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ARS Home » Pacific West Area » Davis, California » Western Human Nutrition Research Center » Obesity and Metabolism Research » Research » Publications at this Location » Publication #329320
Title: Perinatal consumption of thiamin-fortified fish sauce in rural Cambodia: a randomized controlled efficacy trial

Author
item WHITFIELD, KYLY - University Of British Columbia
item KARAKOCHUK, CRYSTAL - University Of British Columbia
item KROEUN, HOU - Helen Keller International (HKI), United States
item HAMPEL, DANIELA - University Of California
item SOKHOING, LY - Helen Keller International (HKI), United States
item CHAN, BENNY - University Of British Columbia
item BORATH, MAM - Ministry Of Planning-Cambodia
item SOPHONNEARY, PRAK - Ministry Of Planning-Cambodia
item MCLEAN, JUDY - University Of British Columbia
item AMINUZZAMAN, TALUKDER - Helen Keller International (HKI), United States
item LYND, LARRY - University Of British Columbia
item LI-CHAN, EUNICE C - University Of British Columbia
item KITTS, DAVID - University Of British Columbia
item GREEN, TIMOTHY - University Of British Columbia

Submitted to: JAMA Pediatrics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/9/2016
Publication Date: 8/8/2016
Citation: Whitfield, K.C., Karakochuk, C.D., Kroeun, H., Hampel, D., Sokhoing, L., Chan, B.B., Borath, M., Sophonneary, P., Mclean, J., Aminuzzaman, T., Lynd, L.D., Li-Chan, E.Y., Kitts, D.D., Green, T.J. 2016. Perinatal consumption of thiamin-fortified fish sauce in rural Cambodia: a randomized controlled efficacy trial. JAMA Pediatrics. doi: 10.1001/jamapediatrics\2016.2065.

Interpretive Summary: Thiamin deficiency can cause infantile beriberi, a potentially fatal disease that remains a public health concern in Cambodia. Low maternal thiamin intake can affect the thiamin status of the infant due to reduced amounts of this essential vitamin in breast milk. In this study, we fortified fish sauce, a popular Cambodian condiment, to increase maternal dietary thiamin intake, and to determine if thiamin-fortified fish sauce aids in the improvement of thiamin status of lactating mothers, their breast milk, and the infants. Thus, women were randomized to one of three groups (n=30 each) per 6 months of fish-sauce consumption: control (no thiamin), low (LC, 2 g/L) or high concentration (HC, 8 g/L). Women consuming the thiamin fortified fish sauce showed improved thiamin status in the mother, infant, and the breast milk, indicating that regular consumption of this fortified staple could aid in the prevention of infantile beriberi.

Technical Abstract: Importance: Infantile beriberi, a potentially fatal disease caused by thiamin deficiency, remains a public health concern in Cambodia and regions where B-vitamin poor, polished white rice is a staple food. Low maternal thiamin intake reduces breast milk thiamin concentrations, placing breastfed infants at risk of beriberi. We fortified fish sauce, a popular Cambodian condiment, to increase maternal dietary thiamin intake. Objective: To determine if ad libitum consumption of thiamin-fortified fish sauce yields higher erythrocyte thiamin diphosphate concentrations (eTDP) among lactating women and their newborn infants, and higher breast milk thiamin concentrations, compared to a control sauce. Design, Setting, and Participants: In this community-based, double-blind randomized controlled efficacy trial, 90 pregnant women (18-45 y; 23 ± 7 wk gestation at enrolment) were recruited in Prey Veng province, Cambodia. Intervention: Women were randomized to one of three groups (n=30 each) for ad libitum fish sauce consumption for 6 months starting at enrollment: control (no thiamin), low (LC, 2 g/L) or high concentration (HC, 8 g/L) thiamin-fortified fish sauce. Main Outcome and Measure: Maternal eTDP was assessed at baseline and endline. At endline, breast milk thiamin concentration and infant eTDP were also measured. Results: Baseline-adjusted endline eTDP (estimated marginal mean, 95% CI) were higher among women in LC (276; 246, 306 nM) and HC (238; 207, 268 nM) groups compared to control (194; 163, 224 nM; P<0.05); LC and HC did not differ (P=0.08). Breast milk total thiamin concentrations were higher among women in LC (211; 187, 236 µg/L) and HC (180; 152, 209 µg/L) groups compared to control (136; 110, 162 µg/L; P<0.05); HC and LC did not differ (P=0.10). Infants of women in the HC group had higher eTDP (257; 215, 298 nM; P<0.05) compared to women in LC (205; 175, 235 nM) and control (181; 153, 210 nM) groups. Conclusions and Relevance: Compared to control, women who consumed thiamin-fortified fish sauce through pregnancy and early lactation had higher eTDP and breast milk thiamin concentrations, and their breastfed infants had higher eTDP. Regular consumption of thiamin-fortified fish sauce has the potential to prevent infantile beriberi in this population.