NORMAL, AVERAGE, AND IDEAL STATES OF NUTRITION. 69 



NORMAL, AVERAGE, AND IDEAL STATES OF NUTRITION. 



It has long been recognized that body-weight alone referred to age 

 may not be considered an ideal indication of the normality of the 

 child's state of nutrition. Many investigators, in attempting to 

 secure an index of nutritional state, have considered height as well as 

 weight, both in reference to age, and others have added the girth of 

 some part of the body or some power of the length. One of the most 

 recent formulas is that suggested by Van der Loo, 1 who states that 

 "as children grow taller they increase more proportionately in weight 

 than in length, so that the weight divided by the square of the length 

 gives a fairly good index for comparison of conditions in different 

 children or in the same child at different times." For practical 

 purposes it would be almost impossible to make direct Du Bois meas- 

 urements and establish the relationship between surface area and 

 any of the other physical factors as an index of normality of nutrition, 

 although we have given tables (tables 14 and 15) whereby the surface 

 area can be very closely approximated by computation based upon 

 several constants. 



Normal height. From our earlier discussion it seems quite clear 

 that we must consider the normal condition of the child from several 

 bases. In the first place, what is the normal height of the child? 

 With adults there is no such thing as normal height. The ranges of 

 height with men and with women are very extended indeed. We 

 form definite opinions as to whether a man is especially short or 

 especially tall, but no one would care to state the normal height for 

 man. The average height for a man is commonly given as 170 cm., 

 but it is granted that there are very wide variations from this average 

 height. With adults, then, the difference between normal and average 

 is clearly recognized, but the average is taken as normal. Thus, the 

 heights of a large group of individuals representing the general run 

 of the population are measured and averaged, and this average value 

 is considered as the normal value. We contend that this procedure 

 is entirely erroneous when applied to children, although it is regularly 

 employed and is a basis of most of the tables and charts in current use. 



With children there should be, or at least there is properly supposed 

 to be, a reasonably definite height for an age. It has been stated 

 earlier in our discussion that age, weight, and height are rather closely 

 correlated with children, in contradistinction to the situation with 

 adults. As children grow older they increase in height and weight 

 approximately in the same degree. It has been repeatedly shown that 

 racial characteristics appear very prominently in height. Our Ameri- 

 can population is by no means of a pure strain, and a group of children 



1 Van der Loo, Nederl. Tijdschr. v. Geneesk., Amst., 1919, 1, p. 447; cited in Journ. Am. Med. 

 Assoc., 1919, 72, p. 1403. 



