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Clinically unapparent infantile thiamin deficiency in Vientiane, Laos.

Khounnorath S, Chamberlain K, Taylor AM, Soukaloun D, Mayxay M, Lee SJ, Phengdy B, Luangxay K, Sisouk K, Soumphonphakdy B, Latsavong K, Akkhavong K, White NJ, Newton PN - PLoS Negl Trop Dis (2011)

Bottom Line: Thiamin treatment could improve outcome.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.This may contribute to mortality and a low clinical threshold for providing thiamin to sick infants may be needed.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Mahosot Hospital, and Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic.

ABSTRACT

Background: Beriberi 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 findings: A 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/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.

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Related in: MedlinePlus

Boxplot of α per month of infant age.Median and 1st and 3rd quartiles and outliers.
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pntd-0000969-g003: Boxplot of α per month of infant age.Median and 1st and 3rd quartiles and outliers.

Mentions: Infant basal ETK<0.59 micromoles/min/gHb was associated with a significantly (P<0.02) higher frequency of infants presenting at ≥2 months of age, infant breastfeeding, death when ≥2 months old, a pneumonia discharge diagnosis, a lower frequency of prematurity discharge diagnosis, vomiting, dyspnoea, a lower pulse rate, fewer years of maternal schooling, a higher frequency of maternal Lao Sung ethnicity and maternal pork, chicken, fish or vegetables consumption since parturition (Table 1). α>31% was associated with a higher frequency of infants presenting at ≥2 months of age, of infant breastfeeding, vomiting, dyspnoea, cold fingers, maternal Lao Sung ethnicity, mothers being rice farmers and fewer years of maternal schooling. There was no apparent relationship between biochemical measurements of thiamin status and maternal food avoidance behaviour. There was a tendency for basal ETK to decline with infant age up to 6 months and then to increase (Fig. 2), whilst there was a tendency for α to rise in the first 3–6 months of age (Fig. 3). There was no obvious relationship between measures of biochemical thiamin deficiency and seasonality (data not shown).


Clinically unapparent infantile thiamin deficiency in Vientiane, Laos.

Khounnorath S, Chamberlain K, Taylor AM, Soukaloun D, Mayxay M, Lee SJ, Phengdy B, Luangxay K, Sisouk K, Soumphonphakdy B, Latsavong K, Akkhavong K, White NJ, Newton PN - PLoS Negl Trop Dis (2011)

Boxplot of α per month of infant age.Median and 1st and 3rd quartiles and outliers.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3050987&req=5

pntd-0000969-g003: Boxplot of α per month of infant age.Median and 1st and 3rd quartiles and outliers.
Mentions: Infant basal ETK<0.59 micromoles/min/gHb was associated with a significantly (P<0.02) higher frequency of infants presenting at ≥2 months of age, infant breastfeeding, death when ≥2 months old, a pneumonia discharge diagnosis, a lower frequency of prematurity discharge diagnosis, vomiting, dyspnoea, a lower pulse rate, fewer years of maternal schooling, a higher frequency of maternal Lao Sung ethnicity and maternal pork, chicken, fish or vegetables consumption since parturition (Table 1). α>31% was associated with a higher frequency of infants presenting at ≥2 months of age, of infant breastfeeding, vomiting, dyspnoea, cold fingers, maternal Lao Sung ethnicity, mothers being rice farmers and fewer years of maternal schooling. There was no apparent relationship between biochemical measurements of thiamin status and maternal food avoidance behaviour. There was a tendency for basal ETK to decline with infant age up to 6 months and then to increase (Fig. 2), whilst there was a tendency for α to rise in the first 3–6 months of age (Fig. 3). There was no obvious relationship between measures of biochemical thiamin deficiency and seasonality (data not shown).

Bottom Line: Thiamin treatment could improve outcome.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.This may contribute to mortality and a low clinical threshold for providing thiamin to sick infants may be needed.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Mahosot Hospital, and Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic.

ABSTRACT

Background: Beriberi 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 findings: A 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/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.

Show MeSH
Related in: MedlinePlus