Niacin, also known as vitamin B3, plays a crucial role in the metabolism of macronutrients such as carbohydrates, proteins, and fats by serving as a coenzyme for NAD and NADP. It is an essential water-soluble vitamin that the body cannot produce, so it must be obtained through dietary sources.
Pellagra is a severe form of niacin deficiency that was first described by the Spanish physician Don Gaspar Casal in 1763. It is commonly referred to as the “4 Ds disease” because it is indicated by, diarrhea, dermatitis, dementia, and death if left untreated.
However, not all symptoms may be present, and recent studies have linked niacin deficiency to several other health conditions, including Alzheimer’s, Parkinson’s, Huntington’s disease, cognitive impairment, and schizophrenia.
Epidemiology
Pellagra is caused by a deficiency of niacin or tryptophan in the diet. While pellagra is now rare in developed nations due to the widespread availability of niacin-enriched foods, it remains a significant public health concern in developing nations.
For instance, in Angola, approximately one-third of the surveyed women and 6% of the surveyed infants and children aged 6 months to 5 years were found to have pellagra. Similarly, in India and parts of China, pellagra is still prevalent. Reports also suggest that pellagra is a concern for refugees, with recent cases being reported in various parts of the world.
In contrast, pellagra is relatively rare in the United States, where nutritional deficiencies have decreased significantly due to the enrichment of foods. However, there are instances where niacin deficiencies occur, such as among adolescent girls aged 10 to 13 in India, where 13% of the surveyed population were deficient in niacin.
Anatomy
Pathophysiology
Niacin is an essential nutrient that plays a crucial role in the metabolism of macronutrients such as carbohydrates, proteins, and fats. This is because niacin is a component of two important coenzymes, NAD and NADP, which are involved in various metabolic processes in the body. A niacin deficiency can result in reduced NAD and NADP coenzymes levels, commonly observed in malnutrition cases in resource-limited countries.
The oxidation of glucose produces a significant amount of chemical energy, and NAD or NADH transfers electrons in a pathway that captures this energy by producing high-energy phosphate bonds. This adenosine triphosphate provides the energy required for other intermediary metabolism reactions while simultaneously regenerating NAD from the reduced NADH. A portion of this cofactor is converted to NADPH, which plays important role.
In addition to inadequate dietary intake, other mechanisms can contribute to niacin deficiency. For instance, altered tryptophan metabolism is observed in conditions such as carcinoid syndrome, which can lead to decreased niacin production. Similarly, Hartnup disease, an autosomal recessive condition, can impair tryptophan absorption, leading to niacin deficiency.
Prolonged use of certain medications, such as isoniazid, can also decrease the production of tryptophan or inhibit the conversion of tryptophan to niacin, thereby increasing the risk of niacin deficiency. Other drugs that can inhibit niacin production include 6-mercaptopurine, 5-fluorouracil, and azathioprine. Therefore, it is essential to ensure adequate intake of niacin through dietary sources or supplements and to be aware of the various factors that can contribute to niacin deficiency.
Etiology
Niacin deficiency can result from inadequate dietary intake. Pellagra is caused by niacin deficiency and was prevalent in populations consuming a high corn-based diet, as corn has low bioavailability of niacin. Additionally, several factors such as alcoholism, drugs, gastrointestinal tract diseases, and malignancies, can also cause niacin deficiency.
Excessive alcohol consumption can impair niacin absorption, and malabsorptive disorders such as chronic diarrhea and inflammatory bowel disease can decrease niacin absorption. Medications like isoniazid can inhibit niacin absorption and endogenous production from tryptophan, leading to pellagra development.
Specific chemotherapeutic agents and carcinoid tumors can also result in niacin deficiency. To maintain adequate niacin levels, a diet containing both niacin and tryptophan is necessary, and avoiding factors that reduce niacin absorption is essential.
Genetics
Prognostic Factors
If left unaddressed, pellagra will advance and ultimately result in fatality. The absence of adequate dietary intake or persistent diarrhea, infections, or neurological factors can cause severe malnutrition, leading to death. Non-treatment could result in mortality within 4 to 5 years.
Clinical History
Clinical History
Medical history can vary, including anorexia, weight loss, nausea, dyspepsia, diarrhea, abdominal pain, excessive salivation, skin rash, headaches, fatigue, dizziness, irritability, dementia, tremors, anxiety, and depression. One condition that warrants particular attention in this regard is pellagra, which is caused by a niacin deficiency.
Pellagra is characterized by the triad of dementia, dermatitis, and diarrhea, and if left untreated, can be fatal. The skin lesions caused by pellagra are similar to sunburn and are typically found on the skin exposed to sunlight, such as the elbows, hands, knees, and feet. In addition to the physical symptoms, pellagra can also cause neurological changes.
Patients may initially experience anxiety, poor concentration, fatigue, and depression. However, as the condition progresses, more severe symptoms such as dementia and delirium may occur.
Physical Examination
Physical Examination
When conducting a physical examination, it is important to evaluate both the general health and mental status of the patient. In particular, assessing for signs of progressive derangement, confusion, and tremors is essential. In addition, a thorough head examination should be performed to evaluate the tongue for signs of swelling, tenderness, and a beefy red appearance, as well as to check for oral manifestations such as stomatitis, gingivitis and glossitis.
Another aspect of the physical examination is the evaluation of skin rash, which may present as a symmetrical and bilateral sunburn-like rash, Casal’s collar necklace-like rash, facial butterfly sign, hyperpigmentation, eruption with desquamation and thick dry skin. Additionally, signs of malnutrition, such as dehydration, weight loss, weakness, muscle wasting, or edema, should be assessed.
During the cardiac examination, abnormal heart rate and blood pressure should be noted. In a pulmonary examination, labored breathing may indicate weakness in respiratory muscles. Abdominal examination may reveal a scaphoid abdomen or hepatosplenomegaly. It is also important to evaluate wounds for poor healing, as well as for lower extremity swelling.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Differential Diagnoses
Crohn Disease
Drug Eruptions
Ulcerative Colitis
Porphyria Cutanea Tarda
Cutaneous Lupus Erythematosus
Drug Induced Dermatitis
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Niacin, also known as vitamin B3, is an essential nutrient that plays a vital role in the body’s metabolic processes. Nicotinamide is the preferred form of niacin supplement for treating a deficiency because it does not cause the flushing and tingling sensations associated with nicotinic acid. The recommended dosage for nicotinamide supplementation is 250 to 500 mg orally daily.
Patients with pellagra should avoid sun exposure and alcohol consumption to prevent worsening symptoms. People who receive isoniazid for tuberculosis prophylaxis are at an increased risk of developing a niacin deficiency. Therefore, it is essential to consider B complex multivitamin or nicotinamide supplementation to prevent deficiency.
Patients with excessive alcohol use may experience multiple vitamin B deficiencies, including niacin. In such cases, treatment with a B complex supplement that contains insufficient amounts of niacin or with pyridoxine and thiamine therapy alone without niacin could worsen the neurological clinical state or trigger alcoholic pellagra encephalopathy.
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References
https://www.ncbi.nlm.nih.gov/books/NBK557728/
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Niacin, also known as vitamin B3, plays a crucial role in the metabolism of macronutrients such as carbohydrates, proteins, and fats by serving as a coenzyme for NAD and NADP. It is an essential water-soluble vitamin that the body cannot produce, so it must be obtained through dietary sources.
Pellagra is a severe form of niacin deficiency that was first described by the Spanish physician Don Gaspar Casal in 1763. It is commonly referred to as the “4 Ds disease” because it is indicated by, diarrhea, dermatitis, dementia, and death if left untreated.
However, not all symptoms may be present, and recent studies have linked niacin deficiency to several other health conditions, including Alzheimer’s, Parkinson’s, Huntington’s disease, cognitive impairment, and schizophrenia.
Pellagra is caused by a deficiency of niacin or tryptophan in the diet. While pellagra is now rare in developed nations due to the widespread availability of niacin-enriched foods, it remains a significant public health concern in developing nations.
For instance, in Angola, approximately one-third of the surveyed women and 6% of the surveyed infants and children aged 6 months to 5 years were found to have pellagra. Similarly, in India and parts of China, pellagra is still prevalent. Reports also suggest that pellagra is a concern for refugees, with recent cases being reported in various parts of the world.
In contrast, pellagra is relatively rare in the United States, where nutritional deficiencies have decreased significantly due to the enrichment of foods. However, there are instances where niacin deficiencies occur, such as among adolescent girls aged 10 to 13 in India, where 13% of the surveyed population were deficient in niacin.
Niacin is an essential nutrient that plays a crucial role in the metabolism of macronutrients such as carbohydrates, proteins, and fats. This is because niacin is a component of two important coenzymes, NAD and NADP, which are involved in various metabolic processes in the body. A niacin deficiency can result in reduced NAD and NADP coenzymes levels, commonly observed in malnutrition cases in resource-limited countries.
The oxidation of glucose produces a significant amount of chemical energy, and NAD or NADH transfers electrons in a pathway that captures this energy by producing high-energy phosphate bonds. This adenosine triphosphate provides the energy required for other intermediary metabolism reactions while simultaneously regenerating NAD from the reduced NADH. A portion of this cofactor is converted to NADPH, which plays important role.
In addition to inadequate dietary intake, other mechanisms can contribute to niacin deficiency. For instance, altered tryptophan metabolism is observed in conditions such as carcinoid syndrome, which can lead to decreased niacin production. Similarly, Hartnup disease, an autosomal recessive condition, can impair tryptophan absorption, leading to niacin deficiency.
Prolonged use of certain medications, such as isoniazid, can also decrease the production of tryptophan or inhibit the conversion of tryptophan to niacin, thereby increasing the risk of niacin deficiency. Other drugs that can inhibit niacin production include 6-mercaptopurine, 5-fluorouracil, and azathioprine. Therefore, it is essential to ensure adequate intake of niacin through dietary sources or supplements and to be aware of the various factors that can contribute to niacin deficiency.
Niacin deficiency can result from inadequate dietary intake. Pellagra is caused by niacin deficiency and was prevalent in populations consuming a high corn-based diet, as corn has low bioavailability of niacin. Additionally, several factors such as alcoholism, drugs, gastrointestinal tract diseases, and malignancies, can also cause niacin deficiency.
Excessive alcohol consumption can impair niacin absorption, and malabsorptive disorders such as chronic diarrhea and inflammatory bowel disease can decrease niacin absorption. Medications like isoniazid can inhibit niacin absorption and endogenous production from tryptophan, leading to pellagra development.
Specific chemotherapeutic agents and carcinoid tumors can also result in niacin deficiency. To maintain adequate niacin levels, a diet containing both niacin and tryptophan is necessary, and avoiding factors that reduce niacin absorption is essential.
If left unaddressed, pellagra will advance and ultimately result in fatality. The absence of adequate dietary intake or persistent diarrhea, infections, or neurological factors can cause severe malnutrition, leading to death. Non-treatment could result in mortality within 4 to 5 years.
Clinical History
Medical history can vary, including anorexia, weight loss, nausea, dyspepsia, diarrhea, abdominal pain, excessive salivation, skin rash, headaches, fatigue, dizziness, irritability, dementia, tremors, anxiety, and depression. One condition that warrants particular attention in this regard is pellagra, which is caused by a niacin deficiency.
Pellagra is characterized by the triad of dementia, dermatitis, and diarrhea, and if left untreated, can be fatal. The skin lesions caused by pellagra are similar to sunburn and are typically found on the skin exposed to sunlight, such as the elbows, hands, knees, and feet. In addition to the physical symptoms, pellagra can also cause neurological changes.
Patients may initially experience anxiety, poor concentration, fatigue, and depression. However, as the condition progresses, more severe symptoms such as dementia and delirium may occur.
Physical Examination
When conducting a physical examination, it is important to evaluate both the general health and mental status of the patient. In particular, assessing for signs of progressive derangement, confusion, and tremors is essential. In addition, a thorough head examination should be performed to evaluate the tongue for signs of swelling, tenderness, and a beefy red appearance, as well as to check for oral manifestations such as stomatitis, gingivitis and glossitis.
Another aspect of the physical examination is the evaluation of skin rash, which may present as a symmetrical and bilateral sunburn-like rash, Casal’s collar necklace-like rash, facial butterfly sign, hyperpigmentation, eruption with desquamation and thick dry skin. Additionally, signs of malnutrition, such as dehydration, weight loss, weakness, muscle wasting, or edema, should be assessed.
During the cardiac examination, abnormal heart rate and blood pressure should be noted. In a pulmonary examination, labored breathing may indicate weakness in respiratory muscles. Abdominal examination may reveal a scaphoid abdomen or hepatosplenomegaly. It is also important to evaluate wounds for poor healing, as well as for lower extremity swelling.
Differential Diagnoses
Crohn Disease
Drug Eruptions
Ulcerative Colitis
Porphyria Cutanea Tarda
Cutaneous Lupus Erythematosus
Drug Induced Dermatitis
Niacin, also known as vitamin B3, is an essential nutrient that plays a vital role in the body’s metabolic processes. Nicotinamide is the preferred form of niacin supplement for treating a deficiency because it does not cause the flushing and tingling sensations associated with nicotinic acid. The recommended dosage for nicotinamide supplementation is 250 to 500 mg orally daily.
Patients with pellagra should avoid sun exposure and alcohol consumption to prevent worsening symptoms. People who receive isoniazid for tuberculosis prophylaxis are at an increased risk of developing a niacin deficiency. Therefore, it is essential to consider B complex multivitamin or nicotinamide supplementation to prevent deficiency.
Patients with excessive alcohol use may experience multiple vitamin B deficiencies, including niacin. In such cases, treatment with a B complex supplement that contains insufficient amounts of niacin or with pyridoxine and thiamine therapy alone without niacin could worsen the neurological clinical state or trigger alcoholic pellagra encephalopathy.
https://www.ncbi.nlm.nih.gov/books/NBK557728/
medtigo
Vitamin B3 Deficiency
Updated :
September 5, 2023
Niacin, also known as vitamin B3, plays a crucial role in the metabolism of macronutrients such as carbohydrates, proteins, and fats by serving as a coenzyme for NAD and NADP. It is an essential water-soluble vitamin that the body cannot produce, so it must be obtained through dietary sources.
Pellagra is a severe form of niacin deficiency that was first described by the Spanish physician Don Gaspar Casal in 1763. It is commonly referred to as the “4 Ds disease” because it is indicated by, diarrhea, dermatitis, dementia, and death if left untreated.
However, not all symptoms may be present, and recent studies have linked niacin deficiency to several other health conditions, including Alzheimer’s, Parkinson’s, Huntington’s disease, cognitive impairment, and schizophrenia.
Pellagra is caused by a deficiency of niacin or tryptophan in the diet. While pellagra is now rare in developed nations due to the widespread availability of niacin-enriched foods, it remains a significant public health concern in developing nations.
For instance, in Angola, approximately one-third of the surveyed women and 6% of the surveyed infants and children aged 6 months to 5 years were found to have pellagra. Similarly, in India and parts of China, pellagra is still prevalent. Reports also suggest that pellagra is a concern for refugees, with recent cases being reported in various parts of the world.
In contrast, pellagra is relatively rare in the United States, where nutritional deficiencies have decreased significantly due to the enrichment of foods. However, there are instances where niacin deficiencies occur, such as among adolescent girls aged 10 to 13 in India, where 13% of the surveyed population were deficient in niacin.
Niacin is an essential nutrient that plays a crucial role in the metabolism of macronutrients such as carbohydrates, proteins, and fats. This is because niacin is a component of two important coenzymes, NAD and NADP, which are involved in various metabolic processes in the body. A niacin deficiency can result in reduced NAD and NADP coenzymes levels, commonly observed in malnutrition cases in resource-limited countries.
The oxidation of glucose produces a significant amount of chemical energy, and NAD or NADH transfers electrons in a pathway that captures this energy by producing high-energy phosphate bonds. This adenosine triphosphate provides the energy required for other intermediary metabolism reactions while simultaneously regenerating NAD from the reduced NADH. A portion of this cofactor is converted to NADPH, which plays important role.
In addition to inadequate dietary intake, other mechanisms can contribute to niacin deficiency. For instance, altered tryptophan metabolism is observed in conditions such as carcinoid syndrome, which can lead to decreased niacin production. Similarly, Hartnup disease, an autosomal recessive condition, can impair tryptophan absorption, leading to niacin deficiency.
Prolonged use of certain medications, such as isoniazid, can also decrease the production of tryptophan or inhibit the conversion of tryptophan to niacin, thereby increasing the risk of niacin deficiency. Other drugs that can inhibit niacin production include 6-mercaptopurine, 5-fluorouracil, and azathioprine. Therefore, it is essential to ensure adequate intake of niacin through dietary sources or supplements and to be aware of the various factors that can contribute to niacin deficiency.
Niacin deficiency can result from inadequate dietary intake. Pellagra is caused by niacin deficiency and was prevalent in populations consuming a high corn-based diet, as corn has low bioavailability of niacin. Additionally, several factors such as alcoholism, drugs, gastrointestinal tract diseases, and malignancies, can also cause niacin deficiency.
Excessive alcohol consumption can impair niacin absorption, and malabsorptive disorders such as chronic diarrhea and inflammatory bowel disease can decrease niacin absorption. Medications like isoniazid can inhibit niacin absorption and endogenous production from tryptophan, leading to pellagra development.
Specific chemotherapeutic agents and carcinoid tumors can also result in niacin deficiency. To maintain adequate niacin levels, a diet containing both niacin and tryptophan is necessary, and avoiding factors that reduce niacin absorption is essential.
If left unaddressed, pellagra will advance and ultimately result in fatality. The absence of adequate dietary intake or persistent diarrhea, infections, or neurological factors can cause severe malnutrition, leading to death. Non-treatment could result in mortality within 4 to 5 years.
Clinical History
Medical history can vary, including anorexia, weight loss, nausea, dyspepsia, diarrhea, abdominal pain, excessive salivation, skin rash, headaches, fatigue, dizziness, irritability, dementia, tremors, anxiety, and depression. One condition that warrants particular attention in this regard is pellagra, which is caused by a niacin deficiency.
Pellagra is characterized by the triad of dementia, dermatitis, and diarrhea, and if left untreated, can be fatal. The skin lesions caused by pellagra are similar to sunburn and are typically found on the skin exposed to sunlight, such as the elbows, hands, knees, and feet. In addition to the physical symptoms, pellagra can also cause neurological changes.
Patients may initially experience anxiety, poor concentration, fatigue, and depression. However, as the condition progresses, more severe symptoms such as dementia and delirium may occur.
Physical Examination
When conducting a physical examination, it is important to evaluate both the general health and mental status of the patient. In particular, assessing for signs of progressive derangement, confusion, and tremors is essential. In addition, a thorough head examination should be performed to evaluate the tongue for signs of swelling, tenderness, and a beefy red appearance, as well as to check for oral manifestations such as stomatitis, gingivitis and glossitis.
Another aspect of the physical examination is the evaluation of skin rash, which may present as a symmetrical and bilateral sunburn-like rash, Casal’s collar necklace-like rash, facial butterfly sign, hyperpigmentation, eruption with desquamation and thick dry skin. Additionally, signs of malnutrition, such as dehydration, weight loss, weakness, muscle wasting, or edema, should be assessed.
During the cardiac examination, abnormal heart rate and blood pressure should be noted. In a pulmonary examination, labored breathing may indicate weakness in respiratory muscles. Abdominal examination may reveal a scaphoid abdomen or hepatosplenomegaly. It is also important to evaluate wounds for poor healing, as well as for lower extremity swelling.
Differential Diagnoses
Crohn Disease
Drug Eruptions
Ulcerative Colitis
Porphyria Cutanea Tarda
Cutaneous Lupus Erythematosus
Drug Induced Dermatitis
Niacin, also known as vitamin B3, is an essential nutrient that plays a vital role in the body’s metabolic processes. Nicotinamide is the preferred form of niacin supplement for treating a deficiency because it does not cause the flushing and tingling sensations associated with nicotinic acid. The recommended dosage for nicotinamide supplementation is 250 to 500 mg orally daily.
Patients with pellagra should avoid sun exposure and alcohol consumption to prevent worsening symptoms. People who receive isoniazid for tuberculosis prophylaxis are at an increased risk of developing a niacin deficiency. Therefore, it is essential to consider B complex multivitamin or nicotinamide supplementation to prevent deficiency.
Patients with excessive alcohol use may experience multiple vitamin B deficiencies, including niacin. In such cases, treatment with a B complex supplement that contains insufficient amounts of niacin or with pyridoxine and thiamine therapy alone without niacin could worsen the neurological clinical state or trigger alcoholic pellagra encephalopathy.
https://www.ncbi.nlm.nih.gov/books/NBK557728/
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