By Youngmee K. Park, PhD, Christopher T. Sempos, PhD, Curtis N.
Barton, PhD, John E. Vanderveen, PhD, and Elizabeth A. Yetley, PhD, in the American Journal of Public Health
Effectiveness
of Food Fortification in the United States: The Case of Pellagra
May 2000, Vol. 90, No. 5
We traced chronological changes in pellagra mortality and
morbidity and compared them with the development of federal regulations, state
laws, and other national activities pertaining to the fortification of
cereal-grain products with niacin and other B vitamins. We also compared these
changes with other concurrent changes that would have affected pellagra
mortality or morbidity.
Results. The results show the difficulty of
evaluating the effectiveness of a single public health initiative such as food
fortification without controlled experimental trials. Nonetheless, the results
provide support for the belief that food fortification played a significant
role in the elimination of pellagra in the United States.
Conclusions. Food fortification that is
designed to restore amounts of nutrients lost through grain milling was an
effective tool in preventing pellagra, a classical nutritional deficiency
disease, during the 1930s and 1940s, when food availability and variety were
considerably less than are currently found in the United States. (Am J Public Health. 2000;90:727–738)
Mortality statistics for the United States1 indicate that
pellagra was perhaps the most severe nutritional deficiency disease ever
recorded in US history. Pellagra is a classical nutrient deficiency disease
characterized by dermatitis, diarrhea, inflammation of mucous membranes, and,
in severe cases, dementia. Death can occur if treatment is not received.
Pellagra is associated with diets low in the B vitamin niacin, flares up when
skin is subjected to strong sunlight.
Niacin intakes and requirements are generally expressed as
niacin equivalents. Dietary sources of niacin equivalents include preformed dietary
niacin and the metabolic conversion of the amino acid tryptophan to niacin
(approximately 60 mg of tryptophan are equivalent to 1 mg of niacin).2
In the early 1900s, when it was prevalent, pellagra occurred
to some extent in every state in the United States.1 It was, however, most
serious in the southern states, where income was low, most of the available
land was used for nonfood crops such as cotton and tobacco, and corn products
were a major dietary staple.
With the advent of motorized corn mills, the corn used as a
dietary staple was particularly low in niacin. Annual deaths from pellagra far outnumbered
deaths from other nutritional deficiency diseases. During the peak incidence years
of 1928 and 1929, it was the eighth or ninth highest cause of death, exclusive
of accidents, in many southern states.3 The early history of pellagra is
covered in detail by Harris4 and summarized by Sebrell.5
Pellagra is one of the few deficiency diseases for which there
are records of annual deaths in the United States from the beginning of the
20th century to the present. The availability of mortality statistics and the
relatively high rates of mortality and morbidity for pellagra in the United
States make pellagra a useful model for examining the complex interrelationships
between the decline of a nutritional deficiency disease and possible contributing
factors to this decline.
A brief comparison of the total number of deaths from pellagra
and voluntary bread enrichment has been published previously.6,7
In this report, we present a more in-depth evaluation of the
effects of various contributing factors, including food fortification, on the
eventual elimination of pellagra in the United States. The effects on this
evaluation of several changes in the recording system for pellagra deaths are
also discussed.
No comments:
Post a Comment