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Summary The rate of growth in length of infants given one teaspoonful of high grade cod liver oil (340 to 400 U.S.P. units of vitamin D daily) has been compared with the rate of linear growth of infants given the same type of diet, but with the source of vitamin D from irradiated milk (60 to 135 U.S.P. units of vitamin D daily) or its vitamin D equivalent as cod liver oil or cod liver oil concentrate milk, and with standard growth rates reported in the literature. A review of the growth standards shows that the rate of linear growthin infancy is increasing. Standards reported in 1929 and 1933 show rates of growth definitely increased over those of older standards. Infants given 340 to 400 U.S.P. units of vitamin D daily grow at rates definitely more rapid than those of even the recent standards. Infants ingesting from 60 to 135 U.S.P. units of vitamin D daily grow at the same rate as the recent standards. Exposure to sunlight increased the rate of growth in the few infants in whom this measure was tried and who were receiving the lower of the two stated amounts of vitamin D. The increased rate of linear growth is ascribed chiefly to the increased intake of vitamin D and its resultant effect on skeletal growth. Although the influence of vitamin A has not been entirely excluded, certain of the observations recorded indicate that vitamin A was not the limiting factor in the growth of the infants studied.

Metabolic studies of calcium, phosphorus, and nitrogen in children with moderate to severe idiopathic scoliosis have been carried out. The findings demonstrated no clear-cut abnormality in mineral metabolism, but did show a serious disturbance in catabolism of protein with excessive wastage of nitrogen through the urine. The metabolic error also appears to involve derivatives of sulphur-containing amino acids. The scoliotic children tended to excrete a larger number of essential amino acids than did normal children of the same age range.

Summary The rate of linear growth of nine infants given from 1,800 to 4,600 units of vitamin D daily has been compared with standard rates of growth, and with the growth of infants given the same dietary regimen but amounts of vitamin D varying from 135 to 340 units daily. The rates of growth with the very high vitamin D intake were similar to or less than those of infants given 135 units daily, and definitely lower than the growth rates of infants given 340 units of vitamin D daily. It is concluded that the effect of vitamin D on increasing linear growth reaches a maximum when the vitamin D intake is greater than 135 and less than 1,800 units, probably in the neighborhood of 340 to 600 units daily. Vitamin A in amounts exceeding those of the food (milk, vegetable, and fruit purees) apparently does not affect linear growth of infants. Factors affecting growth rates of individual infants are discussed. It is concluded that in order to determine the effect of the dietary regimen, growth should be studied well past 6 months of age, preferably during the greater part of infancy. Growth during the first 8 weeks of life may be affected by factors other than the dietary regimen of the infant.

Abnormal levels of serum phosphorus are found in association with various metabolic disturbances, such as renal insufficiency, hyper and hypo-parathyroidism, rickets and osteomalacia. In this study, we have attempted to determine the effect of experimental hyperphosphatemia upon some of the other constituents of the serum, and upon the urinary constituents. The work was planned to supply values which could be used as standards of comparison for future studies, using animals that will be subjected to various procedures which might be expected to alter their mineral metabolism.Sodium glycerophosphate injections were used to raise the serum phosphate level. The glycerophosphate was chosen because it was thought that it would be tolerated in larger amounts than the inorganic salt, and because of the growing opinion that phosphate esters may play an important role in the metabolism of calcium and phosphorus.Dogs were given intravenous injections of 50% solution of sodium glycerophosphate, in amounts equivalent...

This report concerns the quantities of calcium retained and the growth in length and weight of 5 white infants fed evaporated milk containing the unsaponifiable fraction of cod liver oil (Zucker concentrate) in an amount which allowed 400 U.S.P. units of vitamin D to the reconstituted quart. When the experiment was started one infant was 11 weeks, one 6 weeks, and the remaining 3 infants 10 to 20 days of age. The vitamin D intake of the youngest infants was 245 units daily; the maximum intake was 400 units a day. The intakes and retentions of calcium per kilogram of body weight are plotted on the chart. For comparison are shown average values from former observations. The solid line shows the average calcium retentions of infants given 340 U.S.P. units of vitamin D daily as cod liver oil and represents 200 periods of study of 24 infants; the dotted line shows the average retentions from 135 U.S.P. unit milk (60 to 135 units daily) as determined from 40 periods of study of 7 infants. The quantities of calc...

This report concerns the preliminary findings regarding the utilization by the human infant of vitamin D from different sources. The criterion chosen was the quantity of calcium retained by well infants given the same amount of milk and the same rat unitage of vitamin D. Irradiated evaporated milk containing 50 units,∗ and evaporated milk containing the unsaponifiable fraction of cod liver oil (Zucker concentrate) allowing 150 units per quart of reconstituted milk respectively, were compared with evaporated milk plus vitamin D given separately as a cod liver oil containing 40 units of D per gram. The Zucker concentrate milk was mixed with plain evaporated milk, and the quantities of cod liver oil were so chosen that the vitamin D unitage of each diet was constant for any given intake of milk, and was regulated by the amount present in the irradiated milk. The youngest infants received only 22 units daily, but by 16 weeks of age, all the infants were ingesting approximately 50 units of D daily. The plan of...

Children 4-12 years of age have been given calcium salts in amounts such that the calcium content was equivalent to that in a pint or quart of milk. The retentions of calcium and phosphorus have been determined and compared with the retentions from the equivalent quantities of milk. The calcium and phosphorus retentions of children from 1 to 4 years of age have been determined when a quart of milk was given as the chief source of calcium, and when a calcium salt was substituted for one pint of the milk. A few studies were made wherein the salt was substituted for all of the milk. The protein intake of each diet was kept approximately constant during the salt and milk periods. The salts used were calcium lactate, carbonate, gluconate, and the di- and tri-phosphates. The latter was given either as the salt or in the form of a purified bone meal. No difference was observed in the relative retentions from the two sources. The results are summarized in Table I.In general, the calcium and phosphorus retentions ...

Summary1. Male rats injected subcutaneously with β-aminopropionitrile and aminoacetonitrile developed the same skeletal lesions of lathyrism as did those fed these compounds. 2. Methyleneaminoacetonitrile fed to rats produced very severe skeletal lesions and is probably more active than the aminoacetonitrile. 3. Diets high in casein, gelatin, vit. E. and other antioxidants did not protect the rats fed Lathyrus odoratus seeds from developing skeletal lesions. 4. Radio-autographs of the skeleton after injection of S35 and studies on sulfur excretion of rats fed Lathyrus odoratus peas and rats fed a control diet showed that the metabolism of sulfur is probably not altered in lathyrism.

The regulation of vitamin-D dosage in resistant rickets (familial or essential hypophosphatemia) is best accomplished by measuring the twenty-four-hour urinary calcium output against the curve of normal excretion. For such comparison the subject's weight and a fairly close estimate of calcium intake are also necessary. Qualitative tests for urine calcium are of no real value in determining the child's status with respect to vitamin-D therapy. Urinary calcium values before treatment are usually three standard deviations or more below the normal mean excretion value. With high doses of vitamin D, urinary calcium rises toward the mean, the rate of rise paralleling the size of the dose. Maintenance of urine calcium at values approximating the normal mean will promote healing of clinical rickets and avoid hypervitaminosis D. A rise of urinary calcium to approximately three standard deviations above the mean, or higher, means hypervitaminosis, and the dosage should be decreased sharply. The abnormal rise in urinary calcium from overtreatment precedes a rise in serum calcium by days or weeks, except after operative treatment when the child will be thrown into acute hypervitaminosis D unless the vitamin is discontinued for a time starting before operation.

In addition to rickets arising from diets deficient in vitamin D or salts of calcium or phosphorus, bone dystrophy has been noted in various disturbances of mineral metabolism which lead to imperfect deposition of the mineral constituents of bone, or to their excessive mobilization. Because of the similarity of clinical picture and the mechanics of production, the term rickets may justifiably be applied to the whole of this diverse group of bone dystrophies. Those cases arising from deficient absorption of inorganic bone constituents should be considered of exogenous origin, whether the deficient absorption be due to inadequate intake of minerals or of vitamin D, to inadequate ultraviolet irradiation, or to other cause. Those instances in which the metabolic disturbance is not dependent upon inadequate absorption are secondary to some endogenous disturbance of metabolism.Several patients with endogenous rickets have been studied intensively in this clinic, and while their bone lesions were very similar, t...

Few reports are available on urinary excretion of thiamine and riboflavin by children, in relation to different food sources in the diet. An opportunity for such study presented itself in connection with a study of utilization of various foodstuffs. Each child in the original study was given in succession a basal diet, which was planned as a diet adequate in all known nutrients, and two experimental diets, wherein one food was substituted at two levels for the given percentage of each food in the basal diet. Thiamine intake varied from 0.47 to 2.83 mg. daily; riboflavin intake, from 0.79 to 3.23 mg. a day. In addition, six children were given diets containing 0.35 mg. or less of thiamine daily until urinary excretion of this vitamin had apparently reached a minimum level or until it was deemed medically desirable to increase the thiamine intake. Materials and Methods The data comprise 84

RHEUMATIC fever has long been recognized as a disease occurring most frequently in children receiving poor environmental care. In the past two decades, the nutritional background of children with rheumatic fever has attracted growing interest.* At the present time, however, it is still not clear whether or how suboptimal nutrition, acting in conjunction with other adverse living conditions, such as poor housing, overcrowding, repeated exposures to infections, and less protection from physical and emotional stresses, increases the susceptibility and modifies the response of the hosts to the disease. Jackson and others 4 found that the recurrence rate of rheumatic fever was lowered in children who had special attention devoted to improvement in their environments, including nutrition. Of the various factors possibly involved, the most significant association was observed between the dietary ratings and the recurrence rate of the disease. They found a significant correlation (inverse) between the adequacy of the

The normal variations in the components of blood phosphorus throughout the period of growth have been established in a previous study. 1 It has also been shown that both in severe rickets in rats 2 and in late rickets in children, 3 the ester (acid-soluble organic) phosphorus of the corpuscles as well as the inorganic phosphorus of the serum is much depleted and that during healing an increase in ester phosphorus is often the first alteration in the blood phosphorus with treatment. The phosphatase content is much increased during active rickets, and it decreases slowly with treatment. 3 The following report concerns alterations in the blood phosphorus in diseases of infants and children, particularly such diseases as may be associated with alterations in serum calcium or inorganic phosphorus. The analytic methods used have been discussed in detail elsewhere. 1 Calcium was determined by the Kramer and Tisdall method; 4 the

Calcium, phosphorus and magnesium are usually considered together, from a nutritional point of view, because all three occur in bone, and, with carbonate, make up the major part of the bone mineral. The metabolic paths of the three elements are by no means wholly parallel, even though the major part of the body content of each is found in the same tissue. Whereas 99 per cent of body calcium is found in the skeletal structures, bones and teeth, both phosphorus and magnesium are important constituents of soft tissue also. The small amount of calcium not in bone is a component of extracellular fluid; magnesium and phosphate, on the other hand, are components of intracellular fluids, and the phosphate radical appears to be essential in an ever increasing number of metabolic reactions. Milk and its derivatives, such as cheese and ice cream, are the chief sources of calcium in the diet

The healing of late rickets has been observed in the pediatric clinic of the State University of Iowa coincident with the maintenance of a low level of inorganic phosphorus in the serum.1One possible explanation of this phenomenon is that sufficient ester phosphorus (acid-soluble organic phosphorus) was available at the site of the deposition of mineral so that, through the action of phosphatase, calcium phosphate could be deposited.2If this explanation is correct, an increase in the ester phosphorus of the blood without a concomitant increase in the inorganic phosphorus of the serum might result in healing of the rachitic process. This report presents the results of a study of the phosphorus partition in whole blood and in serum during healing of late rickets in two children. The serum calcium and the plasma phosphatase have also been studied. The methods used for phosphorus partition are discussed in detail

For many persons some vitamin D in addition to that ordinarily obtained by exposure to sunshine is necessary for the most efficient utilization of calcium and phosphorus. The vitamin acts by increasing the amounts of these substances available for the mineralization of bones and teeth. Measurement of the requirement of vitamin D presupposes the ingestion of a diet adequate in all other respects and particularly containing ample amounts of calcium and phosphorus; it should include also recognition that the human requirement of vitamin D (or of any other nutritional factor) includes both the quantity necessary to prevent obvious clinical pathologic changes and an amount which promotes a condition of normal nutrition and health. The requirements of vitamin D may be defined as those amounts which, with ample intakes of calcium and phosphorus and a diet otherwise adequate, insure sufficient retention of calcium and phosphorus to permit (a) normal growth and

The calcium and phosphorus metabolism of two white girls, 12 and 13 years old, with clinical, roentgenological and chemical evidence of rickets was studied over a period of several months. During this time there was definite roentgenological evidence of healing of the ricketic lesions; the amounts of calcium and phosphorus retained by each child were ample for bone formation; yet the serum inorganic phosphorus of each child remained consistently low, ranging from 2 to 3.2 mg. %. The healing was not due to seasonal influence for it occurred during the late winter months.

The partition of phosphorus in whole blood and serum, the serum calcium and plasma phosphatase have been studied in 2 patients during the slow healing of late rickets of the low phosphorus type. The evidence obtained indicates that the organic acid-soluble (ester) phosphorus of corpuscles is markedly decreased in active late rickets. The lowest value observed was 41.5 mg. per 100 cc. (normal for the age, 66 mg.). This fraction of the blood phosphorus responds very quickly when antirachitic treatment is given, and may reach the normal value before any definite change in serum inorganic phosphorus is observed. The intake of vitamin D by one patient was apparently insufficient to maintain the increased level of corpuscle ester phosphorus. Relatively much greater increases in vitamin D intake were necessary to induce a second rise, and the normal level was not attained until after the serum inorganic phosphorus had been normal for a period of about 4 weeks.The plasma phosphatase values of both patients were 5...

The institution of a milk-free diet is sometimes considered desirable for infants who exhibit an allergic response to milk protein. The use of soy bean flour in these diets has been advocated. The advantages of soy beans in infant feeding have been discussed by Tso 1 and by Hill and Stuart. 2 Soy bean flour is rich in protein, but the protein is of poorer quality than milk protein, and consequently must be fed at a higher level, from 20 to 22 per cent of the total calories. 3 The mineral content of soy bean flour differs considerably from that of milk. 2 Soy beans are rich in potassium and magnesium, but contain very little sodium, calcium and chloride. The percentage of phosphorus is not very different from the percentage of phosphorus in milk solids. In feeding soy bean preparations to infants, it is customary to add sodium chloride and

In the study of the metabolism of calcium and phosphorus, not only are the absolute retentions of these elements of importance, but of almost equal significance is the relation between the amounts of these elements retained. From the total amounts retained, rough standards of the minimal retentions desirable for normal growth have been attained. Through an understanding of the ratio of retained calcium and phosphorus, a better interpretation of the type of metabolism in the child studied may be realized. Of the calcium retained by the body, from 97 to 98 per cent is utilized in the formation of bone; the remainder is found in the body fluids. For practical purposes, the retention of calcium can thus be used as an index of the rate of the growth of bone. Phosphorus, on the other hand, is utilized not only by bone, but also by the soft tissues, particularly the muscles

Until recently, interest in rickets has been concerned more especially with the role of calcium, other elements being considered of secondary importance in the metabolic disturbance. Schabad,1however, early called attention to the phosphoric acid imbalance, believing that it was a more significant factor than the calcium deficiency. In a comparative study of the relation of the phosphorus of the urine and feces of normal and rachitic infants, he observed that there was a marked increase in the phosphorus of the feces in both breast-fed and artificially fed infants affected by rickets, and a corresponding decrease in the elimination through the kidneys. The normal breast-fed infants under his observation excreted 80 per cent of the ingested phosphorus through the kidney and 19 per cent through the tract; while in his normal infants who were artificially fed, 65 per cent of the ingested phosphorus was eliminated in the urine and

If ever a child exerts his maximum capacity for growth, it is during a rapid recovery from severe malnutrition. The increased appetite and rapid increase in weight of such children are well known. This report concerns the growth in height and weight and the retention of nitrogen, calcium and phosphorus of a 3½ year old boy during a rapid recovery from chronic diarrhea and malnutrition which had existed since the age of 2 months. REPORT OF CASE History .—R. W., a white boy, aged 3½ years, suffered from chronic infection of the upper respiratory tract and chronic diarrhea. The child had been born at full term, and weighed 8 pounds (3.6 Kg.) at birth. He had been bottle fed during infancy. At the age of 2 months, he suffered from severe diarrhea, which became chronic. At 6 months, he weighed 8½ pounds (3.9 Kg.). At this time an intolerance toward

Clinical studies1have shown that infants fed evaporated milk grow rapidly and apparently are equal physically to infants fed fresh milk. It has been demonstrated, however, that the calcium of certain forms of heat-treated milk is less available to the human infant than is that of quickly boiled fresh milk.2Because of this it was deemed advisable to study the actual retentions of infants fed evaporated milk. For this purpose nine healthy male infants were studied for periods lasting from eighteen to forty-eight weeks. The evaporated milk used for the feedings was purchased in the open market, diluted with an equal quantity of 12 per cent corn syrup solution and acidified with lactic acid. This mixture was intended to be approximately equivalent to undiluted acidified fresh milk with the addition of 6 per cent corn syrup, which had been employed for similar observations on another group of infants