Primary prevention
Coordinated, evaluated, public health actions are still required to eradicate thiamine deficiency as a major cause of infant pathology and mortality in many lower and middle income countries.[1] In countries where diets are low in thiamine (e.g., countries in Asia where there is a high consumption of thiamine-depleted polished rice, African nations where cassava root is a primary source of energy), vitamin B1 deficiency and outbreaks of beriberi are common.[5]The risk of beriberi can be reduced through the inclusion of pulses and/or nuts in the diet, using non-polished rice, or by enriching food with thiamine.[5] [38] Several countries, including the US, fortify flour with thiamine, but additional supplementation is required to be an effective preventative strategy in people with alcohol dependence.[42][43]A more successful method of prevention in the developed world may be the fortification of alcoholic drinks with thiamine.[44] Although this has been proposed, it is not practised. General measures to reduce the incidence of alcohol abuse and prevent chronic malnutrition in chronic alcohol abusers will reduce the incidence of thiamine deficiency in the developed world.
Secondary prevention
If the cause of vitamin B1 deficiency cannot be corrected, long-term oral thiamine supplementation should be considered. The likelihood of compliance and the ability to absorb oral therapy should be taken into account.
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