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Pellagra

2007 Schools Wikipedia Selection. Related subjects: Health and medicine

   CAPTION: Pellagra
   Classifications and external resources

   Niacin
     ICD- 10   E 52.
     ICD- 9    265.2
   DiseasesDB  9730
   MedlinePlus 000342
    eMedicine  ped/1755
   MeSH        C18.654.521.500.133.699.529

   Pellagra is a vitamin deficiency disease caused by dietary lack of
   niacin (vitamin B3) and protein, especially proteins containing the
   essential amino acid tryptophan. Because tryptophan can be converted
   into niacin, foods with tryptophan but without niacin, such as milk,
   prevent pellagra. However, if dietary tryptophan is diverted into
   protein production, niacin deficiency may still result.

   Some sources also claim a relationship between lysine and pellagra, but
   this position does not have nearly as much support.

Symptoms

   The symptoms of pellagra include:
     * high sensitivity to sunlight
     * aggression
     * dermatitis
     * red skin lesions
     * insomnia
     * weakness
     * mental confusion
     * diarrhea
     * dementia (eventually)

   The main results of pellagra can easily be remembered as "the four
   D's": diarrhea, dermatitis, dementia, and death.

Epidemiology

   Pellagra can be common in persons who obtain most of their food energy
   from corn, since untreated corn is a poor source of niacin (vitamin
   B3). Corn is also a poor source of tryptophan. This disease can be
   common among people who live in rural South America where corn is a
   staple. The symptoms usually appear during spring, increase in the
   summer due to greater sun exposure, and return the following spring. It
   is also one of several diseases of malnutrition common in Africa, and
   was endemic in northern Italy, Spain, and southeastern Europe. Alkali
   treatment of the corn corrects the niacin deficiency, and was a common
   practice in native American cultures that grew corn. The amino acid
   deficiency must be balanced by consumption of other sources of protein.
   It was also common amongst prisoners of Soviet labor camps, the
   infamous Gulag.

Prognosis

   Untreated, the disease can kill within four or five years.

   With treatment pellagra can be cured.

History

   Portrait of Dr. Joseph Goldberger
   Enlarge
   Portrait of Dr. Joseph Goldberger

   The traditional food preparation method of corn, nixtamalization, by
   native New World cultivators, who had domesticated corn, required
   treatment of the grain with lime, an alkali. It has now been shown that
   the lime treatment makes niacin nutritionally available and reduces the
   chance of developing pellagra. When corn cultivation was adopted
   worldwide, this preparation method was not accepted because the benefit
   was not understood. The original cultivators, often heavily dependent
   on corn, did not suffer from pellagra. Pellagra became common only when
   corn became a staple that was eaten without the traditional treatment.

   Pellagra was first described in Spain in 1735. It was an endemic
   disease in northern Italy, where it was named "pelle agra" (pelle,
   skin; agra, sour) by Francesco Frapoli of Milan. Because pellagra
   outbreaks occurred in regions where maize was a dominant food crop, the
   belief for centuries was that the maize either carried a toxic
   substance or was a carrier of disease. It was not until later that the
   lack of pellagra outbreaks in Mesoamerica, where maize is a major food
   crop (and is processed), that the idea was considered that the causes
   of pellagra may be due to factors other than toxins.

   There has been speculation that the legend of vampires may have been
   furthered in the 1700s during pellagra outbreaks in Europe.

   In the early 1900s, pellagra reached epidemic proportions in the
   American South. There were 1,306 reported pellagra deaths in South
   Carolina during the first ten months of 1915; 100,000 Southerners were
   infected in 1916. At this time, the scientific community held that
   pellagra was probably caused by a germ or some unknown toxin in corn.
   The Spartanburg Pellagra Hospital in Spartanburg, South Carolina was
   the nation's first facility dedicated to discovering the cause of
   pellagra. It was established in 1914 with a special congressional
   appropriation to the U.S. Public Health Service (PHS) and set up
   primarily for research. In 1915 Joseph Goldberger, assigned to study
   pellagra by the Surgeon General of the United States, showed that
   pellagra was linked to diet by inducing the disease in prisoners, using
   the Spartanburg Pellagra Hospital as his clinic. By 1926, Goldberger
   established that a balanced diet or a small amount of baker's yeast
   prevented pellagra. Skepticism still persisted in the medical community
   until 1937 when Conrad Elvehjem showed that the vitamin niacin cured
   pellagra (manifested as black tongue) in dogs. Later studies by Tom
   Spies, Marion Blankenhorn and Clark Cooper established that niacin also
   cured pellagra in humans, for which Time Magazine dubbed them its 1938
   Men of the Year in comprehensive science.
   Retrieved from " http://en.wikipedia.org/wiki/Pellagra"
   This reference article is mainly selected from the English Wikipedia
   with only minor checks and changes (see www.wikipedia.org for details
   of authors and sources) and is available under the GNU Free
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