Thiamine deficiency in Gambian women of reproductive age.

Megan W Bourassa,Albert Koulman,Andrew M Prentice,Carla Cerami,Filomena Gomes,Kerry S Jones

doi:10.1111/nyas.14695

Abstract

Thiamine deficiency disorders are associated with a variety of clinical symptoms affecting the nervous and cardiovascular systems. There is growing recognition that thiamine deficiency can occur in populations well beyond the classical region of South Asia, and at‐risk populations include those who receive a large proportion of their energy from polished white rice (or other low‐thiamine staple foods) and with low dietary diversity. Reports of thiamine deficiency in West Africa over the last century have suggested that this has historically been an issue in this population, but in more recent decades, these reports have been limited to prison populations. To understand if thiamine deficiency might be an unrecognized problem in the communities of this region, erythrocyte samples collected during the wet and dry seasons from 226 women of reproductive age (mean age = 28 years old) were assessed for thiamine status by measuring the erythrocyte transketolase activity coefficient (ETKac). Overall, 35.8% of the sample was at high risk of thiamine deficiency (ETKac ≥ 1.25). Risk of thiamine deficiency was significantly higher in the wet (47.9%) compared with the dry season (22.9%) (P < 0.001). To our knowledge, this is the first report of biochemical thiamine deficiency in a free‐living population in West Africa in the 21st century and suggests that further investigation is warranted.

Highlights

In recent decades, reports of thiamine deficiency in sub-Saharan Africa have largely been in isolated cases, including groups of refugees,[1] prisoners,[2,3] soldiers,[4] and those in remote communities.[5,6] As a result, thiamine deficiency, which is most commonly described in Southeast Asia, is generally not considered a problem in Africa
Using erythrocyte transketolase activity coefficient (ETKac) to assess thiamine status, we found in this study population of women of reproductive age (WRA) living in rural Gambia that more than one third (35.8%) were at high risk (ETKac ≥ 1.25) of thiamine deficiency
This study shows a trend for an increased risk of thiamine deficiency in obese women

Summary

Introduction

Reports of thiamine deficiency in sub-Saharan Africa have largely been in isolated cases, including groups of refugees,[1] prisoners,[2,3] soldiers,[4] and those in remote communities.[5,6] As a result, thiamine deficiency, which is most commonly described in Southeast Asia, is generally not considered a problem in Africa. There is recent evidence that thiamine deficiency is much more widespread than previously believed, and its vague and variable clinical presentations make it easy to overlook or misdiagnose.[7] For example, thiamine deficiency was recently identified as the cause of a frequent and nearly always fatal illness in infants and postpartum women in Northern India, where it went undetected and undiagnosed for decades.[8] This case, as well as others, are well outside the classical geographic locations associated with thiamine deficiency and have, raised questions about the true global prevalence of thiamine deficiency.[9,10,11,12] In areas where thiamine deficiency is a known problem, it can have a serious impact on infant mortality.

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