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Pellagra is a systemic nutritional wasting disease caused by a deficiency of vitamin B3 (niacin), which is an essential component of several coenzymes. Besides ingestion, niacin can be endogenously synthesized from its natural precursor, tryptophan. Pellagra occurs when levels of niacin and tryptophan are low or when conversion of the essential amino acid to the coenzyme is compromised.

Symptoms of Pellagra

  • Weakness
  • Skin inflammation
  • Diarrhea
  • Weight loss
  • Irritability


No biological sexual predilection for the development of pellagra is recognized. The only risk factors for the development of pellagra is dietary deprivation or defective endogenous generation of niacin.

Epidemiological data collected during the pellagra epidemic in the United States demonstrated that women, children, and elderly persons of both sexes had the highest prevalence of pellagra. Infants, adolescents, and working young males were least frequently affected. These disparities are believed to be secondary to an unbalanced distribution of food within households.


Pellagra typically is an adult disease. Adolescents and young children could develop pellagra if exposed to a pellagragenic diet. Pellagra rarely occurs during infancy. Historically, the dermatitis of kwashiorkor has been mistaken as infantile pellagra.


Dietary deficiency of bioavailable niacin and of its precursor, tryptophan, or malabsorption of these nutrients results in pellagra. Several mechanisms can lead to compromised conversion of tryptophan to niacin. Certain peculiar dietary amino acid imbalances can affect the body's ability to synthesize niacin and can cause pellagra.

  • Compromised intake of niacin or tryptophan
    • Poverty
    • Poor nutrition
    • Chronic alcoholism
    • Neglect and abuse, resulting in malnutrition
    • Famine
    • Anorexia nervosa: This association needs to be kept in mind as the relationship of these conditions is symbiotic. Deficiency of NAD leads to the manufacture of hunger–suppressive endorphins eliminating normal satiety signals making it easier to starve one self.  
  • Compromised ability to absorb ingested niacin and tryptophan
    • Malabsorptive states
    • Prolonged diarrhea

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