Pellagra is a disease caused by a deficiency of vitamin niacin (vitamin B 3 ). Symptoms include inflamed skin, diarrhea, dementia, and mouth sores. Skin areas exposed to sun or friction are usually affected first. Over time the affected skin may become darker, stiffer, starting to peel, or bleed.
There are two main types of pellagra, primary and secondary. Primary pellagra is due to a diet that does not contain enough niacin and tryptophan. Secondary pelagra is caused by poor ability to use niacin in food. This can occur as a result of alcoholism, long-term diarrhea, carcinoid syndrome, Hartnup disease, and a number of drugs such as isoniazid. Diagnosis is usually symptomatic and may be assisted by urine testing.
Treatment is with niacin or nicotinamide supplements. Repairs usually start within a few days. General improvements in diet are also often recommended. Reducing sun exposure through sunscreen and proper clothing is important when the skin heals. No treatment of death can occur. This is most common in developing countries, particularly sub-Saharan Africa.
Video Pellagra
Signs and symptoms
The classic symptoms of pellagra are diarrhea, dermatitis, dementia, and death ("the four Ds"). The list of more complete symptoms includes:
- High sensitivity to sunlight
- Aggression
- Dermatitis, alopecia (hair loss), edema (swelling)
- Smooth, red glossy red (tongue inflammation)
- Red leather lesions
- Insomnia
- Weakness
- Mind confusion
- Ataxia (lack of coordination), limb paralysis, peripheral neuritis (nerve damage)
- Diarrhea
- Dilated cardiomyopathy (enlarged heart, weakening)
- Finally dementia
J. Frostig and Tom Spies (according to Cleary and Cleary) describe more specific psychological symptoms of pellagra as:
- Psychosensory disorders (impression as pain, disturbing bright light, intolerance odor that causes nausea and vomiting, dizziness after sudden movement)
- Psychomotor disorders (anxiety, tension and desire to quarrel, increase readiness for motor action)
- Emotional Disorder
Despite the clinical symptoms, tryptophan levels or urinary metabolites such as the 2-pyridone/N-methylniacinamide ratio & lt; 2 or ratio of NAD/NADP in red blood cells can be used to diagnose pellagra. Diagnosis may be confirmed after rapid improvement of symptoms in patients taking high-dose niacin (250-500 mg/day) or niacin-fortified foods.
Maps Pellagra
Pathophysiology
Pellagra can develop in accordance with several mechanisms, classically as a result of niacin deficiency (vitamin B3), resulting in decreased NAD production leading to most pathology (because NAD and phosphorylated NADP forms are the necessary cofactors in many body processes, pathological impact of pellagra extensive and cause death if untreated).
The first mechanism is a simple niacin diet. Second, it may be the result of a lack of tryptophan, an essential amino acid found in meat, poultry, fish, eggs and nuts that are converted into niacin. Third, it may be caused by excessive leucine, because it inhibits quinolinate phosphoribosyl transferase (QPRT) and inhibits the formation of niacin or nicotinic acid into a nicotinamide mononucleotide (NMN) that causes pellegra-like symptoms to occur.
Some conditions can prevent the absorption of niacin or tryptophan and cause pellagra. The inflammation of the jejunum or ileum can prevent the absorption of nutrients, which causes pellagra, and this in turn can be caused by Crohn's disease. Gastroenterostomy can also cause pellagra. Chronic alcoholism can also lead to poor absorption that combines with the already low diet of niacin and tryptophan to produce pellagra. Hartnup's disease is a genetic disorder that reduces the absorption of tryptophan, which causes pellagra.
Changes in protein metabolism can also produce symptoms similar to pellagra. An example is carcinoid syndrome, a disease in which neuroendocrine tumors along the digestive tract use tryptophan as a source for serotonin production, which limits tryptophan available for niacin synthesis. In normal patients, only one percent of dietary tryptophan is converted to serotonin; However, in patients with carcinoid syndrome, this value can increase up to 70%. Carcinoid syndrome can thus produce niacin deficiency and clinical manifestations of pellagra. Anti-tuberculosis drugs tend to bind to vitamin B 6 and reduce the synthesis of niacin, because B 6 (aka pyridoxine) is the cofactor needed in tryptophan-to-niacin reactions.
Some therapeutic drugs can provoke pellagra. These include isoniazid antibiotics, which decrease the availability of B 6 by binding it and making it inactive, so it can not be used in the synthesis of niacin, and chloramphenicol; fluorouracil anti-cancer agent; and merkaptopurine immunosuppressants.
Treatment
If left untreated, pellagra can kill in four or five years. Treatment is with nicotinamide, which has the same vitamin function as niacin and similar chemical structures, but has a lower toxicity. The frequency and amount of nicotinamide administered depends on the extent to which the condition has developed.
Epidemiology
Pellagra can be common in people who derive most of their food energy from corn, especially in rural South America, where corn is the staple food. If corn is not nixtamalized, it is a poor source of tryptophan, as well as niacin. Nixtamalization improves the deficiency of niacin, and is a common practice in native American cultures that grow corn. After the corn cycle, symptoms usually appear during the spring, summer increases due to greater sun exposure, and the return of the following spring. Indeed, pellagra was once endemic in the poorer southern states of the United States, such as Mississippi and Alabama, where its spring cycle emerged after a fleshy winter diet caused it to be known as "spring disease" (especially when it emerged among children more vulnerable), and among the prison population and the orphanage as Dr. Joseph Goldberger.
Pellagra is common in Africa, Indonesia, and China. In a prosperous society, the majority of patients with clinical pellagra are poor patients, homeless, alcohol dependent, or psychiatrists who refuse food. Pellagra is common among prisoners of Soviet labor camps (Gulag). In addition, pellagra, as a micronutrient deficiency disease, often affects refugee populations and other displaced persons due to their unique long-term residence conditions and their reliance on food aid. Refugees usually depend on the limited sources of niacin given to them, such as peanuts; instability in the nutritional content and distribution of food aid may be the cause of pellagra in displaced populations. In the 2000s, there were outbreaks in countries such as Angola, Zimbabwe and Nepal. Particularly in Angola, recent reports have shown similar incidence of pellagra since 2002 with clinical pellagra in 0.3% of women and 0.2% of children and niacin deficiency in 29.4% of women and 6% of children associated with consumption of maize not maintained.
In other countries such as the Netherlands and Denmark, even with adequate niacin intake, cases have been reported. In this case the deficiency may occur not only because of poverty or malnutrition but secondary to alcoholism, drug interactions (psychotropic, cytostatic, tuberculosis or analgesic), HIV, vitamin B 2 and B 6 deficiency, or malabsorption syndrome such as Hartnup and carcinoid.
History
The traditional food preparation method of corn ("corn"), nixtamalization, by a native New World cultivator who has tamed corn, needs grain treatment with lime, alkali. The treatment of lime has been shown to make niacin available nutritionally and reduce the possibility of developing pellagra. When corn planting is adopted around the world, this preparation method is not accepted because the benefits are not understood. The original cultivators, often very dependent on maize, do not suffer from pellagra; it becomes common only when corn becomes the staple food eaten without traditional treatment.
Pellagra was first described for its dermatology effect in Spain in 1735 by Gaspar Casal. He explained that the disease causes dermatitis in areas of exposed skin such as hands, feet and necks and that the origin of the disease is poor diet and atmospheric influences. His work was published in 1762 by his friend Juan Sevillano entitled 'Historia Natural y Medicina del Principado de Asturias' or Natural and Medical History of the Kingdom of Asturias (1762). It causes a disease known as "Asturian leprosy", and it is recognized as the first modern pathological description of the syndrome. It is an endemic disease in northern Italy, where it is named (in lombard) pell agra agra = like holly or serum-like; pell = leather) by Francesco Frapolli from Milan. With pellagra affecting more than 100,000 people in Italy in the 1880s, the debate raged on how to classify the disease (as a form of scurvy, elephantiasis or as something new), and more than its cause. In the 19th century Roussel began a campaign in France to limit consumption of corn and eradicate diseases in France, but remained endemic in many rural areas of Europe. Since the pellagra outbreak occurred in areas where corn is the dominant food crop, the most convincing hypothesis during the late nineteenth century, as embraced by Cesare Lombroso, is that corn either carries a toxic substance or a disease carrier. Louis Sambon, an Anglo-Italian physician working at the London School of Tropical Medicine, believes that pellagra is carried by insects, along the lines of malaria. Then, the lack of outbreaks of pellagra in Mesoamerica, where corn is the main food crop, directs researchers to investigate processing techniques in the region.
Pellagra studied mainly in Europe until the late 19th century when it became an epidemic especially in the southern United States. In the early 1900s, pellagra reached epidemic proportions in South America. Between 1906 and 1940 over 3 million Americans were affected by pellagra with more than 100,000 deaths, but the epidemic recovered itself right after fortification of dietary niacin. The death of Pellagra in South Carolina totaled 1,306 during the first ten months of 1915; 100,000 southerners were affected in 1916. At the present time, the scientific community believes that pellagra may be caused by germs or some unknown toxins in maize. The Spartanburg Pellagra Hospital in Spartanburg, South Carolina, is the first state facility dedicated to discovering the cause of pellagra. Founded in 1914 with a special congressional allocation to the US Public Health Service (PHS) and was formed primarily for research. In 1915, Joseph Goldberger, who was assigned to study pellagra by the Surgeon General of the United States, showed that it was linked to diet by observing the pellagra outbreak in orphanages and mental hospitals. Goldberger notes that children between the ages of 6 and 12 (but not older or younger children in an orphanage) and patients in mental hospitals (but not doctors or nurses) are those who seem most vulnerable to pellagra. Goldberger theorizes that the lack of meat, milk, eggs and nuts makes certain populations vulnerable to pellagra. By modifying the food served in these institutions with "a sharp increase in fresh animal and protein pod food," Goldberger was able to show that pellagra can be prevented. In 1926, Goldberger determined that a diet that included this food, or a bit of beer yeast, prevented pellagra.
Goldberger experimented on 11 prisoners (one of whom was dismissed for prostatitis). Prior to the experiment, the prisoners were eating the prison fees granted to all inmates at Rankin Prison Farm in Mississippi. Goldberger began giving them limited food from porridge, syrup, porridge, biscuits, cabbage, sweet potatoes, rice, mustard, and coffee with sugar (without milk). Healthy white male volunteers are selected because typical skin lesions are more easily seen in Caucasians and this population is perceived as the most susceptible to disease, and thus provides the strongest evidence that the disease is caused by nutritional deficiencies. Subjects had mild, but typical, cognitive and gastrointestinal symptoms, and within five months of a cereal-based diet, 6 of the 11 subjects appeared in the skin lesions required for the diagnosis of pellagra. Lesions appear first on the scrotum. Goldberger was not given the opportunity to experimentally reverse the effects of diet-induced pellagra when prisoners were released soon after the pellagra diagnosis was confirmed. In the 1920s he connected pellagra with a rural diet with a corn-based diet rather than an infection, contrary to the general medical notion of the time. Despite all his efforts, some doctors took his ideas because of the need for social reform, especially in the land system of the time, which caused many deaths and stereotypes to avoid. Goldberger is remembered as "the unknown hero of the American clinical epidemiology". However, he failed to identify certain elements that did not exist that caused pellagra.
In 1937, Conrad Elvehjem, a professor of biochemistry at the University of Wisconsin-Madison, pointed out that vitamin niacin cures pellagra (manifested as black tongue) in dogs. Further research by Dr. Tom Spies, Marion Blankenhorn, and Clark Cooper determined that niacin also cures pellagra in humans, which Time magazine called it 1938 Men of the Year in comprehensive science.
Research conducted between 1900 and 1950 found the number of cases of women with pellagra consistently doubled the number of cases of men suffering. This is thought to be due to the estrogen inhibitory effect on the conversion of amino acid tryptophan to niacin. Some researchers at the time gave some explanation of the difference.
Gillman and Gillman linked skeletal and pellagra tissue in their study in Blacks South Africa. They provide some of the best evidence for skeletal manifestation of pellagra and bone reactions in malnutrition. They claimed radiology research from adult pellagrins showed marked osteoporosis. The negative mineral balance in pellagrins is noted, which indicates active mobilization and excretion of endogenous mineral substances, and no doubt has an impact on bone turnover. Dental caries is present in more than half of pellagra patients. In most cases, caries is associated with "severe gingival retraction, sepsis, cementum exposure, and loosening of teeth".
United States
Pellagra was first reported in 1902 in the United States, and has "caused more deaths than other nutritional-related diseases in American history", reaching epidemic proportions in South America during the early 1900s. Poverty and consumption of maize are the most frequently observed risk factors, but the exact cause is unknown, until Joseph Goldberger's innovative work. A 2017 National Economic Research Bureau paper explores the role of cotton production in the emergence of disease; One notable theory is that "widespread cotton production supersedes the local production of niacin rich foods and encourages poor South farmers and factory workers to consume milled Midwestern corn, which is relatively cheap but also contains no niacin necessary to prevent pellagra. " This study provides evidence supporting the theory: there is a lower pellagra rate in areas where farmers have been forced to abandon cotton production (a very profitable crop) in favor of food crops (less favorable plants) due to bovine weevil beetle leaf bacillus ).
All dried corn kernels contain nutritious germs and a thin layer of seeds that provide some fiber. There are two important considerations for using whole grain corn.
- Germ contains oil exposed by grinding, so whole grains of cornmeal and grits change rapidly at room temperature and should be cooled.
- Whole grains and grits require longer cooking times as seen in the following cooking instructions for whole grain grains;
"Put the grit in a skillet and cover it with water, allow the grit to finish a full minute, tilt the pan, and strain and remove the husk and stomach with a fine tea strainer and cook the grits for 50 minutes." if the porridge was soaked overnight or 90 minutes otherwise. "
Most of the niacin in ripe grain cereals is present as niacytin, which is niacin bound in a complex with hemicellulose that is not available nutritionally. In mature corn this may be up to 90% of the total content of niacin. The nixtamalization preparation method using all dried corn kernels makes this niacin available naturally and reduces the possibility of developing pellagra. Niacytin is concentrated in the aleuron layer and the germ is removed by grinding. Milling and maize degerming in cornmeal making became feasible with the development of Beall degderator originally patented in 1901 and used to separate sand from germ in corn processing. However, this degeneration process reduces the content of niacin from corn flour.
Casimir Funk, who helped explain the role of thiamin in the etiology of beriberi, was the investigator of the early pellagra problem. Funk suggests that changes in the milling method of corn are responsible for pellagra rupture, but no attention is given to his article on this subject.
Pellagra develops primarily among vulnerable populations in institutions such as orphanages and prisons, due to the monotonous and limited diet. Soon pellagra began to occur in epidemic proportions in the southern states of the Potomac and Ohio rivers. The pellagra epidemic lasted for nearly four decades beginning in 1906. There are an estimated 3 million cases and 100,000 deaths from pellagra during the epidemic.
Popular culture
- George Sessions Perry's 1941 novel Preserve Fall in Your Hands Ã, - and the adaptation of Jean Renoir's film in 1945, The Southerner Ã, - combine pellagra ("spring sickness") as a major plot element in the story of a poor Texas farmer's family.
See also
- Middle Chromatolysis
- Harriette Chick
- Zeism
References
Further reading
External links
- PellagraÃ, - Food and Agriculture Organization (FAO)
Source of the article : Wikipedia
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