THE

AMERICAN

Vol.

JOURNAL

23,

No.

8,

OF

Printed

Original

CLINICAL

1970,

August,

in

NUTRITION

pp.

1017-1026

U.S.A.

Communications

Clinical

and Biochemical
of Adult
Beriberi13

VICHAI

TANPHAICHITR,4

DHANAMITrA,#{176}

AND

RIN

AND

that

HIS

the

ketolase

activity

(ETK)
defect
clinical

Several

dietary

survey

stimulatory

the

these

beriberi

is still
It

(4-6)

Bangkok,
on

(7)

on
indicate

health

if a correlation

exists

tests,
and

the

study

between

including
of

effect,

beriberi

the

Hospital

and

Hospital,
2

Faculty
the

Health

of

part

A-592l,

Center,

and

and

Bangkok,

by

National

the

SEATO

Thai

the

Ramathibodi

Medicine

University,

in

Grant

search

Medicine,

Faculty

Mahidol

Supported

of

Siriraj

Thailand.

of

Clinical

National

requests

M.D.,

I)epartment

pital,

Rama

of

VI

Instructor,
of

Lecturer,

#{176}

Road,

reprints

to:

Pediatrics,

Re

Research

of

Department

Ramathibodi

Chairman,

Department

Medicine,

Ramathibodi

Faculty

Hospital.

Biochemistry,

Medicine,

Hos-

Medicine,

Faculty
of

Pediatrics,

Hospital.
of

Pediatrics,

wards

until

Faculty
Faculty

causes,

based

the

with
or
failure

peripheral

of

samples

thia-

without
in wet

neuropathy

and

4) good

of

clini-

for

activity
usually

istration

(30 mm,
thiamin

thiamin

administration.

of

Hospital.
1017

at

Sauberlich
hemoglobin

2 hr,
was

with
(8)

was

Erythrocyte

effect

were

thiamin

24 hr,

in some

using
of

and

is expressed
hemolysate

cases).

at 24 hr

measured

the

again
admin-

modifications
of

the

hydro-

the

of micrograms
in

weeks.

determined

activity

imby

thiamin

after

or

after-

followed

TPP

1 hr

paren-

daily

markedly

mg

2-4
and

treated

given

was

another

de-

effect
thiaof

then

and

10-30

the

consumption

were

This
of

transketolase

appearance

of

patients

Urinary

for
TPP
before

were

of admission

administration

(1)

before

patients

weeks).

ETK

drawn

hydrochloride

day

chloride/day

and

and

and
All

the

technique

were

activity
and
were
collected

thiamin

the

(1-8

The

Sciences.

Professor

100 mg
on

Lecturer,

of

edema
of cardiac

of ETK
specimens

measured

Valyasevi,

4, Thailand.

Ramathibodi

of

Aree

Ramathibodi

Bangkok

Department

Medicine,

Department

for

was

suggested

2)

known

Hospital,

diagnosis
that

evidence

Blood

terally

oral

Council.
Address

3)

other

proved

Institute

history

P1
diagnosed

at Siriraj

The

mm
administration
the hospital
diet.

in

with
From

studied

was low,
and
signs

termination
and
urine

adlults.
1

dietary

istration.

urinary
TPP

manifestations

were

observations,
clinically

cal response
to thiamin
administration.
Serial
chest
roentgenograms
and
electrocardiograms
were
obtained
before
and after
thiamin
admin-

in

this

beriberi,
without

that

problem
of

and

were

Thailand.

1)

METHODS

(22

twice)

mm
intake
symptoms

ETK

AND

patients

admitted

as beriberi

thiamin

effect)

purpose

excretion

(1-

pyrophosphate

a public

clinical

was

using

urinary

the

Twenty-one

the

deficiency

Thailand

critelia

biochemical

thiamin

detect
appear

(TPP

was

to determine

and!

thiamin

D.SC.

MATERIALS

trans-

to

thiamin

as

Thailand.
the

in
in

effect
of

used

D.SC.

D.SC.

M.D.

shown

erythrocyte

be

VIMOKESANT,5

M.D.,

VALYASEVI,7

have

techniques,

or

all

AREE

manifestations

studies

excretion,
or

of

can

biochemical
before
3).

CO-WORKERS

L.

SERENE

M.D.,

SAKHORN

Studies

Brins
Bunce

as

pentose

after

the

per
per

hour

disgram
of

Tanphaichitr

1018
TABLE

Description

of patients

and

types

of

on

beriberi

Sex

Age

Occupation

The
biochemical
tests
also
were
10 patients
suffering
from
various

eases

except

beriberi,

specificity
of
the
possibility

Patients

and type
of beriberi

et a!.

Residency

contribute
Vet
P1

21

Unemployed

Nakorn

22

P3

60

Unclnployed

Bangkok

p4

57

Unemployed

Bangkok

p5

43

Carpenter

Kanchana-

P6

18

Student

Samut-

P7

17

Factoryworker

Bangkok

P8

15

Factory

P9

50

Farmer

Nontabuni

plo

17

Student

Thonburi

P11

48

Unemployed

Thonburi

P12

17

Blacksmith

Bangkok

P13

17

Jeweller

Bangkok

P14

17

Farmer

Non

P15

18

Farmer

Chacherng-

P16

16

Trader

Samutsak-

Carpenter

to

to

UlO.

mm

pathom
P2

Ui

Hau-Hin

U7

to the

presence
the

to

Bangkok

Description

I shows

patient

hospital
percent

taburi

P1

twice,
of

having

the

patients

the
from

of

Thonbuni

Shoemaker

Bangkok

under

20

Student

Bangkok

P20

66

Farmer

Suphanburi

45 years.
Their
milled
rice with

P21

15

Vatch

_________
Sawan

incubation.
The
TPP
effect
is expressed
as
percent
stimulation
of the enzyme
by added
thiamin
pyrophosphate.
The estimation
of uri-

of thiamin
Both

(9) and

per
ETK

cretion

were

subjects,

age

tion,

urinalysis,

chest

X-ray

ranging

hr
again

Five

after

physicians
tests

the

rest

physical

including

received

parenterally
of blood
thiamin
for

and

Three

had

blood

the

initial
At

1 and

and

of

gave

the

1-2

weeks

for

to

the

hospital.

had

changed

rice

(Oryza

rice

(Oryza

the

onset
to

P11

had

had

given

before

Clinical

were

of

over

food
was
of cooked

of

pork

home-pounded
to

disease,

history

glutinous
milled

ordinary

2 months

prior

respectively.

of drinking

a chronic
patients

received

alcohol,

(P17,
multivitamin

to

the

In

alcoholic
1 year

drinking

admission

consump-

to their
admission
patients,
P12 and P13,

1 and

the

up

km
were

prior

saliva),

Four
had

history
Two

been

29%

source
portions

glutinosa)

the

gard

50

patients

Meat
was occasionally
P7 and
PS,
who
were

from

of

of

Bangkok,

within

the
and

small

siblings,
tion

age;

major

vegetables.
except

P21)

findhy-

years

fish and
consumed,

mission.

examinastudy,

samples.

vari-

examinations

revealed
normal
100 mg thiamin
after

urine

exThai

21 to 40 years.

electrocardiographic

subjects

drawn

thiamin

in 24 control

and

Routine

(10).

urinary

from

examination

drochloride
lection

and

determined

thio-

as micrograms

creatinine

activity
also

of them were
ous occupations.
and laboratory

ings.

gram

expressed

the

25

as

76%

in
or

of

the

diagnosed

interest,

either

62%

Trader

to

Fifty-four

were
Of

Thailand,

35

Nakorn

apart.

Bangkok;

and
of this

period

admitted

resided

capital

51

method

a
the

Habits

occupations,

was

patients

chrome

further

UlO.

the

beriberi.

by

no

various

For instance,
detected
in

10 months

the

wet

P18
P19

done

U8
thia-

but

In
after

Dietary

sex,

During

P17

was

hospital,

and

age,

beriberi.

of

study,

horn

excretion

to the

in
with

treated

was observed.
was established

of Patients

Table
types

sao

thiamin

in patients

RESULTS

Dry

nary

the

neuritis

were

prakarn

repairer

of edema

admitted

improvement
the diagnosis

establish

and to exclude
deficiency
might

peripheral

patients

first

to

investigations
were performed.
large
amount
of arsenic
was
urine of patients
U8,
U9,
and

bun

worker

order

treatment
thiamin

and
These

when

clinical
cases,

in

thiamin
that

performed
other
dis-

only

but

prior
P18,

to
re-

he

to adP20,

and

injections

hospital.

Manifestation

col24

injection,
blood
samples
were
ETK
activity
and TPP
effect.

Two

major

systems,

and
nervous
systems,
dence
of peripheral

the
were
neuritis

cardiovascular
involved.
Eviwas observed

Adult
both

in

wet

portant

and

beriberi

were

muscles

dry

and

difficulty

in

all

whereas
and

P21.

impaired!

months
time

taken

weakness,
21

for

the

was
(lid

Absent
jerks

in

after

the

hypoactive

16

patients

Edlema

knee

and

ankle

for

only
in

failure

was

all

showed

ben-

four

cases,

but
in

pa-

These

small

findings

after

thiamin

a
0.45

Eight

of

eleven

prolonged
Q-T
intersec.
Three
patients

low

voltages.

Abnormali-

waves
in the precordial
in seven
patients.
This
or inverted
T waves.
inversion

of

the

precorc!ial leads
during

cases

the

abnormalities

these

were

beriberi.

relatively

right

wet
only

showed

1 month

wet

ties of the T
were
observed
sisted!
of flat
the

seen

eleven
congestion,

effusion.

averaging

maniin

present

cardliac

patients

in

pronounced

months

Cardiovascular

observed

of

months.

over
was
in

electrocardiograms

only

showed

motor

remained

was

congestive

out

12

of

two

pleural
within

found
val

from

these,

of

Abnormal

touch
These

in

exceed!

treatment.
were

i)eri.

recovery

Nine
pulmonary

among

disappeared

after

observed

subject.

ratio
of
The
ratio
administration

administration.

administration.

not

or

festations

and

disappeared
thiamin

and,

P18,

P18.

one

amount

senses

pain

but

tien ts demonstrated

P21,

P16,

in

of

which

patients,

two

of

sensations

days--I

and

P15,

observed

all

the

vibration

only

Hyperesthesia
was

from

of superwas pres-

P18,

and

in

sensations

The

P13,

position

affected

rising

1019

hibited
a cardiac-to-thoracic
50%
before
the
therapy.
rec!uced
under
thiamin

im-

diagnosing
the
calf

Hypesthesia
and
touch)

except

joint

were

The

in
over

in

squatting
position.
ficial
sensation
(pain
ent

beriberi.

that
helped
tenderness

signs

Beriberi

were

wave

in

observed

recovery

in

period.

became

40 days after thiamin

leads
conMore

All

normal

within

administration.

patients.
The

outstanding

thiamin

changes

administration

BIOCHEMICAL

following

in

wet

beriberi

Table

were:
1)

Diuresis,

18 hr

after

body

weight

kg

which

thiamin

tile
2)

to

days

depending

26.6

P1

pulmonary
P11

and!

and!

rose

in

2nd

upon

diseases.
in

cases

and

After

24

and
120/80

hr

of

P3

mm
treatment,

Hg
mm
Two

namely

and returned
to
Hg 10 days later.
significant
were

patients
patients

24

(1st

90/30,

Hg,
their

respectively.
blood
pres-

and

frequently
with

wet
with

and

were

and!

120/80

160/

180/120
and

beriberi.
wet

Eight
beriberi

was

they

24

patients,

various

increases

not

observed

at

(P

after

mean

effect

0.15)

(P

demonstrated

The

TPP
at 1 hr

significantly

hr

anti

from

after

(P

thiamin

administration.
Beriberi

patients

divided

into

this

in

two

groups,

nontreated
and

P19)

and

six

P17,

P18,

P20,

and

P21)

group
vitamin

of

riched

The

to

the

included

mean

could
16

those

before

ETK

(P1-P6,
patients
treated

hospital.

supplements
d!iet

study
namely,

patients

P16,

in
ex-

subjects,
patients,

significant

were

affected

nor

control

administration

0.01).

of

urinary

beriberi

were

thiamin

(P

not

0.21)

subjects,

admission

con-

demonstrated

but

viously,

150/

findings,

pulmonary

0.10)

hr

24

suffering

activities

after

values
and

beribei-i

patients

control
ETK

24

On

hr.

P1

roentgenologic

cardiomegaly

gestion,

in

200/110,

rose to 100/50,

sures

within

pres-

in

treated
10

1 hr

mean
effect,

nontreated

6 previously
another

disappeared
blood

pressures

adlmissions)

100,

diastolic

two

blood

admission,

excretion

after

crepi-

the

TPP

previously

In
and

in

Systolic

sures

the

3-15

activity,

thiamin
16

48 hr.

3)

eleven

Total

1.8

from
of

rhythm

noted

within

100

varied

penio1

24-

thiamin.

of edema.

Gallop

tation

within

of

supplementation

severity

mm

(lose

loss

within

occurred

first

the

shows

II

ETK

STUDIES

who
or

be
preP9-

(P7,

P8,

prior

to

The

treated

had

received

thiamin-en-

admission.

activity

before

thiamin

Tanphaichitr

1020

et
II

TABLE

Mean

values

of ETK,

TPP,

before

and

and

urine

after

thiarnin

thiamin
ETK

Time
u b ject b

after
gien,

excretion

in

various

groups,

administrationa

activity,
sg
of hemolysate

Hb

al.

pentose/g
per hr

TPP

effect,
NoTPP

Plus

Urine
mg/g

%d

thiamin,
creatinine

TPP

Control

(24)

6,694

507

7,104

507

7.2

2.1

(5)

7,951

1,151

8,350

1,189

5.4

1.3

24

8,849

1 ,700

9,133

1 ,806

2.7

1 .2

(5)

0.07

0.02

0.15

0.06

Beriberi

(l6)#{176}

3,934

732

5,327

844

46.4

6.4

(16)

6,147

809

6,330

848

2.6

0.7

24

6,262

853

6,667

859

7.6

2.3

84.66

12.17

(6)!

8,826

1,301

9,182

1,303

4.7

1.9

0.17

0.13

(5)

1-2

8,594

1,357

8,645

1,342

0.9

0.6

24

9,680

1 ,461

9,728

1 ,493

0.3

0.3

25.98

12,613

943

943

5.0

1.4

0.51

(15)
Beriberi

(6)
Various
(lO)o
Values
bers

of

effect

are

mean

subjects.
as

treatment

and

(2),

comparisons

(P

group,

ETK

tively),
not

but

the
(P

value

fluctuation
were

in

The

was

the

initial

at
than

Figure

ETK

activity

initial

TPP

in
higher

subjects

(P

was

significantly

effect

(P

<

lower

<

the

in

parentheses

of

treated

added
with

(I),

syndrome

indicate

d Thiamin

presence

0.001).

changes

num-

pyrophosphate

thiamin

pyrophosphate.

vitamins

or

enriched

(2),

cardiomyopathy

tion

of

after

the

rice.

autoimmune

increased

nine.
The
tients

before

day

not

significantly

the

control

hr

TPP
effect

than
the
Sequential

ETK

the

of

vitamin

the

of
P

observed!

the
the

than
mean

previously

B1 injection

patients

at

administration
than

excretion

and

activity

whereas

lower
The

pa-

those

0.28

thiamin

TPP
were

from

(P
Among

significantly
(P < 0.001).
before

and

administration

higher
0.015),

creati-

beriberi

different

the

significantly
(P

activity

thiamin

was

mg/g

treated

subjects

after

adminis-

excretion

12.17

ETK

respectively).

24

that
Ex-

of

spite

activity.

thiamin

previously

themselves,

adminis-

ETK

thiamin

84.66

means

in
stimulain

in
after

urinary
to

15%

administration

hours

the

presented

below

fluctuation

Twenty-four

tration,

are

fell

thiamin

daily

the

values

effect

values

of

nontreated
than
0.001).

TPP

of

2. All

Fig.

0.27,

thiamin

significantly

Numbers
parenterally.

effect

level.

effect
before

from

subject
P19,
all exhibited
greater
than
16%.
The
TPP
TPP

24
sig-

24 hr was
the
1 hr

All

for

1 hr

same

1 shows

of patients.

the

control

effects
at

than

patients

tration

cept

the
group

mean

beriberi

of

this

higher

the

initial
ETK
ac< OMO1, respec-

0.46).

of

to day

the

mean
value
higher

significantly

mean

within

at
1 hr
and
administration
were

higher
than
< 0.001
and

in

nephrotic

activities

after thiamin

nificantly
tivity
(P

enzyme

beriberi
pathan
that
of
0.02).
When

made

given

1.00

(3).

lower

were

text.

mg,

/ Previously

(1),

pellagra

nontreated

significantly
subjects

the

13,199

in the

100

admission.

neuropathy

of

tients
was
the
control

reported

of

hospital

arsenical

administration

are

hydrochloride,
stimulation

to

anemia

(1),

P values

percent

prior

Iron-deficiency
disease

SE.

Thiamin

expressed

No

hr

101 .03

diseases

was

initial

TPP

value

effect

was

the
initial
value
urinary
thiamin
treated

in

patients

the

hospital

Adult
was

not

the
after

significantly

higher

than

Beriberi

that

excretion

of

subjects
(P = 0.06).
At 24 hr
administration,
the
urinary
excretion
was
101.03
25.98
mg/g

the

means
of ETK
excretion
of

from

other

<

(P

0.001

although
was

of

and
no

effect

were

those
P

the

0.001,

<

difference

observed

in

(P

respectively),
mean

TPP

In

0.52).

DISCUSSION

Sauberlich

(11)

biochemical

has

recently

this

deficiency

and

chemical

tests,

conduded
namely

that
urinary

thiamin
two
biothiamin

been

done

data

during
thiamin

at

in

(1,

12),

were

experimenberiberi

(14-16),
and
six

(17),

(18, 19). The

on patients
obtained

sug-

thiamin
deficiency
pyrophosphate
was

1 hr

study

transketo-

dry

disease
mainly

in availability.
high
TPP
effect
beriberi
patients

reduction

on

encephalopathy
amblyopia

study,

that

creased
by the
treated

reviewed

in

has

The

status.

based

deficiency

coenzyme

alterations

nutritional

deficiency,

thiamin

gesting

the

transketolase
in evaluating

cases of beriberi
heart
past
studies
were
done
who were alcoholics.

subjects

the

erythrocyte
be performed

(13),
Wernickes
tobacco-alcohol

significantly

control

thiamin

tal

activity
and urinary
the patients
suffering

diseases

than

higher

should

of thiamin
lase activity,

creatinine.
The
thiamin

and

activity,

control
thiamin

thiamin

1021

This
on
and

after

the
de-

is evidenced
ETK
in nonthe significant

thiamin

adminis-

D69s
FIG.
varies
consistently

1. Demonstrating
from

one
lower

patient
than

erythrocyte
to
the

the
activity

other

transketolase
and
after

from
thiarnin

activity
day

to

day

administration.

in
even

nontreated
in

the

beriberi
same

subject.

patients.
Initial

The

ETK

ETK
activity

activity
was

Tanphaichitr

1022

TABLE

TPP

The

effect

et

study

III

in various

al.

groups

of

is similar

to

TPP

ducted

effect

the
Acceptable,

Number

Groups

Low,

16-20

Deficnt,

as

Defense

in

the

criteria

24

21

(88)

Nontreatcd

16

(6)

(100)

(13)

(12)

13

(81)

used

described

of

the

indicates

thiamin

(!ata

substantiate

this

con-

(8),

and

the

same

It has
greater

ICNND.

16%

the

survey
are

TPP

by

Nutrition

Burma

evaluation

by
that

on

(ICNND)

Union
for

suggested
Control

method

Committee

fom National
%

Subjects

the

Interdepartmental

subjects

effect

been

than

deficiency.
criterion,

Our
since

94%

beriberi
Treated

of

beriberi
Various

dis-

10

10

(100)

eases
Subjects
(8).

the

samples

had

were

in

subjects

classified

in

Numbers
each

the

by

Sauberlichs

parentheses

criteria

of

(Table

III).

ing

the

tration

in

thiamin

could

vivo,
in

TPP

whereas

administration

be

transketolase

no

effect

demonstrated.
determination

significant

before
in

and

control

The

subjects

method
used

fect
tients

for
in

greater

this

in

after

decrease

thiamin

2)

16%

effect

of
show

II

the
treatedi

injection

that
the previous
vitamin
or enriched
thiamin
diet

to-

dur-

nontreated
that

a TPP

indicates

in

16%

of

Table

TPP

period
(Fig.

previously

excess

of

who

treatment

in

value

than
A

the

in

results

recovery

deficiency.
after

effect

The
the

patients

previous

patients

effect
difference

TPP

with

beriberi

group.

beriberi

received

showed
gether

percent

show

from

not

thiamin

mean

TPP

beriberi
might

efpa-

indicate

supplementation
received
was

in-

Adult
sufficient

to

tolase

maintain

a maximum

Beriberi
erythrocyte
administration

transke-

activity.

In

1964,

stimulation
vitro
of

Brin

reduced

to

after

parenteral

min
effect

(13).
In
of the
1 hr

at

found
initial

reported

that

by thiamin
thiamin-deficient
normal

range

(20)

in

1967

cyte

three

were observed:
1) An increase
a) when

added

in

tered

vivo

the

of

ETK
ence

of

exogenous

that

was

added

hut

thiamin

activity

no

In

1964,

Brin

was

low

patient

an

in

thiamin

was

was

adminis-

incubated
In six

with
patients,

addition

was
but

phosthe
pres-

the

vivo

thiamin
vitro
to

could

reason

that

not

initial

depleted

in

In

some

cases

to

normal

balance
be

was

due

zyme
with

In

to
itself.

liver

restored,
was

activity

positive
so

a decreased
This

enzyme

after

the

level

re-

nitrogen
defect

of

observed

the
in

might

this

study,
increased

of

thiamin

be

ETK

vivo,

subjects

jects,

mean

ETK

activity

true

both

after

the

ad-

natural

to

the

(15).

pyrophosphate

the

b)

coenzyme

when

increase
fluctuation
Ow-

results

of
en-

needed

after

compared

sub-

patients,

ETK
as

the

control

may

could

in

thiamin
with

the

beriberi
the

before

mechanisms
increase

hr

in

patients
in

be

pyrophos-

to

24

activity

beriberi

not
amount

mechanism

significant
at

nontreated

may

vivo.
is

/Lg/ml

the

thiamin
in

activity

the
py-

(15.4

the

relative

drawn.

by
thiamin

apotransketolase

effective

ETK

of

for

or

1 hr
when

explained

volume)

the

administration

treated

the

tube

was

added
in
This
occur-

vitro

investigation

the
initial

was
sample.

in

that

obtained

amount

conclusions

can

apoen-

diseases.

significantly

dition

the

than

sample

compensate

between

Further

higher

pyrophosphate.
activity
at

be

the

assay
to

decisive

ob-

in vitro.

turned

sample

blood

value

added

rophosphate

binding

was

the

probably

pyrophosphate

activity

blood

thiamin
the ETK

a)

sufficient

activity.

initial

pyrophosphate
the zero time

is more

ETK

thiamin
activity

pyrophosphate

or

the

than

rence

of

did

greater

and

in

ac-

the ETK
activity
thiamin
pyrophos-

equivalent

phate

change

initial

phate

zyme

No

ETK

2 hr after
the
ETK

the

administration,
absence
of added

served
either
after
thiamin
administration
in vivo
or after
the addition
of thiamin

3)

the

thiamin

thiamin
in the

when

hemolysate,

ETK

to

com(P

thiamin-deficient

vivo

with

observed

pyrophosphate
in

of the

equivalent

con-

when

that

every

whereas

was

thiamin,
only

activity

subjects

showed

in

patients

(13). The results of our study showed

that
the initial ETK
activity
in every
nontreated
beriberi
patient
was low, but at 1 hr after

changes

the

is

ETK

control

in

studied,

was

This
of

patients

of

co-

these

in the
thiamin

in vitro
in vivo.
impaired

erythrocyte

level

tivity

level

beriberi
that

This

in

deficiency.
low

nontreated

the
this

0.001).

transketolase

available

the

with

<

(P
the

incubated

activity

administered
increased

the

by

pared
0.02).

erythro-

thiamin

administration

influence

not

thiamin

firmed
of

vivo

thiamin
thiamin

activity.

of

b) without

to

during

thiamin-de-

ETK

of thiamin
pyrophosphate
after
thiamin
administration
2) In those
who
had
phorylation

hr

vita-

pyrophosphate

but
and

the

in

thiamin

vitro

in

to

patterns

in

was

follow-

increase
when

whereas

subjects,

noted

the
ETK

added

hemolysate,

ficient

after

presented

was

enzyme

before
1 hr after

that

administration

persons,
no
was observed

pyrophosphate

indicate

was

from
cases,

30 mm

concerning

In
normal
ETK
activity

might

vita-

administration

reduced
significantly
(P < 0.001).
In two

observations

the

in

in
be

the
mean
TPP
beriberi
patients

thiamin

to be
value

of

this
study,
nontreated

after

Baker

within

administration

hemolysate
and
at

administration

ETK

pyrophosphate
subjects
could

decrease
occurred
within
min injection
(Fig. 2).
ing

the

1023

be

and
due

activity

Dreyfus
be

to

or

reported
explained

by

Tanphaichitr

1024
the

latter

reason

as

is

level

of

ETK

fluctuation
day

to

(21)

and

low

ETK

lated

day

(Fig.

Although

the

of

is

a large

tain

it
the

status.
subjects

Seventy-one
fell in this

to

Thus,

of

criterion

for

an

difficult.
cases

of

spite

the

and

clinical

1954,

and
a

P3

could

crease

in

1942,
that

Garland

cm

the
in

some
de-

total

of

10

various

Groups

Number

Acceptable,

High,
>130

66-129

It

excretion,

Low,

Deficient,

27-65

<27

11(45)

24

4(17)

3 (13)

6(25)

Nontreated

15

3 (20)

1 (7)

3 (20)

1 (17)

1 (17)

4 (66)

8 (53)

beriberi

Treated
Various

dis-

10

6 (60)

3 (30)

1 (10)

eases
Subjects

were

by

ICNND.

cent

of

subjects

classified

Numbers
in

in
each

by
the
group.

criteria

parentheses

designated
show

per-

due

to

the

in-

resistance.

In

heart

reported
about

transverse

diameter

in

(lays

on

of

thiamin

change

therapy.
was

observed

P2.
However,
there
in cardiac
size observed
after thiamin
administration.

was
in

was

no difference
between
Oriental
beriberi.
Alof electrocardiographic

rather
specific

is well

uniform,

known

that

The
results
Thailand
in

mean

civilians

variation

of
mg/
area

received
kcal,

Thai

service

rice.

Thiamin

been

to

ICNND

surthat

B1
kcal

little

The

Thai
mg/

0.28
because

consumed
well

among

with

area.

civilians

excretion

popu-

revealed

thiamin,

the
man

has

vitamin
1,000

more

than

moderately

be

rice-eating

of the
1960 (6)

0.24

from

1,000

cannot

beriberi

among

intake
was

it

to beriberi.

lations.
vey in

related

re-

admission),

(28)
shrank

found

soldier

beriberi

(25-27).
the

(second

McKenny

commonly

the
Control

of
dif-

results
of the
electrocardiographic
are
in
agreement
with
Pallister

considered
creatinine

thia-

and

P1

change

thiamin

more

urinary

reports

probably

(29)
who
showed
Occidental
and
though
the pattern

subjects

Mg/g

to

adequacy

the

peripheral

enlarged

period

The
studies

thiamin
suggested

IV

Urinary

is

manifestations
study
are not

P1

be

its

decrease
patients

Subjects

possible

during

and

some
most

in

Tripathy

is

thiamin
of

total

in

of

effect

of

magnitude

excretion

groups

period

in

TABLE

TPP

previous

only

He

iv).

thiamin
be
dethe re-

and
it

hypertension

This

blood

the

This

(Table

(21)

judging

from

observed

a low

al.

the clinical
the present

(23)

of

thiamin

for

determination

manifestation.

Urinary

not

patients

study

measurement

In general,
beriberi
in

covery

status

excretion

in

thiamin.

results,

the

test

Transient

condition.

nutrition

this

et

these

the

disturbance

between
urinary
TPP
effect
could
results
agreed
with

that

ferent

control
range,
is

in

Brin

thiamin

thiamin
thiamin-deficient

presence

From

Suzawa

accurate

urinary

(9)

subject.
Also,
fluorescent
are excreted
in the urine,

In

high

thiamin

of

(24).

ingested

mm.

less than
considered

alone

to

the

observed

ports

than

thiamin

clinical

due

of

also

specific

cer-

study.

of our
deficient

excretion

in an individual
materials
often
making

percent
low or

was

No correlation
excretion
and
tected.
These

to

Surveys
be

was

propose

this

of

this

survey

deficient

good

thiamin

good

or

in

urinary

individuals,

results

low

appeared

was

is subject

Nutrition

of

corre-

for

that
urinary
thiamin
creatinine
excretion

indicative

that

a!.

This
of

applied

for

yet

always

effect.

criterion

when

Manual

suggests
65 g/g

et

that

a!.

utilization

study.

useful

by

The

Brin

measurement

is evidenced

the
from

reported

not

population,

errors

as

1965,

TPP

in this

by

activity

(22)

was

high

observed

thiamin

In

al.

et

activity

with

also

1).

Dibble

evidenced

et

the

undermilled

in

the

with

urine
thiamin

corin-

take.
As

the

mean

civilian

ii:take

is

0.24

Adult
mg/l,000

kcal

one

can

conclude

national
picture
is one
of
mm
intake.
Thai
people
sume
less

machine-milled
thiamin
than

pounded

rice.

amount

of
the
rice.

85%

the

of

of

also

was

our

histories

revealed

patients

consumed

as

described

by

It

is also

destroyed

enzyme,
fish

sumed!.

This

fish

and

and

is
been
(31,

the

the

in
con-

found

from

Thailand

is

are

in

North

32).

etiology
requires

The

of berifurther

intake
be

Twenty-one
cally
diagnosed
were

adult
as

studied

to

relation
existed
tests,
including
ant!

erythrocyte

great

determine

were
beriberi

cliniand

whether

between
urinary

the
thiamin

transketolase

a cor-

wet

dry

than

changes
in

wet

in

to

beriberi.

following
beriberi

are

activity,

thiamin
appears
The

with

ef-

thiamin

in-

thiamin
the

normal

of

the

level

the

of

ETK

due

value
low

to

in

control

increase

initial

diet

interpretation

established

percent

TPP

supplementation

be

a high

the

after

in

an

in

value

ETK

together

stimulation

on

TPP

can
be used
to measure
the thiamin
adequacy
in man.
The
TPP
effect
is a better
index
than
urinary
thiamin
excretion
for
diagnosing

beriberi;
may
study

with

the

to

however,

be

thiamin

useful

in a large

ex-

criterion

foi-

population

The

authors

wish

to

express

Paul

Gyorgy,

M.D.

for

his

this

study.

Reen,

We

J.

group.

for

us.

cal

of

and

medical

we
Miss

in

wish

to

and

their

help

in

are

indebted

to

the

staffs

of

sending

Siriraj
these

acknowledge

Pa-nga

Van

Ph.D.,
for

We

of

Robert

Viriyapanich,

Hospatients

the

techni-

B.S.

in

the

laboratory.

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Darby,
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thiamin
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a) diuresis,
which

may appear
within
12 hr; and
in cardiac
size as well as clearing
congestion

of

The

from

The

indicate

enriched

However,

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thia-

for judging
Generally,
can

effect.

adminisfaster
in

pears
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included:
response
improvement

include

cannot

subjects.

be-

CONCLUSIONS

patients
having

1) Specific
tration.
The

good
in

than

of

TPP

in

elapses

activity
(TPP)

considered

activity

survey
AN!)

that

(ETK)

appears
within
1 hr
Previous
vitamin

and

diagnosis
time

is observed.

state.

cretion

study.
SUMMARY

more

tests

greater

must

to

administration

immediate

pyrophosphate

j ection.

and

present

for

transketolase

fect

the

of

that
has

cyte

It is difficult
thiamin

because

Biochemical

deficient

cooked

because

to

improvement

the

thiamin

obtained
in
patients

beriberi

of

some

which

enzyme

of thiaminase
of
these

a criterion

value

Thai

they

vegetables

Northeast

role
beri

of
(4)

and

foods

vegetables

as
dry

was

previously.

Thai

and

all

response

TPP
effect
is a
thiamin
deficiency

method

usual

of electrocardiogi-ams.
the

mm

boil-

but

the

that

thiaminase,

some

dis-

intake

that

(6),

possible
in

this

Bisolyaputra

ICNND
survey
rice as described

tion
use

fore

about

patients,

beriberi

the
their

by

1025

2)

by
and

thiamin

dietary
diet,

lost
that

is lost

in

contains
or home-

soaking

The

estimated

is

estimated

vitamin

(30).

thiacon-

a consi!erable

after

It

cooking

not

Furthermore,
water

the

marginal
generally

rice,
which
undermilled

thiamin

carding
ing the

that

Beriberi

the

apheart

which

activity

lase.

I.

Nutr.

M.

2. BRIN,
thiamine
528,

c) reduction
of the pul-

3.

normaliza-

4.

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M.
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