Nama : Renny Ernawati

NIM
: 0910720077
Sumber : Wikipedia.com/ diakses 06 Desember 2009

PELLAGRA
Pellagra is a vitamin deficiency disease caused by lack of niacin (vitamin B3). It can
be caused by decreased intake of niacin, tryptophan, or perhaps leucine. It may also
result from alterations in protein metabolism in disorders such as carcinoid syndrome.
The traditional food preparation method of corn, nixtamalization, by native New
World cultivators who had domesticated corn required treatment of the grain with
lime, an alkali. It has now been shown that the lime treatment makes niacin
nutritionally available and reduces the chance of developing pellagra. When corn
cultivation was adopted worldwide, this preparation method was not accepted
because the benefit was not understood. The original cultivators, often heavily
dependent on corn, did not suffer from pellagra. Pellagra became common only when
corn became a staple that was eaten without the traditional treatment.
Pellagra was first described in Spain in 1735 by Gaspar Casal, who published a first
clinical description in his posthumous "Natural and Medical History of the Asturian
Principality" (1762). This led to the disease being known as "Asturian leprosy", and it
is recognized as the first modern pathological description of a syndrome. It was an
endemic disease in northern Italy, where it was named "pelle agra" (pelle = skin; agra
= rough) by Francesco Frapoli of Milan. Because pellagra outbreaks occurred in
regions where maize was a dominant food crop, the belief for centuries was that the
maize either carried a toxic substance or was a carrier of disease. It was not until later
that the lack of pellagra outbreaks in Mesoamerica, where maize is a major food crop
(and is processed), was noted and the idea was considered that the causes of pellagra
may be due to factors other than toxins.
Dr. Joseph Goldberger
In the early 1900s, pellagra reached epidemic proportions in the American South.
There were 1,306 reported pellagra deaths in South Carolina 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 germ or some
unknown toxin in corn. The Spartanburg Pellagra Hospital in Spartanburg, South
Carolina, 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 U.S.
Public Health Service (PHS) and set up primarily for research. In 1915, Joseph
Goldberger, assigned to study pellagra by the Surgeon General of the United States,
showed that pellagra was linked to diet by inducing the disease in prisoners, using the
Spartanburg Pellagra Hospital as his clinic. By 1926, Goldberger established that a
balanced diet or a small amount of brewer's yeast prevented pellagra. Skepticism
nonetheless persisted in the medical community until 1937, when Conrad Elvehjem
showed that the vitamin niacin cured pellagra (manifested as black tongue) in dogs.
Later studies by Tom Spies, Marion Blankenhorn, and Clark Cooper established that
niacin also cured pellagra in humans, for which Time Magazine dubbed them its 1938
Men of the Year in comprehensive science.

In the research conducted between 1900-1950, it was found that the number of cases
of women with pellagra was consistently double the number of cases of afflicted men.
This is thought to be due to the inhibitory effect of estrogen on the conversion of the
amino acid tryptophan to niacin. It is also thought to be due to the differential and
unequal access to quality foods within the household. Some researchers of the time
gave a few explanations regarding the difference. As primary wage earners, men were
given consideration and preference at the dinner table. They also had pocket money
to buy food outside the household. Women gave protein quality foods to their
children first. Women also would eat after everyone else had a chance to eat. Women
also upheld the triad of maize, molasses and fat back pork which combine to
contribute to cause pellagra.[citation needed]
Gillman and Gillman related skeletal tissue and pellagra in their research in South
African Blacks. 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 osteoporosis. 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
caries were associated with "severe gingival retraction, sepsis, exposure of
cementum, and loosening of teeth".
Pellagra can be common in people who obtain most of their food energy from maize
(often called "corn"), notably rural South America where maize is a staple food.
Maize is a poor source of tryptophan as well as niacin if it is not nixtamalized.
Nixtamalization of the corn corrects the niacin deficiency, and is a common practice
in Native American cultures that grow corn. Following the corn cycle, the symptoms
usually appear during spring, increase in the summer due to greater sun exposure, and
return the following spring. It may even have been known as Spring Sickness in the
American South, according to the movie The Southerner (1945). Indeed, pellagra
was once endemic in the poorer states of the U.S. South, like Mississippi and
Alabama, as well as among the inmates of jails and orphanages as studied by Dr.
Joseph Goldberger.
Pellagra is common in Africa, Mexico, Indonesia, and China. In affluent societies, a
majority of patients with clinical pellagra are poor, homeless, alcohol dependent, or
psychiatric patients who refuse food. It was common amongst prisoners of Soviet
labor camps, the infamous Gulag. It can be found in cases of chronic alcoholism. In
addition, pellagra is a micronutrient deficiency disease that frequently affects
populations of refugees and other displaced people due to their unique, long-term
residential circumstances and dependence on food aid. Refugees typically rely on
limited sources of niacin provided to them, such as groundnuts; the instability in the
nutritional content and distribution of food aid can be the cause of pellagra in
displaced populations.