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Thiamine Deficiency in Hospitalized Veterans Without Alcohol Use Disorder: Prevalence, Biomarker Assessment, and
Elisabeth A Mates1, Alexandrea Kilgore-Gomez2, Claire Phibbs3
1Department of Medicine, VA Sierra Nevada Healthcare System, Reno, NV 89502, USA.
Background:
Thiamine deficiency (TD) causes thiamine deficiency disorders (TDDs) which are frequently overlooked in food-secure countries such as the United States (U.S.). Lack of awareness and the absence of validated, rapidly available biomarkers perpetuate underdiagnosis. Our objective was to determine prevalence of TD in hospitalized U.S. veterans without alcohol use disorder (AUD) and describe clinical characteristics of TDDs. A secondary objective was to evaluate the utility of plasma and whole-blood thiamine biomarkers in identifying thiamine-responsive disorders (TRDs).
Methods:
Newly hospitalized veterans without AUD were recruited. Fasting plasma and whole-blood thiamine were obtained. Interview, physical exam, and chart review were completed to assess clinical signs of TD. Participants were invited to return after thiamine repletion and changes in symptoms and exam findings were noted.
Results:
A total of 286 participants were enrolled: 261 had plasma thiamine results, 259 had whole-blood thiamine results, 179 completed interviews, 164 completed initial examination, and 60 returned for reexamination after repletion. A majority (86.59%) had potential signs or symptoms of TDDs, 26.44% had low plasma thiamine, 2.70% had low whole-blood thiamine, and 97.92% with low plasma thiamine had clinical signs of TDDs and many experienced multiple TD syndromes. Those with low plasma thiamine who returned after repletion showed improvements in cognitive scores (p = 0.0093) and motor strength (p = 0.0417), and most reported symptom improvement. Whole-blood thiamine missed many cases of TRDs.
Conclusions:
TD affects one quarter of hospitalized veterans without AUD. Low plasma thiamine identifies TRDs more frequently than low whole-blood thiamine. Using clinical criteria alone to diagnose TDDs overestimates cases and biomarker confirmation appears necessary.
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