Enzymic evaluation of thiamin, riboflavin and pyridoxine status of parturient women and their newborn infants

Protocol and application of basal erythrocyte transketolase activity to improve assessment of thiamine status

Thiamine (vitamin B1) is an essential micronutrient required as a cofactor in many metabolic processes. Clinical symptoms of thiamine deficiency are poorly defined, hence biomarkers of thiamine status are important. The erythrocyte transketolase activity coefficient (ETKac) is a sensitive measure of thiamine status, but its interpretation may be confounded where the availability of the transketolase enzyme is limited. Basal ETK activity per gram of hemoglobin provides a complementary biomarker of thiamine status; however, its measurement and calculation are poorly described. Here, we describe in detail the assessment of basal ETK activity, including the calculation of path length in microplates and the molar absorption coefficient of NADH specific to the assay, and the measurement of hemoglobin in sample hemolysates. To illustrate the application of the methods, we present ETKac and basal ETK activity from women in The Gambia and UK. In conclusion, we present a clear protocol for the measurement of basal ETK activity that will permit the harmonization of methods to improve replication between laboratories.

Perinatal thiamine deficiency causes cochlear innervation abnormalities in mice

Neonatal thiamine deficiency can cause auditory neuropathy in humans. To probe the underlying cochlear pathology, mice were maintained on a thiamine-free or low-thiamine diet during fetal development or early postnatal life. At postnatal ages from 18 days to 22 wks, cochlear function was tested and cochlear histopathology analyzed by plastic sections and cochlear epithelial whole-mounts immunostained for neuronal and synaptic markers. Although none of the thiamine-deprivation protocols resulted in any loss of hair cells or any obvious abnormalities in the non-sensory structures of the cochlear duct, all the experimental groups showed significant anomalies in the afferent or efferent innervation. Afferent synaptic counts in the inner and outer hair cell areas were reduced, as was the efferent innervation density in both the outer and inner hair cell areas. As expected for primary neural degeneration, the thresholds for distortion product otoacoustic emissions were not affected, and as expected for subtotal hair cell de-afferentation, the suprathreshold amplitudes of auditory brainstem responses were more affected than the response thresholds. We conclude that the auditory neuropathy from thiamine deprivation could be produced by loss of inner hair cell synapses.

Micronutrients and fetal growth

Fetal undernutrition affects large numbers of infants in developing countries, with adverse consequences for their immediate survival and lifelong health. It manifests as intrauterine growth retardation (IUGR), defined as birth weight <10th percentile, which probably underestimates the number failing to achieve full growth potential. Birth weight is a crude measure of the dynamic process of fetal growth and does not capture effects of fetal undernutrition on body composition and the development of specific tissues. The link between maternal nutrition and fetal nutrition is indirect. The fetus is nourished by a complex supply line that includes the mother's diet and absorption, endocrine status and metabolism, cardiovascular adaptations to pregnancy and placental function. Micronutrients are essential for growth, and maternal micronutrient deficiency, frequently multiple in developing countries, may be an important cause of IUGR. Supplementation of undernourished mothers with micronutrients has several benefits but there is little hard evidence of improved fetal growth. However, this has been inadequately tested. Most trials have only used single micronutrients and many were inconclusive because of methodological problems. Several food-based studies (some uncontrolled) suggest benefits from improving maternal dietary quality with micronutrient-dense foods. One trial of a multivitamin supplement (HIV-positive mothers, Tanzania) showed increased birth weight and fewer fetal deaths. Well-conducted randomized controlled trials of adequate sample size and including measures of effectiveness are needed in populations at high risk of micronutrient deficiency and IUGR and should include food-based interventions and better measurements of fetal growth, maternal metabolism, and long-term outcomes in the offspring.

Postpartum thiamine deficiency in a Karen displaced population

BACKGROUND

Before its recognition, infantile beriberi was the leading cause of infant death in camps for displaced persons of the Karen ethnic minority on Thailand's western border.

OBJECTIVE

This study aimed to document thiamine status in the peripartum period to examine the current supplementation program and the correlation between the clinical manifestations of thiamine deficiency and a biochemical measure of thiamine status.

DESIGN

Women were enrolled prospectively at 30 wk of gestation and were followed up weekly until delivery and at 3 mo postpartum. Thiamine supplementation during pregnancy was based on patient symptoms.

RESULTS

At 3 mo postpartum, thiamine deficiency reflected by an erythrocyte transketolase activity (ETKA) > or = 1.20% was found in 57.7% (15/26) of mothers, 26.9% (7/26) of whom had severe deficiency (ETKA > 1.25%). No significant associations between ETKA and putative maternal symptoms or use of thiamine supplements were found.

CONCLUSIONS

Biochemical postpartum thiamine deficiency is still common in Karen refugee women. This situation may be improved by educating lactating women to reduce their consumption of thiaminase-containing foods and by implementing an effective thiamine supplementation program.

Vitamin dependent erythrocyte enzymes in newborns in relation to gestational age and birth weight

In order to search for any difference in riboflavin and pyridoxine nutrition between term appropriate for gestational age (TAGA), term small for gestational age (TSGA) and preterm appropriate for gestational age (PTAGA) newborns, cord blood from 23, 19 and 20 infants, respectively, were studied, and red cell glutathione reductase (riboflavin-dependent) and glutamic oxaloacetic transaminase (pyridoxine-dependent) activities were measured, as well as their respective activity coefficients (GRase AC and GOT AC). Red cell enzymes were assayed according to BEUTLER [4] in a Gilford recording spectrophotometer model 2451 at 37 degrees C. Values of 1.42, 1.39 and 1.32 of GRase AC and values of 1.17, 1.02 and 1.08 GOT AC, respectively were obtained. These data indicate that there is no significant difference between the three categories of newborns with regard to riboflavin and pyridoxine nutrition, and suggest that neither maturity nor adequacy of intrauterine growth were related to differences in the availability of these vitamins. All groups demonstrate a uniform mild deficiency of riboflavin and an adequate level of pyridoxine, probably the effect of maternal diet.

The effects of a combined implant of trenbolone acetate and oestradiol-17 beta on protein and energy metabolism in growing beef steers

1. The effects on growth performance, energy and nitrogen retention, and leucine metabolism of a subcutaneous combined implant of 140 mg trenbolone acetate (TBA)+ 20 mg oestradiol-17 beta (OE) have been examined in Hereford x Friesian beef steers (280-520 kg). Comparisons were made both with the same animals before implantation and with untreated control animals maintained under similar physiological and nutritional conditions. 2. Over a 10 week period the implanted steers showed an improvement in rate of live-weight gain (LWG) of 0.5-0.6 with an even greater proportional increase in N retention compared with control animals. Total energy retention was unaffected and thus the ratio, protein energy: total energy gain was 0.43 for implanted steers compared with 0.26 for untreated animals. 3. Estimates of protein synthesis and protein oxidation were obtained from the specific radioactivities of blood free-leucine and exhaled carbon dioxide during continuous infusions of [1-14C]leucine. Whole-body protein synthesis, based on metabolic size, and amino acid fractional oxidation remained similar for control steers throughout the experiment. Steroid-treated steers showed a slight decline in synthesis which was significant (P less than 0.05) at week +5 post-implant while amino acid oxidation was significantly lower at weeks +2 (P less than 0.01) and +5 (P less than 0.05) compared with control animals. The ratio, protein deposition: protein synthesis was 0.05 for control animals but 0.08-0.10 for steroid-treated animals after implantation. 4. There was a slight decrease in urinary N tau-methylhistidine elimination after implantation which suggested that muscle protein degradation may be reduced although the estimated decrease was insufficient to account for the total improvement in growth rate and N retention. 5. The results suggest that for both control and treated steers, less than 0.5 of total urine N elimination was derived directly from tissue catabolism of protein and amino acids. 6. The combined action of the exogenous steroids in the promotion of protein gain, primarily through a decrease in total protein degradation with little alteration of total energy retention, is compared with present understanding of the role of the endogenous sex hormones.

Effect of riboflavin deficiency on reproductive performance and on biochemical indices of riboflavin status in the rat

Young female rats were made riboflavin-deficient by feeding a purified diet containing casein (210 g/kg). This basal diet provided 0.40 mg riboflavin/kg diet, to which was added additional riboflavin at 0, 0.12 or 0.25 mg/kg diet. Control animals received the same diet with 15 mg added riboflavin/kg. The diets were given for 4 weeks before mating, then throughout pregnancy and for 15 d of lactation. With no added riboflavin in the diet, reproduction was severely impaired and fetal resorption was usually observed. With 0.12 mg added riboflavin/kg diet, however, reproduction was usually successful, and the growth of dams and pups was only marginally depressed in comparison with pair-fed controls optimally supplied with riboflavin. The activation coefficient (stimulated:basal activity) of erythrocyte glutathione reductase (NAD(P)H) (EC 1.6.4.2) was high, and the concentration of riboflavin in the liver was correspondingly low in the dams receiving diets containing 0.12 or 0.25 mg added riboflavin/kg and in their sucking pups at 15 d post partum. Riboflavin levels in the milk from both groups of dams were about eightfold lower than in controls. There was little evidence that the sucking pups could maintain their riboflavin level at the expense of that in the maternal tissues.

Riboflavin status in infants born in rural Gambia, and the effect of a weaning food supplement

Riboflavin status was measured in infants between birth and two years of age, by the erythrocyte glutathione reductase (NAD(P)H2: glutathione oxidoreductase, EC 1.6.4.2) test on finger-prick blood samples. The infants were living in three rural Gambian villages: Keneba, Manduar and Kanton Kundar; those in Keneba were receiving a weaning food supplement between three and 12 months, which provided 0.15 to 0.20 mg riboflavin per day, in addition to their normal intake from breast milk and locally available weaning foods, which provided 0.13 to 0.21 mg/day over the same age range. On the basis of currently accepted criteria of biochemical normality, the unsupplemented infants were born deficient and, in the absence of a supplement, remained so throughout their first two years of life, with only a minor, short-lived improvement during the first few months. In the supplemented group, however, riboflavin status fell within normal limits for the duration of the supplement, but rapidly deteriorated again once the supplement was withdrawn. It is concluded that infants born to deficient mothers are usually deficient at birth, and remain so throughout suckling and weaning on to locally available foods. The daily requirement, to achieve satisfactory biochemical status, is thus greater than 0.13 to 0.21 mg/day, and probably approaches 0.4 mg/day, for most individuals up to the age of one year.

Wernicke's encephalopathy in infancy. Development during parenteral nutrition

Wernicke's encephalopathy documented by characteristic involvement of the mammillary bodies developed in a premature infant during parenteral nutrition. This case illustrates the need for thiamine supplementation in seriously ill patients with inadequate intake of the vitamin.