Dr C P Ravikumar

The availability of good nutrition, especially in children during their developmental stage is extremely important. Children who do not have access to wholesome diets suffer from various nutritional deficiencies, one of which is Vitamin B1 or Thiamine deficiency.

Required Daily amount
    The daily recommended dietary allowances (RDAs) of thiamine are:
infants 0-6 months             0.2 mg
infants 7-12 months             0.3 mg
children 4-8 years             0.5 mg
children 4-8 years             0.6 mg
boys 9-13 years             0.9 mg
men 14 years and older             1.2mg
girls 9-13 years             0.9 mg
women 14-18 years             1mg
women over 18 years             1.1mg
pregnant women             1.4 mg
breast-feeding women             1.5 mg

Sources of Vitamin B1
Natural Sources of Vitamin B1
    • Thiamine is a type of Vitamin B that is present in
  • whole grains
  • brown rice
  • nuts
  • seeds
  • meat
  • fish.
    • In India, thiamine rich foods include
  • ground nuts
  • sesame seeds
  • soya bean seeds
  • mustard seed or oil
  • cashews.

Supplements of Vitamin B1
• Formula milk and cereals are fortified with thiamine.
• Supplements (oral) may be required for pregnant and lactating women, children or elderly patients

Health Benefits of Thiamine
Thiamine helps with the metabolism of carbohydrates leading to energy production in the body, thereby contributing to the growth, development, and function of cells. It helps to prevent Wernicke- Korsakoff syndrome in adults as well as thiamine deficiency in all age groups.

Deficiency of Vitamin B1
• Thiamine deficiency is seen in areas where the diet has a predominance of polished white rice, which is known to be low in vitamin B1.
• Infants of nutritionally deficient mothers who breast feed, also develop thiamine deficiency
• It may also occur due to decreased absorption of nutrients from food, due to problems with the stomach or intestinal lining, chronic diarrhea or vomiting.
Thiamine deficiency causing degenerative brain damage, was commonly seen in adults with chronic alcoholism and was called Wernicke’s Encephalopathy. It was often accompanied by Korsakoff syndrome, where patients had problems with memory and vision, were disoriented. They were often diagnosed as Wernicke- Korsakoff syndrome.
Children with thiamine deficiency may present with varied symptoms.

a. Initial symptoms may be mild, starting with irritability, refusal to feed, vomiting, constipation, difficulty breathing, loud incessant crying. This may progress to aphonia due to paralysis of the vocal cords.

b. Severe cases may present with
• Seizures
• reduced consciousness
• Muscle pains
• Muscle wasting
• Ataxia (lack of muscle co-ordination)
• Abnormal eye changes like nystagmus and ptosis (drooped eyelids),
• Vacant stare and lethargy.
• Untreated severe cases may lead to cardiac or respiratory failure.

It is imperative to get evaluated and treated for thiamine deficiency as soon as possible. Patients who survive after treatment, may still demonstrate intellectual disabilities, seizures, or difficulty in hearing.

Diagnosis of Thiamine Deficiency
In addition to the patient’s clinical findings, blood levels of Thiamine can be determined from serum or plasma. To get a better picture, tests for biomarkers like Thiamine Monophosphate (ThMP) Thiamine Diphosphate (ThDP) and erythrocyte transketolase (ETK) can also be done to determine thiamine metabolism in the body.

Management of Thiamine Deficiency
Thiamine supplements should be given at the earliest, either through oral medications and can also be given intra-muscularly or intra-venously. The treatment should also be supplemented with a diet rich in fortified foods to maintain adequate levels. New mothers with breast feeding infants can be guided on the correct nutritional plans, with top feed with formula milk advised if necessary. Clinical neurologists and pediatric neurologists help to treat the patient in case of any chronic and long-term effects of thiamine deficiency, like neuro-developmental issues or seizures, that children may face. Vitamin deficiency in children requires a holistic approach, beginning with awareness about good nutritional habits, enabling good diet practices in rural areas, as well as education about initial signs and symptoms so that patients can be brought earlier for treatment, before long term complications begin to set in.

Disclaimer: The above information is for awareness and education purposes only and cannot be used for diagnosis or treatment of any condition. Please consult with a physician for any concerns or questions

References:
http://www.indianpediatrics.net/aug2019/aug-673-681.htm#:~:text=In%20India%2C%20there%20are%20limited,usually%20have%20long%2Dterm%20sequelae.
Dr C P Ravikumar

Dr C P Ravikumar

CONSULTANT – PEDIATRIC NEUROLOGY
Aster CMI Hospital, Bangalore