Overcoming the Current Challenges of Thiamine Deficiency Disorders (P10-091-19)

Abstract

ObjectivesThiamine deficiency (the “forgotten scourge of Southeast Asia”) remains a pressing public health challenge as infantile beriberi, the most commonly fatal thiamine deficiency disorder (TDD), often results in death within hours of clinical presentation if left untreated.Objective was to assess the global prevalence, burden of disease, and consequences of thiamine deficiency. MethodsAn expert committee of public health professionals, physicians, neurologists, biochemists and nutritionists was assembled by the Sackler Institute for Nutrition Science. Two technical consultations were held to compile current knowledge on thiamine and identify gaps. Experts presented research findings and participated in discussions to determine the best biomarkers of thiamine status, estimate global prevalence of thiamine deficiency, and devise strategies to improve thiamine status in deficient populations. ResultsTDD remain prevalent in Southeast Asia, 45% of infant deaths during the first six months are attributable to beriberi in parts of Cambodia, and it is the second most common cause of infant deaths between 28 days and 1 year of age in Myanmar. However, the issue is not contained to SEA: 24 published outbreaks of thiamine deficiency were identified in locations, such as Kashmir, Kiribati and some West African countries. Growing evidence also suggests that sub-clinical thiamine deficiency may have lasting impacts on cognitive development and psychomotor functions. ConclusionsSeveral gaps in knowledge impair the ability to address the wide spectrum of TDD, including the lack of an accepted case definition of TDD, poor understanding of biomarkers, unknown status in large regions of the world. Factors triggering clinical disease, and the ability of prophylactic interventions to prevent TDD are also poorly understood. The committee commissioned several studies to address the gaps in knowledge, and to develop control and prevention programs in affected countries. It also proposed a case definition of thiamine deficiency disorders and clinical guidelines for empirical treatment of suspected TDD. The presentation will highlight the work of the expert group and ongoing studies. Funding SourcesBill & Melinda Gates Foundation.