Fast Foods for Adolescents Nutritional Disaster
or
Triumph of Technology?
children and adolesalarm and puzand sometimes their zle their medical advisors as well. The periodically recurring fad diets based on occult or religious beliefs run the gamut from the bizarre and dangerous (brown rice and water) to the nutritionally acceptable. For example, the vegetarian menus, often difficult to select with the necessary precision for protein adequacy, may be nutritionally sound when properly designed. These unusual diets, which must be evaluated individually, do not compose the more general concern about adolescent eating. The heavy patronage of fast-food chains looms much larger. How do such foods compare in nutritional adequacy to the usual "balanced" home diet? Before one can answer such a question, one must have a means for analyzing a diet, and one must have standards of nutritional adequacy. Two inexpensive references, Agriculture Handbook No. 81 and Recommended Dietary Allowances,2 belong in every pediatrician's personal library, and provide the necessary sources. Even armed with these tools, a few problems remain, such as identifying
by Diets parents, frequently eaten cents
components accurately, estimating weights, judging freshness, and the effects of standing and cooking.
The whole process becomes much
simpler if one converts all of the diet into some single denominator whose
units represent a fundamental nutri¬ tional currency. Grover Powers,3 in the pages of this journal 50 years ago, recommended the usefulness and ap¬ plicability of the calory (kilocalorie) as
unit. He referred to infant no matter, the method has universal applicability, as recently noted by Hegsted.' In fact, since World War II, most diets have been analyzed this way by sophisticated nutritionists. What Powers recog¬ nized was that energy requirement was fundamental to all diets, and that energy expenditure determined most obligatory needs. Since energy for humans derives entirely from a few species of compounds—proteins, car¬ bohydrates, and fats (plus ethyl and a few even more toxic alcohols)—the fundamental relationships show up clearly and easily when each of these is expressed in terms of the percent¬ age of calories contributed. The other such
a
foods, but
requisite nutrients, including water,
minerals, and the accessory sub¬ stances (vitamins), may also be best rationally expressed on a per-100calorie basis, since they will be utilized or
expended
in accordance with
ener¬
gy demands. A few months ago I and my colleagues were asked to examine
diets for adolescents. We applied the above principles and the use of Agri¬ culture Handbook No. 81 to express a hypothetical diet of four identical meals consisting of a cheeseburger (115 gm of beef), a portion of Frenchfried potatoes, and a milkshake (the milkshake served by most fast-food stores is made with skim milk and added syrup, a fact not recorded in Handbook No. 8). This menu, an esthetic though not nutritional trage¬ dy in four acts, adds up to about 4,100 calories, on the high side for sedentary pediatricians but only about 400 calo-
Downloaded From: http://archpedi.jamanetwork.com/ by a Michigan State University User on 06/10/2015
ries (10%) higher than the intake for the average US male adolescent. Note that not all hamburgers sold are of the weight indicated above. When further analyzed, the diet provided 17% of calories from protein
(8% is minimum, 12% to 18% is opti¬ mum even for protein of low biologic value, which is not true here), 44%
from carbohydrate, and 39% from fat. The last is hearteningly low despite the greasy sound of our gourmet's nightmare. Virtually all of the vita¬ mins and minerals were there too. Only folie acid and vitamins A and D were appreciably low. The vitamins could easily be restored by using whole (or evaporated) milk twice daily, and the folate would require
leafy vegetables once a day. Alternatively, substituting a generous portion of liver once a week would have made the whole thing nutrition¬ ally adequate. The vitamin C is provided by the potatoes. This as¬ some
they are sliced fresh and served promptly. If one were to recommend changes from our hypothetical diet, which should usually have less calories, a daily glass of fruit juice would be a sound one. The accuracy of pencil-and-paper analysis has been confirmed by two sources. First, inquiry to the head¬ quarters of several of the national hamburger chains has produced from them analyses of their meals by inde¬ pendent laboratories. Second, Con¬ sumers Union,"' running its own labo¬ ratory tests, has recently published analyses of a number of fast-food meals, with results similar to that calculated earlier by us. This report sumes, of course, that
chose
a
slightly different hamburger analyzed a number of
menu, and also
other teenage-type meals from other types of establishments, including those serving chicken, fish, and pizza. While this variety increased the varia¬ bility, the nutrition wasn't bad, although also not complete. While one probably would not recommend a diet consisting solely of such meals, when eaten
occasionally, or even once a day,
apple a day does not really render physician superfluous, neither will fast-food hamburger a day require physician to restore nutrition.
are in our opinion in no way unreasonable. They may even stand up pretty well nutritionally, if not gustatorily, when compared to either the haute cuisine preferred by me or home cooking as usually found. I suspect they match or surpass many a hospital or other institutional menu! The answer to the question posed in the title, thus, is neither, but much closer to success than disaster. If an
they
a a a
LAURENCE FINBERG, MD Department of Pediatrics Montefiore Hospital and Medical Center 111 E 210th St Bronx, NY 10467
References 1. Composition of Foods, agriculture handbook 8. United States Government Printing Office, 1963. 2. Recommended Dietary Allowances, Committee on Dietary Allowances, Food and Nutrition
Don't
4. Hegsted DM: Dietary standards. N Med 292:915, 1975. 5. How nutritious are fast food Consumers Rep 40:278, 1975.
Board, ed 8. National Academy of Sciences,
1974. 3. Powers GF: Comparison and interpretation on a caloric basis of the milk mixtures used in infant feeding. Am J Dis Child 30:453, 1925.
if You Mean Bacteremia (or You Mean Infection)
Say Septicemia
Sepsis
if
The following excerpt is from Churchman's article {JAMA 85:1849-1853, 1925) on the intravenous use of gentian violet in treatment of staphylococcal and other bacterial diseases, ten years before sulfonamides and antibiotics; the entire paper is worth
rereading today. Perhaps we might describe the condition [septicemia] as one which arises when, as a result or complication of a focal infection (which itself may have produced severe symptoms, slight symptoms, or no symptoms at all), the protective barrier between bacteria and host has broken down. Organisms have therefore appeared in the blood, the disease has ceased to be local, and its gravity has at once greatly increased. This focal infection may be obvious (like an inflamed tonsil), or it may be hidden (like an infected heart valve), or it may be difficult and occasionally impossible to demonstrate; but portal of entry into the blood stream there must have been. It is a common mistake to imagine that in septicemia bacteria travel for an indefinite period round and round in the blood stream, reproducing as they go. This is not an accurate picture of what occurs. The micro-organisms have not originated in the blood. They have come somewhence and are going somewhither. Their source is the focus of infection; their destiny, other organs, in which they may set up lesions, or the filtering organs (lymph glands, etc.) where those of them which have escaped the antibacterial defensive mechanism of the circulating blood are either in part or in whole destroyed or eliminated. Eliminate their source, as by complete excision of the focus, and you cut off the supply. They will then fairly soon disappear from the blood stream, provided they have not already produced secondary foci elsewhere, and provided the defensive mechanism of the body has not already completely broken down.... It is, of course, not strictly true to imagine that no damaging process is set up by the bacteria as they travel in the vessels. But the damage they do there is relatively slight compared with the damage they do at their source and at their destination. The mere presence of the bacteria in the blood stream is not, therefore, the most serious feature. The most serious feature is the fact that they are being transmitted by the blood stream, that a barrier has given way, and that a local disease is becoming general. Edward B.
Shaw, MD
University of California
Medical Center San Francisco, CA 94143
Downloaded From: http://archpedi.jamanetwork.com/ by a Michigan State University User on 06/10/2015
Engl
J
meals?
or
Triumph of Technology?
children and adolesalarm and puzand sometimes their zle their medical advisors as well. The periodically recurring fad diets based on occult or religious beliefs run the gamut from the bizarre and dangerous (brown rice and water) to the nutritionally acceptable. For example, the vegetarian menus, often difficult to select with the necessary precision for protein adequacy, may be nutritionally sound when properly designed. These unusual diets, which must be evaluated individually, do not compose the more general concern about adolescent eating. The heavy patronage of fast-food chains looms much larger. How do such foods compare in nutritional adequacy to the usual "balanced" home diet? Before one can answer such a question, one must have a means for analyzing a diet, and one must have standards of nutritional adequacy. Two inexpensive references, Agriculture Handbook No. 81 and Recommended Dietary Allowances,2 belong in every pediatrician's personal library, and provide the necessary sources. Even armed with these tools, a few problems remain, such as identifying
by Diets parents, frequently eaten cents
components accurately, estimating weights, judging freshness, and the effects of standing and cooking.
The whole process becomes much
simpler if one converts all of the diet into some single denominator whose
units represent a fundamental nutri¬ tional currency. Grover Powers,3 in the pages of this journal 50 years ago, recommended the usefulness and ap¬ plicability of the calory (kilocalorie) as
unit. He referred to infant no matter, the method has universal applicability, as recently noted by Hegsted.' In fact, since World War II, most diets have been analyzed this way by sophisticated nutritionists. What Powers recog¬ nized was that energy requirement was fundamental to all diets, and that energy expenditure determined most obligatory needs. Since energy for humans derives entirely from a few species of compounds—proteins, car¬ bohydrates, and fats (plus ethyl and a few even more toxic alcohols)—the fundamental relationships show up clearly and easily when each of these is expressed in terms of the percent¬ age of calories contributed. The other such
a
foods, but
requisite nutrients, including water,
minerals, and the accessory sub¬ stances (vitamins), may also be best rationally expressed on a per-100calorie basis, since they will be utilized or
expended
in accordance with
ener¬
gy demands. A few months ago I and my colleagues were asked to examine
diets for adolescents. We applied the above principles and the use of Agri¬ culture Handbook No. 81 to express a hypothetical diet of four identical meals consisting of a cheeseburger (115 gm of beef), a portion of Frenchfried potatoes, and a milkshake (the milkshake served by most fast-food stores is made with skim milk and added syrup, a fact not recorded in Handbook No. 8). This menu, an esthetic though not nutritional trage¬ dy in four acts, adds up to about 4,100 calories, on the high side for sedentary pediatricians but only about 400 calo-
Downloaded From: http://archpedi.jamanetwork.com/ by a Michigan State University User on 06/10/2015
ries (10%) higher than the intake for the average US male adolescent. Note that not all hamburgers sold are of the weight indicated above. When further analyzed, the diet provided 17% of calories from protein
(8% is minimum, 12% to 18% is opti¬ mum even for protein of low biologic value, which is not true here), 44%
from carbohydrate, and 39% from fat. The last is hearteningly low despite the greasy sound of our gourmet's nightmare. Virtually all of the vita¬ mins and minerals were there too. Only folie acid and vitamins A and D were appreciably low. The vitamins could easily be restored by using whole (or evaporated) milk twice daily, and the folate would require
leafy vegetables once a day. Alternatively, substituting a generous portion of liver once a week would have made the whole thing nutrition¬ ally adequate. The vitamin C is provided by the potatoes. This as¬ some
they are sliced fresh and served promptly. If one were to recommend changes from our hypothetical diet, which should usually have less calories, a daily glass of fruit juice would be a sound one. The accuracy of pencil-and-paper analysis has been confirmed by two sources. First, inquiry to the head¬ quarters of several of the national hamburger chains has produced from them analyses of their meals by inde¬ pendent laboratories. Second, Con¬ sumers Union,"' running its own labo¬ ratory tests, has recently published analyses of a number of fast-food meals, with results similar to that calculated earlier by us. This report sumes, of course, that
chose
a
slightly different hamburger analyzed a number of
menu, and also
other teenage-type meals from other types of establishments, including those serving chicken, fish, and pizza. While this variety increased the varia¬ bility, the nutrition wasn't bad, although also not complete. While one probably would not recommend a diet consisting solely of such meals, when eaten
occasionally, or even once a day,
apple a day does not really render physician superfluous, neither will fast-food hamburger a day require physician to restore nutrition.
are in our opinion in no way unreasonable. They may even stand up pretty well nutritionally, if not gustatorily, when compared to either the haute cuisine preferred by me or home cooking as usually found. I suspect they match or surpass many a hospital or other institutional menu! The answer to the question posed in the title, thus, is neither, but much closer to success than disaster. If an
they
a a a
LAURENCE FINBERG, MD Department of Pediatrics Montefiore Hospital and Medical Center 111 E 210th St Bronx, NY 10467
References 1. Composition of Foods, agriculture handbook 8. United States Government Printing Office, 1963. 2. Recommended Dietary Allowances, Committee on Dietary Allowances, Food and Nutrition
Don't
4. Hegsted DM: Dietary standards. N Med 292:915, 1975. 5. How nutritious are fast food Consumers Rep 40:278, 1975.
Board, ed 8. National Academy of Sciences,
1974. 3. Powers GF: Comparison and interpretation on a caloric basis of the milk mixtures used in infant feeding. Am J Dis Child 30:453, 1925.
if You Mean Bacteremia (or You Mean Infection)
Say Septicemia
Sepsis
if
The following excerpt is from Churchman's article {JAMA 85:1849-1853, 1925) on the intravenous use of gentian violet in treatment of staphylococcal and other bacterial diseases, ten years before sulfonamides and antibiotics; the entire paper is worth
rereading today. Perhaps we might describe the condition [septicemia] as one which arises when, as a result or complication of a focal infection (which itself may have produced severe symptoms, slight symptoms, or no symptoms at all), the protective barrier between bacteria and host has broken down. Organisms have therefore appeared in the blood, the disease has ceased to be local, and its gravity has at once greatly increased. This focal infection may be obvious (like an inflamed tonsil), or it may be hidden (like an infected heart valve), or it may be difficult and occasionally impossible to demonstrate; but portal of entry into the blood stream there must have been. It is a common mistake to imagine that in septicemia bacteria travel for an indefinite period round and round in the blood stream, reproducing as they go. This is not an accurate picture of what occurs. The micro-organisms have not originated in the blood. They have come somewhence and are going somewhither. Their source is the focus of infection; their destiny, other organs, in which they may set up lesions, or the filtering organs (lymph glands, etc.) where those of them which have escaped the antibacterial defensive mechanism of the circulating blood are either in part or in whole destroyed or eliminated. Eliminate their source, as by complete excision of the focus, and you cut off the supply. They will then fairly soon disappear from the blood stream, provided they have not already produced secondary foci elsewhere, and provided the defensive mechanism of the body has not already completely broken down.... It is, of course, not strictly true to imagine that no damaging process is set up by the bacteria as they travel in the vessels. But the damage they do there is relatively slight compared with the damage they do at their source and at their destination. The mere presence of the bacteria in the blood stream is not, therefore, the most serious feature. The most serious feature is the fact that they are being transmitted by the blood stream, that a barrier has given way, and that a local disease is becoming general. Edward B.
Shaw, MD
University of California
Medical Center San Francisco, CA 94143
Downloaded From: http://archpedi.jamanetwork.com/ by a Michigan State University User on 06/10/2015
Engl
J
meals?
