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. 2011 Feb 22;5(2):e969.
doi: 10.1371/journal.pntd.0000969.

Clinically unapparent infantile thiamin deficiency in Vientiane, Laos

Sengmanivong Khounnorath  1 , Karen Chamberlain, Ann M Taylor, Douangdao Soukaloun, Mayfong Mayxay, Sue J Lee, Bounthom Phengdy, Khonsavanh Luangxay, Kongkham Sisouk, Bandit Soumphonphakdy, Khaysy Latsavong, Kongsin Akkhavong, Nicholas J White, Paul N Newton
Affiliations

Clinically unapparent infantile thiamin deficiency in Vientiane, Laos

Sengmanivong Khounnorath et al. PLoS Negl Trop Dis. .

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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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Relationship between α and basal ETK for 382 infants without clinical evidence of beriberi.
Red crosses represent infants who died, The vertical and horizontal red lines represent the lower bound for a normal basal ETK (≥0.59 micromoles/min/gHB) and upper bound for a normal α (< = 0.31 %).
Figure 2
Figure 2. Boxplot of basal EKT per month of infant age.
Median and 1st and 3rd quartiles and outliers.
Figure 3
Figure 3. Boxplot of α per month of infant age.
Median and 1st and 3rd quartiles and outliers.
Figure 4
Figure 4. Proportion of infants aged ≥2 months and infant mortality.
Categorized by basal ETK <0.59 and ≥0.59 in micromoles/min/gHB (n = 382 infants). Black bars – infants aged ≥2 months, grey bars – infants who died.
Figure 5
Figure 5. Number of infant deaths for each month age category.
Black bars – death of infant with basal ETK ≥0.59 micromoles/min/gHB, grey bars - death of infant with basal ETK<0.59 micromoles/min/gHB.
See this image and copyright information in PMC

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