Thiamin Deficiency and Malaria in Adults from Southeast Asia

Published Paper

Field Exchange 5 contained an article which described micro-nutrient deficiency problems amongst Bhutanese refugees in Nepal and how in spite of marked improvements in the food basket low levels of these disorders persisted. Although there is no evidence to link the thiamin deficiency problem in these camps with specific illnesses, a recent piece of research in Thailand on the linkage between malarial infection and thiamin deficiency suggests that non-dietary factors can play a significant role in exacerbating thiamin deficiency.

The prospective study recruited patients with malaria or other febrile illness to a hospital in Thailand. The researchers utilised transketolase (an enzyme which is dependent on thiamin for activity) activity in erythrocytes as a measure of thiamin status. Twelve of the 23 patients with severe malaria and 10 of the 54 patients with uncomplicated malaria where found to have severe thiamin deficiency. The deficiency was most severe in those patients with cerebral malaria.

The following conclusions were drawn in the study:

1. although southeast Asian populations are particularly susceptible to the development of thiamin deficiency because of dietary factors like consumption of polished rice and thiaminase-containing foods, none of the controls had thiamin deficiency which suggests that there is an important relation between malaria infection and thiamin deficiency.
2. the host response to malaria may result in the depletion of thiamin stores. Malarial infection leads to a large increase in metabolic demand for glucose as well as a requirement for increased disposal of lactate. These stresses may exacerbate an underlying tendency towards thiamin deficiency.
3. this type of study should be repeated in different populations where malaria is endemic and where coincidental marginal thiamin deficiency may exist.

Reference

Krishna. S, et al (1999): Thiamin deficiency and malaria in adults from Southeast Asia, The Lancet, vol 353, Feb 13th, 1999