**Niacin deficiency alone does not always cause pellagra** 

  * Because Pellagra is a multi factorial disease.
  - Pellagra is primarily associated with a lack of niacin (vitamin B3) but can also arise due to inadequate intake of tryptophan, an amino acid the body converts into niacin.
  - Additionally, conditions that impair absorption, such as chronic alcoholism, gastrointestinal diseases, or certain medications, can contribute to pellagra. 
  - Diets low in both niacin and tryptophan, such as those heavily reliant on corn without proper preparation, increase the risk. 
  * Thus, while niacin deficiency is a key factor, other nutritional and metabolic issues also play a role.


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  * Niacin deficiency alone cannot cause pellagra because the body can also synthesize niacin from the amino acid tryptophan.
  * even if dietary niacin is low, adequate tryptophan intake can prevent pellagra.
  * therefore, a deficiency in both niacin and tryptophan is necessary for the development of the disease. 
  * Eg, Diets high in corn, which is low in both niacin and readily available tryptophan, are often associated with pellagra because the body cannot efficiently convert the bound niacin in corn.

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