Table Of ContentThe 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
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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
