Proposed standard for human blood vitamin B1 value using HPLC. The Committee for Vitamin Laboratory Standards, Japan

Long-Term Maintenance of Normal Serum Vitamin B1 Levels Is Associated with Better Outcomes in Patients with Heart Failure

Deficiency of vitamin B1 (VB1), an essential micronutrient, causes heart failure (HF). A recent randomized controlled trial failed to show any improvement in HF prognosis after short-term VB1 supplementation. In the current study, we investigated the efficacy of long-term maintenance of normal blood VB1 levels in preventing adverse outcomes in patients with HF.This study included 88 consecutive patients with HF who received guideline-directed medical therapy at Arida Municipal Hospital. The patients were divided into 3 groups: a control group with normal VB1 levels and no VB1 supplementation (normal group, n = 25), and those presenting with VB1 deficiency, who either required short-term VB1 supplementation (short-term supplementation group, n = 25), or long-term maintenance of normal blood VB1 levels (long-term maintenance group, n = 38). The time to the first appearance of composite outcomes, including cardiovascular death and hospitalization for HF, was compared between the 3 groups.VB1 deficiency was observed in 63 (72%) patients. The Kaplan-Meier curve showed that the long-term maintenance group had better outcomes than the other 2 groups. In the multivariate analysis, long-term maintenance of normal blood VB1 levels and age were independent predictors of composite outcomes.VB1 deficiency is frequently observed, and the long-term maintenance of normal blood VB1 levels may result in better outcomes in patients with HF. Our results suggest that the detection of VB1 deficiency and long-term restoration of VB1 levels may be part of the overall therapeutic strategy for HF.

Prevalence of thiamine deficiency in older hospitalized patients

Purpose

Despite some reports of high prevalence of thiamine deficiency in elderly people, the reported prevalence is controversial mainly due to the methods used in assessing thiamin concentrations. In this study, we sought to investigate the prevalence of vitamin B1 deficiency, using the high-performance liquid chromatography (HPLC) method, among older hospitalized patients.

Patients and methods

This cross-sectional study retrospectively analyzed the results of routine measurements of vitamin B1 of 238 older patients who were consecutively hospitalized to a geriatric acute care ward. Whole blood vitamin B1 concentrations were measured using the HPLC method at hospital admission, and the whole blood vitamin B1 level of <20 ng/mL was considered as deficiency.

Results

Of 238 patients, with a mean age of 82.1±7.1 years, 63% of patients were women. In total, the mean whole blood vitamin B1 level was 66.1±24.8 ng/mL (range 29.5-215 ng/mL), indicating no vitamin B1 deficiency in the entire population. In addition, no significant differences in the mean whole blood vitamin B1 concentrations between sexes were observed (P=0.356).

Conclusion

This study indicates that the mean whole blood vitamin B1 concentrations using the HPLC method were within the normal range in older hospitalized patients suggesting that thiamine deficiency appears to be rather uncommon among these patients.

Nutritional deficiencies in homeless persons with problematic drinking: a systematic review

Background

A significant proportion of homeless people drink alcohol excessively and this can lead to malnutrition and consequent medical problems. The aim of this review was to assess the evidence on the range of nutritional deficiencies in the homeless problem-drinking populations.

Methods

We conducted a comprehensive search of nine scientific literature databases and 13 grey literature sources. We included studies of any design that included homeless population with problem-drinking and reported measures of nutritional deficiencies in urine or blood. Study selection and data extraction was done by one reviewer and checked by another. Data on malnutrition profile were summarized narratively.

Results

We found nine studies reporting nutritional deficiencies in homeless populations with problem-drinking. The oldest study was from the 1950s and the most recent from 2013. The following nutrients were reported across studies: vitamins B1, B2, B6, B9, B12, C, A, and E; haemoglobin; and albumin. The most common deficiencies reported were of vitamin B1 (prevalence of deficiency was 0, 2, 6, 45, and 51% in five studies) and vitamin C (29, 84, and 95% in three studies). None of the studies were assessed to be at a low risk of bias.

Conclusions

The limited, low quality and relatively old evidence suggests that homeless people who drink heavily may be deficient in vitamin C, thiamine, and other nutrients. New, well conducted studies are needed in order to optimally inform public health interventions aimed at improving deficiencies in this population.

Trial Registration

PROSPERO CRD42015024247

Electronic supplementary material

The online version of this article (doi:10.1186/s12939-017-0564-4) contains supplementary material, which is available to authorized users.

Increasing consumption of breakfast cereal improves thiamine status in overweight/obese women following a hypocaloric diet

The aim of this study was to analyse the thiamine status in a group of young, overweight/obese women and to analyse the changes in this status produced by two weight-control programmes based on approximating the diet to the theoretical ideal, increasing the relative consumption of vegetables (V) or cereals (C) (especially breakfast cereals). The study subjects were 57 Spanish women with a body mass index (BMI) of 24-35 kg/m(2), all of whom were randomly assigned to one of two slightly hypocaloric diets. Dietetic, anthropometric and biochemical data were collected at the beginning of the study and at 2 and 6 weeks. C and V subjects showed a reduction in their energy intake, body weight and BMI, both at 2 and 6 weeks. Thiamine intake and blood thiamine levels only increased with diet C (both at 2 and 6 weeks). 21.8% cf the women, 21.8% had blood thiamine levels <150 nmol/L at the beginning of the study, but at 6 weeks of intervention only 3.7% of the women in diet C, as compared with 30.8% of the women in diet V, showed blood thiamine levels <150 nmol/L. Although both diet C and diet V induced weight loss and a reduction in BMI, diet C would appear to be more useful in the maintenance of an adequate thiamine status.

Estimation of vitamin B1 excretion in 24-hr urine by assay of first-morning urine

Urinary B1 (vitamin B1) excretion is commonly determined in 24-hr urine specimens to obtain an estimate of nutritional status. The aim of our study was to investigate whether B1 in random urine specimens, corrected for the urine creatinine (Cr), can be substituted for B1 in 24-hr urines. Collection of such hour urines is often fraught with errors; an alternative method is described here. All urine specimens voided over 24 hr were collected from 32 healthy adults as were the first-morning urines from 30 healthy Japanese women. The B1 excretion was expressed as the ratio of B1 to Cr. Although the B1 excretion was expressed as the B1/Cr ratio, the B1 excretion varied with the urine volume and the time of urine collection. The B1/Cr ratio in random urine specimens not collected at a fixed time may mislead the evaluation of the nutritional status. We found that the B1/Cr ratio in the first-morning urine correlated significantly with the ratio in 24-hr urines (r=0.970, P<0.001) and also with the concentration of total B1 (B1 plus its phosphate esters) in whole blood (r=0.733, P<0.001). We conclude that the B1/Cr ratio in 24-hr urines could be estimated by measuring the ratio in the first-morning urine.

Clinical examination of the water-soluble vitamin levels in blood during peripheral parenteral nutrition

The water-soluble vitamin (included vitamin B1, B6, B12 and C) preparations are not always replenished when peripheral parenteral nutrition (PPN) is used in Japan. We evaluated the need for administration of vitamins preparation during PPN, and involved analysis of the blood levels of water-soluble vitamins in patients receiving perioperative PPN before and after gastrectomy. Patients were examined as two set of groups as follows; 18 patients who did not receive water-soluble vitamin preparations during PPN, the Unsupplemented Group, and 22 patients who received such preparations during PPN, the Supplemented Group. Consequently, in the Unsupplemented Group, the blood vitamin B1 level during the early postoperative period was significantly lower than the preoperative level, but in the Supplemented Group, it was significantly higher than the preoperative level. In the Supplemented Group, the blood vitamin B12 level during the early postoperative period was markedly higher than the preoperative level. And in both groups, the blood vitamin C level remained below the lower limit of the criterion range throughout the perioperative period. These results suggested that administration of water-soluble vitamins during PPN was needed to avoid potential vitamin deficiencies after surgery and to prevent a potential onset of severe metabolic complications from any deficiencies.

Stability of fat-soluble and water-soluble vitamins in artificially prepared, vitamin-enriched, lyophilized serum

Vitamin-enriched, lyophilized serum (VES) was prepared for an inter-laboratory study to compare vitamin assays. The VES contained water-soluble vitamins (vitamin B1, vitamin B12, vitamin C, and folate), fat-soluble vitamins (vitamin A and vitamin E), and cholesterol. We performed stability studies and determined vitamin concentrations and total cholesterol in VES stored at -20 degrees C for 12 months. Our recovery of the water-soluble vitamins in reconstituted VES was 70-142%, but we recovered only 33-45% of the fat-soluble vitamins. Physicochemical properties, such as specific gravity and viscosity of the reconstituted VES did not affect manual or automated measurements of these vitamins. Vial-to-vial differences found for the VES were the same as the within-day analytical variations. There was no evidence of degradation of vitamin A, vitamin B1, vitamin B12, vitamin C, folate, and cholesterol over 12 months in VES stored at -20 degrees C. Following deproteinization, vitamin C concentration was found to be lower than when not deproteinated. Vitamin E was less stable in VES, however, and the degradation during 12 months was lower than the between-day analytical variation of the assay. Our VES is the first preparation of lyophilized control serum that contains water-soluble and fat-soluble vitamins.