title: Thiamine pharmacokinetics in Cambodian mothers and their breastfed infants.
abstract: BACKGROUND
  Thiamine deficiency is common in parts of Asia and causes beriberi. Pharmacokinetics of thiamine in deficient populations are unknown.
  
  
  OBJECTIVE
  We characterized thiamine pharmacokinetics in Cambodian mothers and their breastfed infants.
  
  
  METHODS
  Total plasma thiamine, whole-blood thiamine diphosphate (TDP), and breast milk total thiamine were measured in 16 healthy Cambodian mothers and their infants before and after mothers received oral thiamine hydrochloride (100 mg for 5 d). Assays were also performed in 16 healthy American mothers.
  
  
  RESULTS
  On day 1, Cambodian mothers were thiamine deficient, with median (range) total plasma thiamine and TDP concentrations of 2.4 nmol/L (0-4.4 nmol/L) and 58.0 nmol/L (27-98 nmol/L), respectively. After a single oral dose, the mean ± SD maximal concentration of thiamine and net area under the thiamine concentration-time curve were 73.4 ± 45.6 nmol/L and 465 ± 241 h · nmol ∙ L⁻¹. Day 6 median maternal total plasma thiamine and TDP concentrations were normal [18.6 nmol/L (13.4-25.3 nmol/L) and 76.5 nmol/L (48-107 nmol/L), respectively; P ≤ 0.001 compared with day 1]. Median Cambodian total breast milk thiamine concentration increased from 180 nmol/L (85-359 nmol/L) on day 1 to 403 nmol/L (314-415 nmol/L) on day 2 and 503 nmol/L (360-808 nmol/L) on day 6; the corresponding American breast milk value was 500 nmol/L (114-622 nmol/L). Median Cambodian infant total plasma thiamine and TDP concentrations increased from 3.0 nmol/L (0-7.3 nmol/L) and 38.5 nmol/L (23-57 nmol/L), respectively, on day 1 to 5.6 nmol/L (0-9.7 nmol/L) and 45.5 nmol/L (32-70 nmol/L), respectively, on day 6.
  
  
  CONCLUSIONS
  Thiamine-deficient Cambodian mothers effectively absorb oral thiamine, with sharp increases in breast milk thiamine concentrations, but their breastfed infants remain thiamine deficient after 5 d of maternal supplementation. Longer-term maternal supplementation may be necessary to correct thiamine deficiency in breastfed infants. This trial was registered at clinicaltrials.gov as NCT01864057.
authors.affiliation: Eastern Mennonite Missions, Prey Veng, Cambodia.
authors.forename: Debra
authors.initials: D
authors.lastname: Coats
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Frank
authors.forename: Joel M
authors.initials: JM
authors.lastname: Reid
authors.forename: Kevanna
authors.initials: K
authors.lastname: Ou
authors.forename: Mary
authors.initials: M
authors.lastname: Chea
authors.forename: Mengkheang
authors.initials: M
authors.lastname: Khin
authors.forename: Chiva
authors.initials: C
authors.lastname: Preou
authors.forename: Felicity T
authors.initials: FT
authors.lastname: Enders
authors.forename: Philip R
authors.initials: PR
authors.lastname: Fischer
authors.forename: Mark
authors.initials: M
authors.lastname: Topazian
mesh_terms: D000328:Adult; D000569:Americas; D001602:Beriberi / Q000209:etiology / Q000517:prevention & control; D001942:Breast Feeding; D002160:Cambodia; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007223:Infant; D007774:Lactation / Q000378:metabolism*; D008895:Milk, Human / Q000378:metabolism*; D009035:Mothers; D013831:Thiamine / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D013832:Thiamine Deficiency / Q000097:blood / Q000188:drug therapy / Q000378:metabolism*; D013835:Thiamine Pyrophosphate / Q000097:blood; D055815:Young Adult
chemical_list: D013835:Thiamine Pyrophosphate; D013831:Thiamine