TABLE VII.-Nutrition in relation to sex and age.

Percentage of children classed as fair or poor among 9,973 examined and graded as excellent, good, fair, or poor in nutrition.

(Children of native white parents in South Carolina, Virginia, Maryland, Delaware, and New York.)

In determining the extent of underweight and overweight at different ages, Wood's height-weight-age table for boys and girls was used as a standard. Each child was classified as follows:

Underweight. More than 10 per cent below Wood's standard. Normal weight.-Not over 10 per cent below or 20 per cent above Wood's standard.

Overweight. More than 20 per cent above Wood's standard.

Table VIII shows the percentage of children of each sex and age who were more than 10 per cent underweight and the percentage who were more than 20 per cent overweight. Figure 4-B shows the same thing graphically.

TABLE VIII.—Underweight and overweight in relation to sex and age.

Percentage of children of each sex and age who were more than 10 per cent underweight and percentage who were more than 20 per cent overweight according to Wood's height-weight-age tables for boys and girls. (Children of native white parents in South Carolina, Virginia, Maryland, Delaware, and New York.)

* Right Height and Weight of Boys and Girls, prepared by Dr. Thomas D. Wood.

Figure 4-B may be studied in comparison with Figure 4-A, which shows the per cent of children at each age who were "fair" or "poor” in nutrition as judged from clinical evidence. Disregarding the actual. height of the curves, which may not be comparable, the relative incidence of underweight and of unsatisfactory nutrition as judged from clinical evidence among different sexes and ages may be compared. In the chart showing nutrition as judged from clinical evidence (fig. 4-A) tl percentage of children who were not well nourished decreases regularly after the eighth year of age. Moreover, there seems to be no consistent or significant difference between boys and girls in this respect. But in regard to underweight as judged from Wood's table (fig. 4-B) there is an increase in the per cent of children who are underweight through the sixteenth year for boys and through the fourteenth year for girls. Moreover, there are wide and consistent differences between girls and boys, the girls showing more underweight at all ages except 6 and 16 years.

On examination of the lower curves in Figure 4-B, showing the per cent of children who are overweight, it may be seen that there is not only a larger percentage of girls who are underweight, but at all ages except 7 and 9 years the per cent of girls who are overweight is greater than the per cent of boys who are overweight.

Taking all ages together, 19.5 per cent of the boys were underweight, as against 28.9 per cent of the girls. Overweight also showed a larger percentage of girls who were outside the limit of 20 per cent above Wood's table, 1.3 per cent of the boys being overweight, as against 3.2 per cent of the girls.

Reference to a former publication of the U. S. Public Health Service may throw some light on this difference between the sexes in respect to the percentage who are underweight. In this study of heights and weights of children it was found that the average relative variation in weight of children of the same height and age was greater among girls than among boys from 9 to 16 years, inclusive, and moreover that the variation in both boys and girls increased with age up to at least the fourteenth year.

The 10 per cent variation below Wood's standard weight used in classifying children for Table VIII and so generally used in school health work fails to take into account this difference in the relative variation at different ages and for the two sexes. The result is that during the ages of greatest relative variation a higher percentage of children fall below the 10 per cent limit. That it is a matter of normal variation rather than an unusually large amount of malnutrition

3 Heights and Weights of School Children--A Study of the Heights and Weights of 14,335 Native White School Children in Maryland, Virginia, North and South Carolina, by T. Clark, E. Sydenstricker, and S. D. Collins, Public Health Reports, vol. 37, No. 20, May 19, 1922, pp. 1199 ff, especially Table X and fig. 7. See also fig. 4. (Reprint 750.)

NUTRITION IN RELATION TO SEX AND AGE

PERCENTAGE OF CHILDREN OF EACH SEX AND AGE WHO WERE CLASSED AS FAIR OR POOR AMONG 9,973 EXAMINED AND GRADED AS EXCELLENT, GOOD, FAIR OR POOR

UNDERWEIGHT AND OVERWEIGHT IN RELATION TO SEX AND AGE PERCENTAGE OF CHILDREN OF EACH SEX AND AGE WHO WERE MORE THAN 10 PER CENT UNDERWEIGHT AND Percentage WHO WERE MORE THAN 20 PER CENT OVERWEIGHT ACCORDING TO WOOD'S STANDARD WEIGHT FOR SEX, AGE, AND HEIGHT

among girls seems clear from the fact that girls show more overweight as well as more underweight than boys and that the per cent of each sex who are overweight tends to rise at the same ages as the per cent who are underweight.

TABLE IX.-Underweight and overweight in relation to nutrition as judged from clinical evidence.

Percentage of children of each nutrition grade as judged from clinical evidence who were more than 10 per cent underweight and percentage who were more than 20 per cent overweight according to Wood's height-weight-age tables for boys and girls.

(Children of Native White Parents in South Carolina, Virginia, Maryland, Delaware and New York.)

In

The analysis was carried a step further. The per cent of children who were underweight and who were overweight was computed for each nutrition class as judged from clinical evidence. Table IX shows the results. The per cent who were underweight increased as the nutritional status, as judged from clinical evidence, became less favorable. Four per cent of the "excellent" nutrition group were more than 10 per cent underweight according to Wood's standard. None of the "poor" nutrition group were overweight, but 40 per cent of them were within the 10 per cent limit of Wood's table. a comparison of boys and girls in each nutrition class the per cent of girls who were underweight exceeds the per cent of boys in every case. In two of the three nutrition grades in which there were overweight children the per cent of girls who were overweight exceeds that of boys. It should be remembered in this connection that the per cent of girls who were not well nourished ("fair" or "poor”), as judged from clinical evidence, was not significantly or consistently different from the boys.

SUMMARY.

1. Physical examinations were made of 9,973 school children 6 to 16 years of age, inclusive, in South Carolina, Virginia, Maryland, Delaware, and New York State. At the same time the physician set down his judgment of the child's nutrition, checking it as "excellent," "good," "fair," or "poor."

2. The mean measurements of children of "good" or "excellent" nutrition were compared by single years of age with those of "fair" or "poor" nutrition. The "good" or "excellent" group was consistently larger in mean weight, mean standing height, mean sitting height, and in the mean weight-height index.

3. The distributions according to weight, standing height, and sitting height for children of "good" or "excellent" nutrition were compared by age groups with those for children of "fair" or "poor" nutrition. Although the modal weight was greater for the "good" or "excellent" group, there was a large area of overlapping of the two curves. The same was true of the standing and sitting height curves, except that it was not so clear that the modal standing and sitting heights for the "good" or "excellent" group were any greater than for the "fair" or "poor" group.

4. Curves were constructed showing the percentage distribution of children in each of the four nutrition groups according to the percentage deviation from the average weight of all children of the same sex and age. These curves showed that not only did some children of "good" nutrition weigh less than some children of "fair" nutrition, but some of "excellent" nutrition actually weighed less than some of "poor" nutrition.

Although on the average the children of poorer nutrition weigh less than those of better nutrition, weight alone does not seem to be sufficient for determining the nutrition of a given child. In order to pick out individual cases of poor nutrition, a physical examination by a trained physician should supplement physical measurements.

5. The percentage of children who were "fair" or "poor" in nutrition, as judged from clinical evidence, varied with age, increasing in the 6 to 8 year age groups and then declining in succeeding age groups. No significant difference in this respect appeared between boys and girls.

6. The percentage of children who were underweight (10 per cent below) and the percentage who were overweight (20 per cent above), as judged by Wood's table of weight for sex, age, and height, increased as age increased through the fourteenth year for girls and through the sixteenth year for boys. Girls showed a consistently higher percentage of underweight and a consistently higher percentage of overweight than boys.

If average weight is to be used as even a rough index of nutrition, it seems that the percentage deviation allowed for normal variation from the average should vary for different sexes and ages rather than be a constant 7 or 10 per cent, as usually used in school health work.