Pellagra
Niacin (vitamin B3) deficiency syndrome characterized by the "three Ds": dermatitis (photosensitive, symmetric, in sun-exposed areas), diarrhea, and dementia, with death as the fourth D if untreated.
Pellagra historically devastated maize-dependent populations because corn niacin is bound as niacytin and not bioavailable, and corn is also low in tryptophan (which can be converted to NAD+ at ~60:1 ratio). Joseph Goldberger's epidemiologic work identified the dietary cause. Treatment is niacinamide (not niacin, which causes flushing). Alkali treatment of maize (nixtamalization, used traditionally in Mexico) releases niacin and prevents pellagra.
How each textbook covers it
Advanced Nutrition and Human Metabolism, 8th ed. (Gropper) — Glossary
Classical "4 Ds" disease (dermatitis, diarrhea, dementia, death) caused by inadequate niacin or its precursor tryptophan. Endemic historically among maize-dependent populations lacking nixtamalization.
Modern Nutrition in Health and Disease, 12th ed. — Ch 24: Niacin
Pellagra historically devastated maize-dependent populations because corn niacin is bound as niacytin and not bioavailable, and corn is also low in tryptophan (which can be converted to NAD+ at ~60:1 ratio). Joseph Goldberger's epidemiologic work identified the dietary cause. Treatment is niacinamide (not niacin, which causes flushing). Alkali treatment of maize (nixtamalization, used traditionally in Mexico) releases niacin and prevents pellagra.
Related terms
Beriberi, Hartnup disease, NAD, Niacin, Scurvy, Tryptophan