Effectiveness of food fortification in the United States: the case of pellagra

Abstract

OBJECTIVES: We evaluated the possible role of niacin fortification of the US food supply and other concurrent influences in eliminating the nutritional deficiency disease pellagra. METHODS: 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.

Pellagrous encephalopathy presenting as alcohol withdrawal delirium: A case series and literature review

“…More than a decade later, Koehn and Elvehjem [15] were the first to isolate niacin when they demonstrated it could cure black tongue (the canine model of pellagra) in dogs. As a result of widespread fortification with niacin of grains and cereals in the US food supply, endemic pellagra has nearly been eradicated [16]. The rarity of pellagra in the general population may lead clinicians to exclude it from the differential diagnosis, even in malnourished patients.…”

“…Pellagra remains an often overlooked problem in the context of alcohol dependence and malnutrition in developed countries, particularly because endemic pellagra has been virtually eradicated [7,16]. Prior commentaries have overemphasized pellagra’s eradication in industrialized countries [6,23,39], a fact cited by several authors [8,26,28,29,33,40,41].…”

Genetic architectures of psychiatric disorders: the emerging picture and its implications

“…There have been successes, and a few diseases with prominent psychiatric manifestations that were once prevalent are now rare in many parts of the world (e.g., pellagra 4 and neurosyphilis 5 ). These few triumphs stand in contrast to decades of frustration and occasional notoriety when highly publicized and plausible findings failed to replicate.…”

Aetiological doctrines and prevalence of pellagra: 18th century to middle 20th century

“…31 The number of deaths in the USA peaked at about 7000 per year in 1928 with much higher death rates for female than for male individuals and for non-white than for white individuals. 65 A sharp decline in mortality rates occurred between 1928 and 1932 in the USA, and again from 1939 onwards. 57,65 Various factors contributed to the decline in the incidence, including a greater awareness of the nutritional values of foods, voluntary bread enrichment by bakers, and food fortification through federal regulation.…”

“…65 A sharp decline in mortality rates occurred between 1928 and 1932 in the USA, and again from 1939 onwards. 57,65 Various factors contributed to the decline in the incidence, including a greater awareness of the nutritional values of foods, voluntary bread enrichment by bakers, and food fortification through federal regulation. 65 Nutrition programmes in the USA were accelerated in the 1940s when it came to the attention of the authorities that 25% of draftees were rejected from military service as a result of evidence of some or other form of malnutrition.…”