Johnson, Casey R.

Abstract Thiamine is an essential water‐soluble vitamin that plays an important role in energy metabolism. Thiamine deficiency presents many challenges to clinicians, in part due to the broad clinical spectrum, referred to as thiamine deficiency disorders (TDDs), affecting the metabolic, neurologic, cardiovascular, respiratory, gastrointestinal, and musculoskeletal systems. Concurrent illnesses and overlapping signs and symptoms with other disorders can further complicate this. As such, TDDs are frequently misdiagnosed and treatment opportunities missed, with fatal consequences or permanent neurologic sequelae. In the absence of specific diagnostic tests, a low threshold of clinical suspicion and early therapeutic thiamine is currently the best approach. Even in severe cases, rapid clinical improvement can occur within hours or days, with neurological involvement possibly requiring higher doses and a longer recovery time. Active research aims to help better identify patients with thiamine‐responsive disorders and future research is needed to determine effective dosing regimens for the various clinical presentations of TDDs. Understanding the clinical diagnosis and global burden of thiamine deficiency will help to implement national surveillance and population‐level prevention programs, with education to sensitize clinicians to TDDs. With concerted effort, the morbidity and mortality related to thiamine deficiency can be reduced.

Societal Impact StatementLentils are not only rich in protein and micronutrients, but they also have significant amounts of prebiotic carbohydrates, which provide benefits to human health. Beneficial microorganisms ferment lentil prebiotic carbohydrates in the colon, which impart gut health benefits to the consumer. In addition, prebiotic carbohydrates provide benefits to lentil plant health through their roles in carbon transport, storage, and abiotic stress tolerance. Advantageous to both human and plant health, prebiotic carbohydrates should be a prominent target for breeding efforts to improve lentil as a crop, as well as its nutritional value to consumers. Summary Diet‐related ailments, such as obesity and micronutrient deficiencies, have global adverse impacts on society. Lentil is an important staple crop, especially in South Asia and Africa, and has been associated with the prevention of chronic illnesses, including type II diabetes, obesity, and cancer. Lentil, a cool‐season food legume, is rich in protein and micronutrients while also containing a range of prebiotic carbohydrates, such as raffinose family oligosaccharides (RFOs), fructooligosaccharides, sugar alcohols (SAs), and resistant starch (RS), which contribute to lentil's health benefits. Prebiotic carbohydrates are fermented by beneficial microorganisms in the colon, which impart health benefits to the consumer. Prebiotic carbohydrates are also vital to lentil plant health, being associated with carbon transport/storage and abiotic stress tolerance. Important to both human and plant health, prebiotic carbohydrates in lentil are a prominent candidate for nutrigenomic breeding efforts. New lentil cultivars could help to combat global health problems, while also proving resilient to climate change. The objectives of this review are to: (a) discuss the benefits lentil prebiotic carbohydrates confer to human and plant health; (b) describe the biosynthesis pathways of two prominent prebiotic carbohydrate families in lentil, RFOs and SAs; and (c) consider the potential of prebiotic carbohydrates in terms of future nutritional breeding efforts.

Background: Thiamin deficiency is a major public health concern in several low- and middle-income countries (LMICs)—current attention to the problem is lacking. Aim: This review discusses prevalence of thiamin insufficiency and thiamin-deficiency disorders (TDDs) in LMICs, outlines programmatic experience with thiamin interventions, and offers recommendations to improve public-health and research attention to thiamin in LMICs. Discussion: Thiamin insufficiency, i.e. low-blood-thiamin status, is endemic among several Southeast Asian countries: Cambodia (70–100% of infants and 27–100% of reproductive-age women); Laos (13% of hospitalized infants); Thailand (16–25% of children and 30% of elderly adults). Thiamin deficiency accounts for up to 45% of under-5 deaths in Cambodia, 34% of infant deaths in Laos, and 17% of infant deaths in Myanmar. Deficiency also exists in Africa, Asia, and the Americas, but these instances have typically been isolated. Exclusively breastfed infants of thiamin-deficient mothers are at highest risk for TDD and related death. Intervention strategies that have been employed to combat thiamin deficiency include food processing, fortification, supplementation, dietary diversification, and dietary behaviors, all of which have shown varying levels of effectiveness. Conclusions: We recommend universal thiamin-fortification of context-specific staple-foods in LMICs as a promising solution, as well as thiamin supplementation, particularly for pregnant and lactating women. Food processing regulations, dietary diversification, and modification of dietary behaviors to increase consumption of thiamin-rich foods may provide benefits in some circumstances, especially in countries without universal fortification programs or in populations dependent on food aid.

Thiamine deficiency and beriberi are prevalent in Cambodia, although most infants with nonspecific clinical symptoms of beriberi, including tachypnea, lack echocardiographic evidence diagnostic of the disease. Camphor activates transient receptor potential vanilloid 3 (TRPV3), a nonselective ion channel expressed in the medial preoptic nucleus of the hypothalamus and thought to be important for thermo-sensitivity. Because camphorated ointments are used commonly among Cambodian infants, we hypothesized that topical camphor modulates thermoregulatory behaviors, causing beriberi-simulating tachypnea, separate from any influence of thiamine deficiency. We assessed 9 tachypneic and 10 healthy infants for Tiger Balm use and for presence of camphor in whole blood. However, no camphor was found in blood from any infants, indicating that camphor is unrelated to tachypneic illness in Cambodian infants.