 0 - 4 9 above 50 How many years have you l i v e d i n Canada? less than one 1-3 years 4-6 years 7-10 ye.irs 65 66 67 68 69 10 Disregard this c c i u r r A. Check the one occupation that would best professional describe your work, s t r u c t u r a l 70 ' technical homemaker managerial student c l e r i c a l , sales, service temporarily unemployed processing r e t i r e d a g r i c u l t u r e , f i s h in?,, forestry part-time mechanical other (please specify) 5. What degree of education, have you completed? Check one only. 71 pre-high school u n i v e r s i t y degree part of high school post graduate degree high school diploma vocational/technical diploma one to three years u n i v e r s i t y business i other ("lease specify) 6. Where did ynu reside be;:ore -povinr to Cz. nada? 72 7. What i s your r e l i g i o n ? BACKGHOUMI? IiTFaB-fATIOK : WIFE 1. What i s your place of birth ? Canada 7A India other (rclease specify) 2. How old are you? up to 29 75 30 - 39 AO - A9 above 50 3. How many years have you l i v e d i n Canada? one or less 76 1-3 years A-6 years 7-10 years 10 or more vcars A. Check the one occupation that would best professional describe your work? s t r u c t u r a l 77 technical homemaker managerial student c l e r i c a l , sales, service temporarily unemployed processing r e t i r e d Ii. 5. What degree of education have you complied? Check one only. pre-high school university degree part of high school post graduate degree high school diploma vocational/technical diploma one to three years university business other (please specify) 6. Where did ycu reside before moving to Canada? 7. What is your religion? Please check to see that a l l questions have been answered. Thank you for your cooperation and assistance. APPENDIX 1-2 24-HOUR RECALL FORM Date of R e c a l l : Code number: Age: Place of B i r t h : Time of Eating BREAKFAST Food Name Quantity Eaten Code Number; Pr e p a r a t i o n Method E.I. WEST. OTHER iMID-MORNING iLUNCH IM ID-AFTERNOON SUPPER NIGKT SNACK Ts what you ate yesterday t y p i c a l of your d i e t ? Comment: Are you ta k i n g any vi t a m i n or m i n e r a l supplements? Comment: 137 APPENDIX 1-3 NUTRITIONAL STATUS INVESTIGATION FORM FOR ANTHROPOMETRIC MEASUREMENTS 'UBC - \ ^ i H O M E ECONOMICS NUTRfTiv> /TATUS INVESTIGATION 138 NAME OF SUBJECT DATE OF SURVEY 1 rrrrr 3 0 rrrrr I rrrrr 2 rrrr: 3 DAY MONTH YEAR 5 rrrrr 6-"rrr 7 rrrrr e rrrrr 9:::: MONTH MAR APR MAY JUNE JULY AUG SEPT OCT NOV DEC YEAR jB "zz:t9----na-----^J\ r r r r r 7 2 rrrrr 73 :::::74::::55 rrrrr76 rrrrr77 rrr:r 0 r::;r 1 rrr:: 2 rrrrr 3 rrrrr 4 : DAY MONTH YEAR 7 rrrrr a rrrrr 9 JAN FEB MONTH MAR APR MAY JUNE JULY AUG SEPT OCT NOV OEC 1 ::::: 2 ::::: 3 ::::: 4 ::::: 5 HEAD CIRCUMFERENCE I rrrrr z ::::: 3 4 s 6 7 : : : : : B ----- 9 . IN CENTIMETERS .5 rrrrr.6 rsrrr .7 ::::: .8::::: .9 : .0 :;;rr.l rrrrr.2 rrrrr .3 4 : 0 rrrr: I ::::: 2 rrrrr 3 rrr:: 4 5 ;;;;; ARM CIRCUMFERENCE 0 rr::: | ::::: z ::::: 3 rr::: 4 ::::: 5 rr;:: 6 : IN CENTIMETERS .0 rrrrr.| r::rr.2 rrrrr.3 rrrrr .4::::: .5 :::::.6: I r;::: 2 3 ::::: 4::::: 5 ::::: 6::::: 7::::: 3 : : LENGTH OF INFANT 0 ::::: 1 ::::: 2 rrrr: 3 rr::: 4: 5 :::rr 6 r : : : : 7:: : . l :rrrr.2 rrrrr IN CENTIMETERS .3 : : : : : .4:rr:r .5 ::::r .6:::::.7 ::::: .8 0 rrr:: 1 rrrr: 2 ::rrr 3 r::r: 4 :r::: 5 rrrrr 6 rrrrr 7 ::::: 8 rrrr: 9 : YEAR rrrr 1 rrrr: 2 rrrrr 3 rr:;: 4 :::;; 5 ; ; ; ; ; 6 rrr:: 7 rrrrr 8 rrrrr 9-b -zzzz I rrr:: 2rrrrr 3 rrrrr 4 rrrrr 5 ::::r 6 rrrrr 7r IDENTIFICATION I rrrrr 2 rrrrr 3 rrrrr 4 rrrrr 5 rrrrr 6 7 rrrrr 8 rrrrr 9 rrrrr I rrrrr 2 :rrrr 3 : 0 " r r r I rrrrr 2 rrrrr 3 rrrr 0 rrrrr 1 ::rrr 2 rrrrr 3 rr: 4 ::::: 5 rrrrr 6 SKELETAL AGE 4 ::rrr S rrrrr 6 IN MONTHS 4 ::::r 5 :::rr 6 :rrr: 7 rrrrr 8 ::::: 9 : : : 7 r::r: 8 rrr:: 9 : rrrrr 7 rrrrr 8 rrrrr 9 rrrrr I rrrrr 2 rrrr: 3 rrrr; 4 5 rrrrr 6 rrrrr 7 rrrrr 8 rrrrr 9 rr t " r r r 2 " : : : I rrrrr 2 rrrrr 3 rrrr: 4 : STAND4NG r 5 rrrrr 6 HEIGHT IN L ' A B 0 O R " A 0 T O R°_ Y I rrrrr 2 : rrrrr f rrrrr 2 rrrrr 3 rrrrr TIME BLED HOUR 4 rrrrr 5 rrrrr 6 : 7 rrr:: 8 rrrrr 9 : I rrrrr 2 rrrr; 3 rrrrr 4 :;: i; ::::: 2 MINUTES 4 rrr:: 5 " r r r 6 : 7 rrrrr 8 9 ::::: 0 :rrrr ! rr::: 2 rrrrr 3 rrrrr .1 rrrrr. 2 rrrrr.3 : 4 rrrrr 5 rrrrr 6 7"-" 8 9 : CENTIMETERS .4 rrrrr .5 rrrrr.6 rrrrr .7 rrrr: j3 rrrrr .9 : 1 rrrr: 2 rrrrr 3 ::::: 0 1 2 rrrrr 3 4 7rrrrr D AO T A 0 rrrrr I rrrrr 2 rrrrr 3 rrrrr 0 rrrr: I rrrrr 2 :::;; 3 rrrr: BLOOD SAMPLE 4 ::::: S ::::: 6 : IN MILLILITRES 4::::: 5 ::::: 6 : f::::: 9 ::rrr 8 rrrrr 9 rrrrr URINE SAMPLE 4 rr:;: 5 :::;: 6 : IN MILLILITRES 4 rrrrr 5 rrrrr 6 : 8 ::::: 9 : B:::r: 9 SITTING HEIGHT p rrrrr I rrrrr 2 rrrrr 3 rrrr: 4 rrrrr 5 rrrrr 6 rrrrr 7 rrrrr 8 rrrrr 9 : IN CENTIMETERS URINE GLUCOSE 0 rrrr: 1 rrrrr 2 rrrr: 3::::: 4 . 0 rrrrr J rrrr: .2::r:r .3 rrrrr.4 .5 rrrrr .6 rrr:: .7:rrrr.l URINE PROTEIN I rrrrr 2 rrrrr 3 ::::: 4 rrrrr 5 rrrrr 6 rrrrr 7 rrrrr 8 :::rr 9 : I rrrrr 2 rrrrr 3 r:::r 4 rrrrr 5 rrrrr 6 rrrrr 7:rrr: 8::::: 9 : WEIGHT t rrrrr 2 rrrrr 3 ::::: 4 ::rrr 5 :rrrr 6 ::::: 7 ::rrr 8 ::::: 9 : 0 rrrrr I rrrr: 2 0 :::rr I rrrrr 2 rrrrr 3 rrrr: 4: I ::::: 2 ::::r 3 rrrrr 4 : 5 rrrrr 6:r::r 7 rr::: 8::::: 9 ::::: 5 ::::: «::::: 7 : .1 .2---". 3 IN .4 . 5 -KILOGRAMS .6 .7---J1 I 2 3 : e::::: 7 ::•::: 8 : g : .O i : " : : .02 " " : .03 : " : ;04 — : r _ 0 5 :r:::_ 0 6:::::.o7 : : : : : : :.Off-"'-.o§----- Z-.2 rrrrr 3 : 4 rrrrr 5 rrrrr 6::::: 7 ::::: 8:::.:9 CARD NUMBER !::::: 2:::r: 3:::rr 4rrrrr 6rr::r 7::::: errrrr 9:: 0 rrrrr 1 ::::: 2 ::::: 3 ::::; 4;::rr 0 rrrrr I rrrrr 2rr::: 3 SKINFOLD TRICEPS 4 ::::: 5 r:::: j IN CENTIMETERS 0 rr::: 1 ::::: 2 ::::; 3 ::::: 4 rrr:; 5 ::::: g::::: 7 ::::: a :::: 9 : 3 rr::: 4 rrrrr 5 ::::: 6 rrrrr 7 : rrrrr 9 rrr:: 0 rrrr: 1 rrrr: 2 ::::: 3 S rrrrr 6rrrr: 7 ::::: 8 :•::: 9 APPENDIX 1 - 4 NUTRITIONAL STATUS INVESTIGATION FORM FOR BIOCHEMICAL DATA U B C SCHOOL OF HOME ECONOMICS NUTRITIONAL STATUS INVESTIGATION H O PAGE 2 NAME OF SUBJECT' 0 ----- \ 0 ::::: 1 ::::: 2::::: 3; .1 .z-.-.-.-z .3 HEMOGLOBIN 4 5 ;:;:: 6:;;;: 7;;::: 8::::: 9: IN GRAMS A z-.-.-.z .5 .6::::; .7 ::::: .6 rr:.: .9 : 0 rrrrr 1 ::::: 2 0 rrrrr I ;:::: 2 3 ::::: 4 ::::: 3 ::::: 6"::: 7 ::: PLASMA PHOSPHOLIPID 3::rrr 4 ::::: S ::::: 6::::: 7 ::: IN MILLIGRAMS 3::::: 4 ::::: 5::;:: 6-"- 7---<j :; : : : 1 ::::: 2rrrrr 3 rrrrr 4:::.; 5 rrrrr HEMATOCRIT H> rrrrr 1 :r::r 2rrrrr 3:::;: 4::::: S rrrrr 6:":: 7 rrrrr 8: d> rrrrr I -z-z A ::::r | rrrrr 2 rrrrr 3 rrrrr TOTAL PLASMA 4 rrrrr 5 rrrrr 6:==== 7 rrrrr 0 rrrrr t :r:;: 2 ::::: 3 0 rrrrr t rrrrr 2 0 zzz---- | ::::: 2 =—— 3 : PLASMA 4 -.-.zzz 5 ::::: 6 TOTAL LIPIDS 4 ::::: 5 rrrr: 6":: IN MILLIGRAMS 4 ::::: 5 ::::: 6 t> z-.zzz .1 :;:r: .2::rrr.3 rrrrr.4 Op rrrrr.01:::rr.02rrrrr.03r;r; PROTEIN .5 rrrrr .6 rrrrr .7 ---------- .8 r:::r .9 r IN GRAMS .04.;... .05 rrrrr.06rrrrr07rrrrr.08rrrrr.09r 0 -------- I rrrrr 2 rrrrr3 .0 rrrrr.1 r;:::.2 :rrrr.3 rr: PLASMA :: 4 rrrrr 5 rrrr: 6 ALKALINE PHOSPHATASE ; : .4 : : : : : .5 ---------- .6 ::::: .7 ::::; .8::::: .9 :: 11 t zzzzz Z ------zz 3-------.Z 4 :;;:r 5 rrrrr 6 ---------- 7;:;:: 8 ::rrr 9 : : PLASMA ALBUMIN r r . t rrrrr . 2 " : : . .3 rrrrr.4 rrrr: .5 rrrr: .6 rrrrr.7 rrrrr.8 rrrrr.9 rr IN GRAMS rr.01rrrrr.02::::r.03rrrrr.0-Crrrr .05 rrrrr.OSrrrrr .0 7.::rr.06:rrrr.09rr 0 z-.zz-- I ::rr: 2 rr.;: 3 rrrr: 4 ::::: URINARY CREATININE .0 ;;:;;. I ;:;;;.2 :::;;.3 ;; : ; : .4:::r: .5 6 r:::: .7 ::;rr .8 :rrr: .9 rr: IN GRAMS 00 rrrrr.0lr::::.02rrrrr.03:rr::_4rrrrr .05 :::rr.06:rrrr.07::r::.08:::::.09rr PLASMA CAROTENE C ::;:: t ::::: 2;;;:: 3::::: 4 " : : : 5 ::::: 6::::: 7 zzz. h :;;:: t ::::: 2 r IN MICROGRAMS 4:::-: 5 —rr- 6 : : 2 ::;:: 3::::: 4 ----------URINARY Z ZZ--ZZ 3rrrr; 4 --ZZZZ 5 zzzzz GZZZZ-- 7: UREA NITROGEN 7 rrrr: 8 r:;;r 9 : .0 rrrrr 1 :::::.2 ::::: .3: 1 .4:;;;: . 5 - " = .6=:=:: .I"--- .I-------- .9 : IN GRAMS :0!:rr::.02:::::.03:::::.04::::: .05 ::;::.Oft::::.07:::::.08:::::.09:: PLASMA VITAMIN A I :::;; 2;:::: 3:;:;: 4 ::::: 5 ::::: 6 IN MIGROGRAMS I ; : : ; : 9 : : : : : 5 rrrrr 6 ::::: 7 rrrrr 8 rrrrr 9 : JO : : : ; : 1 ::::: 2 " : : ; j PLASMA ASCORBIC ACID 'o : : : : : . ! ;:::: .2::::r .3 ::::: .4 :;::: .5 ::::: .6 :;::: .7 :::::. 8 ::::: 9 :: 1 IN MILLIGRAMS 0 ::::: I ::::: 2 ::::: 3 ::::: URINARY THIAMINE .0 :::::.1 :::::.2 ::::: .3::::: .4 ::::: .5 : : : : : .6:::: .7:::: .8::::: .9 ::: IN MICROGRAMS PER ML. 30 :::::.0l:::::.02rr::r.03:::::.04:::rr .05 ::::: .06r:: : .07:: : " .08"" ;09"r .00 :.01:::::.02:r:::.03::rrr.04rrrrr .05 rrrrr.0 6rrrrr.07::rr:.08rrrrr.0-t:rrrr 10 ::::: 1 ::::: 2::::: 3::::: 4:: : : : j PLASMA VITAMIN E ' IN MILLIGRAMS . 00 :::rr.O 1rrrrr.02:::::.03rrr:r.04rrrrr .0 rrrrr.I ::::: .2::::: .3 ::::: .4 ::::: .5 :::::. 6 ::::: .7 ::::: .8 ::::: .9 ::: URINARY N-METHYLNICOTINAM1DE 00 rrrrr. 0lrrrrr.02rrrrr.03rrrrr.04::::: .05 :::::.OS:::: .07:::: .08:::: .09:: IN MICROGRAMS PER ML. 000:::::.00:l:::;002::::0 03::::.004:::: .003::::. 006::::.007::::. 008:::.009: .05 rrrrr.06:rrrr.07rrrrr,08rrr;r .09:: 0 ::::: 1 ::::: 2::::r 3 ::;:: 4::::: 5 ::::: 6 ::::: 7;::: RED CELL 1 HEMOLYSIS (%) 0" ::::: I :::::2 rrrrr 3 rrrrr 4 ::::: 1 :::::2 :::::3 ::::: 4 : 5 ::;;: 6 ::::: 7 5 ::::: 6 ::::: 7 5 ::::: 6 ::::: 7 .0 :::::.! : 2rr::r.3 :::r: .4: .5 .6 :::::.7 :::::.8 5 ::::: :::;: 9 : 0 ::::: I rrrrr 2r:::: 3 ::::: 4 rrrr: ! PLASMA TOTAL CHOLESTEROL 0 : : : : : t : : : : : 2::::: 3 ::::: 4 ::::: 5 ::::: 6::::: 7::::: 8 ::::: 9 : ! IN MILLIGRAMS .0 ::::: 1 r:::r 2::::: 3 ::::: 4 ::::: 5 rrrrr 6 ::::: 7 rrrrr 8 ::::: 9 : I :;::: 2 ::::: 3::::: 4 ::::: 5 ::::: 6 : CARD NUMBER 0 :;::: I ::::: 2 ::::: 3::::: 4 : 0 ::::: I ::::: 2 ::::: 3 ::::: 4 : 0 ::::: I ::::: 2 ::::: 3 : : : " 4 : 5 ::::: 6 ::::: 7::::: 8::::: 9 : 5 ::::: 6 APPENDIX II NUTRIENT INTAKE ( 24-HOUR RECALL DATA ) CODE SN DAY C AL PROT (G) 11 17 0 4343 88 12 17 0 1309 42 21 17 0 1142 58 22 17 0 2933 86 31 17 0 1215 56 32 17 0 2510 79 33 17 0 1662 50 34 17 0 772 46 41 17 0 2555 91 51 17 0 3822 107 52 17 0 2491 82 61 17 0 1491 66 71 17 0 2233 63 72 17 0 1346 67 8 1 17 0 2927 72 82 17 0 745 42 91 17 0 1207 32 92 17 0 2356 52 94 17 0 3083 81 103 17 0 2164 55 653 17 0 2045 63 122 17 0 24 53 69 123 17 0 2626 70 131 17 0 2C60 70 141 17 0 1817 57 142 17 0 959 51 151 17 0 2330 82 152 17 0 1115 43 161 17 0 820 36 162 17 0 1027 31 171 17 0 178 1 53 192 17 0 2059 89 193 17 0 1858 76 201 17 0 1521 42 202 17 0 9 09 27 211 17 0 1654 43 212 17 0 1249 40 221 17 0 1532 57 222 17 0 1423 58 232 17 0 2274 62 241 17 0 22 74 62 251 17 0 1119 47 252 17 0 2068 57 264 17 0 2303 53 272 17 0 865 23 283 17 c 2496 58 295 17 0 1232 49 304 17 0 2283 59 312 17 0 1171 37 321 17 0 1079 44 322 17 0 8 94. 37 331 17 0 1701 58 342 17 0 1301 55 341 17 0 3016 121 361 17 0 2563 68 NHTRIFMT I N T 4 CALCIUM I RO''.' VIT-A ( MG) (MG) CUI 20331 25.2 1410 32778 8 . 4 6 06 2499 6.2 326 447 14.8 12488 596 7. 0 1480 862 8 . 4 9066 319 8. 6 22 17 972 1.8 1435 5046 8.4 6265 27082 30. 4 3195 12872 17. 5 30 75 13232 107. 0 1060 9320 7. 4 5356 1770 6.5 57 59 789 1 1.0 6023 9075 2. 8 5940 484 4 . 6 3222 739 9.2 4477 1218 13.0 7324 698 1 0 . 6 1774 41095 12. 7 1396 1813 10. 7 57 53 8 40 11 . 4 3405 32878 13.2 53 C4 1258 6 . 5 34 83 81 74 9.7 4645 40e4 9.8 5329 1012 3. 5 4570 998 2.3 8750 827 3 . 4 1401 13449 7 . 4 2487 2522 9.3 3929 I 564 7. 3 34 76 578 6. 7 2694 877 1 7.8 988 437 5.5 2839 10507 5. 5 76 73 24927 9.8 2244 17525 8.9 2002 21892 9 . 9 17 80 21892 9 . 9 1780 9880 5.3 1000 403 9.8 2727 578 1 1 . 9 2194 413 2.8 2042 17259 7 . 9 3075 4914 6 . 5 89 75 877 8.5 12097 675 5. 4 2060 9729 8.2 1 335 720 6 . 8 2845 51443 6.7 2442 595 7.0 5935 3617 16.0 26 87 2037 11.0 4629 :: 2 4 H f\ . R E VIT-E THIA RIBO (HG) (MG} (MGI 338.5 0.65 0.80 175.4 0.85 0.39 141.8 0.49 0.62 103.3 4.33 3.74 37.0 0.90 1 .09 22.3 4.14 3.92 2 9. 1 0.88 0.64 12. 5 0.40 1 .49 112.7 1.59 3.19 148. 5 1.25 2 .67 295. 3 1.10 2 .57 24.6 0.47 1.06 86.0 1.13 1.70 83.4 0.78 1.85 116.7 1.22 1.37 12.2 0.92 2.60 26.8 0.46 0.74 215.8 1.20 1.18 334. 9 1. 10 1 .39 688.5 1.41 1.42 332.8 1.47 0.81 104. 8 1.02 1 .47 188.7 1.21 1 .35 219. 5 1.34 0 .93 31.1 0.94 1.39 9.4 1.43 2.96 248. 5 0.93 1 .52 16.6 0.60 1.55 22.4 3.45 3.83 11 5. 8 0. 52 1.15 179.7 1.01 1.39 29.4 1.10 3.09 153.5 0.93 2.19 171.0 0.69 0.82 99.3 0.62 0.36 181.3 0.86 0.82 105. 8 3.89 3 .49 180.8 1.15 1.03 182.8 1.31 1.31 146.0 1.21 1.11 146.0 1.21 1.11 190.6 0.75 1.46 112.8 1.07 0.94 57. 5 0.94 1.16 14. 0 0.47 0.58 404.4 1.01 1.62 350.6 3.56 3.41 265.4 0.88 1.25 58.5 0.61 1.06 145.1 1.06 1.20 143.6 0.88 1.29 40.0 0.83 1 .29 37. 3 4.07 3.63 190.3 0.86 1.21 115.6 1.18 1.29 : A L L O A T A IIACIN ASCQRB T-FAT (MGI (MGI (Gl 14.2 48 209 9. 5 22 30 26.0 60 47 45.2 175 86 13.9 123 47 29.9 245 69 9.6 71 50 6.3 7 35 14.3 92 132 16. 1 330 192 14. 7 298 130 8.7 6 64 9.9 140 85 10.6 22 55 9.3 224 82 6.4 89 37 3.5 1 1 32 8. 6 231 70 12.7 100 85 22. 8 184 108 15.0 70 53 8.7 24 93 16. 7 100 88 19.5 65 65 7.0 123 72 9.3 47 51 9.8 41 91 3.0 87 37 22.5 63 34 2. 6 59 43 6. 2 160 52 6. 5 118 89 11.6 179 79 5.0 4 53 5.4 17 15 11.1 112 67 28.2 150 43 10.2 106 53 8.2 107 49 13.2 156 61 13.2 156 61 5. 5 6 56 1 1.9 142 64 7. 3 3 89 2. 5 123 24 9.2 37 112 27. 1 56 66 6.0 175 93 6.5 64 48 9.2 77 13 8.3 91 12 6.3 143 54 30. 5 53 43 23.0 2 119 11.5 100 88 SAT MONO POLY CARB (Gl (Gl (Gl (G| 30 32 13 354 10 12 1 60 11 I 7 19 112 7 14 5 373 9 7 1 133 13 9 1 206 3 3 1 120 17 11 1 48 50 33 10 250 32 26 0 236 35 34 I 191 24 25 4 106 24 18 1 284 27 13 2 156 20 16 5 217 18 11 0 57 11 7 0 93 25 22 1 233 16 23 7 213 22 61 20 259 18 24 2 126 36 25 3 203 27 24 14 241 20 23 4 142 20 13 2 153 18 11 0 45 25 26 7 154 15 9 0 112 18 13 1 93 17 16 2 125 19 18 1 209 36 21 0 162 33 30 3 177 20 12 1 178 5 6 2 167 16 18 15 228 15 12 2 174 17 18 2 86 18 19 3 109 17 17 9 270 17 17 9 270 17 17 1 101 6 5 0 176 11 7 0 249 5 6 1 82 45 41 2 243 22 31 6 110 22 20 1 173 22 14 0 169 4 5 1 160 4 5 1 171 17 12 2 221 18 14 2 178 44 43 1 187 15 14 1 235 NUTRIF\T I M l A K E : 2 4 :ODE SN DAY C AL PRor CALCIUM I RON v IT -a VI T-E (G) (KG) (MG) ( IU) ( MG ) 362 17 0 1778 52 739 7.6 2515 105.4 372 17 0 1559 37 657 7.3 2468 51.8 371 17 0 2270 49 551 7. 8 84 64 253. 3 374 17 0 1265 30 439 4. 4 4121 123. 5 331 17 C 668 41 16505 8.8 3758 5.4 391 17 0 2033 49 1478C 8. 2 23214 192.0 39 2 17 0 2520 57 14760 9. 1 21403 230. 0 39 3 17 c 15 73 68 4174 10.7 4941 49. 1 40 I 17 0 1714 73 2364 7.2 3425 12 1.7 403 17 0 1123 42 8876 4. 8 1732 112.3 411 17 0 3155 83 4346 15.2 13577 486. 1 412 17 0 2792 30 4026 12. 3 1 2488 438. 2 42 3 17 0 2113 44 14952 17.0 8 34 401.7 43 1 17 0 2931 114 13759 19.3 1 8463 78. 9 441 17 0 1159 34 9113 5.2 3840 182.6 442 17 0 743 22 205C6 5.2 I 06 92 29. 5 402 17 0 1163 58 2228 4. 3 100 10 19. 1 451 17 0 2 894 49 60 3 10. 1 2564 135.7 453 17 0 1915 63 758 10. 1 2004 93.7 454 17 0 2302 68 760 12.2 4140 121.9 46 1 17 0 1493 57 40C9 6.6 5734 203. 1 462 17 0 969 39 335 5.2 5205 34.0 482 17 0 2490 97 9 10 16. 1 57R4 430.3 49 1 17 0 1433 59 2029 8. 2 7554 184. 1 501 17 0 1581 55 862 7. 1 7253 82.1 511 17 0 1247 30 218 7.8 2060 .117.4 521 17 0 2384 67 1 505 9.8 1 33 73 25 3.7 53 I 17 0 749 28 1387 3.2 925 86.6 541 17 0 668 25 59 4.0 1025 23. C 551 17 0 2287 74 8678 11.4 2832 186.0 562 17 0 4171 104 34960 34. 1 69 65 673. 1 563 17 0 2232 64 11216 16.4 4259 34 8.0 575 17 0 1794 40 16483 11.0 1675 58.0 58 1 17 0 42 41 127 9874 20.5 41 38 411.9 582 17 0 3959 115 22524 24.2 34 91 195. 7 583 17 0 3232 100 118S2 19.5 3193 298. 9 591 17 0 2386 102 7742 25.0 142 75 64. 7 592 17 0 2119 78 4215 24. 0 13556 59. 1 59 3 17 0 2069 85 W l « 5 13.8 12928 68.7 601 17 0 2570 53 3200 6. 5 30 41 481.4 602 17 0 1587 40 1965 6. 8 44 89 195. 8 603 17 0 1587 46 1043 6.9 2355 57.7 604 17 0 1181 38 3165 10.4 3089 50. 8 613 17 0 3973 355 193L6 21.6 8337 154. 4 621 17 0 1814 64 20221 12. 6 12985 139. 0 622 17 0 1274 45 8C57 9. 7 3405 99. 3 642 17 0 1891 82 49740 15.5 3468 94.2 652 17 0 1168 44 9051 5. 2 7 54 172. 1 661 17 0 861 26 32C8 6. 4 11 52 48. 4 671 17 0 2704 69 11573 16. 4 759 38.5 672 17 0 1983 31 492 5.5 1135 208. 3 682 17 0 2219 55 5 08 10.6 6210 286.7 692 17 0 741 18 346 3.4 955 30.5 691 17 0 1779 44 6899 13.4 8975 82. 1 701 17 0 1380 58 1374 4. 1 8704 39.7 K E C A L L D A T A TH I A R 180 NIACIN ASCOR") T-F AT SAT MONO POLY CARB (MG) ( MG) (MG) (MG) (G) (G) (G) (G) (G) 0.9 5 I .28 8.4 117 61 14 13 1 198 0. 62 1 .05 5. 1 116 45 19 12 0 153 1.03 1 .00 8.4 151 75 24 25 2 152 0.59 0.78 4. 7 95 42 15 13 1 96 0.77 0.49 4.2 30 27 1 1 1 31 O.BO 1 .34 6.9 149 77 19 18 1 116 0.92 I .36 10.7 151 102 24 23 11 123 0.93 1 .37 10.6 78 74 12 13 1 U l 1. 03 2.31 6.8 81 78 32 26 4 189 0.70 1 .20 6. 9 20 33 18 15 1 120 4.3 1 7.60 28.7 288 1 15 32 43 7 258 4.00 7.72 28.5 113 115 38 44 5 227 0.51 0 .46 5. 3 6 106 11 30 4 146 1.81 1 .89 20.2 246 95 36 25 2 318 1.22 1 .48 9. 7 139 37 11 15 2 132 0.83 1 .41 6.6 39 18 5 4 0 89 0.67 1 .73 5.7 81 58 20 13 2 119 0.82 0 .99 13.0 42 97 38 28 12 469 1. 16- 1 .46 13.3 54 65 21 17 9 231 1.36 1.40 16. 1 250 69 26 28 10 366 0.84 1 .02 11.8 107 73 33 30 2 142 0.59 0.55 8. 5 77 47 23 18 1 100 1.86 2 .53 23. 5 222 129 33 39 17 243 3.92 3.74 34. 1 279 33 8 5 0 238 4.21 3.77 33.4 189 56 19 17 6 175 0. 57 0.58 7.8 73 44 10 12 9 193 3.98 4 .45 2 8.0 229 102 43 36 8 205 0.31 0 .45 7.5 29 26 7 7 6 99 0.49 0.21 9.4 114 8 1 1 1 79 1.03 2 .14 5.4 193 112 31 25 1 192 1.04 1 .07 1 0.6 191 224 23 41 6 204 0.50 0.94 6. 5 53 115 17 23 2 130 1.25 0.45 12.5 112 30 10 7 0 258 1.46 2.16 35. 2 54 215 57 76 26 399 0.77 I .94 I 1.6 11 193 49 41 1 223 0.77 2 .04 11.6 32 158 45 39 2 257 4.86 4.04 40.8 264 73 22 22 10 246 4.79 3 .86 36.7 276 60 16 16 1 I 241 4.53 4.71 33.9 205 72 30 21 9 199 0.40 0.50 1 1.6 12 80 14 35 5 219 0.77 1.22 7. 7 68 42 16 16 3 215 0.92 1.59 7.5 303 44 23 14 2 259 0.81 1 .06 7.3 62 33 7 5 4 182 4.07 6 .04 158. 3 74 135 33 32 4 317 1.59 2 .22 16.7 217 57 18 17 8 203 1.26 I .72 I 1. 5 135 32 14 13 0 163 1.52 0.43 25.5 55 42 17 13 2 74 0.72 1 .20 5.7 29 35 9 13 1 128 0.33 1.10 2.0 94 29 7 4 0 106 0.62 1 .35 9.8 46 112 19 16 12 258 0.61 0.79 9.9 52 66 22 28 18 321 4.17 3.38 37.0 190 83 24 27 17 314 C.49 0.53 3.5 77 15 8 5 0 133 1.05 0.98 8. 1 172 48 14 9 0 245 3.62 4.74 24.2 66 60 27 20 5 157 NUTRIENT INTAKE: 2 4 CODE SN DAY f, AL PROT CALCIUM I RON VIT - A VIT-E (Gl ( MG) (MG 1 (IU) (MG) 702 17 0 1210 54 1 366 4. 0 3690 39. 1 711 17 0 12 83 63 2814 17.6 7076 133. 1 72 5 17 0 2764 76 1243 9. 5 5425 391. 5 726 17 0 1754 51 625 7. 4 3748 82.3 731 17 0 1C25 30 621 4. 4 58 79 198.9 741 17 0 1480 72 803 7.7 2470 64. 4 754 17 0 2140 36 417 7.5 2620 322. 2 424 17 0 1553 38 9468 7.4 1186 52.9 425 17 0 3544 70 17737 20.4 2052 126.9 771 17 0 2070 66 3257 10. 0 1942 63. 7 772 17 0 1697 57 2865 7.5 20 40 49.3 773 17 0 1920 46 1355 9.3 1455 65.4 781 17 0 1210 44 833 3. 1 1626 75.6 732 17 0 1200 44 832 3. 1 1607 75.4 79 1 17 0 4548 89 3 8 871 34.2 1539 112.3 792 17 0 1726 49 1954 9. 1 6245 53.2 80 1 17 0 824 41 905 5.0 35 51 37. 1 802 17 0 824 41 905 5.0 3551 37. 1 761 17 0 963 37 32340 4.2 4087 35.3 712 17 0 42 3 7 45682 0.0 910 0.0 73 17 0 358 6 38654 0. 0 7 70 0.0 50 2 17 0 2210 76 ue57 18.7 7093 75.0 H R . R E C A L L D A T A THI A R IBO NIACIN ASCORB T-FAT SAT MONO POLY CARB (MG) < MG) (MG) (MG) ( G I (G) (Gl (Gl (Gl 0.61 2 .21 4. 1 16 58 27 19 4 122 3.62 3.86 28.4 95 49 21 16 3 151 1.30 1 .91 10.0 433 90 25 39 5 264 0.84 1.13 7.6 166 70 22 22 10 204 3.65 3 .38 24.6 70 34 9 11 1 152 0.92 1.74 11.3 88 77 29 19 0 129 0.99 0 .93 14.6 322 88 25 26 21 306 0.79 0 .64 9.5 24 53 20 18 9 218 0.70 I .28 4.7 104 157 25 27 3 319 0.94 0.98 20.9 139 77 21 20 25 279 0. 70 1.18 13.2 115 68 20 21 17 216 0.90 0.78 17.9 155 83 18 18 28 244 0.50 1.31 5. 1 10 46 19 19 3 160 0.50 1 .31 5. 1 9 46 19 19 3 157 0.90 0.8 I 7.3 8 206 19 24 0 249 1.18 0.82 10.4 277 43 15 12 3 231 0.63 1 .41 3.9 101 25 8 4 0 117 0.63 1.41 3.9 101 25 8 4 0 117 0.49 2.92 5.7 97 33 8 5 0 100 0.13 0.13 0.0 20 20 0 0 0 0 0.11 0.11 0.0 17 17 0 0 0 0 4.19 4.44 31.0 130 94 14 10 0 165 NUTRIENT ANALYSIS PROGRAM APPLIED TO PUNCHED OUTPUT: NONE AUTOMATIC DAY COUNTER IS ON M •P-APPENDIX III ANTHROPOMETRIC MEASUREMENTS 146 1 £ E N E R A L A N 0 A N T H R 0 P 0 M E T R 1 C D A T A C 0 1 0 E O R D E R CODE SURVEY BIRTH AGE(YR) ID SX STHT SITHT SIT/ST WT(KG) SKIN HC AC 11 6 / 6 / 7 6 4 / 4 / 6 2 1 4 . 1 7 7 H 1 6 5 . 6 8 5 . 8 0 . 5 1 8 4 5 . 4 6 1 . 1 0 5 2 . 8 2 4 . C 12 6 / 6 / 7 6 2 8 / 1 0 / 6 6 9 . 6 7 4 F 1 3 9 . 6 7 0 . 2 0 . 502 2 9 . 1 5 1 . 0 2 4 8 . 5 1 8 . 8 21 6 / 6 / 7 6 2 5 / 7 / 6 5 1 0 . 9 2 1 M 1 4 5 . 9 7 5 . 8 C . 5 1 9 3 9 . 2 5 1 . 9 5 5 5 . 0 2 3 . 9 22 6 / 6 / 7 6 6 / 1 / 6 3 8 . 5 0 1 F 1 3 5 . 7 6 9 . 7 0 . 513 3 1 . 0 0 1 . 3 2 5 2 . 1 2 0 . a 31 6 / 6 / 7 6 1 4 / 1 1 / 6 8 7 . 5 9 1 F 1 2 5 . 3 64 . 4 0 . 5 1 3 2 5 . 0 0 0 . 8 0 5 1 . 1 1 9 . 5 32 6 / 6 / 7 6 4 / 1 2 / 6 9 6 . 5 0 1 F 1 1 7 . 7 6 2 . 4 c. 5 3 0 2 0 . 2 5 C . 5 8 5 1 . 2 1 6 . 7 33 6 / 6 / 7 6 1 3 / 1 / 7 0 6 . 5 0 1 F 1 1 5 . 5 6 2 . 9 0 . 544 1 9 . 8 0 0 . 8 0 4 9 . 5 1 7 . 4 3 4 6 / 6 / 7 6 1 8 / 1 / 7 3 3 . 5 0 1 F 9 6 . 6 5 4 . 7 0 . 5 6 6 1 5 . 3 5 0 . 9 0 4 8 . 2 1 7 . 0 41 6 / 6 / 7 6 2 3 / 1 0 / 6 7 0 . 6 7 5 1 4 6 . 4 7 6 . 1 0 . 5 1 9 4 2 . 2 0 1 . 5 6 5 3 . 6 2 4 . 3 51 6 / 6 / 7 6 1 1 / 1 0 / 6 4 1 1 . 6 7 3 F 1 4 7 . 5 7 5 . 1 0 . 5 0 9 4 9 . 2 0 0 . 3 8 5 4 . 3 2 6 . 8 52 6 / 6 / 7 6 2 1 / 7 / 7 0 5 . 9 2 1 M 1 2 2 . 8 6 3 . 0 0 . 512 2 0 . 10 C . 6 0 5 0 . 8 1 6 . 3 61 6 / 6 / 7 6 1 2 / 1 0 / 6 2 1 3 . 6 7 2 F 1 6 0 . 7 8 6 . 3 0 . 5 3 7 4 9 . 2 5 1 . 3 6 5 3 . 7 2 3 . 5 71 8 / 6 / 7 6 1 6 / 1 0 / 6 2 1 3 . 6 7 5 M 1 4 1 . 8 7 4 . 1 0 . 522 3 4 . 9 0 0 . 6 2 5 3 . 8 1 9 . 4 72 8 / 6 / 7 6 6 / 3 / 6 3 1 3 . 2 5 5 1 3 8 . 7 7 0 . 4 0 . 5 0 7 3 1 . 2 0 0 . 5 4 5 3 . 0 1 8 . 6 73 7 / 6 / 7 6 2 8 / 3 / 7 6 0 . 2 5 1 F 6 0 . C 4 0 . 0 0 . 6 6 6 5 . 6 5 1 . 1 0 3 9 . 5 1 2 . 0 81 7 / 6 / 7 6 4 / 6 / 7 3 3 . 0 0 1 M 9 0 . 6 51 . 0 0 . 562 1 2 . 1 5 C . 7 0 4 8 . 9 1 4 . 2 82 7 / 6 / 7 6 2 1 / 1 0 / 7 5 0 . 6 7 1 M 6 8 . 1 4 4 . 4 0 . 6 5 1 8 . 4 0 1 . 2 0 4 3 . 5 1 4 . 5 91 7 / 6 / 7 6 2 1 / 7 / 5 9 1 6 . 9 2 6 M 1 6 5 . 9 8 6 . 9 0 . 523 5 1 . 3 0 0 . 6 0 5 5 . 7 2 2 . 2 92 7 / 6 / 7 6 1 8 / 1 2 / 6 0 1 5 . 5 0 6 W 1 6 7 . 5 6 7 . 7 0 . 4 0 4 4 3 . 0 2 0 . 7 8 5 3 . 9 2 1 . 6 94 8 / 6 / 7 6 1 9 / 9 / 6 5 1 0 . 7 5 6 . M 1 4 0 . 3 7 2 . 6 0 . 5 1 7 3 0 . 8 0 0 . 8 6 5 0 . 6 1 9 . 5 1 0 3 7 / 6 / 7 6 4 / 6 / 6 1 1 5 . 0 0 7 M 1 6 7 . 8 8 4 . 3 0 . 502 4 6 . 0 0 0 . 5 0 5 2 . 9 2 1 . 8 122 7 / 6 / 7 6 9 / 4 / 6 2 1 4 . 1 7 4 M 1 6 4 . 9 8 0 . 9 0 . 4 9 0 5 3 . 9 5 1 . 0 8 5 3 . 1 2 3 . 7 1 2 3 8 / 6 / 7 6 3 / 1 / 6 7 9 . 5 0 4 M 1 3 5 . 2 6 9 . 5 c . 514 3 6 . 6 0 1 . 4 4 5 2 . 1 2 2 . 3 131 7 / 6 / 7 6 1 7 / 1 / 6 6 1 0 . 5 0 4 H 1 4 0 . 2 7 4 . 0 0 . 5 2 7 4 4 . 2 0 1 . 5 6 5 2 . 7 2 4 . 6 141 7 / 6 / 7 6 2 / 8 / 7 3 2 . 8 4 1 F 9 9 . 0 5 4 . 1 0 . 5 4 6 1 3 . 9 5 0 . 6 6 4 7 . 5 1 4 . 8 142 7 / 6 / 7 6 1 6 / 8 / 7 5 0 . 3 4 1 F 7 6 . 9 48 . 7 0 . 63 3 1 0 . 15 0 . 9 0 4 5 . 0 1 4 . 5 151 8 / 6 / 7 6 6 / 4 / 7 0 6 . 1 7 5 M 1 1 6 . 1 6 2 . 0 534 2 8.00 0 . 3 8 5 1 . 4 1 7 . 9 152 8 / 6 / 7 6 1 C / 7 / 7 4 1 . 9 2 1 M 8 4 . 4 4 8 . 3 0 . 5 7 2 1 2 . 10 1 . 2 0 4 9 . 2 1 5 . 5 161 8 / 6 / 7 6 2 7 / 6 / 7 2 4 . 0 0 6 F 1 0 4 . 4 54 . 8 0 . 5 2 4 1 5 . 6 0 1 . 1 0 4 9 . 1 1 6 . 7 162 8 / 6 / 7 6 2 6 / 1 2 / 7 3 2 . 5 0 6 F 8 9 . 4 5 1 . 9 • . 0 . 5 8 0 1 3 . 1 0 2 . 1 6 4 8 . 7 1 6 . 3 171 8 / 6 / 7 6 2 8 / 7 / 6 9 6 . 9 2 2 M 1 2 2 . 9 6 3 . 0 0 . 5 1 2 2 4 . 0 0 * " 0 . 8 3 5 0 . 8 1 8 . 9 192 8 / 6 / 7 6 9 / 9 / 6 5 1 0 . 7 5 1 M 13 5 . 4 6 8 . 7 0 . 5 0 7 2 9 . 6 5 0 . 8 2 5 1 . 4 1 9 . 3 193 1 0 / 6 / 7 6 2 6 / 1 2 / 6 6 9 . 5 0 1 F 1 2 0 . 3 6 1 . 7 0 . 512 1 9 . 9 5 C . 7 3 4 9 . 8 1 6 . 2 2 0 1 1 0 / 6 / 7 6 9 / 8 / 6 7 8 . 8 4 2 F 1 2 6 . 7 6 7 . 2 0 . 53 0 2 2 . 6 0 1 . 6 6 5 0 . 3 1 6 . 6 2 02 8 / 6 / 7 6 1 6 / 8 / 6 9 6 . 8 4 2 M 1 2 3 . 5 6 4 . 9 0 . 5 2 5 2 1 . 6 5 0 . 6 2 5 2 . 4 1 3 . 2 2 1 1 8 / 6 / 7 6 2 1 / 1 1 / 6 7 8 . 5 9 7 M 1 2 4 . 2 6 4 . 6 c . 5 2 0 2 0 . 0 0 0 . 6 2 5 1 . 1 1 5 . 2 2 1 2 1 0 / 6 / 7 6 2 4 / 2 / 7 0 6 . 4 2 1 M 1 1 3 . 4 5 9 . 9 0 . 52 8 1 6 . 9 5 0 . 6 2 5 0 . 7 1 7 . 1 221 8 / 6 / 7 6 2 8 / 8 / 6 6 9 . 8 4 2 M 1 3 7 . 6 7 2 . 9 0 . 5 3 0 3 3 . 5 5 1 . 1 6 5 0 . 8 2 1 . 2 2 2 2 8 / 6 / 7 6 7 / 1 2 / 6 7 8 . 5 0 6 M 1 2 8 . 0 6 6 . 4 0 . 5 1 8 2 6 . 7 0 1 . 0 2 5 1 . 8 1 8 . 8 232 C / C / 6 8 0 / 0 / 0 9 . 0 0 7 F 0 . 0 0 . 0 0 . 0 0 . 0 O . C 0 . 0 0 . 0 241 0 / C / 6 8 0 / 0 / 0 8 . 0 0 7 F 0 . 0 0 . 0 0 . 0 0 . 0 0 . 0 0 . 0 O.C 2 5 1 I 0 / 6 / 7 6 2 / 1 1 / 6 6 9 . 5 9 2 F 1 2 9 . 8 6 8 . 3 0 . 52 6 2 5 . 8 0 C . 7 0 4 8 . 1 1 9 . 1 2 52 9 / 6 / 7 6 1 2 / 7 / 6 8 7 . 9 2 2 M 1 2 1 . 1 6 3 . 7 0 . 526 2 0 . 5 5 0 . 7 6 5 2 . 3 1 8 . 1 2 6 4 9 / 6 / 7 6 2 8 / 1 1 / 6 4 1 1 . 5 9 2 M 1 4 0 . 7 7 1 . 5 0 . 5 0 8 2 7 . 5 0 0 . 6 4 5 1 . 3 1 7 . 4 272 9 / 6 / 7 6 1 9 / 8 / 6 8 7 . 8 4 1 F 1 2 2 . 0 6 3 . 9 0 . 5 2 3 2 3 . 3 0 1 . 3 6 5 0 . 9 1 3 . 3 2 83 9 / 6 / 7 6 1 7 / 1 0 / 6 4 1 1 . 6 7 4 f* 1 4 0 . 7 7 3 . 1 0 . 5 1 9 3 5 . 0 0 1 . 4 4 5 1 . 3 2 1 . 4 2 9 5 9 / 6 / 7 6 2 6 / 7 / 6 7 8 . 9 2 1 F 1 2 2 . 5 6 3 . 9 0 . 5 2 1 2 1 . 0 5 0 . 8 4 4 8 . 5 1 6 . 7 304 9 / 6 / 7 6 1 4 / 2 / 6 4 1 2 . 4 2 5 F 1 2 8 . 5 6 4 . 4 0 . 501 2 5 . 6 0 1 . 0 4 4 6 . 1 1 8 . 4 3 1 2 9 / 6 / 7 6 2 6 / 8 / 6 8 7 . 8 4 2 M 1 2 6 . 2 6 6 . 3 0 . 5 2 5 2 1 . 7 C 0 . 6 8 5 0 . 3 1 5 . 9 3 2 1 9 / 6 / 7 6 1 0 / 2 / 6 8 8 . 4 2 7 F 1 3 0 . 4 6 9 . 4 0 . 532 3 1 . 2 C 1 . 8 0 5 1 . 6 2 0 . 4 3 2 2 9 / 6 / 7 6 2 1 / 1 / 7 0 6 . 5 0 7 F 1 2 2 . 7 6 5 . 6 0 . 5 3 4 2 5 . 0 5 1 . 5 4 5 2 . 3 1 9 . 3 3 3 1 9 / 6 / 7 6 1 1 / 1 1 / 6 0 1 5 . 5 9 4 F 1 5 1 . 7 8 1 . 0 0 . 533 4 0 . 1 0 1 . 1 2 4 9 . 7 2 0 . 8 341 9 / 6 / 7 6 2 5 / 6 / 6 2 1 4 . 0 0 6 1 6 6 . 1 8 3 . 6 0 . 5 0 3 4 8 . 9 5 0 . 9 0 5 1 . 4 2 3 . 3 147 G E N E R C O O E C R CODE :' SURVEY B IRTH 342 5/ 6/76 10/ 6/64 361 10/ 6/76 20/ 7/65 362 10/ 6/76 22/12/66 371 1C7 6/76 28/12/67 372 10/ 6/76 21/ 1/69 374 10/ 6/76 3/ 1/73 381 10/ 6/76 26/10/74 391 13/ 6/76 20/ 6/61 392 13/ 6/76 2/12/62 393 13/ 6/76 9/ 1/66 401 _0/ 6/76 17/ 4/70 402 <-7/ 6/76 1/ 6/71 403 20/ 6/76 20/ 3/72 411 20/ 6/76 5/ 5/64 412 20/ 6/76 22/11/67 423 20/ 6/76 13/11/6C 424 15/ 6/76 12/ 1/64 425 1/ 8/76 10/11/67 431 _.o/ 6/76 1/ 5/68 441 2 0/ 6/76 11/ 1/74 442 2 0/ 6/76 15/ 8/75 451 2 6/ 6/76 9/11/59 4 53 .6/ 6/76 3/ 7/63 454 26/ 6/76 21/ 5/65 461 26/ 6/76 17/ 4/65 462 _:6/ 6/76 19/ 7/68 482 26/ 6/76 30/ 6/62 491 2 6/ 6/76 8/ 3/61 501 3/ 7/76 3/ 9/69 502 11/ 7/76 3/ 7/72 511 3/ 7/76 6/ 5/68 521 3/ 7/76 28/10/66 531 3/ 7/76 14/ 1/70 541 3/ 7/76 1/ 4/72 551 3/ 7/76 15/ 8/69 562 4/ 7/76 31/ 5/60 563 4/ 7/76 18/ 1/62 575 11/ 7/76 1/ 4/59 581 11/ 7/76 16/ 9/62 582 11/ 7/76 1/ 5/66 583 11/ 7/76 17/ 8/66 591 11/ 7/76 26/10/64 592 11/ 7/76 16/12/66 593 11/ 7/76 19/ 7/72 601 IB/ 7/76 4/ 6/62 6C2 1 8/ 7/76 25/ 9/64 603 i 8 / 7/76 1C/12/66 604 18/ 7/76 18/ 7/68 613 18/ 7/76 25/ 7/65 621 1 8/ 7/76 26/12/64 622 18/ 7/76 22/ 7/69 642 2 5/ 7/76 14/ 5/59 652 2 5/ 7/76 14/12/6C A L A N O A N T 0 E R AGE (YRI ID SX STHT 12.00 4 F 149.0 10.92 2 M 144. 8 9.50 2 M 124.1 8.50 2 M 125.6 7.50 2 M 121.7 3.50 1 M 99.4 1 .67 1 M 81.3 15.00 2 F 154.8 13.50 2 F 152.0 10.42 2 M 143.4 6. 17 2 F 121.1 5.00 1 F 111.5 4.25 1 M 106. 1 12. C9 1 F 148. 8 8.59 I M 12 3. 7 15 .59 4 F 153.8 12.66 4 F 150.8 8.75 7 M 126.2 8.09 5 M 131.9 2.50 6 F 89.7 0.84 6 F 70.0 16.59 5 M 177.7 12.92 6 F 149.8 11.09 6 ' F 141.1 11.17 6 F 140. 1 7.92 6 F 119.5 14.00 6 M 163. 5 5.25 1 M 123.1 6.83 1 F 116.0 4.00 1 M ioo. a 8.17 6 F 118.5 9.75 6 F 137. 8 6.58 2 F 121.3 4.25 2 F 103.0 6.92 1 F 119.6 16.17 I F 159.1 14.58 1 F 154.4 17.25 2 F 165.1 13.83 7 M 163.C 10.17 7 F 159.0 9.92 7 M 134. £ 11.75 2 M 149.2 9.58 2 M 133.9 4.CO 1 F 101.2 14.08 8 F 161.8 11.83 8 F 148.7 9.58 8 M 134.3 6.00 8 M 128. 8 11.00 2 M 146. 5 11.58 2 F 155.3 7.00. 2 F 129.7 17.17 1 M 168.8 15.58 7 F 153.1 H R O P O M E T R I SITHT SIT/ST WT(KG) 74.7 0.501 38.00 73.9 0.510 33.30 65.5 0.527 22.15 67.4 0.52C 22.15 64.0 0.525 19.60 54.9 0.552 14.70 50.0 C.615 11.45 80.0 0.516 41.85 77.0 0.506 37.60 74.2 0.517 36.55 63.1 0.52 1 22.40 58.4 0.523 18.40 58.4 0.550 17.25 75.4 C.506 32.70 61.9 0.500 20.75 81.0 0.526 43.60 76.8 0.509 41.80 63.1 C.500 25.45 70.6 C.535 26.50 52.0 0.579 15.00 45.6 0.651 9.10 91.3 0.513 61.30 76.2 0.508 33.25 71.6 0.507 28.85 73.0 0.521 32.20 62.4 0.522 18.10 83.3 0.5C9 42.15 63.1 0.525 22.35 59.9 0. 516 21.90 55.6 0.551 15.10 63.9 0.535 . 19.15 70.5 0.511 2 8.00 64.8 0.534 22.70 55.4 0.537 15.20 64.4 0.538 20.15 83.5 0.524 44.65 77.1 0.499 44.30 89.1 0.540 51.00 82.9 0.508 43.70 82.8 0.520 45.30 68.3 0.506 27.50 73.7 0.493 32.65 69.0 0.515 26.20 54.1 C.534 14.35 84.2 0.520 44.45 77.1 0.518 37.65 71.2 0.530 22.60 69.7 0.541 24.40 74.9 0.511 38.10 79.2 0.509 43.85 68.3 0.526 27.60 89.1 0.527 52.50 80.5 0.525 41.25 C D A T A SKIN HC AC 0.92 52.4 20.4 1.06 52.5 19.7 0.82 49.3 16.8 0.50 50.2 16.4 0.60 49.9 16.8 0.66 50.2 16.5 C.94 48.4 15.8 1.18 51.9 22.2 1.18 51.9 20.1 1.38 54.1 22.0 1.04 50.4 18.2 1.10 48.9 17.3 1.08 47.8 17.3 0.84 49.9 19.8 1.04 49.8 17.4 1.56 49.8 22.4 0.98 51.5 20.6 1.48 50.9 19.4 0.66 53.7 17.2 1.30 48. 1 18.3 0.84 41.1 15.3 C.98 57.1 24.9 0.62 50.8 18.5 0.90 50.4 17.4 C.94 53.8 19.7 1.04 49.1 16.3 0.70 51.1 19.7 0.90 51.4 18.4 1.18 51.9 17.6 1.02 50.7 16.4 0.78 51.7 17.2 1.32 52.6 18.7 1.28 50.9 18.6 0.7C 50.3 16.4 0.94 5C.5 16.9 1.12 51.1 19.6 1.06 52.6 20.4 0.56 53.4 22.6 0.60 52.6 20.5 1.16 54.2 19.4 0.76 53.7 18.2 C.78 52.3 18.3 0.88 51.3 16.1 1.04 48.7 15.2 1.82 54.1 25.3 1.30 51.6 21.3 0.84 53.1 19.4 0.08 51.9 18.2 1.30 53.2 22.5 1.80 54.7 23.6 1.76 52.4 20.8 0.72 55.4 24.1 1.64 51.8 21.9 148 G E N E R A L A N 0 C 0 0 E C R 0 E R CODE S U R V E Y B I R T H A G E ( Y R ) I D S 6 5 3 7/ 6/76 18/10/62 13.67 7 M 6 6 1 1 8 / 7/76 15/12/74 1.58 1 M 6 7 1 1/ 8/76 14/ 3/64 12.41 7 F 6 7 2 1/ 8/76 14/ 4/67 9.33 7 M 6 8 1 1/ 8/76 10/11/64. 11.75 7 F 6 9 1 1/ 8/76 27/ 9/65 10.91 6 M 6 9 2 1/ 8/76 19/ 9/71 4.91 1 M 7 0 1 1/ 8/76 17/12/72 3.66 7 M 7C2 0/ C/68 C/ 0/ 0 2.00 1 F . 7 1 1 0/ 0/68 0/ 0/ c . 2.50 1 F • 712 0/ C/68 0/ 0/ 0 0.33 1 F 72 5 8/ 8/76 4/ 9/57 18.91 4 M 7 2 6 8/ 8/76 2C/ 7/59 17.08 4 F 731 6/ 8/76 1/ 6/72 4. 16 1 M 7 4 1 8/ 8/76 27/ 5/71 5.25 6 F 7 5 4 8/ 8/76 27/11/60 15.75 2 F 7 6 1 15/ 6/76 11/ 6/75 1.16 1 M . 771 15/ 8/76 12/ 2/59 17.58 7 F 772 15/ 8/76 30/12/61 14.66 7 F 7 7 3 5/ e/76 5/ 8/68 8.00 2 F 7 8 1 15/ E/76 23/12/70 5.66 - 1 F 7 8 2 15/ 6/76 1C/ 4/73 3.33 1 M 7 9 1 15/ 8/76 17/ 7/64 12.08 2 M 7 9 2 15/ 6/76 10/11/65 10.75 1 F 801 ^5/ 8/76 6/10/72 3.83 1 F 8 0 2 ^5/ 8/76 7/ 2/74 2.50 1 F A N T H R O P O M E T R I C D A T A IX STHT SITHT SIT/ST KTIKG) SKIN HC AC 148.7 74.1 C.498 41.25 1.60 49.3 23.3 80.6 51.9 0.643 12.15 0.12 46.0 17.8 156.0 80.6 0.510 47.70 1.96 51.8 24.5 135.0 70.1 0.519 27.50 0.80 50.7 19.3 153.2 80.0 C.522 39.95 1 .42 52.6 21.6 14C.3 75.0 0.534 4C.50 2.14 54.3 24.5 107.0 58.0 0.542 16.95 1.02 49.6 16.3 93.6 50.6 C.540 14.70 1.14 48.9 17.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C O 0.0 0.0 O.C O.C 0.0 0.0 168.5 84.8 0.503 48.20 1.86 51.5 25.2 155. 1 80.2 0. 517 56.00 0.72 54. 0 21.2 112.0 60.3 0.538 16.60 0.31 49.5 15.2 108.2 58.3 C.538 17.70 0.94 4 8 . G 16.2 159.2 87.4 C.548 48.60 0.17 53.2 22.5 76.9 46.3 0.602 10.05 0.78 47.5 14.2 155.2 85.7 C.552 59.90 0.19 55.0 25.0 151.0 80.4 0-532 43.10 1.02 . 53.0 21.C 123.5.65.5 C.530 23.80 0.70 50.2 18.5 117.0 62.8 0.536 18.90 0.61 50.6 16.2 98.6 54.3 0.550 14.00 0.96 49.5 15.5 156.3 77.4 0.495 51.80 1.32 53.1 25.5 126.6 64.6 0.510 28.10 1.52 49.8 21.7 98.9 57.0 0.576 14.20 0.98 48.9 16.0 89.2 52.3 0.586 11.55 0.36 46.3 15.7 APPENDIX IV BIOCHEMICAL DATA B I O C H E M I C A L D A T A 150 C O D E O R D E R CODE PN SN HB HCT CAROT VITA VI TC V ITE PL TI G % UG UG MG MG SAT FE BC UG UG 12 2 17 13. 1 37 163 48 1.12 0.59 23.5 99 422 31 2 17 13. 6 41 26 5 44 1.62 0.64 24. 0 111 463 32 2 17 14.2 41 128 35 1. 32 0.56 20.4 84 412 33 2 17 13. 4 40 184 37 1. 17 0.54 24.9 107 429 51 2 17 14.2 41 0 23 1. 51 0.76 17.9 78 43 5 52 2 17 13. 9 39 35 45 1. 62 1.02 29.5 132 447 161 2 17 15. 5 43 219 31 1. 67 0. 81 41 V 1*33 2 17 14.2 42 146 3 2 1.51 0.99 21. 5 93 435 221 2 17 14.6 41 453 40 0.71 0.77 15.1 65 429 2 22 2 17 14.4 42 499 61 0.76 0.74 27. 1 145 53 5 2 83 2 17 13.5 3 8 212 21 1. 33 0.54 2 0. 3 86 425 401 2 17 13.4 3 8 216 45 1. 73 0.73 14. 1 5 9 421 402 2 17 13.0 37 272 43 1.62 0.66 22.5 96 427 4 23 2 17 14. 4 43 228 28 0.74 0.58 20. 1 85 1 424 424 2 17 13. 6 41 221 47 1. 12 1 .01 7.7 32 423 4 25 2 17 13. 8 3 8 16 42 1.. 38 0.6 1 13.2 55 42 0 441 2 17 12.6 36 430 99 0. 54 0.70 25.1 113 451 5 01 2 17 15.2 43 279 60 2.12 0. 84 18.5 78 419 502 2 17 14.2 39 3 84 45 1. 84 0.89 19.9 77 38 7 531 2 17 14.9 42 198 35 1. 12 0.2 3 14.9 63 421 551 2 17 13.6 40 499 69 0. 44 0.73 15.6 60 383 591 2 17 13. 0 3 9 465 76 1.90 0.99 21.0 89 423 592 2 17 12.7 3 9 384 82 1. 79 1.07 25.7 119 464 601 2 17 13. 8 43 453 53 0. 33 0.79 16.2 69 427 602 2 17 14.6 41 499 71 0. 62 0.95 30.8 147 47 6 603 2 17 15.2 44 499 66 0.60 0.93 16.0 640 401 604 2 17 13.3 40 499 76 1.15 0.80 22. 1 93 423 6 13 2 17 13. 6 4 0 499 107 0. 74 0.97 30.2 152 501 621 2 17 13.6 41 451 69 1. 03 0.99 31.0 142 458 642 2 17 15. 8 47 88 35 1. 03 0.75 9.7 67 688 6 52 2 17 11.4 37 0 15 0.95 1.29 4.3 16 383 653 2 17 12.8 3 9 G -i> 1. 37 0.64 27.7 133 48G 6 71 2 17 14.2 41 81 59 1.12 0.53 11.7 49 419 672 2 17 13 . 3 38 77 49 1. 53 0.6 5 25.4 127 502 681 2 17 15.7 45 198 61 1 .67 0.75 20.2 83 413 691 2 17 14.6 42 200 42 1. 37 0.56 12.6 48 385 692 2 17 12.3 37 22 8 44 1.34 0.57 22.2 98 440 701 2 17 13.2 39 209 48 1. 04 0.62 16.6 66 399 725 2 17 14.9 46 349 8 1 1. 17 0.68 37.5 184 490 726 2 17 13. 6 42 339 32 0. 94 0.66 22.4 98 439 741 2 17 14. 0 39 29 3 32 2. 06 0.59 22.0 93 42 2 754 2 17 14. 6 41 253 37 1.39 0.44 18.5 76 413 761 2 17 13.6 38 349 55 1.39 0.93 2 3.4 104 445 771 2 17 14. 6 39 349 50 1. 34 0.31 20.6 89 431 772 2 17 14.2 41 233 43 1. 51 0.97 32.4 159 484 773 2 17 13.3 37 499 48 1.51 0.97 12. 6 51 408 781 2 17 15.2 42 279 65 1.39 0.80 17.7 74 418 791 2 17 13. 0 41 58 49 1.45 0.87 17.2 70 409 792 2 17 13.3 3 9 326 61 1.90 1.17 22.2 99 445 801 2 17 14.1 40 151 3 0 1. 56 0.16 19.7 85 433 802 2 17 13. 1 3 8 198 52 1. 56 0.20 22. 9 100 437 APPENDIX V THANK YOU LETTER 153 FOOD HABITS & NUTRITIONAL STATUS OF EAST INDIAN CHILDREN DIETARY TIPS AND RECOI^ iENDATIONS ' The results of the study in general do not indicate gross inadequacies in the nutritional status of the East Indian children. From the food habit data, i t appears that most children consume adequate amount of protein rich foods. However, results of the blood and diet analysis \ show that a certain percentage of children may be inadequate in calories, iron, calcium, vitamin A, vitamin C and the B vitamins. The following dietary recommendations are, therefore, made to improve the nutritional status of the East Indian children. 1) increase the sise and number of servings from each food group to provide adequate calories essential for better growth and development. 2) increase the intake of green leafy vegetables, dried fruits - prunes, raisins, figs: eggs, whole lentils and whole grain cereals to provide adequate iron and at the same time improve the intake of B vitamins. 3) increase the intake of dairy products: milk, cheese (panir), yogurt and buttermilk (lassi) for protein and calcium essential for proper physical growth. 4) increase the intake of fruits and/or green and yellow vegetables to improve the intake of vitamin A and Vitamin C. 5 ) increase the intake of pulses (dahls) and legumes (beans) for improving the intake of protein, iron, calcium and other trace minerals. 6) discourage use of non-nutritious snacks and beverages (pops, potato chips, chocolate bars, .candies, etc.) and encourage nutritious snacks such as roasted peanuts, cheese & crackers,' raw vegetables (carrot & celery sticks), dried fruits and nuts: fruit juices and ample milk as healthy beverages. Adequate diet for children as recommended by the B.C; food guide is as follows: 2-3 servings of. milk and milk products per day 2 servings of meat or meat alternates per day .3 servings of fraits and vegetables per day 3 servings of breads and cereals per day {.l:;J>:i:':£g,PF..JHl.__.IRV^-J?Nl F 0 0 D - . ] 1 A B T T S & NUTR I T T O N A L S T A T U S OF FA_ST TNliT AN CHIl.Tl I . NUTRIENT INTAKE No. o f s u b j e c t s : 1 3 2 F e m a l e : by M a l e : 6 3 Number o f S u b j e c t s W i t h N u t r i e n t I n i a k e L e s s T h a n T w o - t l i i r d s  o f Recomniended D a i l y N u t r i e n t I n t a R e Sex C a l o r i e s P r o t e i n T h i a m i n e N i a c i n H i b o i ' l a v i n V i t a m i n C M 1 4 1 1 2 31 14 5 F 2 0 0 15 2 b 15 a Sex V i t a m i n A V i t a m i n E C a l c i u m I r o n M S 0 7 17 F 1 3 0 9 2 6 11. BLOOD ANALYSIS No. o f s u b j e c t s : 51 F e m a l e : 31 M a l e : 2 0 DISTRIBUTION UF SUBJECTS IN RISK CATEGORIES DEFINED BY  NUTRITION CANADA Sex l l i & h R i s k M o d e r a t e R i s k Low R i s k h e m o g l o b i n . .iM 0 1 19 F 0 1 3 0 MCiiC M 0 1 19 F 0 1 3 0 Serum T r a n s f e r r i n M k 4 1 2 ( '/o s a t u r a t i o n ) F 6 6 17 Serum V i t . A M 1 1 16 F 0 4 2 7 Serum V i t . C M 0 1 1 9 F 0 3 28 155 Dear Mr. and Mrs. The f o l l o w i n g i s the r e s u l t o f your 's ( a&e . ) b l o o d a n a l y s i s as compared w i t h the N u t r i t i o n Canada i n t e r p r e t i v e s t a n d a r d s : HEM0GL013IN (g/100 ml) 4.3 NUTRITION CANADA INTERPRETIVE STANDARD RISK CATEGORIES HIGH MODERATE LOW MC11C(> ) SERUM TRANSFERRIN s a t u r a t i o n ) SERUM VITAMIN A (mcg/lOOml) SERUM VITAMIN C (mg/100 ml) BIOCHEMICAL D A T A HEMOGLOOIN' 5- 2 2 (0/100 ml) 0-1 yr M 4 F below 9.0 9.0 - 10.0 above 10.0 2-5 yrs M & F below 10.0 10.0 - 11.0 above 11.0 6-12 yrs M & F below 10.0 10.0 - 11.5 above 11.5 13-16 yrs M bolow 12.0 12.0 - 13.0 above 13.0 13-16 yrs F below 10.0 10.0 - 11.5 above 11.5 17+ yrs M bolow 12.0 12.0 - 14.0 above 14.0 17+ yrs F below 10.0 10.0 - 12.0 above 12.0 Pregnant Women , ; below 9.0 9.0 - 10.5 above 10.5 M C H C ( % ) a ' 2 3 ' 2 ' 1 All ages M 4 F below 30 30 32 above SERUM TRANSFERRIN^' * 2 * 2 2 (% saluration) -All ages M & F below 16 16 20 above 20 SERUM VITAMIN A 1 5 " \ (mcg/100ml) -All ages M & F below 10 10 30 above 30 SERUM VITAMIN C 2 5 (mg/100ml) 0-19 yrs M 4 F 20,+ yrs M 4 F below below 0.2 0.2 0.2 0.2 0.6 0.4 \ above 0.6 above 0.4 Hemoglobin (g/100 ml) Homalocnl (%) * 100 Serum Iron (mcg/iQQ m p . lotal serumTon binding capacity x 1 0 0 Milk and Milk Products ildren 2-3 servings Adolescents .... 4 servings Adults 1-2 servings Expectant and Nursing Mothers ... 4 servings Examples of one serving: • 1 eight ounce cup of milk (whole, 2%, or skim) • 1 eight ounce cup of cottage cheese ' or yoghurt • 1 ounce firm cheese • 3 medium scoops ice cream IV. Milk can be used as a beverage, as cheese, as ice cream or in other foods such as sauces, puddings, and soups. I 157 Meat and Alternates 2 servings Fish, poultry, and eggs are included in this group. Vegetable proteins such as dried beans and peas, peanut butter, and nuts can be used in place of meat. Examples of one serving: • 2-3 ounces of lean meat, fish, or poultry • 3 ounces of meat such as weiners, luncheon meat,* or salami • 2 eggs 4 tablespoons peanut butter • 1 cup baked beans Fruits and Vegetables 3 servings or more Sources of Vitamin C and A are important. Eat a Vitamin C rich choice every day. Some Vitamin C rich choices are: oranges, grapefruit and their juices; tomatoes and tomato juice; raw cabbage; baked potatoes; vitaminized apple juice; fresh strawberry. Some Vitamin A rich choices are: carrots, sweet potatoes, squash, apricots, cantaloup, peaches; spinach, beet greens, chard or other dark green vegetables. Example of one serving: • Vi cup fruit, vegetables or their A variety of colorful fruits juices. and vegetables can be chosen. J Breads and Cereals 3 servings Whole grain or enriched cereals, breads, and pastas should be chosen. Examples of one serving: • % cup cooked cereal such as oatmeal • 1 cup flaked cereal • 1 slice whole grain or en-riched bread • % cup of enriched pasta such as spaghetti, macaroni, or noodles • Vi cup cooked brown or con-verted rice (j VitaminHp 

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