Dietitians of Canada

Patients with congestive heart failure (CHF) may be at increased risk of thiamin deficiency (TD) as a result of diuretic induced urinary thiamin excretion, and malnutrition. Prevalence estimates of TD in CHF patients range widely depending on the population studied. Since TD can manifest as symptoms of CHF, it is critical to determine if hospitalized patients are at risk for TD as well as the factors contributing to TD. The purpose of this study was to determine the prevalence of TD in a cross-section of hospitalized CHF patients and to investigate factors (diuretic type and dosage, urinary thiamin excretion, disease severity, thiamin intake, nutrition status, hospitalization, age and gender) that may contribute to its development. Thiamin status, determined by erythrocyte thiamin pyrophosphate (TPP) concentrations, was measured in 100 hospitalized CHF patients, and compared to 50 age and sex matched controls (C). The prevalence of TD was significantly higher in CHF patients compared to C (33% vs. 12%, p=0.007, respectively). Factors that were significantly associated with TD in the CHF group included use of pre-admission spironolactone (p=0.04), non-use of thiamin-containing supplements (p=0.046), and preserved renal function (p=0.046). Thiamin status tended to be associated with worsened CHF, malnutrition, decreased appetite, and inadequate thiamin intake. TD was not associated with gender, age, hospitalization and increased urine thiamin excretion. Urine thiamin excretion (mg/g creatinine) was the only significant positive predictor of thiamin status using multiple regression analysis (p = 0.03). This study has found that 33% (CI 26-41%) of hospitalized CHF patients have TD. Urine thiamin excretion was the best predictor of thiamin status. However this finding was opposite to current thinking, in that greater urine thiamin excretion was positively associated with thiamin status. This study suggests that there is a place for thiamin supplementation in hospitalized CHF patients. Future trials should be aimed at assessing the effects of thiamin supplementation on CHF disease severity and symptoms.