Historical Background
Pellagra was initially described by a Spanish Physician Gasper Casal.1 Previously nutritional deficiency was the leading and recognised cause of pellagra in the world. This is no longer the case in the developed world where it has been almost eradicated as a manifestation of primary nutritional deficiency. Instead, chronic alcoholism, malabsorption syndrome, anorexia nervosa and drug-induced niacin deficiency are the leading causes of pellagra in such settings.2, 3 In low-income economies of Africa and Asia, pellagra remains a problem and upsurge of cases have occurred worsened by periods of inadequate food supplies. Malfait et al described an epidemic of pellagra among Mozambican refugees after a change in protein supplements in their food rations in a refugee camp in Malawi.4 Associated with the food insecurity triggered by the civil war, many cases of pellagra were reported during and after the war in Angola.5 In an impoverished population in central Malawi, an outbreak of pellagra was reported due to lack of niacin in the diet and niacin fortification was suggested as one way to stop pellagra in that setting.6
For many years, pellagra was thought to be a form of leprosy and regarded as an insect-borne communicable disease until Casmiri Funk in 1912 proposed the vitamin hypothesis of pellagra as a diet-related disease.2 Later in the 20th century an American public health doctor, Joseph Goldberger reported his study in which he experimented induction of pellagra in prison inmates by changing their diet and later correcting the condition by a diet supplemented with meat and vegetables. He established nutritional factor as a cause of pellagra, but the deficient nutrient was still unrecognised.2, 7 It only became evident when Conrad Elvehjem and co-workers showed cure of pellagra with niacin when treating black tongue disease in dogs and pellagra-like condition in rats.2, 7