Establishing a case definition of thiamine responsive disorders among infants and young children in Lao PDR: protocol for a prospective cohort study

Annals of the New York Academy of Sciences

Johnson

Koshy³

et al. 2020

Thiamine is an essential water‐soluble vitamin that plays an important role in energy metabolism. Thiamine deficiency presents many challenges to clinicians, in part due to the broad clinical spectrum, referred to as thiamine deficiency disorders (TDDs), affecting the metabolic, neurologic, cardiovascular, respiratory, gastrointestinal, and musculoskeletal systems. Concurrent illnesses and overlapping signs and symptoms with other disorders can further complicate this. As such, TDDs are frequently misdiagnosed and treatment opportunities missed, with fatal consequences or permanent neurologic sequelae. In the absence of specific diagnostic tests, a low threshold of clinical suspicion and early therapeutic thiamine is currently the best approach. Even in severe cases, rapid clinical improvement can occur within hours or days, with neurological involvement possibly requiring higher doses and a longer recovery time. Active research aims to help better identify patients with thiamine‐responsive disorders and future research is needed to determine effective dosing regimens for the various clinical presentations of TDDs. Understanding the clinical diagnosis and global burden of thiamine deficiency will help to implement national surveillance and population‐level prevention programs, with education to sensitize clinicians to TDDs. With concerted effort, the morbidity and mortality related to thiamine deficiency can be reduced.

Section: Treatment and Prevention Of Tddsmentioning

confidence: 99%

Thiamine deficiency disorders: a clinical perspective

Annals of the New York Academy of Sciences

Johnson

Koshy³

et al. 2020

“…ultrasonography) are not available. We are currently conducting a prospective cohort study among hospitalised infants and young children in Laos that aims to fill this knowledge gap by developing a case definition for TRD, assess the associations between TRD and biomarkers of thiamine status and explore risk factors associated with TRD and biochemically defined thiamine deficiency (Hess et al 2020…”

Section: Development Of a Standardised Clinical Case Definition Of Thiamine Responsive Disorders (Trd)mentioning

confidence: 99%

“…As a response to thiamine is often described as rapid, a response to thiamine is defined as a response within 48–72 hours, with the assumption that a response to antibiotics and other treatments and medications would require a longer period of time. A community cohort of age, sex and village of residence matched infants will serve as a comparison group for the evaluation of potential predictors of TRD and thiamine deficiency in a non‐hospitalised cohort (Hess et al 2020…”

Section: Development Of a Standardised Clinical Case Definition Of Thiamine Responsive Disorders (Trd)mentioning

confidence: 99%

Infantile thiamine deficiency in South and Southeast Asia: An age‐old problem needing new solutions

Hess

2021

Nutrition Bulletin

Infantile beriberi, a potentially fatal disorder caused by thiamine deficiency, is often viewed as a disease confined to history in regions of the world with predominant white rice consumption. Recent case reports have, however, highlighted the persistence of thiamine deficiency as a cause of infant mortality in South and Southeast Asia. Low infant thiamine status and incidence of beriberi is attributable to maternal thiamine deficiency and insufficient breast milk thiamine. Poor dietary diversity, food preparation and cooking practices and traditional post-partum food restrictions likely play a role in these high-risk regions. Given the contribution of thiamine deficiency to infant mortality and emerging evidence of long-lasting neurodevelopmental deficits of severe and even subclinical deficiency in early life, public health strategies to prevent thiamine deficiency are urgently needed. However, efforts are hampered by uncertainties surrounding the identification and assessment of thiamine deficiency, due to the broad nonspecific clinical manifestations, commonly referred to as thiamine deficiency disorders (TDD), that overlap with other conditions resulting in frequent misdiagnosis and missed treatment opportunities, and secondly the lack of readily available and agreed upon biomarker analysis and cutoff thresholds. This review will discuss the key challenges and limitations in the current understanding of TDD and explore how ongoing initiatives plan to fill persistent knowledge gaps, namely in the development of a standardised case definition to help more accurately diagnose and treat TDD in low-resource settings. Given more attention and ensuring greater recognition of TDD will support the design and implementation of treatment and prevention programmes, and ensure beriberi can truly be considered 'the forgotten disease of Asia'.

“…Although local knowledge of restrictive diets is widespread in Laos, there has been little in-depth exploration of these practices. The aim of this analysis was to describe commonly consumed and restricted foods and attainment of minimum dietary diversity (MDD-W) among postpartum women in Laos.Data were collected from 323 mother-child (aged 21 days -<18months) dyads participating in the Lao Thiamine Study (3) , an ongoing prospective cohort study in Laos. Mothers reported which foods were either consumed or restricted in weekly (for the first four weeks) and monthly intervals postpartum until 6 months and then subsequent months (7-18).…”

mentioning

confidence: 99%

“…Data were collected from 323 mother-child (aged 21 days -<18months) dyads participating in the Lao Thiamine Study (3) , an ongoing prospective cohort study in Laos. Mothers reported which foods were either consumed or restricted in weekly (for the first four weeks) and monthly intervals postpartum until 6 months and then subsequent months (7-18).…”

mentioning

confidence: 99%

Traditional postpartum food restrictions among women in northern Laos: preliminary analysis of an ongoing prospective cohort study

Tan

Sitthideth³

et al. 2021

Proc. Nutr. Soc.

Highly restrictive, deeply rooted traditional diets are common among postpartum women in Laos, with some women limiting their diet to just rice and salt after delivery (1,2) . Animal source foods and vegetables may also be consumed, often in small quantities (1) . Food restrictions continue for 2 days to 2-3 years and vary between, and even within, different ethnic groups. Although local knowledge of restrictive diets is widespread in Laos, there has been little in-depth exploration of these practices. The aim of this analysis was to describe commonly consumed and restricted foods and attainment of minimum dietary diversity (MDD-W) among postpartum women in Laos.Data were collected from 323 mother-child (aged 21 days -<18months) dyads participating in the Lao Thiamine Study (3) , an ongoing prospective cohort study in Laos. Mothers reported which foods were either consumed or restricted in weekly (for the first four weeks) and monthly intervals postpartum until 6 months and then subsequent months (7-18). Dietary intake in the previous 24 hours was gathered to determine MDD-W ( 4 ) . K-means cluster analysis classified women into groups based on similar food group restriction patterns.Mean ± SD maternal age was 24.9 ± 6.5 years and 95% were breastfeeding their child. Almost all women (97%) reported adhering to food restrictions after delivery for a median (IQR) length of time of 1 (1, 3) month (range 1 week to 36 months). Rice consumption was universal throughout the postpartum period. Cluster analysis revealed four distinct dietary patterns. One cluster of women were characterised by very restrictive diets in postpartum months 1 and 2, with less than 10% of women consuming any type of meat, poultry, fish, eggs, vegetables or fruits for 2 months (n = 60). A second cluster of women were the least restrictive, with 67-100% of women consuming most food groups (n = 45). A third cluster widely consumed vegetables in the first month postpartum (92-100%), but with minimum consumption of all other food groups (<15%) (n = 52). A final cluster of women were very restricted in the first month postpartum, with only 0-6% of women consuming food groups other than rice, but who resumed their normal diet in the second month postpartum (n = 161). Tradition within the family or ethnic group was the primary reason for following food restrictions reported by 82% of women. Just 16% of women achieved MDD-W. Among women not following a restricted diet at the time of the interview, 18% achieved MDD-W, compared to 11% of women following dietary restrictions at the time (p = 0.12).Postpartum dietary restrictions are widespread among women in northern Laos. These highly restrictive diets and poor dietary diversity likely contribute to micronutrient deficiencies in mothers that may have important consequences for their breastfed infants through reduced micronutrient content of breastmilk, which requires further exploration.