Niacin metabolite excretion in alcoholic pellagra and AIDS patients with and without diarrhea

Monteiro, Jacqueline Pontes; Cunha, Daniel Ferreira da; Filho, Dalmo Correia; Silva‐Vergara, Mario León; Santos, Vitorino Modesto dos; Costa, José Carlos da; Etchebehere, Renata Margarida; Gonçalves, J. C. de S. I.; Cunha, Selma Freire de Carvalho da; Jordão, Alceu Afonso; Chiarello, Paula Garcia; Vannucchi, Hélio

doi:10.1016/j.nut.2004.05.008

Cited by 22 publications

(20 citation statements)

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“…This is the first report of a household population survey of niacin status in a region with a pellagra endemic and has brought to light a serious prevalence of low and deficient niacin status in women. Biochemical surveys in other areas have targeted schoolchildren or hospital admissions (25)(26)(27)(28). These previous studies have assessed niacin status by quantifying the major urinary metabolites 1-MN and 2-PYR and sometimes the less abundant metabolite 1-methyl-4-pyridone-3-carboxamide.…”

Section: Discussionmentioning

confidence: 99%

Low and deficient niacin status and pellagra are endemic in postwar Angola

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Creeke

Dibari

et al. 2007

The American Journal of Clinical Nutrition

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Background: Outbreaks of pellagra were documented during the civil war in Angola, but no contemporary data on the incidence of pellagra or the prevalence of niacin deficiency were available. Objective: The objective was to investigate the incidence of pellagra and the prevalence of niacin deficiency in postwar Angola and their relation with dietary intake, poverty, and anthropometric status. Design: Admissions data from 1999 to 2004 from the pellagra treatment clinic in Kuito, Angola, were analyzed. New patients admitted over 1 wk were examined, and urine and blood samples were collected. A multistage cluster population survey collected data on anthropometric measures, household dietary intakes, socioeconomic status, and clinical signs of pellagra for women and children. Urinary excretion of 1-methylnicotinamide, 1-methyl-2-pyridone-5-carboxymide, and creatinine was measured and hemoglobin concentrations were measured with a portable photometer. Results: The incidence of clinical pellagra has not decreased since the end of the civil war in 2002. Low excretion of niacin metabolites was confirmed in 10 of 11 new clinic patients. Survey data were collected for 723 women aged 15-49 y and for 690 children aged 6 -59 mo. Excretion of niacin metabolites was low in 29.4% of the women and 6.0% of the children, and the creatinine-adjusted concentrations were significantly lower in the women than in the children (P 0.001, t test). In children, niacin status was positively correlated with the household consumption of peanuts (r ҃ 0.374, P ҃ 0.001) and eggs (r ҃ 0.290, P ҃ 0.012) but negatively correlated with socioeconomic status (r ҃ Ҁ0.228, P ҃ 0.037). Conclusions: The expected decrease in pellagra incidence after the end of the civil war has not occurred. The identification of niacin deficiency as a public health problem should refocus attention on this nutritional deficiency in Angola and other areas of Africa where maize is the staple.Am J Clin Nutr 2007;85:218 -24.

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Section: Discussionmentioning

confidence: 99%

Low and deficient niacin status and pellagra are endemic in postwar Angola

Seal

Creeke

Dibari

et al. 2007

The American Journal of Clinical Nutrition

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“…Hypolipidaemic and cardiovascular protection (810,811) ; cancers (812) ; AIDS (813) ; arthritis (814) ; catecholamine stimulation of lipolysis (815,816) (cited in Marcus et al (817) and Figge et al (810) )…”

Section: Appendixmentioning

confidence: 99%

New hypotheses for the health-protective mechanisms of whole-grain cereals: what is beyond fibre?

2010

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Epidemiological studies have clearly shown that whole-grain cereals can protect against obesity, diabetes, CVD and cancers. The specific effects of food structure (increased satiety, reduced transit time and glycaemic response), fibre (improved faecal bulking and satiety, viscosity and SCFA production, and/or reduced glycaemic response) and Mg (better glycaemic homeostasis through increased insulin secretion), together with the antioxidant and anti-carcinogenic properties of numerous bioactive compounds, especially those in the bran and germ (minerals, trace elements, vitamins, carotenoids, polyphenols and alkylresorcinols), are today well-recognised mechanisms in this protection. Recent findings, the exhaustive listing of bioactive compounds found in whole-grain wheat, their content in whole-grain, bran and germ fractions and their estimated bioavailability, have led to new hypotheses. The involvement of polyphenols in cell signalling and gene regulation, and of sulfur compounds, lignin and phytic acid should be considered in antioxidant protection. Whole-grain wheat is also a rich source of methyl donors and lipotropes (methionine, betaine, choline, inositol and folates) that may be involved in cardiovascular and/or hepatic protection, lipid metabolism and DNA methylation. Potential protective effects of bound phenolic acids within the colon, of the B-complex vitamins on the nervous system and mental health, of oligosaccharides as prebiotics, of compounds associated with skeleton health, and of other compounds such as a-linolenic acid, policosanol, melatonin, phytosterols and para-aminobenzoic acid also deserve to be studied in more depth. Finally, benefits of nutrigenomics to study complex physiological effects of the 'whole-grain package', and the most promising ways for improving the nutritional quality of cereal products are discussed. Whole-grain wheat: Bioactive compounds: Physiological mechanisms: Health IntroductionThere is growing evidence that whole-grain cereal products protect against the development of chronic diseases. The most important of these in terms of public health are obesity (1,2) , the metabolic syndrome (3,4) , type 2 diabetes (5,6) , CVD (7) and cancers (8 -12) . Whole-grain cereal consumption has also been shown to be protective against mortality, as was shown with inflammation-related death (i.e. noncardiovascular and non-cancer inflammatory diseases such as, for example, respiratory system diseases) (13) and with cancer and CVD (4,14,15) . These conclusions are supported by the effects of consuming refined cereal products (bread, pasta and rice), as these have been associated with an increased risk of digestive tract, pharynx, larynx and thyroid cancers in northern Italians (16) . However, an association between a lower risk of developing a chronic disease and a high whole-grain cereal consumption does not mean a direct causal relationship and provides no information about the physiological mechanisms involved.These metabolic diseases are related to our daily lifestyle, no...

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“…Niacin deficiency is usually assumed by the appearance of symptoms of pellagra and, occasionally, by the determination of metabolites of niacin excreted in the urine [12,13]. Pellagra is characterised by photosensitivity, diarrhoea, dermatitis and dementia.…”

Section: Introductionmentioning

confidence: 99%

Antidepressants may lead to a decrease in niacin and NAD in patients with poor dietary intake

2015

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The term niacin is the generic name for the two compounds nicotinic acid and nicotinamide, the major dietary precursors for two important coenzymes, nicotinamide adenine dinucleotide (NAD) and its phosphorylated form, NADP. Niacin is important for the maintenance of cellular integrity and energy production and is involved in more than 500 intracellular reactions. Deficiencies of niacin may contribute to neuropsychiatric and neurodegenerative disorders. Patients who develop nutritional deficiencies as a result of poor dietary intake, could potentially suffer from niacin deficiency and NAD depletion.However, de novo synthesis of niacin and NAD in the kynurenine pathway of tryptophan metabolism may compensate for impaired dietary intake. The rate of synthesis of NAD and niacin from tryptophan oxidation depends on the induction of the enzyme indoleamine 2,3-dioxygenase (IDO) by pro-inflammatory cytokines such as interferon-gamma. Niacin 2 synthesis is not limited by a decrease in tryptophan and excessive IDO activity may therefore lead to a decline in tryptophan levels. Antidepressants have an anti-inflammatory effect, including reduction of interferon-gamma and therefore inhibition of IDO, the ratelimiting enzyme of the kynurenine pathway. In theory, this could account for increased serotonin as more tryptophan becomes available for serotonin synthesis. However, the downside may be that less NAD and niacin are synthesised downstream, which could exacerbate common psychiatric problems. It is our hypothesis that patients with poor dietary intake, who are treated with antidepressants, are at risk of developing niacin/NAD deficiency with possible development of associated neuropsychiatric symptoms.We therefore propose that niacin supplementation be considered in patients with inadequate diets who are treated with antidepressants. We believe that if this does not happen, a subclinical niacin deficiency may result, which would be difficult to detect as it would cause the same symptoms of the original illness (e.g. depression). Niacin deficiency should be considered and ruled out in all patients with treatment-resistant depression, who have a poor response to antidepressants. This is potentially a cost-effective and easy intervention, which could be examined in a randomized controlled trial.

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Niacin metabolite excretion in alcoholic pellagra and AIDS patients with and without diarrhea

Cited by 22 publications

References 18 publications

Low and deficient niacin status and pellagra are endemic in postwar Angola

Low and deficient niacin status and pellagra are endemic in postwar Angola

New hypotheses for the health-protective mechanisms of whole-grain cereals: what is beyond fibre?

Antidepressants may lead to a decrease in niacin and NAD in patients with poor dietary intake

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