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September 23, 1950, Vol 144, No. 4 >
Other Articles | September 23, 1950

DEFICIENCIES OF THE WATER-SOLUBLE VITAMINS

JOHN B. YOUMANS, M.D.
[+] Author Affiliations

Nashville, Tenn.

From the School of Medicine, Vanderbilt University, Nashville.


JAMA. 1950;144(4):307-314. doi:10.1001/jama.1950.62920040005006
Text Size: A A A
Published online
Article
References

THIAMINE  There is probably no other vitamin, with the possible exception of vitamin C, for which the need in man is more clearly demonstrated than thiamine, no other vitamin for which, with the exception of some question about intestinal formation, dependence on outside sources is so clearly demonstrated, no other vitamin about which so much is known of the intimate biochemical reactions in which it participates without knowledge of the mechanism by which a deficiency causes the symptoms, physical signs and functional and organic lesions that accompany that deficiency.The chemical nature, biochemistry and physiology of thiamine have been described in detail elsewhere, as has the chemical lesion of the deficiency.1 The effects of a deficiency are peripheral neuritis and congestive heart failure. In addition to these clearcut, unmistakable functional and structural disorders, there are, apparently, disturbances in the psyche2 and, possibly, in certain endocrine functions.3

Pathologic 

REFERENCES

1 +
Handbook of Nutrition, to be published.
2 +
Williams, R. D.; Mason, H. L.; Power, M. H., and Wilder, R. M.:  Induced Thiamine (Vitamin B1) Deficiency in Man: Relation of Depletion of Thiamine to Development of Biochemical Defect and of Polyneuropathy , Arch. Int. Med. 71:38, 1943;.
3 +
Hulse, M. C., and others:  Subclinical Vitamin Deficiency: Assay of Subclinical Thiamine Deficiency , Ann. Int. Med. 21:440, 1944;.
4 +
Musselman, M. M.:  Nutritional Diseases in Cabanatuan , War Med. 8:325, 1945;.
5 +
Biskind, M. S.:  Nutritional Deficiency in the Etiology of Menorrhagia, Metrorrhagia, Cystic Mastitis and Premenstrual Tension: Treatment With Vitamin B Complex , J. Clin. Endocrinol. 3:227, 1943;.
6 +
Klatskin, G.; Salter, W. T., and Humm, F. D.:  Gynecomastia Due to Malnutrition: I. Clinical Studies , Am. J. M. Sc. 213:19, 1947;
7 +
 Gynecomastia Due to Malnutrition: II. Endocrine Studies , Am. J. M. Sc. 213:31, 1947;.
8 +
Spillane, J. D.: Nutritional Diseases of the Nervous System: With a Foreword by George Riddoch , Baltimore, Williams and Wilkins Company, 1947;.
9 +
Campbell, A. C. P., and Russell, W. R.:  Wernicke's Encephalopathy: Clinical Features and Their Probable Relationship to Vitamin B Deficiency , Quart. J. Med. 10:41, 1941;.
10 +
Wintrobe, M. M.; Miller, M. H.; Follis, R. H., and Stein, H. J.:  What Is the Antineuritic Vitamin? Tr. A. Am. Phys. 57:55, 1942;.
11 +
Wenckebach, K. F.:  Der Mechanismus des plötzlichen Herztodes bei der Beriberi , Klin. Wchnschr. 11:1641, 1932;.
12 +
Burwell, C. S., and Dexter, L.:  Beriberi Heart Disease , Tr. A. Am. Phys. 60:59, 1947;.
13 +
Ruffin, J. M.; Cayer, D., and Perlzweig, W. A.:  The Relationship Between the Clinical Picture of a Mild or Early Vitamin Deficiency and Laboratory Determinations of Vitamin Levels , Gastroenterology 3:340, 1944;.
14 +
Hou, H. C.:  The Dietary Intake and Urinary Output of Vitamin B and Their Relation to Beriberi Among Chinese , Chinese M. J. 61:6, 1942;.
15 +
Blankenhorn, M. A.:  Diagnosis of Beriberi Heart Disease , Ann. Int. Med. 23:398, 1945;.
16 +
Hibbs, R. E.:  Beriberi in Japanese Prison Camps , Ann. Int. Med. 25:270, 1946;.
17 +
Ruffin, Cayer and Perlzweig.9a Klatskin, Salter and Humman.3b
18 +
Johnson, R. E.; Henderson, C. R.; Robinson, P. F., and Consolazio, F. C.:  Comparative Merits of Fasting Specimens and Oral Loading Tests in Field Nutritional Surveys , J. Nutrition 30:89, 1945;.
19 +
Oldham, H. G.; Davis, M. V., and Roberts, L. J.:  Thiamine Excretions and Blood Levels of Young Women on Diets Containing Varying Levels of B Vitamins, With Some Observations on Niacin and Pantothenic Acid , J. Nutrition 32:163, 1946;.
20 +
Holt, L. E., Jr., and Najjar, V. A.:  A Simple Method for the Laboratory Diagnosis of Subclinical Deficiencies of Thiamine, Riboflavin, and Nicotinic Acid , Bull. Johns Hopkins Hosp. 70:329, 1942;.
21 +
Papageorge, E., and Lewis, G. T.:  A Study of the Fasting-Hour Excretion of Thiamine in the Urine of Normal Subjects , J. Nutrition 34:301, 1947;.
22 +
Youmans, J. B., and Patton, E. W.:  The Laboratory Diagnosis of Nutritional Deficiencies , Clinics 1:303, 1942;.
23 +
Melnick, D., and Field, H., Jr.:  Thiamine Clearance as an Index of Nutritional Status , J. Nutrition 24:131, 1942;.
24 +
Ruffin, J. M.; Cayer, D., and Perlzweig, W. A.:  The Relation Between the Clinical Picture of a Mild or Early Vitamin Deficiency and Laboratory Determinations of Vitamin Levels , Gastroenterology 3:340, 1944;.
25 +
Johnson, R. E.; Sargent, F.; Robinson, P. F., and Consolazio, F. C.:  Assessment of Nutritional and Metabolic Condition in the Field: General and Clinical Aspects , War Med. 7:227, 1945;.
26 +
Goldsmith, G. A., and Sarett, H. P.:  Urinary Excretion of B Vitamins in Persons on Normal and Restricted Diets , Federation Proc. 7:288, 1948;.
27 +
Goldsmith, G. A.:  The Blood Lactate-Pyruvate Relationship in Various Physiologic and Pathologic States , Am. J. M. Sc. 215:182, 1948;.
28 +
Weiss, S., and Wilkins, R. W.:  The Nature of the Cardiovascular Disturbances in Nutritional Deficiency States (Beriberi) , Ann. Int. Med. 11:104, 1937;.
29 +
Salcedo, J., Jr.; Carrasco, E. O.; Jose, F. R., and Valenzuela, R. C.:  Studies on Beriberi in an Epidemic Sub-Tropical Area , J. Nutrition 36:561, 1948;.
30 +
Freidemann, T. E.; Kmieciak, T. C.; Keegan, P. K., and Shift, B. B.:  The Absorption, Destruction and Excretion of Orally Administered Thiamine by Human Subjects , Gastroenterology 11:100, 1948;.
31 +
Sebrell, W. H., and Butler, R. E.:  Riboflavin Deficiency in Man , Pub. Health Rep. 53:2282, 1938;.
32 +
Kruse, H. D.; Sydenstricker, V. P.; Sebrell, W. H., and Cleckley, H. M.:  Ocular Manifestations of Ariboflavinosis , Pub. Health Rep. 55:157, 1940;.
33 +
Goldberger, J., and Tanner, W. F.:  A Study of the Pellagra-Preventive Action of Dried Beans, Casein, Dried Milk, and Brewer's Yeast, With a Consideration of the Essential Preventive Factors Involved , Pub. Health Rep. 40:54, 1925;.
34 +
Wheeler, G. A.:  The Pellagra Preventive Value of Autoclaved Dried Yeast, Canned Flaked Haddock, and Canned Green Peas , Pub. Health Rep. 48:67, 1933;.
35 +
Stannus, H. S.:  Pellagra in Nyasaland , Tr. Roy. Soc. Trop. Med. & Hyg. 5:112, 1912;.
36 +
Landor, J. V., and Pallister, R. A.:  Avitaminosis B2 , Tr. Roy. Soc. Trop. Med. & Hyg. 29:121, 1935;.
37 +
Aykroyd, W. R., and Krishman, B. G.:  Stomatitis Due to B2 Deficiency , Indian J. M. Research 24:411, 1936;.
38 +
Deleted in proof.
39 +
Gaunt, R.; Liling, M., and Mushett, C. W.:  Disturbances of Water Metabolism in Vitamin Deficiencies and Effects of Adrenal Cortical Hormones , Endocrinology 38:127, 1946;.
40 +
Wiehl, D. G., and Kruse, H. D.:  Medical Evaluation of Nutritional Status: Prevalence of Deficiency Diseases in Their Sub-Clinical Stage , Milbank Memorial Fund Quarterly 19:241, 1941;.
41 +
Tisdale, F. F.; McCreary, J. F., and Pearce, H.:  The Effect of Riboflavin on Corneal Vascularization and Symptoms of Eye Fatigue in R. C. A. F. Personnel , Canad. M. A. J. 49:5, 1943;.
42 +
Gregory, M. K.:  The Ocular Criteria of Deficiency of Riboflavin , Brit. M. J. 2:134, 1943;.
43 +
Mann, I.:  Ariboflavinosis , Am. J. Ophth. 28:243, 1945;.
44 +
Sydenstricker, V. P.; Sebrell, W. H.; Cleckley, H. M., and Kruse, H. D.:  The Ocular Manifestations of Ariboflavinosis: A Progress Note , J. A. M. A. 114:2437 ( (July 22) ) 1940;
45 +
 Ocular Manifestations of Ariboflavinosis , Pub. Health Rep. 55:157, 1940;.
46 +
Vail, D., and Ascher, K. W.:  Corneal-Vascularization Problems , Am. J. Ophth. 26:1025, 1943;.
47 +
Sydenstricker, V. P.; Schmidt, H. L., and Hall, W. K.:  The Corneal and Lenticular Changes Resulting From Amino Acid Deficiencies in the Rat , Proc. Soc. Exper. Biol. & Med. 64:59, 1947;.
48 +
Finnerud, C. W.:  Perlèche: Its Nosologic Status , J. A. M. A. 126:737 ( (Nov. 18) ) 1944;.
49 +
Ellenberg, M., and Pollack, H.:  Pseudo Ariboflavinosis , J. A. M. A. 119:790 ( (July 4) ) 1942;.
50 +
Darby, W. J.:  The Oral Manifestations of Iron Deficiency , J. A. M. A. 130:830 ( (March 30) ) 1946;.
51 +
Machella, T. E.:  Studies of B Vitamins in Human Subject: The Response of Cheilosis to Vitamin Therapy , Am. J. M. Sc. 203:114, 1942;.
52 +
Cayer, D.; Ruffin, J. M., and Perlzweig, W. A.:  The Clinical Significance of Glossitis and Cheilosis in Deficiencies of the B-Complex , South. M. J. 38:111, 1945;.
53 +
Jeghers, H.:  Nutrition: The Appearance of the Tongue as an Index of Nutritional Deficiency , New England J. Med. 227:221, 1942;
54 +
Nutrition Rev. 1:116, 1943;.
55 +
Snell, E. E., and Strong, F. M.:  A Microbiological Assay for Riboflavin , Indust. and Engin. Chem., (Analyt. Ed.) 11:346, 1939;.
56 +
Ferrebee, J. W.:  Urinary Excretion of Riboflavin: Fluorometric Methods for Its Estimation , J. Clin. Investigation 19:251, 1940;.
57 +
Najjar, V. A.:  Fluorometric Determination of Riboflavin in Urine and Other Biological Fluids , J. Biol. Chem. 141:355, 1941;.
58 +
Bessey, O. A., and Lowry, O. H.:  Biochemical Methods in Nutritional Surveys , Am. J. Pub. Health 35:941, 1945;.
59 +
Johnson, R. E.; Sargent, F.; Robinson, P. F., and Consolazio, F. C.:  Assessment of Nutritional and Metabolic Condition in the Field: General and Clinical Aspects , War Med. 7:227, 1945;.
60 +
Nutritional Surveys: Their Techniques and Values , National Research Council, Bulletin No. 17, Washington, D. C., (May) 1949;.
61 +
Holt, L. E., Jr.: Exhibit , New York Academy of Medicine, Post Graduate Fortnight, (October) 1947;.
62 +
Fish, M.:  Acne Rosacea Keratitis and Riboflavin (Vitamin B2) , Brit. J. Ophth. 27:107, 1943;.
63 +
Youmans, J. B.:  Deficiencies of the Fat-Soluble Vitamins , J. A. M. A. 144:34 ( (Sept. 2) ) 1950;.
64 +
Youmans, J. B.: Unpublished data.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Handbook of Nutrition, to be published.
2 +
Williams, R. D.; Mason, H. L.; Power, M. H., and Wilder, R. M.:  Induced Thiamine (Vitamin B1) Deficiency in Man: Relation of Depletion of Thiamine to Development of Biochemical Defect and of Polyneuropathy , Arch. Int. Med. 71:38, 1943;.
3 +
Hulse, M. C., and others:  Subclinical Vitamin Deficiency: Assay of Subclinical Thiamine Deficiency , Ann. Int. Med. 21:440, 1944;.
4 +
Musselman, M. M.:  Nutritional Diseases in Cabanatuan , War Med. 8:325, 1945;.
5 +
Biskind, M. S.:  Nutritional Deficiency in the Etiology of Menorrhagia, Metrorrhagia, Cystic Mastitis and Premenstrual Tension: Treatment With Vitamin B Complex , J. Clin. Endocrinol. 3:227, 1943;.
6 +
Klatskin, G.; Salter, W. T., and Humm, F. D.:  Gynecomastia Due to Malnutrition: I. Clinical Studies , Am. J. M. Sc. 213:19, 1947;
7 +
 Gynecomastia Due to Malnutrition: II. Endocrine Studies , Am. J. M. Sc. 213:31, 1947;.
8 +
Spillane, J. D.: Nutritional Diseases of the Nervous System: With a Foreword by George Riddoch , Baltimore, Williams and Wilkins Company, 1947;.
9 +
Campbell, A. C. P., and Russell, W. R.:  Wernicke's Encephalopathy: Clinical Features and Their Probable Relationship to Vitamin B Deficiency , Quart. J. Med. 10:41, 1941;.
10 +
Wintrobe, M. M.; Miller, M. H.; Follis, R. H., and Stein, H. J.:  What Is the Antineuritic Vitamin? Tr. A. Am. Phys. 57:55, 1942;.
11 +
Wenckebach, K. F.:  Der Mechanismus des plötzlichen Herztodes bei der Beriberi , Klin. Wchnschr. 11:1641, 1932;.
12 +
Burwell, C. S., and Dexter, L.:  Beriberi Heart Disease , Tr. A. Am. Phys. 60:59, 1947;.
13 +
Ruffin, J. M.; Cayer, D., and Perlzweig, W. A.:  The Relationship Between the Clinical Picture of a Mild or Early Vitamin Deficiency and Laboratory Determinations of Vitamin Levels , Gastroenterology 3:340, 1944;.
14 +
Hou, H. C.:  The Dietary Intake and Urinary Output of Vitamin B and Their Relation to Beriberi Among Chinese , Chinese M. J. 61:6, 1942;.
15 +
Blankenhorn, M. A.:  Diagnosis of Beriberi Heart Disease , Ann. Int. Med. 23:398, 1945;.
16 +
Hibbs, R. E.:  Beriberi in Japanese Prison Camps , Ann. Int. Med. 25:270, 1946;.
17 +
Ruffin, Cayer and Perlzweig.9a Klatskin, Salter and Humman.3b
18 +
Johnson, R. E.; Henderson, C. R.; Robinson, P. F., and Consolazio, F. C.:  Comparative Merits of Fasting Specimens and Oral Loading Tests in Field Nutritional Surveys , J. Nutrition 30:89, 1945;.
19 +
Oldham, H. G.; Davis, M. V., and Roberts, L. J.:  Thiamine Excretions and Blood Levels of Young Women on Diets Containing Varying Levels of B Vitamins, With Some Observations on Niacin and Pantothenic Acid , J. Nutrition 32:163, 1946;.
20 +
Holt, L. E., Jr., and Najjar, V. A.:  A Simple Method for the Laboratory Diagnosis of Subclinical Deficiencies of Thiamine, Riboflavin, and Nicotinic Acid , Bull. Johns Hopkins Hosp. 70:329, 1942;.
21 +
Papageorge, E., and Lewis, G. T.:  A Study of the Fasting-Hour Excretion of Thiamine in the Urine of Normal Subjects , J. Nutrition 34:301, 1947;.
22 +
Youmans, J. B., and Patton, E. W.:  The Laboratory Diagnosis of Nutritional Deficiencies , Clinics 1:303, 1942;.
23 +
Melnick, D., and Field, H., Jr.:  Thiamine Clearance as an Index of Nutritional Status , J. Nutrition 24:131, 1942;.
24 +
Ruffin, J. M.; Cayer, D., and Perlzweig, W. A.:  The Relation Between the Clinical Picture of a Mild or Early Vitamin Deficiency and Laboratory Determinations of Vitamin Levels , Gastroenterology 3:340, 1944;.
25 +
Johnson, R. E.; Sargent, F.; Robinson, P. F., and Consolazio, F. C.:  Assessment of Nutritional and Metabolic Condition in the Field: General and Clinical Aspects , War Med. 7:227, 1945;.
26 +
Goldsmith, G. A., and Sarett, H. P.:  Urinary Excretion of B Vitamins in Persons on Normal and Restricted Diets , Federation Proc. 7:288, 1948;.
27 +
Goldsmith, G. A.:  The Blood Lactate-Pyruvate Relationship in Various Physiologic and Pathologic States , Am. J. M. Sc. 215:182, 1948;.
28 +
Weiss, S., and Wilkins, R. W.:  The Nature of the Cardiovascular Disturbances in Nutritional Deficiency States (Beriberi) , Ann. Int. Med. 11:104, 1937;.
29 +
Salcedo, J., Jr.; Carrasco, E. O.; Jose, F. R., and Valenzuela, R. C.:  Studies on Beriberi in an Epidemic Sub-Tropical Area , J. Nutrition 36:561, 1948;.
30 +
Freidemann, T. E.; Kmieciak, T. C.; Keegan, P. K., and Shift, B. B.:  The Absorption, Destruction and Excretion of Orally Administered Thiamine by Human Subjects , Gastroenterology 11:100, 1948;.
31 +
Sebrell, W. H., and Butler, R. E.:  Riboflavin Deficiency in Man , Pub. Health Rep. 53:2282, 1938;.
32 +
Kruse, H. D.; Sydenstricker, V. P.; Sebrell, W. H., and Cleckley, H. M.:  Ocular Manifestations of Ariboflavinosis , Pub. Health Rep. 55:157, 1940;.
33 +
Goldberger, J., and Tanner, W. F.:  A Study of the Pellagra-Preventive Action of Dried Beans, Casein, Dried Milk, and Brewer's Yeast, With a Consideration of the Essential Preventive Factors Involved , Pub. Health Rep. 40:54, 1925;.
34 +
Wheeler, G. A.:  The Pellagra Preventive Value of Autoclaved Dried Yeast, Canned Flaked Haddock, and Canned Green Peas , Pub. Health Rep. 48:67, 1933;.
35 +
Stannus, H. S.:  Pellagra in Nyasaland , Tr. Roy. Soc. Trop. Med. & Hyg. 5:112, 1912;.
36 +
Landor, J. V., and Pallister, R. A.:  Avitaminosis B2 , Tr. Roy. Soc. Trop. Med. & Hyg. 29:121, 1935;.
37 +
Aykroyd, W. R., and Krishman, B. G.:  Stomatitis Due to B2 Deficiency , Indian J. M. Research 24:411, 1936;.
38 +
Deleted in proof.
39 +
Gaunt, R.; Liling, M., and Mushett, C. W.:  Disturbances of Water Metabolism in Vitamin Deficiencies and Effects of Adrenal Cortical Hormones , Endocrinology 38:127, 1946;.
40 +
Wiehl, D. G., and Kruse, H. D.:  Medical Evaluation of Nutritional Status: Prevalence of Deficiency Diseases in Their Sub-Clinical Stage , Milbank Memorial Fund Quarterly 19:241, 1941;.
41 +
Tisdale, F. F.; McCreary, J. F., and Pearce, H.:  The Effect of Riboflavin on Corneal Vascularization and Symptoms of Eye Fatigue in R. C. A. F. Personnel , Canad. M. A. J. 49:5, 1943;.
42 +
Gregory, M. K.:  The Ocular Criteria of Deficiency of Riboflavin , Brit. M. J. 2:134, 1943;.
43 +
Mann, I.:  Ariboflavinosis , Am. J. Ophth. 28:243, 1945;.
44 +
Sydenstricker, V. P.; Sebrell, W. H.; Cleckley, H. M., and Kruse, H. D.:  The Ocular Manifestations of Ariboflavinosis: A Progress Note , J. A. M. A. 114:2437 ( (July 22) ) 1940;
45 +
 Ocular Manifestations of Ariboflavinosis , Pub. Health Rep. 55:157, 1940;.
46 +
Vail, D., and Ascher, K. W.:  Corneal-Vascularization Problems , Am. J. Ophth. 26:1025, 1943;.
47 +
Sydenstricker, V. P.; Schmidt, H. L., and Hall, W. K.:  The Corneal and Lenticular Changes Resulting From Amino Acid Deficiencies in the Rat , Proc. Soc. Exper. Biol. & Med. 64:59, 1947;.
48 +
Finnerud, C. W.:  Perlèche: Its Nosologic Status , J. A. M. A. 126:737 ( (Nov. 18) ) 1944;.
49 +
Ellenberg, M., and Pollack, H.:  Pseudo Ariboflavinosis , J. A. M. A. 119:790 ( (July 4) ) 1942;.
50 +
Darby, W. J.:  The Oral Manifestations of Iron Deficiency , J. A. M. A. 130:830 ( (March 30) ) 1946;.
51 +
Machella, T. E.:  Studies of B Vitamins in Human Subject: The Response of Cheilosis to Vitamin Therapy , Am. J. M. Sc. 203:114, 1942;.
52 +
Cayer, D.; Ruffin, J. M., and Perlzweig, W. A.:  The Clinical Significance of Glossitis and Cheilosis in Deficiencies of the B-Complex , South. M. J. 38:111, 1945;.
53 +
Jeghers, H.:  Nutrition: The Appearance of the Tongue as an Index of Nutritional Deficiency , New England J. Med. 227:221, 1942;
54 +
Nutrition Rev. 1:116, 1943;.
55 +
Snell, E. E., and Strong, F. M.:  A Microbiological Assay for Riboflavin , Indust. and Engin. Chem., (Analyt. Ed.) 11:346, 1939;.
56 +
Ferrebee, J. W.:  Urinary Excretion of Riboflavin: Fluorometric Methods for Its Estimation , J. Clin. Investigation 19:251, 1940;.
57 +
Najjar, V. A.:  Fluorometric Determination of Riboflavin in Urine and Other Biological Fluids , J. Biol. Chem. 141:355, 1941;.
58 +
Bessey, O. A., and Lowry, O. H.:  Biochemical Methods in Nutritional Surveys , Am. J. Pub. Health 35:941, 1945;.
59 +
Johnson, R. E.; Sargent, F.; Robinson, P. F., and Consolazio, F. C.:  Assessment of Nutritional and Metabolic Condition in the Field: General and Clinical Aspects , War Med. 7:227, 1945;.
60 +
Nutritional Surveys: Their Techniques and Values , National Research Council, Bulletin No. 17, Washington, D. C., (May) 1949;.
61 +
Holt, L. E., Jr.: Exhibit , New York Academy of Medicine, Post Graduate Fortnight, (October) 1947;.
62 +
Fish, M.:  Acne Rosacea Keratitis and Riboflavin (Vitamin B2) , Brit. J. Ophth. 27:107, 1943;.
63 +
Youmans, J. B.:  Deficiencies of the Fat-Soluble Vitamins , J. A. M. A. 144:34 ( (Sept. 2) ) 1950;.
64 +
Youmans, J. B.: Unpublished data.

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