Public health implications of thiamin deficiency in an endemic population: lessons from a community-based study in Kashmir.

Thiamin deficiency is a significant public health concern in Kashmir due to widespread reliance on white-polished rice, traditional cooking practices that reduce thiamin content, and previously documented thiamin deficiency disorders in multiple population groups in the region. The presence of background thiamin deficiency and reliance on polished white rice as the primary staple food in our population prompted us to evaluate the burden of thiamin deficiency among community-dwelling Kashmiri adults. A total of 500 participants were enrolled in the study and their demographic; socioeconomic and dietary information was collected. The prevalence rates of thiamin deficiency were determined and their associations with various factors were examined. Follow-up examinations were conducted to evaluate the effect of thiamin deficiency on health outcomes. The prevalence of thiamin deficiency in the study population was 18.4% (n = 92), with a significantly higher frequency among women (69.6%) than men (30.4%) (P = .034). Consumption of white-polished rice, particularly when washed more than two to three times before cooking, was more common in the low-thiamin group (72.8%; P < .05). The use of proton pump inhibitors were also significantly associated with lower thiamin diphosphate (TDP) concentration (28.3% vs 18.6%, P = .045). Follow-up assessments showed higher rates of weakness (16.3% vs 2.45%, P = .003), fatigue (11.9% vs 1.47%, P = .001), and lower-limb weakness (14.1% vs 0.49%, P = .001) in individuals with low thiamin status. Demographic and dietary factors, washing rice more than twice (AOR 1.82; 95% CI 1.05-3.18), tea consumption (AOR 1.55; 95% CI 1.01-2.38), proton pump inhibitor use (AOR 1.93; 95% CI 1.03-3.58), and female sex (AOR 1.48; 95% CI 1.01-2.21) were independently associated with low thiamin status. This study highlights the substantial burden of thiamin deficiency in an endemic population and underscores the need for improved dietary awareness and preventive public health strategies.