Blood Thiamine Research Articles

Clinicopathologic features of folate-deficiency neuropathy.

The clinical significance and characteristics of neuropathy caused by folate deficiency remain to be established. We examined the clinicopathologic features of 18 consecutive patients with neuropathy caused by folate deficiency who presented with low serum folate levels but normal blood thiamine and serum cobalamin levels in the absence of chronic alcoholism. Symptoms were relatively uniform, characterized by slowly progressive polyneuropathy with predominant involvement of the lower extremities, with a tendency to manifest as sensory rather than motor neuropathy and predominant deep rather than superficial sensory loss. The electrophysiologic features were consistent with axonal neuropathy. The histopathologic features of sural nerve biopsy specimens indicated large fiber-predominant axonal loss without segmental demyelination. Although macrocytosis was found in 7 patients, only 3 patients exhibited hemoglobin levels less than 10 g/dL. During the same study period, we found 12 patients who had low blood thiamine levels but normal serum folate and cobalamin levels without chronic alcoholism. Compared with patients who had thiamine-deficiency neuropathy, patients with a folate deficiency showed significantly slower progression (p < 0.01), a tendency to manifest sensory neuropathy (p < 0.05), predominant deep sensory loss (p < 0.01), and preservation of biceps tendon reflexes (p < 0.05). Folate-deficiency neuropathy was characterized by a slowly progressive and sensory-dominant pattern, which was different from thiamine-deficiency neuropathy (i.e., beriberi neuropathy). This study demonstrates the importance of folate deficiency in the differential diagnosis of neuropathy, particularly in countries where folic acid fortification has not yet been practiced.

Thiamine deficiency in tachypnoeic Cambodian infants.

Background: Beriberi is endemic in South-east Asia. Diagnosis is based on clinical findings, but correlation of clinical features with blood thiamine concentrations is uncertain. Objectives: To investigate in tachypnoeic Cambodian infants the correlation between whole blood thiamine diphosphate (TDP) concentrations, clinical findings and blood TDP levels after therapy. Methods: Infants hospitalised with tachypnoea were enrolled from October 2011 to January 2012. Initial clinical features, diagnostic test results and final diagnoses were recorded. Blood for TDP determination was collected prior to treatment and at discharge. Matched infants from the general outpatient clinic with minor complaints were enrolled as controls. Thiamine was administered at the discretion of the treating paediatrician. Results: Of the 47 tachypnoeic and 47 control infants, median initial blood TDP concentrations were 83 and 93 nmol/L, respectively (P = 0·69), and were below the estimated limit of normal (<70 nmol/L) in 43% vs 34% (P = 0·40). Median initial TDP levels were 72 and 91 nmol/L in tachypnoeic infants who did or did not receive thiamine, respectively (P = 0·56); at hospital discharge, median TDP concentration had increased by 107 and 3·5 nmol/L in these two subgroups (P<0·001). Classical findings of beriberi such as dysphonia, tachycardia and hepatomegaly did not correlate with low initial TDP concentrations, but infant age, Tiger Balm use, absence of wheezing and low blood CRP levels were associated with low initial TDP levels. Use of infant formula was associated with higher initial TDP levels. Conclusions: Thiamine deficiency is common in tachypnoeic Cambodian infants, but routine clinical assessments do not accurately identify those with low blood TDP concentrations. Parenteral thiamine administration markedly increases TDP levels. Empirical thiamine treatment should be considered for tachypnoeic infants in regions with endemic thiamine deficiency.

Effectiveness of B vitamin supplementation following bariatric surgery: rapid increases of serum vitamin B12.

Few prospective studies have compared changes of nutrient intake while assessing effectiveness of thiamin, vitamin B12, and folate supplementation to prevent B vitamin deficiencies immediately following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Therefore, we determined the response to 3 months supplementation on maintaining blood B vitamin concentrations. Women undergoing RYGB (n = 11) and SG (n = 11) consumed bariatric vitamin supplements (12 mg thiamin, 350 μg vitamin B12, 800 μg folic acid) daily for 3 months. Height, weight, body mass index, and blood vitamin concentrations were measured preoperatively and at 3 months. Wilcoxon signed-rank analyses compared body weight parameters, laboratory indices, and nutrient intake at baseline and 3 months. Supplementation for 3 months maintained blood thiamin, increased serum folate from 13.1 ± 5.4 to 16.3 ± 6.0 nmol/L (P = 0.049), and increased serum vitamin B12 concentrations from 498 ± 150 to 736 ± 340 pg/mL (P = 0.005). Dietary intake of thiamin and folate decreased in the combined surgical groups, while dietary intake of B12 was maintained. Bariatric B vitamin supplements provided multiple intakes of the Recommended Dietary Allowances (1090% thiamin, 14,583% vitamin B12, 200% folate). Although energy intake decreased 64%, B vitamin supplementation for 3 months resulted in a 48% increase of serum vitamin B12, a modest increase of serum folate, and no reduction of blood thiamin concentrations. Long-term effects of the rapid rise of serum B12 levels attributed to the high content of supplements warrant further investigation.

Beriberi Outbreak among Myanmar and Thai workers in a Factory in Chachoengsao Province, Thailand, 2012-2013

Beriberi is a clinical syndrome which develops from prolonged severe thiamine deficiency in diet. In July 2013, the Ministry of Public Health, Thailand received reports of three deaths among Myanmar workers in a factory. We identified suspect beriberi cases, reviewed clinical history and conducted a survey among both Myanmar and Thai workers in the factory. Blood thiamine levels were measured and foods served in the factory canteen were also examined. Seventeen suspect cases (attack rate = 17%) were identified, with median age of 26 years (range 20-30 years) and male to female ratio of 3.3:1. All fatalities were young men (case fatality proportion = 17.6%). Prevalence of thiamine deficiency among Myanmar and Thai workers were 7.1% (95% CI = 0-22.0) and 26.7% (95% CI = 1.3-52.0) respectively. This outbreak was likely to be caused by long exposure to low thiamine intake and heavy physical activities. After distributing thiamine supplements and improving diet, no more cases occurred. We recommended improving hospital staff’s ability to differentiate beriberi from other cardiomyopathies and neurologic diseases, and raising awareness of thiamine deficiency in this area.

Prevention of delirium in trauma patients: Are we giving thiamine prophylaxis a fair chance?

Delirium is associated with increased morbidity and mortality in injured patients. Wernicke encephalopathy (WE) is delirium linked to malnutrition and chronic alcoholism. It is prevented with administration of thiamine. Our primary goal was to evaluate current blood alcohol level (BAL) testing and thiamine prophylaxis in severely injured patients. We retrospectively reviewed the cases of 1000 consecutive severely injured patients admitted to hospital between Mar. 1, 2009, and Dec. 31, 2009. We used the patients' medical records and the Alberta Trauma Registry. Among 1000 patients (mean age 48 yr, male sex 70%, mean injury severity score 23, mortality 10%), 627 underwent BAL testing at admission; 221 (35%) had a BAL greater than 0 mmol/L, and 189 (30%) had a BAL above the legal limit of 17.4 mmol/L. The mean positive BAL was 41.9 mmol/L. More than 4% had a known history of alcohol abuse. More patients were assaulted (20% v. 9%) or hit by motor vehicles (10% v. 6%) when intoxicated (both p < 0.05). Most injuries occurred after falls (37%) and motor vehicle collisions (33%). Overall, 17% of patients received thiamine prophylaxis. Of the 221 patients with elevated BAL, 44% received thiamine prophylaxis. Of those with a history of alcohol abuse, 77% received thiamine prophylaxis. Despite the strong link between alcohol abuse, trauma and WE, more than one-third of patients were not screened for alcohol use. Furthermore, a minority of intoxicated patients received adequate prophylaxis against WE. Given the low risk and cost of BAL testing and thiamine prophylaxis and the high cost of delirium, standard protocols for prophylaxis are essential.

Prognostic factors for morbidity and mortality in elderly patients undergoing acute gastrointestinal surgery: a systematic review

Elderly patients undergoing acute gastrointestinal (GI) surgery experience increased morbidity and mortality compared with younger and elective patients. Prognostic factors can be used to counsel patients of these risks and, if modifiable, to minimize them. We reviewed the literature on prognostic factors for adverse outcomes in elderly patients undergoing acute GI surgery. We searched PubMed and Embase using a strategy developed in collaboration with an expert librarian. Studies examining independent associations between prognostic factors and morbidity or mortality in patients aged 65 and older undergoing acute GI surgery were selected. We extracted data using a standardized form and assessed study quality using the QUIPS tool. Nine cohort studies representing 2958 patients satisfied our selection criteria. All studies focused on postoperative mortality. Thirty-four prognostic factors were examined, with significant variability across studies. There was limited or conflicting evidence for most prognostic factors. Meta-analysis was only possible for the American Society of Anesthesiologists (ASA) score, which was found to be associated with mortality in 4 studies (pooled odds ratio 2.77, 95% confidence interval 0.92-8.41). While acute GI surgery in elderly patients is becoming increasingly common, the literature on prognostic factors for morbidity and mortality in this patient population lags behind. Further research is needed to help guide patient care and potentially improve outcomes.

Thiamine Deficiency and Cardiac Dysfunction in Cambodian Infants

To compare blood thiamine concentrations, echocardiography findings, and plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in infants with clinically diagnosed beriberi and healthy matched controls, and to evaluate changes after thiamine treatment. Sixty-two Cambodian infants (20 cases and 42 controls), aged 2-47 weeks, were enrolled in this prospective study. Echocardiography and phlebotomy were performed at baseline and after thiamine treatment. Both cases and controls were thiamine-deficient, with median blood thiamine diphosphate (TDP) concentrations of 47.6 and 55.1 nmol/L, respectively (P = .23). All subjects had normal left ventricular ejection fraction. The median NT-proBNP concentration in cases (340 pg/mL [40.1 pmol/L]) was higher than previously reported normal ranges, but not statistically significantly different from that in controls (175 pg/mL [20.7 pmol/L]) (P = .10), and was not correlated with TDP concentration (P = .13). Two cases with the lowest baseline TDP concentrations (24 and 21nmol/L) had right ventricular enlargement and elevated NT-proBNP levels that improved dramatically by 48hours after thiamine administration. Only a minority of thiamine-deficient Cambodian infants demonstrate abnormal echocardiography findings. Thiamine deficiency produces echocardiographic evidence of right ventricular dysfunction, but this evidence is not apparent until deficiency is severe. NT-proBNP concentrations are mildly elevated in sick infants with normal echocardiography findings, indicating possible physiological changes not yet associated with echocardiographic abnormalities.

The effects of endurance training and thiamine supplementation on anti-fatigue during exercise.

The purpose of this study was to find the effect of endurance training and thiamine supplementation on anti-fatigue during the exercise. Each nine students from K Women’s University went through three cross-over treatments: placebo treatment, training treatment and thiamine treatment. Training treatment was performed with bicycle ergometer exercise for four weeks (five days per week). Each exercise was performed for an hour with intensity set at 70% (50rpm) of maximal oxygen uptake. Thiamine treatment group was given 10mg of thiamine tetrahydrofurfuryl disulfide per one kilogram for four weeks. The bicycle ergometer exercise was performed at 70% of maximal oxygen uptake in exercise intensity which 60 minutes of exercise was performed at 50rpm . Lactate concentration was significantly decreased during 15 to 30 minutes of exercise for those with training treatment and 15 to 60 minutes of exercise for those with thiamine treatment compared to placebo treatment group. Ammonia concentration was significantly decreased during 15 to 60 minutes of exercise and 15 to 30 minutes of recovery for those with training and thiamine treatment compared to placebo treatment. Resting blood thiamine concentrations of placebo treatment were significantly lower than training treatment. 60 minutes after the exercise, plasma thiamine concentration was significantly increased in all treatment group. To sum up the previous, thiamine intake during exercise positively benefits carbohydrate metabolism in a way that will decrease lactate concentration, ammonia concentration, and anti- fatigue by reducing the RPE. Therefore, we can consider thiamine intake to be utilized as similar benefits as endurance training.

Slowly progressive folate-deficiency myelopathy: Report of a case

BackgroundFolate deficiency is known to be associated with subacute combined degeneration of the spinal cord; however, reports of long-standing cases are rare. Although neurological deficits due to folate deficiency have been reported to respond to folic acid supplementation, the functional outcomes have not been fully elucidated. ObjectiveThe aim of the study was to evaluate the clinical features and response to folate supplementation in a patient with folate deficiency manifested over 10years as a slowly progressive myelopathy. MethodsWe performed comprehensive clinical screening, electrophysiological testing, and posturography before and after folate supplementation. ResultsA 49-year-old man had a slowly progressive gait disturbance for 10years. He had not eaten fresh green vegetables for more than 10years. Neurological examination revealed spastic paraplegia and absence of any vibration sense in the lower limbs accompanied by a positive Romberg's sign. Serum folate level was low, and plasma homocysteine level was elevated. Levels of blood thiamine and serum cobalamin were normal. We diagnosed the patient with myelopathy due to folate deficiency. Folic acid supplementation led to improvement of his symptoms; posturography and walking speed tests showed partial improvement, while the somatosensory-evoked potentials and central motor conduction time remained unchanged. ConclusionsFolate deficiency should be considered as a differential diagnosis of chronic slowly progressive myelopathy. The present case suggests the importance of early diagnosis and treatment before the adverse neurological manifestations of folate deficiency become irreversible.

Thiamine and its phosphate esters in relation to cardiometabolic risk factors in Saudi Arabs

BackgroundThiamine deficiency has suggested to be linked to several insulin-resistance complications. In this study, we aim to associate circulating thiamine levels among cardiometabolic parameters in an Arab cohort using a simple, sensitive, rapid and selective high-performance liquid chromatography (HPLC) method that has recently been developed.MethodsA total of 236 randomly selected, consenting Saudi adult participants (166 males and 70 females) were recruited and screened for the presence of the metabolic syndrome (MetS) using the modified National Cholesterol Education Program–Adult Treatment Panel III definition. Blood thiamine and its derivatives were quantified using HPLC.ResultsA total of 140 participants (53.9%) had MetS. The levels of thiamine and its derivatives of those with MetS were not significantly different from those without. However, hypertensive subjects had significantly higher urinary thiamine (P = 0.03) as well as significantly lower levels of thiamine diphosphate (TDP) (P = 0.01) and total thiamine (P = 0.02) than the normotensive subjects, even after adjusting for age and body mass index (BMI). Furthermore, age- and BMI-matched participants with elevated blood glucose levels had significantly lower levels of thiamine monophosphate (P = 0.020), TDP (P < 0.001) and total thiamine (P < 0.001) and significantly elevated levels of urinary thiamine (P = 0.005) compared to normoglycemic participants.ConclusionsLow thiamine levels are associated with elevated blood glucose and hypertension in Saudi adults. Determination of thiamine status may be considered and corrected among patients with, or at high risk for, MetS, but the question whether thiamine deficiency correction translates to improved cardiometabolic status needs further longitudinal investigation.

Constipation in Patients with Thiamine Deficiency after Roux-en-Y Gastric Bypass Surgery

Background/Aims: Roux-en-Y gastric bypass surgery is the most common bariatric surgery worldwide. We have described thiamine deficiency in patients with small intestinal bacterial overgrowth after gastric bypass. We hypothesized that symptoms of thiamine deficiency are common after gastric bypass. The aims of this study were to examine the prevalence of and treatment of symptoms of thiamine deficiency after gastric bypass. Methods: This is a prospective study performed in a large urban, community hospital. Consecutive gastric bypass patients seen from February 1, 2008 to May 1, 2009 are included. Thiamine deficiency in this study included both: consistent clinical symptoms and either (1) low blood thiamine level or (2) resolution of clinical symptoms after receiving thiamine. Results: Of 151 patients, 25 females and 2 males met the criteria for thiamine deficiency (prevalence of 18%). In these 27 patients, 12 had one symptom of thiamine deficiency, while 15 had symptoms consistent with multiple subtypes. Eleven patients reported constipation at 0.33-12 years (mean 4.8) after gastric bypass. Elevated serum folate levels were seen in 6 of 10 tested patients and there was an abnormal glucose-hydrogen breath test in 9 of 10 tested patients, supporting the presence of small intestinal bacterial overgrowth. Frequency of defecation improved after thiamine treatment. Conclusion: Thiamine deficiency resulting from small intestinal bacterial overgrowth should be considered in patients being seen for constipation after gastric bypass surgery.

Understanding the role of sulfur–thiamine interaction in the pathogenesis of sulfur-induced polioencephalomalacia in beef cattle

This study examined the role of sulfur (S) in the pathogenesis of S-induced polioencephalomalacia (PEM) in beef cattle in the context of thiamine status and metabolism. Thiamine, thiamine monophosphate (TMP) and thiamine pyrophosphate (TPP) status in rumen fluid, blood and brain tissue were determined in beef heifers fed 2 levels of S [low S (LS) vs. high S (HS)] at 2 forage-to-concentrate ratios (F:C). High S diet did not affect ruminal and blood thiamine status. Interestingly, however, HS diet showed increased brain thiamine levels. No gross or histopathological changes indicative of PEM were detected in the brains of the heifers. Of note, during the course of the present study, we documented an outbreak of S-induced PEM in commercial feedlot steers. Brain thiamine variables in experimental animals fed HS diet were then contrasted with brain thiamine status in PEM affected feedlot steers. Interestingly, in clinically normal animals, exposure to HS diet resulted in increased levels of both TMP and TPP in the brain tissue, in comparison to animals fed LS diet. In contrast, the PEM affected brains showed overall lower levels of thiamine phosphates. It is noteworthy that TPP levels were 36.5% lower, despite 4.9-fold higher free thiamine in PEM brains compared to normal brains. Our results indicate that high dietary S may increase the metabolic demand for TPP, and that animals incapable of maintaining requisite levels of brain TPP are at high risk to develop fulminant cerebrocortical necrosis.

Altered blood thiamine metabolism in Alzheimer's disease

Altered blood thiamine metabolism in Alzheimer's disease

Mo2116 Development of Institutional Guidelines for the Identification and Management of Refeeding Syndrome Among Acutely Admitted Patients

Refeeding Syndrome refers to biochemical and physical abnormalities, arising as a result of shifts in electrolytes and fluid balance in malnourished individuals following the initiation of feeding. This is an acute complication of malnutrition among hospitalised patients with the potential for significant morbidity and mortality. We audited the percentage of patients admitted over 6 days at a tertiary referral centre at high risk of Refeeding Syndrome. Analysis of identification and management centred on NICE (National Institute of Clinical Excellence) Guidelines, CG32. 102 patients were included and 22 (21.5%) patients were at a high risk for developing Refeeding Syndrome. 8 patients from the high risk group did not have electrolyte levels monitored. Of the 14 high-risk patients who had bloods assayed, their treating physician prescribed only 7 patients thiamine. Only 32% of patients at high risk of Refeeding Syndrome were managed according to best practice, and 9% of the patients at high risk progressed to develop Refeeding Syndrome with one mortality. Following these findings, we formed amultidisciplinary committee comprisingmembers from the Department of Gastroenterology and Hepatology, Department of Nutrition and Dietetics, Department of Pharmacy and Nursing Administration. We developed institutional guidelines derived from literature review and NICE Guidelines for the identification and management of Refeeding Syndrome. We also developed guidelines for repletion of electrolytes with specific reference to formulations and doses appropriate to the levels of repletion required. A programme of education for nursing and clinical staff alike was undertaken, with the addition of regular patient weights applied to nursing charts and more streamlined dietician referral practices applied throughout the hospital. Flowcharts for expedient clinical intervention were available on all wards and the accident and emergency department, as were the above-mentioned electrolyte repletion guidelines. We are pleased to report that a repeated audit after initial implementation of these guidelines revealed that 11/54 patients (20%) were at high risk of Refeeding Syndrome. 45.5% of these patients were managed according to the guidelines, receiving both thiamine and appropriate blood investigations, which is comparable to 32% in the initial audit. This demonstrates progress after only 2months of widespread implementation of these guidelines at our institution. This audit cycle highlights the importance of identification and management of patients at risk of Refeeding Syndrome. The application of formal guidelines generated in a multidisciplinary manner as demonstrated at our institution yields improvements in patient management, giving clear recommendations and improving clinical education and awareness of malnutrition.

Development and Validation of an LC/MS Method for Quantitative Determination of Thiamine in Blood Plasma

A new sensitive method based on liquid chromatography with mass-spectrometric detection (LC/MS) was developed and validated for the quantitative determination of thiamine in blood plasma. The method is highly sensitive and selective due to the combination of LC and MS and can be used for determining the thiamine blood concentration during pharmacokinetic investigations.

Thiamine and Fatigue in Inflammatory Bowel Diseases: An Open-label Pilot Study

To demonstrate that fatigue and other disorders related to ulcerative colitis and Crohn's disease are the manifestation of an intracellular mild thiamine deficiency and not due to malabsorbtion, augmented requirements, or nutritional factors, and that this dysfunction is curable with high doses of thiamine administered orally or parenterally. In this pilot study, we treated fatigue in eight patients with ulcerative colitis and four patients affected by Crohn's disease from January to April 2011. The patients were recruited through general practitioners' surveys and among personnel and affiliated personnel of the clinic Villa Immacolata. Fatigue was measured using the chronic fatigue syndrome scale, and the determination of thiamine and thiamine pyrophosphate levels in the blood was carried out through blood tests. The levels of thiamine and thiamine pyrophosphate in the blood were normal. All patients were assigned to receive high doses of thiamine orally. Depending upon the body weight of each patient, dosage ranged from 600 mg/day (60 kg) to 1,500 mg/day (90 kg). The chronic fatigue syndrome scale as well as thiamine and thiamine pyrophosphate levels in the blood were measured 20 days after the beginning of the therapy. Ten patients out of twelve showed complete regression of fatigue, while the remaining two patients showed nearly complete regression of fatigue compared to the chronic fatigue syndrome scale scores before therapy. The absence of blood thiamine deficiency and the efficacy of high-dose thiamine in our patients suggest that fatigue is the manifestation of a thiamine deficiency, likely due to a dysfunction of the active transport of thiamine inside the cells, or due to structural enzymatic abnormalities. The administration of large quantities of thiamine increases the concentration in the blood to levels in which the passive transport restores the normal glucose metabolism in all cells and leads to a complete regression of fatigue.

Supplementary Thiamine is Still Important in Alcohol Dependence

To assess the effect of mandatory thiamine enrichment of wheat flour on blood thiamine levels in an alcohol-dependent population. Alcohol-dependent clients (n = 100) entering an inpatient service for the management of alcohol withdrawal had thiamine blood tests and diet interviews. Approximately half (n = 46) the alcohol-dependent participants reported taking vitamin supplements prior to admission. Standard treatment included thiamine supplementation in the form of an intramuscular injection and 100 mg tablets. If consent was gained, a second thiamine blood test was taken prior to discharge (n = 77). Control participants (n = 20) with no history of treatment for alcohol abuse had thiamine blood tests and diet interviews. Control participants consumed significantly larger amounts of thiamine in their diet compared with alcohol-dependent participants (P < 0.0001). Alcohol-dependent participants who reported no use of vitamin supplements had significantly lower (P < 0.05) blood thiamine levels compared with controls, whereas controls and those who reported using vitamin supplements had no significant difference. No significant correlation was found between thiamine blood levels and reported levels of alcohol consumption. Reduced blood levels of thiamine in people who are alcohol dependent, compared with those with no history of alcohol abuse, are likely to be because of the poor diet. Consumption of vitamin supplements appears to bring thiamine levels closer to those seen in control participants. Supplementation of dietary intake of thiamine in people who are alcohol dependent remains an important measure for the prevention of Wernicke-Korsakoff's syndrome in this population.

Serial Evaluation of Children With ALF With Advanced MRI, Serum Proinflammatory Cytokines, Thiamine, and Cognition Assessment

This prospective, sequential study was done to understand changes in cerebral edema (CE) on magnetic resonance imaging and magnetic resonance spectroscopy, liver functions, and neurocognitive testing (NCT) in children with acute liver failure (ALF). A total of 11 ALF and 8 healthy controls were evaluated with advanced magnetic resonance (MR) imaging, blood proinflammatory cytokines (PCs), thiamine levels, liver functions, and NCT. Reevaluation was done at 43.5 ± 26.9 days (first follow-up, n = 8) and 157.3 ± 52.3 days (second follow-up, n = 6) after discharge. At diagnosis, patients with ALF had vasogenic and cytotoxic CE, raised brain glutamine (23.2 ± 3.4 vs. 15.3 ± 2.7), and serum PCs (tumor necrosis factor [TNF]-α 40.1 ± 8.9 vs. 7.2 ± 2.7 pg/mL, interleukin [IL]-6 29.2 ± 14.4 vs. 4.7 ± 1.2 pg/mL). The mammillary bodies (MBs) were smaller, and brain choline (1.9 ± 0.36 vs. 2.6 ± 0.6) and blood thiamine (55.2 ± 6.7 vs. 81.8 ± 10.2 nmol/L) were lower than controls. At first follow-up, the brain glutamine and CE recovered. Brain choline and MBs volume showed improvement and thiamine levels normalized. Significant reduction in TNF-α and IL-6 was seen. The patients performed poorly on NCT, which normalized at second follow-up. Liver biochemistry and thiamine levels were normal and TNF-α and IL-6 showed further reduction at second follow-up. Patients with ALF have CE contributed by raised brain glutamine and PCs. MBs are small because of thiamine deficiency and show recovery in follow-up. CE and brain glutamine recover earlier than normalization of NCT and liver functions. Persistence of raised cytokines up to 6 months after insult suggests possible contribution from liver regeneration.

The connection between maternal thiamine shortcoming and offspring cognitive damage and poverty perpetuation in underprivileged communities across the world

The acquisition of cognitive, sensory-motor and social emotional functions depend on a proper development of the Central Nervous System (CNS). This set of functions, known as intelligence, allows a better adaptation to the environment. In the last decades, an increase in the average of intelligence has been reported. However, such an increase cannot be observed in an equivalent way in economically and social underprivileged regions. Children from those regions are in great risk of being affected by mental retardation or impaired cognitive development. In later life they will, probably, be unable to transform and improve themselves and their communities, perpetuating the poverty of the region. Therefore, knowledge of factors involved in CNS development is a matter of health closely related to social improvement.Malnutrition throughout pregnancy and breastfeeding is clearly identifiable as a cause of damage in CNS development. Vitamin B1 (Thiamine) is a micronutrient important to the growth and maturity of the CNS. Thiamine shortcoming may affect 50% of pregnant women. Thiamine function in cerebral development is still not well known. There is a gap in the literature regarding systematical research about the blood thiamine concentration throughout the periods of gestation and breastfeeding. These studies are relevant in populations with a high level of nutritional vulnerability, because in a follow up offspring cognitive exam they could reveal if the maternal thiamine deficiency is related to child CNS impairment.This paper introduce the hypothesis that thiamine shortcoming during pregnancy and breastfeeding is directly related to cognitive impairment of child. Data about the neurophysiological role of thiamine, consequences of its shortcoming in experimental models, populations under the risk of thiamine shortcoming are presented.The hypothesis that maternal thiamine shortcoming causes damage related to child cognitive development needs to be considered. Thus, thiamine shortcoming during gestation and breastfeeding and its effects on children must be studied in many populations in order to know the magnitude of the problem and to indicate actions to overcome it.

Wernicke’s Encephalopathy: Expanding the Diagnostic Toolbox

Wernicke's encephalopathy (WE) is a life threatening neurological disorder that results from thiamine (Vitamin B1) deficiency. Clinical signs include mental status changes, ataxia, occulomotor changes and nutritional deficiency. The conundrum is that the clinical presentation is highly variable. WE clinical signs, brain imaging, and thiamine blood levels, are reviewed in 53 published case reports from 2001 to 2011; 81 % (43/53) were non-alcohol related. Korsakoff Syndrome or long-term cognitive neurological changes occurred in 28 % (15/53). Seven WE cases (13 %) had a normal magnetic resonance image (MRI). Four WE cases (8 %) had normal or high thiamine blood levels. Neither diagnostic tool can be relied upon exclusively to confirm a diagnosis of WE.