Abstract
BackgroundBeriberi occurs in Vientiane, Lao PDR, among breastfed infants. Clinical disease may be the tip of an iceberg with subclinical thiamin deficiency contributing to other illnesses. Thiamin treatment could improve outcome.Methodology/Principal FindingsA cohort of 778 sick infants admitted during one year without clinical evidence of beriberi were studied prospectively and erythrocyte transketolase assays (ETK) performed. Biochemical thiamin deficiency was defined both in terms of the activation coefficient (α>31%) and basal ETK activity <0.59 micromoles/min/gHb. Of the 778 infants, median (range) age was 5 (0–12) months, 79.2% were breastfed, 5.1% had α>31% and 13.4 % basal ETK<0.59 micromoles/min/gHb. Infants ≥2 months old had a higher frequency of biochemical markers of thiamin deficiency. Mortality was 5.5% but, among infants ≥2 months old, mortality was higher in those with basal ETK<0.59 micromoles/min/gHb (3/47, 6.4%) than in those with basal ETK≥0.59 micromoles/min/gHb (1/146, 0.7%) (P = 0.045, relative risk = 9.32 (95%CI 0.99 to 87.5)). Multivariate regression analysis indicated that infant age ≥2 months and fewer maternal years of schooling were independently associated with infant basal ETK<0.59 micromoles/min/gHb.Conclusions/SignificanceClinically unapparent thiamin deficiency is common among sick infants (≥2 months old) admitted to hospital in Vientiane. This may contribute to mortality and a low clinical threshold for providing thiamin to sick infants may be needed.
Highlights
Beriberi, or clinically apparent thiamin deficiency, may present with a variety of syndromes including peripheral neuropathy, myocardial dysfunction, encephalopathy, hypoglycemia and lactic acidosis
Conclusions/Significance: Clinically unapparent thiamin deficiency is common among sick infants ($2 months old) admitted to hospital in Vientiane. This may contribute to mortality and a low clinical threshold for providing thiamin to sick infants may be needed
Clinical disease may be the tip of an iceberg with subclinical thiamin deficiency contributing to sickness in infants without overt clinical beriberi
Summary
Clinically apparent thiamin deficiency, may present with a variety of syndromes including peripheral neuropathy, myocardial dysfunction, encephalopathy, hypoglycemia and lactic acidosis. With the advent of mechanical rice milling in the late 19th century, beriberi became a dominant public health problem in Asia, responsible for a considerable mortality, especially amongst infants [1,2,3,4,5,6,7,8]. This stimulated a large research effort and identification of the aetiology led to changes in diet, supplementation and targeted health programs to ensure adequate thiamin intake.
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