What dietary advice should I provide to patients at risk of thiamine deficiency, particularly those with alcohol dependence?

The provided UK guidelines do not offer specific dietary advice regarding thiamine-rich foods for patients at risk of thiamine deficiency, particularly those with alcohol dependence ¹,². Instead, the guidelines focus on the medical provision of thiamine supplementation ¹,².

For patients at high risk of developing, or with suspected, Wernicke's encephalopathy, thiamine should be offered ¹. This includes harmful or dependent drinkers who are:

• Malnourished or at risk of malnourishment ¹.
• Have decompensated liver disease ¹.
• Are in acute withdrawal ¹.
• Before and during a planned medically assisted alcohol withdrawal ¹.

In these cases, prophylactic oral thiamine should be offered ¹.

Prophylactic parenteral thiamine followed by oral thiamine should be offered to harmful or dependent drinkers if they are malnourished or at risk of malnourishment, or have decompensated liver disease, and additionally attend an emergency department or are admitted to hospital with an acute illness or injury ¹. For people with acute alcohol-related hepatitis, their nutritional requirements should be assessed ¹.