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Dobersek U, Bender M, Etienne A, Fernandez Gil GE, Hostetter C. Meat consumption & positive mental health: A scoping review. Prev Med Rep 2024; 37:102556. [PMID: 38186660 PMCID: PMC10770626 DOI: 10.1016/j.pmedr.2023.102556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
The objective of this scoping review was to examine the breadth of the existing literature on the relation between meat consumption or meat abstention and positive psychological functioning. In April 2022, we conducted a systematic search of online databases (PubMed, PsycINFO, CINAHL Plus, Medline, Cochrane Library, and Web of Science) for primary research examining positive psychological functioning in meat consumers and those who abstain from meat. Thirteen studies met the inclusion/exclusion criteria, representing 89,138 participants (54,413 females and 33,863 males) with 78,562 meat consumers and 10,148 meat abstainers (13-102 years) from multiple geographic regions. The primary outcomes were life satisfaction, "positive mental health", self-esteem, and vigor. The secondary outcomes were "meaning in life", optimism, positive emotions, and psychological well-being. Eight of the 13 studies demonstrated no differences between the groups on positive psychological functioning, three studies showed mixed results, and two studies showed that compared to meat abstainers, meat consumers had greater self-esteem, "positive mental health", and "meaning in life". Studies varied substantially in methods and outcomes. Although a small minority of studies showed that meat consumers had more positive psychological functioning, no studies suggested that meat abstainers did. There was mixed evidence for temporal relations, but study designs precluded causal inferences. Our review demonstrates the need for future research given the equivocal nature of the extant literature on the relation between meat consumption and meat abstention and positive psychological functioning.
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Affiliation(s)
- Urska Dobersek
- Department of Psychology, University of Southern Indiana, Evansville, IN, USA
| | - Mary Bender
- Department of Psychology, University of Southern Indiana, Evansville, IN, USA
| | - Alexandria Etienne
- Department of Psychology, University of Southern Indiana, Evansville, IN, USA
| | | | - Claire Hostetter
- Department of Psychology, University of Southern Indiana, Evansville, IN, USA
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Basouny N, Spigos J, Khvolis D, McFarlane-Ferreira Y, Lee A. Wernicke Encephalopathy in a Pediatric Patient with Avoidant Restrictive Food Intake Disorder: A Rare Presentation of Thiamine Deficiency. Am J Case Rep 2023; 24:e940717. [PMID: 37632134 PMCID: PMC10467509 DOI: 10.12659/ajcr.940717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/17/2023] [Accepted: 07/11/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Wernicke encephalopathy is traditionally associated with chronic alcoholism, nutritional imbalance, prolonged intravenous feeding, hyperemesis, anorexia nervosa, and malabsorption syndromes. We report a case of Wernicke's encephalopathy in a 12-year-old girl with avoidant restrictive food intake disorder. CASE REPORT The patient had lost 45.4 kg of body weight due to self-imposed changes to her diet, before presenting with decreased oral intake for 2-3 weeks, intermittent nausea, crampy epigastric pain, and post-prandial emesis. Her weight on admission was 78.2 kg. She received intravenous fluids of dextrose 5% with normal saline while she initially attempted to eat, but the post-prandial emesis persisted. She developed a fear of vomiting, which led to even more severe food intake restriction. After a week, she began to report double vision and blurred peripheral vision, with physical findings of nystagmus and an ataxic gait. She was empirically started on thiamine after negative neurology workup, with improvement of her gait, blurry vision, and nystagmus. Thiamine deficiency was later confirmed. CONCLUSIONS In patients with large amounts of weight loss presenting with neurological symptoms, Wernicke's encephalopathy must be considered in the differential diagnosis. Avoidant restrictive food intake disorder is rarely reported to cause Wernicke's encephalopathy. To the best of our knowledge, this is the first pediatric case demonstrating that Wernicke encephalopathy can occur in this type of eating disorder and not just in anorexia nervosa.
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Affiliation(s)
- Noha Basouny
- Department of Pediatrics, NewYork Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - John Spigos
- Department of Pediatrics, NewYork Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Dmitri Khvolis
- Department of Pediatrics, NewYork Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | | | - Ada Lee
- Department of Pediatrics, Stony Brook Children’s Hospital, Stony Brook, NY, USA
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Gibson D, Watters A, Bauschka M. Seizures in eating disorders. Int J Eat Disord 2023; 56:1650-1660. [PMID: 37092766 DOI: 10.1002/eat.23969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE To complete a descriptive study of seizure etiology in a large population of eating disorder (ED) patients and to better understand whether malnutrition itself, in those with EDs, is associated with seizure development. METHOD In this retrospective study, 75 patients with documented seizures met inclusion criteria from a total of 1664 charts. RESULTS Prevalence of seizures in this ED cohort was found to be 4.5%, with 29.3% of individuals experiencing seizures due to psychogenic nonepileptic seizures (PNES). Other common causes of seizures included substance abuse/withdrawal (18.7%), primary seizure disorder (12%), and electrolyte abnormalities/hypoglycemia (10.7%). Three patients (4%) also developed their seizures presumably due to Wernicke's encephalopathy (WE). DISCUSSION Several etiologies of seizures are reported from this large sample of ED patients, and this is also the first study to report on a possible association of WE as a cause of seizures in ED patients. The contribution of WE and malnutrition toward the development of seizures in this population remains to be determined, and future studies should also seek to better understand the inter-relationship between malnutrition and the other variables discussed in this article, such as hypomagnesemia, toward seizure development. PUBLIC SIGNIFICANCE The medical complications of EDs are myriad but seizures have not historically been considered one of those direct complications of malnutrition. The findings of this retrospective study suggest that seizure development may be a direct and indirect complication associated with EDs. The presentation of Wernicke's encephalopathy, which can also be associated with development of seizures, requires further investigation in those with EDs.
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Affiliation(s)
- Dennis Gibson
- ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ashlie Watters
- ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Maryrose Bauschka
- ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, Denver, Colorado, USA
- Eating Recovery Center, Denver, Colorado, USA
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Mantero V, Rifino N, Costantino G, Farina A, Pozzetti U, Sciacco M, Ripolone M, Bianchi G, Salmaggi A, Rigamonti A. Non-alcoholic beriberi, Wernicke encephalopathy and long-term eating disorder: case report and a mini-review. Eat Weight Disord 2021; 26:729-732. [PMID: 32130681 DOI: 10.1007/s40519-020-00880-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/19/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Nowadays, reports of beriberi are rare in developed countries. Wernicke encephalopathy may be present in about 25% of patients with beriberi. CASE REPORT We report the case of a woman with history of depression and chronic eating disorder, who complained Wernicke encephalopathy and beriberi. Sural nerve and muscular biopsy were performed, showing severe axonal neuropathy. Thiamine supplementation was started with rapid improvement of the pulmonary and cardiac affections; improvement of peripheral neuropathy was incomplete. CONCLUSIONS Thiamine deficiency can be misdiagnosed. Beriberi is an important cause of acute flaccid paralysis; hence, clinicians should consider this diagnosis and prompt start thiamine treatment to avoid permanent neurological sequelae.
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Affiliation(s)
- Vittorio Mantero
- Neurology Unit, "A. Manzoni" Hospital-ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy.
| | - Nicola Rifino
- Neurology Unit, "A. Manzoni" Hospital-ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Gisella Costantino
- Neurology Unit, "A. Manzoni" Hospital-ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Andrea Farina
- Cardiology Unit, "A. Manzoni" Hospital-ASST Lecco, Lecco, Italy
| | - Ugo Pozzetti
- Department of Internal Medicine, "A. Manzoni" Hospital-ASST Lecco, Lecco, Italy
| | - Monica Sciacco
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michela Ripolone
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Graziella Bianchi
- Neurology Unit, "A. Manzoni" Hospital-ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Andrea Salmaggi
- Neurology Unit, "A. Manzoni" Hospital-ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Andrea Rigamonti
- Neurology Unit, "A. Manzoni" Hospital-ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
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Steiner L, Hewlings S. A Systematic Review of the Role of Thiamine Supplementation in Treatment of Refeeding Syndrome. TOP CLIN NUTR 2021; 36:36-51. [DOI: 10.1097/tin.0000000000000235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Post-mortem neuropathological and in vivo neuroimaging methods have demonstrated the vulnerability of the inferior colliculus to the sequelae of thiamine deficiency as occurs in Wernicke-Korsakoff Syndrome (WKS). A rich literature in animal models ranging from mice to monkeys-including our neuroimaging studies in rats-has shown involvement of the inferior colliculi in the neural response to thiamine depletion, frequently accomplished with pyrithiamine, an inhibitor of thiamine metabolism. In uncomplicated alcoholism (i.e., absent diagnosable neurological concomitants), the literature citing involvement of the inferior colliculus is scarce, has nearly all been accomplished in preclinical models, and is predominately discussed in the context of ethanol withdrawal. Our recent work using novel, voxel-based analysis of structural Magnetic Resonance Imaging (MRI) has demonstrated significant, persistent shrinkage of the inferior colliculus using acute and chronic ethanol exposure paradigms in two strains of rats. We speculate that these consistent findings should be considered from the perspective of the inferior colliculi having a relatively high CNS metabolic rate. As such, they are especially vulnerable to hypoxic injury and may be provide a common anatomical link among a variety of disparate insults. An argument will be made that the inferior colliculi have functions, possibly related to auditory gating, necessary for awareness of the external environment. Multimodal imaging including diffusion methods to provide more accurate in vivo visualization and quantification of the inferior colliculi may clarify the roles of brain stem nuclei such as the inferior colliculi in alcoholism and other neuropathologies marked by altered metabolism.
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Affiliation(s)
- Tanuja Bordia
- Neuroscience Program, SRI International, Menlo Park, CA, United States
| | - Natalie M. Zahr
- Neuroscience Program, SRI International, Menlo Park, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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Bahat H, Reisler G, Brandriss N, Bar-Chaim A, Goldman M. Thiamine Deficiency in Adolescents with Eating Disorders: A Prospective Cohort Study. Nutrients 2020; 12:E1396. [PMID: 32414050 DOI: 10.3390/nu12051396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Pediatric eating disorders (PED) patients are prone to nutritional deficiencies. Thiamine deficiency is well described in other malnutrition states but is not routinely screened for in PED. In the current study we evaluated the prevalence of thiamine deficiency among PED patients on their first admission to an outpatient day hospital for eating disorders (DH). Methods: In this prospective cohort study, we measured whole blood thiamine pyrophosphate concentrations (TPP) in addition to a routine laboratory workup in 69 girls on their first admission to DH. Two subgroup analyses were performed: (I) Patients with a previous dietary intervention (“diet” group, n = 30) or naïve-to-treatment patients (“naïve” group, n = 39) and (II) Type of PED: Restrictive (group R, n = 44) or binge-eating/purging (group BP, n = 25). Results: Thiamine deficiency was identified in four girls (6%), all in the “naïve” group. Three of them had BP, and one had R. Patients in the “diet” group had a significantly higher TPP compared to the “naïve” group (55.5 µg/L vs. 46.7 µg/L, p = 0.004). TPP levels returned to normal after two weeks of the treatment program in all deficient patients. Conclusion: Thiamine deficiency was uncommon among PED patients and was easily replenished. Screening for deficiency should be performed among treatment-naïve patients. Keynotes: Whole blood thiamine pyrophosphate concentrations (TPP) are seldom screened for among PED patients. In the current study, we detected thiamine deficiency in only 6% of patients on their first admission to an outpatient day hospital for eating disorders. All deficient patients did not have a recent dietary intervention. We recommend considering screening for thiamine deficiency in treatment-naïve PED patients.
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Taleban R, Heidari-Beni M, Qorbani M, Esmaeil Motlagh M, Fazel-Tabar Malekshah A, Moafi M, Hani-Tabaei Zavareh N, Kelishadi R. Is dietary vitamin B intake associated with weight disorders in children and adolescents? The weight disorders survey of the CASPIAN-IV Study. Health Promot Perspect 2019; 9:299-306. [PMID: 31777710 PMCID: PMC6875549 DOI: 10.15171/hpp.2019.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 08/22/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Weight disorders are highly prevalent at the global level. Vitamin B groups are clearly involved in intracellular mechanisms, energy equation, and weight gain. The present study aims to evaluate the association of dietary vitamin B intake and obesity in a large pediatric population. Methods: This cross-sectional study was conducted among children and adolescents, aged 6-18years, living in urban and rural areas of 30 provinces of Iran. The BMI-for-age classifications were as follow: percentile <0.1, (emaciated), 0.1 ≤percentile <2.35 (thin), 2.35 ≤percentile≤84.1 (normal), 84.1 <percentile ≤97.7 (overweight), 97.1 <percentile (obese). A valid 168-item semi-quantitative Food Frequency Questionnaire (FFQ) was used to assess the usual dietary intake including vitamin B. Results: Out of 5606 children and adolescents participated (mean age: 11.62, SD: 3.32),46.8% were girls. The intake of thiamin, pyridoxine, niacin and pantothenic acid increased the likelihood of obesity, compared with the normal-weight group. Odds ratios (ORs) (95% CI) of obesity for vitamin B1, B3, B5, and B6 were 1.32 (1.14-1.53), 1.01 (1.00-1.02), 1.04 (1.00-1.08),and 1.20 (1.04-1.38), respectively. Riboflavin, cyanocobalamin, biotin and folic acid did not have any significant association with weight disorders (B2: OR=1.09, 95% CI =0.99-1.20); B12:OR=1.00, 95% CI=0.98-1.03; B8: OR=1.00, 95% CI=0.99-1.00 B9: OR=1.00, 95% CI=1.00-1.00). Conclusion: The current study showed a significant correlation between consumption of vitamin B group and increased risk of excess weight.
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Affiliation(s)
- Roya Taleban
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Motahar Heidari-Beni
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | | | | | - Mohammad Moafi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
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Eraslan C, Güler A, Kurt E, Çallı C, Kitiş Ö. Non-alkolik nedenlere bağlı gelişen Wernicke ensefalopatisinde manyetik rezonans görüntüleme bulguları. Ege Tıp Dergisi 2019. [DOI: 10.19161/etd.418147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
This case discusses the course of a woman with a history of epilepsy, alcohol use disorder, herpes simplex virus (HSV) encephalitis, and Wernicke encephalopathy (WE) who presented with altered mental status following approximately 48 hours of vomiting. After experiencing a tonic-clonic seizure in the emergency department, she developed a fluent aphasia. Aphasias are ordinarily attributed to structural changes in the brain parenchyma, often from stroke, neoplasm, or infection. When the magnetic resonance imaging of brain failed to show changes that could explain her fluent aphasia, the neurology team consulted psychiatry to workup psychogenic aphasia. During an admission 9 months earlier, she had been diagnosed with HSV encephalitis and possible WE. There was a high degree of suspicion for recurrent HSV infection, intermittent focal seizure activity, postictal psychosis, pseudobulbar affect, or a vascular cause of her fluent aphasia. After 3 days of treatment with levetiracetam, high-dose intravenous thiamine, and aripiprazole, the patient's fluent aphasia reversed. The authors conclude that the patient's reversible fluent aphasia was not psychiatric in etiology but likely caused by her seizures, the result of subtherapeutic phenytoin levels; her electroencephalogram showed focal seizure activity in the temporal lobes, possibly affecting her language centers. Language-related neurological conditions, or aphasias, can mimic psychiatric conditions such as conversion disorder or psychosis. In patients with substance use disorders, the line between psychiatric and neurological conditions becomes even more difficult to distinguish. The paper also discusses how unique aspects of her medications - levetiracetam conferring neuron membrane fluidity; aripiprazole, a drug shown to halt brain atrophy in mouse models; and parenteral thiamine to address her deficiency and WE - have aided in the reversal of the fluent aphasia. Levetiracetam should be considered in WE and the rare occurrence of aphasia after seizures.
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Affiliation(s)
| | | | - Chandler E Gill
- Department of Neurology, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Edwin Meresh
- Department of Psychiatry, Consultation-Liaison Psychiatry, Loyola University Medical Center, Maywood, IL 60153, USA,
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Oudman E, Wijnia JW, Oey MJ, van Dam MJ, Postma A. Preventing Wernicke's encephalopathy in anorexia nervosa: A systematic review. Psychiatry Clin Neurosci 2018; 72:774-779. [PMID: 29984541 DOI: 10.1111/pcn.12735] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/21/2018] [Accepted: 07/03/2018] [Indexed: 12/12/2022]
Abstract
Anorexia nervosa (AN) is a common eating disorder that affects 2.9 million people worldwide. Not eating a balanced diet or fasting can cause neurological complications after severe vitamin B1 malnourishment, although the precise signs and symptoms of Wernicke's encephalopathy (WE) are not clear. Our aim was to review the signs and symptoms of WE in patients with AN. We searched MEDLINE, EMBASE, Scopus, and PiCarta on all case descriptions of WE following AN. All case descriptions of WE in AN, irrespective of language, were included. Twelve WE cases were reviewed, suggesting that WE following AN is still a relatively rare neuropsychiatric disorder. WE is characterized by a triad of: mental status change, ocular signs, and ataxia. In alcoholism, this triad is present in 16% of cases, but eight out of 12 AN cases presented themselves with a full triad of symptomatology. Importantly, patients often had a more complex triad than has been previously described, involving vertigo, diplopia, and the consequences of refeeding syndrome. The development of a full triad and additional symptomatology suggests a late recognition of signs and symptoms of WE in AN. A complicating factor is the overlap between symptoms of thiamine deficiency and the symptoms of WE. Specifically, patients who show rapid weight loss are vulnerable for the development of WE. Eating disorders, such as AN, can lead to WE. Prophylactic thiamine checks and treatment in patients with AN are relevant, and in case of suspicion of WE, adequate parenteral thiamine supplementation is necessary.
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Affiliation(s)
- Erik Oudman
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.,Korsakoff Center Slingedael, Lelie Care Group, Rotterdam, The Netherlands
| | - Jan W Wijnia
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.,Korsakoff Center Slingedael, Lelie Care Group, Rotterdam, The Netherlands
| | - Misha J Oey
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.,Korsakoff Center Slingedael, Lelie Care Group, Rotterdam, The Netherlands
| | - Mirjam J van Dam
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.,Korsakoff Center Slingedael, Lelie Care Group, Rotterdam, The Netherlands
| | - Albert Postma
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.,Korsakoff Center Slingedael, Lelie Care Group, Rotterdam, The Netherlands
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12
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Jeynes KD, Gibson EL. The importance of nutrition in aiding recovery from substance use disorders: A review. Drug Alcohol Depend 2017; 179:229-239. [PMID: 28806640 DOI: 10.1016/j.drugalcdep.2017.07.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Nutrition is a prerequisite for health; yet, there is no special nutritional assessment or guidance for drug and alcohol dependent individuals, despite the fact that their food consumption is often very limited, risking malnutrition. Further, the premise is examined that malnutrition may promote drug seeking and impede recovery from substance use disorders (SUD). METHOD A narrative review addressed the relationship between substance use disorders and nutrition, including evidence for malnutrition, as well as their impact on metabolism and appetite regulation. The implications of the biopsychology of addiction and appetite for understanding the role of nutrition in SUD were also considered. RESULTS The literature overwhelmingly finds that subjects with alcohol use disorder (AUD) and drug use disorder (DUD) typically suffer from nutrient deficiencies. These nutrient deficiencies may be complicit in the alcoholic myopathy, osteopenia and osteoporosis, and mood disorders including anxiety and depression, observed in AUD and DUD. These same individuals have also been found to have altered body composition and altered hormonal metabolic regulators. Additionally, brain processes fundamental for survival are stimulated both by food, particularly sweet foods, and by substances of abuse, with evidence supporting confusion (addiction transfer) when recovering from SUD between cravings for a substance and craving for food. CONCLUSION Poor nutritional status in AUD and DUD severely impacts their physical and psychological health, which may impede their ability to resist substances of abuse and recover their health. This review contributes to a better understanding of interventions that could best support individuals with substance use disorders.
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Affiliation(s)
- Kendall D Jeynes
- Department of Life Sciences, Whitelands College, University of Roehampton, London SW15 4JD, UK
| | - E Leigh Gibson
- Department of Psychology, Whitelands College, University of Roehampton, Holybourne Avenue, London SW15 4JD, UK.
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Thota D, Rudinsky S. Wernicke’s Encephalopathy in a Patient Without Chronic Alcohol Abuse. Clin Pract Cases Emerg Med 2017; 1:95-97. [PMID: 29849420 PMCID: PMC5965427 DOI: 10.5811/cpcem.2016.12.32769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/08/2016] [Accepted: 12/12/2016] [Indexed: 11/25/2022] Open
Abstract
Wernicke’s encephalopathy (WE) is traditionally seen in the emergency department in patients with chronic alcohol abuse. WE can result in significant morbidity and mortality if untreated, making early diagnosis and intervention paramount. We discuss a case of WE in a 63-year-old female with no history of chronic alcohol abuse, who presented with bilateral opthalmoplegia that resolved after intravenous thiamine administration. This case report highlights the varied clinical settings other than chronic alcohol abuse in which the diagnosis of WE should be considered.
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Khalsa SS, Kumar R, Patel V, Strober M, Feusner JD. Mammillary body volume abnormalities in anorexia nervosa. Int J Eat Disord 2016; 49:920-929. [PMID: 27414055 PMCID: PMC5064812 DOI: 10.1002/eat.22573] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Several case reports of Wernicke's Encephalopathy in anorexia nervosa (AN) caused by thiamine deficiency have described mammillary body (MB) injury, but systematic studies are lacking. Here we evaluated whether underweight and weight-restored individuals with AN demonstrate evidence of abnormal MB morphology, via retrospective examination of a previously collected data set. METHOD Using standard-resolution T1-weighted magnetic resonance imaging at 3 Tesla, we measured MB volume and fornix area in a cross-sectional study of 12 underweight AN, 20 weight-restored AN, and 30 age- and sex-matched healthy comparisons. Because of the small size of these structures, a manual tracing approach was necessary to obtain accurate measurements. A blinded expert rater manually traced MB and fornix structures in each participant. RESULTS We observed significantly smaller MB volumes in the underweight AN group. However, the weight-restored AN group exhibited significantly larger MB volumes. The right fornix was smaller in the weight-restored AN group only. DISCUSSION These findings suggest the possibility that MB volume and fornix area could represent potential biomarkers of acute weight loss and restoration, respectively. Verification of this finding through prospective studies evaluating MB morphology, cognition, and thiamine levels longitudinally across individual illness trajectories might be warranted. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:920-929).
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Affiliation(s)
- Sahib S. Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, 74136,Faculty of Community Medicine, University of Tulsa, Tulsa, OK, 74104,Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA,Corresponding author:
| | - Rajesh Kumar
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA 90095, USA,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, USA,Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA
| | - Vandan Patel
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Jamie D. Feusner
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
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15
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Sharp CS, Wilson MP, Nordstrom K. Psychiatric Emergencies for Clinicians: Emergency Department Management of Wernicke-Korsakoff Syndrome. J Emerg Med 2016; 51:401-4. [PMID: 27553920 DOI: 10.1016/j.jemermed.2016.05.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/15/2016] [Accepted: 05/17/2016] [Indexed: 12/27/2022]
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16
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Prakash S, Kumar Singh A, Rathore C. Chronic Migraine Responding to Intravenous Thiamine: A Report of Two Cases. Headache 2016; 56:1204-9. [PMID: 27197607 DOI: 10.1111/head.12838] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 03/07/2016] [Accepted: 03/07/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Migraine is a risk factor for thiamine deficiency and Wernicke's encephalopathy (WE). WE is a highly underdiagnosed condition. The misdiagnosis is associated more with early or mild WE. The interrelation between migraine and thiamine deficiency is unknown CASE REPORTS Here, we report two female patients with chronic migraine. During examinations, we also noted clinical signs pertinent with a diagnosis of WE. Both patients had low blood thiamine level. Intravenous thiamine supplementation led to the improvement of both WE and associated headaches. DISCUSSION Nausea, vomiting, and anorexia of migraine may lead to mild to moderate thiamine deficiency and WE. Review of the literature suggests that WE in early or subclinical form will have nonspecific symptoms that may include frequent headache, nausea, vomiting, and anorexia. So, WE in the early stage may simulate migrainous features and this will further aggravate thiamine deficiency and a vicious cycle may be formed, and that will progressively increase the chronicity of headaches and other features. Breaking of this cycle by thiamine supplementation might be a promising therapy in a subset of patients with chronic migraine. CONCLUSION Thiamine deficiency due to nausea, vomiting and anorexia of migraine may further aggravate migraine like headaches in cyclical pattern.
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Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth University, Piperia, Baroda, Gujarat, India
| | - Ajai Kumar Singh
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Gomti Nagar - Lucknow, India
| | - Chaturbhuj Rathore
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Piperia, Sumandeep Vidyapeeth University, Baroda, Gujarat, India
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17
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Abstract
Thiamine deficiency usually occurs with prolonged nutritional deficiency and is almost universally identified with Wernicke's encephalopathy or beriberi. It is also, however, a rare cause of elevated lactate and gastroenterological symptoms. This case report describes a 30-year-old man with 2 weeks of gastroenterological symptoms and intermittent oral intake, who was found to have an elevated lactate level. Neurological exam was normal and an extensive workup was negative, but after being treated with thiamine, his lactate level improved overnight and all of his symptoms resolved. Thiamine levels returned low at 44 nmol/L (normal 78-185 nmol/L). Lack of recognition of this phenomenon, while rare, can lead to unnecessary tests and procedures and increased morbidity and mortality.
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Affiliation(s)
- James Duca
- John A. Burns School of Medicine, 651 Ilalo St., Honolulu, 96813, HI, USA
| | - Corey J Lum
- University of Hawaii Internal Medicine Program, 1356 Lusitana St. # 510, Honolulu, 96813, HI, USA
| | - Angela M Lo
- The Queen's Medical Center, 1301 Punchbowl St., Honolulu, 96813, HI, USA.
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18
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Abstract
BACKGROUND Wernicke's encephalopathy is a critical condition of neurological dysfunction resulting from a deficiency in thiamine. Chronic alcoholism is recognized as the most common cause of Wernicke's encephalopathy, but other causes, including fasting/starvation and malnutrition, have been documented within the scientific literature. These causes may not be readily recognized by healthcare professionals and may lead to Wernicke's encephalopathy being overlooked as a diagnosis when a nonalcoholic patient presents with classic signs and symptoms of the disorder. MATERIALS AND METHODS A narrative review of thiamine and its relationship to the development, diagnosis, and treatment of Wernicke's encephalopathy is presented based on a review of evidence-based guidelines and published research. To heighten awareness of the development of Wernicke's encephalopathy in fasted/starved and malnourished patients and to contribute to the scientific body of knowledge for the identification and management of Wernicke's encephalopathy in these patients, the clinical course and treatment of an adult woman who developed Wernicke's encephalopathy following a 40-day water-only fasting diet is outlined. RESULTS Clinical suspicion was required to identify the patient's condition and initiate immediate intervention through parenteral thiamine administration. Oral thiamine supplementation of 100 to 800 mg per day for 6 months was required to aid recovery. OUTCOMES The patient's clinical course and response to treatment illustrate the necessity for clinical awareness and suspicion of Wernicke's encephalopathy among healthcare professionals, timely and adequate parenteral thiamine administration, and oral thiamine supplementation at therapeutic doses to correct the nutrient deficiency, halt the progression of Wernicke's encephalopathy, and promote recovery.
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Affiliation(s)
- Deborah A Hutcheon
- School of Health Related Professions, Department of Nutritional Sciences, Rutgers, The State University of New Jersey, Newark, New Jersey Department of Food, Nutrition, and Packaging Sciences, Clemson, University, Clemson, South Carolina
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19
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Vernau K, Napoli E, Wong S, Ross-Inta C, Cameron J, Bannasch D, Bollen A, Dickinson P, Giulivi C. Thiamine Deficiency-Mediated Brain Mitochondrial Pathology in Alaskan Huskies with Mutation in SLC19A3.1. Brain Pathol 2014; 25:441-53. [PMID: 25117056 DOI: 10.1111/bpa.12188] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/05/2014] [Indexed: 02/05/2023] Open
Abstract
Alaskan Husky encephalopathy (AHE(1) ) is a fatal brain disease associated with a mutation in SLC19A3.1 (c.624insTTGC, c.625C>A). This gene encodes for a thiamine transporter 2 with a predominately (CNS) central nervous system distribution. Considering that brain is particularly vulnerable to thiamine deficiency because of its reliance on thiamine pyrophosphate (TPP)-dependent metabolic pathways involved in energy metabolism and neurotransmitter synthesis, we characterized the impact of this mutation on thiamine status, brain bioenergetics and the contribution of oxidative stress to this phenotype. In silico modeling of the mutated transporter indicated a significant loss of alpha-helices resulting in a more open protein structure suggesting an impaired thiamine transport ability. The cerebral cortex and thalamus of affected dogs were severely deficient in TPP-dependent enzymes accompanied by decreases in mitochondrial mass and oxidative phosphorylation (OXPHOS) capacity, and increases in oxidative stress. These results along with the behavioral and pathological findings indicate that the phenotype associated with AHE is consistent with a brain-specific thiamine deficiency, leading to brain mitochondrial dysfunction and increased oxidative stress. While some of the biochemical deficits, neurobehavior and affected brain areas in AHE were shared by Wernicke's and Korsakoff's syndromes, several differences were noted likely arising from a tissue-specific vs. that from a whole-body thiamine deficiency.
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Affiliation(s)
- Karen Vernau
- Department of Surgical and Radiological Sciences, University of California Davis, Toronto, Ontario, Canada
| | - Eleonora Napoli
- Molecular Biosciences, University of California Davis, Toronto, Ontario, Canada
| | - Sarah Wong
- Molecular Biosciences, University of California Davis, Toronto, Ontario, Canada
| | - Catherine Ross-Inta
- Molecular Biosciences, University of California Davis, Toronto, Ontario, Canada
| | - Jessie Cameron
- Department of Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Danika Bannasch
- Pathology, Microbiology and Immunology, University of California Davis, Sacramento, CA
| | - Andrew Bollen
- Department of Pathology and Laboratory Medicine, University of California San Francisco
| | - Peter Dickinson
- Department of Surgical and Radiological Sciences, University of California Davis, Toronto, Ontario, Canada
| | - Cecilia Giulivi
- Molecular Biosciences, University of California Davis, Toronto, Ontario, Canada.,Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, Sacramento, CA
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20
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Manzo G, De Gennaro A, Cozzolino A, Serino A, Fenza G, Manto A. MR imaging findings in alcoholic and nonalcoholic acute Wernicke’s encephalopathy: a review. Biomed Res Int. 2014;2014:503596. [PMID: 25050351 PMCID: PMC4094710 DOI: 10.1155/2014/503596] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/28/2014] [Indexed: 12/14/2022]
Abstract
Wernicke's encephalopathy (WE) is a severe neurological syndrome caused by thiamine (vitamin B1) deficiency and clinically characterized by the sudden onset of mental status changes, ocular abnormalities, and ataxia. Apart from chronic alcoholism, the most common cause of WE, a lot of other conditions causing malnutrition and decreasing thiamine absorption such as gastrointestinal surgical procedures and hyperemesis gravidarum must be considered as predisposing factors. Due to its low prevalence and clinical heterogeneity, WE is often misdiagnosed, leading to persistent dysfunctions and, in some cases, to death. Nowadays, MR imaging of the brain, showing T2 and FLAIR hyperintensities in typical (thalami, mammillary bodies, tectal plate, and periaqueductal area) and atypical areas (cerebellum, cranial nerve nuclei, and cerebral cortex), is surely the most important and effective tool in the diagnostic assessment of WE. The aim of this paper is to propose a state of the art of the role of MR imaging in the early diagnosis of this complex disease.
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21
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Mushtaq R, Shoib S, Shah T, Bhat M, Singh R, Mushtaq S. Unusual presentation of uncommon disease: anorexia nervosa presenting as wernicke-korsakoff syndrome-a case report from southeast Asia. Case Rep Psychiatry 2014; 2014:482136. [PMID: 24963430 DOI: 10.1155/2014/482136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 04/26/2014] [Accepted: 05/02/2014] [Indexed: 11/23/2022] Open
Abstract
Anorexia nervosa presenting as Wernicke-Korsakoff
syndrome is rare. The causes of Wernicke-Korsakoff syndrome are multiple like alcohol abuse, thyrotoxicosis, haemodialysis, severe malnutrition because of gastric carcinoma and pyloric obstruction, hyperemesis gravidarum, and prolonged parenteral feeding. We report a case of anorexia nervosa, who presented with Wernicke's encephalopathy and progressed to Korsakoff's syndrome. Knowledge, awareness, and early intervention of anorexia nervosa by mental health professionals can prevent development of Wernicke-Korsakoff syndrome.
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22
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Liu M, Alimov AP, Wang H, Frank JA, Katz W, Xu M, Ke ZJ, Luo J. Thiamine deficiency induces anorexia by inhibiting hypothalamic AMPK. Neuroscience 2014; 267:102-13. [PMID: 24607345 DOI: 10.1016/j.neuroscience.2014.02.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/08/2014] [Accepted: 02/21/2014] [Indexed: 01/26/2023]
Abstract
Obesity and eating disorders are prevailing health concerns worldwide. It is important to understand the regulation of food intake and energy metabolism. Thiamine (vitamin B1) is an essential nutrient. Thiamine deficiency (TD) can cause a number of disorders in humans, such as Beriberi and Wernicke-Korsakoff syndrome. We demonstrated here that TD caused anorexia in C57BL/6 mice. After feeding a TD diet for 16days, the mice displayed a significant decrease in food intake and an increase in resting energy expenditure (REE), which resulted in a severe weight loss. At the 22nd day, the food intake was reduced by 69% and 74% for male and female mice, respectively in TD group. The REE increased by ninefolds in TD group. The loss of body weight (17-24%) was similar between male and female animals and mainly resulted from the reduction of fat mass (49% decrease). Re-supplementation of thiamine (benfotiamine) restored animal's appetite, leading to a total recovery of body weight. The hypothalamic adenosine monophosphate-activated protein kinase (AMPK) is a critical regulator of food intake. TD inhibited the phosphorylation of AMPK in the arcuate nucleus (ARN) and paraventricular nucleus (PVN) of the hypothalamus without affecting its expression. TD-induced inhibition of AMPK phosphorylation was reversed once thiamine was re-supplemented. In contrast, TD increased AMPK phosphorylation in the skeletal muscle and upregulated the uncoupling protein (UCP)-1 in brown adipose tissues which was consistent with increased basal energy expenditure. Re-administration of thiamine stabilized AMPK phosphorylation in the skeletal muscle as well as energy expenditure. Taken together, TD may induce anorexia by inhibiting hypothalamic AMPK activity. With a simultaneous increase in energy expenditure, TD caused an overall body weight loss. The results suggest that the status of thiamine levels in the body may affect food intake and body weight.
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23
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Tóth A, Aradi G, Várallyay G, Arányi Z, Bereczki D, Vastagh I. Wernicke’s encephalopathy induced by the use of diet pills and unbalanced diet. Orv Hetil 2014; 155:469-74. [DOI: 10.1556/oh.2014.29847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Wernicke’s encephalopathy is an acute, potentially life-threatening, neurological syndrome resulting from thiamine deficiency. The disorder is still greatly underdiagnosed and, without prompt treatment, the condition can lead to the chronic form of the disease, Korsakoff’s syndrome or even death. In developed countries Wernicke’s encephalopathy has been associated with alcoholism, but in recent years there has been an increasing number of non-alcoholic cases. Authors report the case of a 23-year-old woman who developed oculomotor dysfunction, encephalopathy and ataxia as a result of an extreme diet and use of diet pills. The diagnosis of Wernicke’s encephalopathy was supported by the resolution of neurological signs after parenteral thiamine replacement. This case is presented because of the rare etiology and diagnostic difficulty, and the latest diagnostic and therapic guidelines are also highlighted. Orv. Hetil., 2014, 155(12), 469–474.
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Affiliation(s)
- Adrián Tóth
- Semmelweis Egyetem, Általános Orvostudományi Kar Neurológiai Klinika Budapest Balassa u. 6. 1083
| | - Gabriella Aradi
- Semmelweis Egyetem, Általános Orvostudományi Kar Neurológiai Klinika Budapest Balassa u. 6. 1083
| | - György Várallyay
- Szentágothai Tudásközpont – Semmelweis Egyetem MR Kutatóközpont Budapest
| | - Zsuzsanna Arányi
- Semmelweis Egyetem, Általános Orvostudományi Kar Neurológiai Klinika Budapest Balassa u. 6. 1083
| | - Dániel Bereczki
- Semmelweis Egyetem, Általános Orvostudományi Kar Neurológiai Klinika Budapest Balassa u. 6. 1083
| | - Ildikó Vastagh
- Semmelweis Egyetem, Általános Orvostudományi Kar Neurológiai Klinika Budapest Balassa u. 6. 1083
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24
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Abstract
Wernicke–Korsakoff syndrome is a neuropsychiatric disorder resulting from thiamine deficiency and commonly associated with chronic alcoholism, but we describe the first case report resulting from self-neglect associated with depression.
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Affiliation(s)
- Karen A Cocksedge
- Carrick North Community Mental Health Team, 57 Pydar Street, Truro, Cornwall TR1 2SS, UK
| | - Adrian Flynn
- Psychiatric Liaison Service, Wellbeing Centre, Royal Cornwall Hospital, Truro, Cornwall TR1 3LJ, UK
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25
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Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc 2013; 88:1127-40. [PMID: 24079682 PMCID: PMC3975915 DOI: 10.1016/j.mayocp.2013.06.012] [Citation(s) in RCA: 394] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 05/31/2013] [Accepted: 06/26/2013] [Indexed: 02/07/2023]
Abstract
Lactate levels are commonly evaluated in acutely ill patients. Although most often used in the context of evaluating shock, lactate levels can be elevated for many reasons. While tissue hypoperfusion may be the most common cause of elevation, many other etiologies or contributing factors exist. Clinicians need to be aware of the many potential causes of lactate level elevation as the clinical and prognostic importance of an elevated lactate level varies widely by disease state. Moreover, specific therapy may need to be tailored to the underlying cause of elevation. The present review is based on a comprehensive PubMed search between the dates of January 1, 1960, to April 30, 2013, using the search term lactate or lactic acidosis combined with known associations, such as shock, sepsis, cardiac arrest, trauma, seizure, ischemia, diabetic ketoacidosis, thiamine, malignancy, liver, toxins, overdose, and medication. We provide an overview of the pathogenesis of lactate level elevation followed by an in-depth look at the varied etiologies, including medication-related causes. The strengths and weaknesses of lactate as a diagnostic/prognostic tool and its potential use as a clinical end point of resuscitation are discussed. The review ends with some general recommendations on the management of patients with elevated lactate levels.
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Affiliation(s)
- Lars W. Andersen
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Julie Mackenhauer
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
| | - Jonathan C. Roberts
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Katherine M. Berg
- Department of Medicine, Division of Pulmonary Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Michael N. Cocchi
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Anesthesia Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Michael W. Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Medicine, Division of Pulmonary Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
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26
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Ghorbani A, Fatehi F, Soltanzadeh A, Hamidieh A, Vahabi Z. Wernicke's Encephalopathy in a Young Girl Suffering from Acute Myeloblastic Leukemia. Iran J Pediatr 2012; 22:574-5. [PMID: 23429972 PMCID: PMC3533170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 04/01/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Askar Ghorbani
- Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Fatehi
- Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author:Address: Shariati Hospital and Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran. E-mail:
| | - Akbar Soltanzadeh
- Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirali Hamidieh
- Hematology-Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Vahabi
- Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran
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27
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Sum SS, Brody R. The Link Between Thiamine Supplementation and Treatment of Wernicke-Korsakoff Syndrome in Patients with Alcoholism. TOP CLIN NUTR 2012; 27:334-8. [DOI: 10.1097/tin.0b013e31826f915e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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McCormick LM, Buchanan JR, Onwuameze OE, Pierson RK, Paradiso S. Beyond alcoholism: Wernicke-Korsakoff syndrome in patients with psychiatric disorders. Cogn Behav Neurol. 2011;24:209-216. [PMID: 22134191 DOI: 10.1097/WNN.0b013e31823f90c4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Wernicke encephalopathy and Korsakoff syndrome (the combined disorder is named Wernicke-Korsakoff syndrome [WKS]) are preventable, life-threatening neuropsychiatric syndromes resulting from thiamine deficiency. WKS has historically been associated with alcoholism; more recently, it has been recognized in patients who have anorexia nervosa or have undergone bariatric surgery for obesity. However, patients with nutritional deficiencies of any origin are at risk for WKS. We present clinical histories and neuroimaging data on 2 young adults with underlying psychiatric disorders who became malnourished and developed WKS. METHODS A young woman with bipolar disorder and somatization disorder was hospitalized for intractable vomiting. A young man with chronic paranoid schizophrenia developed delusions that food and water were harmful, and was hospitalized after subsisting for 4 months on soda pop. RESULTS Acute, life-threatening Wernicke encephalopathy was confirmed in both patients by brain magnetic resonance imaging showing classic thalamic injury. The patients were left with persistent cognitive and physical disabilities that were consistent with Korsakoff syndrome. CONCLUSIONS Failure to suspect a vitamin deficiency led to permanent cognitive and physical disabilities that may necessitate lifelong care for these patients. The neuropsychiatric consequences could have been prevented by prompt recognition of their thiamine deficiency.
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29
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Rigaud D, Tallonneau I, Brindisi MC, Vergès B. Prognosis in 41 severely malnourished anorexia nervosa patients. Clin Nutr 2012; 31:693-8. [PMID: 22459953 DOI: 10.1016/j.clnu.2012.02.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 02/23/2012] [Accepted: 02/25/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND & AIMS To report the prognosis in 41 anorexia nervosa (AN) patients suffering from very severe malnutrition (mean BMI: 10.1 ± 0.57 kg/m(2)). PATIENTS AND METHODS Compared with 443 less malnourished AN patients, the 41 patients were older (27.8 ± 5.4 vs 22.4 ± 2.1 yrs), their AN was longer (9.6 ± 3.4 vs 5.0 ± 1.5 yrs) and more often of the restrictive subtype (P < 0.05). RESULTS In 27% of the patients, all nutritional marker levels were in normal range. All patients received a prudent tube-refeeding: energy was increased from 12 to 40 kcal/kg/day, protein from 1.0 to 1.5 g/kg/day within 10 days. During stay, 1 patient died, 2 others suffered from myocardial infarction, 2 others from acute pancreatitis, and 5 from mental confusion. Compared with the other 443 AN patients, the 40 remaining patients had worse 6-yr prognosis: 2 died (7% vs 1.2%), 29% had severe outcome (vs 10%), and only 41% recovered (vs 62%). CONCLUSION In AN patients with BMI < 11 kg/m(2), a prudent tube-refeeding could avoid short-term mortality, but long-term prognosis was bad.
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Affiliation(s)
- Daniel Rigaud
- Service d'Endocrinologie-Nutrition, CHU Le Bocage: 2, Bd du Maréchal de Lattre de Tassigny, 21000 Dijon, France.
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30
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Vetreno RP, Ramos RL, Anzalone S, Savage LM. Brain and behavioral pathology in an animal model of Wernicke's encephalopathy and Wernicke-Korsakoff Syndrome. Brain Res 2012; 1436:178-92. [PMID: 22192411 PMCID: PMC3266665 DOI: 10.1016/j.brainres.2011.11.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 11/16/2011] [Accepted: 11/18/2011] [Indexed: 01/24/2023]
Abstract
Animal models provide the opportunity for in-depth and experimental investigation into the anatomical and physiological underpinnings of human neurological disorders. Rodent models of thiamine deficiency have yielded significant insight into the structural, neurochemical and cognitive deficits associated with thiamine deficiency as well as proven useful toward greater understanding of memory function in the intact brain. In this review, we discuss the anatomical, neurochemical and behavioral changes that occur during the acute and chronic phases of thiamine deficiency and describe how rodent models of Wernicke-Korsakoff Syndrome aid in developing a more detailed picture of brain structures involved in learning and memory.
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Affiliation(s)
- Ryan P. Vetreno
- Behavioral Neuroscience Program, Department of Psychology, State University of New York at Binghamton, Binghamton, NY 13902
| | - Raddy L. Ramos
- Department of Neuroscience & Histology, New York College of Osteopathic Medicine, New York Institute of Technology, Old Westbury NY 11568
| | - Steven Anzalone
- Behavioral Neuroscience Program, Department of Psychology, State University of New York at Binghamton, Binghamton, NY 13902
| | - Lisa M. Savage
- Behavioral Neuroscience Program, Department of Psychology, State University of New York at Binghamton, Binghamton, NY 13902
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31
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Mayr J, Freisinger P, Schlachter K, Rolinski B, Zimmermann F, Scheffner T, Haack T, Koch J, Ahting U, Prokisch H, Sperl W. Thiamine pyrophosphokinase deficiency in encephalopathic children with defects in the pyruvate oxidation pathway. Am J Hum Genet 2011; 89:806-12. [PMID: 22152682 DOI: 10.1016/j.ajhg.2011.11.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 10/31/2011] [Accepted: 11/09/2011] [Indexed: 01/31/2023] Open
Abstract
Thiamine pyrophosphate (TPP) is an essential cofactor of the cytosolic transketolase and of three mitochondrial enzymes involved in the oxidative decarboxylation of either pyruvate, α-ketoglutarate or branched chain amino acids. Thiamine is taken up by specific transporters into the cell and converted to the active TPP by thiamine pyrophosphokinase (TPK) in the cytosol from where it can be transported into mitochondria. Here, we report five individuals from three families presenting with variable degrees of ataxia, psychomotor retardation, progressive dystonia, and lactic acidosis. Investigation of the mitochondrial energy metabolism showed reduced oxidation of pyruvate but normal pyruvate dehydrogenase complex activity in the presence of excess TPP. A reduced concentration of TPP was found in the muscle and blood. Mutation analysis of TPK1 uncovered three missense, one splice-site, and one frameshift mutation resulting in decreased TPK protein levels.
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Abstract
PURPOSE OF REVIEW To describe the etiology and complications of the refeeding syndrome. RECENT FINDINGS Complications of the refeeding syndrome can include electrolyte abnormalities, heart failure, respiratory failure, and death. This syndrome is of particular importance to critically ill patients, who can be moved from the starved state to the fed state rapidly via enteral or parenteral nutrition. There are a variety of risk factors for the development of the refeeding syndrome. All of these risk factors are tied together by starvation physiology. Case reports and case series continue to be reported, suggesting that this entity continues to exist in critically ill patients. Initiation of enteral nutrition to patients with starvation physiology should be gradual and careful monitoring of electrolytes and organ function is critical during the early stages of refeeding. SUMMARY The refeeding syndrome remains a significant issue in critically ill patients. Knowledge of the risk factors and the clinical signs of the refeeding syndrome is important to optimize outcomes.
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Affiliation(s)
- Matthew C Byrnes
- Division of Surgical Critical Care, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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