Pellagra: A diagnosis to be taken in account in the 21th century

Pellagra is a well known malnutrition, linked directly to corn consumption, poverty and alcoholism. In certain areas of the world, including Romania, the disease had a great extension a few decades ago, but different public health measures, as well as the lowering number of people confronted with poverty arrived to solve the problem. After the Romanian economical and political changes from 1989, the conditions for the onset of pellagra showed up again in certain rural areas and to certain groups of population. In the present study we tried to evaluate the possible presence of the disease in two villages (one with a high rate of poverty, the other with a high standard of living) and in two general hospitals of Bucharest (2006-2008). To assess the eating pattern and the nutritional status of the persons involved in the study we used a food frequency questionnaire, anthropometry, clinical and laboratory examinations, including the evaluation of a particular metabolite (N-methylnicotinamid) which is able to predict quite well the pellagra hazzard.The poverty level was reckoned by comparing the person’s income with the guaranteed minimum income in Romania. Our results showed that only the correlation of all the above tools is reliable in identifying cases of pre-clinical or clinical manifested pellagra. During the 2 years of the study, we found 4 cases of pellagra in the village with a high level of poverty and 14 cases in the general hospitals. In all cases, except 2, all the 3 determinant factors of pellagra were present, with poverty as main cause. Alcoholism was also an important etiological factor, being correlated with metabolic changes driving to malnutrition and also generating “per se” poverty. In conclusion, we defined medical, educational and economical measures to be taken for pellagra prophylaxis and treatment.