Lifestyle and eating patterns can also lead to nutrient deficiencies. Years ago, the homemaker was the person who planned the meal; today more than half of adult females are in the labor force and half of married women have children under the age of 18. In 1982, 32 million children or 55 percent of all children under 18 had working mothers. In addition, the number of single-parent households is increasing at twice the rate of two-parent households. These changes have an impact on our eating patterns. There is now an increased demand for convenience foods, and the fast-food market is very successful because the married working woman has less time to spend in the kitchen. Cost is another factor, especially in households with single working women as their heads.

Eating patterns have also changed. A nine-year study conducted by the National Center for Health Statistics has shown that 26 percent of the population say they never eat breakfast, and 60 percent of those who do eat breakfast tend to be older. The USDA Nationwide Food Consumption Survey (USDA-NFCS) supports those findings: breakfast skipping is prevalent in 19-22 year olds (29 percent) and 23-34 year olds (25 percent), as compared with 14 percent of the population overall. In addition, 23 percent of the groups surveyed admitted to skipping lunch. Sixty-one percent of the people surveyed by the USDA-NFCS and 38 percent of the people surveyed by the National Center for Health Statistics reported that they snack.

Eighteen percent of the people said they ate away from home once in the twenty-four-hour period, and most of these were young adults. Sixty percent of the men aged 23-24 and 50 percent of the women aged 23-24 had eaten away from home on the day of the survey. Poor food choices and processing of foods are other areas of concern.

In the HANES II study, people were asked to choose a food that they liked and considered "balanced." For a "balanced" vegetable, the majority chose French fries over broccoli; for meat/legume, hot dogs over split peas; and for grain, white bread over whole wheat. In the same study, favorite foods included coffee, doughnuts, soft drinks, and hamburgers. The percentage of calories in the American diet derived from fat is 42; from sugar, 24.

In addition, to eat well you really have to take the time and have the knowledge to plan proper meals. When caloric intakes fall below 1,600 calories, there is no guarantee that all nutritional guidelines can be met. In the menus published by the U.S. Department of Agriculture in "Ideas for Better Eating" in which meals were planned by competent professionals, the diets consisting of 1,600 calories fall short of the recommended level of some essential nutrients.26 As was stated before, the average caloric intake of women in this country is at or around this level, as is also the case for the elderly and many dieters.

Data from the national HANES II study show that the median caloric intake of the general population is 1,831 calories, which suggests that 50 percent of the population surveyed take in less than that amount.

Outright vitamin deficiencies occur in two groups of people. In the first group, an individual is unable to buy the right kinds of food either because of the expense or because he is not knowledgeable about the proper foods. It is estimated that 25 percent of U.S. households do not have nutritionally balanced diets because people do not know what foods to buy or because vitamins and minerals are lost through cooking. The milling process used to make white flour has been reported to remove twenty-two nutrients from the wheat, including about 90 percent of the vitamin E content. When flour is labeled "enriched," usually only four of these nutrients are replaced: thiamine, riboflavin, niacin, and iron. Sugar refinement also removes most of its vitamins and minerals. Cooked and reheated potatoes are reported to have only 10 percent of the vitamin content of raw potatoes. The second group consists of people whose nutrient deficiency occurs as the result of a specific disease or a drug or other treatment therapy.

Only 12 percent of 120 patients had normal vitamin levels (RDA standards); 88 percent had at least one vitamin deficiency. What is even more interesting is that many had more than one vitamin deficiency. In spite of this, 61 percent of the total group of 120 patients were eating what is considered to be a normal American diet!