Primary prevention

Consumption of a balanced diet rich in niacin and/or tryptophan including meat, chicken and fish, peanuts, milk, eggs, and fortified cereals is central to the prevention of vitamin B3 deficiency.[21] B vitamin supplements are recommended for patients taking certain medications, such as isoniazid; those with conditions associated with malabsorption, such as Crohn's disease; and those with chronic alcohol use disorder. Fortification of cereal staple foods in countries where many in the population subsist on corn would be an important form of both primary and secondary prevention. The WHO recommends a safe upper limit of niacin intake of 255.5 micromol/day (35 mg/day).[3]​ The daily dietary niacin requirements for different populations are reported in niacin equivalents (NE).[35][76]​​

  • Children aged 0 to 12 months: adequate intake of 14.6 to 29.2 micromol/day (2 to 4 mg/day)

  • Children aged 1 to 8 years: recommended dietary allowance (RDA) of 43.8 to 58.4 micromol/day (6 to 8 mg/day)

  • Children aged 9 to 13 years: RDA of 87.6 micromol/day (12 mg/day)

  • Males aged >14 years: RDA of 116.8 micromol/day (16 mg/day)

  • Females aged >14 years: RDA of 102.2 micromol/day (14 mg/day)

  • Pregnant females: RDA of 131.4 micromol/day (18 mg/day).

Multiple micronutrient nutrition and multiple food fortification of normal staple foods should be initiated, enforced, and monitored in low- to medium-income countries.[77][78]​ These measures can prevent 'multiple micronutrient malnutrition', including vitamin B3 deficiency. Because niacin is already naturally present in wheat flour and is removed during the milling process, the WHO recommends that the restoration of niacin in wheat flour should be considered regular practice.[79]

Secondary prevention

Continued compliance with niacin supplements and/or a balanced diet are essential for the prevention of recurrence. In those with chronic alcohol use disorder, 10 mg per day of niacin is recommended as a preventive measure.[90]

Continued niacin supplementation may be advisable in such clinical settings as chronic alcohol use disorder, chronic inflammatory bowel disease (e.g., Crohn's disease), and following clinically significant small-bowel resection, or bariatric surgery.

Use of this content is subject to our disclaimer