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Thiamine Deficiency from a Global Public Health Perspective

Weekly Seminar | Not Open to the Public
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Thiamine deficiency disorders, including beriberi, remain a pressing public health problem. Without rapid recognition of symptoms and treatment, it is often fatal, especially in infants, and can have lasting neurological effects for survivors. Over the last several years, we have created the Global Thiamine Alliance, which is a community of country representatives, public health professionals, physicians and researchers who are working to quantify the prevalence of thiamine deficiency disorders globally and create control and prevention strategies. Research projects undertaken as part of this alliance in Southeast Asia and Sub-Saharan Africa are increasing our understanding of the prevalence and impact of thiamine deficiency and are setting the stage future population health interventions. A placebo-controlled, dose-response randomized controlled trial in rural Cambodia has demonstrated that thiamine supplementation at levels close to the estimated average requirement (1.2 mg/day) are sufficient in raising breastmilk thiamine concentrations to adequate levels for infants. However, cognitive assessment of these infants suggests that higher levels (10 mg/day) are needed to optimize cognitive outcomes. However, the best predictor of cognitive outcomes was the baseline thiamine status of the mother at enrollment, which indicates that supplementation needs to start earlier than two weeks post-partum. A separate biomarker study of thiamine status in The Gambia has also shown that thiamine deficiency is likely occurring well outside of the classical geographical area of Southeast Asia. These new data confirm our hypothesis that there is likely an unrecognized prevalence of thiamine deficiency in other settings. The Global Thiamine Alliance is now working to raise awareness among the public health and medical professionals in areas where the diets are low in thiamine to ensure that its diagnosis is not overlooked and is preparing for a salt fortification trial in Cambodia as a population-wide intervention to prevent thiamine deficiency.

Dr. Megan Bourassa's Figure


Kyly C Whitfield, Megan W Bourassa, Bola Adamolekun, Gilles Bergeron, Lucien Bettendorff, Kenneth H Brown, Lorna Cox, Aviva Fattal-Valevski, Philip R Fischer, Elizabeth L Frank, Laurent Hiffler, Lwin Mar Hlaing, Maria Elena Jefferds, Hallie Kapner, Sengchanh Kounnavong, Maral P S Mousavi, Daniel E Roth, Maria-Nefeli Tsaloglou, Frank Wieringa 18, Gerald F Combs Jr
Thiamine deficiency disorders: diagnosis, prevalence, and a roadmap for global control programs
Ann N Y Acad Sci. 2018 Oct;1430(1):3-43. doi: 10.1111/nyas.13919. Epub 2018 Aug 27.
Megan W Bourassa, Gilles Bergeron, Kenneth H Brown
A fresh look at thiamine deficiency-new analyses by the global thiamine alliance
Ann N Y Acad Sci. 2021 May 3. doi: 10.1111/nyas.14594. Online ahead of print.
Megan W Bourassa, Saskia J M Osendarp, Seth Adu-Afarwuah, Saima Ahmed, Clayton Ajello, Gilles Bergeron, Robert Black, Parul Christian, Simon Cousens, Saskia de Pee, Kathryn G Dewey, Shams El Arifeen, Reina Engle-Stone, Alison Fleet, Alison D Gernand, John Hoddinott, Rolf Klemm, Klaus Kraemer, Roland Kupka, Erin McLean, Sophie E Moore, Lynnette M Neufeld, Lars-Åke Persson, Kathleen M Rasmussen, Anuraj H Shankar, Emily Smith, Christopher R Sudfeld, Emorn Udomkesmalee, Stephen A Vosti
Review of the evidence regarding the use of antenatal multiple micronutrient supplementation in low- and middle-income countries
Ann N Y Acad Sci. 2019 May;1444(1):6-21. doi: 10.1111/nyas.14121. Epub 2019 May 27.


Tuesday, July 27, 2021 - 12:30pm


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