title: Clinically unapparent infantile thiamin deficiency in Vientiane, Laos.
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.
  
  
  RESULTS
  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
  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.
authors.affiliation: Department of Pediatrics, Mahosot Hospital, and Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic.
authors.forename: Sengmanivong
authors.initials: S
authors.lastname: Khounnorath
authors.forename: Karen
authors.initials: K
authors.lastname: Chamberlain
authors.forename: Ann M
authors.initials: AM
authors.lastname: Taylor
authors.forename: Douangdao
authors.initials: D
authors.lastname: Soukaloun
authors.forename: Mayfong
authors.initials: M
authors.lastname: Mayxay
authors.forename: Sue J
authors.initials: SJ
authors.lastname: Lee
authors.forename: Bounthom
authors.initials: B
authors.lastname: Phengdy
authors.forename: Khonsavanh
authors.initials: K
authors.lastname: Luangxay
authors.forename: Kongkham
authors.initials: K
authors.lastname: Sisouk
authors.forename: Bandit
authors.initials: B
authors.lastname: Soumphonphakdy
authors.forename: Khaysy
authors.initials: K
authors.lastname: Latsavong
authors.forename: Kongsin
authors.initials: K
authors.lastname: Akkhavong
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
authors.forename: Paul N
authors.initials: PN
authors.lastname: Newton
mesh_terms: D058070:Asymptomatic Diseases / Q000453:epidemiology*; D004912:Erythrocytes / Q000201:enzymology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007812:Laos / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D013832:Thiamine Deficiency / Q000453:epidemiology*; D014174:Transketolase / Q000378:metabolism
chemical_list: D014174:Transketolase