Research Showcase Abstracts
Explore abstracts from CFDR’s annual research showcase at the DC Conference.
Year
2006
Language
English
Title
Prevalence of Thiamin Deficiency in Hospitalized Patients with Congestive Heart Failure
Introduction/Purpose
At the Partners Breakfast on May 4, 2006, CFDR supporters had the opportunity to listen to Dr. Mary Keith describe her CFDR-funded research, which has received international attention.
More than 350,000 Canadians are afflicted with congestive heart failure (CHF), and mortality rates one year after diagnosis range from 25% to 40%. Research to identify new treatment and management options is crucial given the predicted future impact of CHF as our population ages. Nutrition has long been a cornerstone of treatment. Dr. Keith described her team's research, the largest study of thiamin deficiency among hospitalized patients with CHF. The team includes Stacy Douglas-Hanninen, RD, MSc, who conducted the research for her Masters of Science thesis, and Pauline Darling, PhD, RD, both of St. Michael's Hospital and University of Toronto; Dr. Michael Sole, MD, FRCPC, FACC, Cardiologist at the University Health Network and Professor at the University of Toronto; and Aiala Barr, PhD, University of Toronto.
Deficiency of thiamin (vitamin B1) manifests as symptoms of heart failure and therefore may present as worsening CHF. It is thus critical to determine if hospitalized patients are at risk for thiamin deficiency, as well as the factors contributing to that deficiency. Mary Keith's team measured thiamin status among 100 heart failure patients admitted to St. Michael's Hospital in Toronto, compared with 50 matched healthy subjects. Based on red blood cell levels of thiamin, 33% of these CHF patients had thiamin deficiency, a statistically significant difference from the 12% of those without the disease.
Dr. Keith and her team also investigated factors that may contribute to the development of thiamin deficiency (diuretic type and dosage, urinary thiamin excretion, disease severity, thiamin intake, nutrition status, hospitalization, age and gender). Having low urinary thiamin losses, not using thiamin-containing supplements, and having good kidney function were significantly related to thiamin deficiency. In contrast to some previous studies, they did not find a relationship between the development of thiamin deficiency and the amount or duration of diuretic use, or urinary thiamin excretion. In fact, increased urinary loss of thiamin was found to be the only significant predictor of improved thiamin status. Their findings confirm that the development of deficiency is complex, not simply related to the dose or duration of diuretic use. Building on the CFDR-funded research, Dr. Keith also described an adjunct study in which her team investigated the status of riboflavin and vitamin B6 in the same CHF patients. They found that riboflavin deficiency was significantly related to thiamin deficiency, along with a high overall prevalence of B vitamin deficiency in these CHF patients (71%).
The team noted that heart failure may increase the body's need for certain nutrients, so that even individuals with healthful diets may still come up short on thiamin. Their findings raise questions about the need for B vitamin supplementation in this population. Dr. Keith indicated that routine supplementation of thiamin appears safe and justifiable; however, supplementation with B6 requires additional investigation to determine the impact of both deficiency status and the dose. Further research is needed to substantiate risk factors for thiamin deficiency, to assess whether thiamin supplementation improves thiamin status and disease severity in CHF patients, and to determine the impact of specific disease states on nutritional requirements in CHF patients.
More than 350,000 Canadians are afflicted with congestive heart failure (CHF), and mortality rates one year after diagnosis range from 25% to 40%. Research to identify new treatment and management options is crucial given the predicted future impact of CHF as our population ages. Nutrition has long been a cornerstone of treatment. Dr. Keith described her team's research, the largest study of thiamin deficiency among hospitalized patients with CHF. The team includes Stacy Douglas-Hanninen, RD, MSc, who conducted the research for her Masters of Science thesis, and Pauline Darling, PhD, RD, both of St. Michael's Hospital and University of Toronto; Dr. Michael Sole, MD, FRCPC, FACC, Cardiologist at the University Health Network and Professor at the University of Toronto; and Aiala Barr, PhD, University of Toronto.
Deficiency of thiamin (vitamin B1) manifests as symptoms of heart failure and therefore may present as worsening CHF. It is thus critical to determine if hospitalized patients are at risk for thiamin deficiency, as well as the factors contributing to that deficiency. Mary Keith's team measured thiamin status among 100 heart failure patients admitted to St. Michael's Hospital in Toronto, compared with 50 matched healthy subjects. Based on red blood cell levels of thiamin, 33% of these CHF patients had thiamin deficiency, a statistically significant difference from the 12% of those without the disease.
Dr. Keith and her team also investigated factors that may contribute to the development of thiamin deficiency (diuretic type and dosage, urinary thiamin excretion, disease severity, thiamin intake, nutrition status, hospitalization, age and gender). Having low urinary thiamin losses, not using thiamin-containing supplements, and having good kidney function were significantly related to thiamin deficiency. In contrast to some previous studies, they did not find a relationship between the development of thiamin deficiency and the amount or duration of diuretic use, or urinary thiamin excretion. In fact, increased urinary loss of thiamin was found to be the only significant predictor of improved thiamin status. Their findings confirm that the development of deficiency is complex, not simply related to the dose or duration of diuretic use. Building on the CFDR-funded research, Dr. Keith also described an adjunct study in which her team investigated the status of riboflavin and vitamin B6 in the same CHF patients. They found that riboflavin deficiency was significantly related to thiamin deficiency, along with a high overall prevalence of B vitamin deficiency in these CHF patients (71%).
The team noted that heart failure may increase the body's need for certain nutrients, so that even individuals with healthful diets may still come up short on thiamin. Their findings raise questions about the need for B vitamin supplementation in this population. Dr. Keith indicated that routine supplementation of thiamin appears safe and justifiable; however, supplementation with B6 requires additional investigation to determine the impact of both deficiency status and the dose. Further research is needed to substantiate risk factors for thiamin deficiency, to assess whether thiamin supplementation improves thiamin status and disease severity in CHF patients, and to determine the impact of specific disease states on nutritional requirements in CHF patients.
Objective(s)/Process or Summary of Content
What are the main causes of a heart failure?
Conclusions(s)/Recommendations
NIH call recognizing paucity of data
Routine supplementation of B1 appears safe and justifiable
Supplementation with B6 requires additional investigation to determine: the impact of deficiency status, the impact of does (high or low)
Continue to investigate the impact of specific disease states on nutritional requirements.
Routine supplementation of B1 appears safe and justifiable
Supplementation with B6 requires additional investigation to determine: the impact of deficiency status, the impact of does (high or low)
Continue to investigate the impact of specific disease states on nutritional requirements.
