PEDIATRICS Vol. 23 No. 2 February 1959, pp. 384-399
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DETERMINATION AND SIGNIFICANCE OF A DIETARY ALLOWANCE OF PROTEIN FOR INFANTS

Needed: A Shift of Emphasis in Nutrition

Charles D. May M.D.1

1 Department of Pediatrics, College of Physicians and Surgeons, Columbia University and Babies Hospital, New York

PROBABLY the greatest contributions to successful artificial feeding of infants that will ever be witnessed have already been made, namely: the discovery of the importance of bacterial contamination; the recognition of the role of vitamins; and the realization that fresh cow's milk produces large curds in the infant's stomach and must be treated by heat or other means to improve its digestibility.

Elimination of these major handicaps of artificial feeding permitted attention to be focused on determination of precise figures for the amounts of individual nutrients which should be supplied by the diet to foster sound nutrition. Especial interest was attracted by the question of the relative adequacy of the protein in cow's milk and human milk. This called for refinement in methods of appraising the state of nutrition and clarification of the ultimate goal in infant feeding—the most desirable state of nutrition.

Premature or excessive emphasis on selection of a figure for the dietary allowance of a nutrient is liable to arouse emotional controversy and distract nutritionists from the fundamental issues involved in judging nutritional status. Progress in the science of nutrition could easily be hampered by satisfaction with the sort of pseudosophistication so readily conveyed by plain numbers.

If a figure for an allowance is proposed, there is a great temptation to exploit such a handy value by matching the composition of food products against this kind of "standard." The clamor of conflicting claims in the market place threatens to obscure the deficiencies in the fundamental knowledge upon which a meaningful figure for the allowance of protein or any other nutrient must be based.

The Food and Nutrition Board of the National Research Council has now wisely recognized these considerations by not including a figure for protein allowance in infancy in the 1958 revision of their Recommended Dietary Allowances which states: "Breast-feeding is the best and desired procedure for meeting the nutrient requirements in the first months of life."

This is a favorable setting in which to survey the principles which should govern the determination of the dietary allowance of protein for infants and to dwell upon the significance to be attached to any value proposed.