This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2005.08.060v1 47/2/354    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (17) Citing Articles via Google Scholar Google Scholar Articles by Hanninen, S. A. Articles by Keith, M. E. Search for Related Content PubMed PubMed Citation Articles by Hanninen, S. A. Articles by Keith, M. E.

CLINICAL RESEARCH: HEART FAILURE

The Prevalence of Thiamin Deficiency in Hospitalized Patients With Congestive Heart Failure

Stacy A. Hanninen, RD, MSc^_*,, Pauline B. Darling, PhD, RD^,, Michael J. Sole, MD, FRCPC, FACC^||,_**, Aiala Barr, PhD^¶ and Mary E. Keith, PhD^,#,_*

^_* Heart and Vascular Program, St. Michael’s Hospital, Toronto, Ontario, Canada
Department of Nutrition, St. Michael’s Hospital, Toronto, Ontario, Canada
Division of Cardiovascular and Thoracic Surgery, St. Michael’s Hospital, Toronto, Ontario, Canada
Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
^|| Heart and Stroke/Richard Lewar Centre of Excellence, University of Toronto, Toronto, Ontario, Canada
^¶ Department of Public Health, University of Toronto, Toronto, Ontario, Canada
^# Department of Surgery, University of Toronto, Toronto, Ontario, Canada
^_** Division of Cardiology, University Health Network, Toronto, Ontario, Canada.

Manuscript received December 15, 2004; revised manuscript received August 9, 2005, accepted August 23, 2005.

^_* Reprint requests and correspondence: Dr. Mary E. Keith, Research Associate, Cardiovascular and Thoracic Surgery, 8 Bond Wing, Suite 003J, St. Michael’s Hospital, MB5 1W8. (Email: keithm{at}smh.toronto.on.ca).

OBJECTIVES: The purpose of this study was to determine the prevalence of thiamin deficiency (TD) in a cross section of hospitalized congestive heart failure (CHF) patients and to investigate factors that contribute to its development.

BACKGROUND: Thiamin deficiency manifests as symptoms of CHF and, therefore, may worsen existing heart failure. Congestive heart failure patients may be at increased risk for TD as a result of diuretic-induced urine thiamin excretion, disease severity, malnutrition, and advanced age.

METHODS: Erythrocyte thiamin pyrophosphate concentrations, using high-performance liquid chromatography, were measured in 100 CHF patients and compared to 50 control subjects. Variables including diuretics (type and dose), left ventricle dysfunction, New York Heart Association functional classification, creatinine clearance, thiamin intake (diet and supplements), malnutrition, appetite ratings, and age were related to TD using univariate statistics and multiple logistic regression analysis.

RESULTS: Thiamin deficiency was more prevalent in CHF patients (33%) compared to control subjects (12%) (p = 0.007). Thiamin deficiency was related to urine thiamin loss (p = 0.03), non-use of thiamin-containing supplements (p = 0.06), and preserved renal function (p = 0.05). Increased urinary thiamin loss (µg/g creatinine) was found to be the only significant positive predictor of thiamin status on multiple logistic regression analysis (p = 0.03).

CONCLUSIONS: One-third of hospitalized CHF patients were TD. In contrast to previous studies, increased urinary losses of thiamin were predictive of improved thiamin status. Thiamin supplementation may be protective against TD in the clinical setting. Future studies are warranted to determine if thiamin supplementation improves thiamin status and disease severity in CHF patients.

Abbreviations and Acronyms   CHF = congestive heart failure   CI = confidence interval   EAR = estimated average requirement   EF = ejection fraction   HPLC = high-performance liquid chromatography   LV = left ventricular   SGA = subjective global assessment   TD = thiamin deficiency   TPP = thiamin pyrophosphate

This article has been cited by other articles:

				K. Sriram, W. Manzanares, and K. Joseph Thiamine in Nutrition Therapy Nutr Clin Pract, February 1, 2012; 27(1): 41 - 50. [Abstract] [Full Text] [PDF]

				R. Kumar, H. D. Nguyen, J. A. Ogren, P. M. Macey, P. M. Thompson, G. C. Fonarow, M. A. Hamilton, R. M. Harper, and M. A. Woo Global and regional putamen volume loss in patients with heart failure Eur J Heart Fail, June 1, 2011; 13(6): 651 - 655. [Abstract] [Full Text] [PDF]

				L. F. P. d. Lima, H. P. Leite, and J. A. d. A. Taddei Low blood thiamine concentrations in children upon admission to the intensive care unit: risk factors and prognostic significance Am J Clin Nutr, January 1, 2011; 93(1): 57 - 61. [Abstract] [Full Text] [PDF]

				P. Singer and I. Kagan Chapter 31 Nutrition support in acute cardiac care The ESC Textbook of Acute and Intensive Cardiac Care, December 1, 2010; 1(1): med-9780199584314-chapter - med-9780199584314-chapter. [Abstract] [Full Text] [PDF]

				V. Soukoulis, J. B. Dihu, M. Sole, S. D. Anker, J. Cleland, G. C. Fonarow, M. Metra, E. Pasini, T. Strzelczyk, H. Taegtmeyer, et al. Micronutrient Deficiencies: An Unmet Need in Heart Failure J. Am. Coll. Cardiol., October 27, 2009; 54(18): 1660 - 1673. [Abstract] [Full Text] [PDF]

				J. A. Wooley Characteristics of Thiamin and Its Relevance to the Management of Heart Failure Nutr Clin Pract, October 1, 2008; 23(5): 487 - 493. [Abstract] [Full Text] [PDF]