1. family and parenting

editor:
Robert
B.
Bradfield,
international
Nutritional
status of the Puerto
master
sample
survey1’2
Nelson
and
A.
Irma
Fern#{225}ndez,3
Rosa,5
M.D.,
Jos#{233}C. Burgos,3
M.D.,
search
team
chemistry
the
from
and
University
of
Department
and
the
of
Health,
and
personnel
districts.
of the
opportunity
rapid
to
assistance
Puerto
Rico
of the
Puerto
medical
various
the
Rican
prove
current
health
Rico
study
growth
economic
the
the
from
may
for
public
Puerto
of Medicine,
with
of
status
significance
tion
and
the world.
Rico,
Research
Bio-
of
School
of
paramedical
island
health
This
study
nutritional
Department
Nutrition,
of Puerto
Office
to
diet
be
and
of
great
problems
in nutriin different
parts
of
furnishes
the unique
the
relationships
of
and nutritional
sta-
tus.
This
tional
publication
status
and
pects
of
1966,
compares
the
summarizes
related
Puerto
Rican
our
the
nutri-
socioeconomic
as-
in
population
findings
with
a
similar
carried
previous
nutrition
problems
Socioeconomic
observed
between
and
of
the
nutritional
discrepancies
status
and
A more
Both
eco-
growth.
the
As
848
detailed
Bulletin
of
sociation
(2).
the
publication
Puerto
was
Rico
made
Medical
952
Ph.D.,
the
stated
families.
Supported
tional
and
socioeconomic
survey
was done
developed
by the
using
Office
The American
a stratified
of Research
Journal
master
of the
of Clinical
clinical
and
the
laboratory
procedures
(4-9).
studies
described
were
in our
information
before,
the final sample
Of these,
405 or 47.8%
consisted
of
were urban,
in
As-
Methodology
The
sample
Asenjo,4
out using
publications
by
Institutes
Biochemistry
Methodology
information
F.
Commonwealth
Department
of Health
(3). The
study was carried
out in two basic steps:
1) Family
interviews.
From July through
September
1966,
848 families
were
interviewed
in
their
homes.
The
data
recorded
included
socioeconomic
information
such as family
income,
educational
level,
family
composition,
waste
disposal,
and
facilities
for cooking,
serving,
storing,
and
consuming
foods.
Data
on dietary
patterns
and
the frequency
of consumption
of foods
including
the various
kinds
of milk,
meat,
seafoods,
eggs,
cheese,
cereals,
legumes,
vegetables,
fruits,
fats,
desserts,
and beverages
were also collected.
2) Clinical
and
biochemical
examinations.
These
were
done
during
October
and November
1966
in a stratified
subsample
of 142 families
selected
systematically
from
the original
master
sample.
The clinical
data were recorded
on punch
cards
similar
to the Interdepartmental
Committee
on Nutrition
for National
Defense
(ICNND)
detailed
examination
forms,
and biochemical
tests
included
hemoglobin,
hematocrit,
and plasma
values of total
proteins,
albumin,
carotene,
vitamin
A, and
vitamin
C. Urinary
excretion
rates
of
thiamin,
riboflavin,
and N’-methylnicotinamide/g
creatinine
were
done
in casual
urine
specimens.
Stools for ova and parasites
were examined
quantitatively
in 543 subjects.
study
carried
out in 1946 by Roberts
and
Stefani
(1), and provides
some practical
recommendations
for the solution
of the existing
nomic
population:
Grant
of
and
Health
Nutrition,
AM-06032
to
the
School
from
the
Na-
Department
of
of
Medicine,
University
of Puerto
Rico,
San Juan,
Puerto
Rico
00905.
2 Presented
at the
2nd
Western
Hemisphere
Nutrition Congress held at San Juan, Puerto Rico,
August
26-29,
1968.
Assistant
Professor.
‘Professor
and
Head
of Department.
Research Dietitian.
Nutrition
24:
AUGUST
1971,
pp. 952-965.
Printed
in U.S.A.
Downloaded from ajcn.nutrition.org by guest on October 6, 2014
out July
resentative
lation.
Conrado
nutrition
B.S.
islandwide nutrition survey
was carried
through
November
1966
in a repsample
of the Puerto
Rican
popuThe
survey
was
conducted
by a re-
An
Rican
Ph.D.
NUTRITIONAL
and 443
distribution
or
STATUS
lived
in the rural
zone.
The
by annual
income
was as
follows:
under $500, 8.4%;
$500
to 999,
13.0%;
$1,000
to 1,999,
21.6%;
$2,000
to 2,999,
17.8%;
$3,000
to 3,999,
1 1.6% ; $4,000
to 4,999,
6.2%;
$5,000
to 5,999,
3.9%
; $6,000
to 6,999,
3.9%;
over $7,000,
13.5%.
Family
size
was
classified
in four
different
groups
and the distribution
of the families
was as
follows:
1 to 3 members,
35.4%;
4 to 6 members,
42.7%;
7 to 10 members,
17.9% ; and
over
10
members,
3.9%.
Larger
families
were more
prevalent in the rural areas.
52.2%
of
families
Cooking
facilities
are summarized
in Table
1.
Gas, electric,
and kerosene
stoves were the most
popular.
Gas stoves were used by the highest percent of the families
(45.5%).
The use of the
‘fog#{243}n”or
Regarding
the
different
kitchen
and
Cooking
1
and
kitchen
storage
facilities,
953
At an income
over $5,000
dollars,
all
owned refrigerators.
Kitchen
storage
space is also described
lies
had
the
higher
better
facilities
the income
were.
Regarding
the
than
level,
of families
Cooking
Gas stove
Electric stove
Kerosene
stove
Cement
hearth
Three stones
None
Storage
Built-in cabinets
Movable
cabinets
Sets of shelves
Improvised
None
the
the
sanitary
rural
better
ones
the
facilities,
and
facilities
about
halt
(50.5%)
had flush toilets
in their
homes
and 48.5%
used latrines.
Only 0.5% among
the rural
families
disposed
of human
wastes
by
using a hole in the ground,
and 1.6% reported
a
Of
the
complete
families
lack
of a waste
disposal
five percent
of the rural
and 73%
used latrines.
of the homes
had flush
22%
used latrines.
facility.
Twenty-
families
had flush toilets
In the urban
zone,
78%
toilets,
and the remaining
#{182}
Dietary
findings
Information
obtained
food
different
about
by two
consumption
methods.
In
was
recorded.
a 24-hr
family
diet
history
The other method
consisted
in recording
frequency
with which
the families
foods
such as milk,
cheese,
meats,
reals,
legumes,
oils, desserts,
ceding
week.
fruits,
vegetables,
beverages
Milk
obtained
information
dividual
and
was
one,
the
consumed
eggs, cefats
and
the prewas the only
during
consumption
quantitatively
on an in-
basis.
of families
Annual
income
families
Rural
,
Number
in Ta-
ble 1. Only 7.4% of all the families
had no storage
space at all. The remaining
92.6%
had some kind
of storage
facility,
from
built-in
cabinets
to simplc, improvised
facilities.
In general,
urban
fami-
Zone
All
families
eating
utensils
owned
by the family,
we can state
that
income
determined
the amount
and variety
found
in the house.
Families
of low
income
usually
cooked
simple
meals
that
required
few utensils.
As income
increased,
the menus
became
more
varied
and more utensils
were needed.
The
situation
in relation
to refrigeration
facilities
showed
that 82.3%
of the families
had a
refrigerator.
The
remainder
did not have
refrigerators,
but 5.5%
used one in a nearby
store
or
one belonging
to a neighbor.
The percent
of urban
families
that
owned
a refrigerator
(92%)
was
much
higher
than
that
for
rural
families
(73%).
The
proportion
owning
refrigerators
increased
with income.
In those families
earning
less
than $500 a year only 53.8% had a refrigerator.
TABLE
RICANS
PUERTO
848
443
Urban
405
Under
$2,000
371
45.5
24.6
22.8
2.4
1.3
2.2
46.3
9.5
33.4
4.0
2.3
2.9
44.7
1.5
41.2
9.4
37.2
4.3
2.6
3.5
30.3
36.1
9.1
17.1
14.4
41.1
10.2
24.8
47.7
30.6
7.9
8.6
9.7
39.3
12.9
24.5
7.4
9.5
5.2
13.5
41.2
11.1
0.5
0.2
$2,00Co
362
i
$7,000
and
113
56.4
26.0
13.8
1.1
0
1.7
25.7
70.8
3.5
0
0
0
34.5
84.0
40.3
11.5
7.7
14.1
0.9
2.7
3.3
0.9
Downloaded from ajcn.nutrition.org by guest on October 6, 2014
cement
hearth
had come
down
to a
mere
2.4%
of the families,
mostly
rural. Higher
income
families
used
mostly
electric
and gas
stoves,
whereas
the use of kerosene
stoves
was
more frequent
in the lower income
groups.
OF
954
FERN#{193}NDEZ ET
TABLE
2
Milk consumption,
cups
per
person
per
AL.
day
Zone
Age
group,
years
Urban
<1
year
1-5
6-12
13-18
20-39
40-59
i
Amount
of
milk
3.6
3.3
4.7
2.9
748
654
2.0
2.4
1.7
1.9
2.0
2.0
2.3
2.2
2.2
1.6
1.8
1.8
345
2.0
3,928
2.2
2.2
2.4
1.7
2.0
consumed
to
4.3
cups.
However,
children
of the lowest
income
$500)
showed
a considerably
gestion.
Also,
in the income
$4,000
the daily
ingestion
by
12 years
old was less than 2
preschool
level (under
low milk ingroups
below
children 6 to
cups. Among
adults,
among
milk intake
was consistently
deficient
low and low-middle
income
subjects.
Above
60-years
old, only those belonging
to
the highest
bracket
(over
$7,000)
had an intake of more
than
2 cups/day.
As a whole,
fresh milk was consumed
by
a larger percentage
of subjects
and families.
Evaporated
milk was next in order of consumption.
The smallest
percentage
of individuals
consuming
fresh
milk was found
in
the infant
group,
in which
less than one-half
(42.6%)
drank
it. Evaporated
milk was consumed
by 34%
of them.
The proportion
of
subjects
consuming
dry whole
milk was also
higher
in infants
(19%)
than for the remaining age groups.
As in the case of evaporated
milk,
the
dry whole
The
milk
proportion
of
milk
decreased
frequency
was low
All
of them
families
drank
subjects
consuming
as age increased.
of consumption
of dry skim
in all age groups.
included,
fresh
milk.
income
we
found
Even
that 86%
in the lowest
#{176}
$2,000
$l.?ed
3.5
3.9
4.2
2.8
3.3
4.1
1.5
1.5
2.0
2.1
4.0
3.0
1.7
1.6
1.9
2.0
2.6
2.4
1.7
1.8
1.7
2.3
2.3
2.9
income
groups,
69 % of the families
consumed
fresh milk. Evaporated
and dry whole
milk were
consumed
by 12%
and 10%,
respectively.
Skim milk was used by only 5%.
Ninety-one
percent
of the urban
families
and
82%
of the rural
ones consumed
fresh
milk.
Among
welfare
beneficiaries
we
observed
that
the
consumption
of the
fresh
product
was also higher
than
of any other
type
of
milk.
The
proportion
of families
consuming
fresh
milk
increased
with
higher
incomes.
Skim
milk
was consumed
the most by the
poorest
ones
of families
was found
The
fresh
The
(13%).
highest
percentage
that
did not drink
in the lowest
income
proportion
milk
of
decreased
However,
milk
level.
families
as their
that
size
(3.8%)
drank
augmented.
even
in the largest families
of over
74%
consumed
fresh milk. The
ingestion
of evaporated,
dry whole,
and dry
skim milks
showed
the opposite
relation.
Families
were
also asked
which
type
of
milk they liked most
and it was found
that
80.2%
preferred
fresh milk. Evaporated
was
next
with
7.4%.
Dry
whole
and
dry skim
were
preferred
by 6.1%
and 2.7%,
respec10 members,
tively.
Fresh
milk
among
all families,
zone,
or whether
they
fits or not.
Dietary
the
regardless
received
most
popular
of income,
welfare
bene-
patterns
Several
food
appear
more
supper,
and
hr family
viewers.
was
combinations
frequently
between
diet
history
were
at breakfast,
meals,
recorded
based
found
to
lunch,
on the
24-
by the inter-
Downloaded from ajcn.nutrition.org by guest on October 6, 2014
Table 2 shows the average
milk consumpby age group, zone, and income.
All age
groups
consumed
at least 2 or 3 cups of milk
daily;
infants
were
the best
consumers
as
they drank
3.9 cups. Income
did not seem
to be a determinant
of milk consumption
in
infancy.
One-year-old
children
in all income
levels consumed
daily amounts
that ranged
2.4
Under
3.9
3.1
tion
from
Rural
91
541
934
615
Allages
Annual
All families
Number
NUTRITIONAL
At
breakfast,
we
found
milk and bread
was
the highest
proportion
Next
was
which
This
coffee
appeared
means
that
with
milk
coffee
that
coffee
combination
of families
with
milk,
OF
with
Food
used by
(22. 1 %).
egg,
and
bread
in 14.9%
of the families.
most
of the homes
used
plus
some
other
food
for
breakfast.
Less
not
breakfast.
have
the
STATUS
than
1%
of
the
families
did
containing
coffee
with
milk,
cereal,
fruit,
and eggs were
observed
more
frequently
in urban
households;
but also, more of these skipped
breakfast.
The
elaborate
Breakfasts
proportion
breakfasts
of families
having
increased
directly
more
with
income.
meat.
The
rural
popular
families,
first
in
one
was
more
whereas
urban
ones.
increased,
families
their
lunches
vegetables.
such
It was
common
the
As
among
latter
was
a rule,
included
more
other
foods
as meat,
milk,
and
in the lowest
income
in
salad
level
that we found
the highest
percentage
having
only
rice
and beans.
However,
the largest
proportion
of
families (13.4%)
skipping
lunch
was
observed
in
the
upper
income
At
supper,
combination
centage
of the
of
rural
supper,
age
rice
cluding
more
beans
with meat
was
by the highest
per(15.3%).
Fifteen
percent
had
for
urban
but
was
and
eaten
families
ones
very
low.
three
or
common
in
variety
was
of
also
only
rice
and
dwellers
Supper
beans
this
for
percent-
combinations
four
different
urban
than
in-
foods
in
were
rural
fami-
lies.
The
pertime
In the lowest
of the
supper,
families
whereas
it
less
was
groups,
ilies
it was
included
the foods
included
directly
related
to
income
1
sup-
income.
level, over one-fourth
had
only
rice
in the highest
than
at
In
%.
more
elaborate
meat,
milk,
the
and
beans
for
income
group
upper
and
and
more
income
fam-
vegetables,
in
addition to rice and beans.
The
most
popular
was coffee. Coffee
with
in 31 % of all families,
rural
ilies
dwellers.
did
not
between-meals
milk
was
particularly
snack
the
Regarding
the frequency
of consumption
of foods
by the families
during
the week preceding
the interview,
the following
relevant
findings
were obtained:
Eggs
favorite
among
Nearly
one-fourth
of the famhave
anything
between
meals.
were
used
more
frequently
than
any
other
protein
food.
Families
of the lowest
income
bracket
ate them about
three
times
a
week,
and the wealthiest
families
had eggs
almost
daily.
Among
the
meat
products,
smoked
ham
was the most
frequently
used
on all levels.
Beef was consumed
at least once
a week
by the lower
income
families
and as
income
increased,
it was eaten
more
often,
reaching
an average
of 3.5 times
a week
in
the highest
income
group.
Poultry
was less
popular
than
beef
in upper
income
levels,
whereas
in the poorer
families
the opposite
was
true.
Liver
was
not
commonly
contwo
at any
or
income
three
families
of
level.
times
and
Codfish
a week
slightly
in the higher
more
income
consumption
by
other
eaten
low
than
levels.
of
was
the
income
once
The
a week
frequency
seafoods
very
was
low.
Red
kidney
beans
were
preferred
above
other
legumes.
In general,
families
ate
all
them
groups.
the
consumption
sumed
as income
955
RICANS
three
beans
were
the poorer
by the
peas
or four times a week.
White
navy
eaten
less than
once
a week
by
families and even
less
frequently
upper
not
gardless
ones.
to be
Chick
very
were
were
very
eaten
popular
three
weekly
at
all
Banana
income,
income
was
eaten
all families.
eaten
at
wealthier
five
times/week.
very
as plantain,
bananas,
and
or two times
levels.
favorite
to
fruit
four
regardless
times
of
by
weekly
Oranges
and
pineapples
were
least
once
or
twice
a week
by
families,
but
for the poorest
ones
frequency
also eaten
fresh
families,
Among
the
two
tion
was
about
levels.
Grapefruits,
other
re-
in all families.
to
Other
starchy
vegetables,
such
breadfruit,
taniers,
yams,
green
sweet
potatoes
were
eaten
one
the
were
pigeon
and
popular,
of income.
Potatoes
They
income
seem
did
fruits
was
much
lower.
in season
and their
once
a week
West
were
Indian
seldom
at
Mangoes
consumpall
income
cherries,
used
and
by
the
particularly
the lower
income
ones.
the
cereals,
rice
was
consumed
frequently.
Only
families
with
annual
Downloaded from ajcn.nutrition.org by guest on October 6, 2014
Including
all the families,
the most
popular lunch
combinations
were
starchy
vegetables
with codfish,
and rice and beans
with
PUERTO
956
incomes
above
$6,000
every
day. Bread
was
did
not
FERN#{193}NDEZ
ET
rice
subjects
consume
also frequently
eaten,
especially
by families
with higher
incomes.
Lard
was frequently
used by all families,
but it was more popular
among the less privileged ones. Vegetable
oils, on the contrary,
were preferred
Only families
by the higher
of the higher
ets
more
ate
dessert
cream
was
annual
cream
pastes,
the
than
preferred
income
income
a week.
one.
Those
were
the
wealthier
consumed
at least
once
with
a week
by
families.
Coffee was drunk more
all income
levels. Families
as often
as 9 to 10 times
than once daily at
consumed
coffee
during
the week.
Carbonated
beverages
and malt
beer
were
also used,
particularly
by the upper
income
families
who consumed
these
over 4 times
a
week.
Higher
income
families
also drank
alcoholic
beverages
more
often
than
the less
privileged
in persons
the
also
over
tongue.
more
In
signs
there
was
prevalence)
and
of
frequent
signs associated
with
follicular
hyperkeratosis
vitamin
was
with
Dental
prevalence
de(62%
with
associated
ficiencies.
a low
specific
caries
were
nutritional
common
increasingly
age.
Among
the
A deficiency,
the
of
from
most
15%.
common,
This
2 years
junctival
infection
with
sign
up
was
to old
(3%)
a general
prevalence
observed
age.
and
regularly
Bilateral
xerosis
con(4%)
of
the skin were less frequent.
Gingivitis,
papillary atrophy,
and bleeding
of the gums were
commonly
associated
with poor
oral hygiene
and
pyorrhea.
Only
9%
of the subjects
showed
diffuse gum inflammation
be related to vitamin
C deficiency.
seborrhea
was the most
common
boflavin
groups
deficiency.
It was present
with
an overall
prevalence
It was mostly
that could
Cutaneous
sign of riin all age
of 15%.
nasolabial;
but in a large numboth nasolabial
and retroauricular
lesions
were found.
Teeth malposition was a consistent
finding in all age groups
except infants.
One hundred
and thirty-seven
ber
of
subjects,
thiamin,
small
cases
over
possible
protein
the
bilateral
knee
and
Eight-one
bilateral
40-years-old.
Other
deficiency
thiamin,
riboflavin,
deficiency
occurred
ilies;
whereas
those
vitaminosis
C and
areas.
Also,
niacin,
of deficiency
income
extremely
prevalence
deficiency
to vitamin
and
protein
in urban
famhypo-
possible
more
in
per
the
higher
a slightly
signs
of
person
in the
groups.
The
height,
salient
weight,
a high
prevalence
particularly
was
in
signs
were
more
often
related
to
D prevailed
there
percent
appeared
edema
rare.
Rural
people
showed
a lower
of clinical
signs
associated
with
than urban
subjects.
Signs related
A,
edges
was
older persons.
related
to a de-
children.
of
persons
Twenty-two
tip and
atrophy
absence
or
ankle
reflexes
common
(7%).
The
finding
prevalent
among
older
was not found
among
in-
of the
and
the
upper
general,
among
possibly
Glos-
particularly
of age.
the signs
the most
particularly
women.
Edema
fants
condition.
only the
papillary
prevalent
of
average
Clinical data
60 years
were
was
rural
ones.
the
Tongue
diminution
of
showed
in 27 individuals,
or 8 1 % involved
cases
of
2 1%
found
clinical
findings
and
skin-fold
women
dation
of growth
in
cent
standard
weights
of
obesity
(10);
children.
(Table
and
in relation
thickness,
among
to
were
adults,
a slight retarThe
mean
per-
3) showed
that
moderate
undernutrition,
10 to 20% underweight,
prevailed
among
children
and adolescents.
Adults,
particularly
women,
showed
adequate
weights
for their heights.
Children
6 to 12 years
old had the lowest
mean percent standard
weight.
The percent
standard
weight
was calculated
in terms
of weightfor-age
up to 18 years, and weight for height
above that age. Body length and weight were
close
to the standard
in early
infancy
(3
months)
but afterward
fell progressively
below the standards,
with some recovery
during
adolescence.
At age 17, urban
youngsters
had attained
a complete
weight
recovery,
whereas
the rural ones at age 18 were 9 lb
below the standard.
Men were about 5 inches
taller than women on the average,
and young
people
tended
to be taller than their elders,
particularly
women.
An elevated
prevalence
of obesity was ob-
Downloaded from ajcn.nutrition.org by guest on October 6, 2014
they
or
was
ficiency
Ice
incomes
above
$6,000
consumed
ice
over
2.5
times a week.
Cake,
sweet
fresh
and canned
fruits,
and cookies
not
used
as often
as ice cream,
but
were
sitis
Among
homes.
brack-
once
AL.
NUTRIIIONAL
TABLE
3
Clinical
data
Agegrotp,
years
<1
Sex
STATUS
2-5
0-12
OF
13-18
MF
13
5.2’
15
15.4
168
9.0
39
15.0
45
15.3
Mean
height,
inches
Mean
weight,
lb
Mean
% standard
wt
% 10- to 20
overweight
% over 20% overweight
Mean
skin fold, mm
Arm
Back
24.9
14.6
96.5
30.0
21.6
91.7
67
3.6
38.2
31.2
90.7
50.5
62.3
61.1
57.5
102
108
87.8
88.1
97.1
5
3
5
9.2
6.3
PF
to 69.2
females.
9.2
7.4
pregnant
in years.
=
served
in
adults.
cent,
respectively,
over
19 years
9.4
6.6
9.2
6.5
LF
of
age
and
the
were
7
87
28.8
60.9
127
107
11
3
7
18
22
8.0
7.2
16.9
13.1
12.6
16.3
21.1
20.0
females.
12
women
and
above
20%
lence
raries.
showed
of
obesity
regard
difference
rural
a
than
to height
in the
adults.
family
United
over-
higher
rural
there
mean
no
significant
of urban
those
over
preva-
contempo-
was
heights
However,
income
much
their
with
$7,000
an
were
and
annual
almost
2
inches
taller,
on the average,
than
adults
with yearly
incomes
below
$1,000.
In children and adolescents
there
was a direct
relationship
between
the percent
standard
heights
and
weights
and
annual
incomes
up
to
$7,000.
Above
increase
was
In
and
increased
up to $7,000.
in both
was
with
ever,
that
annual
showed
prevalence
income
observed.
the
mean
adults,
weight
also
Mean
LF
M
F
M
8
2
50
49.0
31
27.0
47
50.6
31
28.8
68.8
59.3
121
104
62.6
132
108
0
64.6
59.5
64.3
141
131
102
112
19
20
136
99.6
16
69.2
58.7
124
108
13
0
9
38
10
29
19.0
15.5
12.0
14.9
22.5
23.8
8.9
11.5
20.0
18.0
17.1
17.6
age
6V
in months.
(1 1,
States
standards
(13)
were
evaluation
of height
Laboratory
findings
Mean
12)
and
used
in
and
F
age from
3.6
Puerto
the
weight
Rican
preceding
data.
Women
communities
In
a
permen
40 to 59 years of age showed
the
highest
prevalence
of obesity
(38%).
Among
men,
moderate
and
marked
overweight
was more
common
in the 19 to 39
age group.
Obesity
was more
prevalent
in
urban
people,
but among
young
adults
(19
to 39 years
old)
the
occurrence
was
about
the same.
School
children,
adolescents,
and
persons
over 60 years of age from the urban
weight.
PF
60
29.6
66.0
149
105
20
lactating
=
Twenty-eight
of
F
40-59
the
general
in
incomes
a
that
further
percent
standard
of
obesity
income
a decrease
of families
relation
to
income
Children
of $3,000
consistent
of obesity.
no
prevalence
direct
Over
observed.
level
and
increase
up,
howin
the
A low prevalence
of anemias
was observed
(Table
4). Only
5.0%
and
7.2%
showed
low-deficient
levels of hemoglobin
and mean
corpuscular
hemoglobin
concentrations
(MCHC),
respectively.
All the anemias
were
of the hypochromic
type,
as shown
by the
mean
corpuscular
hemoglobin
concentrations.
Fourteen
percent
of the subjects
examined
had low hematocrit
values,
but only
less than
1 % was deficient.
Infants
showed
the highest
low-deficient
hematocrit
values.
A considerable
prevalence
of deficient
mean corpuscular
hemoglobin
concentrations
was
found
in one-year-old
children.
Above
that
age,
the hypochromias
observed
were
mostly
in the low range.
The
most
severe
forms
of iron deficiency
anemias
were
concentrated
among
infants
and preschool
children.
In general,
there
was a higher
prevalence
of low-deficient
hematologic
values
in the
lower
income
families.
However,
a considerable
prevalence
of
low
and of low-deficient
mean
centrations
was observed
income
groups.
deficient
MCHC
families
with
The
values
corpuscular
among
the
conhigher
highest
values
an
hematocrit
annual
was
occurrence
of
found
among
income
above
Downloaded from ajcn.nutrition.org by guest on October 6, 2014
MF
age
21-32
M
MF
Mean
M
957
RICANS
19-39
MF
Number
PUERTO
9S8
FERN#{193}NDEZ
TABLE
ET
AL.
4
Hematologic
findings
Age group, years
Sex
<1
1 5
6-12
ME
MF
MF
7
11.2
14.3
14.3
76
12.0
5.2
6.5
7
13-18
Zone
19-39
M
F
M
162
13.4
0
1.2
39
14.7
20.5
0
42
13.8
0
0
61
16.1
1.6
0
85
13.6
0
2.4
75
35.5
20.0
2.7
162
38.9
1.9
0.6
39
42.8
43.6
0
42
40.5
21.4
0
61
46.8
1.6
0
75
33.8
162
34.2
3.7
1.2
39
34.4
42
34.1
7.7
0
40-50
FPF
60
Urban
Rural
412
13.8
3.4
2.2
LF
M
F
M
F
8
12.4
12.5
0
2
12.9
0
0
46
15.8
2.2
0
50
13.9
0
0
31
15.1
12.9
6.5
31
13.9
0
0
219
14.1
2.7
1.4
85
39.9
18.8
1.2
8
36.5
25.0
0
2
37.5
50.0
0
46
45.8
4.3
0
50
41.1
12.0
0
31
31
219
411
44.1
40.6
41.0
40.4
25.8
0
16.1
0
14.6
0.5
13.6
1.0
61
85
8
2
46
50
31
31
219
411
34.0
34.1
34.0
34.3
34.4
33.7
34.3
34.2
34.3
34.1
7.1
6.6
7.1
12.5
0
2.2
8.0
9.7
0
4.1
7.1
0
0
2.4
0
0
0
0
0
0
1.4
1.2
=
mean
Hemoglobin,
g/l00
ml
Number
Mean
% Low
% Deficient
PF
concent
=
32.0
42.9
14.3
7
34.6
0
0
pregnant
ations.
9.4
5.3
females.
LF
=
lactating females.
MCHC
$7,000.
Urban
mean
hemoglobin,
hematocrit, and MCHC
were always
slightly
higher
than
the corresponding
rural
values.
The
hematologic
findings
were
evaluated
according to Wintrobe
(14),
except
those
for pregnant
women,
in which
ICNND
guides
(15)
were used.
Severe
hypoproteinemia
was very rare, but
a considerable
number
of low total
proteins
and albumin
levels
were observed
(Table
5).
Children
2 to 5 years
old showed
the highest
prevalence
of low total plasma
proteins,
but
and
deficient
examined
values
appeared
among
school
chil-
dren,
adolescents,
and
young
adults.
All
pregnant
and lactating
women
had adequate
plasma
total proteins.
Hypoalbuminemia
was
present
in all age groups
with a general
prevalence
of 9.6%.
Subjects
over
60 years
old
and small
children
showed
the highest
cccurrence
of low albumin
values.
Only 3 cases
fell in the deficient
range.
The
highest
percentage
of deficient
total
proteins
was
observed
in families
with
an
annual
income
above
$6,000,
and all the three
cases
of
deficient
plasma
albumin
values
fell
in this
same
income
group.
With
the exception
of the $5,000
to 5,999
income
group,
the mean
albumin
levels
of the poorer
families were higher
than those
of the wealthier;
corpuscular
hemoglobin
the
prevalence
of hypoalbuminemia
was
the low income
families
than in the
two
upper
income
groups.
In regard
to zone,
a higher
percentage
of
low and deficient
levels
of total proteins
and
albumin
was observed
in the urban
families.
lower
All
in
three
subjects
with
less
than
2.8
ml albumin,
and four
out of the
with total proteins
below
6 g/100
from urban
areas.
Vitamin
A levels
were
higher
pected,
values,
with
less
showing
however,
than
low
were
1%
values.
much
of
the
Low
more
g/ 100
five
ml,
cases
came
than
ex-
subjects
carotene
common,
particularly
among
small
children.
Plasma
ascorbic
acid levels
were adequate.
The
highest
prevalence
of low carotene
concentrations
was observed
in the lowest
income
family
group.
Also,
families
with an
annual
income
above
$7,000
had the highest
mean vitamin
A concentration.
Mean ascorbic
acid
plasma
levels
increased
with
income
from
1.2 to 1.6 mg/ 100 ml. Urban
mean
values
of carotene
and vitamin
A were higher
than the rural
ones. Vitamin
C plasma
levels
were slightly
higher
in the rural communities.
Table
6 summarizes
the data
on urinary
vitamin
excretion
rates.
The
urinary
excretion of thiamin
was low-deficient
in 35 sub-
Downloaded from ajcn.nutrition.org by guest on October 6, 2014
Hematocrit,
%
Number
Mean
% Low
% Deficient
MCHC,
g/100 ml
Number
Mean
% Low
% Deficient
NUTRITIONAL
TABLE
STATUS
OF
PUERTO
959
RICA.NS
5
Plasma
proteins
Age group, yea’s
6-12
PF
LF
M
F
M
F
58
157
39
41
60
83
8
2
46
50
31
31
7.0
13.8
7.4
7.6
5.1
0
7.5
4.9
2.4
7.6
1.7
1.7
7.6
3.6
2.4
6.9
0
0
8.1
0
0
7.5
6.5
0
7.4
8.0
0
7.5
3.2
7.7
3.2
7.5
5.8
7.5
5.2
0
0
2.4
0.3
4.2
4.2
4.1
4.0
4.9
0
3.3
1.7
4.1
10.8
0
3.6
2.6
0
4.1
4.3
0
4.0
10.0
3.9
19.3
0
3.9
22.6
0
3.9
10.6
1.4
4.1
8.3
0
3.8
3.8
13.8
4.0
7.0
1.7
0.6
lactating
=
females.
of
6
in
and
TABLE
6
Urinary
vitamin
of
Thiamin,
agg
Number
Median
% Low
% Deficient
Riboflavin,
ag/g
Number
PF
=
0
Values
females.
nary
0
of <6.0 and <5.5 g/l00
Values
<3.50 were
ml were used
used for preg-
excretion
rates
of
were
years
uri-
N1-methylnicotina-
mide,
but, only
0.5%
was in the deficient
range.
Low excretions
were distributed
fairly
evenly
among
the various
age groups
with
prevalences
varying
from
11 to 20%.
The
highest
occurrence
was
observed
in young
creatinine
Age group,
2-5
6-12
MF
MF
3
156
38
43
1,167
762
505
385
2.7
3.8
3.8
7.9
2.6
7.0
5.4
38
1,225
18.4
2.6
158
501
13.3
12.7
38
352
13.2
7.9
35
156
4.0
16.0
1.3
38
4.0
13.2
0
Sex
0
cient
prevalences
of more
than
20%
observed
in individuals
from
2 to 39
of age.
Sixteen
percent
showed
low-deficient
in
excretion/g
0
a
in the case of pregnant
examined.
Poor
all the
age
higher
proportion
prevailed
in
school
children.
urinary
excretion
rates
were
in 23%
of the cases.
Fifty subwere
deficient.
The
highest
deficient
values
was
observed
to 12 years
old and
among
lactating
women.
Low-defiobserved
25.0
13-18
years
Zone
40-59
19-39
M
>60
Urban
Rural
204
366
0
3.4
1.0
4.6
2.5
F
PF
LF
M
F
60
83
1.7
347
2.4
8
636
0
2
285
50.0
44
379
0
2.4
0
0
50
415
2.0
0
367
3.3
0
43
263
11.6
9.3
60
287
25.0
3.3
84
298
19.0
9.5
8
2
82
0
50.0
42
50
29
29
205
366
326
0
12.5
341
9.5
606
6.9
271
10.3
10.3
13.2
15.0
7.1
415
10.0
6.0
2.9
11.2
41
4.0
17.1
58
3.0
24.1
83
3.0
9.6
1.2
7
2
50.0
0
30
2.0
23.3
0
362
0
0
50
4.0
18.0
0
200
2.0
44
3.0
6.8
0
28
6.0
3.0
17.9
0
16.5
14.6
0
0.8
M
259
9.1
0
F
M
30
3.4
29
238
3.4
‘g
pregnant
5.0
11 .4
0
females.
LF
=
0
lactating
0
females.
Downloaded from ajcn.nutrition.org by guest on October 6, 2014
groups,
but a
preschool
and
Riboflavin
low-deficient
jects
or 8.6%
Median
‘
Low
% Deficient
N’-methylnicotinamide,
mg
Number
Median
% Low
% Deficient
387
F
of all subjects
were
children
pregnant
208
M
1.3
or 6.0%
prevalence
Rural
F
PF = pregnant
females.
LF
as low and deficient,
respectively,
nant fenales.
excretions
Urban
M
<2.8
jects
(0
ml
% <3.528
%
40-59
MF
Number
% <6.0#{176}
Albumin,
g/100
Mean
19-39
13-18
ME
Sex
Total proteins,
g/l00 ml
Mean
% <6.5#{176}
Zone
960
FERN#{193}NDEZ
low excretions
ban
families.
Regarding
was
slightly
severe
prevalence
prevailed
occurrence
were
more
in the ur-
of intestinal
parin all age groups,
but the highest
was observed
in
children
2 to 14 years
old. The general
preyalence
of trichuriasis
was 39.7%
. Ascariasis
was
also
particularly
prevalent
among
the
younger
age groups,
showing
a very low cccurrence
after
1 9 years of age. Moderate
and
asites,
the
higher
trichuriasis
cases
prevalent
in children
2 to 14 years old, and the highest
prevalence
was
observed
among
preschool
children.
Hookworm
infestations
were
observed
from
2 years
of
age to adulthood.
The highest.
prevalence
was
found
between
6 and
14
years
of age.
The
general
prevalences
of
Ascaris
and
hookworm
were
12.4%
and
13.1 %,
respectively.
Endamoeba
coil
was considerably
prevalent from
preschool
children
to old age with
prevalences
varying
from
9 to 20.5%
in the
various
age groups.
This
protozoan
had
a
general
prevalence
of 13.6%.
Giardia
lamblia cases
occurred
mostly
in children
up to
14 years
of age.
Endamoeba
histoiytica
was
mainly
a problem
of schoolchildren
and adolescents,
and its general
prevalence
was low
(2.6%).
Endoiimax
nana
was regularly
prevalent
from
preschool-age
to old age, with
a
general
occurrence
of 6.4%.
The
prevalence
distribution
of intestinal
parasites
by income
groups
showed
that the
lower
income
families
had
a much
higher
AL.
parasitic
the
prevalence.
prevalence
festations
Ascaris.
with
prevalence
than
in
This
of
was
moderate
also
and
Trichuris,
true
severe
hookworm,
for
inand
There
was
a significantly
higher
of intestinal
parasites
in the rural
the urban
families.
Discussion
and
recommendations
Discussion
Socioeconomic
information.
We sought
to
compare
the socioeconomic
and dietary
findings of our survey
with those of Roberts
and
Stefani
in 1 946 (1) in order
to find out what
changes
occurred
during
the past 20 years.
As mentioned
previously,
our final sample
consisted
of 848 families,
47.8%
of which
were
urban
and 52.2%
of which
lived in the
rural
zone.
These
figures
represented
a
marked
increase
in the proportion
of urban
families
in comparison
with the 1 946 study.
At that
time
57.5%
of the families
were
rural dwellers
and 42.5%
were urban.
Family
income
showed
a dramatic
increase.
In 1946,
about
44%
of the families
had annual
incomes
under
$500,
whereas
in
1966 only 8.4%
lived with such low income.
In Roberts
and Stefani’s
study
approximately
three-fourths
of the families
lived
with
less
than $1 ,000
a year and a few (8 %) had incomes
above
$2,000.
In our
survey
only
21.4%
of
the
families
earned
under
$1,000
yearly
and over
one-half
of them
surpassed
$2,000.
Fifty-one
percent
had
annual
incomes
between
$ 1 ,000 and $4,000.
The proportion
of families
composed
of 4
to 6 members
was about
the same
in 1946
and 1966
(41.9%
and 42.7%,
respectively).
The main differences
were an increase
in the
proportion
of families
with
1 to 3 members
from
26.1%
to 35.4%
and
a decrease
of
those
composed
of 7 to 10 members
from
27.6%
to
17.9%.
The
mean
number
of
members
per household
diminished
from
5.4
in 1946
to 4.8 in our study.
In comparing
the cooking,
serving,
refrigeration,
and storage
facilities
of the families,
we
found
that in 1946
the modern
types
of
cooking
fixtures
were
rare
in
the
Puerto
Rican
homes.
Only 3.6%
of the families
had
electric
or
gas
70.1 % had either
Charcoal
was the
stoves,
one
most
whereas
in
1966,
the other
of them.
frequent
cooking
fuel
or
Downloaded from ajcn.nutrition.org by guest on October 6, 2014
adult
males
(24. 1 % ) and men over 60 years
old (23.3%).
Lower
income
did not necessarily
mean
lower
urinary
excretion
values.
In the case
of thiamin
and riboflavin,
the higher
prevalences
of low-deficient
excretion
rates
were
observed
mostly
among
the middle
income
families.
However,
the general
prevalence
of
deficient
excretions
of these two vitamins
was
higher
in the lower
income
groups.
The low
excretion
rates
of
N’-methylnicotinamide
were
somewhat
evenly
distributed
among
the
various
income
groups.
In general,
middle
income
families
tended
to be better
off than
those
with a lower
or higher
income.
There
was
a higher
prevalence
of lowdeficient
excretion
rates of thiamin
and riboflavin
in the
rural
areas.
In the case
of
N’-methylnicotinamide,
the
prevalence
of
ET
STATUS
NUTRITIONAL
1946.
utilized
At that
it, but
in
dropped
to
showed
marked
time,
36.6%
of the homes
in 1966
use
of charcoal
than
1%
Rural
dwellers
less
of
their
PUERTO
961
RICANS
sisted
solely
of coffee
alone
3 1 .3 % of the families,
but
dropped
to only 8% in 1966.
.
improvement
OF
cook-
the
of
ing
families
had
or with milk in
such
proportion
In 1946,
14.4%
black
coffee
only
for
breakfast,
whereas
in our data less than
1%
of
the families
did so. As in Roberts
and
Stefani’s
study,
in 1966 coffee
with milk and
bread
still remained
the favorite
breakfast
combination,
although
in a smaller
proportion.
The percentage
of homes
having
other
foods
added
to their
breakfasts
was much
higher
in 1966 than in 1946.
Lunches
also showed
improvement
since
1946.
Starchy
vegetables
with
codfish
remained
as the most
popular
combination,
but the percent
of families
that used
it was
much
lower
in 1 966
(1 2.9 and
8.3 % , respectively).
In
1946,
less than
one-half
of
facility.
homes
included
Consequently,
using
latrines
the
dropped.
proportion
of
The
propor-
of rural
dwellers
with
a
sanitary
facilities
was reduced
1946
to just 1.6%
in 1966.
Dietary
findings.
As mentioned
average
intake
of milk
showed
groups
consumed
at least
2
daily.
Roberts
and Stefani
did
total
from
tion
per
capita
groups
is
not
people
almost
milk
In
intake
from
1946,
and
spectively.
19.5
and
regard
to
10.4
were
of
milk
in
as we did, therefore
possible.
Nevertheless,
8.1
doubled
to
15.4
7.5
and
other
kind.
Breakfasts
than in 1946.
and
the
various
consumption
cups/person
rural
age
comparison
in 1966
our
of
per
week.
averaged
day,
reOur
corresponding
figures
were
16 ounces.
The characteristics
in
milk preferences
and consumption
similar
in both
studies.
The majority
of
families,
regardless
of zone
or income,
the
preferred
urban
of
in
before,
the
that
all age
or more
cups
not record
the
such
the
lack
27%
families
ounces/person
consumed
were
In
per
fresh
milk
over
much
better
in our
that
year,
breakfast
any
survey
con-
the
households
included
codfish,
meat,
or
some
other
protein
food
in their
lunches,
whereas
in 1966,
71.2%
of them
did so.
In 1 946,
supper
was
even
poorer
than
lunch.
At
had
that
only
14.9%
their
of
of
food.
the
families
In our
the
practice
tween
meals
when
83.4%
ever,
in
the
supper
increased
not
of the
1966,
the
included
survey,
of
was
of
families
supper
and only
a protein
food
in
1966,
almost
three-
for
included
meal.
In
in
come.
The
47.4%
foods
them
evening
fourths
tein
time,
starchy
some
variety
with
having
some
food
very
common
in
families
76.5%
of
had
them
none.
had
pro-
of foods
the
in-
be1946
Howhabit.
In regard
to the frequency
with which
different
kinds
of foods
were
included
in the
diet; both in 1946
and 1966,
the family
income
was the most
important
determining
factor.
As income
increased,
the frequency
of use of certain
foods
and the variety
of the
diet
also
increased.
In our
study,
several
food
products
that
were
luxury
foods
in
1946
were now available
to a large
portion
of our population.
Eggs
only
some
used
high
to
be
income
a
luxury
product
families
could
that
afford
to have
daily.
The
lowest
income
families
had them
only
once
in 2 weeks
or even
less
often.
In 1966,
we found
that even families
with incomes
under
$500
a year
ate eggs at
least three
times
a week.
In Roberts
and Stefani’s
study
very
few
families could
afford
to have
meat
or meat
Downloaded from ajcn.nutrition.org by guest on October 6, 2014
facilities.
A striking
improvement
was found
in relation
to the owning
or use of a refrigerator.
In Roberts
and Stefani’s
study,
only 1 1 % of
all the families
owned
or could
use a refrigerator.
In 1966
that percentage
had risen
to
87.8 % . This
remarkable
change
was
also
observed
in relation
to zone and income.
All
families
with
annual
incomes
above
$5,000
owned
a refrigerator.
However,
in the lowest
income
group,
earning
less than $500 a year,
we found
that
nearly
one-half
(46.2%)
of
them
still lacked
this facility.
The
availability
of storage
space
in the
homes
also
revealed
marked
advancement
since
1946.
At that time,
a total
of 40.6%
of the families
had
no storage
facilities
at
all. In our study
the proportion
was reduced
to just 7.4%.
Sanitary
facilities
showed
great progress
in
our
study.
In 1 946 flush toilets
were uncommon
in Puerto
Rico
and only
20%
of the
families
had
one.
Twenty
years
later
we
found
that one-half
of them
(50.5%)
had this
962
FERN#{193}NDEZ
products
daily and a high percentage
of them
had it very rarely
or never.
In 1966,
families
in all income
levels
ate meat
or meat
products
at least
once
a day.
Special
reference
must be made
to poultry,
which
in 1946 was
also a luxury
food,
particularly
for the low
income
homes.
In 1966,
it had
become
a
popular
food
that
was included
more
than
once
a week
in the diet of families
from
all
income
levels.
Among
the
seafoods,
codfish
remained
the most
popular,
as in 1946.
In that time
about
three-fourths
of the families
included
codfish
as a regular
part of their diet. In our
study,
the situation
was
about
the same,
esfor
the
low
income
homes,
which
included
codfish
two or three
times
in the
week.
Legumes
have
always
been
preferred
by
our families
and constitute
an important
part
of the diet
at all income
levels.
Unfortunately,
those
with
a higher
protein
nutritive
value,
like pigeon
and chick
peas were
not
consumed
so frequently.
At all times,
starchy
vegetables
have made
up the bulk of the diet of many
of our families, especially
the poor rural
ones.
Eaten
in
large amounts,
they constitute
a good source
not only
of calories,
but
also
of vitamins
such as B and C. It should
be noted
that in
the rural communities
surveyed
by our group
they
were
the
explanation
for
the
C (4-8).
In
preference
it was found
that,
both
and in 1966,
the most favored
were
green
plantain,
green
bananas,
and
consumption
of
vitamin
adequate
order
of
in 1946
potatoes,
ripe ba-
nanas.
Tropical
fruits
are very common
in Puerto
Rico and therefore
one would
expect
a high
consumption.
However,
in 1946,
although
many
families
could
have
them
free
of
charge,
they were not consumed
as often
as
desirable.
In 1966
the consumption
of fresh
fruits
was
still low. It was found
that
only
bananas
were
eaten
more
than
once
a week
at
all income
levels.
Oranges,
pineapples,
and mangoes
were
eaten
more
than
once
a
week
only by the high
income
families.
In
our study
the consumption
of canned
fruits
had diminished
considerably.
Among
the cereals
commonly
used by our
families,
rice
was
the favorite
in both studies.
In
AL.
1946,
90.8%
of the families
ate it daily,
and in 1966
it was also consumed
daily
at
all income
levels.
Bread
was used
daily
by
about
two-thirds
of the families
in 1946.
In
1966 it was used less frequently,
particularly
by those
of low income.
Crackers
were
also
popular in 1946 and in 1966.
Lard
continues
to be the most
used fat in
Puerto
Rico,
although
in 1 966 the higher
income
families
preferred
vegetable
oils.
In
1 946,
oil,
butter,
and
even
margarine,
seemed
to be luxury
products
used
only by
families
that
could
afford
to buy them.
In
1966
it was found
that such fats were
consumed
at homes
from
all income
levels
and
even
the lowest
income
families
used
them
more
than once a week.
Both
in 1946
and 1966
desserts
played
a
minor
role
high
once
income
a week.
were
sweet
in
Puerto
Rican
families
ate
The favorite
pastes,
fruits.
In 1 966
followed
closely
dietaries.
Only
dessert
more
desserts
in
than
1946
preserved
and
canned
the favorite
was ice cream,
by cake.
Clinical
data.
Clinical
and
biochemical
studies
were not done in 1 946. In our survey,
a low prevalence
of specific
deficiency
signs
and
symptoms
was
observed.
However,
a
greater
occurrence
of signs
associated
with
vitamin
A, riboflavin,
and niacin
deficiency
was found
as compared
with our rural
studies
(4-8).
With
the exception
of vitamin
A
deficiency
signs,
which
showed
an equal
distribution
between
urban
and
rural
groups,
the urban
population
was
mostly
affected.
An interesting
observation
was
the higher
prevalence
of deficiency
signs
in families
with yearly
incomes
above
$4,000.
The
considerable
prevalence
of obesity
found
in our
study
represents
a new public
health
problem.
It was
considerably
high
even in middle
income
families.
It was more
common
in urban
families
and increased
with
income,
therefore
appearing
to be a problem
of
affluence.
A disturbing
finding
was that
over
22%
of our children,
mostly
adolescents
belonging
to middle
class families,
were
becoming
obese.
In our opinion
this problem
merits
prompt
action,
and measures
to curb
this trend
should
not wait.
In regard
to growth,
it was encouraging
to find that young
people
were growing
taller
Downloaded from ajcn.nutrition.org by guest on October 6, 2014
pecially
ET
NUTRITIONAL
STATUS
minimum
the
high
In
requirements.
prevalence
of
older
children,
intestinal
parasites
was
a major
contributing
factor
to anemia,
whereas
in pregnant
women
the increased
requirements
for iron
were
probably
not met.
The
decreased
prevalence
of hypochromic
anemias
as income
augmented
cannot
be explained
on a dietary
basis alone.
Better
sanitation
and
general
health
care
were
undoubtedly
involved.
Vitamin
A levels
were
higher
than
expected
with
less than
1 % of the subjects
examined
showing
low values.
However,
it is
suspected
that these
higher
values
were a result
of prolonged
storage
of the
samples.
Adequate
ascorbic
acid levels
in serum
were
expected.
Rural
people
obtained
a large share
of this vitamin
from
starchy
vegetables
which
they
consumed
in
appreciable
quantities,
whereas
in the urban
area
there
was a larger
consumption
of citrus
fruits,
juices,
and concentrates.
The
excretion
of B vitamins
in
PUERTO
urine
followed
the
communities.
nant
or
963
RICANS
pattern
Preschool
lactating
found
children
showed
females
in
and
the
rural
preglowest
excretions.
Recommendations
According
to our
findings,
higher
ecostandards
and greater
food availability
do not
necessarily
mean
better
nutrition.
Perhaps
this is due to an ineffective
coordination
between
our present
food
and nutrition programs
and the rapid economic
growth
experienced
in Puerto
Rico
in recent
years.
Thus,
the islandwide
establishment
of food
and nutrition
policies
based
on the true prevailing
needs
of our population
and of continuous
health
and
nutrition
surveillance
mechanisms
are indispensable
in order
to
correct
the existing
nutritional
problems
and
to prevent
the appearance
of new ones.
A
better
coordination
among
governmental
agencies
such
as Health,
Agriculture,
Education,
Economic
Development,
Consumer’s
Protection
Administration,
and so forth
is
highly
desirable.
Related
professional
organizations
(medical,
dietetic,
and other
health
societies)
and private
food
industry
(dairy,
fabricated
foods)
should
be involved.
nomic
A strong
organized
body,
either
voluntary
like the Puerto
Rico Nutrition
Committee,
or
created
by legislation,
but with
enough
authority
and official
governmental
support
to
assure
optimum
efficiency,
would
be the ideal
instrument
for achieving
adequate
coordinalion
and for establishing
sound
food and nutrition
policies
to
satisfy
the real
needs
of
our people.
Staple
and nutritious
foods
at the lowest
possible
price
should
be made
available
to
the population
with
emphasis
on preschool
children
and pregnant
women.
Milk
should
be priced
low enough
to be readily
available
to
low income
families.
This
could
be accomplished
by allowing
the production
of
adequate
milk
substitutes
such
as filled
milk,
by means
of food
stamps
for this product,
by expanding
the existing
milk
distribution
programs,
particularly
those
serving
preschool
children
and pregnant
women,
or by
subsidy.
Milk,
which
is consumed
in insufficient
quantities,
would
represent
an ideal
supplement
for
our
people
and would
help
Downloaded from ajcn.nutrition.org by guest on October 6, 2014
than their elders.
Infants
from the upper
economic
levels
tended
to be longer
at birth and
continued
in this growth
pattern,
resulting
in
taller
adults,
on the average.
Children
from
the
lower
economic
groups
lagged
below
both
Puerto
Rican
and
North
American
standards,
catching
up partially
during
adolescence,
but resulting
in shorter
adults
by 2
to 2.5 inches.
This retardation
of growth
in
regard
to chronological
age in the low income
group
was similar
to the one observed
in our
studies
of isolated
rural
communities,
which
indicated
the existence
of a problem
of borderline
undernutrition.
These
findings
contrasted
with the high occurrence
of obesity discussed
above.
The higher
prevalence
of nutritional
deliciency
signs in middle
and upper
class penple, accompanied
by a high prevalence
of excess weight,
makes
an interesting
situation
as well
as a new
public
health
challenge.
Puerto
Rico
is a country
of rapid
mobility
towards
higher
social
and economic
standards;
therefore
the coexistence
of problems
of undernutrition
and overnutrition
demands
our
greatest
concern.
Laboratory
findings.
The low prevalence
of anemia
in adults
can be explained
by an
adequate
intake
of iron.
Anemia
in infancy
was
frequently
due
to intakes
below
the
OF
964
FERN#{193}NDEZ
consumers.
Educational
programs
should
expand
to
include
problems
of unbalanced
diet resulting
in obesity,
atherosclerosis,
and
other
degenerative
diseases;
and
proper
mechanisms
should
be established
to assure
the
participation
of the
private
food
market
and
the
advertising
industry
in consumer
education.
It is necessary
to enlist
the assistance
and cooperation
of the food
industry in introducing
new foods
or altering
current
food
habits.
New
fabricated
foods
will
continue
to
appear
and
our
governmental
agencies
will never
be able to satisfactorily
counteract
the
tremendous
public
impact
of food
advertisements
through
the press,
radio,
Our
and
television.
should
concentrate
its
milk
consumption
in
particular
among
the
poorer
families.
It
should
also
stimulate
a greater
preference
for
cheaper
forms
of
milk,
such
as evaporated
or dried
milk.
Milk,
as
previously
mentioned,
is
an
ideal
dietary
supplement
for the leading
deficiencies
now
prevalent.
Other
foods
that
should
be strongly
recefforts
government
in
increasing
AL.
ommended
are: chick
and pigeon
peas,
yellow
and
green
vegetables,
and
fruits
and
juices
rich
in vitamins
A and
C. These
food
items
are not being
consumed
either
regularly
or in desirable
amounts.
Summary
An islandwide
nutrition
survey
was carried out in 1 966 in a representative
stratifled sample
of the Puerto
Rican
population.
The survey
included
the collection
of socioeconomic,
dietary,
clinical,
and biochemical
data.
Eight
hundred
and seventy-seven
famiies
were
interviewed
at their
homes,
and
information
in regard
to income,
occupation,
educational
level,
family
composition,
and
waste
disposal
facilities
was obtained.
Detailed
data about
dietary
patterns,
frequency
of consumption
of all kinds
of foods,
and the
facilities
of the families
for the storage,
preparation,
and serving
of foods
were
also recorded.
Clinical
and biochemical
tests
were
done
in 663 and 655
subjects,
respectively,
from
a highly
representative
stratified
subsample
of 142 families.
The
clinical
data
were
recorded
on punch
cards
similar
to the
ICNND
detailed
examination
forms.
Biochemical
tests
included
hemoglobin,
hematocrit,
and plasma
values
of total
proteins,
albumin,
carotene,
vitamin
A, and vitamin
C. Urinary
excretion
rates
of thiamin,
riboflavin,
and N1-methylnicotinamide
per gram
of creatinine
were
done in casual
urine
spec-.
imens.
Stools
for ova and parasites
were examined
quantitatively
in 528
subjects.
All
data
were
transferred
to
a format
designed
for
electronic
data
processing
and subjected
to detailed
evaluation.
This
study reveals
very
interesting
information
regarding
the
various
patterns
of
food consumption
among
the different
socioeconomic
levels
and
the urban
and
rural
people.
It
shows
that
higher
economic
standards
do not
necessarily
improve
the
nutritional
value
of
the diet.
People
from
remote
rural
communities
were
better
fed
than
urban
people
from
slums
in regard
to
several
nutrients.
References
1.
ROBERTS,
Living
Puerto
L. J.,
and
in Puerto
Rico:
Univ.
R. L.
STRFANI.
Rican
Families.
Puerto
Rico
Press,
Patterns
San
of
Juan,
1949.
Downloaded from ajcn.nutrition.org by guest on October 6, 2014
alleviate
the main
nutritional
deficiencies
(vitamin
A, riboflavin,
and calcium).
Other
measures
to increase
the availability
of desirable
foods
would
be to allow the importation
of staple
and nutritious
foods
at
the lowest
possible
price
to the consumer
by
eliminating
or modifying
existing
trade
restrictions
that
raise
the cost
of imported
foods,
and to stimulate
the enrichment
of natural
or synthetic
food products
with the nutrients
most frequently
deficient
in the Puerto
Rican
diet.
Also,
all food
distribution
programs
should
be based
on the existing
nutritional
problems
and all decisions
on nutritional
needs
and values
of foods
in relation
to these
programs
should
be made
by nutrition experts
and not by administrators.
It is urgent
to intensify
nutrition
education programs
at all levels,
including
government workers
and consumers,
both in relation
to existing
problems
and new ones that have
arisen
as a result
of the rapid
changes
occurring
in Puerto
Rico.
Emphasis
must
be
given
to preschool
children
and
pregnant
women.
Administrators
of food
programs
should
be acquainted
with
or educated
on
the
nutritional
needs
and problems
of the
to
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21: 646, 1968.
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M. L., AND E. D. FOARD. Heights
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V. B. Stature,
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Nutritional
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areas
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N. A., J. C. BURGOS,
L. J.
ROBERTS
AND
C. F. ASENJO.
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Rico:
survey
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Duey
Alto,
San
German,
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17: 215,
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7. FERN#{193}NDEZ, N. A., I. C. BURGOS,
L. J. ROB-
N.
C. F.
AND
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FERN#{193}NDEZ,
FERN#{193}NDEZ,
people
in isolated
areas
of Puerto
Rico:
survey of Barrio Montones
4, Las Piedras, Puerto
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Assoc.
53: 119, 1968.
Puerto
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Rept., March, 1963.
N. A., J. C. BURGos, I. C. PLOUGH,
L. J. ROBERTS
AND
C. F. ASENJO.
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965
RICANS
ERTS
the
Sta-
PUERTO