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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 #332289
Title: Perinatal consumption of thiamine-fortified fish sauce in rural Cambodia. A randomized clinical 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
item SOKHONIG, 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 Health
item MCLEAN, JUDY - University Of British Columbia
item TALUKDER, AMINUZZAMAN - Helen Keller International (HKI), United States
item LYND, LARRY - University Of British Columbia
item LI-CHAN, EUNICE - University Of British Columbia
item KITTS, DAVID - University Of British Columbia
item Allen, Lindsay - A
item GREEN, TIMOTHY - University Of British Columbia

Submitted to: JAMA Pediatrics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/1/2016
Publication Date: 8/8/2016
Citation: Whitfield, K.C., Karakochuk, C.D., Kroeun, H., Hampel, D., Sokhonig, L., Chan, B.B., Borath, M., Sophonneary, P., Mclean, J., Talukder, A., Lynd, L.D., Li-Chan, E.C., Kitts, D.D., Allen, L.H., Green, T.J. 2016. Perinatal consumption of thiamine-fortified fish sauce in rural Cambodia. A randomized clinical trial. JAMA Pediatrics. 170(10):e162065.

Interpretive Summary: Infantile beriberi, a potentially fatal disease caused by thiamine deficiency, is a public health concern in Cambodia and regions where thiamine-poor white rice is a staple food. Low maternal thiamine intake reduces breast milk thiamine placing breastfed infants at risk of beriberi. The objective was to determine if consumption of thiamine-fortified fish sauce improves thiamine status of lactating women and their newborn infants (increases erythrocyte thiamine diphosphate concentrations, eTDP) and increases breast milk thiamine. Pregnant women from Prey Veng province, Cambodia were randomized to 1 of 3 groups (n = 30/group) for 6 mo: control (no thiamine), low-concentration (2 g/L), or high-concentration (8 g/L) fish sauce. Women's mean (SD) age and gestational stage were 26 (5) y and 23 (7) wk respectively. Mean baseline-adjusted eTDP at the end of the study was higher among women in the low-concentration (282nM) and high-concentration (254nM) groups compared with the control group (193nM)(P < .05); low-concentration and high-concentration groups did not differ. Breast milk total thiamine concentrations were 14.4 ug/dL for the control group, 20.7 ug/dL for the low-concentration group and 17.7 ug/dL for the high-concentration group. Mean (SD) infant age at endline was 16 wk for the control group, 17 wk the low-concentration group, and 14 wk for the high-concentration group. Infant eTDP was higher among those in the high-concentration group (257nM; P < .05) compared with the low-concentration (212nM) and control (187nM) groups. Compared with women in the control group, women who consumed thiamine-fortified fish sauce through pregnancy and early lactation had higher eTDP and breast milk thiamine concentrations and their infants had higher eTDP especially in the high group. Thiamine-fortified fish sauce could prevent infantile beriberi in this population.

Technical Abstract: Infantile beriberi, a potentially fatal disease caused by thiamine deficiency, is a public health concern in Cambodia and regions where thiamine-poor white rice is a staple food. Low maternal thiamine intake reduces breast milk thiamine placing breastfed infants at risk of beriberi. The objective was to determine if consumption of thiamine-fortified fish sauce increases erythrocyte thiamine diphosphate (eTDP) among lactating women and newborn infants as well as breast milk thiamine. Pregnant women were recruited in Prey Veng province, Cambodia and randomized to 1 of 3 groups (n = 30/group) for ad libitum fish sauce consumption for 6 mo: control (no thiamine), low-concentration (2 g/L), or high-concentration (8 g/L). Maternal eTDP was assessed at baseline and endline and breast milk thiamine and infant eTDP at endline. Women's mean (SD) age and gestational stage were 26 (5) y and 23 (7) wk respectively. Mean baseline-adjusted endline eTDP was higher among women in the low-concentration (282nM; 95%CI, 235 to 310nM) and high-concentration (254nM; 95%CI, 225 to 284nM) groups compared with the control group (193nM; 95%CI, 164 to 222 nM; P < .05); low- and high-concentration groups did not differ (P = .19). Breast milk total thiamine concentrations were 14.4 ug/dL for the control group (95% CI, 12.3 to 16.5 ug/dL); 207 ug/dL for the low-concentration group (95%CI, 18.6 to 22.7 ug/dL ); and 17.7 ug/dL for the high-concentration group (95%CI, 15.6 to 19.9 ug/dL). Mean (SD) infant age at endline was 16 (8)wk for the control group, 17 (7)wk for the low-concentration group, and 14 (8) for the high-concentration group. Infant eTDPwas higher among those in the high-concentration group (257nM; 95%CI, 222 to 291nM; P < .05) compared with the low-concentration (212nM; 95%CI, 181 to 244nM) and control (187nM; 95%CI, 155 to 218nM) groups. Compared with the control group, women who consumed thiamine-fortified fish sauce through pregnancy and early lactation had higher eTDP and breast milk thiamine concentrations and their infants had higher eTDP, especially in the high group. Thiamine-fortified fish sauce could prevent infantile beriberi in this population.