Sugar maple, Acer saccharum, decline disease is incited by multiple disturbance factors when imbalanced calcium (Ca), magnesium (Mg), and manganese (Mn) act as predisposing stressors. Our objective in this study was to determine whether factors affecting sugar maple health also affect growth as estimated by basal area increment (BAI). We used 76 northern hardwood stands in northern Pennsylvania, New York, Vermont, and New Hampshire, USA, and found that sugar maple growth was positively related to foliar concentrations of Ca and Mg and stand level estimates of sugar maple crown health during a high stress period from 1987 to 1996. Foliar nutrient threshold values for Ca, Mg, and Mn were used to analyze long-term BAI trends from 1937 to 1996. Significant (P < or = 0.05) nutrient threshold-by-time interactions indicate changing growth in relation to nutrition during this period. Healthy sugar maples sampled in the 1990s had decreased growth in the 1970s, 10-20 years in advance of the 1980s and 1990s decline episode in Pennsylvania. Even apparently healthy stands that had no defoliation, but had below-threshold amounts of Ca or Mg and above-threshold Mn (from foliage samples taken in the mid 1990s), had decreasing growth by the 1970s. Co-occurring black cherry, Prunus serotina, in a subset of the Pennsylvania and New York stands, showed opposite growth responses with greater growth in stands with below-threshold Ca and Mg compared with above-threshold stands. Sugar maple growing on sites with the highest concentrations of foliar Ca and Mg show a general increase in growth from 1937 to 1996 while other stands with lower Ca and Mg concentrations show a stable or decreasing growth trend. We conclude that acid deposition induced changes in soil nutrient status that crossed a threshold necessary to sustain sugar maple growth during the 1970s on some sites. While nutrition of these elements has not been considered in forest management decisions, our research shows species specific responses to Ca and Mg that may reduce health and growth of sugar maple or change species composition, if not addressed.