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Wernicke–Korsakoff syndrome in Sydney hospitals after 6 years of thiamin enrichment of bread

  • S Rolland (a1) and AS Truswell (a1)
  • DOI: http://dx.doi.org/10.1079/PHN19980018
  • Published online: 01 June 1998
Abstract
AbstractObjective:

To estimate the incidence of Wernicke's encephalopathy (WE) and Korsakoffs psychosis (KP) before and after the introduction of thiamin enrichment of bread in Australia.

Design and subjects:

Inpatient records were examined in 17 major public general hospitals in greater Sydney for the 4 years 1993–96 (inclusive) with the International Classification of Diseases (ICD) 9 diagnoses 265.1 (WE), 291.1 and 294.0 (KP). Relevant clinical data were recorded on a specially designed form so that cases could be classified as confirmed or probable WE, confirmed or probable KP, confirmed or probable Wernicke–Korsakoff syndrome (WE + KP) or not WE or KP. The average number of cases of WE + KP was 38 acute (new) cases and 69 total (acute+chronic) cases per annum for all the hospitals combined.

Results:

This study used the same methods as our earlier retrospective examination of Wernicke–Korsakoff cases in essentially the same hospitals for 1978–93. Records for 1993 were thus pulled twice and, while individual cases (using hospital index number) did not always coincide, the total numbers for 1993 were 69 and 70.

For the 5 years after 1991 the number of acute cases of WE and KP in Sydney hospitals was 61% of the number for the 5 years before 1991 (P<0.01). There is, however, no continuing downward trend.

Conclusions:

These results are consistent with a 40% reduction of the incidence of acute WE and KP since bread has been enriched with thiamin. The disease complex has, however, not been eliminated. To achieve this, further public health action would be needed, such as addition of thiamin to beer.

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Corresponding author
*Corresponding author: E-mail S.Truswell@biochem.usyd.edu.au
Linked references
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1C Zubaran , JG Fernandes , R Rodnight . Wernicke–Korsakoff syndrome. Postgrad. Med. J. 1997; 73: 2731.

2C Harper . Wernicke's encephalopathy: a more common disease than realised. J. Neurol. Neumsurg. Psychiaty 1979; 42: 226–31.

6J Price , R Kerr . Some observations on the Wernicke–Korsakoff syndrome in Australia. Br. J. Addiction 1985; 80: 69–76.

8PS Bergin , P Harvey . Wernicke's encephalopathy and central pontine myelinolysis associated with hyperemesis gravidarium. Br. Med. J. 1992; 305: 517–18.

10C Harper . Clinical signs in the Wernicke–Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy. J. Neurol. Neurosurg. Psychiaty 1986; 49: 341–5.

12AS Truswell , F Apeagyei . Alcohol and cerebral thiamin deficiency. In: DB Jelliffe , EFP Jelliffe , eds. Adverse Effects of Foods. New York: Plenum, 1982: 253–8.

14J Price . MT Theodoros . The supplementation of alcoholic beverages with thiamine – a necessary preventive measure in Queensland? Aust. N.Z.J. Psychiaty 1979; 13: 315–20.

23D Caine , GM Halliday , JJ Kril , CG Harper . Operational criteria for the classification of chronic alcoholics: identification of Wernicke's encephalopathy. J. Neurol. Neurosurg. Psychiatry 1997; 62: 51–60,

26C Harper , J Gold , M Rodriguez , M Perdices . The prevalence of the Wernicke–Korsakoff syndrome in Sydney, Australia: a prospective necropsy study. J. Neurol. Neurosurg. Psychiatry 1989; 52: 282–5

27C Harper . The incidence of Wernicke's encephalopathy in Australia – a neuropathological study of 131 cases. J. Neurol. Neurosurg. Psychiatry 1983; 46: 593–8.

30L Connelly . J Price . Preventing the Wernicke–Korsakoff syndrome in Australia: cost-effectiveness of thiamin supplementation alternatives. Aust. N.Z.J. Publ. Health 1996; 20: 181–7.

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Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
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