Thiamine deficiency in Cambodian infants with and without beriberi.
OBJECTIVE
To test the hypothesis that heavy metal toxicity and consumption of thiaminase-containing foods predispose to symptomatic thiamine deficiency.


METHODS
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.
Eastern Mennonite Mission, Prey Veng, Cambodia.
Debra
D
Coats
Kelsey
K
Shelton-Dodge
Kevanna
K
Ou
Vannara
V
Khun
Sommon
S
Seab
Kimsan
K
Sok
Chiva
C
Prou
Silvia
S
Tortorelli
Thomas P
TP
Moyer
Lisa E
LE
Cooper
Tadhg P
TP
Begley
Felicity
F
Enders
Philip R
PR
Fischer
Mark
M
Topazian
D044466:Asian People; D001602:Beriberi / Q000150:complications / Q000175:diagnosis*; D002160:Cambodia; D016022:Case-Control Studies; D005260:Female; D006400:Hematocrit; D006801:Humans; D006867:Hydrolases / Q000378:metabolism; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019216:Metals, Heavy / Q000633:toxicity; D012424:Rural Population; D013831:Thiamine; D013832:Thiamine Deficiency / Q000150:complications / Q000175:diagnosis* / Q000209:etiology*; D013835:Thiamine Pyrophosphate / Q000097:blood
D019216:Metals, Heavy; D006867:Hydrolases; C022731:thiaminase II; D013835:Thiamine Pyrophosphate; D013831:Thiamine