Thiamine deficiency and cardiac dysfunction in Cambodian infants

J Pediatr. 2014 Jun;164(6):1456-61. doi: 10.1016/j.jpeds.2014.01.049. Epub 2014 Mar 5.


Objectives: To compare blood thiamine concentrations, echocardiography findings, and plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in infants with clinically diagnosed beriberi and healthy matched controls, and to evaluate changes after thiamine treatment.

Study design: Sixty-two Cambodian infants (20 cases and 42 controls), aged 2-47 weeks, were enrolled in this prospective study. Echocardiography and phlebotomy were performed at baseline and after thiamine treatment.

Results: Both cases and controls were thiamine-deficient, with median blood thiamine diphosphate (TDP) concentrations of 47.6 and 55.1 nmol/L, respectively (P = .23). All subjects had normal left ventricular ejection fraction. The median NT-proBNP concentration in cases (340 pg/mL [40.1 pmol/L]) was higher than previously reported normal ranges, but not statistically significantly different from that in controls (175 pg/mL [20.7 pmol/L]) (P = .10), and was not correlated with TDP concentration (P = .13). Two cases with the lowest baseline TDP concentrations (24 and 21 nmol/L) had right ventricular enlargement and elevated NT-proBNP levels that improved dramatically by 48 hours after thiamine administration.

Conclusion: Only a minority of thiamine-deficient Cambodian infants demonstrate abnormal echocardiography findings. Thiamine deficiency produces echocardiographic evidence of right ventricular dysfunction, but this evidence is not apparent until deficiency is severe. NT-proBNP concentrations are mildly elevated in sick infants with normal echocardiography findings, indicating possible physiological changes not yet associated with echocardiographic abnormalities.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asian People / statistics & numerical data
  • Beriberi / blood
  • Beriberi / complications
  • Beriberi / ethnology
  • Biomarkers / metabolism
  • Case-Control Studies
  • Echocardiography, Doppler / methods
  • Female
  • Follow-Up Studies
  • Heart Function Tests
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Natriuretic Peptide, Brain / blood*
  • Peptide Fragments / blood*
  • Reference Values
  • Risk Assessment
  • Severity of Illness Index
  • Thiamine Deficiency / blood
  • Thiamine Deficiency / complications*
  • Thiamine Deficiency / drug therapy
  • Thiamine Deficiency / ethnology
  • Thiamine Pyrophosphate / blood
  • Thiamine Pyrophosphate / therapeutic use*
  • Treatment Outcome
  • Ventricular Dysfunction, Left / diagnosis
  • Ventricular Dysfunction, Left / ethnology
  • Ventricular Dysfunction, Left / etiology*


  • Biomarkers
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • Thiamine Pyrophosphate