Nutrition in Thailand

Utah State University
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All Graduate Plan B and other Reports Graduate Studies
5-1966
Nutrition in Thailand
Methee Larptavee
Utah State University
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Larptavee, Methee, "Nutrition in Thailand" (1966). All Graduate Plan B and other Reports. 824.
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NUTR ITION IN THAILAND
by
Methee Larptavee
Report No. l submitted in partial f ulfillment

of the requirements for the degree
of
MASTER OF SCIENCE
in
Food and Nutrition
Plan B
UTAH STATE UNIVERSITY•

Logan, Utah
1966
ACKNOWLE
DGMENT
This thesis was accomplished by the h el p of Dr. Ethelwyn B.
Wilcox. I do appreciate her creativity , intellectual ability , and
her assistance in preparing this piece of work.
I do appreciate Dean Phy lli s R. Snow and Mrs. Grace Smith for
their support, advice, and app ro val of this thesis so it can appear
as it is .
Methee Larptavee
TABLEOF CONTENTS
Page
INTRODUCTION
NUTRITIONOF THAI PEOPLE 3
Nutritional status in Bang Chan, 1952-1954 3
Dietary survey in the north and north east, 1955-1956 5
Dietary survey in the Royal Thai Army, 1955-1956
Dietary survey in the Royal Thai Navy, 1956
Mother and infant dietary survey, 1957 9
Dietary survey in urban and rural areas, 1957 10
Child health survey in rural areas, 1957-1958 11
Nutrition survey in civi li ans and military units, 1960 11
Bang Chan follow-up studies, 1960 34
BODYWEIGHT, HEIGHT, ANDMORTALITYRATE OF THE THAIS 36
THAI FOODSOURCESAND THEIR ABILITY TO SUPPLYNEEDED

CALORIES, PROTEIN, MINERALS,ANDVITAMINS 41
A BASIC FOODPATTERNFOR THAILAND 42
CONCLUSIONS
AND RECOMMENDATIONS 46
LITERATURECITED 51
APPENDIX 53
LIST OF TABLES
Table Page
1. The percentage of reconunended allowance of each

nutrient furnished by Thai diets , 6
2. Methods of rice cooking, Royal Thai Navy, 1956 8
3. Nutritional diseases, Royal Thai Navy, 1956 9
4. Average dietary nutrients per person in three areas

of Thailand, 1957 12
5. Areas surveyed in Thai ICNNDnutrition study, 1960 14
6, Angular lesions among Thai civilians in terms of age 18
7. Prevalence of goiter among civilians 22

131 127
8. 1 uptake and 1 excretion among the Thai military 23
9. Mean serum vitamin C levels among civilians in terms

of ages 28
10. Data on average weight and height of Thai and

American infants 37
11. The composition of foods calculated in terms of 100 gm

retail or cooked weight , 54
LIST OF FIGURES
Figure Page
1. The map of Thailand 2
2. Average daily thiamine intake of Thai people 16
3. Average daily riboflavin intak e of Thai people 17
4. Average daily dietary iron intakes of the Thai

people 19
5. Distribution of subjects according to levels of

hemoglobin 21
6. Average daily vitamin A intake of Thai people 25
7. Average daily vitamin C intake of Thai people 27
8. Average daily fat intakes of Thai people 30
9. Percentage of persons with destructive periodontal

disease by age and sex - military and civilian 32
10. Mean number of decayed, mi ssi ng, and filled teeth per
person by age - males and females combined 33
11 . Average weight of Thai male children compared with

those of United States 38
12. Weight changes of civilian adult males compared with

those of Americans 39
13. Cumulative mortality in infants 40
14. Food for health in Thailand . Eat food from each

group daily 43
INTRODUCTION
Thailand is located in southeast Asia between Burma, Laos, and
Cambodia (Figure 1). It has a long coast line as one strip of land
reaches out into the sea. It has a warm climate with much rain,
espec ially in the south. There are 27 mil lion people in th e area of
200,000 square miles. Rice rank s number one in the Thailand diet.
Next to rice is fish, bo th from fresh water and from th e sea .
A nutritional sur vey was first made in Thailand in Bang Chan
Village in 1952-54, in connection with the Cornell-Thailand proj ec t.
Since the results covered only a sma ll seg ment of the populat ion, a
number of surveys have since been made which were direct ed toward
finding information on nutriti ona l status of additional group s of
Th ai people in other areas of Thai land . The most extensive s u rvey
eve r made in Thailand was the work of the Interdepartment a l Commi ttee
on Nutrition for National Defense in 1960 .
Malnutrition does exist i n spite of the fact that Thai l and is a
food surplus country. Factors in vo lved are an imbalanc e of foods
eaten, often low intake of protein, economic problems in many rural
areas, and sometimes even in urb a n areas, and ignorance or l ack of
education in nutrition .
2
Burma
Ardamen Sea
Malaya ~
Figure l. The map of Thai land (Berry, 1962, p. VI).
NUTRITION OF THAI PEOPLE
The nutritional status of the people of Thailand has been
studied quite extensively since 1952 by a number of investigators
who will be identified as their results are discussed. The first
survey included people in a small village. Additional population
groups of Thai people were studied in seven separate surveys. Then
in 1960 a follow-up survey was made of the people in the first vil -
lage studied.
Nutritional status in Bang Chan, 1952-1954
Between 1952 and 1954 the nutritional status of the people in
Bang Chan, a rice producing village, was determined by Hauck et al.
(1958) as part of the Cornell-Thailand Project. The Bang Chan popu-
lation was divided into two gro ups, A and B, group B being relatively
more prosperous than group A. The people were asked to measure their
food daily. Their activity, economic level, general health, and
dental health were observed. Extensive observations on the general
health of Bang Chan elementary school children were made.
Every house had a fish pond and raised chickens and ducks, but
three out of five of the eggs from the pou ltr y were sold. Every
family had some type of kitchen garden , including banana trees and
some edible plants. However, much of the garden space was used to
raise seasoning (herbs, etc.) and chili which were the preferred
plants. Swamp cabbage, the green leafy vegetable used most often,
grew wild in the canals.

4
Diets were mainly rice a nd fish. Th e highest in take of protein
occurred in the post-harvest seaso n whe n fish ponds were drained.
Pou l try , oxen , and oth er flesh foods were us ed occasiona ll y . Foods,
including vegetables , were prepared hot a nd eaten in small amounts.
Fruits an d desserts were considered as chi ld re n's snacks and were not
preferred by adults.
The heavy work periods for this rice-producing village occurred
during tra nsplan ti ng and harvesting at which times per capita calorie
consu mption was 20 per cent higher.
Since rice was cooked in excess water, and the c ooking water was
u su al l y discarded, the losses of water so luble vitamins such as thi -
amine and riboflavin were high.
Families in group B co ns umed more of all nutrient s exce pt vita-
min A a nd riboflavin than those in gro up A. In ge ner a l, diets of
Bang Cha n people wer e l ower in iro n, ca lcium, vi tamin A, thiamine a nd
riboflavin than the a ll owances for Thai peop l e developed by Hauck et
a l. (1958). This basic table of recommended allowances for nutri e nt
intake of th e Thai people was conse r va ti ve and was a modification of
Nicholl's allowances for people i n t ropic s which took into account
information in the Reconunended Di eta ry All owances of the National
Resea rch Council of the United States an d FAO recommendations. Physi-
ca l signs of malnutrition or und e rnutr iti on most often noted were
changes in the tongue , lip s , skin an d ha ir, and absence of knee and
a nkl e jerk. These symptoms might reasonably be associated with ap -
parent defic i e nc ies of r iboflavin , vi t amin A, and thiamin e in th e
diet. In general, more of the ad ul ts than chi ldren and adolescents
were found to show sign s of malnutrition.

5
Bang Chan e l ementary school child r en, both boys and girls, were
not as tall as the urban Thai children of the same age. Moreover,
Bang Chan children appeared to have seasonal variations in weight for
both sexes and all ages. More than half of them did not eat a regu-
lar lunch .
Of 226 Bang Chan children whose teeth were examined, 68 per cent
were free of caries in their permanent teeth. Redness of gums was
found in about one-fourth of the children.
Certain other signs of nutritional deficiency were found among
these school children. Such signs occurred in 54 per cent of the
school children as compared to six per cent of children six years old
or under and 24 per cent of those aged 15 to 19 in the random sampling
of village households. Two or more such signs were noted in 19 per
cent of the schoo l children although little or no severe malnutrition,
which would cause marked apathy, and no clearly defined deficiency
disease were found among them. Hemoglobin va lues of 11.5 gm or less
per 100 ml were observed in nine per cent of the children .
Deficiency signs most frequently obse rved were in the following
per ce ntages : xerosis of the skin, 15; enlarged liver, 9; hair that
tended to stand on end, 8; leg ulcer, 6; dermatitis of the skin re-
lated to vitamin A deficiency, 5; and bowed legs, 4.
Dietary survey in the north and north east, 1955-1956
Caloric and nutrient content of Thai diets in the villages of the
North and North East sections of Thailand were shown to be below the
recommended dietary allowances of Nicholls (Hauck et al., 1958) by

6
dietary surveys conducted in 1955-1956 by Bisolyaputra and Bocobo
(1959).
The provinces chosen were Chiengmai and Chiengrai in the North,
and Ubon and Udorn in the North East. The serious deficiencies, in
descending order, were of: calcium, riboflavin, thiamine, vitamin A,
and vitamin C. The daily intakes of niacin, iron, iodine, calo .ries,
and protein were acceptable (67 to 95 per cent of the requirement) .
The data for the comparison of intake with requirements is shown in
Tab le 1.
Table 1. The percentage of recommended allowance of each nutrient

furnished by Thai dietsa
Calo- Pro- Cal- Vita- Thia- Ribo- Nia- Vita-

ries tein cium Iron min A mine flavin cin min C
Areas 'lo % % % % % % % %
Ubon villages 86 93 15 87 28 27 23 69 26
Udorn villages 81 78 17 78 44 34 22 73 45
Chieng mai
villages 92 95 22 91 56 41 23 73 74
Chieng rai
villages 79 75 17 75 72 38 17 67 46
aBisolyaputra and Bocobo (1959, p. 41).
One of the important clinical signs of deficiency in these vil-
lages, especially in the North, was beriberi caused by the use of
highly milled glutinous rice. Goiter was also found in this survey.
Dietary su rvey in the Roya l Thai Army, 1955-1956
A dietary survey in the Royal Thai Army was made by Kanchanalaks
and Prasertsom (1959) in 16 units of provincial garrisons during
1955-56. 6905 men aged 21-22 were weighed. Average weight was 55
kg. Food consumption was observed. Total calories per capita aver-
aged 3000 with which 80 per cent of the calories coming from rice.
Fat, protein, calcium, vitamin A, and riboflavin consumption were
below the United States standard set by the National Research Council
in 1948.
Dietary survey in the Royal Thai Navy 1 1956
Dietaries of the Royal Thai Navy were studied in 1956 by
Chalowyoo and Tansathit as reported by Kanchanalaks and Prasertsom
(1959). The naval personnel were classified into three groups ac-
cording to their activities: naval school attendants consisting of
naval cadets and rating trainees; sailors and marines consisting of
shore personnel and fleet personnel; and naval military convicts.
The survey was made in three periods of four months each, so that each
unit was surveyed at three different times of the year for each daily
meal during each period.
Because the personnel surveyed were rice-eating people, observa-
tions on rice consumption and method of cooking the rice were made.
It was observed that the amount of rice consumed was approximately
half of the total weight of food taken, A poor intake of animal pro-
tein, fat and fruits among some classes of naval personnel was ob-
served.
8
Methods of cookin g the rice for the various groups are shown in
Table 2. The wate r used in cooking the rice was discarded by some
groups and not by others.
Table 2. Methods of rice cooking, Royal Thai Navy, 1956a
Class of naval Kind of rice Raw rice

personnel used wash in<> Gookin<> method
1. Naval school
attendants:
Nava l cadets White, highly Once Steamed in individual
milled bowls.
Rating White, highly Closed type; no dis-
Trainees milled Once carding of excess
cooking water.
2. Sailors and
Marines:
Fleet person- White, highly Once Open type; excess cook -
nel milled ing water discarded.
Shore person- Moder;,tely Twice Open type; excess cook-
nel milled ing water discarded.
3. Military Undermilled Once Open type; no dis card-

convicts ing of excess cooking
water.
aChalowyoo and Tansathit (1959, p. 94).
The incidence of nutritional deficiencies was high in the group
which consumed the rice that had the cooking water discarded (Table
3). The high incidence of beriberi for sailors and marines, as com-
pared to that of the naval schoo l attendants (187 vs 5), showed
clear l y that essential nutrients were greatly depleted by cooking
methods.
9
Table 3. Nutritional diseases, Royal Thai Navy, 1956a
Naval School Sailors and

Diseases Attendants Marines Total
1. Anemia of nutri-
tional origin 1 18 19
2. Berib e ri 5 187 192
3. Cholecystitis - 2 2
4. Glossitis,
Che ilitis 2 32 34
5 . Hypertension - 26 26
6. Stomatitis - 27 27
7. B-complex deficiency - 1 1
8. Scurvy 1 2 _3
Total 9 295 304
aChalawyoo and Tansathit (1959, p. 92).
According to the report of the Nutritional Committee of FAO
(Chandrapanond, 1959a), some methods of washing and cooking rice may
cause losses of 10 to 15 per cent of the calories, 10 per cent of the
protein, and as much as 80 per cent of the thiamine.
Mother and infant dietary survey, 1957
The 1957 studies of mother and infant nutrition and health were
made in the urban and rural areas by Chandrapanond (1959a). Pregnant
women and infants in Sathorn Maternal Child Health Center of Bangkok
were observed. It was found that incidence of prematurity of infants,
toxemia in the mother, and neonatal death of the infant were caused
10
from the inadequate maternal diets low in vitamins, minerals, and
proteins.
Infants were mainly breast fed. Some had supplements of cow's
milk. Adult foods were used as supplements at a very early age. At
the age of seven months, about 85 per cent of these infants were
being fed cooked rice as the main supplement. Other foods such as
eggs, pork, other meat, vegetables and fruits were given but in very
small amounts compared with the amount of rice. When infants were
given supplemental foods, milk intake was reduced. Only 15 per cent
of these infants were given vegetables, generally in the form of
soup. In this study eggs were used by 75 per cent of the people
while animal liver was not used . Bananas and oranges were given
frequently.
Dietary survey in urban and rural areas 1 1957
Random sampling was used to select 72 families in Bangkok for a
· year ' s study, 80 families in Chiengmai for three days at different
seasons, and 95 families in Ubol for three days at different seasons
by Chandrapanond ( 1959a) in 1957.
There was a relation between the food habits, general nutritional
status of the population, and availabi l ity of food resources with the
ease of transportation and distribution and with land fertility.
In Chiengmai, people used foods in season, as good transportation
was not available even though the land was ferti l e.
In Bangkok , transportation was good, and thus food markets were
full even during the depression. The foods came from every town and
city. However, the average food intake was somewhat low when compared
11
to the standard adult group in Nicholls' allowances for people in
tropics (Hauck et al., 1958).
In Ubol, the food supply was inadequate, because of the semi-
arid cond ition of the land.
Results of the survey are summarized in Table 4.
Urban diets were more nutritious than those of rural areas be-
cause of the greater variety of foods. The addition of 0.05-0.l per
cent calcium carbonate to the Bangkok diet brought about a marked
increase in weights in albi no rats. The addition of thiamine, vitamin
B-complex, and calcium carbonate to the rural diet increased the
weight of the rats.
Chi ld health sur vey in rural areas , 1957-1958
Some aspects of child health in Thailand were surveyed during
1957-58 in six different rural parts and one of the most crowded part
of Bangkok by Stah li e (1961).
It was found that more than 90 per cent of the babies in the
rural area and 66 per cent of the babies in Bangkok were breast fed
for at l east nine months. This was frequently supplemented with
rice, fruits and some kind of protein food at a very early age. The
principal fruit was banana which was found to contain 40 mg vitamin B
in 100 gm. Egg and lean pork were used as the protein supp l ement.
Nutrition survey in civilians and military units , 1960
Dietary habits and the nutritional status of the people in 12
civilian and 11 military units were studied du.ring October-Dec ember
1960 by the Interdepartmental Committee on Nutrition for National

Table 4. Average dietary nutri ents per person in three areas of Thai land, 1957a
Thia- Ribo - Nia - Ascorbic

Calorie Protein FatsCHO Calcium Iron Vit. A mine flavin cin Acid
Area gm gm gm mg mg IU mg mg mg mg
Bangkok ( urban) 1409 47 42 208 180 7.3 1678 0.82 0.61 10. 2 60
Chiengmai (N) 1851 46 23 365 354 8.4 1368 0 .80 0.80 12.0 87
Ubol (E) 1722 43 6 330 430 6.99 465 0 . 56 0.40 11.0 96
aChandrapanond (1959,i, p.. 89).
,...
N
13
Defense (ICNND) (Berry, 1962). The civi li an gro up s included 1107
boys, 587 of whom were under and 520 of whom were over 15 years of
age; a l so 1282 gir l s with 6 11 under and 671 over 15 years of age.
The 4325 military personnel ave r aged 22 years of age. The l ocation
of the areas of the survey is shown in Table 5.
Vi ll ages selected for this surv ey were particularly small, were
not situated on a main transportation arte r y, and were at least five
km f rom a town. For the boys and g irl s in the survey, food intakes
were calculated and c linic a l s i gns of nutritional deficiencies were
tabulated. Food resources were rice , fish , meat and some vegetables.
Rice was mainl y consumed as milled r eg ular rice and glutinous r ice .
Except for iron and calories, glutinous rice was superior to regular
ric e. Fish were caught along the sea coasts of the Andamen Sea and
the Gulf of Siam, along th e rivers, lakes, canals, and from fish
ponds. Cows, pigs, chickens an d ducks were raised by the farmers.
The choice of foods was related to preferences developed by the
Thai people. Seasonings and sp ic es were used in most dishes . Vege -
tables were not in the regular daily menu. Fruits were often us ed for
children's snacks. Among th e civilians, some foods were ea t en half
raw and half cooked but among the military, foods were well cooked .
Rain, wells, and canal wat e r were us ed in the areas where a supply of
running water was not available. Large a luminum tanks (for civi li ans)
and cement tanks (for militar y) were general ly used to coll ec t rain
water during the rainy seasons.
The average nutrient intake of the civilians was smaller than
that of the military, perhaps b eca use the civilian groups in c lud ed
14
Table 5. Areas surveyed in Thai ICNND nutrition study, 1960a
Military: 11 location sb Civilian: 12 loc ations
1. Chiengmai area 1. Chiengmai Area

7th RCT and Chiengmai MP, Ban Fon Vi lla ge
RTA ( town) c San Pong Village
7th RCT, RTA (environ s) Padad Vi ll age
2. Udorn Area 2. Udor'l Area
13th RCT, RTA (environs)d Rachinutis High School
13th RCT, RTA (town) Phon Ngam Village
Marg Yah Village
3. Ubol Area
6th RCT, RTA 3. Ubol Area
Sri Kai Village
4 . Lopburi Area
Ban Kao Village
Kokethiem Air Base, RTAF
Nong Manao Village
(enlisted)
Kokethiem Air Base, RTAF 4. Central Area
(NCO' S) Bang Chan Vi ll age
5. Bangkok Area 5 . Lopburi Area
1st Cavalry Regiment, RTA Ta Kae Vi ll age
11th In fantry Regiment, RTA 7. Songkhla Area
6. Sattaheef Area Bang Dan (Buddhist) Village
Marine Base, RTN Dan Kee Leg (Islam) Village
7. Songkhla Area
5th RCT and Songkhla MP, RTA
~Berry (1962, p. VII).

Abbreviations: RTA = Royal Thai Army
RTN = Royal Thai Navy (Mar i ne Corps)
RTAF = Royal Thai Air Force
MP = Mili tary Province (Militia)
RCT = Regimental Combat Team
c(town) = examination site within the city.
d(environs) = examination site well outside the city.
15
people of all ages, from one year to old age. The findings of the
nutritional status survey of the various groups of Thai people were
discussed for each nutrient studied.
Thiamine nutrition. The Department of Health recorded that 1770
persons died of beriberi in 1957. The principal endemic area for
beriberi was in the Chiengmai area.
The International Conunittee on Nutrition for National Defense
(Berry, 1962, p. 35) reported that Ramalin gaswami found the incidence
of peripheral neuropathy among adults and adolescents in Chiengrai
and Ubol to be 24 and 12 per cent respective l y, and that prevalence
paralleled the infant mortality rates. In infants, beriberi caused
rapid death or the child made a rapid recovery. The loss of deep
tendon reflex and bilateral loss of ankle jerks were found to be
associated with beriberi. One per cent of the subjects showed this
loss of bilateral ankle jerk. Thiamine intake was deficient among
civilians. The mean intake was 0.24 mg per 1000 calories for the
civilians as compared to 0.63 mg for the military (Figure 2) .
Riboflavin nutrition. All groups except the military in Songkhla
were below "acceptable" level in dietary intake of riboflavin (Figure
3). Angular lesions at the corners of the mouth were observed among
both civilian and military groups in every area studied, the higher
incidence areas (10 to 12 per cent of the subjects) being in Udorn,
Ubol and Chiengmai. Among the military, angular lesions were more
prevalent in the younger men 21 to 24 years old (six per cent) as
compared to the incidence for a ll older men (one per cent). Among
the civilians, there was a definite peak of incidence exceeding 12
per cent for both males and females 5 to 9 years of age (Table 6).
16
efi- I Accept-
cient •Low able High- 1. Chiengmai
2. Udorn
No. of Subjects 3. Ubol
1 --- --, 96 4. Lopburi
2 127 5. Bangkok
3 123
4 60 6. Sattaheep
7 107 7. Songkh l a
513
i===J Civilian
(ZZZZZJ Military
~ !'-,,'-r+-rr~~ LO.
21"-7''-+-,,<..,,,_,,.-,,.....,,_.,'-r'+-.,,_.,~
l l'-,<'-,L--,L-,,,_,,.'-,''-,1-~
7 912
0. 2 0 .4 0.6 0.8 1.0 1. 2 1.4 1. 6
mg per 1000 calories
Figure 2. Average daily thiamin e intake of Tha i people

(Berry, 1962, p. 32) .
17
I
Deficient I Low Acceptab l e
I I
: No . of Subject~
~ f--~~~~~~~~~--' 96 1. Chiengma i
127 2. Udorn
123
i 1---~----'-- 60 3. Ubo l
71--------I 107 4.
5.
Lopburi
Bangkok
513
6. Sattaheep
7. Songkhla
r:::==:::=J
Civilian
cz::::z::z::a
Milit ary
9 12
0. 0. 0.6 0.8 1.0 1. 2 1.4 1. 6
mg per person per day
Figure 3. Average daily riboflavi n in take of the Thai people

(Berry, 196 2, p. 38).
18
Table 6. Angular lesions among Thai civilians in terms of agea
Aoe lvears\ 0 - 4 5 - 9 10 - 14 15 - 44 45+
An2u l ar Lesions Per cent orevalence
Males 3.0 12 . 2 10 . 7 6. 3 2, 3
Females 4.5 12.4 4.4 4 .3 3.5
Females, pregnant 6.0
Females, lactating 4. 2
aBerry, 1962, p . 40.
Although there was considerable variation from area to area in
the prevalence of angular lesions , such variations did not correlate
well with th e dietary and biochemical findings, nor was any exp lan a-
tion readily apparent for the higher incidence in the 5 to 9 year old
children. However, children of this age group had the highest ribo-
flavin excretion values ( 40 to 48 mcg per gm of creatinine). The
median excretion for the civi li an grou p was 30 mcg per gm which was
slightly higher than the 24 mcg for the military group.
Iron nutrition. Mean iron intakes exceeded 18 mg per person per
day for both the military and civ ilian groups (Figure 4) , However,
a nemi a was found to be prevalent o Other studies have shown that
anemia in many developing tropica l countries does not respond to iron
therapy . Also, the existance of infections by parasites or chronic
infectious diseases will cause anemia even when iron intake is high.
19
D L A
e o c1
fr: Cl High
i I el
c I I pl
i I It 1
e l Ia
1
n I I bl 1. Chiengmai
I 111 2. Udorn
I
e 3. Ubol
1 96 4. Lopburi
2 127 5. Bangkok
3 123
6. Sat taheep
1 189 7. Songkhla
Total 513
~~~~!Civilian
1
2
3
4
5
6 361
7
Tota
0 9 18 27 36 45 54 63 72 81 90 99
Figure 4. Average daily dietary iron intakes of the Thai people

(Berry, 1962, p . 44).
20
Mean hemoglobin v a lues for the military were fairly good with a
mean value of 13 gm per 100 ml of blood . However, 12 per cent of the
military had hemoglobins below ten grams . Civilians had similar
values with their mean being 11 . 6 gm (Figure 5). More civilians than
military showed signs of anemia; 22 per cent had hemoglobins below ten
gm with some below four gm.
The incidence of anemia was partly due to the incidence of
intestinal and other diseases including malaria and typhoid fever .
In 1957, 10,458 deaths occurred in Thailand from malaria and 1 , 556
deaths from typhoid and paratyphoid fevers . Amoebae , round worm,
hookworm, and liver flukes were all observed with appreciable fre-
quencies . Many subjects were infested with more than one parasite .
These findings applied to both the military and civilian groups .
Less than ten per cent of either group was completely free of
parasites or enteric pathogens .
Iodine nutrition. The International Committee on Nutrition for
National Defense (Berry, 1962, p. 55) observed that Sem Pring-paung-
glo delineated a "goiter belt" during his studies from 1933 to 1951
that extended from Burma across northern Thailand on into Laos . In
1956, Ramalingaswami (Berry , 1962, p . 55) found that the incidences of
goiter were 58, 58, 21, and 15 per cent among people in Chiengmai,
Chiengrai, Ubol and Udorn respectively . Suwarick et al . (Berry,
1962, p . 55) found an increased uptake of radioactive iodine in iodine
deficient subjects .
There was a prevalence of goiter among both military and civili-
an groups except in the Bangkok and Songkhla area . In the army ,

21
35 I
Deficient Low I Acceptab l e High ---,.
I
I
30 I
25 t==t Civilian
" [llZZ'.l Military

-~
.., 20
~
....
.D
...
..,
....
"' 15
"O
..,
"u
"'
.. 10
"'"'
3.0-3.9 4.0 -5. 9 6 . 0- 7 . 9 8 . 0 - 9 . 9 10 .0- 11.9 12 . 0-13 . 914 . 0- 14 . 915.0-16.9 17 . 0-19.9
gm per 100 ml of blood
Figur e 5 . Di st ribution of s ubjects accor din g to l eve l s of hemog lo bi n

(Berr y , 1962, p. 45) .
22
ther e were one and th r ee per cent visib l e goiter and 13 and 20 per
cent invisib l e goiter in Udorn and Ubol respect i ve l y; in the air
force, one per cent visible goiter and eight per cent invisib le
goiter; in the navy, two per cent visib l e go i ter and 14 per cent
invisib l e goiter . For civilians, data are recorded by age group in
Tab l e 7. Regardless of the age group, Chiengmai and Ubol areas had
the highest percentages of civilian subjects with goiters. In Lop-
buri, subje c ts over 15 years of age showed a fair l y high incidence of
goiter but the younger children did not show this high frequency .
Pr eg nant and l actating women showed an incidence of 25 to 35 per cent
having goiters.
Table 7. Preva l ence of goiter among civi l iansa
Location Ages 0-14 vears Ages 15 + vears

Male Female Mal e Femal e
No. % No. % No. ')'. No. %
Songkh l a 81 0 90 0 94 0 116 2
Chiengmai 114 28 111 33 136 21 163 58
Lopburi 41 2 33 6 34 12 58 43
Udorn 2 15 4 231 11 129 10 158 30
Ubol 136 40 147 75 127 48 145 72
aBerry, 1962, p. 48.

23
The affinity of tt ,e thyroid gland for administered radioactive
iodine among military subjects is shown by the uptake and excretion
data in Table 8.
131 127
Table 8. 1 uptake and 1 excretion among the Thai militarya
1131 uptake Meg 1LZ/ in urine per gm

Per cent rro ,f- 'nino
131
Mean 1
Site No. of Mean and No. of Mean and uptake for
Province area subiects S.D. subiects S.D. this grouo
Songkhla 15 36± 7. 1 15 38:±"6. 5 36 .0
Bangkok 12 48:±"8.9 8 55:±-32_5 47.4
Chiengmai 14 58:!:"14.5 11 29~13 . 8 57 . 3
Ubol 13 46±11. 5 12 78::29 . 9 47 . 5
Udorn 15 59:: 7 . 2 -- -- --
Washington, D.C. -- -- 15 180:'.57. 7 --
aBerry, 1962, p. 49.
131
The mean uptakes of 1 for both civilian and military subjects
in Songkhla and Bangkok were lower than in the Chiengmai areas which
131 131
had the highest mean uptake of 1 The normal mean for 1 uptake
127
should fall within the range of 30 to 45 per cent. Excretion of 1
by all groups of the Thai military was much lower than was found for
subjects in Washington, D.C . The reason for the low urinary iodine
values was not clear . There was evidence that goiter was mor e preva-
lent in females than in males . There was also evidence that iodine
24
malnutrition was a serious problem in Thai l a nd . This st udy recommends
that a ll sa lt shipped from Bangkok be iodized as most of the sa lt
used throughout the coun tr y passes through Bangkok.
Protein nutrition. Mean prot e in intakes were found to be at
"acc e ptabl e " l eve ls, that is, in excess of one gram per kg in eve ry
gro up studied, for both the military and civilian subjects . Bio -
che mi cal ana l ysis for serum a lbumin for each of both group s atta in ed
mean va lu es i n th e "acceptable" range. Thus total protein intakes
see med satisfa ctory. However, a lar ge proportion of the total prot e in
int ake was of vegetab l e origin, principally rice. During the sur vey
it was found that, among both mi li tary and civi l ian groups, an ave r age
of about on e -t hird of th e protein intake was derived from anima l
s our ces. In the military group, approximate l y 58 per cent of the
total prot e in intake came from rice.
The 1955 report by Netrasiri, A and Netras iri, C (Berry, 196 2 ,
p. 59) estab li shed that prot e in malnutrition exis t ed in Thai l a nd in
the form of typical kwashiorkor, with over half of their 54 cases in
Bangkok being in the one to two-year -·o l d age group. Infections,
particu l ar l y meas l es, ascarias is, amoebiasis, bacillary dysentery,
angular l es ion s, and ocular l es ions assoc i ated with v it amin A defi-
ciency were found among the lower socio-economic group. The ass ocia-
tion between kwashiorkor a nd xer ophth a lmia had been empha s i zed by
oth e r workers.
Vitamin A nutrition. Although th e dietary studies suggested that
vitamin A intake among both military and civilian group s was in the
"de fici e nc y " and "lo w" ranges res pect i ve l y (Figure 6), th e mea n
25
1
?
J
Deficient I
I
!
Low
' ~8
!Acceptab l e : High
I No. o~ Subjects
19
I
- 1.
2.
Chiengrnai
Udorn
4 l' u I I
3. Ubol
7 23 1 4. Lopburi
Total I 93 j I 5. Songkhla
l 6. Sattaheep
I
I I 7. Songkh l a
I
I I I c=:=:=Jci vilian
l 1T7 7777A 527
I e2:.Z.Z..21Military
2 1777 777'! lll7I I I
i ,,
7.,.
7 77771
/////
156 I I
838
5 7 777'"71 l 495
6 1 /// ///
I 361
I I
]// ////J
I 912 I l
-, -7 77711 4402
Total 17T7 I
I
I
I
I I
I I I
I I
I I
I I
I
I I
I
1000
!
2000 3000
I
I
4000
.
l
5000 6000
I.U. per person per day
Figure 6. Average daily vitamin A int ake of Thai peopl e

(Berry, 1962 , p. 60).
26
calculated serum vitamin A and serum carotene values showed that al-
most all groups fell into the "acceptable" range. Very few subjects
were in the very high or very low ranges. There was a gradual rise
in serum levels of vitamin A and carotene with age.
A total of eight cases of Bitof ' s spots was seen in all age
groups among the civilians, six of which were in the moslem village
of Don Kee Leg near Songkhla. Xeropthalmia was thought to exist
although the survey did not find it. The January-June 1960 Semi-
Annual Report of the Children's Hospital of Bangkok (Berry, 1962,
p. 61) listed nine cases of vitamin A deficiency out of a total of
3,500 patients, or 0.26 per cent.
Oomen (Berry, 1962, p. 62), in discussing vitamin A deficiency
in Southeast Asia, stated that neither the serum level of vitamin A
nor that of carotene was very helpful in establishing a diagnosis ex-
cept when the level was so low that xeropthalmia or keratomalacia
developed.
Vitamin C or ascorbic acid nutrition. Scurvy was not considered
a problem in Thailand. No clinical evidence was found. However,
vitamin C intakes were in the ranges of low and acceptable (Figure 7).
The mean serum values for vitamin C in the various locations were
universally in the "high" or "acceptable" ranges. The values among
civilians were considerably higher than among the military groups,
presumably a reflection of the absence of almost all fruits from the
military diets. Among the civilians, the Oto 4-year-old children
had the lo west values as shown in Table 9.
In the clinical findings red and swollen gingiva were observed in
10 to 18 per cent of the civilian men and women over 15 years of age.
27
Def i- : I
cient
I
Low I Acceptable High ---->-
I
No. cit Subjects
l I 96 l. Chiengmai
2 I I 127 2. Udorn
3 I I 123
4 60 3. Ubol
7 I
I 107 4. Lopburi
I
Total I 513 5. Bangkok
I 6. Sattaheep
I
I 7. Songkhla
I
I
I I
1
j
4
/////////!
///////..11
//////
'./////////Al
I
I 1m
527
R38
Civilian
V 7 77 %Military
5 I/ / / / / / / / / / / / 495
6 //////I 361
7 //////////1 912
Total ///////// 4402
I I I
I
I I
I I I
I I I
I I
I I I
I I
I I
I I I 1
10 20 }O do 50
1
60
Figure 7. Average daily vitamin C intakes of Thai people

(Berry, 1962, p. 64).
28
Table 9. Mean serum vitamin C levels among civilians in terms of

ages a
Age (years)
0-4 5-9 10-14 15-44 45+
Males:
Serum vitamin C, mg/100 ml 0.46 0.86 0.94 0. 70 0.68
Percentage with low values 14 .3 -- -- 1. 9 5.3
Females:
Serum vitamin C, mg/100 ml 0.58 0.82 1.03 0.85 0.63
Percentage with low values 22.2 -- 5.0 -- --
aBerry, 1962.
Fewer cases were found in the younger age groups. For the military
the incidence was 4 to 13 per cent. Recession of gingiva was more
prevalent among the older civilian gro ups, 30 to 58 per cent, than
among the military, 5 to 25 per cent.
Niacin nutrition. No evide nce of pellagra was seen during the
course of survey. Since rice in any form contains appreciable amounts
of niacin, and this is largely retained through milling, washing,
soaking and cooking, niacin nutrition presents no public health prob-
lems to Thailand. Biochemical excretion data clearly show that ap-

1
preciable amounts of N meth y lnicotinamide were uni versal l y excreted
in the urine, and not one subject, military or civilian, proved to
have an excretion of less than 0.50 mg per gm of creatinine.
Calcium and phosphorus nutrition. The civilian intake suggested
that calcium intakes were marginal. However, no clinical evidence of
any type was e ncountered to suggest calcium deficiency even among

29
children and pregnant women, and no cases of rickets were seen to
suggest that vitamin D metabolism was compromised. Average calcium
intake figures which included those for children were 266-278 mg per
person per day.
The military intake of calcium was adequate with a mean of 675
mg per person per day.
Phosphorus intake was much higher than that for calcium. As
calculated from standard food tables, the mean intake of phosphorus
among all army units combined was 1,422 mg per man per day, and among
all civilian groups combined was 658 mg per person per day.
Fat and cholesterol. Average fat intake was low among both
civilian and military groups (Figure 8). However, there was wide
variation from family to family, and from area to area. The mean
cholesterol level was 128 mg per 100 ml of serum for 24 children less
than 15 years of age, and 132 mg for 38 adult civilians. Only one
child had cholesterol values which exceeded 200 mg. This was a girl
in the 5 to 9-year age range.
Salt intake and blood pressure. Sea salt intake was considered
high enough to create some degree of hypertension. Average intake of
salt was 9 gm per person per day for civilian, and 18 gm per person
per day for military. This might be due to the preferenc e of high
seaso nings and the use of much salted fish by the Thai people.
The mean blood pressure among the military for all groups com-
bined based on 880 subjects was 117 and 74 mm of mercury for the
sys tolic diastolic pressures with a range of mean systolic pressures
for each location of 114 to 120 mm and of mean diastolic pressures of

30
No. of Subjects
1 1. Chiengmai
2 2. Udorn
3 3. Ubol
4 4. Lopburi
7 107
5. Bangkok
Total 513
6. Sattaheep
7. songkhla
1
2
r:::=:==:=J
Civilian
3 I/// ,1 Military
4
5 495
6
7
Total
0 10 20 30 40 50 60
gm per person per day
Figure 8. Average daily fat intakes of Thai people (Berry, 1962,

p. 70) .
31
69 to 77 mm. Among civilian adults (15+ years), 384 determinations
provided a mean of 118 and 73, with a range of mean systolic pres-
sure of 108 to 123 mm of mercury, and of mean diastolic pressures of
67 to 79 mm of mercury. These blood pressure values were within the
normal range. Hypertension was no problem. Very little increase in
blood pressure accompanied advancing years until the eighth decade.
Then the values were 142/81 mm for men and 134/82 mm for women.
Dental health. Fluoride in water samples ranged from 0.00 to
0.80 ppm. Fluoride in urine samples ranged from 0.78 to 2.92 ppm.
Thus fluoride intake was not from water alone. Dental fluorosis was
low in the south but high in the north where dental decay and the
mean number of DMF teeth were extremely low.
Periodontal disease (Figure 9) was prevalent in spite of low
dental decay and DMF number (Figure 10) . By age 33, 50 per cent of
the civilian males were affected and 45 per cent of the females.
Only 20 per cent of the military of this age group had developed
severe cases. The same relationship in number of cases between
civilians and military occurred at age 44. Less periodontal disease
among the military was considered to be the result of the oral hy-
giene practiced by them.
The number of decayed, missing and filled teeth per person was
extremely low compared with the levels in the United States. These
low DMF levels (below two) were constant until after 40 years of age
when there was a sharp rise due to the loss of teeth caused by
periodontal disease.
32
100
/
""' 90 I
"'"
U) I
I
·~
///
-0
..... 80
"'
'-'
c I I
0
,//
-0
0
·~ 70
"0."
·~";,
'-'
<.J
60
I
I
//
I
""
'-'
U)
//'
"
-0
50
..c:
'-'
·~
:,
I
//
I
----
U)
/I
c 40
0
U)
Civilian males
""
0. I I t--- __ _.
.... Civilian fema l es
0 30
I
I
'
I
"Oil Military males
~
c
"
<.J
""
20 //
I/
0. / I
10 j
_/j'
0
5 10 15 20 25 30 35 40 45 50 55 60
Age in yea rs
Figure 9. Percentage of per s on s with des tructive periodont a l

disease by age and sex - military and civilian (Berry,
1962, p . 79) .
33
24
22
20 Th a il a nd
"o ,a o Ba l t imo r e , Md ., U. S . A.
...
<I) 18
<11
a.
...
<11
a. 16
,;=;
<11
<11 14
"
.,:,
<11
.-<
....
.-<
4..;
12
.,:,
""' 10
"°
....
"
<I)
<I)
8
·g
.,:,
Q) 6
>,
"'
u
Q)
.,:,
4..;
4
o
...
Q)
.D 2
z
9
0 0- 5- 10- 15 - 20- 30- 40- 50 +

4 9 14 19 29 39 49
Age in yea r s
Fig u re 10 . Me an numbe r o f d eca y ed., mi ss ing, and fill ed tee th pe r

p e r s on by age - mal es a nd f emales combin ed (Be rr y,
1962, p . 79) .
34
Bang Chan follow-up studies, 1960
In 1960 Bang Chan village was revisited by Hauck and the 1960
ICNND Thai-American Nutrition Survey Team (Berry, 1962, p. 247-261).
They found that the food consumed was somewhat lik e that observed in
1952. Rice provided four-fifths of the calories in the diet. Rice
was cooked in excess water, and the cooking water was usually dis-
carded. Fish was the food next in abundance. The highest intake of
protein occurred in the post-harvest season, when the fish ponds were
drained. Nearly all the families raised chicke ns and some raised
ducks. Eggs appeared to be used to a greater extent in 1960 than
they were in 1953-54.
Every family had a kitchen garden, but seasonings and chilies
were much more commonly grown than vegetab l es and fruits. Swamp cab -
bage, the green leafy vegetable used most often, grew wild in the
cana l s.
Over 90 per cent of children ate snacks which usually were des-
serts and fruits. Many of them ate no regular lunch.
Dietary patterns during pregnancy, postpartum rest period and
lactating, and for infant feeding, were much lik e those in 1952.
During pregnancy most women in Bang Chan continued to eat as usual.
Only some women omitted some kinds of food. During the postpartum
rest period most women ate a very strict diet which made them prone
to develop beriberi and other signs of deficiencies. During la cta-
tion most women ate the family diet. Breast feeding for most infants
was continued into the second year. Half of the infants had been
weaned by 18 months and nine-tenths of them by the time they were two
35
years old. Few recei v ed animal milk after weaning. Sometimes
sweetened condensed milk was used.
Most infants gained in weight up to six months of age; there-
after most of them experienced constant weight, or even weight loss
and stunted growth. Weaning appeared not to be a major factor . Such
periods were observed among school children 7 to 14 years of age, as
well as infants and small children.
The signs observed among Bang Chan people were generally those
associated with low intakes of thiamine, riboflavin, protein, and
vitamin A. These were the same as those found in the 1952 survey.
However, there was neither beriberi nor loss of ankle jerk or knee
jerk among 251 individuals.
The Bang Chan biochemical findings among five to nine - year-old
males were lower than the average found in the general Thailand
survey of 1952 . Total serum protein and serum hemoglobin values were
lower than in the general survey. An exceptionally severe degree of
hypochromic anemia was also found in the Bang Chan follow-up study.
Dental decay was not often found. However, evidences of marginal
gingivitis were found in the majority of children and all of the
adults. This condition began at a very early age and rapidly pro-
gressed to advanced stages of periodontal disease by middle age.

BODYWEIGHT, HEIGHT, ANDMORTALITYRATE
OF THE THAIS
Weight and height of 20 infants in Sathorn Maternal Child Health
Center, Bangkok, were collected monthly for a period of one year by
Chandrapanond (1959b). Data were compared with those from American
infants as shown in Table 10. Weight and heights were found to be
similar for the two groups of infants up to eight months of age .
Then the United States infants showed somewhat better growth than the
Thai infants.
From 1 to 20 years of age height and weight of Thai males (Figure
11) continued to be lower than that for United States males (Berry,
1962, p. 15-18) . Female s showed a similar pattern.
The Thai people are relatively small in sta tur e compared with
people of the United States. Their maximum body weight is reached at
the age of 20, followed by a gradual decline in weight. Vietnamese
are of similar stature and follow a similar pattern. The weight of
American people rises steadily until the age of 60 and 70. These dif-
ferences for men 15 to 75 years of age are shown in Figure 12.
Females showed a similar pattern.
The mortality rate was observed to be high, especially among
infants and children as compared with American children (Figure 13) .
Of the liv e births 50 per cent of the Thai were dead by age 15 years
in 1957 and in the United States by age 63 years in 1958 .

37
Table 10 . Data on ave r age weight and height of Thai and American
infants 8
Thai American
Age in Weight Height Weight Height
months kg cm kg cm
Birth (0) 3.1 3.46
l 3.97 55.2 3.98 51. 5
2 5 . 09 57. l 4.8 55.9
3 5.98 60.7 5.5 58.7
4 6.7 62.5 6.2 60.9
5 7 .11 63.0 6.7 63 . 5
6 7.48 65.6 7 .4 65.6
7 7. 77 67.9 7.78 67.2
8 7.87 68.8 8.1 68 . 4
9 8.22 69.9 8.6 70.l
10 8.4 69 . 9 8.9 71. 2
11 8.58 71. 7 9. 2 73.3
12 8 . 76 73.3 9.5 74 . l
aChandrapanond, 1959b, p. 7..

38
60
55
50
45
40
35
30
00
c.., 25
-"00
..,
~ 20
15
10
l 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Age (years)
Figure 11. Average weight of Thai male children compared with those
of United States (Berry, 1962, p. 16).
39
65
60
55
so
~ 45
:=,
..,
_,::
-~
~
40 0 0 u .s.
:,:
Thai
35
30
15 25 35 45 55 65 75
Age (years)
Figure 12 . Weight changes of civilian adult males compared with

those of Americans (Berry, 1962, p. 18) .
40
45
"
.,.
4...
.....
4...
0 40
...
"'
"
;,,
.., 35
....
"'
,.
4...
00
30
.,.
c:
...
::>
25 0 -----<O
"' U.S.A. - 1958
"'
.c
µ
"' 20
"'"
.....
µ
µ
"'
0
4...
0
µ
c:
"u
...
"
0..
12
Age (month s)
Figure 13 . Cumulative mortality in infants (Berry, 1962, p . 21).

THAI FOODSOURCESANDTHEIR ABILITY TO SUPPLY
NEEDEDCALORIES,PROTEIN, MINERALS,
ANDVITAMINS
Foods high in protein, minera l s, and vitamins that are available
to the Thai people and their food values as obtained from food tables
of Chatfie l d (1954), Watts and Merrill (1963), and Wenkam and Miller
(1965) are shown in Table 11, Appendix.

A BASIC FOOD PATTERNFOR THAILAND
Nutrition workers in the United States have found that the
easiest way the average housewife can be assured of giving her family
a good diet is to use the Basic Four Food Groups (Page and Phipard,
1957). The use of the minimum number of servings listed for each of
the food groups forms a foundation for a good diet . Workers in other
countries have adapted this plan using foods common to their locali-
ties and the dietary customs of their people. Of particular impor-
tance is the chart developed by Roberts (1954) which lists Puerto
Rican foods that need to be emphasized for an adequate diet . A simi-
lar chart is used with native foods in Hawaii. Such a guide provides
a simple pattern that can be used by women in all areas of a country.
The author has worked out such a plan for Thailand .
In Thailand, calcium intak e is often marginal. Howev e r, milk is
expensive and is not available to everyone. Even dried skim milk is
e xpensive. Sweetened condensed milk is used in coffee and tea.
Small fish of several kinds often are the best source of calcium .
Dry sesame seeds , seaweeds, molasses, green mustards, and soybean
curd (tofu) are the next best sources . These foods form group l in
Figure 14 . This group also would provide protein and the B-vitamins .
In the second group high quality protein, iron, and the B-vita-
mins are provided . This group is for muscle bui l ding, blood building
a nd for genera l good health . It is especial l y important in pregnancy,
for children, and for adolescents. Fish, pork, chicken, ducks , and
43
1. 2.
small fish fish
crustaceans poultry, eggs
crabs meat - liver, kidney,
mullusks heart, etc .
shrimp peanuts, cashew nuts
soybean curd gree n cow peas
green mustard pigeon peas
dry sesame seeds soybean, broad bean
okra dry mung bean seeds
mung beans green lima beans
mollasses dry hyacinth bean
seaweeds seeds
milk : cow, goat other nuts
4. 3.
vita-rice or par- spinach cauliflower
boiled white rice swamp cabbage taro l eaves
coconut turnips cararnbola
enriched bread or ripe tomato pummelo
whole cereal bread squash cabbage
sweet corn pumpkin sorrel
sweet potatoes
-=-=-=-="'----'--"--""'-'c..=.:'-"''--'::.:.:."-'"""---"'
a~nd~ 1 gree n onions
carrots ~G~r~o~u~p'--"'--':.::.;~:c::.:""-~
mangoes
guava
Figur e 14. Food for health in Thailand. Eat foods from each group
daily.
44
eggs are the best anim a l sources in Thailand. Beef is used also.
Liver, heart, and kidneys are especia ll y rich and should be used .
Other foods that may be used for protein are dry mature seeds of
hyacinth beans, dry sesame seeds, soybeans, pigion peas, cowpeas
(immature seeds), peanuts, sunflower seeds, yeast, almonds, mung
beans (dry mature seeds), broad beans, cashew nuts, and lima beans
(immature).
Vegetables and fruits make up the third group. They provide
many of the important v itamins and minerals . Foods in this group
shou l d supp l y over half the vitamin A and all of the vitamin C
recommended daily for good nutrition.
The use of three to four servings per week of dark green leafy
or deep yellow vegetables or yel low fruits will supply sufficient
vitamin A and part of the B-complex vitamins. Vegetables and fruits
high in vitamin A and B-complex vitamins are green mustard, okra,
green onions, mangoes, papaya, green peas , chili peppers, dock,
hyacinth beans, cow peas, pumpkin, purslane, soybeans (immature seeds)
carrots, white mustard, snap beans, lim a beans, broad beans, spin -
ach, swamp cabbage, sweet potatoes, tanger ines, ripe tomatoes, and
squash.
Citrus fruits or other vegetab l es which are good sources of
vitamin C sho uld be eaten every day. Vegetab les and fruits high in
vitamin Care guava, green mustard, papaya, oranges, mangoes, sorrel,
jujube, horseradish, soursop, cauliflower, sweet potato es, pummelo,
carambola, cabbage, broad beans , spinach, taro leaves, tomatoes, chili
peppers, green onions, and green peas.

45
The cereals group provid es energy as well as nutrients . Since
highly milled white rice is widely used in Thailand, a wise selection
is needed. Parboiled rice and enriched rice under the name "Vita-
Rice" should be chosen for their nutrient value. An on-going exten-
sive educational program is needed to teach all the Thai people to
use the processed rice. Methods of cooking rice should be improved .
The people should be taught to cook rice with just enough water so
that a ll will be absorbed. The Thai government has sought to en-
courage this method but continued educat ion is needed.
The amount of food consumed from the cereal group depends on
age, size, sex, and activity as we ll as the amount of starchy and high
calorie foods in other groups.
For better understandin g, the four groups of foods in Figure 14
shou ld be illustrated with colored pictures of the foods. Size
serving of foods in each group for different ages should be listed by
th e food pictures. Important nutrients provided by each group should
be exp l ained on the back of the "Food for Health" Chart (Figure 14).
CONCLUSIONS
ANDRECOMMENDATIONS
The differences in food habits, cultures, and the food economy
in different parts of Thailand, or even in the same area but of dif-
ferent fami li es, makes it hard to surrnnarize and draw conclusions con -
cerning the nutritional status of the Thai people as a whole. The
data for each of the surveys made by the Thai public health officers
and by the American survey team were obtained from military person-
nel, from different areas of Bangkok, and from farmers and people in
small vil l ages. Different levels of socio-economic status were
included in the surveys.
With these limit ations in mind, genera lizations are as follows:
l. Education in the use of proper sanitation in raising food, in
providing a safe water supply, and in proper cooking of foods to
reduce the incidence of intestinal i nf estations, diarrhea and other
related illnesses must precede or accompany any program of nutrition
education. This will prevent needless loss or increased requirement
of nutrients.
2. Calorie intake from carbohydrate and fat sources was ade qu ate.
Education must be emphasized to see that these foods carry more than
just calories. Correct method of cook in g rice and use of forms of
rice other than highly polished white rice must be encouraged. Calo-
rie intake ranged from 1860 to 2947 calories.
3. Protein intakes ranged from 39 gm to 56 gm per person per
day for the civilians, and 59 gm to 150 gm per man per day for the
47
military. Though prot e in intakes exceed on e gm per person p e r day,
albumin levels are low and globulin levels high. This is because
less than one-third of the total protein intake is derived from
animal sources. Too often rice protein is the main protein source.
The use of soybeans, nuts, fish, and of some vegetable mixtures,
which give a good quality protein when combined, needs to be en-
couraged. Poultry and eggs are available but are often sold by the
farmers who raise them. Excess heat should be avoided in the cooking
of vegetable protein. The use of more high quality protein,
especially for pregnant women and children, is recommended. Develop-
ment of ways of processing or using more kinds of fish from the sea
or ponds should be encouraged. More fermented fish and small dried
fish eaten whole could be used .
4. Calcium intake is 675 mg per man per day for the military .
The civilian intake is not quite so clear with the mean intake of
266 mg per person per day, and with considerable differences among
communities.
Calcium sources like small fi s h, skim milk, sesame seeds, molas-
ses, seaweeds, and green mustard should be especially encouraged for
pregnant and lactating women, infants, children, and adolescents.
Since milk is expensive and largely unavailable, use of foods that
contain calcium commonly available to Thai people must be stressed.
Small fish when eaten whole are the best source of calcium in
Thailand.
5. Iron intake is high among both the civilian and military
populations. However, blood hemoglobin is low, especially for the

48
civilians. The deficiencies may be caused by intestinal parasites
acquired from use of half-raw half-cooked meat. If sanitary condi-
tions are improved, raw vegetables and other raw foods could then be
safely eaten.
6. The average vitamin A intake is approximately 3000 IU per
person per day for civilians and 1800 IU per man per day for military
personnel. However, the mean serum vitamin A and serum carotene in
most of the groups studied is in the acceptable ranges. A few cases
of bitot's spots are found although xeropthalmia is not seen.
Green leafy or deep yellow vegetables and yellow fruits such as
sweet potatoes, hot chili, carrot, dock, spinach, green mustard,
turnips, swamp cabbage, and mangoes are good sources of vitamin A and
are plentiful.
7. Thiamine intake is approximately 0.24 mg per 1000 calories
for civilians and 0.64 mg per 1000 calories for the military. The
intake among the civilians is marginal. However, there is consider-
able variation from area to area. Endemic beriberi is observed in
areas where there is a low intake of thiamine. Selection of thiamine-
rich foods cooked in a small quantity of water and until just done
should be stressed.
8. Riboflavin intake is deficient for civilians and low for
military groups except for the military in Songkhla area. There is a
high incidence of angular lesions observed among both military and
civilian groups. Children five to nine years of age had the highest
incidence of angular lesions.

49
Foods high in riboflavin are recommended for the normal function
of enzyme systems. Rice is low in riboflavin. Careful planning of
diets is needed to get foods rich in riboflavin every day.
9. Niacin intake is adequate in every group observed. Rice
furnishes much of the niacin.
10. Vitamin C or ascorbic acid intake is low, but mean serum
vitamin C is high. The intake is higher than 18 mg per person per
day in every location observed. Infants Oto four years of age have
the lowest vitamin C serum level. The serum levels of the military
are lower than those of the civilians.
Foods high in vitamin Care plentiful and their use should be
encouraged.
11. Iodine intake is low in both civilian and military groups
except for the groups in Bangkok and Songkhla. Endemic goiter is
more prevalent in females than males.
Iodine should be added to the salt before it leaves Bangkok,
especially for people in endemic areas. Use of more products from
the sea would also help.
12. Salt intake seems to be high but the prevalence of hyper-
tension has not been established. It is found that death rate from
diseases of heart was 16 .4 per 100,000. The causes of this disease
are variable, and the high consumption of malt in relation to heart
disease is doubted.
Increasing the supply and intake of certain nutrients and im-
provement of sanitary conditions by better methods of farming, educa -
tion in nutrition and work in the field of public health are needed
50
to solve the problems of nutrition. A start might be made in nutri-
tion education with a basic four plan keyed to Thailand. A beginning
plan has been designed. Addition of pictures, number of servings
needed daily, and an explanation of use of foods in each group in the
body would make the "Food for Health" chart more useful. Foods
native to each area of the country that can be used in each food
group should be identified. Sanitation must be stressed.
An educational program with a many pronged attack should be
developed. Public health workers, teachers in secondary schools, and
government workers in rural areas similar to extension agents in the
United States, will need to implement the educational program. Devel-
opment of school lunch programs or similar organizations would
provide another avenue of reaching the people.
Improvement of the economic status and general educational level
of the people is needed to occur concurrently with the nutritional
educational program to have far reaching results.

LITERATURECITED
Berry, F. B. 1962. The Kingdom of Thailand nutrition survey. A

report by the Interdepartmental Committee on Nutrition for
National Defense. Published by United States Government Print-
ing Office: 0-629788, p. 1-245.
Bisolyaputra, U., and D. L. Bocobo. 1959 . Dietary surveys in selected

rural areas of Thailand~l955. In Proceedings of the Ninth
Pacific Science Congress of the Pacific Science Association,
1957, 15:39-41 .
Chalawyoo, S., and P. Tansathit. 1959. Dietary survey in the Royal

Thai Navy~l956. Proceedings of the Ninth Pacific Science
Congress of the Pacific Science Association, 1957, 15:92-96.
Chandrapanond, A. 1959a. Dietary surveys in Thailand. In Pro-

ceedi ngs of the Ninth Pacific Science Congress of the Pacific
Science Association, 1957, 15:88-90.
Chandrapanond, A. 1959b. Weight of Thai infants. In Proceedings of

the Ninth Pacific Science Congress of the Pacific Science
Association, 1957, 15:7-9.
Chatfield, C. 1954. Food composition tables~minerals and vitami ns

for international us e. Food and Agriculture Organization of the
United Nations Bulletin No. 11, p. 10-27.
Hauck, H. M., S. Sudsaneh, and J. R. Hanks. 1958. Food habits and

nutrient intakes in a Siamese rice village. Studies in Bang
Chan, 1952-1954. Cornell University, Ithaca, New York, p. 1-
129.
Kanchanalaksana, P., and S. Prasertsom. 1959. Dietary survey in the

Royal Thai Army. In Proceedings of the Ninth Pacific Science
Congress of the Pacific Science Association, 1957, 15:91.
Page, L., and E. F . Phipard. 1957. Essentials of an adequate diet.

U.S.D.A. Home Economics Research Report No. 3:1-12.
Roberts, L. J. 1954. A basic food pattern for Puerto Rico. Journal

of the American Dietetic Association 30:1097-1100.
Stahlie, T. D. 1961. Some aspects of child health in Thailand.

Journal of Tropic Medical Hygiene 64:79-87.
52
Watt, B. K., and A. L. Merrill. 1963 . Composition of foods raw,

proc essed, prepar ed. United States Department of Agricultur e
Handbook No. 8 : 6-67.
Wenkam, N. S., and C. D, Miller . 1965 . Composition of Hawaii fruits.

Hawaii Agricu ltural Experiment Station Bulletin No. 135 :3 0-35.
APPENDIX
Table 11. The composit i on of foods calculated in terms of 100 gm r e tail or cooked weight
Food it ems Vita- Thia- Ribo- Ascorbic

Calories Prot e in Ca Fe min A mine flavin Niacin acid a
100 gm gm mg mg IU mg mg mg mg
Recormnended a ll owance,
me n, 70 kg, U.S. 1963 2900 70 800 10 5000 1. 2 1. 7 19 70
Animal resources
Meat
Beef, medium 217 14.9 9 1. 8 30 0.05 0 . 13 3. 1 0
Veal, medium 146 15.l 9 1.8 20 0.11 0 . 20 5.0 0
Pork, medium 396 10.4 6 1. 2 0 0 . 36 0.10 2.4 0
Buffa l o, carcass-lean 80 12.8 7 1. 9 0 0.05 0.11 3 .0 0
Poultry
Chick en, dressed, not
drawn 122 12.3 7 0.9 250 0.06 0.10 4.9 0
Duck s, dressed , not
drawn 205 10 8 1.1 540 0.05 0.12 3.5 0
~
Hen-in she ll 144 11 44 2. 2 890 0.09 0. 27 0.1 0
Duck-in she ll 164 11. 3 so 2 .4 1040 0. 13 0.26 0.1 0
Fish and she llfi sh
All unspecified-fillet 132 18.8 31 1.0 so 0 . 06 0 . 15 2.5 0
All unspecifi ed-round 62 8.8 15 0. 5 20 0.03 0.07 1. 2 0
Fish 1 medium cured
Larg e f i sh , bone not
eaten 178 27 54 1. 6 70 0 . 07 0.24 3.0 0
Sma ll fish , bone eaten 261 40 1600 2.4 100 0.1 0.36 4.4 0
Canned fish in oi l 314 22 44 1. 3 110 0.06 0.20 2.6 0
Crustac e ans, cann e d 92 17 . 5 108 1.8 0 0 . 02 0.09 1.4 0 ,,_
u,
·~
Vitamin C
Table 11. Continued
Vita- Thia- Ribo- Ascorbic

Food items Calories Protein Ca Fe min A mine flavin Niacin acid
Mollusks, canned 47 7 78 9.4 250 0 . 12 0.11 0.9 0

Crab, blue, cooked 93 17.3 43 0 .8 2170 0.16 0 . 08 2.8 2
Crayfish , fresh water,
raw 72 14.6 77 1. 5 - 0.01 0 . 04 1. 9 -
Eel, American, raw 233 15.9 18 0.7 1610 0. 22 0.36 1.4 -
smoked 330 18. 6 - - - - - - -
Grouper , raw 87 19 . 3 - - - 0.17 - - -
Mackerel, cooked 236 21.8 6 1.2 530 0.15 0.27 7.6 -
smoked 219 23 . 8 - - - - - - -
canned 180 21. l 260 2.2 30 0.03 0.33 8.8 -
Mullet, striped , raw 146 19 . 6 26 1.8 - 0.07 0 . 08 5.2 -
Mussels, mea t, raw 95 14.4 88 3.4 - 0.16 0.21 - -
Ocean perch, cooked 227 19.0 33 1.3 - 0.1 0 . 11 1.8 -
Oyster, raw meat, East 66 8.4 94 5.5 310 0.14 0.18 2.5 -
Pheasant, raw, total 151 24.3 - - - - - - -
Red and grey snapper,
raw
Scallop, cooked
93 19.8 16 0.8 - 0.17 0.02 - -
112 23.2 - - - - - - -
Shad, baked 201 23 . 2 24 0 .6 30 0.13 0.26 8.6 -
Shrimp, cooked, french
fried 225 20 . 3 72 2 - 0 . 04 0.08 2.7 -
Shate, raw 98 21. 5 - - - 0.02 - - -
Snail 90 16.l - 3.5 - - - - -
Squid, raw 84 16.4 12 0 .5 - 0.02 0 . 12 - -
Terrapin, raw 111 18. 6 - 3.2 - - - - -
Whale meat, raw 156 20.6 12 - 1860 0 . 09 0 . 08 - 6
Milk
Milk, human 77 1.1 33 0.1 240 0.01 0 . 04 0.2 5 v,
v,
Tab l e 11 . Con tinue d
Vita - Thia - Ri bo - Asco r b i c

Food i t ems Cal or i es Prot e in Ca Fe min A mi ne flavin Niaci n acid
Cow, whol e l i quid 66 3.5 117 - 150 0.03 0 . 17 0 .1 l

Cow, skim l i quid 36 3.6 121 - - 0.04 0. 18 0.1 l
Cow, who l e powde r 502 26.4 909 0.5 1130 0.29 1.46 0 .7 6
Cow, skim pov.Uer 363 35 . 9 1308 0.6 30 0 . 35 1.8 0 0.9 7
Canned eva porated
(unsweet) 137 7 252 0.1 320 0 . 04 0.34 0.2 1
Cann ed co nde nsed
(sweetened} 32 1 8.1 262 0.1 360 0.08 0.38 0.2 l
Pl a nt reso urces
Misce ll aneous
Almond s, dried 598 18 . 6 234 4.7 0 0. 24 0.92 3.5 -
Bamboo shoots , raw 27 2.6 13 0.5 20 0 . 15 0.07 0.6 4
Bana na, baking banana,
r aw 119 1. 1 7 0. 7 118 0.06 0.04 0.6 14
Bea n s , l ima , co o ked
immat u re 111 7.6 47 2.5 280 0.18 0. 1 1. 3 17
Bean f l our , l i ma 343 21. 5 - - - - - - -
Bea n s , mun g: mat u re
see d s, dry, r aw 340 24 . 2 118 7.7 80 0 . 38 0. 21 2. 6 -
Spro ut ed seeds, co oked
a nd drained 28 3.2 17 0.9 20 0.09 0.1 0.7 6
Spr outed seeds,
uncooked 35 3.8 19 1. 3 20 0.13 0 . 13 0.8 19
Bea ns, snap, green, raw 32 1. 9 56 0.8 600 0.08 0 . 11 0.5 19
cooked 25 1.6 50 0.6 540 0.06 0 . 08 0. 3 10
Beve r ages
Al coho li c v,
°'
Table 11. Continued
Vita - Thia - Ribo- Ascorbic

Food items alories Protein Ca Fe min A mine flavin Niacin acid
Beer, alcoholic 3.6%

by wt. 42 0.3 5 - - - 0.03 0.6 -
Gin, rum, vodka,
whiskey 100 proof
(42.5% ale. by wt.) 295 - - - - - - - -
Wine , 9 . 9% a l e. by wt. 85 0. 1 9 0.4 - - 0.01 0.1 -
Carbonated: co l a type 39 - - - - - - - -
Bread fruit, medium,
raw 134 0.07 20 . 8 0 . 26 41 0 . 12 0.06 l. 54 20 . 5
Broadbea ns, raw:
immature seeds 105 8.4 27 2.2 220 0 .28 0.17 l. 6 30
Mature seeds, dry 338 25.l 102 7. l 70 0.50 0.30 2.5 -
Cabbage, common, raw 24 l. 3 49 0.4 130 0 . 05 0.05 0.3 47
cooked 20 1.1 44 0.3 130 0.04 0.04 0. 3 33
Cabbage, Chinese, raw 14 l. 2 43 0.6 150 0.05 0.04 0.6 25
Cabbage, whit e musta rd:
cook ed 14 1. 4 148 0.6 3 100 0.04 0.08 0.7 15
Carambola, seeds re moved 37 0 .85 0.9 0 . 06 21 0.04 0.04 0. 71 35
Carrot, coo ked 31 0.9 33 0.6 10500 0.05 0.05 0.5 6
Cashew nuts 561 17.2 38 3.8 100 0.43 0.25 1.8 -
Cauliflower, cooked,
drained 22 2. 3 21 0 .7 60 0.09 0 . 08 0.6 55
Cherim oya, seeds removed 110 1. 54 8.9 0 . 25 0 0. 11 0 . 11 1.02 12 . 2
Chestn ut s, fresh 194 2.9 27 l. 7 - 0.22 0.22 0.6 -
dried 377 6.7 52 3.3 - 0.32 0.38 l. 2 -
Coconut cream, prepared
wit h tt 2o 252 3 .21 16 . 3 1. 64 0 0.02 - 0 . 76 2.8
Soft meat with the nut v,
__,
H20 - - 16 .4 0.07 0 - - - -
Table 11. Continued

Mature meat, fresh 346 3.5 13 l. 7 0 0.05 0.02 0.5 3
Coconut water 22 0.3 20 0.3 0 - - 0.1 2
Celery, cooked 14 0.8 31 0.2 230 0.02 0 . 03 0.3 6
Corn, sweet: kernel
corn on cob 91 3.3 3 0.6 400 0.12 0.10 1.4 9
Corn flour 368 7.8 6 1.8 340 0.2 0.06 1.4 -
Cowpeas, immature seed
raw 127 9.0 27 2.3 370 0.43 0.13 1.6 29
cooked 108 8.1 24 2.1 350 0.30 0.11 1.4 17
Mature seed dry ,
cooked 76 5.1 17 l. 3 10 0.16 0 . 04 0.4 -
Cucumbers, raw,
not pared 15 0.9 25 1.1 250 0.03 0.04 0.2 11
pared
Dack-sheep roviel,
14 0.6 17 0.3 - 0.03 0.04 0.2 11
cooked 19 l. 6 55 0.9 10800 0.06 0.13 0 .4 54
raw 28 2.1 66 l. 6 12900 0 . 09 0 . 22 0.5 119
Egg plant, cooked 19 1.0 11 0 .6 10 0.05 0.04 0.5 3
Fennel, common, leaves,
raw 28 2.8 100 2.7 3500 - - - 31
Figs, raw 51 0.68 28 . 3 0 . 16 65 0.03 0 . 03 0 . 34 2
Garlic, cloves, raw 137 6.2 29 1.5 - 0.25 0 . 08 0.5 15
Ginger root, fresh 49 1.4 23 2.1 10 0 . 02 0 . 04 0. 7 4
Guavas, whole, conunon,
raw 62 0.8 23 0.9 280 0 . 05 0.05 l. 2 242
Horseradish, raw 87 3.2 140 1.4 - 0.07 - - 81
v,
00
Table 11 . Continued

Hyacinth beans, young

pods, raw 35 2.8 57 1.0 580 0.09 0.11 0.9 20
Mature seed dry 338 22.2 73 5.1 - 0.62 0.18 2.1 -
Ice cream cones 377 10 156 0.4 - 0.05 0.21 0.5 -
Jackfruit, raw 98 1. 3 22 - - 0 . 03 - 0.4 8
Juju be, raw 105 1.2 29 0.7 40 0.02 0.04 0.9 69
dried 287 3.7 79 1.8 - - - - 13
Lemons raw, peeled 27 1.1 26 0.6 20 0.04 0.02 0.1 53
Longans , raw 61 1.0 10 1. 2 - - - - 6
dried 286 4.9 45 5.4 - 0.04 - - 28
Loquests,
Macaroni,
raw
cooked till
48 0.4 20 0 .4 670 - - - 1
tender 111 3.4 9 0.4 - 0.01 0.01 0.3 -

Mangoes, raw 66 0.7 10 0.4 4800 0.05 0.05 1.1 35
Molasses, cane , 3rd
extraction 213 - 684 16.1 - 0.11 0.19 2. 0 -
Mushrooms, conunercial,
~aw 28 2.7 6 0.8 - 0.1 0.46 4.2 3
Muskmelons, casaba 27 1.2 14 0 .4 30 0.04 0.03 0.6 13
Mustard, greens, raw 31 3.0 183 3.0 7000 0.11 0.22 0.8 97
cooked 23 2.2 138 1.8 5800 0.08 0.14 0.6 48
Nectarines, raw 64 0.6 4 0.5 1650 - - - 13
Oatmeal, cooked 60 2.3 10 0. 6 - 0.06 - - -
Okra , raw 36 2.4 92 0.6 520 0.17 0.21 1.0 31
cooked 29 2.0 92 0.5 490 0.13 0 . 18 0.9 20
Olive, green, pickl ed 116 1.4 61 1.6 300 - - - -
Onions mature, dry, raw 38 1. 5 27 0.5 40 0.03 0.04 0.2 10
cooked 29 1. 2 24 0.4 40 0.03 0.03 0.2 7 \.n
"'
Table 11. Continued

Onions, Young green,

all raw 36 1. 5 51 1.0 2000 0.05 0.05 0.4 32
Oranges, raw,
commercially 49 1.0 41 0.4 200 0,1 0.04 0.4 50
Orange juice, raw,
commercially 45 0.7 11 0.2 200 0.09 0.03 0.4 50
Papaya, raw 39 0.6 20 0.3 1750 0.04 0.04 0.3 56
Parsnip, cooked 66 1.5 45 0.6 30 0.07 0.08 0.1 10
Carrot 371 1. 1 38 2. 9 730 0.88 0. 38 6.0 -
Peanut, boiled 376 15.5 43 1. 3 - 0.48 0.08 10.0 -
roasted
Peas,
with
green,
skins 582 26.2 72 2.2 - 0.32 0.13 17.1 -
immature,
raw 84 6.3 26 1. 9 640 0.35 0.14 2.9 27
cooked 71 5.4 23 1.8 540 0.28 0.11 2.3 20
Mature seeds, dry,
cooked 115 8.0 11 1. 7 40 0.15 0.09 0.9 0
Pepper, hot chili,
immature, raw 37 1. 3 10 0.7 770 0.09 0.06 1. 7 235
Mature, red, raw, with
seeds 93 3.7 29 1. 2 21600 0.22 0.36 4.4 369
Mature, red, without
seeds 65 2.3 16 1.4 21600 0.1 0.2 2.9 369
Persimmons, raw, native 127 0.8 27 2.5 - - - - 66
Pigeon peas, raw, im-
mature seed 117 7.2 42 1. 6 140 0.4 0.17 2.2 39
Mature seeds, dry 342
52
20.4 107 8.0 80 0.32 0.16 3.0 -
Pineapple, raw 0.45 18.4 0.26 - 0.08 0.03 0.24 10 . 1
,,.,
0
Table 11 . Continued

Pomegranate pulp, raw 95 20.4 - - - 0.05 0.10 1.6 -

Potato flour 351 8.0 33 17. 2 - 0.42 0.14 3.4 19
Pum melo or Shaddock 34 0.76 7.4 0.15 - 0.03 0.02 0.22 39.9
Pumpkin, raw 26 1 21 0.8 1600 0.05 0.11 0.6 9
Purslane, raw 21 1. 7 103 3.4 2500 0.03 0.1 0.5 25
cooked 15 1. 2 103 3.5 2100 0.02 0.06 0.4 12
Radishes, raw, orient 19 0.9 35 0.6 10 0.03 0.02 0.4 32
Rhubarb, raw 16 0.6 96 0.8 100 0.03 0.07 0.3 9
Rice, white unenriched,
cooked 109 2.0 10 0.2 - 0.02 0.01 0.4 -
Brown, unenriched,
cooked 119 2.5 12 0.5 - 0.09 0.02 1.4 -
Roseapple, raw 56 0.6 29 1. 2 130 0.02 0.03 0.8 22
Roselle 34 0.96 - - 17 2 0.01 0.03 0.31 12 . 0
Sapodilla, raw 89 0.5 21 0.8 60 - 0.02 0.2 14
Sapote, raw 125 1. 8 39 1.0 410 0.01 0.02 1. 8 20
Seaweeds, raw, Agar - - 567 6.3 - - - - -
Sesame seeds, dry,
whole 563 18. 6 1160 10.5 30 0.98 0.24 5.4 -
Shallot bulbo, raw 72 2. 5 37 1. 2 - 0.06 0.02 0.2 8
Soursop
Soybean,
pulp 71 0.69 8.8 0.82 - - - - 56
immature seed,
raw 134 10.9 67 2.8 690 0.44 0 . 16 1.4 29
cooked 118 9.8 60 2.5 660 0.31 0.13 1. 2 17
Mature seed, dry,
cooked 130 11.0 73 2.7 30 0.21 0.09 0.6 -
Curd (kofu) 72 7.8 128 1. 9 0 0.06 0.03 0.1 -
Flour, full fat 421 36.7 199 8.4 110 0.85 0.31 2.1 -
°'
Table 11. Continued

Food items Calories Prot e in Ca Fe min A mine flavin Niacin acid
low fat 356 43 . 4 263 9.1 80 0.83 0.36 2.6 -
Milk, fluid 33 3.4 21 0.8 40 0.08 0.03 0.2 -
Milk, powder
Spinach, cooked
33
23
3.4
3.0
21
93
0.8
2.2
40 0.08 0.03 0.2 -
8100 0.07 0.14 0.5 28
Squash, cooked 14 0.9 25 0.4 390 0.05 0.08 0.8 10
Sunflower seeds,
kernels, dry
Swamp cabbage, cooked
560
21
24 . 0
2.2
120
55
7. 1
1. 5
50
5200
1. 96 0. 23 5.4 -
0.05 0.08 0.5 16
Sweet potato, dehy-
drated flakes 379 4.2 60 2. 2 4700 0.06 0.13 1. 3 45
Tamarind, raw 239 2.80 74 2.8 30 0. 34 0.14 1. 2 2
Tang e rine 34 o.71 13.6 0.21 830 0.1 0.02 0.16 30 . 8
Tapioca, dry
Taro, raw, corms, and
352 0.6 10 0.4 - - - - -
tubers 98 1. 9 28 1.0 20 0.13 0.04 1.1 4
Leaves and stems 40
24
3.0 76 1.0 - - - - 31
Tomato, green, raw 1. 2 13 0.5 270 0.06 0.04 0.5 20
Ripe, raw 22 1.1 13 0.5 900 0.06 0.04 0.7 23
Tomato catsup, bottled 106 2.0 22 0.8 1400 0.09 0.07 1.6 15
Towel gourd, raw 18 0.8 19 0.9 380 0.03 0.04 0.4 8
Turnip and rutabaga
tops 23 2.3 221 1.8 6090 0.14 0. 28 0.6 94
Water chestnut,
Watermelon,
raw
Charleston
79 1.4 4 0.6 - 0.14 0.20 1.0 4
Grey 26 0.51 1. 3 0.2 179 0.04 0.02 - 7.3
Yambean, tuber, raw 55 1.4 15 0.6 - 0.04 0.03 0.3 20
Yeast: baker's, dry 282 36.9 44 16.1 - 2.33 5.41 36.7 -
brewer's debittered 283 38.8 210 17.3 - 15.61 4. 28 37.9 - °'
N
PROTEIN NUTRITIONFOR MATERNAL
AND CHILD HEALTH
by
Methee Larptavee
Report No. 2 submitted in partial fulfillment

of the r equirements for the degree
of
MASTEROF SCIENCE
in
Food and Nutrition
Plan B
Approved:
UTAHSTATE UNIVERSITY
Logan, Utah
1966
TABLEOF CONTENTS
Page
INTRODUCTION
.
REVIEWOF LITERATURE
Protein nutrition for maternal health
Protein nutrition for child health. 10
INTERNATIONAL
SUPPLIES OF AVAILABLEPROTEIN 20
Improvement of maternal and child protei n nutrition 21
CONCLUSION
ANDRECOMMENDATION 29
SUMMARY 32
LITERATURECITED 33
LIST OF TABLES
Table Page
1. The components of protein storage in normal

pregnancy by weight . 5
2. Correlation of maternal stature and weight-for-height

with mean birth weight of the infant 6
3. Distributions of low birth weights and first-week

death rates
4. Recommended allowances for dietary protein during

pregnancy and lactation 8
5. Summary of report ed diets of pregnant women 9
6. Effect of nutritional state on weight gain at dif-

ferent levels of caloric intake . 11
7. Effect of protein intake and nutritional state on

weight gain at different levels of caloric intak e 12
8. Effect of protein so ur ce , protein intake, and nutritional

state on weight gain at different l eve ls of calorie
intake . 12
9. Essential amino acids in 1957 FAQ provisional pattern

and in milk and egg protein 14
10. Var iatio ns in chemical scores of selected proteins 16
11. Protein requirements of children and the effect of

prot e in quality 17
12. U. S. minimum requirements and recorrunended dietary

allowances for children 19
13 . Complementation between corn and soybean flour

prot e in . 22
14. Nutrient content of 100 gm of INCAP mixture 9 B 23

LIST OF FIGURES
Figure Page
1. Growth of rats fed INCAP vegetable mixture 9, skim

milk, and casein. 25
INTRODUCTION
The world food problem today in relation to nutrition refers to
a calorie-protein deficit. Foods containing carbohydrates and fats
to furnish calories or energy and proteins to provide for growth need
to be provided in adequate amounts to solve the malnutrition problems
in developing countries. Often carbohydrates can be more easily sup-
plied from local foods which fit the prevailing cultural and religious
beliefs than can high quality proteins . A low quality protein or
imbalanced amino acid intake is often the cause of poor health,
especially in pregnancy and lactation and in the growth years for
infants and children. Such imbalance leads to deficiency diseases of
different degrees in many developing coun t ries, where food processing,
food technology, food storage, and transportation are poor; and in
low-income families in the well-developed countries. During the last
few years medical science has made much progress and has lowered
death rates . In those countries where the birth rate is high and
death rates are decreasing, problems of protein nutrition can be more
serious than in other countries .
Diets in pregnancy and lactation are concerned directly with
maternal and child health. Poor diet often leads to nutritional dis-
eases.
REVIEWOF LITERATURE
Protein nutrition for maternal hea l th
~- Venkatachalam and Remanathan (1964) used diets contain-
ing (a) 7 per cent wheat protein and (b) 18 per cent mixed protein to
feed rats during gestation and lactation . It was found that the 7
per cent wheat diet severely affected the quantity of milk produced
but not the concentration of protein produced. Pups born to and
suckled by mothers receiving such a diet suffered 100 per cent
mortality. Pups born to rats receiving the 18 per cent mixed protein
diet but suckled by mothers receiving the 7 per cent wheat protein
diet showed very high mortality and l ow weaning weight. Among those
born to mothers receiving the per cent wheat protein diet but
suckled by rats receiving the 18 per cent mixed protein diet, the
mortality was less and the weaning weight higher than in those of the
above group. The highest weaning weight was shown in rats born to
and suckled by mothers r eceiving the 18 per cent mixed protein diet.
Shaw and Griffiths (1963) conducted experiments with thre e
strains of rats to determine the influence of a low-protein diet dur-
ing the reproductive cycle on the development of tooth decay , It was
found that in the offspring of all three strains, the low-protein diet
caused high mortality during lactation, very l ow body weights at wean -
ing, reduction in the size of the molars, delay in third molar erup-
tion, high frequency of missing cuspids on third molars and increased
susceptibility to carious lesions in the occlusa l sulculi and on the

3
smooth surfaces of t he molars. A supplement of one per cent methi -
onine to the low protein diet throughout the reproduction cycle led
to striking reductions in the frequency of the various abnormalities.
Administration of protein during the post-weaning period was too late .
Lee and Chow (1965) reported that dietary restriction by 50 per
cent during pregnancy and lactation of rats resulted in perman ent
growth stunting of the progeny, despite ad libitum feeding after
wean ing. These might be due to low dietary intake, poor absorption,
and abnormal metabolism. Average food consumption per unit body
weight of the progeny of the restrict ed mother was greater than
normal. There was some impa irm ent of protein absorption but greater
amounts of nitrogen excretion, coupled with an abnormal distribution
among the nitrogen-containing components of urine.
In humans. Hytten (1964) noted that average well-fed pregnant
women were taller and generally healthier, and had lar ger and healthi-
er babies than women on poor diets. In Aberdeen, weight gain which
was r es tricted at first, but was increased to an average gain of
about one pound per week or the total of 27.5 lb or 12 .5 kg in the
last two-thirds of pregnancy was considered to create the low est
perinatal mortality rate . For lower weight gains there was a higher
incidence of prematurity ; for higher weight gains an increasing inci-
dence of pre-eclamptic toxemia.
Maternal and fetal protein needs were discussed in the WHOexpert
committee report no . 302 (1965) . An average addition of 0 . 5, 3 . 0,
4 .5, and 5 . 7 gm of protein daily during the successive quarters of
pregnancy, giving a total of some 950 gm, was needed for the formation
4
of new maternal tissues, foetal growth and maintenance, and for the
prevention of an incidence of pregnancy wastage, prematurity, and
neonatal mortality . The protein storage in various tissues during
pregnancy is shown in Table 1. The average daily increment during
the last two trimesters was thus 5 gm to which 20 per cent should be
added to allow for individual variation. The reference protein dur-
ing the last two trimesters was thus 6 gm per day.
As for a lactating mother, it was recommended that the addi-
tional allowance to cover the needs of lactation should be set at 15
gm of reference protein per day owing to the fact that human milk
contains 1.2 gm of protein per 100 ml and most women secreted 850 to
1200 ml of milk daily. Thus, the upper limit of daily protein output
in milk was about 15 gm. Since 1 gm of milk protein was produced
from 2 gm of food protein, the addition of 30 gm food protein daily
was needed for this purpose .
Fat storage during 10, 20, 30, and 40 weeks of pregnancy was
found to be 367, 1930, 3613, 4464 gm respectively. Total gain in
weight by average healthy well-fed Scottish women for the same peri-
ods of pregnancy, 10, 2Q, 30, and 40 weeks was 650, 4000, 8500, and
12,500 gm.
Although adult stature is largely determined by genetic factors,
the WHOExpert Committee (1965, p,. 22) cited the information that
Illsley and Kincaid in the United Kingdom, and O'Brien and Shelton in
the United States, have reported socio-economic gradients in adult
stature. In the United Kingdom 41 per cent of t t1e wives of profes-
sional men were tall (165 cm or more) while only 26 per cent of the
5
Table 1. The components of protein storage in normal pregnancy by

weigh ta
Protein stora2e (2m) after weeks of oregnancv

10 20 30 40
Foetus 0. 3 27 160 435
Placenta 2 16 60 100
Liquid 0 0.5 2 3
Uterus 23 100 139 154
Breasts 9 36 72 81
Blood 0 30 102 137
Total 35 210 535 910

awHo Report No. 302, 1965, p. 33.
wives of semi - ski lled and unskilled men were this tall . Similar find-
ings were observed in the United States. Short women among the
Aberdeen primipasae studied by Hytten and Leitch (WHOreport no. 302 ,
1965, p. 23) had babies about eight per cent lighter on the average
then tall women and underweight women had babies eight per cent
lighter than the overweights. This correlation is shown in Table 2.
Tall and heavy women had babies about 14 per cent heavi er than short
and li ght women. The socio-economic gradient in birth weight is seen
more often within ethnic groups. Differences in mean birth weight
between ethnic groups are inf lu enced by genetic differ ences. Just
how much may he due to enviro nmental or to genetic diff erences is not
c l ear.
6
Table 2. Corre l ation of maternal stature and weight-for - height with

mean birth weight of the infanta
Mean birth weights (gm) in relation to maternal

heiehts
Maternal Under 61 in. 61-63 in. 64 in. & over All
height (155 cm) (155-162 cm) (163 cm) heights
Weight-for-
heightb
Underweight 2987 3 110 3223 3114
Average 3114 3228 3396 3251
Overweight 3204 335 1 3482 3355
Mean birth
weight of
all infants 3101 3228 3373 3241
awHO Report No. 302, 1965, p. 22.
b"Underweight" was in the lowest 25 per cent of the distribution
of weight according to height.
"Overweight" was in the upper quartile.
"Average" consisted of the remaining 50 per cent.
Stillbirth and neonatal death rates usually show a socio -
economic gradient. The rates are low where the standard of living is
high and high where the standard of living is low. There are excep-
tions in some parts of the world, however.
Mortality rates are lower in second and third pregnancies than
in first. Beyond this, as the number of pregnancies rise, the mortality
begins to increase.
Babies of low birth weight have relatively high mortality rates.
The relation between lo w birth weight and mortality rate at the be-
ginning of lif e is shown in Table 3.

Tab l e 3. Distribution s of low birth weights and first - week death
rates a
Birth United Kin~dom Cevlo n India

Weight Morta l ity Morta li ty Mortality
(gm) No. % No. % No. %
1000 20 90 22 68 32 87.5
1500 31 51. 6 65 55 89 58.6
2000 76 10 . 5 270 12 410 18.0
2500 276 3.9 1123 2. 7 1740 3 .1
All under
2500 403 14 .1 1480 7. 7 2271 9. 1
awHo Report No. 301, 1965, p. 15 .
Dietary recommendations for protein for pregnancy and lactation
from different co untries have been compared by the WHOExpert Com-
mittee ( 1965) in Table 4. They have also summarized and reported the
dietary intakes of protein of pregnant women in vario us countries in
the worl d (Table 5) . In several countries (Scotland, Holland,
Austra l ia, United States, Israel , and Egypt) the prot ei n intake was
70 gm or more for t h e groups studied which included many low income
groups. The 70 gm would be above the Canadian recommendation but
somewhat be low the recommendations of most other countries listed in
Tab l e 4.
In India and New Guinea, protein intake was only one - fifth to
one-half the r ecommend ed a ll owance . Al l of these women were li sted as
in th e poor or lo w inco me group.

Table 4. Reconnnended allowances for dietary protein during pregnancy and lactationa
Weight Calories Protein Weight Calories Protein

Country lb or kg gm Country lb or kg gm
1. USA, 196 3, F&N Board 6. Holland, 1961

Non-pr egnan t 120 lb 2100 58 Non-pregnant 2400 60
Pregnant, 4-9 mos 2300 78 Pregnant, 7-9 mos 2700 - 80
Lactating 3100 98 Lactating 3100 100
2 . Canada 7. South Africa, 1956

Non-pregnant 124 lb 2400 40 Non-pregnant 130 lb 2300 55
Pregnant, 7-9 mos 2900 50 Pregnant, 7-9 mos 2600 80
Lactating 2900- 60- Lactating 80
3400 70
3. Great Britain, 1950 8. Japan, 1961
Non-pregnant 2250 66 Non-pregnant 2100 60
Pregnant, 1-5 mos 2500 63 Pregnant, 1- 5 mos 2400 75
6-9 mos 2750 102 6-9 mos 2700 90
Lactating 3000 111 Lactating 3000 95
4. Norway, 1957 9. Central America,

Non-pregnant 60 kg 2500 60 1955, INCAP
Pregnant, 7-9 mos 2900 85 Non-pregnant 50 kg 2000 50
Lactating 3500 100 Pregnant, 7-9 mos 2500 75
Lactatin g 3000 90
5. India
Non-pregnant 45 kg 2300 45
Pregnant, 5-9 mos 2300 100
Lactating 2700 110
aWHo Report No. 302, 1965, p. 50.
co
Table 5. Summary of r epo rted diets of pregnant womena
Tri - Protein
Country mester Year Subjects Calories gm
Scotland III 1958 Wives of skilled

(Aberdine) worker.s 2512 78
Wives of unskilled
workers 72
Holland middle 1953 Rural districts 2770 81

(Amsterdam) III Urban dwellers 2620 76
Australia III 1963 Clinic atte nders 2342 82

(Adelaide)
U.S.A. III Middle or lower

(Tennessee) income group 2020 70
(New England) III Various income groups 1915 67
Israel III 1970 Women of poor edu-

(Nagov) cation 2064 71
Egypt III 1960 Poor women 2046 72

(Alexandria)
India 33-36 1962 Low socio -economic

(Calcutta) stat us 2010 41
South India II 1962 Poor-class women 1520 40

(Hyderabad)
(Coonoor) 1958 Poor-class women 1815 44
New Guinea
(Chimbu) In poor condition 1490 19
(Ajamaroe) 1958 In poor circumstances 1450 31
(Waropen) In poor circumstances 1170 15
aWHOReport No. 302, 1965, pp . 49 - 51.

The recommendations for dietary protein are similar for the
United States, Great Britain, Norway, India, and Holland with Japan
and Central America being only slightly lower. Canada and South
Africa have the lowest recommendations.
Protein nutrition for child health
Graham, Cordano, and Baertle (1963) classified infant malnutri-
tion in Peru by a developmental quotient which was obtained by con-
verting the actual weight into the age in months to which it cor -
responded on a curve for healthy Peruvian infants. This weight-age
was divided by chronologic age and multiplied by 100.
In general, a protein level of 2.0 gm and 75 kcal per kg body
weight per day was satisfactory for gain in weight in severely mal-
nourished infants . If not, calories were increased by adding cotton-
seed oil and cane sugar, maintaining the same relative proportion of
fat and CHO as in the original preparation.
In certain cases, when hypoalbuminemia was present with or with-
out edema, the protein intake was increased by substituting milk and
casein for oil and sugar.
The effects of feeding infants suffering from malnutrition of
different developmental cuotients with different levels of total
calories are shown in Table 6. It was clear that to achieve the
desired gain in weight at least 125 kcal per kg body weight per day
was needed. Increases in calories above 150 kcal per kg did not
produce further gain in weight.
Protein intake of two gm or less per kg per d ay did not produce
a satisfactory gain in weight un l ess the developmental quotient was

11
Table 6. Effect of nutritional state on weight gain at different

levels of caloric intakea
Developmental
quotient % Intake in kcal per kg per day
75 100 125 - 130 150 175
( - wt.age x 100) Average weight gain in gm per day
age
Less than 10 -13 6 10 16 30
10 - 29 -14 10 22 29 39
30 - 49 -14 11 30 39 -
50 or more 5 19 34 55 -
aGraham ~ .!!l·, 1963, p. 251 .
30 or above for the 125 kcal per kg or for lower developmenta l quo-
tients the calorie intake had to be 175 kcal per kg per day (Table
7). Thus, an intake at a level of 2.0 gm of protein per kg per day
did not meet the minimum requirement for many infants. However, at
the higher l evels of developmental quotient the r e was no apparent
advantage to the higher intake of protein .
The effects of protein from both anima l and vegetable origin are
shown in Table 8. At the lower ca l oric levels and low development
quotient there ap peared to be a great advantage to using mi l k. The
fact that this difference was not evident at the higher levels of
caloric intake and development quotients suggested that the vegetab l e
pr otein mixtu r e was utilized more efficie n tly when additional ca l ories
wer e provided.
12
Table 7. Effect of protein intake and nut ritio nal state on weight
gai n at different l eve ls of ca loric intakea
Developmental
quotient
Protein In take in kcal per kg per dav
wt.age x 100) int ake 75 100 125- 130 150 17 5
(=
age gm/kg/day Average wei ght gain in gm per day
Less than 10 2.0 or l ess - 12 -6 5 11 28

over 2.0 -23 12 12 24 44
10-29 2.0 or less -14 3 20 28 35

ove r 2.0 - 13 24 31 47
30-49 2.0 or less -2 6 11 29 40 -

over 2.0 3 - 33 37 -
50 or more 2.0 or l ess 5 19 36 55 -
over 2 . 0 - - 23 - -
aGraham ~ .§!l., 1964 , p. 252 .
Table 8. Effect of protein so u rce, protein intake, and nutritional

state on we ight g ain at differ e nt l evels of calorie intakea
Development Intak e i n kcal per kg per dav

quoti e nt 75 100 125-130 150 1175
tt.age x 100) Protein Protein Avercige wei gh t gain in
age so urc e gm/kg/ da y gm per day
10-29 Vege t able

2.0 or l ess
or mixed -18 -7 8 29 34
Cow's milk 2.0 or l ess - 13 7 24 27 35
Cow's milk over 2.0 - 13 24 31 47
30-4 9 Vegetable
o r mixed 2.0 or le ss - - 26 39 -
Cow 1 s milk
2 . 0 or l ess - 26 11 33 43 -
Cow ' s mi lk ove r 2 .0 3 - 33 37 -
50 or more Vege tab l e
or mi xed 2 . 0 or less 10 21 37 55 -
Cow' s milk2.0 or less 1 17 32 - -
Cow's milk over 2 . 0 - - 23 - -
<Gr aham~ .§!l. , 1963, p . 253.
13
Snyderman (1965) re ported that histidine is an essential amino
acid for infants. Weight gain and nitrogen retention were depressed
in infants fed a histidine-free diet.
Holt~ .i!.h·, (1963) found that the limiting nutrient in nitro-
geneous in kwashiorkor is nitrogen which can be supplied by either
essential or unessential amino acids.
The committee on protein malnutrition and the committee on child
nutrition of the NRC Food and Nutrition Board (1964) stated that:
1. Millions of deaths in pre-school children in the world were
due to protein malnutrition diseases, coupled with unsanitary condi-
tions which brought about diarrhea, infections, and parasitic
diseases.
2. The children not killed by these diseases showed permanently
impaired physical growth and probably irreversible mental and emo-
tional damage . Defects in brain due to severe protein deficiency in
infancy were based on the fact that growth of human brain at time of
birth was largely dependent upon protein synthesis. The rate of gain
in brain weight should range from one to two mg per minute when pro-
tein was normally synthesized. Protein deficiency also caused a
disturbed function of cerebral cortex affecting processes of internal
inhibition and intensity of reflex action.
3. Since protein foods are also good sources of many other
essential vitamins and minerals, protein deficiency might result in
severe nutrient deficiencies. This often resulted in death or chronic
disease which might weaken the productive capacities later in adult
life.
14
The FAO/WHOExpert Group (1965) showed the diff erences in amino
acid patterns of human's milk, hen's egg, and cow's milk from the FAQ
provisional reference pattern in Table 9.
Table 9. Essential amino acids in 1957 FAQ provisional pattern and

in milk and egg proteina
1957 FAQ
Amino acid
provisional
oat tern Cow's milk
gm of amino acid/100
Human milk
gm protein
I Hen's eo:o:
Isoleucine 4.2 6.4 6.4 6.6
Leucine 4.8 9.9 8.9 8.8
Lysine 4.2 7.8 6.3 6.4
Phenylalanine 2.8 4.9 4.6 5.8
Tyrosine 2.8 5.1 5.5 4.2
Cystine 2.0 0.9 2.1 2.4
Methionine 2.2 2 .4 2.2 3.1
Threonine 2.8 4.6 4.6 5.1
Tryptophan 1.4 1.4 1. 6 l. 6
Valine 4.2 6.9 6.6 7.3
"wttoReport No. 301, 1965, p. 36.
Hen's egg and human milk were completely utilized by the body
under normal condition, thus net protein utilization (NPU) of each of
them was 100. Other protein sources were lower in NPU value, since
their amino acid patterns differed in some degree thus reducing their
utilization by the body. Most vegetable proteins had imbalanced

15
amino acid patterns and lower NPU va lu e than animal proteins. The
quantities of food in very poor quality diets necessary to meet pro-
tein requirements were beyond the intake capacity of very young
children . Some additional source of high-quality protein was neces-
sary for the feeding of a child aged 2-3 years if the full growth
potential was to be realized. A well-prepared vegetable protein mix-
ture was also effective, even though an inhibitor of digestive
enzymes was present in the low quality proteins which resulted in
poor digestion if the inhibitors were not heated.
Diets of children of high income families in developed countries
had an NPU va lu e of 70-80. For those of lower incomes in developing
countries, an NPU of 60-70 was common. Situations existed, particu -
larly with diets based mainly on such foods as cassava, where the NPU
was as low as 50-60. The NPU values for some proteins are given in
Table 10.
The protein requirements of infants is high during the first few
months of lif e . This requirement decreases rapidly up to one year;
then more slowly through chi ldh ood and adolescence. At Oto three
yea r s of age it is 2.3 gm protein per kg; at three to six months , 1.8
gm; at six to nine months, 1.5 gm; and at nine to twelve months, 1.2
gm. By four to six years of age the requirement has decreased to
0.81 gm. The average requirements for protein for children by age
group and by quality of protein (NPU) are shown in Table 11. These
figures are the estimated average protein requirement for a popula-
tion . If va lues are calcu l ated for 20 per cent below these figures ,
the l evel is that below which protein d eficiency may be expected to

16
Table 10. Variations i n chemical scores of selected proteinsa
Limiting amino
acid based on
Food egg pattern NPU
Milk (cow's) sb 75
Egg -- 100
Beef muscle s 80
Pork tenderloin s 84
Fish Tryptophan 83
Rice Lysine 57
Ground nut s 48
Soy flour s 56
Sesame seed Lysine 56
Sunflower seed Lysine 65
Cotton seed s 66
Navy bean s 47
Peas s 44
Sweet potato s 72
:From Table 9 in WHOReport No. 301, p. 48.

Sulfur-containing essential amino acids.
Tabl e 11. Protein requirements of children and the effect of protein qualitya
gm oer kg bodv weight oer dav

Age NPU = 100 NPU = 90 NPU = 80 NPU = 70 NPU = 60 NPU = 50
Children (yrs)
l-3b 0.88 0.98 1.10 1. 25 1.46 1. 76
4-6 0.81 0.90 1. 01 1.16 1. 34 1.62
7-9 o. 77 0.86 0.96 1.10 1. 28 1. 54
10-12 0. 72 0.80 0.90 1.03 1. 20 1.44
Adol esce nt s
13-15 0.70 0. 78 0.88 1.00 1.16 1.40
16-19 0.64 0. 71 0.80 0.92 1.06 1.28
Adults 0.59 0.66 0. 74 0.84 0.98 1.18
:From WHOReport No. 301, 1965, p. 49.

The intake capacity of children of this age might not be adequate if NPU is below 60.
.....
.._,
18
occur in all but a very few individuals (2.5 per cent). A level 20
per cent above the average is li kely to cover the requirements of all
but a very small proportion of the population (2.5 per ce nt) .
When the recommended minimum requirements and dietary allowances
of the Food and Nutrition Board (1964) of the National Research
Council for protein for children in the United States are converted
into gm per kg per day (Table 12), the values can be compared direct-
ly with those listed in Table 11 for international use. The minimum
requirements for protein as listed for United States children are
higher than the international recommendations when the protein
quality has an NPU valu e of 70 and are much more generous than re-
quirements given for the poor quality protein (NPU = 50). Most
children in the United States would be using good quality protein
with a high NPU value.
Nitrogen loss and diseases in protein deficiency children were
noted by the FAD/WHOexpert group (1965) as follows:
1. The consumption of inadequate calorie and imbalanced amino
acid protein food sources resulted in protein malnutrition which
caused nitrogen losses. Castro - intestinal function could be so
altered by a protein deficiency that diarrhea became self - perpetu-
ating . Malnourished children were very susceptible to the effects
of parasitism and might even have more parasites under the same
environmental conditions than well-f ed chi l dren would have.
2. The more advanced states of protein-calorie deficiency,
kwaskiokor, and marasmas, which result in death i f not properly
cured, were often found in underdeveloped countries.

19
Table 12. U. S. minimum requirements and recommended dietary

allowances for children.
Protein imper kg
Age Minimurna Recommended u
years requirement allowance
Children 1-3 2.0 2.46

3-6 1. 3 2.22
6-9 1. 2 2.17
Boys 9-12 1. 3 1. 82
12-15 1. l 1. 67
15-18 0.9 1. 39
Girls 9-12 1. 2 1.66

12-15 1.0 1. 32
15-18 0.8 1.09
~National Research Council, Food and Nutrition Board, 1964, p. 13.

Calculated from recommended daily protein allowance of the NRC
Food and Nutrition Board, 1964, p. vii.
INTERNATIONALSUPPLIES OF AVAILABLEPROTEIN
The available protein in the current food supply based on FAQ
food balance sheets of a number of countries has been reported in FAO
reports numbered 24 (1959a, b), 28 (1961) and 36 (1965). Ten coun-
tries in Far East Asia have had from 43 to 58 gm available per person
per day with 6 to 24 gm coming from animal sources. Protein
furnished 9 to 12 per cent of the calories. Exceptions hav e occurred
in Japan from 1954 to present time, Korea in 1948, and Thailand in
1960 when the supply equaled or exceeded the recommendations for
daily protein intake of the pregnant woman. In Middle East Asia four
countries reported low protein intakes of 58-66 gm during pregnancy.
Tunisia and Turkey had good dietary protein intakes.
In Africa and the Near East, two countries reported that avail-
able protein per person was less than the amount recommended for the
pregnant woman. Four other countries had an adequate protein supply.
In Europe the available protein per person in 18 countries is
high compared to quantity available in the Near East. The proportion
of the protein that comes from animal sources is also high (25 to 56
gm).
In North America protein content of diets is high and the per
cent of animal protein is 63 to 65. Most countries had adequate to
high intakes of animal protein. The Latin Ameri can countries showed
great variation with some low, as in Columbia and Peru, and some high,
as in Argentina and Uruguay. Their animal intake was also high.

21
To summarize these findings, the countries that had adequate
amounts of protein available on a per capita basis tend ed to have
adequate supplies of animal protein. The re ve rse was also true with
some countries having 40 to 45 gm protein available of which only six
to eight or sometimes ten gm was animal protein.
Improvement of maternal and child

protein nutrition
Bressani and Behar (1964) reported factors affecting protein
quality and the use of plant protein in human feedings. The imper-
tant factors are: amino acid compositions which are imbalanced in
the majority of vegetable, but not of animal, proteins; digestibility,
which is lower in vegetable than in animal foods due to the fact that
many vegetables contain enzyme-resisting substances or toxic sub-
stances; absorption of nitrogen, which is l ess with vegetable protein
than with animal protein; and processing methods, parti c ul arly tern-
perature and time of cooking. For example, over-cooked vegetable
protein is associated with protein molecular changes such as (1)
protein interaction with carbohydrate or other compounds which cause
the protein to become resistant to enzymatic hydrolysis or (2) the
formation of peptide linkages which could not be split by enzymatic
hydrolysis.
The anti-nutritional factors in some vegetable protein sources
that are known are: a trypsin inhibitor present in legumes and soy-
beans, a goitrogenic factor present in ground nuts and soybeans, an
anti-coagulant factor in soybeans, and gossypol in cottonseed flour

22
which reacts with lysine during processing and exerts a toxic effec t
to some animals.
Combinations of vegetable proteins have been used to make low-
cost protein mixtures designed to prevent protein malnutrition,
especially in children of rapid growth age, and to cure children who
have kwashiorkor and marasmus. Genera ll y, such mixtures are made from
local sources of protein such as cereal grains, legume seeds, ale-
aginous seeds and products, nuts, palm kernels, leaf and algae pro-
teins, and microbial proteins such as plankton and yeasts.
A balanc e in amino acid composition and methods of processing
have been developed so that the mixture can be effectively utilized
in the body. The following data show the effect of how suitable
vegetable protein mixtures may complement each other (Table 13).
Table 13. Complementation between corn and soybean flour proteina
Corn in Soybean Protein

diet in diet in diet Corn/soya
% 7. % protein PERb
90 0.0 7.8 1/0 1.60

72 3.2 8.0 1/0 . 25 2.29
54 6.3 7.8 1/0.6 6 2. 27
36 9.5 8.0 1/ 1. 50 2.91
18 12.7 8.2 1/3.30 2.67
0 16.0 8.1 1/10 2.56
:Bressani and Behar, 1964, p. 190 .

PER= protein efficiency ratio.
23
The first such mixture, a combination of vegetable and cereal
proteins, was developed at the Institute of Nutrition of Central
America and Panama in Guatemala (INCAP). The complete protein mixture
is acceptable to the native population and at a price that they can
afford. This mixture, INCAP mixture 9 B, is cooked with water and
eaten as a gruel. The composition of the mix in percentages is as
follows: whole ground sorghum (or other cereals) 28, gro und corn 28
(or 56 per ce~t of other cereals), cottonseed flour 38, torula yeast
3, leaf meal 3 or 0, Caco 3 1, and vitamin A, 4500 I.U. Allowance is
made for use of local cereals in other Central or Latin Americans.
The nutrient content of mixture 9 Bis shown in Table 14 .
Table 14. Nutrient content of 100 gm of INCAP mixture 9 Ba
Ingredients Essential amino acids
Protein 27.5 gm Arginine 2.57 gm

Fat 4.2 gm Histidine 0.53 gm
Carbohydrate 53.8 gm Isoleucine 1.11 gm
Calories 370 Leucine 2.08 gm
Vitamin A 4500 I.U . Lysine 1.09 gm
Thiamine 2.3 mg Methionine}+ 0.82 gm
Riboflavin 1.1 mg Cystine

Niacin 7.8 mg Phenylalaninj 2.11 gm
Calcium 656.0 mg Tyrosine +
Iron 8.4 mg Threonine 1.18 gm
Phosphorus 698.0 mg Tryptophan 0.29 gm
Sodium 3.7 mEq Valine 1.44 gm
Potassium 27. 9 mEq
aBressani and Behar, 1964, p. 194.

24
Growth curves of rats fed mixtur e 9 and milk at 20 and 10 per
cent protein levels, and of vegetab l e mixture 9 and casein at 24 per
cent l eve ls, are shown in Figure 1. At low levels of protein intake
the animal protein produced a higher growth rate, but at the higher
level of intake the growth rate was simi lar for both groups of rats.
Growth rate in rats when skim milk replaced half of the mixture was
nearly as high as that when skim milk alone was us ed to supplement the
rural diet. Total serum proteins and a lbumin in rats depended on th e
lev e ls of protein intake. Serum globulins, blood ur ea , red blood
cells, white cells, and heamoglobin were simi lar at the same levels
of protein intake.
It was noted that although the absorption of nitrogen was lower
for the vegetab le mixture, there was no significa nt difference in
retention at adequate lev e ls of protein intake. Only when intake was
below two gm per kg per day, which is considered insufficient for the
children 1- 5 years of age , was higher retention observed on the milk
diet.
When this mixture was used in the treatment of kwashiorko r,
there were c linical and biochemical changes which paralleled the
recov ery when milk alone was used. However, the return of serum pro-
teins to normal values was s lower when vegetable mixtures only were
given.
Another widely us ed vegetable protein mixture is INCAP vegetab le
mixture 8 which, in percentages, consists of dried lim e -treated corn
flour 50, sesame flour (full fat) 35, cottonseed flour 9, torula
yeast 3, and kikuya leaf meal 3. This mixture, containing 25.1

25
200
20 per cent protein
in diet
180
160
140
cent
in diet
120
§, 100
'-'
.c
....
00
0)
:,
80
0)
00
"'
...
0)
~ 60
40 mixture no. 9
,__.._. ___. skim milk
20
a----- casein (vitamin free)
0 14 21 28 0 14 21 28
Days Days
Figure 1. Growth of rats fed INCAP vege table mixture 9, skim milk,
and casein (Bressani and Behar, 1964, p . 195).
26
prot ei n , gave a nitr og e n retentio n e qui va l e nt to that of milk when
2.4 -3.8 gm protein per kg per day was used. It was also eff ective
for ch i ld ren with kwashiorkor.
Mixtures made in the Central Food Tech nological Research Insti-
tute, Mysore, India , have been reported as follows: Mysore Food A,
25 per cent chickpea a nd 75 per cent peanut meal; Mysor e Food B, 25
per cent chickpea, 65 per cent peanut f l ou r and 10 per cent sesame
meal.
Oth er successful mixtures includ e: (1) tapioca-macaroni, a blend
of tapioca f lour, peanut f lour, and wheat semolina in the ratio of
60:15:25, and contai n ing about 11 per cent protein; (2) Panshtik
atta, a mixture o f whole wheat flour wi th pea nut flour and some
tapioc a; (3) Nutro or protein rich bis cuits, made from a 2:3 blend
of peanut a nd wheat f l our and co ntai nin g sugar , salt, l eave ning,
vitamins, and about 17 per cent protein; (4) s oyb ea n products such as
a soybean-banana mixture made for the treat me nt of protein malnutri-
tion and a soybean milk mixture used as a n infant food; (5) blends
with peanuts as a ba se s uch as peanut s, coconut, and chickpea flour;
peanuts with soybeans; peanut f lour fortified with c a lcium and v ita-
mins; peanut flour with sk im milk powder ; and peanut flour with soy -
bean fortified with l ysi ne , methionine, vitamins, and minerals; (6)
sesam e and coco nut meals, for tified with lysine, methionine, and
thr eon in e; (7) cashew-nut f l our a nd cowpea flour, in the proportion
of 3:1; (8) Bengal gram (chickpea) wi t h banana and Bengal gram with
rice; a nd (9) wheat br ea d a nd skim milk. All of thes e mixes have

27
given satisfactory results in the t reat me nt of malnutrition when they
were used as s uppl ements to the rural diets (Bressani and Behar,
196 4).
In Uganda , in fants aged s ix months a nd o ld er were fed a biscuit
consisting of whole peanuts (which provided 60 per cent of the total
prot ei n) , corn meal, sugar, and some dry milk. The mixture was about
as effect i ve as a mil k diet.
In Ni geria , a mixture of peanut f lour and cassava was well ac-
cept ed.
In Mexico , a mixture of chickp eas and soybean flour supp lemented
with methionine has been merc handi sed .
In Ar gentina , a mixt ur e named "Arge ntarina" was developed in
1962 . The compositio n of this mixture in percentag es is as follows:
ground nut flou r 4, sorghum flou r 20, whea t flour 10, millet flour
17 , white bean f lour 10, ye ast 2, Caco 1, and Vit amin A 4,500 I.U.
3
The mixture conta in s 27 . 8 per cent protein and has a good pattern of
essential amino acids. Accepta bility trials were satisfactory.
A mixture cal l ed "V protein," co ntaining wheat genn, the aleurone
la yer of the whea t kernel and processed defatted soybean mea l, was
found to compare favorably in protein values with casein and other
animal proteins.
Dan i e l (1965) i nvestigated prot ei ns made of blends of soya,
sesame, and sk im mi l k powder. In protein blend I, soya flo ur: sesame
flour ~ 64:36 . In protein blend II, soya flour:sesame f lour:skim
milk powder ~ 28:32:40. The protein efficiency ratios of the mixes
were for blend I, 2.70 and for b l end II, 3.34 . These compared with
28
2.14 for soy proteins and 3.08 for milk prot e ins. Fortification of
bl e nd I and b l e nd II with L-lysine an d DL-me thionin e brought about an
incr ease in PER to 3 .30 and 3.49 respective ly. Soybean and skim milk
powder fortifi ed with DL-meth ionin e gave PERs of 3.07 and 3.78.
Guttik ar (1965) experimented with two samp l es of pro cesse d
prot e in food based on fortified bl e nds of gro und nut, Bengal gram ,
and sesa me f lour, and of ground nut, soybean and sesame flour. A
dail y intake of 50 g of th ese food s would provide abo ut half th e dai ly
requirement of prot e in, calcium and certai n essentia l vitamins needed
by pre-schoo l childr e n.
Daniel et al. (1964) found that there was a significant increase
in PER va lu e when both ground nut f l our and skim milk powder were
r eplaced by soy flour in th e b l end of wheat f lour, gro und nut, and
skim mi lk powder in th e r atio n of 60:30: 10. A mixture of soy and
sesam e f lour s gave th e same result . Forti f ication of the b l end of
whea t and ground nut f lour s wi th l ys in e , methionine, and threo nin e
brou ght a signif ic ant incr ease in PER value . A bl e nd of 60:40 wheat
and soy flours fortified with methionine gave a PER value near l y
equal to that of mil k protein .

CONCLUSIONAND RECOMMENDATION
A period of great physiological cha nge takes pl ace during preg-
nancy and lactation. Protein of good qu a lity should b e supplied in
an adequate amount for maternal hea l th and for the normal growth
and ph ysica l and ment al deve l opment of fet us, infant, and child bo th
for present gro wth and for lat er l ife . Since protein values d epe nd
on th e ir amino acids patterns , vegetab l e mi x ture s, to have a high
prot ei n va lu e, should hav e th e ir amino acid patterns balanced to
agree with the FAQ standard ami no acid pattern.
In th e United Stat es , it is thought th at a prot ein intake of
gm per kg per day is adequate in non-p r eg nant women. An addit ion of
20 gm per day is ne eded during the four to nin e months of pregnancy,
and 40 gm per day in l actation.
In Cana d a, a prot ein intake of abo u t 1 gm per 3 l b bo dy weight
per day is consider ed adequate for non-pregnant women. An addition
of 10 gm per day durin g th e seven to nine months of pregnancy and o f
20 to 30 gm per day durin g l actatio n are recommended.
In Norway, a protein i n take of 1 gm per kg per day is r ecommended
for non-pregnant women. An additio n of 25 gm per day durin g th e
seven to nine months of pregn a ncy and 40 gm per day during lactation
are r ecormnended.
In Great Britain, protein i ntake for non-pregnant women i s 66 gm
per d ay. An addition of 27 gm per day during the one to five months
of pregnancy, 36 gm per day during six to nine months of pregnancy,

30
and 45 gm per day duri ng l actation are recommended .
The infant and child are in the ages of the high e st growth rate
of lif e. If protein intake is not adequate, growth will be st unt ed
and th e individual will have lo w r esistance and will be susceptib le
to diseases, infections, and parasites. Nitrogen intake must be high
enough to maintain high positive balance at all times. Since the
quantities of diet, when of ve r y poor quality protein , necessary to
meet protein requirements are beyond the intake capacity of infant
and young child, protein of high qualit y is needed in their feedings.
Proteins of human milk and of hen's egg have about the same
amino acid patterns which ar e somewhat lower in many amino acids than
the FAQ provisional pattern. Their biological value l , and NPU
100. Though cow's milk ha s lower biological and NPU values, its
protein concentration i s higher. There is no distinction between
human's milk and cow's milk feeding at recommended l evels as show n
below :
Age a gm of human' s or cow' s milk/kg

0-3 months 2.3
3-6 months 1.8
6-9 months l. 5
9-12 months l. 2
a(WHO Repott No. 301, 196?, p. 23)
For children aged mor e than one year old, protein of NPU lower
than 100 and lower concentration than milk can be fed , fortified with
protein of high NPU values.
Children aged one to three years old need about 1 . 2 gm protein
per 0.45 kg body weight per day (we i ght 27 lb needs 32 gm protein).
31
Children aged three t o nin e years need about l gm protein per 0.45 kg
l:o dy weight per day.
The use of low cost, high quality pr o tein from vegetable mix-
ture s will prevent malnutriti on in the pregnant woman and infant.
Their use should be encouraged in all developing countries.

SUMMARY
Dietary protein in adequate amounts is recommended to be higher
for maternal and child health than for the normal woman and child.
Probl ems of providing ade quate protein foods are mostly found in
deve l op in g countr i es in the areas whe r e socio -econ omical l eve ls are
low. For such areas, breast f eeding is desirable for th e feeding of
infant s to provide a n easily a c cessi bl e foo d containing adeq uate
nutri ents in the proper proportions and to so l ve the sa nitary prob-
l ems. Fortif i ed vegetab l e mixtures of high qu a lit y protein sho uld be
encouraged in infant diets after weaning to prevent prot ei n malnutri -
tion and accompa nyin g diseases. These mixt ures a r e a l so useful, if
animal protein i s not available, to insure ade quat e di ets in pregnancy
and lactation.
LITERATURECITED
Berry, F, B. 1962. The Kingdom of Thailand Nutrition Survey. A

report by the Interdepartmental Committee on Nutrition for
National Defense. Published by United States Government Pr i nt-
ing Office, 0 - 629788, p. 1-245.
Bressani, R., and M. Behar. 1964. The use of plant protein foods in
preventing malnutrition. Proceedings of the Sixth Internationai
Congress of Nutrition. E & S Livingstone LTD, London. p. 181-
204.
Conunittee on protein malnutrition and the conunittee on child nutri-

tion of the food and nutrition board. 1964. A summary of an
international conference on prevention of malnutrition in the
pre-school child. Pre-school child malnutrition. National
Academy of Sciences. National Research Council, 2101 Constitu-
tion Avenue, Washington, D.C, p. 1-9.
Daniel, V. A. 1965. The nutritive value of blends of soybean, sesame

and milk proteins fortified with limiting amino acids. Journal
of Nutrition and Dietetics (India) 2:17-20. (Original not seen;
abstracted in Nutrition Abstracts and Reviews 36:99, no. 602,
1966).
Daniel, V. A., R. Leela, K. Hariharan, V. S. Rao, D. Rajalakshmi, M.

Swaminathan, and A. N. Parpia. 1964 . Nutritive value of proteins
of blends of wheat, ground nut, soybean, Bengal gram, sesame and
skim milk powder fortified with limiting essential amino acids.
Journal of Nutrition and Dietetics (India) 1:293-296. (Origina l
not seen; abstracted in Nutrition Abstracts and Reviews 35:293-
296, no. 5799, 1965).
F.A.O. 1961 . Report of the Technical Meeting on Nutrition . In Food

Policy and Planning in Asia and the Far East. 1960. F.A . O,
Nutrition meeti ngs report series no . 28:1-49.
F,A,O. 1959a. Report of the Fourth Conference on Nutrition Problems

in Latin America, 1957. F,A,O . Nutrition meetings report series
no. 18:1-66.
F.A.O. 1959b. Report of the Nutrition Committee for the Middle East,
1958. F,A,O , Nutrition meeting report series no. 24:1-50.
F.A.O. 1965. Report of the Joint Symposium on Industrial Feeding and

Canteen Management in Europe, 1963. F.A.O . Nutrition meeting
report series no. 36:1 - 41 .
34
F . A.O./W.H.O. Expert Group. 1965. Protein requirements. W.H.O.

Technical report series no. 301:1 - 71.
Graham, G. A., A. Cordano, and J.M. Baertle. 1963. Effect of pro-

tein a nd calorie intake on weight gain. Journal of Nutrition
81:249-254.
Guttikar, M. N., M. Panemangalore, N. M. Rao, R. Pajagopalan, and M.

Swaminathan. 1965. Studies on processed protein foods based on
blends of ground nut, Bengal gram, soybean, sesame flours and
fortified with minerals and vitamins. Journal of Nutrition and
Dietetics (India) 2:21. (Original not seen; abstracted in Nutri -
tion Abstracts and Reviews 36:99, no. 603, 1966).
Hytten, F. E. 1964. Nutritional aspects of foetal growth. In pro-

ceedings of the Sixth International Congress of Nutrition. E &
S Livingstone LTD, London . p. 59-65.
Holt, L. E., E. S. Snyderman, M. P. Norton, E. Roitman, and J. Finch.

1963. The plasma aminogram in kwashiorkor. Lancet II:1343-1348.
Lee, C. J., and B. F. Chow. 1965. Protein metabolism in the off-

spring of underfed mother rats. Journal of Nutrition 87:439-443.
National Research Council, Food and Nutrition Board. 1964. Recom-

mended Dietary Allowances. 6th Revised Edition, Publication
1146.
Shaw, J. S., and D. Griffiths . 1963. Dental abnormaliti es in rats

attributable to protein deficiency during reproduction. Jo urnal
of Nutrition 80:123-141.
Snyderman, S, S. 1965. An eczematoid dermatitis in histidine

deficiency. Journal of Pediatrics 66:212 - 215.
Venkatachalam, P. S., and K. S , Ramanathan. 1964. Effect of protein

def iciency during gestation and lactation on body weight and
composition of offspring. Journal of Nutrition 84:38-42 .
W. H. O. Expert Committee. 1965. Nutrition in pregnancy and lactation .

W.H. O. technical report series no . 302, p. 1- 54.

Nutrition in Thailand

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Utah State University

All Graduate Plan B and other Reports Graduate Studies

Follow this and additional works at: https://digitalcommons.usu.edu/gradreports

Part of the Nutrition Commons

This Report is brought to you for free and open

Report No. l submitted in partial f ulfillment

Food and Nutrition

UTAH STATE UNIVERSITY•

This thesis was accomplished by the h el p of Dr. Ethelwyn B.

Wilcox. I do appreciate her creativity , intellectual ability , and

her assistance in preparing this piece of work.

NUTRITIONOF THAI PEOPLE 3

Nutritional status in Bang Chan, 1952-1954 3

Dietary survey in the north and north east, 1955-1956 5

Dietary survey in the Royal Thai Army, 1955-1956

Dietary survey in the Royal Thai Navy, 1956

Mother and infant dietary survey, 1957 9

Dietary survey in urban and rural areas, 1957 10

Child health survey in rural areas, 1957-1958 11

Nutrition survey in civi li ans and military units, 1960 11

Bang Chan follow-up studies, 1960 34

BODYWEIGHT, HEIGHT, ANDMORTALITYRATE OF THE THAIS 36

THAI FOODSOURCESAND THEIR ABILITY TO SUPPLYNEEDED

A BASIC FOODPATTERNFOR THAILAND 42

1. The percentage of reconunended allowance of each

2. Methods of rice cooking, Royal Thai Navy, 1956 8

3. Nutritional diseases, Royal Thai Navy, 1956 9

4. Average dietary nutrients per person in three areas

5. Areas surveyed in Thai ICNNDnutrition study, 1960 14

6, Angular lesions among Thai civilians in terms of age 18

7. Prevalence of goiter among civilians 22

9. Mean serum vitamin C levels among civilians in terms

10. Data on average weight and height of Thai and

11. The composition of foods calculated in terms of 100 gm

1. The map of Thailand 2

2. Average daily thiamine intake of Thai people 16

3. Average daily riboflavin intak e of Thai people 17

4. Average daily dietary iron intakes of the Thai

5. Distribution of subjects according to levels of

6. Average daily vitamin A intake of Thai people 25

7. Average daily vitamin C intake of Thai people 27

8. Average daily fat intakes of Thai people 30

9. Percentage of persons with destructive periodontal

11 . Average weight of Thai male children compared with

12. Weight changes of civilian adult males compared with

13. Cumulative mortality in infants 40

14. Food for health in Thailand . Eat food from each

Thailand is located in southeast Asia between Burma, Laos, and

Next to rice is fish, bo th from fresh water and from th e sea .

A nutritional sur vey was first made in Thailand in Bang Chan

Village in 1952-54, in connection with the Cornell-Thailand proj ec t.

finding information on nutriti ona l status of additional group s of

Th ai people in other areas of Thai land . The most extensive s u rvey

on Nutrition for National Defense in 1960 .

Malnutrition does exist i n spite of the fact that Thai l and is a

food surplus country. Factors in vo lved are an imbalanc e of foods

eaten, often low intake of protein, economic problems in many rural

areas, and sometimes even in urb a n areas, and ignorance or l ack of

The nutritional status of the people of Thailand has been

studied quite extensively since 1952 by a number of investigators

who will be identified as their results are discussed. The first

survey included people in a small village. Additional population

groups of Thai people were studied in seven separate surveys. Then