The assessment of thiamine status

ABSTRACT

There is indirect evidence that Jamaican children with protein energy malnutrition and adult alcoholics with cirrhosis may be thiamine deficient because of sudden death of some malnourished children during rehabilitation and observation of a good clinical response to thiamine supplements by the alcoholic patients with cirrhosis. The aim of this study is to examine the thiamine status of severely malnourished children aged 6-24 months and in adult patients with alcoholic liver disease. Erythrocyte transketolase activity (ETLA) was determined in 25 children (14 boys, 11 girls) aged 7 weeks to 27 months, consecutively admitted to hospital for the treatment of severe protein energy malnutrition, before any vitamin supplementation and twice during rehabilitation. ETKA determinations were carried out upon 9 adult alcoholics with liver disease (8males, 1 female) aged 32 and 73 years, before and after thiamine supplementation, as well as 28 normal healthy control children attending child well-baby clinic and 22 normal healthy adult blood donors. In 36 percent of the malnourished children, the thiamine pyrophosphate stimulation effect (TPP-E) was greater than 15 percent (mean TPP-E percent 23.6ñ6.2 SD) with moderate thiamine deficiency in 4 and severe deficiency in 5. All survived. Of the 16 with normal thiamine status on admission, 5 died subsequently. In two of these, TPP-E percent of 21 and 103 was found in ante-mortem specimen. Specific clinical features were associated with biochemical thiamine deficiency in only one child. Of the 9 adult alcoholics, 3 were found to be thiamine deficient (mean TPP-E percent 20.6ñ7.3 SD), 1 marginally and 2 severely. Although all appeared to improve with thiamine therapy, responses were slow. Unlike the malnourished children the adults' clinical features appeared to validate the biochemical findings. It was concluded that (1) thiamine deficiency is present in 7 percent of control children, 14 percent control adults, 36 percent severely malnourished children and 33 percent adult alcoholics this may represent a public health problem in Jamaica; (2) thiamine status improves with the standard therapeutic regime in most infants and adult alcoholics, but slow response was seen with pharmacological doses; (3) there are no specific features associated with the deficiency; and (4) in very sick children, a masked thiamine deficiency on admission may become overt on the standard therapeutic regimen (AU)