VITAMIN DEFICIENCY

DISEASES

NIACIN & FOLATE

By-
V.Janarthanan
II-MBBS
NIACIN
Vitamin B3
Pellagra preventing factor of
GOLDBERG

Nicotinic acid and nicotinamide and their

biologically active derivatives.
 RDA :
 Infants - 5-6 mg NE
 Children - 9-13 mg NE
 Males - 15-20 mg NE
 Females - 13-15 mg NE
 Pregnancy - 17 mg NE
 Lactation - 20 mg NE

 1 NE = 1 mg of niacin \ 60 mg of tryptophan
 SOURCES :
• Niacin bioavailability is high from beans, milk,
meat, and eggs; bioavailability from cereal grains
is lower. Since flour is enriched with the "free"
niacin (i.e., non-coenzyme form), bioavailability is
excellent.
• The amino acid tryptophan can be converted to
niacin with an efficiency of 60:1 by weight.
 COENZYMES :
• NAD
• NADP

• They play a vital role in redox reactions.

 ABSORPTION :
• Nicotinic acid and nicotinamide are absorbed well
from the stomach and small intestine.

EXCRETION :
• The urinary excretion products of niacin
include 2-pyridone and 2-methyl nicotinamide,
measurements of which are used in diagnosis
of niacin deficiency.
 DEFICIENCY - PELLAGRA
• Rough skin
• 4 D syndrome
dermatitis, diarrhea, and dementia leading to death
• Incidence
mostly found among people eating corn-based diets in parts of
China, Africa, and India
• Etiology
<9.0 NE / Day [Alcoholism, vitamin B6 deficiency, riboflavin
deficiency, tryptophan deficiency]
• Morphology :
Dermatitis –
Bilaterally symmetrical
Exposed areas

Diarrhea -
Atrophy of the columnar epithelium
Ulceration

Dementia –
Neuronal degeneration
 CLINICAL PICTURE :
• Early symptoms –
loss of appetite, generalized weakness and irritability, abdominal pain,
and vomiting

• Advanced symptoms –
Bright red glossitis, a characteristic skin rash that is pigmented and
scaling, particularly in skin areas exposed to sunlight. This rash is
known as Casal's necklace because it forms a ring around the neck
,vaginitis and esophagitis. Diarrhea ,depression, seizures, and
dementia are also part of the pellagra syndrome
REDNESS, THICKENING, ROUGHENING, AND SCALING OF EXPOSED SKIN

BEFORE TREATMENT AFTER TREATMENT

 TREATMENT :
• Oral supplementation of 100–200 mg of
nicotinamide or nicotinic acid three times daily for
5 days.

• High doses of nicotinic acid (2 g/d in a time-

release form) are used for the treatment of
elevated cholesterol and triglyceride levels and/or
low high-density lipoprotein (HDL) cholesterol
level
 TOXICITY :
• Prostaglandin-mediated flushing
• Skin dryness, itching, paresthesia, and headache
• Nausea, vomiting, and abdominal pain
• Hepatic toxicity
• Glucose intolerance, hyperuricemia, macular
edema, and macular cysts