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Maternal consumption of thiamine-enhanced fish sauce protects Cambodian newborns from beriberi
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Thiamine-fortified fish sauce consumed by breast-feeding Cambodian women provided higher erythrocyte thiamine diphosphate and breast milk thiamine concentrations, therefore yielding improved thiamine levels in their babies and offering immunity against beriberi-related infant death, according to study findings.
“Supplementation of thiamine-deficient lactating women has been shown to improve breast milk thiamine concentration; however, supplementation is a targeted, resource-intensive intervention that relies heavily on individual compliance,” Timothy J. Green, PhD, professor of nutrition and dietetics at the South Australian Health and Medical Research Institute, Adelaide, Australia, and colleagues wrote. “Alternatively, food fortification is a passive intervention that requires little to no behavior change. An estimated 90% of Cambodian individuals consume fish sauce, and this condiment is already a fortification vehicle for iron. As such, thiamine fortification of fish sauce could be sustainable, low-cost and passive intervention to improve the dietary thiamine intake of pregnant and lactating women and in turn their breast-fed infants.”
Green and colleagues developed a double-masked, randomized clinical trial that included 90 rural Cambodian women aged 18 to 45 years who were 3 to 8 months pregnant with a single fetus and planned to breast-feed after birth to 6 months to assess whether low or high concentrated thiamine-fortified fish sauce would yield improved erythrocyte thiamine diphosphate (eTDP) to infants through maternal consumption. Participants received fish sauce after the baseline visit and at every 2 weeks; the participants’ diets were followed for 6 months.
The participants were randomly assigned into three groups: low-concentrated thiamine-fortified fish sauce (2g/L; n= 30), high-concentrated thiamine-fortified fish sauce (8 g/L; n= 30) or a control group that consumed fish sauce that lacked thiamine fortification (n = 30). Mean participant age was 25 years and gestational stage 23 weeks at baseline. Blood collection analysis at end line yielded 28 participants for the control group, 29 participants for low-concentrated fish sauce and 23 participants for high-concentrated fish sauce. Higher levels of eTDP were associated with breast-feeding participants who consumed the thiamine-fortified fish sauces compared with the control group (P < .05). There was no significant difference between low-concentration and high-concentration groups (P = .19). Mean infant age at end line was 16 weeks perinatal for the control group, 17 weeks for the low-concentrated group and 14 weeks for the high-concentrated group. Infants had higher eTDP from breast milk in the high-concentrated compared with the low-concentrated group and control group (P < .05).
“Herein, we showed that consumption of thiamine-fortified fish sauce, a condiment consumed by most Cambodians, for 6 months throughout late pregnancy and early lactation was associated with maternal eTDP and breast milk thiamine and in turn infant eTDP,” the researchers wrote. “This intervention is facilitated by existing fortification infrastructure within existing factories because fish sauce has already been successfully fortified with iron in Cambodia and Vietnam.” – by Kate Sherrer
Disclosure: The researchers report no relevant financial disclosures.
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