protein utilization (NPU) were established of the various fractions obtained, and technological choices were made primarily on nutritional considerations. Where PER and NPU values of individual products appeared borderline or low, mixed or amino acid-fortified products were developed.

3. After a large series of animal tests and subsequent formulation of feasible protein food blends for human consumption, feeding experiments were carried out in controlled populations of children in Mysore. These involved many different blends based on the raw materials enumerated above. Significant increases in height, weight, red cell count and hemoglobin levels were noted in children receiving daily supplements to their usual marginal diet with some of these blends, as compared with control groups receiving isocaloric cereal supplements.

4. A series of feeding trials has established minimal requirements for supplementation of typical, poor, rice diets with lysine, methionine (or dl-methionine hydroxy analogue) and threonine to obtain optimal biological value and net protein utilization in children.

5. A weaning food for infants based primarily on a nutritious mixture of inexpensive vegetable proteins has been developed and has now been accepted for commercial production by the largest Indian manufacturer of infant foods. The product has already seen smallscale animal and clinical testing in Mysore.

6. A Mysore-pioneered mixture of wheat (65%), peanut flour (25%), and Bengal gram (10%) under the brand name of Balahar is presently made by five different food manufacturers for use in the famine in the state of Bihar. The commercial price is 2.5 rupees per kilogram suitable for prevailing economic conditions in India.

and thus

7. Small-scale experiments in Mysore, involving twenty-four 6- to 9-year-old children, have shown that lysine supplementation of a typical marginal sorghum diet can result in a distinct increase in growth and nitrogen retention. Similar experiments are being continued involving other types of local marginal diets.

8. The most important advance in Mysore is the development of a process which destroys aflatoxin in peanut flour. Almost all of the high protein supplements developed in Mysore and tested in Vellore in an effort to provide inexpensive, indigenous protein nutriture to preschool children as a prophylaxis against kwashiorkor are based on peanut flour. Unfortunately, because of the vagaries of the peanut harvest, and the lax methods of harvesting and storage used in India, much of the peanut stores is infested with aspergillus mold and consequantly contain the highly toxic factor aflatoxin. Unless a commercially

feasible method is found to destroy or remove aflatoxin from peanut flour in India, work with this promising base for any type of local, inexpensive high-protein supplement remains a theoretical exercise. The new process developed in Mysore which is now in the pilot plant stage is capable of destroying aflatoxin without inflicting organoleptic or nutritional damage on the basic raw material. Cost of detoxification is presently reported at one and one-half to two cents per kilogram, which makes it economically feasible and not prohibitive for a food supplement to be bought by the poorest strata of the population. Animal studies carried out thus far seem to show that the process does not affect the protein efficiency ratio of the peanut protein.

9. A new method has also been developed for the spectrophotometric quantitative determination of aflatoxin. Preliminary results seem to demonstrate that the new method gives faster and more accurate results than the presently used biological tests.

10. In Vellore, a series of clinical trials involved children with kwashiorkor who were fed a variety of fish protein concentrates during convalescence (after recovery had been initiated with feeding of skim milk protein). One of these preparations from CFTRI in Mysore was found satisfactory with respect to clinical progress, nitrogen retention as judged by nitrogen balances, and regeneration of serum albumin. Another showed equivocal results, and suggestions for nutritive improvement of the product were proposed.

11. A very important finding was made during extensive studies on vitamin A metabolism in undernourished preschool children. Contrary to current practice and to previously published reports the group in Vellore has demonstrated unequivocally that the prophylactic injection of a single large dose of vitamin A in oil in children on marginal diets does not have prophylactic value with respect to eventual vitamin A deficiency and its clinical sequellae (which may include xerophthalmia and blindness). On the other hand, the feeding of one ounce per day of mixed green vegetables during a six month period protects such children from an excessive fall in serum vitamin A levels during the subsequent six months on a marginal diet devoid of greens. The Vellore group has now shown quite convincingly that injectable vitamin A in oil is prophylacticall inactive in children with frank kwashiorkor. In contrast, the water soluble injectable vitamin A is highly effective. It has also been shown in Vellore that orally administered vitamin A in oil will not improve vitamin A serum levels (or liver storage) in children with kwashiorkor, but will be readily absorbed and will result in improved vitamin A levels once the children have recovered from the acute phase of kwashiorkor. In view of the well controlled observations concerning the prophylactic failure of the injection of vitamin A in oil, efforts will be made to communicate these findings. as broadly as possible, since in many quarters the injection of vitamin A in oil is relied on as a prophylactic measure in threatened child populations. The scientific staff of one of the manufactuers of this material in the United States has been apprised of the lack of efficacy of this material.

A new facet has recently been added to the Vellore project - studies on the fortification of wheat with lysine. Like many vegetable proteins, wheat protein is not of high enough biological quality to support rapid growth in children and to serve as the main source of protein in the human diet. Proteins of high biological value (usually from animal sources, such as milk, eggs, meat and fish) have a qualitatively and quantitatively more complete complement of amino acid components. The first, most limiting amino acid in the incomplete wheat protein is lysine. There are indications that the addition of inexpensive synthetic lysine to wheat from the United States, which is used for control of undernutrition in India and other underdeveloped countries, might improve the biologic quality of wheat considerably to the point where lesser quantities of the expensive and unobtainable animal proteins would be needed to attain satisfactory nutrition in the population. Because of the excellent clinical and field testing facilities already operating in Vellore, a new program of experimental enrichment of wheat (as it is used in its various forms in the local diet) has been started, coupled with laboratory, clinical and field testing of the nutritive efficacy of lysine fortification.

Benefits to U. S. From Overseas Nutrition Research

The Mysore-developed protein rich products which are evaluated in Vellore and the Vellore-initiated lysine fortification of wheat serve as prototypes for similar efforts in other underdeveloped regions of the world wherever agricultural necessities and economic and social factors preclude large scale inclusion of animal proteins in the diet.

The scientific findings emanating from this work are enriching the fund of scientific knowledge in the United States. Of particular importance are the contributions concerning intermediary metabolism during protein deprivation and vitamin deficiency which could not have been carried out in the United States adequately because of lack of sufficient patient material concentrated in any one particular locality. Since the majority of these findings are published in American scientific journals they are disseminated to the rest of the world through the medium of the American scientific literature and are thus enhancing the standing and immage of American science. These particular studies are also an example of effective and beneficial use of PL-480 funds in biomedical studies and demonstrate the value of continued Congressional support of this funding mechanism.

These efforts also contribute specifically to the technological knowhow of the United States food industry. Of particular importance are the contributions to our knowledge concerning aflatoxin. Traces of aflatoxin have been found in U. S.-made peanut butter. There is considerable importation of peanuts (which may be contaminated with aflatoxin) to the United States from abroad, and little is known

concerning the presence of aflatoxin in many feeds used in the United States and the potential economic importance of such contamination. The laboratory techniques and technologic achievements in aflatoxin destruction developed in Mysore are of considerable importance in the United States both from the public health standpoint and that of agricultural and food economics.

Projects like those, in addition to the scientific aspects beneficial to the United States, are aimed at helping an underdeveloped country help itself. Rather than letting the host country rely on gifts of expensive protein-rich foods (such as powdered milk) from the United States which this country' cannot afford forever, it gives the underdeveloped country the scientific wherewithall to utilize effectively inexpensive proteins which it can produce by itself and with the aid of which it can cope successfully with the problem of protein malnutrition among its children.

Guide to Nutrition Terminology

Under the terms of a contract with Vanderbilt University awarded jointly by this Institute and the National Institute of Child Health and Human Development, A Guide to the Classification of Nutrition Terminology for Indexing and Retrieval is being developed. A broadening awareness of the relationships between diet and total health, combined with the rapid increase in world population which demands the most efficient nutritional technology, have created an urgent need for coordinate resources for nutrition data. The guide should help to make such data more readily available and definitive to researchers in the future.

OUTLOOK

Despite the wide reduction of frank nutritional deficiency diseases in this country, the margin of safety is not large. Improved methods of determining nutritional status and revised criteria for normal nutritional status have contributed to a new emphasis on the definition and diagnosis of malnutrition. Through application of new principles and laboratory techniques learned in recent years from studies of intermediary metabolism, many supported by this Institute, the evaluation of nutritional status in the absence of overt disease is no longer dependent on ill-defined lesions and symptoms or the subjective judgment of physicians. These advances in knowledge now form the basis for exacting nutrition surveys needed to pinpoint pockets of malnutrition in vulnerable population groups in the United States. They will also be necessary in many developing countries to cope with the world-wide famine and malnutrition predicted for the near future if the runaway disproportion between population increase and agricultural selfsufficiency is not drastically reyersed in the near future.

In relation to specific diseases, the discovery of the chemical nature of hereditary molecular diseases and of many physiological consequences of other lesser known diseases of uncertain etiology have contributed effectively to our understanding of the probable roles of required nutrients. Scientists now appear to be near to describing the nutritional participation of individual amino acids and fatty acids as well. The relationship of nutrients to ultramicroscopic physical structures is simultaneously evolving. Of greatest importance, among currently ongoing studies, is elucidation of the role which dietary adjustments in lipid intake may play in large scale prophylaxis of atherosclerotic heart disease in the United States.

Once again, the study of nutrition has taken on the vigor which provided its first big advances with the discovery of vitamins fifty years ago. With continued research, investigators in the field of nutrition expect rewards in the near future to be fully as extensive.