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Thiamine deficiency in Cambodian infants with and without beriberi
Debra Coats1, Kelsey Shelton-Dodge, Kevanna Ou
1Eastern Mennonite Mission, Prey Veng, Cambodia.
Insights
Thiamine deficiency is common in Cambodian infants and mothers, but heavy metals and thiaminase-containing foods are not the causes. This highlights an unrecognized public health issue in the region.
Area of Science:
- Nutritional Science
- Public Health
- Pediatrics
Background:
- Thiamine deficiency (TD) can cause beriberi.
- Factors contributing to TD in rural Cambodia are unclear.
- Heavy metals and thiaminase-containing foods were investigated as potential causes.
Purpose of the Study:
- To test if heavy metal toxicity and thiaminase-containing foods cause symptomatic thiamine deficiency.
- To assess thiamine diphosphate (TDP) blood concentrations in infants and mothers in Cambodia.
- To compare TDP levels and heavy metal exposure between cases and controls.
Main Methods:
- Case-control study design.
- Measured thiamine diphosphate (TDP) blood concentrations in 27 infants with beriberi, their mothers, and controls.
- Assessed blood and urine heavy metal levels (lead, arsenic, cadmium, mercury, thallium) and food thiaminase activity.
Main Results:
- Infants and mothers in rural Cambodia had significantly lower TDP levels than American controls.
- No correlation found between heavy metal levels and TDP or case status.
- No thiaminase activity detected in local food samples.
Conclusions:
- Thiamine deficiency is endemic and often clinically inapparent in infants and nursing mothers in rural Cambodia.
- Heavy metal toxicity and thiaminase-containing foods do not explain the observed thiamine deficiency.
- Further research is needed to identify the causes of widespread thiamine deficiency.
Objectives:
To test the hypothesis that heavy metal toxicity and consumption of thiaminase-containing foods predispose to symptomatic thiamine deficiency.
Study Design:
In a case-control study, thiamine diphosphate (TDP) blood concentrations were measured in 27 infants diagnosed with beriberi at a rural clinic, as well as their mothers and healthy Cambodian and American controls. Blood and urine levels of lead, arsenic, cadmium, mercury, and thallium were measured. Local food samples were analyzed for thiaminase activity.
Results:
Mean TDP level among cases and Cambodian controls was 48 and 56 nmol/L, respectively (P = .08) and was 132 nmol/L in American controls (P < .0001 compared with both Cambodian groups). Mean TDP level of mothers of cases and Cambodian controls was 57 and 57 nmol/L (P = .92), and was 126 nmol/L in American mothers (P < .0001 compared with both Cambodian groups). Cases (but not controls) had lower blood TDP levels than their mothers (P = .02). Infant TDP level decreased with infant age and was positively associated with maternal TDP level. Specific diagnostic criteria for beriberi did not correlate with TDP level. There was no correlation between heavy metal levels and either TDP level or case/control status. No thiaminase activity was observed in food samples.
Conclusions:
Thiamine deficiency is endemic among infants and nursing mothers in rural southeastern Cambodia and is often clinically inapparent. Neither heavy metal toxicity nor consumption of thiaminase-containing foods account for thiamine deficiency in this region.
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