Effectiveness of food fortification in the United States: the case of pellagra.
OBJECTIVE
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.
Park
Y K
YK
Food and Drug Administration, Office of Nutritional Products, Labeling, and Dietary Supplements, Washington, DC 20204, USA. ypark@cfsan.fda.gov
Sempos
C T
CT
Barton
C N
CN
Vanderveen
J E
JE
Yetley
E A
EA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001939:Bread; D002648:Child; D002675:Child, Preschool; D003644:Death Certificates; D005260:Female; D005523:Food Supply / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D005527:Food, Fortified; D006801:Humans; D007182:Income / Q000706:statistics & numerical data / Q000639:trends; D007223:Infant; D008297:Male; D008875:Middle Aged; D018673:Nutrition Policy / Q000331:legislation & jurisprudence / Q000639:trends; D009749:Nutrition Surveys; D010383:Pellagra / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D011159:Population Surveillance; D015397:Program Evaluation; D015980:Public Health Practice / Q000331:legislation & jurisprudence; D014481:United States