Late stage of severe and prolonged niacin deficiency, vitamin required for adequate cellular function and metabolism as an essential component in coenzyme I and coenzyme II, which either donate or accept hydrogen ions in vital oxidation-reduction reactions; primary disease: inadequate nicotinic acid (i.e., niacin) and/or tryptophan intake in diet; secondary disease: adequate amounts of niacin present in the diet, but other diseases or conditions interfere with absorption and/or processing, such as chronic diarrhea, carcinoid syndrome, or Hartnup syndrome

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