The Importance of Vitamins to Human Health: Proceedings of the IV Kellogg Nutrition Symposium held at the Royal College of Obstetricians and Gynaecologists, London, on 14–15 December, 1978 PDF
Preview The Importance of Vitamins to Human Health: Proceedings of the IV Kellogg Nutrition Symposium held at the Royal College of Obstetricians and Gynaecologists, London, on 14–15 December, 1978
The Importance of Vitamins to Human Health The Importance of Vitamins to Human Health Proceedings of the IV Kellogg Nutrition Symposium held at the Royal College of Obstetricians and Gynaecologists, London, on 14-15 December, 1978 Edited by T.G. Taylor Rank Professor of Applied Nutrition, School of Biochemical and Physiological Sciences, University of Southampton ':~ 2~,~ i~~·. ••.• ". MTPPRESS I.IMIT[D·LANCA~TER·ENGLAND International MedicallUblishers Published by MTP Press Limited Falcon House Lancaster, England Copyright © 1979 MTP Press Limited Softcover reprint of the hardcover 1st edition 1979 All rights reserved. No part ofthis publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the publishers. British Library Catalocuing in Publication Data Importance of Vitamins to Human Health. (Coriference). London. 1978 The importance of vitamins to human health. \. Vitamins in human nutrition - Congresses I. Taylor, Thomas Geoffrey, b. /9/8 II. Kellogg Company of Great Britain 613.2'8 TX553.V5 ISBN-13: 978-94-011-6231-9 e-ISBN-13: 978-94-011-6229-6 DOl: 10.1007/978-94-011-6229-6 Contents List of contributors vii Foreword ix Preface xi I Man's needs for vitamins - a need for review? J. W. T. Dickerson 2 Developments in the determination of water-soluble vitamins in 9 fu~ R. A. Wiggins 3 Vitamin B\ supply in industrialized countries 17 G. B. Brubacher 4 Effects of riboflavin deficiency on erythrocytes 27 D. l. Thurnham, F. M. Hassan and Hilary J. Powers 5 Nutritional and biochemical aspects of vitamin B\2 41 A. V. Hoffbrand 6 Folic acid 47 l. Chanarin 7 Clinical biochemistry of vitamin B6 53 S. B. Rosalki 8 Inappropriate vitamin C reserves: their frequency and significance in an urban popUlation 61 C. J. Schorah v THE IMPORTANCE OF VITAMINS TO HUMAN HEALTH 9 Developments in analytical methods for the determination of fat- soluble vitamins in foods 73 R. A. Wiggins 10 Vitamin A deficiency and excess 81 G. A. J. Pitt II The importance of sunlight as a source of vitamin D for man 91 D. E. M. Lawson 12 Vitamin E in human nutrition 101 M. S. Losowsky 13 The effects of processing on the stability of vitamins in foods III A. E. Bender 14 The clinical diagnosis of vitamin deficiencies in everyday medical practice 127 A. N. Exton-Smith 15 Vitamin deficiencies in disease states 139 J. Kelleher 16 Progress in the prevention and treatment of nutritional rickets 151 G. C. Arneil 17 Food enrichment 163 A. E. Bender Index 173 Vi List of contributors G.C.ARNEIL D. E. M. LA WSON Department of Child Health, MRC Dunn Nutritional Laboratory, University of Glasgow University of Cambridge Royal Hospital for Sick Children M. S. LOSOWSK Y A.E.BENDER University Department of Medicine, Department of Food Science and Nutrition, St James's Hospital, Leeds Queen Elizabeth College, University of London G.A.J.PITT Department of Biochemistry, G. B. BRUBACHER University of Liverpool Dep~rtment of Vitamin and Nutritional Research, Hilary J. POWERS F. Hoffmann-La Roche & Co. Ltd., Department of Human Nutrition, Basle, Switzerland London School of Hygiene and Tropical Medicine I.CHANARIN S. B. ROSALKI Section of Haematology, Department of Chemical Pathology, M RC Clinical Research Centre, The Royal Free Hospital, London Harrow J. W. T. DICKERSON C. J. SCHORAH Division ot Nutrition and Food Science, Department of Chemical Pathology, Department of Biochemistry, University of Leeds University of Surrey, Guildford T.G.TAYLOR A. N. EXTON-SMITH School of Biochemical and Department of Geriatric Medicine, Physiological Sciences, University College Hospital Medical School, University of Southampton London D.1. THURNHAM F.M.HASSAN Department of Human Nutrition, Department of Human Nutrition, London School of Hygiene and London School of Hygiene and Tropical Medicine Tropical Medicine R. A. WIGGINS A. V.HOFFBRAND Department of Industry, Department of Haematology, Laboratory of the Government Chemist, The Royal Free Hospital, London London J. KELI.EHER University Department of Medicine, St James's Hospital, Leeds Vll Foreword The Kellogg Company ranks among the world's leading food manufacturers, and it follows, therefore, that our corporate policies are important to human health. Indeed food manufacturers, as a combined industrial force, must bear a major responsibility for the health of mankind because commercially processed foods are increasingly an indispensable part of the mosaic of human nutrition. This is particularly true in advanced industrialised societies. Here, in Great Britain, 40% ofthe people live in major conurbations and 41 % of the food they eat is either pre-cooked or preserved, compounded or frozen, dehydrated or concentrated, or modified in some other way to satisfy a consumer need or preference. These preferences are communicated to the manufacturer through the competitive forces of the market, and are then translated into products in their most attractive and saleable form. However, it is questionable how far consumer choice, depending largely on sight and taste, can be relied upon to ensure a correctly balanced and nutritionally adequate diet. The probable answer is that if we all relied, solely, on our senses and our appetites, many of us would be suffering from some form of nutritional imbalance. A serious nutritional responsibility therefore rests with the modern food manufacturer. We, at Kellogg's, are conscious of the need, not only to make the foods we produce attractive to the purse and palate, but to ensure that they make a sound contribution in nutritional terms. The dietary Tole of vitamins is therefore of pressing importance to us; and we are currently fortifying our products in line with the best available advice. But the progress of knowledge in this sphere is relatively slow moving, and we organised the symposium which is the subject of this book because we believed the time to be opportune for an assembly of leading nutritionists, IX THE IMPORTANCE OF VITAMINS TO HUMAN HEALTH medical practitioners, specialists and researchers in the field so that the latest advances could be explored and discussed. We believe that the papers here presented will constitute an important contribution to the science of human nutrition. In conclusion we wish to express our appreciation for the considerable assistance of various speakers and their associates given to us in the planning and organization of this Symposium. In particular, we wish to thank the two chairmen of the Symposium and the Editor of these Proceedings, respectively Professor I. MacDonald, Guy's Hospital, London; Dr M.R. Turner, British Nutrition Foundation, London and Professor T.G. Taylor, Southampton. G.D. ROBINSON CHAIRMAN AND MANAGING DIRECTOR Kellogg Company of Great Britain Ltd. x Preface Doctors and professional nutritionists have always been aware of the impor tance of vitamins to health but the components of the diet that have been most exposed to the glare of publicity in recent years have tended to be substances other than vitamins, in particular, fat, fibre, sugar and food additives. The publication of this symposium, therefore, is particularly welcome at the present time in restoring the balance. Vitamin deficiency conditions are traditionally associated with poor, restricted diets and although the classical vitamin-deficiency diseases of pellagra, scurvy and beri-beri are mercifully rare in Britain, the same circumstances that combined together to produce these diseases in the past - poverty and ignorance - still operate to a lesser degree to-day in the vulnera ble groups of the community, particularly in the elderly. Vitamins of the B-group tend to have a similar distribution in foods, so that when deficiencies occur, several members of the group are likely to be implicated, and conditions of multiple deficiency result. These deficiency conditions are seldom severe enough to induce the deficiency symptoms typical of the individual vitamins. The manner in which marginal, mUltiple vitamin deficiency conditions express themselves are fairly non-specific and may be no more than a general malaise. These problems and the factors that contribute to them are discussed by Dr Exton-Smith, Dr Schorah, Dr Kelleher and by Dr Brubacher. How then are these sub-clinical deficiency conditions to be diagnosed? Fortunately there are biochemical tests by which these marginal vitamin deficiencies can be identified and these tests are discussed by Dr Brubacher, Dr Thurnham, Dr Rosalki, Dr Kelleher and Professor Hoffbrand. A deficiency of vitamin C is in all probability more widespread than a deficiency of any other vitamin and much controversy still surrounds the Xl THE IMPORTANCE OF VITAMINS TO HUMAN HEALTH significance of low tissue reserves of this vitamin in congenital defects, in wound healing and in malignant conditions. Other uncertainties relate to the possible role of megadose vitamin C therapy in the maintenance of health and to the relationship between smoking and ascorbic acid status. These questions are discussed by Dr Schorah. Apart from primary vitamin deficiencies associated with poor diets including diets consisting mainly of alcoholic drinks, a problem high-lighted by Dr Kelleher - secondary vitamin deficiency conditions induced by drugs present ever increasing problems in the community and these are considered by Professor Dickers~m. A secondary deficiency of vitamins also occurs in various malabsorption syndromes: folic acid and the fat-soluble vitamins are the ones most likely to be involved under these circumstances. Folic acid deficiency is, however, more common in pregnancy, expressing itself as a megaloblastic anaemia and this vitamin is considered in detail by Dr Chanarin. Vitamin A is discussed by Dr Pitt and whereas a deficiency of this vitamin is widespread in South America, Indonesia and Southern India, often as part of a complex of nutritional deficiencies, there is little evidence of a lack of this vitamin in Britain. There has been a great deal of nonsense written about vitamin E and its role in human nutrition and the most exaggerated claims have been made for its curative properties for a most diverse collection of diseases. In this context, it 1S refreshing to read Professor Losowsky's paper which sets the record straight. His conclusions are that vitamin E deficiency certainly occurs in the infant, particularly if pre-term, and that this deficiency must be treated. In adult men and women, however, deficiency occurs almost only in association with fat malabsorption syndromes and the consequences ofthis deficiency are mmor. Vitamin D deficiency is a major public health problem, particularly in cities where there is a large population of Asian immigrants. It may affect pregnant women and their unborn babies, infants, toddlers, adolescents and the elderly, causing rickets in infants and children and osteomalacia in adults. Professor Arneil discusses these problems and the inadequate response of the health services to them in a most forceful and challenging article. The general view among nutritionists in the past has been that, although people are able to synthesize vitamin D in their skin by the action of ultraviolet light from the sun, the diet provides the major source of this vitamin. This view is now being questioned and Dr Lawson summarizes an impressive body of evidence indicating that, for most people, sunlight makes a greater contribution than food to their supplies of vitamin D. It would seem, therefore, that low exposure to sunlight is the main reason for the existence of vitamin D deficiency in vulnerable groups of the community although the main hope for preventing and curing this deficiency in these groups is still by way of the diet or by supplements of the vitamin. XII
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