In which state of India is Pellagra most commonly found?

Appeared in: Bihar CHO - 2021

Explanation

Pellagra is a deficiency disease caused by a lack of niacin (Vitamin B3).
It is prevalent in populations whose staple diet is Jowar (Sorghum), such as in the Telangana region of Andhra Pradesh.
Jowar has a high content of the amino acid Leucine, which interferes with the body's ability to convert another amino acid, Tryptophan, into Niacin.
This metabolic interference leads to a niacin deficiency, even if tryptophan is present in the diet, causing Pellagra.

Option A: The staple diet in Kerala is rice and fish. Fish is a good source of niacin, and this balanced diet does not lead to the amino acid imbalance that causes Pellagra.
Option C: Similar to Kerala, the staple diet in West Bengal is rice and fish, which provides adequate niacin and does not pose a risk for Pellagra.
Option D: The primary cereals in Bihar are rice and wheat. These do not have the high leucine content found in Jowar, so they are not associated with Pellagra.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Geographical prevalence of Pellagra in India based on dietary habits as background academic context rather than a clinical decision trigger.
When assessing a patient with suspected nutritional deficiencies, a detailed dietary history is crucial, especially regarding staple foods like Jowar or maize.
Public health nurses in regions where Jowar is a staple food should focus on dietary diversification programs to prevent Pellagra.
What if? If a patient from this region presents with a photosensitive rash (dermatitis) and confusion (dementia), the nurse should have a high index of suspicion for Pellagra and inquire about their primary cereal intake.

How to Approach the Question

First, identify the key term in the question: 'Pellagra'.
Recall the cause of Pellagra, which is a deficiency of Niacin (Vitamin B3).
Connect the deficiency to dietary factors. Pellagra is classically associated with diets high in maize (corn) or Jowar (Sorghum).
Analyze the options, which are Indian states. Consider the staple diet of each region.
Recognize that Jowar is a staple crop in the Deccan plateau, which includes parts of Andhra Pradesh.
Conclude that Andhra Pradesh is the most likely answer among the choices due to its Jowar-consuming population.

Concept Tested & Keywords

Concept Tested: Geographical prevalence of Pellagra in India based on dietary habits.
Stem keywords: Pellagra, India, state, commonly found
Lead-in keywords: most commonly
Negative lead-in flag: false

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E6 Parks TextBook of Preventive & Social Medicine part 2 — Subpart A (pp 1-232 of 464) p. 154-156

E6 textbook of Applied Biochemistry and Nutrition & Dietetics 2nd Edition Harbans Lal (pp 26-464 of 479) p. 26-464

Practise the full Bihar CHO - 2021

Attempt every question from this paper in a timed mock, then review the full solution for each one.