Thiamin status, diuretic medications, and the management of congestive heart failure.
OBJECTIVE
To assess the prevalence of thiamin deficiency in patients with congestive heart failure who are treated with diuretics that inhibit sodium and chloride reabsorption in the thick ascending limb of the loop of Henle (loop diuretic therapy).


METHODS
A cross-sectional investigation of thiamin status of consecutive patients with congestive heart failure being treated with loop diuretic therapy.


METHODS
Cardiology clinic of a midwestern tertiary-care medical center.


METHODS
Thirty-eight patients were recruited (mean age +/- standard deviation = 55 +/- 14 years). Validation of methodology was conducted with nine age-matched control subjects.


METHODS
Thiamin status was assessed biochemically by in vitro erythrocyte transketolase activity assay. Assessment of dietary intake of thiamin was accomplished with a semiquantitative food frequency questionnaire.


METHODS
Fisher's exact test and logistic regression were used to evaluate relationships between thiamin status and variables of interest.


RESULTS
Biochemical evidence of thiamin deficiency was found in 8 of 38 (21%) patients. Evidence of risk for dietary thiamin inadequacy was found in 10 of 38 patients (25%). Seven of the 8 patients with biochemical evidence of thiamin deficiency met study criteria for dietary adequacy, although quantified data suggested that only 4 of the patients achieved two thirds of the Recommended Dietary Allowance. Biochemical evidence of thiamin deficiency tended to be more common among patients with poor left ventricular ejection fractions (P = .07).


CONCLUSIONS
Thiamin deficiency may occur in a substantial proportion of patients with congestive heart failure, and dietary inadequacy may contribute to increased risk.
Brady
J A
JA
McAuley Health System, Ann Arbor, Mich., USA.
Rock
C L
CL
Horneffer
M R
MR
D000328:Adult; D000368:Aged; D002034:Bumetanide / Q000009:adverse effects / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D015930:Diet Records; D005260:Female; D018565:Food-Drug Interactions; D005665:Furosemide / Q000009:adverse effects / Q000627:therapeutic use*; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013831:Thiamine / Q000008:administration & dosage; D013832:Thiamine Deficiency / Q000139:chemically induced / Q000453:epidemiology* / Q000209:etiology; D016277:Ventricular Function, Left
D002034:Bumetanide; D005665:Furosemide; D013831:Thiamine