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May 29, 1943


JAMA. 1943;122(5):299-306. doi:10.1001/jama.1943.72840220004008

The terms "malnutrition," "nutritional deficiency disease," "nutritional failure," "beriberi," "pellagra," "scurvy," "riboflavin deficiency" and similar terms signify to many persons disorders arising solely from an inadequate diet. But all these may occur in the presence of dietary adequacy. As pointed out by Kruse,1 these terms should denote a deficiency in the bodily tissues rather than in the diet. If a tissue deficiency arises from an inadequate diet it is known as a primary deficiency. If the tissue deficiency is caused by factors other than an inadequate diet alone it is known as a conditioned or secondary deficiency. Conditioned deficiencies are caused by factors that interfere with the ingestion, absorption or utilization of essential nutrients, or by factors that increase their requirement, destruction or excretion.2

The importance of these conditioning factors as a cause of deficiency disease has not been generally recognized. In surveys of the nutritional status of