Pellagra - Knowledge

857:, biscuits, cabbage, sweet potatoes, rice, collards, and coffee with sugar (no milk). Healthy white male volunteers were selected as the typical skin lesions were easier to see in Caucasians and this population was felt to be those least susceptible to the disease, and thus provide the strongest evidence that the disease was caused by a nutritional deficiency. Subjects experienced mild, but typical cognitive and gastrointestinal symptoms, and within five months of this cereal-based diet, 6 of the 11 subjects broke out in the skin lesions that are necessary for a definitive diagnosis of pellagra. The lesions appeared first on the scrotum. Goldberger was not given the opportunity to experimentally reverse the effects of diet-induced pellagra as the prisoners were released shortly after the diagnoses of pellagra were confirmed. In the 1920s, he connected pellagra to the corn-based diets of rural areas rather than infection as contemporary medical opinion would suggest. Goldberger believed that the root cause of pellagra amongst Southern farmers was limited diet resulting from poverty, and that social and land reform would cure epidemic pellagra. His reform efforts were not realized, but 545: 838:, showed it was linked to diet by observing the outbreaks of pellagra in orphanages and mental hospitals. Goldberger noted that children between the ages of 6 and 12 (but not older or younger children at the orphanages) and patients at the mental hospitals (but not doctors or nurses) were the ones who seemed most susceptible to pellagra. Goldberger theorized that a lack of meat, milk, eggs, and legumes made those particular populations susceptible to pellagra. By modifying the diet served in these institutions with "a marked increase in the fresh animal and the leguminous protein foods," Goldberger was able to show that pellagra could be prevented. By 1926, Goldberger established that a diet that included these foods, or a small amount of 1184:. A 2017 National Bureau of Economic Research paper explored the role of cotton production in the emergence of disease; one prominent theory is that "widespread cotton production had displaced local production of niacin-rich foods and driven poor Southern farmers and mill workers to consume milled Midwestern corn, which was relatively cheap but also devoid of the niacin necessary to prevent pellagra." The study provided evidence in favor of the theory: there were lower pellagra rates in areas where farmers had been forced to abandon cotton production (a highly profitable crop) in favor of food crops (less profitable crops) due to 621:); the instability in the nutritional content and distribution of food aid can be the cause of pellagra in displaced populations. In the 2000s, there were outbreaks in countries such as Angola, Zimbabwe and Nepal. In Angola specifically, recent reports show a 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 related to high untreated corn consumption. 804: 269: 4289: 281: 1326:, which entails pre-processing corn by soaking in an alkaline solution. Doing so prevents pellagra by increasing the digestibility of tryptophan-containing proteins. They furthermore combined corn with legumes to form a complete protein. (Several sources repeat a claim that corn contains "niacytin", niacin bound up in a complex with 814:

than 100,000 deaths, yet the epidemic resolved itself right after dietary niacin fortification. Pellagra deaths in South Carolina numbered 1,306 during the first ten months of 1915; 100,000 Southerners were affected in 1916. At this time, the scientific community held that pellagra was probably caused by a

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Pellagra was studied mostly in Europe until the late 19th century when it became epidemic especially in the southern United States. In the early 1900s, pellagra reached epidemic proportions in the American South. Between 1906 and 1940 more than 3 million Americans were affected by pellagra with more

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in the poorer states of the U.S. South, such as Mississippi and Alabama, where its cyclical appearance in the spring after meat-heavy winter diets led to it being known as "spring sickness" (particularly when it appeared among more vulnerable children), as well as among the residents of jails and

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Men of the Year, outstanding in comprehensive science were three medical researchers who discovered that nicotinic acid was a cure for human pellagra: Drs. Tom Douglas Spies of Cincinnati General Hospital, Marion Arthur Blankenhorn of the University of Cincinnati, Clark Niel Cooper of Waterloo,

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Pellagra was first reported in 1902 in the United States, and has "caused more deaths than any other nutrition-related disease in American history", reaching epidemic proportions in the American South during the early 1900s. Poverty and consumption of corn were the most frequently observed risk

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or as something new), and over its causation. In the 19th century, Roussel started a campaign in France to restrict consumption of maize and eradicated the disease in France, but it remained endemic in many rural areas of Europe. Because pellagra outbreaks occurred in regions where maize was a

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production, which limits the available tryptophan for niacin synthesis. In normal patients, only one percent of dietary tryptophan is converted to serotonin; however, in patients with carcinoid syndrome, this value may increase to 70%. Carcinoid syndrome thus may produce niacin deficiency and

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The pellagra epidemic in the American south had subsided in periods of low cotton production (late 1910s to early 1920s, the Great Depression), but it had consistently rebounded as cotton production recovered. The cause would not be understood until 1937, when niacin was discovered. Voluntary

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in the Southern United States, and the accompanying improvement in diet, dramatically reduced the risk of pellagra. Goldberger is remembered as the "unsung hero of American clinical epidemiology". Though he identified that a missing nutritional element was responsible for pellagra, he did not

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Gillman and Gillman related skeletal tissue and pellagra in their research in South Africans. They provide some of the best evidence for skeletal manifestations of pellagra and the reaction of bone in malnutrition. They claimed radiological studies of adult pellagrins demonstrated marked

34: 905:. A negative mineral balance in pellagrins was noted, which indicated active mobilization and excretion of endogenous mineral substances, and undoubtedly impacted the turnover of bone. Extensive dental caries were present in over half of pellagra patients. In most cases, 600:

Pellagra is common in Africa, Indonesia, and China. In affluent societies, a majority of patients with clinical pellagra are poor, homeless, alcohol-dependent, or psychiatric patients who refuse food. Pellagra was common among prisoners of Soviet labor camps (the

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National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee to Review the Dietary Reference Intakes for Sodium and Potassium (2019). Oria, Maria; Harrison, Meghan; Stallings, Virginia A. (eds.).

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Monteiro JP, da Cunha DF, Filho DC, Silva-Vergara ML, dos Santos VM, da Costa JC Jr, Etchebehere RM, Gonçalves J, de Carvalho da Cunha SF, et al. (2004). "Niacin metabolite excretion in alcoholic pellagra and AIDS patients with and without diarrhea".

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Using corn as the sole source of food carries a risk of pellagra and other nutritional deficiencies, because directly ground, untreated corn contains neither sufficient niacin nor enough digestible tryptophan. The Mesoamerican civilizations developed

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In other countries such as the Netherlands and Denmark, even with sufficient intake of niacin, cases have been reported. In this case, deficiency might happen not just because of poverty or malnutrition but secondary to alcoholism, drug interaction

751:. He explained that the disease causes dermatitis in exposed skin areas such as hands, feet and neck and that the origin of the disease is poor diet and atmospheric influences. His work published in 1762 by his friend Juan Sevillano was titled 1191:

Pellagra developed especially among the vulnerable populations in institutions such as orphanages and prisons, because of the monotonous and restricted diet. Soon pellagra began to occur in epidemic proportions in states south of the

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referred to pellagra as an endemic disease of the Southern states in the lyrics of his 1960 song "I Wanna Go Back to Dixie" -- "I'll go back to the Swanee / Where pellagra makes ya scrawny / And the honeysuckle clutters up the

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and germ layers, removing much of the (already low) amounts of bioavailable niacin and tryptophan found within. The milling and degerming of corn in the preparation of cornmeal became feasible with the development of the

536:, which has the same vitamin function as niacin and a similar chemical structure, but has lower toxicity. The frequency and amount of nicotinamide administered depends on the degree to which the condition has progressed. 1270:, was an early investigator of the problem of pellagra. Funk suggested that a change in the method of milling corn was responsible for the outbreak of pellagra, but no attention was paid to his article on this subject. 3067: 3727: 3712: 605:). In addition, pellagra, as a micronutrient deficiency disease, frequently affects populations of refugees and other displaced people due to their unique, long-term residential circumstances and dependence on 892:

Research conducted between 1900 and 1950 found the number of cases of women with pellagra was consistently double the number of cases of affected men. This is thought to be due to the inhibitory effect of

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and periods of mandatory fortification on the state and federal levels soon followed, coinciding with a continuous drop in pellagra deaths. By the 1950s, the disease is virtually eliminated from the US.

1736: 451:, as it inhibits quinolinate phosphoribosyl transferase (QPRT) and inhibits the formation of niacin or nicotinic acid to nicotinamide mononucleotide (NMN) causing pellagra-like symptoms to occur. 744:. Nixtamalization makes the niacin nutritionally available and prevents pellagra. When maize was cultivated worldwide, and eaten as a staple without nixtamalization, pellagra became common. 588:. Following the corn cycle, the symptoms usually appear during spring, increase in the summer due to greater sun exposure, and return the following spring. Indeed, pellagra was once 1200:. The pellagra epidemic lasted for nearly four decades beginning in 1906. It was estimated that there were 3 million cases, and 100,000 deaths due to pellagra during the epidemic. 428:(NAD). Since NAD and its phosphorylated NADP form are cofactors required in many body processes, the pathological impact of pellagra is broad and results in death if not treated. 2900: 849:). Before the experiment, the prisoners were eating the prison fare fed to all inmates at Rankin Prison Farm in Mississippi. Goldberger started feeding them a restricted diet of 210:, and sores in the mouth. Areas of the skin exposed to friction and radiation are typically affected first. Over time affected skin may become darker, stiffen, peel, or bleed. 3043: 3015:

Perspectives in Human Malnutrition: A Contribution to the Biology of Disease from a Clinical and Pathological Study of Chronic Malnutrition and Pellagra in the African

1235:"Place the grits in a pan and cover them with water. Allow the grits to settle a full minute, tilt the pan, and skim off and discard the chaff and hulls with a fine 1170: 1046: 394:

Psychosensory disturbances (impressions as being painful, annoying bright lights, odors intolerance causing nausea and vomiting, dizziness after sudden movements),

3609:"The Mastery of Pellagra: The Mysterious Disease, Almost Unknown in This Country Fifteen Years Ago, That Now Claims 7,500 Victims A Year And Is Spreading Rapidly" 240:

supplementation. Improvements typically begin within a couple of days. General improvements in diet are also frequently recommended. Decreasing sun exposure via

826:, was the nation's first facility dedicated to discovering the cause of pellagra. It was established in 1914 with a special Congressional appropriation to the 1732: 3209: 1251: 3240: 1229:

The germ contains oil that is exposed by grinding, thus whole-grain cornmeal and grits turn rancid quickly at room temperature and should be refrigerated.

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can diagnose pellagra. The diagnosis is confirmed by rapid improvements in symptoms after doses of niacin (250–500 mg/day) or niacin enriched food.

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Wolf, R; Orion, E; Matz, H; Tüzün, Y; Tüzün, B (2002). "Miscellaneous treatments, II: Niacin and heparin: Unapproved uses, dosages, or indications".

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prevents pellagra by librating this niacin. However, a long line of evidence shows that nixtamalization has no effect on the niacin content of corn.)

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Pellagra can develop according to several mechanisms, classically as a result of niacin (vitamin B3) deficiency, which results in decreased

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Independently of clinical symptoms, blood level of tryptophan or urinary metabolites such as 2-pyridone/N-methylniacinamide ratio <2 or

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on the conversion of the amino acid tryptophan to niacin. Some researchers of the time gave a few explanations regarding the difference.

409: 3676: 1813: 788:, was that the maize either carried a toxic substance or was a carrier of disease. Louis Sambon, an Anglo-Italian doctor working at the 2884: 2594:

Goldberger, Joseph; Waring, C. H.; Willets, David G. (1915). "The Prevention of Pellagra: A Test of Diet among Institutional Inmates".

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There are two main types of pellagra, primary and secondary. Primary pellagra is due to a diet that does not contain enough niacin and

1296: – incorporates pellagra ("spring sickness") as a major plot element in the story of an impoverished Texas farm family. 3075:. The National Academies Collection: Reports funded by National Institutes of Health. Washington, DC: National Academies Press (US). 3501: 3035: 1417: 775:. With pellagra affecting over 100,000 people in Italy by the 1880s, debates raged as to how to classify the disease (as a form of 244:

and proper clothing is important while the skin heals. Without treatment death may occur. The disease occurs most commonly in the

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Whole-grain cornmeal and grits require extended cooking times as seen in the following cooking directions for whole-grain grits:

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Goldberger, J; Wheeler, GA (12 November 1915). "Experimental pellagra in the human subject brought about by a restricted diet".

3540:"Reports and Resolutions of the General Assembly of the State of South Carolina, Regular Session Commencing January 11, 1916". 3327: 3080: 2997: 2894: 1807: 3333: 2708:

Goldberger, Joseph; Wheeler, G. A. (1915). "Experimental Pellagra in the Human Subject Brought about by a Restricted Diet".

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Psychomotor disturbances (restlessness, tense and a desire to quarrel, increased preparedness for motor action), as well as

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which is nutritionally unavailable. They claim that niacytin is up to 90% of the total niacin content in grain, and that

827: 3379:"Studies on pellagra. The influence of the milling of maize on the chemical composition and nutritive value of the meal" 1384: 725: 3347: 3688: 3562: 3460: 3299: 1780: 577: 454:

Some conditions can prevent the absorption of dietary niacin or tryptophan and lead to pellagra. Inflammation of the

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can also cause poor absorption, which combined with a diet already low in niacin and tryptophan produces pellagra.

3574:"Studies of tryptophan and albumin metabolism in a patient with carcinoid syndrome, pellagra, and hypoproteinemia" 3151: 2449:

Sydenstricker, VP (1958). "The history of pellagra, its recognition as a disorder of nutrition and its conquest".

4163: 4131: 3935: 3877: 870: 763:", and it is recognized as the first modern pathological description of a syndrome. It was an endemic disease in 3306:– Section 5.2 "Lime-treated maize (part II)", Section 5.3 "Arepas", Section 8 "Improvement of maize diets" 1827:

Jagielska G, Tomaszewicz-Libudzic EC, Brzozowska A (2007). "Pellagra: a rare complication of anorexia nervosa".

3846: 3477: 3232: 217:. Secondary pellagra is due to a poor ability to use the niacin within the diet. This can occur as a result of 2961:

Brenton, B. P. (2000). "Pellagra, Sex and Gender: Biocultural Perspectives on Differential Diets and Health".

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Casal, G. (1945). "The natural and medical history of the principality of the Asturias". In Major, RH (ed.).

1254:, which was originally patented in 1901 and was used to separate the grit from the germ in corn processing. 1166: 1042: 3940: 3031: 858: 573: 3826: 4210: 2840:

Elmore, JG; Feinstein, AR (1994). "Joseph Goldberger: An unsung hero of American clinical epidemiology".

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World Health Organization (2000). Pellagra And Its Prevention And Control in Major Emergencies (Report).

1409: 823: 800:, where maize is a major food crop, led researchers to investigate processing techniques in that region. 881:, Marion Blankenhorn, and Clark Cooper established that niacin also cured pellagra in humans, for which 4279: 3633:

Crabb, Mary Katherine (1992). "An Epidemic of Pride: Pellagra and the Culture of the American South".

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Baquet, S.; Wuillaume, F.; van Egmond, K.; Ibañez, F. (2000). "Pellagra outbreak in Kuito, Angola".

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that provides some fiber. There are two important considerations for using ground whole-grain corn.

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Excepted from: Staying Healthy with Nutrition: The Complete Guide to Diet and Nutritional Medicine

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Frostig J. P., Spies T. D. "The initial syndrome of pellagra and associated deficiency diseases".

444: 3945: 3626: 2240: 2194: 886: 576:, as well as niacin. Nixtamalization corrects the niacin deficiency, and is a common practice in 2401:

Semba, RD (2000). "Théophile Roussel and the elimination of pellagra from 19th century France".

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dominant food crop, the most convincing hypothesis during the late 19th century, as espoused by

4023: 589: 485:, a disease in which neuroendocrine tumors along the GI tract use tryptophan as the source for 431:

The first mechanism is simple dietary lack of niacin. Second, it may result from deficiency of

390:—according to Cleary and Cleary—described more specific psychological symptoms of pellagra as: 368: 120: 3793: 3608: 2371: 2114:

Delgado-Sanchez, L.; Godkar, D.; Niranjan, S. (2008). "Pellagra: Rekindling of an Old Flame".

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Seal, AJ; Creeke, PI; Dibari, F; Cheung, E; Kyroussis, E; Semedo, P; van den Briel, T (2007).

1239:. Cook the grits for 50 minutes if the grits were soaked overnight or else 90 minutes if not." 4183: 4116: 3984: 3684: 2629:

Swan, P. (2005). "Goldberger's War: The Life and Work of a Public Health Crusader (review)".

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clinical manifestations of pellagra. Anti-tuberculosis medication tends to bind to vitamin B

2853: 2552:"Politics and pellagra: The epidemic of pellagra in the U.S. In the early twentieth century" 4094: 4088: 4080: 4065: 4046: 436: 3175:

Politics and Pellagra: The Epidemic of Pellagra in the U.S. in the Early Twentieth Century

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for adults, except for potassium, which is estimated based on expert recommendation from

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for adults, except for potassium, which is estimated based on expert recommendation from

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Alterations in protein metabolism may also produce pellagra-like symptoms. An example is

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Vitamins in Foods: Analysis, Bioavailability, and Stability; Food Science and Technology

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can prevent nutrient absorption, leading to pellagra, and this can in turn be caused by

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by binding to it and making it inactive, so it cannot be used in niacin synthesis, and

482: 463: 257: 249: 222: 191: 103: 70: 3736: 3590: 3573: 2818: 2414: 1883: 4223: 4218: 4173: 4168: 4010: 3997: 3753: 3595: 3558: 3528: 3471: 3427: 3408: 3323: 3295: 3201: 3143: 3139: 3086: 3076: 2993: 2943: 2890: 2857: 2822: 2787: 2690: 2573: 2466: 2418: 2345: 2295: 2287: 2283: 2133: 2088: 2084: 2053: 2009: 2004: 1987: 1968: 1922: 1887: 1844: 1803: 1776: 1682: 1602: 1598: 1548: 1510: 1505: 1488: 1469: 1181: 1136: 1012: 839: 831: 807: 741: 626: 614: 594: 518: 467: 110: 58: 2869: 2650: 2521: 2357: 2145: 2021: 1899: 1614: 1522: 613:(which, in Africa, may be supplied in place of local groundnut staples, such as the 4136: 4051: 3804: 3642: 3585: 3518: 3510: 3497:"Pellagra and the origin of a myth: evidence from European literature and folklore" 3398: 3394: 3390: 3191: 3135: 2970: 2935: 2849: 2814: 2752: 2717: 2680: 2638: 2603: 2563: 2507: 2458: 2410: 2337: 2279: 2244: 2198: 2125: 2100: 2080: 2045: 1999: 1958: 1879: 1836: 1766: 1712: 1672: 1594: 1500: 768: 685:, but its exact origins are disputed. "Pell" certainly arises from classical Latin 682: 344: 245: 3958: 1856: 4293: 4158: 4153: 3747: 3613: 3317: 2886:

White Rose History, Volume I: Coming Together (January 31, 1933 – April 30, 1942)

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Dhakak, M; Limbu, B; Neopane, A; Karki, DB (2003). "A typical case of pellagra".

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Cleary MJ, Cleary JP (1989). "Anorexia nervosa: a form of subclinical pellagra".

1331: 1323: 866: 854: 785: 733: 660: 634: 618: 585: 569: 510: 475: 374: 233:. Diagnosis is typically based on symptoms and may be assisted by urine testing. 226: 133: 2270:

Rajakumar, K (2000). "Pellagra in the United States: A Historical Perspective".

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Oliveira, A.; Sanches, M.; Selores, M. (2011). "Azathioprine-induced pellagra".

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Pellagra was first described for its dermatological effect in Spain in 1735 by

609:. Refugees typically rely on limited sources of niacin provided to them, often 521: 501:

Several therapeutic drugs can provoke pellagra. These include the antibiotics

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is a genetic disorder that reduces tryptophan absorption, leading to pellagra.

3758: 2049: 1840: 4303: 4228: 4126: 3432: 2974: 2328:

Stratigos, J.D.; Katsambas, A. (1977). "Pellagra: A still existing disease".

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If untreated, pellagra can kill within four or five years. Treatment is with

303:, and death ("the four Ds"). A more comprehensive list of symptoms includes: 3721: 3289: 2939: 1963: 1947:"Low and deficient niacin status and pellagra are endemic in postwar Angola" 1946: 1677: 1660: 1376: 677: 4146: 4121: 4075: 3869: 3412: 3355: 3147: 3090: 2826: 2791: 2470: 2462: 2437:

Studi clinici ed esperimentali sulla natura, causa e terapia delle pellagra

2422: 2299: 2137: 2092: 2057: 2013: 1972: 1926: 1891: 1848: 1606: 1514: 1473: 1255: 1236: 902: 792:, was convinced that pellagra was carried by an insect, along the lines of 748: 698: 533: 514: 311: 273: 253: 237: 156: 42: 3532: 3205: 3030: 2861: 2694: 2642: 2577: 498:(pyridoxine) is a required cofactor in the tryptophan-to-niacin reaction. 4266: 4256: 4141: 3897: 3887: 3788: 3599: 2947: 2349: 2225: 2179: 1686: 1661:"Vitamin B6 nutritional status of pellagrins and their leucine tolerance" 1287: 1218: 1185: 1180:

factors, but the exact cause was not known, until groundbreaking work by

846: 797: 565: 553: 413: 285: 125: 63: 3654: 2496: 3916: 3815: 3810: 3294:. Rome: Food and Agriculture Organization of the United Nations. 1992. 3120: 2764: 2729: 2615: 1826: 1771: 1717: 1300: 1197: 1086: 962: 803: 653: 646: 630: 471: 432: 348: 307: 296: 218: 214: 199: 75: 3704: 3555:

The Spartanburg Pellagra Hospital. In: The South Carolina Encyclopedia

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Goldberger experimented on 11 prisoners (one was dismissed because of

3799: 3764: 3646: 3629:" Office of History, National Institutes of Health. 3 September 2010. 878: 664: 638: 502: 486: 387: 328: 241: 230: 164: 137: 129: 50: 3262: 2756: 2721: 2607: 4261: 3930: 3892: 3821: 3627:

Dr. Joseph Goldberger and the War on Pellagra, By Alan Kraut, Ph.D.

2512: 1267: 1263: 1246: 918: 894: 606: 380: 363: 339: 334: 317: 300: 292: 207: 203: 83: 79: 46: 3769: 2034: 268: 4070: 1733:"Case study- Pellagra - Biochemistry for Medics - Clinical Cases" 1259: 1116: 992: 793: 760: 455: 448: 187: 4059: 3838: 3716: 3669: 2317:(3rd ed.). Springfield: Charles C Thomas. pp. 607–12. 1869: 914: 906: 873:, showed that the vitamin niacin cured pellagra (manifested as 776: 737: 610: 581: 440: 353: 280: 1799:

Nutrition in Public Health: Principles, Policies, and Practice

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Gehring, W (2004). "Nicotinic acid/niacinamide and the skin".

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Clay, Karen; Schmick, Ethan; Troesken, Werner (August 2017).

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Good (with treatment), death in ~ 5 years (without treatment)

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Rare (developed world), relatively common (developing world)

33: 3548:. Columbia, S.C.: Gonzales and Bryan, state printers. 1916. 1222: 757:

Natural and Medical History of the Principality of Asturias

3058: 3036:"Daily Value on the Nutrition and Supplement Facts Labels" 2926:

Miller DF (1978). "Pellagra deaths in the United States".

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Pellagra can be common in people who obtain most of their

3121:"Pellagra in the United States: A Historical Perspective" 1757: 1706: 759:(1762). This led to the disease being known as "Asturian 642: 2778:

Goldberger, J (2006). "The etiology of pellagra. 1914".

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infestation of cotton crops (which occurred randomly).

711:, a suffix for maladies itself borrowed from the Greek 3542:

Annual Report of the State Board of Health (1915–1916)

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Historia Natural y Medicina del Principado de Asturias

4277: 3557:. Columbia, S.C: University of South Carolina Press. 2497:"The Rise and Fall of Pellagra in the American South" 2177: 3694: 2223: 2494: 1658: 736:, in which the grain is treated with a solution of 276:

skin rash around the neck associated with pellagra.

3072:Dietary Reference Intakes for Sodium and Potassium 3012: 2804: 2327: 2224: 2178: 1985: 1940: 1938: 1936: 1486: 1217:The whole dried corn kernel contains a nutritious 830:(PHS) and set up primarily for research. In 1915, 356:(lack of coordination), paralysis of extremities, 3680:. Vol. 21 (11th ed.). 1911. p. 69. 3170: 3026: 3024: 2742: 2707: 1126: 1002: 691:, meaning "skin". "-agra" may arise from Lombard 16:Human disease caused by a lack of vitamin niacin 4301: 3571: 3166: 3164: 1765:. World Health Organization. pp. 496, 500. 580:cultures that grow corn, but most especially in 3572:Swain CP, Tavill AS, Neale G (September 1976). 2839: 2165:, Imp. Regia Stamperia, 1840–1843, vol. I, III. 1933: 1761:(2009). Stuart MC, Kouimtzi M, Hill SR (eds.). 659:deficiency, or malabsorption syndromes such as 3021: 1988:"Pellagra: Dermatitis, dementia, and diarrhea" 1702: 1700: 1698: 1696: 1489:"Pellagra: Dermatitis, dementia, and diarrhea" 1487:Hegyi, J.; Schwartz, R. A.; Hegyi, V. (2004). 1061:Nutritional value per 100 g (3.5 oz) 937:Nutritional value per 100 g (3.5 oz) 822:in corn. The Spartanburg Pellagra Hospital in 3854: 3161: 2987: 2889:. Exclamation! Publishers. Appendix D, p. 2. 2448: 692: 310:(characteristic "broad collar" rash known as 3354:. Beall Degerminator Company. Archived from 2992:. Stroudsburg, PA: Hutchinson Ross Pub. Co. 2269: 1820: 1538: 3552: 2666: 1693: 1652: 862:discover the specific vitamin responsible. 796:. Later, the lack of pellagra outbreaks in 717:, meaning "a catch-point, a hunting trap". 712: 706: 686: 3861: 3847: 3494: 3032:United States Food and Drug Administration 2919: 2777: 2451:The American Journal of Clinical Nutrition 2157: 2155: 1951:The American Journal of Clinical Nutrition 1455: 32: 3589: 3522: 3402: 3348:"Beall Degerminators General Information" 3263:"Simple Buttered Antebellum Coarse Grits" 3195: 3118: 2925: 2684: 2622: 2567: 2545: 2543: 2511: 2003: 1986:Hegyi, J; Schwartz, RA; Hegyi, V (2004). 1962: 1770: 1716: 1676: 1504: 1480: 1453: 1451: 1449: 1447: 1445: 1443: 1441: 1439: 1437: 1435: 1370: 1368: 1366: 728:cultivators who first domesticated corn ( 3606: 3502:Journal of the Royal Society of Medicine 3284: 3282: 3280: 3230: 3184:The Yale Journal of Biology and Medicine 2556:The Yale Journal of Biology and Medicine 1568:American Journal of the Medical Sciences 1534: 1532: 1459: 1404: 1402: 1364: 1362: 1360: 1358: 1356: 1354: 1352: 1350: 1348: 1346: 802: 543: 439:found in meat, poultry, fish, eggs, and 279: 267: 41:The skin features of pellagra including 3614:The World's Work: A History of Our Time 3114: 3112: 2960: 2854:10.7326/0003-4819-121-5-199409010-00010 2152: 1751: 1584: 4302: 3495:Hampl JS, Hampl WS (1 November 1997). 3458: 3425: 3376: 3157:from the original on 24 February 2015. 2549: 2540: 2382:from the original on 30 September 2007 2173: 2171: 1432: 229:, and a number of medications such as 3842: 3632: 3440:from the original on 20 December 2017 3277: 2882: 2662: 2660: 2589: 2587: 2490: 2488: 2486: 2484: 2482: 2480: 2400: 2312: 1795: 1529: 1399: 1343: 1273: 291:The classic symptoms of pellagra are 263: 3315: 3273:from the original on 4 October 2014. 3109: 2628: 2257:participating institution membership 2211:participating institution membership 1992:International Journal of Dermatology 1915:Kathmandu University Medical Journal 1493:International Journal of Dermatology 1374: 836:Surgeon General of the United States 834:, assigned to study pellagra by the 494:and reduce niacin synthesis, since B 447:. Third, it may be caused by excess 3336:from the original on 15 April 2017. 3243:from the original on 6 October 2014 3231:Fletcher, Janet (26 January 2005). 3212:from the original on 28 August 2021 3017:. New York, NY: Grune and Stratton. 2631:Bulletin of the History of Medicine 2168: 1816:from the original on 14 April 2017. 1627: 1258:, who helped elucidate the role of 548:A girl in the London Asylum in 1925 236:Treatment is with either niacin or 13: 3607:Hendrick, Burton J. (April 1916). 3488: 3046:from the original on 27 March 2024 2657: 2584: 2477: 2342:10.1111/j.1365-2133.1977.tb05197.x 1659:Bapurao S, Krishnaswamy K (1978). 1420:from the original on 17 April 2017 1212: 869:, a biochemistry professor at the 790:London School of Tropical Medicine 419: 14: 4321: 3689:Food and Agriculture Organization 3662: 3233:"Waves of Grain / Grain glossary" 3013:Gillman, J.; Gillman, T. (1951). 2903:from the original on 15 July 2023 2786:(Suppl 1): 77–79, discussion 76. 2439:(Bologna: Fava e Garagnani, 1869) 1387:from the original on 9 April 2017 470:can also cause pellagra. Chronic 426:nicotinamide adenine dinucleotide 4287: 3868: 3140:10.1097/00007611-200093030-00005 2528:from the original on 17 May 2018 2284:10.1097/00007611-200093030-00005 2117:American Journal of Therapeutics 2085:10.1111/j.1346-8138.2010.01189.x 2005:10.1111/j.1365-4632.2004.01959.x 1739:from the original on 18 May 2015 1599:10.1111/j.1473-2130.2004.00115.x 1506:10.1111/j.1365-4632.2004.01959.x 1245:The milling of corn removes the 924: 877:) in dogs. Later studies by Dr. 190:caused by a lack of the vitamin 3452: 3419: 3370: 3340: 3309: 3255: 3224: 3097:from the original on 9 May 2024 3006: 2981: 2954: 2876: 2833: 2798: 2771: 2736: 2701: 2442: 2429: 2394: 2364: 2321: 2315:Classic Descriptions of Disease 2306: 2263: 2217: 2107: 2064: 2028: 1979: 1906: 1863: 1789: 1725: 1587:Journal of Cosmetic Dermatology 1315: 1290:'s 1945 film adaptation of it, 871:University of Wisconsin-Madison 539: 284:Man with pellagra with typical 3395:10.1113/jphysiol.1913.sp001631 2330:British Journal of Dermatology 1621: 1578: 1559: 885:Magazine dubbed them its 1938 1: 3591:10.1016/s0016-5085(76)80460-x 3119:Rajakumar, Kumaravel (2000). 2883:Sachs, Ruth (November 2003). 2819:10.1016/S0738-081X(02)00268-7 2415:10.1016/S0899-9007(99)00273-7 2163:Vocabolario Milanese-Italiano 1884:10.1016/S0140-6736(05)73093-2 1460:Pitche P (2005). "Pellagra". 1308: 909:were associated with "severe 593:orphanages as studied by Dr. 505:, which decreases available B 3459:Lehrer, Tom (26 June 2024). 2504:NBER Working Paper No. 23730 2130:10.1097/MJT.0b013e31815ae309 1829:Eur Child Adolesc Psychiatry 1165:Percentages estimated using 1041:Percentages estimated using 670: 527: 7: 3936:Wernicke–Korsakoff syndrome 2842:Annals of Internal Medicine 921:, and loosening of teeth". 824:Spartanburg, South Carolina 771:, by Francesco Frapolli of 767:, where it was named, from 10: 4326: 3515:10.1177/014107689709001114 3476:: CS1 maint: url-status ( 3461:"I Wanna Go Back to Dixie" 3322:. CRC Press. p. 183. 3316:Ball, George F.M. (2005). 3171:Alfred JAY Bollet (1992). 2073:The Journal of Dermatology 889:in comprehensive science. 828:U.S. Public Health Service 720: 371:(enlarged, weakened heart) 4244: 4209: 4107: 4038: 3941:Wernicke's encephalopathy 3915: 3906: 3876: 3779: 3698: 2236:Oxford English Dictionary 2190:Oxford English Dictionary 2050:10.1016/j.nut.2004.05.008 1841:10.1007/s00787-007-0613-4 1802:. CRC Press. p. 79. 1759:World Health Organization 1709:World Health Organization 1299:Satirical singer/pianist 1164: 1156: 1152: 1135: 1114: 1110: 1106: 1099: 1095: 1085: 1069: 1065: 1060: 1040: 1032: 1028: 1011: 990: 986: 982: 975: 971: 961: 945: 941: 936: 713: 574:poor source of tryptophan 173: 163: 151: 143: 119: 109: 98: 90: 69: 57: 40: 31: 26: 3426:Graham, Don (May 1999). 3291:Maize in human nutrition 3128:Southern Medical Journal 2975:10.1525/nua.2000.23.1.20 2963:Nutritional Anthropology 2669:"Prisoners and Pellagra" 2372:"Definition of Pellagra" 2272:Southern Medical Journal 1763:WHO Model Formulary 2008 1284:Hold Autumn in Your Hand 705:juice", or the Latinate 513:; the anti-cancer agent 375:Sensitivity to radiation 76:Inflammation of the skin 3677:Encyclopædia Britannica 3237:San Francisco Chronicle 2241:Oxford University Press 2195:Oxford University Press 1167:US recommendations 1043:US recommendations 693: 2988:Carpenter, K. (1981). 2807:Clinics in Dermatology 2249:10.1093/OED/1000750596 2203:10.1093/OED/1005242239 1796:Spark, Arlene (2007). 1375:Ngan, Vanessa (2003). 1286: – and 1241: 1171:the National Academies 1047:the National Academies 842:, prevented pellagra. 810: 707: 687: 681:is known to come from 549: 400:Emotional disturbances 369:Dilated cardiomyopathy 288: 277: 221:, long-term diarrhea, 121:Differential diagnosis 4117:Electrolyte imbalance 3985:Pyridoxine deficiency 3959:Riboflavin deficiency 2940:10.1093/ajcn/31.4.558 2780:Public Health Reports 2745:Public Health Reports 2710:Public Health Reports 2643:10.1353/bhm.2005.0046 2596:Public Health Reports 1964:10.1093/ajcn/85.1.218 1678:10.1093/ajcn/31.5.819 1630:"Vitamin B3 – Niacin" 1280:George Sessions Perry 1233: 1101:Vitamins and minerals 1056:Peanut, valencia, raw 977:Vitamins and minerals 832:Dr. Joseph Goldberger 808:Dr. Joseph Goldberger 806: 584:and the countries of 547: 331:(tongue inflammation) 283: 271: 53:of sun-exposed areas. 4310:Vitamin deficiencies 4095:Vitamin K deficiency 4089:Vitamin E deficiency 4066:Vitamin D deficiency 4047:Vitamin A deficiency 3946:Korsakoff's syndrome 3553:Beardsley E (2006). 2667:Harkness JM (1996). 2463:10.1093/ajcn/6.4.409 1410:"Orphanet: Pellagra" 859:crop diversification 437:essential amino acid 198:). Symptoms include 86:, sores in the mouth 3352:Beall Degerminators 2550:Bollet, AJ (1992). 2239:(Online ed.). 2193:(Online ed.). 1381:DermNet New Zealand 1057: 933: 911:gingival retraction 564:, where maize is a 445:uses to make niacin 358:peripheral neuritis 272:This child has the 4109:Mineral deficiency 3908:Vitamin deficiency 3780:External resources 3687: – 1274:In popular culture 1252:Beall degerminator 1206:food fortification 1055: 930:Corn grits, yellow 929: 811: 568:. If maize is not 550: 483:carcinoid syndrome 327:Smooth, beefy red 289: 278: 264:Signs and symptoms 258:sub-Saharan Africa 250:disease of poverty 223:carcinoid syndrome 94:Primary, secondary 4275: 4274: 4224:Failure to thrive 4219:Delayed milestone 4103: 4102: 4081:Harrison's groove 4011:Folate deficiency 3998:Biotin deficiency 3836: 3835: 3329:978-1-4200-2697-9 3082:978-0-309-48834-1 2999:978-0-87933-364-5 2928:Am. J. Clin. Nutr 2896:978-0-9710541-9-6 2716:(46): 3336–3339. 2673:Public Health Rep 2602:(43): 3117–3131. 2435:Cesare Lombroso, 2255:(Subscription or 2209:(Subscription or 1878:(9217): 1829–30. 1809:978-0-203-50788-9 1541:Int Clin Nutr Rev 1182:Joseph Goldberger 1177: 1176: 1160: 1159: 1053: 1052: 1036: 1035: 732:) prepared it by 595:Joseph Goldberger 519:immunosuppressant 468:Gastroenterostomy 443:, which the body 181: 180: 115:Based on symptoms 111:Diagnostic method 21:Medical condition 4317: 4292: 4291: 4290: 4283: 3913: 3912: 3863: 3856: 3849: 3840: 3839: 3696: 3695: 3681: 3673: 3671:"Pellagra" 3658: 3647:10.2307/25605634 3622: 3603: 3593: 3578:Gastroenterology 3568: 3549: 3536: 3526: 3482: 3481: 3475: 3467: 3465: 3456: 3450: 3449: 3447: 3445: 3423: 3417: 3416: 3406: 3374: 3368: 3367: 3365: 3363: 3358:on 26 April 2014 3344: 3338: 3337: 3313: 3307: 3305: 3286: 3275: 3274: 3259: 3253: 3252: 3250: 3248: 3228: 3222: 3221: 3219: 3217: 3199: 3181: 3168: 3159: 3158: 3156: 3125: 3116: 3107: 3106: 3104: 3102: 3065: 3056: 3055: 3053: 3051: 3028: 3019: 3018: 3010: 3004: 3003: 2985: 2979: 2978: 2958: 2952: 2951: 2923: 2917: 2916: 2910: 2908: 2880: 2874: 2873: 2837: 2831: 2830: 2802: 2796: 2795: 2775: 2769: 2768: 2740: 2734: 2733: 2705: 2699: 2698: 2688: 2664: 2655: 2654: 2626: 2620: 2619: 2591: 2582: 2581: 2571: 2547: 2538: 2537: 2535: 2533: 2515: 2501: 2492: 2475: 2474: 2446: 2440: 2433: 2427: 2426: 2398: 2392: 2391: 2389: 2387: 2368: 2362: 2361: 2325: 2319: 2318: 2310: 2304: 2303: 2267: 2261: 2260: 2252: 2232: 2221: 2215: 2214: 2206: 2186: 2175: 2166: 2159: 2150: 2149: 2111: 2105: 2104: 2068: 2062: 2061: 2032: 2026: 2025: 2007: 1983: 1977: 1976: 1966: 1942: 1931: 1930: 1910: 1904: 1903: 1867: 1861: 1860: 1824: 1818: 1817: 1793: 1787: 1786: 1774: 1755: 1749: 1748: 1746: 1744: 1729: 1723: 1722: 1721:. WHO/NHD/00.10. 1720: 1704: 1691: 1690: 1680: 1656: 1650: 1649: 1647: 1645: 1640:on 23 March 2007 1636:. Archived from 1625: 1619: 1618: 1582: 1576: 1575: 1563: 1557: 1556: 1536: 1527: 1526: 1508: 1484: 1478: 1477: 1457: 1430: 1429: 1427: 1425: 1406: 1397: 1396: 1394: 1392: 1372: 1335: 1319: 1140: 1130: 1097: 1096: 1058: 1054: 1016: 1006: 973: 972: 934: 928: 818:or some unknown 716: 715: 710: 697:, meaning "like 696: 690: 665:carcinoid tumors 560:, notably rural 386:J. Frostigs and 345:Mental confusion 335:Trouble sleeping 252:associated with 246:developing world 159:supplementation. 147:Consuming Niacin 36: 24: 23: 4325: 4324: 4320: 4319: 4318: 4316: 4315: 4314: 4300: 4299: 4298: 4288: 4286: 4278: 4276: 4271: 4240: 4205: 4099: 4034: 4027: 4020: 4007: 3994: 3981: 3968: 3955: 3927: 3902: 3879: 3872: 3867: 3837: 3832: 3831: 3775: 3774: 3707: 3668: 3665: 3565: 3539: 3491: 3489:Further reading 3486: 3485: 3469: 3468: 3463: 3457: 3453: 3443: 3441: 3424: 3420: 3389:(4–5): 389–92. 3377:Funk C (1913). 3375: 3371: 3361: 3359: 3346: 3345: 3341: 3330: 3314: 3310: 3302: 3288: 3287: 3278: 3261: 3260: 3256: 3246: 3244: 3229: 3225: 3215: 3213: 3179: 3169: 3162: 3154: 3123: 3117: 3110: 3100: 3098: 3083: 3066: 3059: 3049: 3047: 3029: 3022: 3011: 3007: 3000: 2986: 2982: 2959: 2955: 2924: 2920: 2906: 2904: 2897: 2881: 2877: 2838: 2834: 2803: 2799: 2776: 2772: 2757:10.2307/4572984 2751:(46): 3336–39. 2741: 2737: 2722:10.2307/4572984 2706: 2702: 2665: 2658: 2627: 2623: 2608:10.2307/4572932 2592: 2585: 2548: 2541: 2531: 2529: 2499: 2493: 2478: 2447: 2443: 2434: 2430: 2399: 2395: 2385: 2383: 2376:MedicineNet.com 2370: 2369: 2365: 2326: 2322: 2311: 2307: 2268: 2264: 2254: 2222: 2218: 2208: 2176: 2169: 2160: 2153: 2112: 2108: 2079:(10): 1035–37. 2069: 2065: 2033: 2029: 1984: 1980: 1943: 1934: 1911: 1907: 1868: 1864: 1825: 1821: 1810: 1794: 1790: 1783: 1756: 1752: 1742: 1740: 1731: 1730: 1726: 1705: 1694: 1657: 1653: 1643: 1641: 1626: 1622: 1583: 1579: 1564: 1560: 1537: 1530: 1485: 1481: 1458: 1433: 1423: 1421: 1408: 1407: 1400: 1390: 1388: 1373: 1344: 1339: 1338: 1332:nixtamalization 1324:nixtamalization 1320: 1316: 1311: 1276: 1215: 1213:Corn processing 1147: 1138: 1131: 1102: 1081: 1076: 1023: 1014: 1007: 978: 957: 952: 932:unenriched, dry 931: 927: 887:Men of the Year 867:Conrad Elvehjem 786:Cesare Lombroso 734:nixtamalization 726:Native American 723: 673: 661:Hartnup disease 657: 650: 635:tuberculostatic 619:Hausa groundnut 586:Central America 578:Native American 542: 530: 511:chloramphenicol 508: 497: 493: 476:Hartnup disease 464:Crohn's disease 422: 420:Pathophysiology 414:red blood cells 266: 256:, specifically 227:Hartnup disease 197: 134:photodermatitis 49:, scaling, and 22: 17: 12: 11: 5: 4323: 4313: 4312: 4297: 4296: 4273: 4272: 4270: 4269: 4264: 4259: 4254: 4248: 4246: 4242: 4241: 4239: 4238: 4237: 4236: 4226: 4221: 4215: 4213: 4207: 4206: 4204: 4203: 4198: 4197: 4196: 4194:Keshan disease 4186: 4181: 4176: 4171: 4166: 4161: 4156: 4151: 4150: 4149: 4144: 4139: 4134: 4129: 4124: 4113: 4111: 4105: 4104: 4101: 4100: 4098: 4097: 4091: 4085: 4084: 4083: 4078: 4073: 4062: 4056: 4055: 4054: 4042: 4040: 4036: 4035: 4033: 4032: 4031: 4030: 4025: 4018: 4015: 4014: 4013: 4005: 4002: 4001: 4000: 3992: 3989: 3988: 3987: 3979: 3976: 3975: 3974: 3966: 3963: 3962: 3961: 3953: 3950: 3949: 3948: 3943: 3938: 3933: 3925: 3921: 3919: 3910: 3904: 3903: 3901: 3900: 3895: 3890: 3884: 3882: 3878:Protein-energy 3874: 3873: 3866: 3865: 3858: 3851: 3843: 3834: 3833: 3830: 3829: 3818: 3807: 3796: 3784: 3783: 3781: 3777: 3776: 3773: 3772: 3761: 3750: 3739: 3724: 3708: 3703: 3702: 3700: 3699:Classification 3693: 3692: 3682: 3664: 3663:External links 3661: 3660: 3659: 3635:Anthropologica 3630: 3625:Kraut, Alan. " 3623: 3604: 3569: 3563: 3550: 3537: 3509:(11): 636–39. 3490: 3487: 3484: 3483: 3451: 3418: 3369: 3339: 3328: 3308: 3300: 3276: 3254: 3223: 3160: 3134:(3): 272–277. 3108: 3081: 3057: 3020: 3005: 2998: 2980: 2953: 2918: 2895: 2875: 2832: 2797: 2770: 2735: 2700: 2656: 2621: 2583: 2539: 2513:10.3386/w23730 2476: 2441: 2428: 2393: 2363: 2320: 2305: 2262: 2216: 2167: 2161:F. Cherubini, 2151: 2106: 2063: 2027: 1978: 1932: 1905: 1862: 1819: 1808: 1788: 1781: 1750: 1724: 1692: 1665:Am J Clin Nutr 1651: 1620: 1577: 1558: 1528: 1479: 1431: 1398: 1341: 1340: 1337: 1336: 1313: 1312: 1310: 1307: 1306: 1305: 1297: 1293:The Southerner 1282:'s 1941 novel 1275: 1272: 1243: 1242: 1230: 1214: 1211: 1175: 1174: 1162: 1161: 1158: 1157: 1154: 1153: 1150: 1149: 1145: 1143: 1133: 1132: 1125: 1120: 1112: 1111: 1108: 1107: 1104: 1103: 1100: 1093: 1092: 1089: 1083: 1082: 1079: 1077: 1070: 1067: 1066: 1063: 1062: 1051: 1050: 1038: 1037: 1034: 1033: 1030: 1029: 1026: 1025: 1021: 1019: 1009: 1008: 1001: 996: 988: 987: 984: 983: 980: 979: 976: 969: 968: 965: 959: 958: 955: 953: 946: 943: 942: 939: 938: 926: 923: 917:, exposure of 840:brewer's yeast 765:northern Italy 722: 719: 672: 669: 655: 648: 541: 538: 529: 526: 522:mercaptopurine 506: 495: 491: 421: 418: 402: 401: 398: 395: 384: 383: 377: 372: 366: 361: 360:(nerve damage) 351: 342: 337: 332: 325: 320: 315: 265: 262: 195: 179: 178: 175: 171: 170: 167: 161: 160: 153: 149: 148: 145: 141: 140: 123: 117: 116: 113: 107: 106: 100: 96: 95: 92: 88: 87: 73: 67: 66: 61: 55: 54: 38: 37: 29: 28: 20: 15: 9: 6: 4: 3: 2: 4322: 4311: 4308: 4307: 4305: 4295: 4285: 4284: 4281: 4268: 4265: 4263: 4260: 4258: 4255: 4253: 4250: 4249: 4247: 4243: 4235: 4232: 4231: 4230: 4229:Short stature 4227: 4225: 4222: 4220: 4217: 4216: 4214: 4212: 4208: 4202: 4199: 4195: 4192: 4191: 4190: 4187: 4185: 4182: 4180: 4177: 4175: 4172: 4170: 4167: 4165: 4162: 4160: 4157: 4155: 4152: 4148: 4145: 4143: 4140: 4138: 4135: 4133: 4130: 4128: 4125: 4123: 4120: 4119: 4118: 4115: 4114: 4112: 4110: 4106: 4096: 4092: 4090: 4086: 4082: 4079: 4077: 4074: 4072: 4069: 4068: 4067: 4063: 4061: 4057: 4053: 4052:Bitot's spots 4050: 4049: 4048: 4044: 4043: 4041: 4037: 4029: 4022: 4021: 4016: 4012: 4009: 4008: 4003: 3999: 3996: 3995: 3990: 3986: 3983: 3982: 3977: 3973: 3970: 3969: 3964: 3960: 3957: 3956: 3951: 3947: 3944: 3942: 3939: 3937: 3934: 3932: 3929: 3928: 3923: 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