Thiamine state was investigated in patients with
alcoholic liver disease, patients with various non-
alcoholic liver diseases, and controls using a direct technique (
thiochrome assay) to measure
thiamine,
thiamine monophospate, and the active
coenzyme thiamine pyrophosphate in whole blood after isolating the fractions by ion exchange chromatography. Overall nutrition was similar in all groups as assessed by anthropometry, and no patient had clinical evidence of
thiamine deficiency. There was no significant difference among the groups in mean concentration of any form of
thiamine. The scatter was much greater in patients with
alcoholic liver disease but only 8.7% had biochemical
thiamine deficiency (defined as a blood concentration of the active
coenzyme greater than 2 SD below the mean control value). An unexpected finding was of abnormally high total
thiamine concentrations (greater than 2 SD above the mean control value) in 17.4% of patients with
alcoholic liver disease, the highest concentrations being found in two patients with severe
alcoholic hepatitis and
cirrhosis. The ratio of phosphorylated to unphosphorylated
thiamine was calculated as an index of phosphorylation and, although the mean did not differ significantly among the groups, the range was greatest in
alcoholic liver disease. The lowest ratios occurred in the two patients with severe
alcoholic hepatitis, but neither had evidence of
thiamine pyrophosphate deficiency. Contrary to studies using indirect assay techniques, these results suggest that
thiamine deficiency is unusual in well nourished patients with
alcoholic liver disease. The new finding of unexpectedly high
thiamine concentrations in some patients may be due to abnormalities of hepatic storage or release in
liver disease, particularly in severe
alcoholic hepatitis. There was no convincing evidence of impaired
thiamine phosphorylation in any patients with
liver disease. Conclusions from studies using indirect assays on the prevalence and mechanisms of
thiamine deficiency in
liver diseases may not be valid.