Epidemiology

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][10]​​ Pellagra is associated with poverty and malnutrition and is still endemic in resource-poor areas of China, India, and Africa.[3]​​​ 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] 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] It has also re-emerged in East and Southern Africa, as well as in other areas of war or unrest.[13][14][15]​​ Only isolated cases of pellagra have been reported in South Africa since 2000.[16]​ In the developed world, chronic alcohol use disorder is the commonest cause of pellagra.[17] 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][19][20]

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