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Reviewer: Ajpolino (talk · contribs) 22:26, 23 June 2020 (UTC)[reply]


Hello! It's great to see another article for a common nutrient at GAN! Give me a few days to find some time, but I'll get to this review asap. Ajpolino (talk) 22:26, 23 June 2020 (UTC)[reply]

Thanks for taking this on. I am currently part-way into replying to the editor who is doing my GA nomination for pantothenic acid, but believe I can manage both in a timely fashion. David notMD (talk) 01:57, 24 June 2020 (UTC)[reply]
I'll post things as I go. Currently on my first read-through (mostly looking for the first criterion, which I think in this case will be most of my comments). Made it through Dietary recommendations. Will get to the rest asap. Apologies, I already have quite a bit to say. The open review time is typically around a week or two, but we're in no rush. We can leave this open as long as you need (also, as you've seen, I'm a bit slow). If you decide to close the review and make changes outside GAN, I still intend to finish this review, just so that there's a full review for you or other editors/reviewers in the future to reference. I hope all is well during these crazy times. All the best, Ajpolino (talk) 16:52, 28 June 2020 (UTC)[reply]
@David notMD: Hi David notMD, just wanted to let you know I'll be traveling in real life over the next week and will have limited access to the internet. Sorry to leave you hanging in the middle of the review. I look forward to going through the second half of the article when I return. I hope you're well! Ajpolino (talk) 13:36, 30 June 2020 (UTC)[reply]
No problem. I will plod through my responses. All well here (at age risk, and so sequestered). David notMD (talk) 16:26, 1 July 2020 (UTC)[reply]

@Ajpolino: I ran a copy violation check and found a very high overlap with a Niacin article at LibreTexts. This is a copy of the Wikipedia article rather than the other way around. I state this because much of what exists at LibreTexts is content that I wrote for the Wikipedia article. LibreTexts does not acknowledge Wikipedia as a source, and does label its article as copyright. I sent an email asking for an explanation. David notMD (talk) 19:14, 1 July 2020 (UTC) https://med.libretexts.org/Courses/Dominican_University/DU_Bio_1550%3A_Nutrition_(LoPresto)_OLD/07%3A_Vitamins/7.3%3A_Water_Soluble_Vitamins/Vitamin_B3_(Niacin)[reply]

UPDATE: LibreTexts confirmed that its content draws on the Wikipedia article, and will add a mention to that effect. David notMD (talk) 19:24, 1 July 2020 (UTC)[reply]

@Ajpolino: When you return to this GA review I suggest you start at the beginning again, as I have made major section moves to an order that in my opinion makes better sense. For example, lipid modifying mechanisms moved out of Pharmacology and vitamin deficiency history moved from Deficiency to History. David notMD (talk) 15:21, 2 July 2020 (UTC)[reply]

Still working on addressing your comments/requests. David notMD (talk) 13:35, 6 July 2020 (UTC)[reply]
I have addressed all the points raised in the first phase of the GA review. David notMD (talk) 17:48, 9 July 2020 (UTC)[reply]
Great! Digging myself out of the post-vacation hole at my real-life job. Will get to this asap. Looking forward to the read. Stay well! Ajpolino (talk) 17:49, 9 July 2020 (UTC)[reply]
Alright, starting to go back through as I find time. Feel free to address comments as I go, or wait. Up to you. Ajpolino (talk) 17:57, 13 July 2020 (UTC)[reply]
I will wait. Please ping me when this round is completed. Thanks for collapsing first round of comments and responses. David notMD (talk) 12:29, 14 July 2020 (UTC)[reply]

Today (18 July) I will start addressing the second round of comments and recommendations. David notMD (talk) 11:12, 18 July 2020 (UTC)[reply]

A quiet Saturday at last! I'll finish up the second round of review presently. Apologies for the drawn out review. I hope all is well there. Here it's a scorcher; a nice day to be indoors on the web. Ajpolino (talk) 18:09, 18 July 2020 (UTC)[reply]
Much later than expected (real life intruded), but have begun to work through the second set of comments and recommendations. David notMD (talk) 16:22, 23 July 2020 (UTC)[reply]
Hi David notMD. I've marked the nomination as "on hold" for now, which is just to signify to those who watch the GAN queue that I haven't forgotten you. The template says reviews will stay open a week, but we're in no rush here, so take as much time as you need. I've got this on my watchlist, but feel free to ping me back here if I'm slow to respond to anything. I hope all is well! Ajpolino (talk) 03:14, 30 July 2020 (UTC)[reply]
Completing my responses to the second round of comments today. We had two non-COVID family medical emergencies, but of which stabilized. Thank you for your patience. David notMD (talk) 13:43, 7 August 2020 (UTC)[reply]
Your changes look great! I think the article is much improved; I hope you agree. I'll mark this as a pass. More importantly, I hope you and your family are well. All the best. Ajpolino (talk) 18:59, 8 August 2020 (UTC)[reply]
GA review (see here for what the criteria are, and here for what they are not)

1. It is reasonably well written.

a (prose, spelling, and grammar): b (MoS for lead, layout, word choice, fiction, and lists):
First round of comments
  • I think in some ways, the article is currently a somewhat schizophrenic read. This article seems to have an unclear identity: is it about a medical drug, or a nutrient? If it's about a drug, perhaps we'd tell the reader "what is the drug?", "what does it treat?", "what are the drawbacks?", etc. basically per MEDMOS. If it's a nutrient, then we wouldn't lead with what it treats, we'd probably lead with "what is the nutrient?", "how does it contribute to normal biology?", "where in our diets do we get it?", then "what happens when you don't have enough?" as for example is laid out at Vitamin D (which I picked arbitrarily, and where it looks like you've also been involved). From a first read-through, it seems that niacin is primarily a nutrient (I mean it's primarily used to treat its own deficiency), and some re-organization would help this article flow better. I'd suggest pushing the medical uses sections down, and bringing up/creating the sections about niacin the nutrient.
  • Medical uses>Lipids - Is niacin still used to treat hyperlipidemia? The first paragraph makes it sound like it is. The second paragraph makes it sound like we no longer think increasing HDL in statin-treated people is worthwhile.
    • I intend to revise the lipids section. Yes, it is still prescribed to treat hyperlipidemia. As recently as a few years ago (2017 the last year data is available for), U.S. prescriptions more than one million per year. Also yes, combining niacin with statins did not work better than statins alone, and the two statin-niacin combination prescription products were discontinued. Some people cannot tolerate statins, and niacin is an alternative. Niacin is properly prescribed to treat elevated triglycerides in the absence of elevated cholesterol. David notMD (talk) 00:03, 29 June 2020 (UTC)[reply]
  • Adverse effects>Facial flusing - The second paragraph Prostaglandin... the reaction feels like it comes out of left-field. Perhaps this subsection could be rearranged to say "Niacin causes flushing [describe flushing] due to the effect of niacin on [whatever signaling molecules and cells]. Flushing can be prevented by slow release forms, or inhibiting the [whatever] pathway by using COX inhibitors (aspirin, ibuprofen) or a prostaglandin receptor antagonist." I'm not wedded to that particular order, but something could be done to make that subsection read more clearly.
Revised and shortened. David notMD (talk) 18:06, 9 July 2020 (UTC)[reply]
  • Adverse effects>Liver damage - Is the increase in serum aminotransferase, decrease in coagulation factors, and increased bleeding and bruising due to liver damage? It's in the "liver damage" subsection, but the way things are worded makes it seem as if the "liver damage" part of the subsection begins with Niacin can also cause serious hepatotoxicity...
Addressed. David notMD (talk) 17:50, 9 July 2020 (UTC)[reply]
  • Deficiency - For the first paragraph, I assume "normal" levels of niacin (and its metabolites) is defined by some authority body (you have citations to the US Institute of Medicine and the WHO)? Since these are authority-defined thresholds rather than biological facts, perhaps it would be clearer if you directly attributed them in the text.
World Health Organization identified as setting defieicent, low, etc. David notMD (talk) 01:07, 6 July 2020 (UTC)[reply]
  • Deficiency - Opening the "Deficiency" section with some notes on how to measure niacin levels and what the exact thresholds are is somewhat technical and jarring. Presumably most readers will be less interested in and compelled by this information. Is there some way you could rearrange the section to lead with whatever the key information is about niacin deficiency and then launch into the explanations below?
  • Dietary recommendations - I'm impressed with how cleanly you've summarized this topic, with the useful data unobstructively to the side in collapsed tables. Just a few small things here: I'm not sure what AI and UL are. I can't find where they're defined.
  • Little things:
    • Medical uses>Lipids - Extended release niacin... (trade name Mevacor). Do these two sentences say the same thing?
    • There are a couple uses of "patient" to describe someone with flushing or taking anticoagulants. We typically try to avoid calling people "patients" on Wikipedia; see MEDMOS (this, of course, doesn't apply to the use of "patient" in the FDA quote).
    • Adverse effects>Liver damage - Some of the sentences in the subsection are so short they feel like jotted notes rather than part of an encyclopedia article. I'm all for varying sentence length and structure to keep your reader engaged, but a couple of these sentence-lets could probably be merged into other sentences or expanded: Onset is days to weeks., Serum aminotransferase concentration is very high.
Text revised per GA suggestion. David notMD (talk) 17:40, 9 July 2020 (UTC)[reply]
    • Adverse effects>Diabetes - ... profile have been shown to elevate... = profile elevate. The filler words just offer the reader a chance to get lost.
Reworded per suggestion. David notMD (talk) 17:21, 9 July 2020 (UTC)[reply]
    • Adverse effects>Diabetes - Reviews reported that... any reason this is attributed explicitly to "reviews"? Is it not widely held and you're hesitant to state it in Wikipedia's voice? Otherwise, you can drop the attribution Long-term niacin therapy is also associated with increased risk of new-onset type 2 diabetes.
Reworded per suggestion David notMD (talk) 17:21, 9 July 2020 (UTC)[reply]
    • Adverse effects>Other - Perhaps you could merge the first two sentences?
    • Adverse effects>Other - We typically avoid medical advice in Wikipedia voice therefore these should be monitored closely..., instead medical advice should be attributed to the actual authority that gave it (as you did in Medical uses>Treatment of deficiency with the WHO recommendation).
    • Deficiency - which is characterized by diarrhea... and eventually death - is there an extraneous and ("and dementia") in that list? Or is the dementia also sun-sensitive?
"dementia" moved, and some additional changes to the sentence. David notMD (talk) 19:22, 7 July 2020 (UTC)[reply]
    • Deficiency - The alphabet soup in The biochemical mechanism(s) for... due to the niacin deficiency doesn't add much value as-is. At a minimum, perhaps you could add some wikilinks. Also no need to define acronyms you don't use (PARP), and is it supposed to be "ADP-ribose"? I think there's a letter missing.
Better explanation of list of purported mechanisms and addition of Wikilinks ("ADP-ribose" was missing the"r" in the abstract but not in the article text). David notMD (talk) 19:22, 7 July 2020 (UTC)[reply]
    • Deficiency - Chronic alcoholism combined... with niacin supplementation - you already told us above that niacin deficiency can lead to psychiatric symptoms. You also told us way above that alcoholism can cause niacin deficiency. If there's something different you're trying to communicate with this sentence, could you clarify?
Sentence and ref removed, as not contributing David notMD (talk) 20:28, 8 July 2020 (UTC)[reply]
  • In general, I still feel the order of sections is somewhat unnatural as-is. I like the order of the lead. It seems like niacin is most importantly an essential nutrient. Secondarily, high-dose niacin is used to reduce certain blood lipids. It seems unnatural to discuss the latter of those (we use niacin sometimes as a medication) before the former (we all need niacin to survive). I think moving sections around would help make the article a more clear and compelling read.
  • As lipid-modifying medication>Mechanisms - The beginning of paragraph two was surprising to read since I thought we'd just established this in the preceding paragraph. It reads as if paragraph 1 expands on the mechanism listed as #3 in paragraph 2? Perhaps you could merge the two paragraphs (or just re-order sentences a bit) to make clear that niacin acts by several mechanisms including paragraph 1 (activate NIACR1/2, inhibit cAMP...), and the others enumerated in paragraph 2? If I'm totally misunderstanding how those two paragraphs connect, all the more reason to clarify.
  • As lipid-modifying medication>Mechanisms - The sentence Similarly, an Abbott laboratories combination drug (trade name Simcor)... sticks out; the first half repeats the first sentence of that paragraph. Could you smooth out that paragraph (perhaps you could just replace that sentence with "...and Simcor in February, 2008".)
  • As vitamin - Some material here would be better placed in the "Vitamin deficiency" section below (i.e. which form of niacin is used to treat pellagra, doses, how quickly symptoms improve)
  • As vitamin - Perhaps the second paragraph of this section (all about niacin as a dietary supplement) would make more sense in the "Source" section, maybe as a new subsection.
    • Done.
  • Vitamin deficiency - I think this section would be clearer if you flipped the first and second paragraphs (i.e. tell us what pellagra is first, and who gets it second).

Minor things:

  • As lipid-modifying medication - Is there some reasonable wikilnk target for "mixed dyslipidemia"? As a non-physician the term is sadly meaningless to me.
  • As lipid-modifying medication>Mechnisms - ...but not in other expected organs such as... is confusing (personally I had no such expectation). If it's important, perhaps you could clarify? If not, perhaps it could be removed.
  • As lipid-modifying medication>Mechanisms - I assume "apoB" is Apolipoprotein B? If so, either give the full name at first use, or just wikilinik the first use.
  • As lipid-modifying medication>Mechanisms - Wikilink "Acyl-CoA:diacylglycerol acyltransferases 2"? DGAT2 currently redirects to Diglyceride acyltransferase.
  • As lipid-modifying medication>Mechanisms - From a glance at our articles, it looks like NIACR1 and HCA2 are the same thing? If that's true, perhaps you could pick one name and use it throughout.
  • As lipid-modifying medication>Mechanisms - Wikilink catabolism; probably not a word normal-folk know.
  • As lipid-modifying medication>Combined with statins - Just lodging my personal opinion that the full day + month + year of each FDA action is unnecessary detail. Now that we're several years out, I think the month + year alone would suffice. You're more than welcome to ignore that opinion if yours differs.
  • As lipid-modifying medication>Combined with statins - agreed to voluntarily is redundant. Either "agreed to discontinue" or "voluntarily discontinued" would suffice.
  • As lipid-modifying medicine>Contraindications - The absence of efficacy... not approved for children is an odd sentence to read. What statement? Perhaps it could be rephrased as "High-dose niacin has not been tested or approved for use in children under 16 years."
  • As lipid-modifying medicine>Contraindications>Liver damage - The changes are reversed if drug treatment is stopped, and usually resolve even when drug intake is continued. I'm not sure what this means. It sounds like either (1) stopping niacin makes transaminases return to normal; restarting niacin has no effect on transaminases (which is weird), or (2) stopping niacin makes transaminases return to normal; however, continuing if one doesn't stop niacin, transminases eventually return to normal on their own.... If it's (1), that's surprising. But fair enough. If it's (2) could you clarify the way it's written?
  • Vitamin deficiency - Compromise of expression of neuro-protective brain-derived... What does compromise mean here? Elimination? Reduction? Perhaps a different verb would be more clear.
  • Pharmacology>Pharmacodynamics - Would it be equally accurate to say in the first sentence "Niacin and nicotinamide are both converted into the coenzyme NAD in the body"? That would remove some jargon, and NADP is already mentioned in the next sentence.
  • Pharmacology>Pharmacodynamics - Is there any reasonably wikilink or alternative word for "non-hypolipidemic"?
  • Production>Industrial synthesis - I stumble over the words when I read ...and other purposes is of nicotinamide, namely the "Commercial production... is of nicotinamide" is an unusual sentence construction. Perhaps it could be rephrased (e.g. Nicotinamide, which can be coverted to niacin, is used for...)?
  • Preparations>Nicotinamide - Could you wikilink something for "hydrolysed"?
  • Preparations>Combination products - Same for "prostaglandin D2"

2. It is factually accurate and verifiable.

a (reference section): b (citations to reliable sources): c (OR): d (copyvio and plagiarism):
  • There are a few reference-related tags: I see a {{page needed}} (adverse effects>other), {{citation needed}} (Pharmacology>pharmacodynamics), and {{Medical citation needed}} (Chemistry). I haven't looked deeply into any of them, but could you address each please?
Addressed. Provided refs for two. For third, removed mention of esters, as while chemically possible (there are patents), there are no applications. David notMD (talk) 15:58, 3 July 2020 (UTC)[reply]
  • Vitamin deficiency>Measuring vitamin status - For adults, a value of less than 5.8... According to who? It feels strange to read this in Wikipedia's voice. I assume this is some authority's guideline?
  • Preparations>Combination products - Similar problem. It's weird to read Thus, so far there is not enough evidence to recommend IHN to treat dyslipidemia in Wikipedia's voice. Enough evidence for who to recommend it? Us? Perhaps it could be rephrased or directly attributed to some authority?

3. It is broad in its coverage.

a (major aspects): b (focused):
First round of comments
  • Given that the article is about niacin, it would be helpful to start with a brief section on what niacin is. You could very briefly compare it to the other vitamin B3 forms (especially since you mention niacinamide several times), as well as to NAD. Perhaps this could replace the Chemistry section that's currently below (though unlike chemistry sections in other articles, this one need not be overly technical or boring...).
  • Contraindications - Any idea why niacin supplementation is contraindicated in the stated populations? The section now reads like the back of a pill bottle.
    • contraindications for pregnancy, lactating and children are not because there are known adverse effects unique to these populations, but because the drug-level doses (prescription or dietary supplement) have not been evaluated and shown safe in these populations. It is standard practice for drug and supplement labeling. I have added wording to this effect to the article. David notMD (talk) 10:43, 3 July 2020 (UTC)[reply]
  • Deficiency - Between 1906... as a result this material seems out-of-place here. I'm not sure if it should go in the history section here, or if it should just be in the history section of Pellagra.
  • Definition - This section seems a bit odd as it stands. A definition section should answer the question "What is niacin?" This one seems mostly to answer "How much niacin should I put in my body?".
  • As lipid-modifying medication>Contraindications - I like how you've clarified why niacin is contraindicated in women who are breastfeeding. Could you do something similar for the first group of contraindications (liver disease, peptic ulcers, arterial bleeding)?
  • As vitamin - Niacin and niacinamide are used for prevention and treatment of pellagra seems circularly uninformative. It's like opening Food with "Food is used for the prevention of starvation". Instead, it would be clearer to have this section say why we need niacin. We don't need the molecular detail of the pharmacodynamics section here, but just a few sentences would be a great help. Then you could mention that the lack of niacin results in a disease we call pellagra.
  • Sources>Food fortification - The first sentence The Food Fortification Initiative... seems unnecessarily broad and could be chopped to keep the article focused (unless there was some particular point you wanted to make about the FFI).
  • Pharmacology>Pharmacokinetics - For adults a urine 2-pyridone... is already mentioned in Vitamin deficiency>Measuring vitamin status. I don't think much is gained repeating it here.
  • Production>Biosynthesis - The first half of this paragraph is great! The second half could probably be trimmed to keep the article focused. The point about the RDAs for tryptophan and protein is interesting, but I'm not sure I get enough context here to really understand the implications (how much of that RDA for tryptophan do we need for other processes vs. how much is truly free to be turned into niacin? Surely dietary tryptophan content differs broadly based on diet, e.g. you mention a maize-based diet...) I appreciate a good back-of-the-envelope calculation, but this may be getting out over our skis a bit... Also the point about pellagra in maize-rich diets was made in the section Vitamin deficiency; I don't think much is gained by re-noting it here.
  • Preparations - The material at the beginning of the Preparations section has already been mentioned elsewhere (except that the slow release form includes inositol hexanicotinate!); in the interest of flow, focus, and maintainability, I think it'd be best to pick one place for that info.
  • Preparations>Combination products - The second paragraph was all already stated above. Typically if you find you need to duplicate info in multiple sections, it indicates sections that should be close together are instead far apart.
  • History - I always appreciate interesting history, but I think some of the material in the first paragraph ("The term vitamin... name, hence 'vitamin'" at least) can probably be trimmed as a bit of a digression. Perhaps you could wikilink readers to Vitamin#History (where I see you've put in quite a bit of work!) instead.
  • History - Similarly, some of the pellagra information could be streamlined. It should be fleshed out at Pellagra#History rather than at the history section of Niacin.

4. It follows the neutral point of view policy.

Fair representation without bias:

5. It is stable.

No edit wars, etc.:

6. It is illustrated by images and other media, where possible and appropriate.

a (images are tagged and non-free content have fair use rationales): b (appropriate use with suitable captions):

Overall:

Pass/Fail:

DYK nomination 14 August

[edit]
The following is an archived discussion of the DYK nomination of the article below. Please do not modify this page. Subsequent comments should be made on the appropriate discussion page (such as this nomination's talk page, the article's talk page or Wikipedia talk:Did you know), unless there is consensus to re-open the discussion at this page. No further edits should be made to this page.

The result was: promoted by Yoninah (talk) 19:24, 20 August 2020 (UTC)[reply]

(
)
  • ... that niacin is not only a vitamin, but also the first cholesterol-lowering drug, pre-dating statins by decades? From end of History section: "In 1955, Altschul and colleagues described large amounts of niacin as having a lipid-lowering property.[109] As such, niacin is the oldest known lipid-lowering drug.[110] Lovastatin, the first 'statin' drug, was first marketed in 1987.[111]"

Improved to Good Article status by David notMD (talk). Self-nominated at 01:59, 14 August 2020 (UTC).[reply]

General: Article is new enough and long enough

Policy compliance:

Hook: Hook has been verified by provided inline citation
QPQ: Done.

Overall: I cleaned it up just a little by adding "not only." Earwig copyvio detector was down, so I will assume good faith and say it is plagiarism free based on the GA review. Also, this is my first qpq review so let me know if you think I messed up.  Bait30  Talk 2 me pls? 06:11, 18 August 2020 (UTC)[reply]

  • Ref added for Chemistry section. It had been there, then misplaced during some section reordering. During the GA review, Earwig had picked up a major copyright issue, but turns out that website had copied its content from Wikipedia without attribution. The website manager confirmed the situation. David notMD (talk) 12:10, 18 August 2020 (UTC)[reply]
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