Search

Objective: Pellagra is a nutritional deficiency disease associated with niacin (vitamin B3) deficiency. The history of pellagra is well documented for Europe and the USA, but less is known about the prevalence in sub-Saharan African countries. This study documents the history of pellagra in South Africa, as diagnosed based on dermatological symptoms.Design: Scoping review of information from scientific databases, library archives, other archives and record services and from Statistics South Africa.Setting: South Africa, 1897-2019.Participants: South African.Results: Pellagra was first officially recorded in South Africa in 1906, but there are earlier indications of the disease. The prevalence of pellagra peaked after it was all but eradicated in the USA and Europe. Pellagra was never as prevalent in South Africa as in Europe, the USA and Egypt, where special hospitals for pellagrins were established. However, studies on urinary excretion of metabolites conducted in 1960s and 1970s suggested a high prevalence of subclinical (sub-pellagra) niacin deficiency, especially in previously disadvantaged Black populations. As in Europe and the USA, pellagra was associated with poverty and an overdependence on maize as staple food. Malnutrition was the main cause of the disease, but alcohol abuse might have been a contributing factor. In South Africa, reports of pellagra had declined by the late 1980s/early 1990s and hardly any cases were reported by the year 2000.Conclusions: Although pellagra, diagnosed based on dermatological symptoms, appears to be largely eradicated in South Africa, it does not rule out the potential for subclinical niacin deficiency. [ABSTRACT FROM AUTHOR]

The article discusses the pellagra, a nutrition-deficiency disease, which is caused by dermatological and gastrointestinal and neuropsychiatric manifestations. It is noted that pellagra is the syndrome of a severe deficiency of the water-soluble vitamin niacin and its symptoms include dermatitis, diarrhoea and dementia. Topics include the history of the disease, diagnosis of Pellagra in South Africa among Zulu rebel prisoners in 1906 and the link between maize and pellagra.

Objective: The objective was to investigate the absolute micronutrient intake and the possibility of micronutrient dilution of added sugar in the diets of an African population in nutritional transition. Design: A cross-sectional, comparative, population-based design was used. Respondents who consumed sugar were divided into four quartiles of percentage of added sugar intake. Setting: The setting was 37 randomly selected rural and urban areas of the North West province. Subjects: The subjects were 1 742 adult volunteers (739 men and 1 003 women), aged between 15-65 years. After exclusion of low-energy reporters, the sample comprised 1 045 subjects (472 men and 573 women). Outcome measures: The outcomes measures were the macronutrient and micronutrient intakes of subjects in different quartiles of added sugar intake and body mass index (BMI). Results: The average intake of added sugar was 10.01% of total energy (67.12 g) in men and 11.2% total energy (67.10 g) in women. Respondents who consumed the most added sugar had significantly lower mean intakes of alcohol, but higher intakes of energy, macronutrients and most micronutrients. The diets of those in the highest sugar intake group contained significantly less thiamine, riboflavin, niacin, vitamin B12, pantothenic acid, biotin, magnesium, phosphorus and zinc per 4.18 MJ. At every level of added sugar consumption, the mean intakes of fibre (men only), folate, ascorbic acid and calcium (men and women) did not meet the dietary reference intakes [estimated average requirements (EAR)] and pantothenic acid and biotin (women only) did not meet the adequate intake. There were no significant differences in mean BMI across the quartiles of added sugar intakes in men, but the mean BMI of women who consumed the most added sugar was significantly higher than that of those who consumed less sugar. Respondents who consumed the most added sugar had significantly higher intakes of fruit (men only), bread and soft drinks, and lower intakes of maize meal and alcohol (men and women). Conclusion: Absolute intakes of most micronutrients were significantly higher in consumers with a high sugar intake [Quartile (Q) 4] compared with the lowest consumers of sugar (Q1). The lowest percentages of participants whose micronutrient intakes fell below the EAR were in Q4 and Q3. However, expression of micronutrient intake per 4.18 kJ (micronutrient dilution) revealed significantly less of most micronutrients per 4.18 MJ for men and women who consumed the most added sugar, compared with those who consumed the least. [ABSTRACT FROM AUTHOR]

Pellagra, a niacin/tryptophan deficiency disease, is prevalent in populations that have high maize/low protein diets. Historically it has been essentially a disease of undernutrition and social inequality. We offer a unique analysis of both macro- and microstructural skeletal indicators from 31 individuals known to have died from pellagra (n = 14) and non-specific general malnutrition (n = 17). These cases are part of the Raymond Dart Skeletal Collection, housed at the University of Witwatersrand Medical School, Johannesburg, South Africa. This sample was drawn from a mid-to-late 20th century Black South African population. These individuals were found to exhibit a high incidence of alveolar bone loss, dental caries, enamel hypoplasias, periostitic lesions, osteomyelitis, cribra orbitalia, and cranial pitting. The frequency of specific pathological indicators separated the pellagrins from those with non-specific general malnutrition; however, the indicators were not pellagra-specific. We strongly argue that pellagra does affect bone in a noticeable way at both the macro- and micro-level, and therefore as a diet-related disease cannot be excluded as a possible cause for lesions seen in maize-dependent populations. We have also reported on the histological findings for rib samples taken from a subset of pellagra (n = 10) and general malnutrition (n = 14) cases. The critical difference between pellagrins and non-specific malnutrition cases was a decreased cortical area for pellagrins. Given its implications for interpreting the paleonutrition and paleopathology of prehistoric and historical transitions to maize intensive diets we present a checklist of macro- and micro-level indicators for investigating a signature pattern for the skeletal biology of pellagra. The overall synthesis of our findings provides new insights into skeletal-based interpretations of nutrition and micronutrient-related health problems for populations undergoing dietary transitions both past and present. [ABSTRACT FROM AUTHOR]