Thiamine deficiency disease persists in the modern world, but its epidemiology is very different from that of a century ago. Epidemic classical beriberi is rarely seen today. Although signs and symptoms of famine-related thiamine deficiency occur all too often, they are likely to be accompanied by clinical evidence of multiple deficiencies of vitamins and other nutrients. War, disaster, and drought-induced famines will continue into the future as contributors to deficiencies of thiamine, but beriberi as a distinct clinical entity will probably seldom occur in those circumstances.
As an endemic disease, however, beriberi has not disappeared. Some beriberi still occurs where rice is the staple cereal, polished rice is preferred, parboiling is not practiced, and few other sources of thiamine exist in the diet. In other areas, where rice is not the staple, beriberi may occur occasionally when refined carbohydrate foods are dominant in the diet. Davidson and Passmore (1966: 412), for example, mention the common occurrence of beriberi early in this century in the fishing communities of Newfoundland and Labrador. Often cut off during the long winter from outside provisions, people in these areas depended upon winter stores consisting mainly of flour made from highly milled wheat. Beriberi probably continues to appear today in similar circumstances of prolonged and extreme isolation.
In some countries, beriberi is so intimately associated with culturally maintained dietary preferences and practices that it is likely to persist well into the future. In northern Thailand, as noted, consumption of fermented raw fish has been reported to be an important cause of beriberi. Vimokesant and colleagues (1975) also concluded that antithiamine activity of fermented tea and betel nuts must contribute to persistent thiamine deficiency in that region. However, to what extent these effects may result from destruction of thiamine, or from loose binding and partial blocking of activity, remains unclear. Further evaluation of these findings is warranted because of the wide use of these substances not only in Thailand but elsewhere in Asia. If the extensive use of betel nut in some regions of India interferes with thiamine activity or retention, it appears, nevertheless, that the thiamine-preserving effect of rice parboiling can maintain a sufficient thiamine balance to minimize the appearance of signs and symptoms of deficiency. This too is, however, a topic in need of further study, particularly in relation to the occurrence and significance of subclinical or borderline thiamine deficiency.
In addition to the problem of endemic beriberi, thiamine deficiency occurs sporadically in many countries, especially as a result of chronic alcoholism, but also in association with some chronic illnesses and with long-term parenteral nutrition (Altschule 1978:98).As Richard S. Rivlin (1988) reports, thiamine absorption is exquisitely sensitive to ingested ethanol, which can significantly interfere with absorption. Alcoholics may fail to absorb most of their dietary thiamine - thiamine which is likely to be limited, in any case, as the diet is increasingly impaired and restricted. Rivlin notes that about 25 percent of alcoholics admitted to general hospitals in the United States have evidence of thiamine deficiency by either clinical or biochemical criteria. He cites evidence as well that alcohol can adversely affect the intermediary metabolism of thiamine, and that chronic liver disease, resulting from alcoholism, may impair the conversion of thiamine to thiamine pyrophosphate.
World History
