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Thiamine deficiency
Thiamine is used to treat thiamine deficiency which when severe can prove fatal. In less severe cases, non-specific signs include malaise, weight loss, irritability and confusion. Well-known disorders caused by thiamine deficiency include beriberi, Wernicke-Korsakoff syndrome, optic neuropathy, Leigh's disease, African Seasonal Ataxia, and central pontine myelinolysis.

Thiamine deficiency is often present in alcohol misuse disorder. In Western countries, thiamine deficiency is seen mainly in chronic alcoholism. Also at risk are older adults, persons with HIV/AIDS or diabetes, and persons who have had bariatric surgery. Varying degrees of thiamine deficiency have been associated with the long-term use of high doses of diuretics, particularly furosemide in the treatment of heart failure.

Prenatal supplementation
Women who are pregnant or lactating require more thiamine intake. In pregnancy, this increased need is likely due to thiamine being preferentially sent to the fetus and placenta, especially during the third trimester. Pregnant women with hyperemesis gravidarum are also at an increased risk for thiamine deficiency due to rapid thiamine losses when vomiting. For lactating women, thiamine is delivered in breast milk even if it results in thiamine deficiency in the mother.

It has also been suggested that thiamine deficiency plays a role in the poor development of the infant brain that can lead to sudden infant death syndrome (SIDS).

Other uses
Thiamine is a treatment for some types of maple syrup urine disease and Leigh disease.

Occurrence in foods
Thiamine is found in a wide variety of processed and whole foods, with edible seeds, legumes, rice, pork, and processed foods, such as breakfast cereals, having among the highest contents.

The salt thiamine mononitrate, rather than thiamine hydrochloride, is used for food fortification, as the mononitrate is more stable, and does not absorb water from natural humidity (is non-hygroscopic), whereas thiamine hydrochloride is hygroscopic. When thiamine mononitrate dissolves in water, it releases nitrate (about 19% of its weight) and is thereafter absorbed as the thiamine cation.

Dietary recommendations
In the U.S. the Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for thiamine were updated in 1998, by the Institute of Medicine now known as the National Academy of Medicine (NAM).

The European Food Safety Authority (EFSA) refers to the collective set of information as Dietary Reference Values, with Population Reference Intake (PRI) instead of RDA, and Average Requirement instead of EAR. AI and UL defined the same as in United States. For women (including those pregnant or lactating), men and children the PRI is 0.1 mg thiamine per megajoule (MJ) of energy consumed. As the conversion is 1 MJ = 238.8 kcal, an adult consuming 2388 calories should be consuming 1.0 mg thiamine. This is slightly lower than the U.S. RDA. The EFSA reviewed the same safety question and also reached the conclusion that there was not sufficient evidence to set a UL for thiamine.

To aid with adequate micronutrient intake, pregnant women are often advised to take a daily prenatal multivitamin. While micronutrient compositions vary among different vitamins, a typical prenatal vitamin contains around 1.5 mg of thiamine.

For U.S. food and dietary supplement labeling purposes the amount in a serving is expressed as a percentage of Daily Value (%DV). For thiamine labeling purposes 100% of the Daily Value was 1.5 mg, but as of May 27, 2016 it was revised to 1.2 mg to bring it into agreement with the RDA. A table of the old and new adult Daily Values is provided at Reference Daily Intake. The original deadline to be in compliance was July 28, 2018, but on September 29, 2017 the FDA released a proposed rule that extended the deadline to January 1, 2020 for large companies and January 1, 2021 for small companies.