Distribution and Incidence

In the two centuries between 1730 and 1930, pellagra caused much death and chronic misery, first in Europe, then in the Middle East, parts of Africa and Asia, and in North America. It was associated always with a maize diet. Since the 1930s the disease has virtually disappeared from the United States and southern Europe, and its incidence is decreasing in the Middle East. It continues to be a problem in Egypt, among the Bantu in parts of Africa, and in India, particularly in the Hyderabad region, where consumption of jowar, not maize, apparently is the precipitating factor. The disease may appear whenever famine exists.

The greatly reduced incidence of the disease in the United States may be attributed to a changed economic status in the South, where it was once prevalent; to the widespread distribution of brewer's yeast, which is a pellagra preventive; and to the enrichment of bread, flour, and cornmeal with vitamins. An occasional diagnosis of pellagra is still made in the United States, usually in association with alcoholism or a malabsorption malady.

Even in those countries where pellagra continues to be a public health problem, it no longer appears in epidemic form, but rather in endemic foci. It is most likely to occur among agricultural workers whose diets are unsatisfactory, in adults rather than children, and in men rather than women.

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