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CLINICAL RESEARCH

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
Department of Nutrition
Division of Cardiovascular and Thoracic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
Department of Nutritional Sciences
^|| Heart and Stroke/Richard Lewar Centre of Excellence
^¶ Department of Public Health
^# 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

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