Recently Deuel' reaffirmed the fact that vitamin-fortified margarine has a nutritional value substantially equivalent to that of butter. This belief is supported by the conclusions of an entirely unprejudiced group, the committee on public health relations of the New York Academy of Medicine, which recommended in its report of February 1, 1943, that wide publicity, both lay and professional, be given to the fact that margarine fortified with vitamin A is nutritionally equal to butter. A similar conclusion was reached by the Food and Nutrition Board of the National Research Council in its Reprint and Circular Series No. 118, released in August 1943.

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Cowgill 10 concluded: "Edible fats, the melting points of which are not too high to prevent liquefaction in the alimentary tract, are digested and absorbed to about the same degree. Such differences as have been found are of no practical nutritional significance. Natural fats differ with respect to their content of the essential unsaturated fatty acids but the amounts needed by the organism are so small that these are probably of no practical nutritional significance. Natural fats have not been found to differ appreciably in their effect on the body's needs for other dietary essentials. ** * In a diet otherwise nutritionally satisfactory, a vegetable fat such as that contained in a margarine can serve adequately in place of butterfat for growth and reproduction, as shown by experiments with eight and more successive generations of rats."

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Boer and colleagues recently reported on the presence of vaccenic acid in sumer butter. They stated that vaccenic acid has growth-promoting properties in rats. Euler and associates,12 however, reported inability to demonstrate any growth-promoting factor peculiar to butter. Moreover the same authors 13 in later studies "to characterize the physiological influence on the rat's organism of different fats * * * compared the growth, the fertility, and the longevity of rats, which were reared on a fat nutrition, consisting either of butter or of margarine (fat mixture MW)." They concluded "that the nutritional and physiological value of the slightly varying fat mixtures, which we employed under the designation of MW and which correspond to the margarines manufactured in Sweden during the period from October 1943 to November 1946, is in no way inferior to the value of butter."

Deuel and associates," meanwhile found vegetable fats and margarine equal to or better than butter in supporting augmented growth in two series of tests with rats, based on administration of growth hormone from the anterior lobe of the pituitary body.

PLAN OF STUDY

Two groups of children were included in the study, which covered a period of 2 years. One group received only margarine as the table fat in the diet. It was used on bread and vegetables, as well as in the making of pastry and in frying. Fortified margarine was supplied by a number of the various companies now manufacturing the product and was the same as that sold to the public. The margarine used was all derived from vegetable fats, and contained no fat from animal sources. The second group of children used only butter for the same purposes. The margarine group lived in an institution housing 130 children ranging in age from 3 to 16 years. The children were half-orphans, for the most part, from broken homes. They attended the neighborhood schools and returned to the institution for lunch. Samplings also indicated that the children were served margarine on their occasional visits to families outside the institution.

The butter group was in another institution some 10 miles (16 kilometers) away. It included 125 children ranging in age from 6 to 17 years, who were mostly orphans.

Leuel, H. J., Jr.: The Butter-Margarine Controversy, Science 103: 183, February 15, 1946. 10 Cowgill, G. R. Relative Nutritive Values of Animal and Vegetable Fats, Physiol. Rev. 25 664, October 1945.

11 Boer, J. Jansen, B. C. P., and Kentie, A.: On the Growth-Promoting Factor for Rats Present in Summer Butter, J. Nutrition 33: 339, March 1947. Boer, J.; Jansen, B. C. P.; Kentie, A., and Knol, H. W.: The Growth-Promoting Action of Vaccenic Acid, ibid. 33: 359, March 1947.

12 von Euler, B.; von Euler, H., and Saberg, I.: Zur Kenntnis des Nahrwertes verschiedener Fette, Die Ernährung 7:65, 1942; Versuche über die Nahrungsfaktoren der Butter, ibid. 8: 257, 1943.

13 von Euler, B., and von Euler, H.: Biological Facts on Vaccenic Acid, Ark. f. kemi, mimero. o. geol., June 1947, vol. 25B, no. 2.

14 Deuel, H. J., Jr.; Hendrick, C., and Crockett, M. E.: Studies on the Comparative Nutritive Values of Fats: VII, Growth Rate with Restricted Calories and on Injection of the Growth Hormone, J. Nutrition 31: 737, June 1946.

The diet in each institution was carefully supervised by trained dietitians and so regulated that 25 to 30 percent of the total calories were supplied by fat. The margarine constituted approximately 65 to 70 percent of the total fat calories. All of the children in both groups were weighed and measured each month under medical supervision. A careful check was made from time to time to be sure that weights and measurements were accurately determined. Routine redblood-cell counts and hemoglobin determinations were made on each child after the study was started and again 1 year later. Specialists in pediatrics supervised the medical care of all the children. A record was kept of the character and duration of all illnesses contracted by the children.

RESULTS

At the close of the study more than 200 records were available for analysis in the margarine group. Because of the turn-over in the institution, the period of study was not uniform and ranged from about a month to a maximum of 24 months. In the butter group there were about 150 records available, ranging up to 24 months' observation time on weight, height, red blood count, hemoglobin, and illnesses.

It was found that those children who stayed a very short time had extreme irregularities in weight gains. Since it would serve no useful purpose, and only increase the margin of error in the computations, all those records of children who were studied less than 6 months were discarded. About 40 in each group were so eliminated, leaving 160 records in the margarine group and 107 in the butter group.

Blood studies.-There were 65 children in the margarine group and 85 in the butter group from whose records differences in erythrocyte count and hemoglobin could be computed. At the beginning of the study there was an average red-cell count of 4,284,000 in the margarine group, the lowest being 3,710,000 and the highest 4,870,000. One year later the average was 4,198,000, the low 3,440,000 and the high 5,560,000. Comparable figures for the butter group were as follows: At the beginning the average red-blood-cell count was 4,629,000; low, 3,940,000; high, 5,640,000; 1 year later the average was 4,640,000; low, 3,920,000; and high, 5,560,000.

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In the margarine group the average hemoglobin was 13.7 grams per hundred cubic centimeters, with a low of 11.3 and a high of 16.6. One year later the figures were 13.4, 10.5, and 18.6, respectively. For the butter group, at the beginning of the study the hemoglobin figures were: Average, 15.4 grams; low, 13 8; and high, 17.9. One year later the findings were: Average, 15.3; low, 12.4; and high, 17.5. All these figures are within normal limits in our clinical experience. Moreover, according to Osgood and Baker, there is an average of 12 grams of hemoglobin, ranging from 10 to 14 grams in the blood of normal children from 4 to 13 years of age. Griffith and Mitchell stated that the red-blood-cell count remains at about 4,500,000 to 5,000,000 throughout childhood. Hence, it would appear that the blood-cell counts in both institutions were in line with counts found in similar groups of children. Furthermore, any variations which occurred were well within the usual errors in making hemoglobin and red-blood-cell determinations.

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Height and weight.-All the records contained data on weight in pounds and ounces and height in inches. Gains in weight and height are partly a function of time, so a further adjustment had to be made to facilitate valid comparison. The basis of exactly 1 year was used for standardization. The period of the greatest majority of the cases was over a year. Since this means that the majority had to be reduced in value to be standardized, chance errors tend to be reduced as well.

An analysis of the total cases in each group is shown in tables 1 and 2. Average annual weight and height gains for boys and girls are shown. For additional comparison, the average gains for standard height-weight tables are included under the column headed "Standard."

Since changes in weight and height are also a function of age, only groups of like age are compared.

The standard error is appended to each value in the margarine group, and comparable value in the butter group. For a test of statistical significance at the

15 Osgood, E. E., and Baker, R. L.: Erythrocyte, Hemoglobin, Cell Volume and Color, Volume and Saturation Index Standards for Normal Children of School Age, Am. J. Dis. Child. 50: 343, August 1935.

16 Griffith, J. P C., and Mitchell, A. G.: The Diseases of Infants and Children, ed. 2, Philadelphia, W. B. Saunders Co., 1937, p. 38.

5-percent level, the difference between two comparable entries in the margarine and standard columns must be greater than twice the standard error. For instance, on the first line in table 1, under "Boys," in the column headed "Margarine," the average yearly gain in weight was 6.7 pounds (3,039 grams) with a standard error of 0.6 pound (272.2 grams). Twice 0.6 is 1.2, which, added to 6.7, gives 7.9 pounds (3,583.4 grams). The average gain in the standard column is 7.2 pounds (3,265.9 grams), well within the range of the standard error, and the difference is, therefore, not statistically significant.

TABLE 1.-Average yearly gain in weight (in pounds) for children observed at least 6 months

TABLE 2.-Average yearly gain in height (in inches) for children observed at

For a test of significance between a margarine and butter value the formula

is used. In only 3 cases does it seem necessary to perform this test. This is in table 1, under "Boys," ages 6-13 and ages 6-9, and table 3, under "Boys," 6-9 years of age. In none of these cases was the difference found significant.

In both table 1 and table 2 all average gains in the margarine group were at least as great (including the standard error) as the gain in either the butter group or a standard group, with two exceptions. These exceptions were in the 2- to 5-year age groups. This is due to the fact that the average age in this particular group in the margarine study was greater than the midvalue of the group. In fact, there were only one boy and one girl 2 years old included in the study. It is believed that the adjustment of all the values to an annual basis is accurate. However, to eliminate doubt as to the validity of the method, comparisons were made using only those subjects who were observed for the maximum time. There were 51 children in the margarine group who were studied the maximum time of 24 months. In the butter group there were 53 under observation for the maximum 24 months.

Again the values were reduced to an annual average gain, going far to reduce chance errors, since all values were practically halved. Tables 3 and 4 exhibit the data.

In only one case, the 2-5 year age group in the boys, in table 4, is the comparison unfavorable. In all other combinations margarine shows up as at least as efficient a source of fat for growth as butter in the normal diet.

TABLE 3.-Average yearly gain in weight (in pounds) in children observed 24

It is evident from the tables that growth of the group fed margarine, as determined by increases in height and weight, was comparable to that of the children fed butter and to standard height and weight values for the same age group.

TABLE 4.-Average yearly gain in height (in inches) in children observed 24

Furthermore, it was noted that in the margarine group there was no increase in the amount of illness. Illnesses in general had been on the decline in the margarine group for the last 4 or 5 years, and this decrease in the incidence of illness continued during the period of the study. This compares with conditions present in the community for the last 5 years.

It was interesting to observe how the children accepted margarine. When it first made its appearance on the table in its white form-and the study was explained to the children, the younger children promptly accepted it. The children in the older age group did not take to it too kindly. Very shortly thereafter, however, a shipment of colored margarine came in. This was cut up into the usual pats and all the children then ate it readily and liberally. Thereafter it was always served cut in pats and colored.

At no time during the period of the study was it considered that vitamin A played any definite role in the results of the study. The reason, of course, is that all the margarine used contained 15,000 units of vitamin A per pound-which is equal to or greater than the amount present in average butter.

Blood studies showed that there were no significant differences between the margarine or butter groups.

The children in the margarine group experienced a high degree of good health during the study, and in comparing their health to that of the butter group it appears to have been much better.

When infirmary records are compared it is readily seen that the margarine group fared much better than the butter group. We are not making any claims that the margarine group were healthier simply because their diet contained margarine. Other variables are more likely to account for their better health. At no time during the course of the study did either institution experience any type of epidemic, and no doubt this may in part be due to the fact that both institutions practiced accepted preventive measures on all their children.

CONCLUSIONS

Growing children experience normal growth in height and weight when their diets contain only fortified margarine as table fat, as shown by comparison with children fed on similar diets with butter as the source of table fat and by comparison with standard height and weight tables.

TABLE 5.-Group total and average yearly gains in weight (pounds) and height (inches); children observed at least 6 months

Whether the greater part of the fat of the diet is derived from vegetable or animal sources has no effect on growth and health as shown by changes in height and weight and health records of children observed over a 2-year period. During a 2-year period the health of 267 children was uniformly good so far as serious illness is concerned, regardless of whether margarine or butter was the source of the greater part of the fat in the diet.

TABLE 6.-Group total and average yearly gains, by sex, in weight (pounds) and height (inches); children observed at least 6 months

If there is a growth factor present in butter which is not present in margarine, there is no evidence in the present study that such a factor plays any important part in the growth of children as determined by increases in height and weight. Margarine is a good source of table fat in growing children, as determined by a 2-year study. Children readily accept margarine as a table spread when it is colored and served in pats.

The CHAIRMAN. Dr. Carlson is on the list of witnesses.

Mr. RIVERS. They adequately show where growing children using margarine alone in their diet for all and every conceivable purpose in which fat is necessary, have no difference from butter, and certainly the growing features are equal to that of butter.