ABSTRACT
Often thought to be a nutritional issue limited to low- and middle-income countries (LMICs), pediatric thiamine deficiency (PTD) is perceived as being eradicated or anecdotal in high-income countries (HICs). In HICs, classic beriberi cases in breastfed infants by thiamine-deficient mothers living in disadvantaged socioeconomic conditions are thought to be rare. This study aims to assess PTD in HICs in the 21st century. Literature searches were conducted to identify case reports of PTD observed in HICs and published between 2000 and 2020. The analyzed variables were age, country, underlying conditions, clinical manifestations of PTD, and response to thiamine supplementation. One hundred and ten articles were identified, totaling 389 PTD cases that were classified into four age groups: neonates, infants, children, and adolescents. Eleven categories of PTD-predisposing factors were identified, including genetic causes, lifestyle (diabetes, obesity, and excessive consumption of sweetened beverages), eating disorders, cancer, gastrointestinal disorders/surgeries, critical illness, and artificial nutrition. TD-associated hyperlactatemia and Wernicke encephalopathy were the most frequent clinical manifestations. The circumstances surrounding PTD in HICs differ from classic PTD observed in LMICs and this study delineates its mutiple predisposing factors. Further studies are required to estimate its magnitude. Awareness is of utmost importance in clinical practice.
Subject(s)
Thiamine Deficiency/epidemiology , Age Factors , Beriberi/epidemiology , Beriberi/etiology , Beriberi/history , Child , Developed Countries , Disease Management , Disease Susceptibility , History, 21st Century , Humans , Infant , Infant, Newborn , Public Health Surveillance , Socioeconomic Factors , Thiamine/metabolism , Thiamine Deficiency/diagnosis , Thiamine Deficiency/etiology , Thiamine Deficiency/historySubject(s)
Anemia, Megaloblastic/genetics , Diabetes Mellitus/genetics , Hearing Loss, Sensorineural/genetics , Thiamine Deficiency/congenital , Anemia, Megaloblastic/history , Child , Diabetes Mellitus/history , Female , Hearing Loss, Sensorineural/history , History, 20th Century , Humans , Membrane Transport Proteins , Mutation , Thiamine Deficiency/genetics , Thiamine Deficiency/historyABSTRACT
One of the earliest vitamins to be discovered and synthesized, thiamin was originally spelled with an "e". The terminal "e" was dropped when it was found that it was not an amine. It is still spelled with and without the "e" depending on the text. This chapter provides a brief historical review of the association of thiamin with the ancient scourge of beriberi. It emphasizes that beriberi is the model for high calorie malnutrition because of its occurrence in predominantly white rice consuming cultures. Some of the symptomatology of this ancient scourge is described, emphasizing the difference from that seen in starvation. High calorie malnutrition, due to excessive ingestion of simple carbohydrates, is widely encountered in the U.S.A. today. Thiamin deficiency is commonly associated with this, largely because of its cofactor status in the metabolism of glucose. The biochemistry of the three phosphorylated esters of thiamin and the transporters are discussed and the pathophysiology of thiamin deficiency reviewed. The role of thiamin, and particularly its synthetic derivatives as therapeutic agents, is not fully appreciated in Western civilization and a clinical section describes some of the unusual cases described in the scientific literature and some experienced by the author. The possible role of high calorie malnutrition and related thiamin deficiency in juvenile crime is hypothesized.
Subject(s)
Thiamine/physiology , Animals , Beriberi/epidemiology , Beriberi/etiology , Beriberi/history , History, 20th Century , History, 21st Century , Humans , Membrane Transport Proteins/metabolism , Thiamine/analogs & derivatives , Thiamine/therapeutic use , Thiamine Deficiency/complications , Thiamine Deficiency/epidemiology , Thiamine Deficiency/history , Thiamine Deficiency/therapy , Thiamine Triphosphate/physiologyABSTRACT
Ways in which chemical techniques could be applied to the understanding of neural systems, their functioning and their disorders were devised only gradually during the present century. In a particularly successful procedure, now termed assay-guided isolation, neural defects were made good by means of tissue-extracts and the restoration of function was established as an assay-system to guide the chemical separation and identification of the active tissue constituent. Thiamin was so isolated, using an experimental polyneuritis assay; subsequent instances among other metabolites, hormones, neurotransmitters and nerve growth factors are recounted. Procedures of assay-guided characterization ensured that links were retained between specific, sparsely-occurring substances and chosen aspects of their biological roles while their chemical nature was first explored and then established. The procedures discouraged the too-facile postulating of hypothetical molecules and contributed to the distinctiveness of neurochemistry as a subject within the neurosciences.
