Emerging Health Concern in Kashmir

Within a landscape distinguished by culinary opulence, the often-overlooked contributor amidst the array of nutrients is thiamine or Vitamin B1. Classified as an essential water-soluble vitamin, this organic compound plays a pivotal role in various metabolic processes critical for the optimal functioning of the human body. Thiamine is pivotal in facilitating energy production, supporting neurological functions, and contributing fundamentally to the maintenance of overall health. Its deficiency can lead to a range of health issues, including fatigue, neurological complications, and cardiovascular problems. The fact that such inadequacy persists in a population with access to abundant food resources prompts a deeper exploration into the specific dietary patterns, cultural practices, and socio-economic factors at play.

In the 1940s, thiamine deficiency was a serious public health issue, especially in war zones, areas with acute food shortages, refugee populations, and alcoholism. Thanks to improved nutrition awareness and food availability worldwide, thiamine deficiency is now rare. The occurrence of thiamine deficiency in Kashmir raises intriguing questions about the unique factors at play in this region.

In a surprising health conundrum, our community faces a dual challenge — grappling with both overnutrition and thiamine deficiency simultaneously. On the one hand, the prevalent issue of over-nutrition, characterized by excessive and diverse food consumption leading to obesity, is a well-documented modern health concern. Yet, remarkably, this co-occurs with the persistence of thiamine deficiency. The juxtaposition of these nutritional extremes poses a unique set of concerns, shedding light on the complexities of dietary health.

Thiamine is naturally present in the outer layers of rice grains, however, during the milling process that transforms brown rice into white polished rice, a significant portion of this vital nutrient is lost. As a result, a diet heavily reliant on polished white rice may inadvertently lead to insufficient thiamine intake, contributing to its deficiency. This phenomenon is particularly relevant in our region where
white rice is a predominant dietary staple consumed twice a day.

Initially, our community grappled predominantly with infantile beriberi, however, a discernible shift is now evident as adult beriberi manifests with diverse clinical presentations. Recent studies conducted by our team of researchers at Government Medical College have revealed a significant prevalence of thiamine deficiency among various age groups, including, adults, pregnant, children and the elderly. The situation is particularly concerning for pregnant women, as thiamine deficiency during pregnancy can impact both the mother and the developing foetus. Additionally, several distinct forms, notably gastric beriberi, high-output heart failure, and polyneuropathy in adults have been reported by our team. All these manifestations exhibit positive responses to prompt thiamine supplementation making it a preventable catastrophe. Interestingly, the typical features of thiamine deficiency get modified by the clinical features of other diseases like infections, stress etc.Following an accurate diagnosis through clinical assessment and laboratory tests, thiamine supplementation is recommended based on the severity of the deficiency, with oral administration suitable for mild to moderate cases and parenteral routes for severe presentations. Although thiamine deficiency is rampant, but over-prescription of thiamine is also a matter of concern.

To mitigate thiamine deficiency at a population level, a strategic emphasis on food fortification, particularly in staple foods like rice, is highly recommended. Rice is a primary dietary component of our population, and fortifying it with thiamine can be a practical and impactful means of ensuring widespread micronutrient intake. The fortification process involves adding thiamine to rice during the milling process, enriching it with this essential vitamin. Fortifying rice with thiamine not only addresses the nutritional needs of large populations but also aligns with existing consumption patterns. This targeted approach holds the potential to contribute significantly to public health efforts aimed at reducing thiamine deficiency on a broader scale. Implementation should be accompanied by careful monitoring, collaboration with relevant stakeholders, and ongoing assessment to ensure sustained success in improving thiamine status within the population.

The Food Corporation of India (FCI) recently announced that fortified rice will take the place of regular rice in all government schemes by 2024. The enhanced rice variant will contain a blend of vitamin B12, folic acid, and iron. However, it is surprising that thiamine, a crucial nutrient with widespread deficiencies across all age groups and associated with poor perinatal outcomes, has been omitted from the fortification program.

BY DR SOBIA NISAR

Author is Associate Professor, Department of Medicine, Govt Medical College Srinagar and has previously worked as Assistant Professor, Department of Geriatric Medicine, AIIMS New Delhi