American Journal of Clinical Nutrition, Vol 1, 179-199, Copyright © 1953 by The American Society for Clinical Nutrition, Inc.

LACK OF AVITAMINOSIS AMONG ALCOHOLICS

ITS RELATION TO FORTIFICATION OF CEREAL PRODUCTS AND THE GENERAL NUTRITIONAL STATUS OF THE POPULATION

¹ From the Medical Nutrition Laboratory, Chicago; an installation under the jurisdiction of the Surgeon General, U. S. Army; and the Department of Medicine, University of Illinois College of Medicine, Chicago, Ill.

Approximately 16,000 inmates of the House of Correction of the City of Chicago (56 per cent of whom were alcoholics) were screened in 1948-49 for classical nutritional deficiency syndromes; 451 newly admitted alcoholics were given careful nutritional examinations during the "pellagra season," and detailed, serial, physiological, and biochemical observations were made on 24 selected alcoholics before and during therapy.

Among the 451 newly admitted inmates 23 per cent were grossly underweight. Their average hemoglobin was 15.2 Gm./100 ml. Among the 24 selected alcoholics, 39 per cent were grossly underweight. Their average hemoglobin and total protein was 12.3 Gm./ 100 ml. and 6.87 Gm./100 ml., respectively. The admission fasting hour excretion of thiamine and riboflavin by these selected men ranged from 0.7 to 20 and 1.7 to 164 µg./hr., respectively. These levels of excretion of thiamine and riboflavin agreed closely with those reported for active healthy young men.

Among all these men were found only 2 with pellagra, 1 with possible beriberi, 3 with florid ariboflavinosis, 1 with Wernicke's encephalopathy, and 7 with possible nutritional polyneuropathy. No cases of shipboard scurvy, xerophthalmia, or gross phrynoderma were detected. In all, 2.2 per cent of the men were judged to have clinical evidence of avitaminosis.

To explain this unexpectedly low postwar incidence of avitaminosis among a population notoriously subject to nutritional disturbances, pre- and postwar comparisons were made of the incidence of deficiency states among alcoholics in Chicago's Cook County Hospital and the Boston City Hospital. Data from various agencies were analyzed and field observations were made in the "Skid Row" area of Chicago. The end results indicated no significant changes in eating habits, economic status, or alcoholic consumption of the Chicago alcoholic. Vitamin pills and nutrition education have passed him by. The science of fermentation and distillation of spiritous liquors is traditional and liquors are not fortified with vitamins.

The only innovation since 1938 which bears on the alcoholic's nutritional status has been vitamin enrichment of bread, started in Chicago in 1940-41. Alcoholic pellagra virtually disappeared from Cook County Hospital in 1942-43 when niacin, for flour enrichment, was first made by the ton. The alcoholic eats mainly fortified bread, and we conclude that this food habit has been the most significant factor contributing to the present surprising lack of avitaminosis among alcoholics. On the basis of observations on the alcoholic's nutriture, we take the position that primary avitaminoses are uncommon among the population of the United States.