AMERICAN ACADEMY OF PEDIATRICS

ACCEPTANCE OF PRESIDENCY
T HIRTY-THREE men have held this office can Academy of Pediatrics; the Executive
before me-thirty-three of the greatest Board of the Academy continually reviews
names in Pediatrics. With such a heritage I our problems and chants our course; the Ex-
feel very grateful and humble. eccutive Director and Central Office staff
It has been my good fortune to have arrange the cargo, but you-the stock hold-
known most of these men personally, and to ens-must work the cargo if our voyage is to
the following three, I am particularly in- be successful. I will try to the best of my
debted: Dr. J. B. Bildenback, who was my ability to nun a happy and efficient ship-
teacher; Dr. Henry Dietrich, under whom I and hold her steady as she goes.
had my residency; and Dr. Jay I. Dunand
who was the first to interest me in our Acad-
emy and who was always an inspiration to
me.
The founders and officers of the Academy
who have served before me have set the pur-
pose of the voyage of the Good Ship Amen- Seattle 22, Washington

Delivered at the Annual Meeting of the American Academy of Pediatrics, October 9, 1963.
ADDRESS: 736 Broadway, Seattle 22, Washingon.

FACTORS AFFECTING FOOD INTAKE

COMMITTEE ON NUTRITION
E \‘EN in the midst of an abtindant food Will eating between meals “spoil the appe-
supply and adequate knowledge of nu- tite”? Is food intake in later life likely to
tnient requirements, faulty nutritional prac- be influenced by dietary habits established
tices may lead to specific deficiencies on to in infancy and early childhood? Can appe-
gross ovennutmition. The Committee has tite be relied upon as a guide to proper
therefore thought it desirable to call atten- nutrient intake? Under what circumstances
tion to certain emotional, cultural, and edu- will various B vitamins, iron, or other spe-
cational factors that determine or modify cific nutrients serve as effective “tonics” to
food intake and to discuss variations in stimulate appetite?
food intake that occur in relation to age, No attempt will be made to review the
sex, energy expenditure, deficiency of spe- neural, physiologic, or chemical bases for
cific nutrients, presence of certain illnesses, hunger and appetite on to consider the
and administration of various medications. etiology and management of obesity.
An attempt will be made to answer, at
least in pant, some of the following ques- DEFINITIONS
tions believed of interest to the practitioner: Considerable differences of opinion ap-
How do familial and social factors influ- pear to exist among clinicians, physiologists,
ence type and quantity of food ingested? psychologists, and anthropologists with me-

ADDRESS: 1801 Hinman Avenue, Evanston, Illinois.

PEDIATRICS, January 1964
135

Downloaded from http://pediatrics.aappublications.org/ by guest on May 21, 2018

136 FOOD INTAKE

spect to precise definitions of Ilunger, appe- feelings toward home, members of family
tite, and satiety. However, it is generally and, eventually, social implications of
agreed that hunger is a biologic phenome- friendship, good fellowship, and well being.
non and at least predominantly unlearned Conversely, mealtime may come to he inti-
and unconditioned, while appetite has mately associated with fear of punishment
strong emotional connotations being pri- or conflict with the parent. Thus, feeding,
manly a learned response and intimately which in early infancy may have mepre-
associated with memory of past experiences sented merely the relief of uncomfortable
with food. Anorexia may be considered to feelings of hunger, eventually becomes as-
represent the absence of a desire for food sociated with such divers feelings as love
in circumstances in which one might ondi- and approval, defiance and fear.
narily anticipate such a desire. Satiety is a
Cultural Factors
lack of desire to eat that ensues after eat-
ing and is determined primarily by post- Although we tend to think of food taboos
ingestion factors. Pakitability, on the other in relation to strange and seemingly irma-
hand, is related to pmeingestion factors, in- tional practices of primitive societies, such
cluding taste, aroma, texture, temperature, taboos are actually common in our own
appearance, and recollection of past expemi- society also. For example, we eat pig, but
ences. not dog, live oysters but not live shrimp,
duck eggs and duckling but not the three-
EMOTIONAL, CULTURAL, AND quarter-grown duck embryo considered a
EDUCATIONAL FACTORS delicacy in the Philippines.
Emotional Factors Cultural factors in dietary choice have
The very young infant will generally cry been well discussed by Lee.’ In certain
until fed but by four or five months of age cultures it is customary to eat dragon flies,
may stop crying when he hears his mother’s locusts, crickets, water bugs, beetles, en-
footsteps or sees that the formula is being trails, and eyeballs, all of which most Amen-
prepared, presumably having learned to icans would find repugnant. Conversely,
anticipate and to wait for the relief of Americans often have a keen appetite for
hunger pain. In later life, the period of milk, which is considered repulsive in cen-
tantalizing anticipation before a meal may tam other societies. Even the appetite at a
actually be considered pleasurable. The specified season of the year or time of day
repetitive cycle of nutritional and emo- may be based largely on cultural factors.
tional gratification during infancy becomes Thus, a particular appetite for turkey is
further associated with the person giving common at Thanksgiving time. At break-
the food, usually the mother, so that being fast Americans are likely to have an appe-
loved and fed come to be associated in the tite for ham and eggs but not for roast
mind of the infant. pork. In view of such irrational practices,
Even on a physiologic basis, some simi- the child who craves ice cream for break-
lanity seems to exist between response to a fast need not be considered by his parents
loved person and response to food. The to be ill or perverse; he may be merely less
mate of secretion of hydrochloric acid in the regimented by culture than are the adult
stomach of a 15-month-old girl with gastric members of his society.
fistula was shown’ to increase during pen- In America, where obesity is unfashion-
ods of social contact with a loved person able, many women avoid eating rich des-
and to decrease when approached by a serts, cream in their coffee, and butter on
stranger. their toast despite an appetite for these
In later childhood, mealtime, food, and foods. In certain other ctiltures young
eating take on further emotional connota- women stuff themselves with equivalent
tions as tile association widens to include foods, even though they may lack appetite

Downloaded from http://pediatrics.aappublications.org/ by guest on May 21, 2018

 AMERICAN ACADEMY OF PEDIATRICS 137

for them, in an attempt to achieve a fash- tive the desires of their children to eat be-
ionable plumpness. tween meals.
The scale of values varies to some extent A word of warning may be necessary
from one age group to another and from one when extensive eating between meals is
family to another. For example, in our so- customary since “snacks” are frequently rich
ciety, a plump tOdl(Ilcr is considered attrac- in carbohydrate and relatively low in con-
tive but leanness is considered an asset tent of other nutrients. A permissive atti-
after childhood. The pressures exerted upon tude concerning frequency of eating should
an individual to attain an acceptable body not be allowed to interfere with attainment
physique are likely to be most acute during of recommended intakes of all essential flu-
adolescence. In families in which the pan- tnients. Excessive caloric intake must also be
ents did not have sufficient food when they avoided.
themselves were children, undue emphasis The effect of eating between meals on
on food and eating is not uncommon. Par- total caloric intake has been the subject of
ents’ complaints regarding poor appetite of relatively few studies. Caloric intake has
such children may be unfounded when con- been shownc to be greaten when children
sidered in light of actual food consumption are permitted a snack between meals than
and need. when no snack is provided. A snack con-
That choice of food can have moral im- sisting of milk may represent an exception
plications for a child has been suggested since it would appear that milk is slower
by Mead. Similarly, Dubo has pointed out to leave the stomach than most other foods
that children with tuberculosis not uncom- and influences appetite for a longer interval
monly attribute their illness to ingestion of after
the “wrong” foods or to failure to eat the
“right” foods. Educational Factors
An appetite for a particular food may
Eating between Meals
develop in experimental animals as a me-
Among the cultural factors most strongly suit of beneficial experience after ingestion
ingrained in our society is the pattern of of the food. For example, preference ex-
three meals daily. Most parents consider it hibited by thiamine-deficient mats for diets
undesirable for their children to eat exten- containing thiamine can probably be best
sively between meals either because such explained on the assumption that a sense
eating is likely to lead to obesity or because of well-being occurred after such ingestion.8
it “spoils the appetite” at mealtime and When the habit of ingesting the thiamine-
therefore may interfere with nutrition. On containing food has been established, me-
the basis of animal studies and a few obser- moval of thiamine from the food did not
vations relating to man, it has been sug- change the habit. This and other evidence
gested’ that a specified intake of calories suggests that in animals at least “new
and other nutrients taken by an individual habits tend to form in agreement with
in small amounts at relatively frequent in- bodily needs, btit established habits tend
tervals may be more desirable than ingestion to persist as regulators of food selection
of the same quantity of food in larger, even when the food selections are out of
spaced meals. Our familiarity with eating of line with bodily needs.”
spaced meals has apparently led to accept- Although it is diffictilt to establish the
ance of a belief that this is nutritionally reasons for widespread overeating which
sound. Cleanly, the existing cultural pattern leads to our national problem of obesity in
is difficult to modify, but physicians who adult life, certain speculations may be of-
realize that nutritionally sound reasons do fered. Frequently repeated remonstrances
not exist for spaced meal eating may be able of parents to their children to “clean your
to help parents to view in proper perspec- plate” and “drink your milk” may establish

Downloaded from http://pediatrics.aappublications.org/ by guest on May 21, 2018

138 FOOD INTAKE

unfavorable dietary patterns that will pen- offered a variety of simple foods under con-
sist into adult life. Similarly, the practice ditions that precluded the handing down
of offering candy or other food as a reward of dietary information or experience by
for good behavior on as consolation in time either example on instruction. Under these
of unpleasant expenieilce is open to question. circumstances it was not uncommon for a
It seems possible that children who are un- child to eat an entire meal of one or two
able to derive sufficient pleasure and satis- items, e.g., eggs and bananas. Such pat-
faction from other pursuits may turn in- temns of eating were usually of short dura-
creasingly to eating as a primary satisfac- tion and a more varied intake was the rule.
tion. Growth in length and gain in weight were
normal; the children remained free from
UNGUIDED FOOD SELECTION symptoms of indigestion and appeared nor-
Human populations have demonstrated mally resistant to disease. However, it seems
great ability to choose foods in accordance likely that the satisfactory performance of
with physiologic needs provided their these infants may be an indication that ran-
choice was not unduly influenced by educa- dom eating from a well-chosen list of foods
tion, imitation, social, economic, religious, is sufficient to avoid development of defi-
or other considerations.1#{176} Similarly, there is ciency diseases. The infants might not have
no doubt that under certain experimental famed as well if the diet had contained a
conditions animals are able to select an greater number of foods that were deficient
adequate diet from a diverse assortment of in various nutrients.
nutrients. Rats given access to 11 sub- The craving for salt exhibited by chil-
stances (including casein, sucrose, olive oil, dnen with cystic fibrosis of the pancreas on
sodium chloride, dried baker’s yeast, cod adnenogenital syndrome with salt-losing
liver oil, wheat germ, and water) in separate state would appear to be a special instance
containers made selections conducive to in which voluntary food selection is a rela-
excellent growth and normal reproduction.” tively reliable guide to need. Similarly, the
A number of observations indicate that intense thirst of patients with diabetes in-
other animals may also make favorable se- sipidus seems to be related to need for
lections of food on seek out specific nutni- water although equally intense thirst is
ents in which the diet is deficient.1#{176} characteristic of otherwise normal individ-
Nevertheless, abundant evidence9” mdi- uals with the syndrome of habitual or psy-
cates that intake of food by experimental chogenic water ingestion.
animals is often unpredictable and mdi-
VARIATIONS IN FOOD INTAKE
vidual animals vary in their ability to make
nutritionally favorable choices. Scott’3 me- Knowledge of variations in food intake is
ported that only 53 of 89 rats of a mixed somewhat limited because of the made-
strain appeared to have an appetite for quacy of nutritional history as a method of
casein. Those that apparently did not like determining food intake. Depending on the
casein ate less than 0.1 gmlday, lost weight, type of history taken, one group of obese
and died within a short period. Harris et al.8 patients was found to have a food intake
showed that thiamine-deficient rats were of 600 calories per day greater than was
unable to distinguish thiamine-containing revealed by a different form of question-
foods if too many choices of foods were ing.15
offered, if the thiamine content of the foods
Influence of Age, Sex, and Sensory
was less than adequate, or if thiamine, after
Stimulation
being in one food, was transferred to an-
other food with a different flavor. On the basis of nearly 1,400 nutritional
In the classic experiments of Davis,14 surveys, Bea116 has provided information
vigorous, healthy infants and toddlers were concerning the mother’s assessment of her

Downloaded from http://pediatrics.aappublications.org/ by guest on May 21, 2018

 AMERICAN ACADEMY OF PEDIATRICS 139

YEARS

FIG. 1. Evaluation of child’s appetite by mother.

(From Beal, PEDIATRICS, 20:448, 1957.)

child’s appetite (Fig. 1). It would appear food intake becomes severely limited de-
that a great many mothers are dissatisfied spite intense desire for food.
with the food consumption of their children, As previously mentioned, aroma, appear-
especially with reference to children be- ance, temperature, and taste may be im-
tween the ages of 2 and 6 years. Undoubt- pontant in the stimulation of appetite. The
edly, much of this dissatisfaction results ritual of preparation and serving of food
from lack of knowledge concerning normal may also stimulate appetite. Food pre-
patterns of variation in food intake. pared and presented in an attractive man-
A number of nutritional histomiesl7l9 have ner is much more likely to be eaten than
indicated that maximal caloric intakes of the same food presented in a less “appetiz-
girls, averaging about 2,500 calories daily, ing” way.
is reached between the ages of 13 and 16
Individual Variability
years, while maximal intakes of boys, aver-
aging nearly 3,500 calories daily, is reached Results of longitudinal studies”” have
between the ages of 15 and 18 years. indicated extreme variability in intakes of
Not only are caloric requirements of ac- food by children of the same age and sex.
tive, rapidly growing adolescents almost In addition, food intake of a specified child
certainly greater than those of most adults, usually varies considerably in relation to
but the severe emotional stresses character- that of his peers. In a study by Burke et al.18

istic of this age may lead to overeating. On intakes of food by individual subjects were
the other hand, motivation for dieting may considered in three age intervals-i to 6
at times be so great, especially in girls, that years, 6 to 12 years, and 12 to 18 years-and

Downloaded from http://pediatrics.aappublications.org/ by guest on May 21, 2018

140 FOOD INTAKE

were classified as high, medium, or low in particular importance in regard to manage-

relation to intakes of other children of the ment of children whose activity must be
same age and sex. Only one-third of the restricted for medical reasons.
children persisted in the same classification
Satiety Values of Specific Foods
( i.e., always high, always medium, or al-
ways low) in all three age intervals. Little information is available concern-
ing relative satiety values of foods with
Environmental Temperature differing percentages of protein, cambohy-
Studies with a number of experimental drate, and fat. In studies of obese adults
animals” have demonstrated that volun- receiving calorically restricted diets, mela-
tary ingestion of food decreases sharply at tively high intakes of protein have been me-
Iligh environmental temperatures. The spe- ported” to be more satiating than relatively
cific temperature necessary for depression high intakes of carbohydrate or fat. Similar
of food intake varies considerably from one studies carried out with nonobese adults
species to another. Brobeck2o has suggested and with children would be of great in-
that decrease in appetite occurs when en- temest.
vironmental temperature has reached a Available evidence 23 does not permit the
point at which maintenance of body tem- conclusion that variations in content of
perature becomes difficult for the animal. linoleic acid exert a significant effect on the
At this point, heat resulting from ingestion satiety value of a feeding unless the amount
of food would interfere with maintenance of linoleic acid in the feeding is relatively
of body temperature. This theory is obvi- low, i.e., supplies less than 1% of total
ously attractive as an explanation for the calories. Since even whole cow milk sup-
“poor appetite” frequently reported during plies 1% of total calories as linoleic acid,
hot weather. supplementation of the diet with foods
rich in linoleic acid will rarely influence its
Caloric Expenditure satiety value.
Moderate activity, such as walking for
Increased Food Intake
one hour, involves the expenditure of only
about 100 calories, a loss of energy easily Increased food intake is characteristic of
replaced by ingestion of only one slice of patients with cystic fibrosis of the pancreas,
bread and butter. Hence, there has been a hypemthyroidism, diabetes mellitus, and
tendency in recent years to consider weight epinephnine-producing tumors of the
control primarily in terms of food intake. adrenal medulla. It is also observed in pa-
However, a decrease in energy expenditure tients receiving ACTH, adrenal cortical
of 100 calories daily without concomitant steroids, andnogens, estrogens, and isoni-
change in caloric intake will result in azide. Tumors of the hypothalamic region
weight gain of approximately 1 lb pen month and certain traumatic and inflammatory le-
or 12 lb yearly. sions of the brain may excite hypemphagia.
Because the day-to-day relation between Studies in animals have demonstrated that
caloric expenditure and caloric intake is lesions of the hypothalamus at the level of
not regular in adults,” it seems unlikely the ventromedial nucleus induce obesity by
that it is regular in children. The observa- increasing food intake, and that lesions of
tion that a child has “played hand all day” the lateral areas of the hypothalamus (or of
and yet “has no appetite” is therefore not both ventromedial and lateral areas) abolish
to be considered a sign of illness. Fatigue on markedly diminish food intake.” The
itself is likely to interfere with appetite and medial area has been called the “satiety
severe fatigue may cause anorexia. center” and the lateral areas the “feeding
Consideration of the relation between centers.” The function of these hypothal-
caloric intake and energy expenditure is of amic centers is either to inhibit or to fa-

Downloaded from http://pediatrics.aappublications.org/ by guest on May 21, 2018

 AMERICAN ACADEMY OF PEDIATRICS 141

cilitate visual, auditory, olfactory, tactile, is a common symptom of iron deficiency

gustatory, or gastrointestinal “feeding re- anemia in infants and children. Adequate
flexes,” as well as reflexes of attention, ap- iron therapy results in prompt increase in
proach, examination, ingestion (including intake of food,’#{176}and within 7 to 14 days a
chewing and swallowing), and rejection of predictable rise in reticulocyte count and
food.” From the reflexes involved, it would in concentration of hemoglobin. There is
appear that the regulatory system projects no evidence to indicate that deficiency of
beyond the hypothalamus. iron in various enzyme systems occurs in
In patients with cystic fibrosis of the the absence of iron deficiency anemia and
pancreas, the absence of pancreatic en- therefore the use of iron as a “tonic” on
zymes is apparently responsible for rapid appetite stimulant does not seem reason-
emptying of the stomach after ingestion of able.
food,” with resultant failure of ingested
Pharmacologic Agents for Suppression
food to promote satiety.
of Excessive Appetite
Decreased Food Intake Drugs that have achieved the greatest ac-
When growing animals are given nutri- ceptance as anorexigenic agents are tile

tionally inadequate diets, food intake gen- sympathomimetic amines. The various con-
erally decreases, presumably because the sequences of the central stimulation pro-
desire to eat decreases if food is not suitable duced by these agents, including anxiety,
for synthesis of tissue. Regardless of the increased mental and physical activity, and
mechanism, dietary deficiency of any essen- insomnia, cannot be separated from the
tial nutrient is likely to be associated with anonexigenic action.” Perception by expeni-
decrease in voluntary intake of food.’#{176} mental subjects of the central stimulating
Food intake is generally decreased in effects of these drugs has made the double-
acute and chronic febmile illnesses, in de- blind method of evaluation difficult and has
bilitating illnesses such as rheumatoid an- confused efforts at comparative evaluation
thnitis and ulcerative colitis, in certain he- of various preparations. The myriad of
patic and renal diseases, in hypothyroidism, drugs of this type on the market strongly
and in various deficiency states. Reasons for suggests tile lack of clean-cut superiority of
decreased intake are unknown. Studies with any and the limited effectiveness of all.
animals’ indicate that fever itself may de- The appetite depression induced by these
crease food intake. agents may be short-lived and may lead to
habituation. D-amphetamine has strong ap-
“Tonics” for Poor Appetites petite depressing and central nervous sys-
Vitamins act as appetite stimulants only tem stimulating effects. Fazekas32 considers
in the presence of a deficiency state. This phenmetrazine to have less central stimu-
point has been emphasized in a previous lating effect and equivalent anorexigenic
report of the Committee.’8 potency. Many of these agents have been
A number of studies with older children combined with bulk producers, sedatives,
indicate that response to administration of tranquilizers, cathantics, thyroid extract, or
vitamin B,2 is evidenced by increased ap- smooth muscle melaxants for increased effec-
petite and rate of growth and suggest by tiveness. None has been clearly shown to
inference that some individuals in the offer advantages not offset by undesirable
United States are deficient in vitamin BI,.’9 side-effects.
Vitamin B12 deficiency, if it exists, may be
SUMMARY
explained by individual variations in me-
quimement, in dietary intake, and in extent Emotional and cultural factors are of ex-
of absorption. ceptional importance in determining food
Many clinicians have noted that anorexia intake. The deeply ingrained pattern of

Downloaded from http://pediatrics.aappublications.org/ by guest on May 21, 2018

142 FOOD INTAKE

three meals daily may be the cultural factor Nutritional effects of feeding frequency.

most open to criticism.

Amer. J. Clin.
Nutrition, 11:356, 1962.
6. NIunno, N. : How do snacks affect total caloric
In experimental animals, and probably in
intake of preschool children? J. Amer. Diet.
the human, established nutritional habits Ass., 33:601, 1957.
are particularly potent factors in detemmin- 7. Roberts, F. : The feeding of school children.
ing food intake. Proper nutritional educa- Lancet, 2:434, 1950.

tion in early childhood may establish pat- 8. Harris, L. J., et a!.: Appetite and choice of
diet. The ability of the vitamin B deficient
terns of food selection that will be helpful
rat to discriminate between diets containing
in avoiding specific deficiencies and gross and lacking the vitamin. Proc. Roy. Soc. B,
excesses in later life. 131:161, 1933.
Appetite may prove adequate for selec- 9. Young, P. T. : Psychologic factors regulating

tion of a nutritionally acceptable diet under the feeding process. Amer. J. Clin. Nutr.,
5:154, 1957.
certain circumstances but selection of food
10. Lepkovsky, S. : The physiological basis of vol-
on the basis of nutritional principles is more untary food intake (appetite?), in Advances
reliable and is to be recommended. in Food Research (edited by Mrak, E. M.,
A knowledge of normal variations in food and Stewart, G. F.), New York: Academic

intake in relation to age, sex, environmental Press, Inc., 1948, Vol. 1, p. 105.
11. Richter C. P., Holt, L. E., Jr., and Barelare,
temperature, and caloric expenditure is
B., Jr. : Nutritional requirements for normal
beneficial in interpreting the feeding be- growth and reproduction in rats studied by
havior of children. Complaints by parents the self selection method. Amer. J. Physiol.,
that their children have “poor appetites,” 122:734, 1938.
12. Editors of Nutrition Reviews: Self-selection of
are commonly based on a misconception me-
diets. Nutrition Reviews, 2: 199, 1944.
ganding normal patterns of food intake.
13. Scott, E. M. : Self-selection of diet. I. Selection
Vitamins, iron, and other specific nutri- of purified components. J. Nutn., 31:397,
ents act as appetite stimulants only in the 1946.
presence of deficiency of the particular 14. Davis, C. M. : Self-selection of diet by newly

nutrient. weaned infants. Amer. J. I)is. Child., 36:651,

1928.

CoLfrnEE ON NuTRITIoN 15. Beatdoin, R., and Mayer, j. : Food intakes of

obese and non-obese women. J. Amer.
Samuel J. Fomon, M.D., Chairman Diet. Ass., 29:29, 1953.
Richard W. Blumbemg, M.D. 16. Beal, V. A. : On the acceptance of solid foods,

David B. Coursin, M.D. and other food patterns, of infants and chil-
dren. PEDIATRICS, 20:448, 1957.
Gilbert B. Forbes, M.D.
17. Beal, V. A. : Nutritional intake of children. I.
Donald Fraser, M.D.
Calories, carbohydrate, fat and protein.
Robert Kaye, M.D. J. Nutr., 50: 223, 1953.
Charles U. Lowe, M.D. 18. Burke, B. S., Reed, R. B., van den Berg, A. S.,
Michael J. Sweeney, M.D. and Stuart, H. C. : Caloric and protein in-
takes of children between 1 and 18 years of
age. PEDIAmIc5, 24:922, 1959.
REFERENCES
19. Beal, V. A. : Dietary intake of individuals fol-
1. Engel, G. L., Reichsman, F., and Segal, H. L.: lowed through infancy and childhood. Amer.
A study of an infant with a gastric fistula. J. Public Health, 51:1107, 1961.
I. Behavior and the rate of total hydro- 20. Brobeck, J. R.
Food and : temperature. Rec.
chionic acid secretion. Psychosomatic Med., Prog. Hormone Res., 16:439, 1960.
18:374, 1956. 21. Durnin, J. V. G. A. : “Appetite” and the rela-
2. Lee, D. : Cultural factors in dietary choice. tionships between expenditure and intake of
Amer. J. Clin. Nutrition, 5: 166, 1957. calories in man. J. Physiol., 156:294, 1961.
3. Mead, M. : Dietary patterns and food habits. 22. Fryer, J. H., et al.: A study of interrelationship
J. Amer. Diet. Ass., 19:1, 1943. of the energy-yielding nutrients, blood glu-
4. Dubo, S. : Psychiatric study of children with cose levels, and subjective appetite in man.
pulmonary tuberculosis. Amer. J. Ortho- J. Lab. Clin. Med., 45:684, 1955.
psychiat., 20:520, 1950. 23. Adam, D. J. D., Hansen, A. E., and Weise,
5, Cohn, C., Joseph, D., and Allweiss, M.D.: H. F. : Essential fatty acids in infant nutri-

Downloaded from http://pediatrics.aappublications.org/ by guest on May 21, 2018

 AMERICAN ACADEMY OF PEDIATRICS 143

tion. II. Effect of linoleic acid in caloric 28. Committee on Nutrition, American Academy of
intake. J. Nutr. 66:555, 1958. Pediatrics: Appraisal of the use of vitamins
24. Anand, B. K., and Brobeck, J. R. : Hypo- B1 and B12 as supplements promoted for the
thalamic control of food intake in rats and stimulation of growth and appetite in chil-
cats. Yale J. Biol. Med., 24:123. dren. PEDIATRICS, 21 :860, 1958.
25. Brobeck, J. R. : Neural regulation of food 29. Howe, E. E. : Effect of vitamin B12 on growth-
intake. Ann. N.Y. Acad. Sci., 66:44, 1955. retarded children: a review. Amer. J. Clin.
26. Lowe, C. U., May, C. D., Stauffer, H. M., and Nutr., 6: 18, 1958.
Neuhauser, E. D. B. : Fibrosis of the pan- 30. Beutler, E., Fairbanks, V. P., and Fahey, J. L.:
creas; enterogastrone and the “duodenal Clinical Disorders of Iron Metabolism. New
mechanism” in relation to increased appetite. York: Grune & Stratton, Inc., 1962.
Amer. J. Dis. Child., 79:91, 1950. 31. Modell, W. : Status and prospect of drugs for
27. Beamer, W. D., and Thomas, J. E. : The effect overeating. J.A.M.A., 173:1131, 1960.
on appetite in dogs of pyrogenic substances 32. Fazekas, J. F. : Current concepts in therapy.
in intravenous infusions. Gastroenterology, Anorexigenic agents. New EngI. J. Med.,
27:347, 1954. 264:501, 1961.

Downloaded from http://pediatrics.aappublications.org/ by guest on May 21, 2018

 FACTORS AFFECTING FOOD INTAKE: COMMITTEE ON NUTRITION
Pediatrics 1964;33;135

Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/33/1/135.2
Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its
entirety can be found online at:
https://shop.aap.org/licensing-permissions/
Reprints Information about ordering reprints can be found online:
http://classic.pediatrics.aappublications.org/content/reprints

Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it has
been published continuously since . Pediatrics is owned, published, and trademarked by the American
Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright ©
1964 by the American Academy of Pediatrics. All rights reserved. Print ISSN: .

Downloaded from http://pediatrics.aappublications.org/ by guest on May 21, 2018

 FACTORS AFFECTING FOOD INTAKE: COMMITTEE ON NUTRITION
Pediatrics 1964;33;135

The online version of this article, along with updated information and services, is located on
the World Wide Web at:
http://pediatrics.aappublications.org/content/33/1/135.2

Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it has
been published continuously since . Pediatrics is owned, published, and trademarked by the American
Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright ©
1964 by the American Academy of Pediatrics. All rights reserved. Print ISSN: .

Downloaded from http://pediatrics.aappublications.org/ by guest on May 21, 2018