RESEARCH
Thiamin Status, Diuretic Medications, and the Management of Congestive Heart Failure

https://doi.org/10.1016/S0002-8223(95)00148-4Get rights and content

Abstract

Objective To assess the prevalence of thiamin deficiency in patients with congestive heart failure who are treated with diuretics that inhibit sodium and chloride reabsorption in the thick ascending limb of the loop of Henle (loop diuretic therapy).

Design A cross-sectional investigation of thiamin status of consecutive patients with congestive heart failure being treated with loop diuretic therapy.

Setting Cardiology clinic of a midwestern tertiary-care medical center.

Subjects Thirty-eight patients were recruited (mean age±standard deviation=55±14 years). Validation of methodology was conducted with nine age-matched control subjects.

Main outcome measures Thiamin status was assessed biochemically by in vitro erythrocyte transketolase activity assay. Assessment of dietary intake of thiamin was accomplished with a semiquantitative food frequency questionnaire.

Statistical analyses performed Fisher's exact test and logistic regression were used to evaluate relationships between thiamin status and variables of interest.

Results Biochemical evidence of thiamin deficiency was found in 8 of 38 (21%) patients. Evidence of risk for dietary thiamin inadequacy was found in 10 of 38 patients (25%). Seven of the 8 patients with biochemical evidence of thiamin deficiency met study criteria for dietary adequacy, although quantified data suggested that only 4 of the patients achieved two thirds of the Recommended Dietary Allowance. Biochemical evidence of thiamin deficiency tended to be more common among patients with poor left ventricular ejection fractions (P=.07).

Conclusions Thiamin deficiency may occur in a substantial proportion of patients with congestive heart failure, and dietary inadequacy may contribute to increased risk. J Am DietAssoc. 1995; 95:541-544.

Section snippets

Materials and Methods

This study was a cross-sectional investigation of thiamin status of consecutively treated patients of a cardiology clinic in a large, midwestern, tertiary care medical center.

Results

Thirty-eight patients with congestive heart failure participated in the study. The group comprised 29 men and 9 women; 30 were white and 8 were nonwhite; mean age (±standard deviation [SD]) was 55±14 years and median age was 56 years (range=20 to 79 years). Most subjects were being treated as outpatients; however, 11 were admitted to the inpatient service of the medical center.

Analysis of the clinical data revealed that 24 of the patients had ischemic heart disease and 14 had nonischemic heart

Discussion

Biochemical evidence for thiamin deficiency was found in one fifth of the study population of patients with congestive heart failure who were treated with loop diuretic therapy. This finding supports previous suggestions of a high prevalence of thiamin deficiency in patients with congestive heart failure treated with loop diuretic therapy (5), (7), (7). In our study, men and nonwhite patients with congestive heart failure appeared most likely to have evidence of thiamin deficiency, although

Applications

In-depth nutrition assessment of thiamin status, including dietary intake, may be an important component of care for patients with congestive heart failure who are being treated with loop diuretic therapy. The relative contributions of etiologic factors that increase the risk for thiamin deficiency in these patients and the efficacy of intervention remain to be determined. Confirmation of a specific drug-nutrient interaction awaits controlled clinical trials. Attention to thiamin status is of

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    Thiamin

  • Evaluation of the patient with cardiovascular disease

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