The overall global prevalence of vitamin B3 deficiency is not known. Pellagra is predominantly a disease of adults, most commonly affecting those between the ages of 20 and 50 years. It can also affect school-age children and adolescents, but rarely affects infants and young children.[9]World Health Organization. The management of nutrition in major emergencies. 2000. [internet publication].
http://www.who.int/nutrition/publications/emergencies/9241545208/en
[10]Chawla J, Kvarnberg D. Hydrosoluble vitamins. Handb Clin Neurol. 2014;120:891-914.
http://www.ncbi.nlm.nih.gov/pubmed/24365359?tool=bestpractice.com
Pellagra is associated with poverty and malnutrition and is still endemic in resource-poor areas of China, India, and Africa.[3]WHO/FAO. Vitamin and mineral requirements in human nutrition. Report of a joint FAO/WHO expert consultation. Bangkok, Thailand. Rome. 2004. In the US, pellagra was common in the early 1900s in the Southern states where corn was the major staple food, peaking in 1928 and 1929.[11]Park YK, Sempos CT, Barton CN, et al. Effectiveness of food fortification in the United States: the case of pellagra. Am J Public Health. 2000 May;90(5):727-38.
http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.90.5.727
http://www.ncbi.nlm.nih.gov/pubmed/10800421?tool=bestpractice.com
However, by 1955, mainly due to food fortification with niacin, deaths from pellagra were eliminated. Since the 1980s, pellagra has mainly been reported globally in refugees and displaced people due to inadequate food supplies.[12]Mason JB. Lessons on nutrition of displaced people. J Nutr. 2002 Jul;132(7):2096S-2103S.
http://jn.nutrition.org/content/132/7/2096S.full
http://www.ncbi.nlm.nih.gov/pubmed/12097702?tool=bestpractice.com
It has also re-emerged in East and Southern Africa, as well as in other areas of war or unrest.[13]Seal AJ, Creeke PI, Dibari F, et al. Low and deficient niacin status and pellagra are endemic in postwar Angola. Am J Clin Nutr. 2007 Jan;85(1):218-24.
http://www.ajcn.org/content/85/1/218.full
http://www.ncbi.nlm.nih.gov/pubmed/17209199?tool=bestpractice.com
[14]Lee BY, Thurmon TF. Nutritional disorders among workers in North China during national turmoil. Ann Nutr Metab. 2001;45(4):175-80.
http://www.ncbi.nlm.nih.gov/pubmed/11464001?tool=bestpractice.com
[15]Malfait P, Moren A, Dillon JC, et al. An outbreak of pellagra related to changes in dietary niacin among Mozambican refugees in Malawi. Int J Epidemiol. 1993;22:504-511.
http://www.ncbi.nlm.nih.gov/pubmed/8359968?tool=bestpractice.com
Only isolated cases of pellagra have been reported in South Africa since 2000.[16]Viljoen M, Bipath P, Tosh C. Pellagra in South Africa from 1897 to 2019: a scoping review. Public Health Nutr. 2021 Jun;24(8):2062-76.
https://www.cambridge.org/core/journals/public-health-nutrition/article/pellagra-in-south-africa-from-1897-to-2019-a-scoping-review/5D2EC1BADFCB0360609534C552D232AF
http://www.ncbi.nlm.nih.gov/pubmed/33769244?tool=bestpractice.com
In the developed world, chronic alcohol use disorder is the commonest cause of pellagra.[17]MacDonald A, Forsyth A. Nutritional deficiencies and the skin. Clin Exp Dermatol. 2005 Jul;30(4):388-90.
http://www.ncbi.nlm.nih.gov/pubmed/15953078?tool=bestpractice.com
Additionally, cases of pellagra, due to gastrointestinal malabsorption and medications such as isoniazid and antidepressants, are reported in Western Europe, the US, Australia, and Japan.[18]Pipili C, Cholongitas E, Ioannidou D. The diagnostic importance of photosensitivity dermatoses in chronic alcoholism: report of two cases. Dermatol Online J. 2008 Nov 15;14(11):15.
http://www.ncbi.nlm.nih.gov/pubmed/19094853?tool=bestpractice.com
[19]Kertesz SG. Pellagra in 2 homeless men. Mayo Clin Proc. 2001 Mar;76(3):315-8.
http://www.ncbi.nlm.nih.gov/pubmed/11243279?tool=bestpractice.com
[20]Viljoen M, Swanepoel A, Bipath P. Antidepressants may lead to a decrease in niacin and NAD in patients with poor dietary intake. Med Hypotheses. 2015 Mar;84(3):178-82.
http://www.ncbi.nlm.nih.gov/pubmed/25596911?tool=bestpractice.com