Location: Obesity and Metabolism ResearchTitle: Maternal consumption of thiamin-fortified fish sauce during pregnancy and lactation improves maternal and infant thiamin status and breast milk thiamin concentrations. Author
|Whitfield, Kyly - University Of British Columbia|
|Karakochuk, Crystal - University Of British Columbia|
|Hampel, Daniela - University Of California|
|Kroeun, Hou - Helen Keller International (HKI), United States|
|Lynd, Larry - University Of British Columbia|
|Li-chan, Eunice C - University Of British Columbia|
|Kitts, David - University Of British Columbia|
|Green, Timothy - University Of British Columbia|
Submitted to: Meeting Abstract
Publication Type: Abstract Only
Publication Acceptance Date: 10/9/2015
Publication Date: 3/2/2016
Citation: Whitfield, K.C., Karakochuk, C.D., Hampel, D., Kroeun, H., Lynd, L.D., Li-Chan, E.Y., Kitts, D.D., Allen, L.H., Green, T.J. 2016. Maternal consumption of thiamin-fortified fish sauce during pregnancy and lactation improves maternal and infant thiamin status and breast milk thiamin concentrations.. Meeting Abstract. 18th Int. Soc. for Res. in Human Milk and Lactation Conf.Stellenbosch, S. Africa, 3/3-7/16.
Technical Abstract: Infantile beriberi, a disease caused by thiamin (vitamin B1) deficiency, remains a public health concern in Cambodia and other parts of Southeast Asia. Infantile beriberi presents during the exclusive breastfeeding period and without treatment commonly results in death within *24 hours of clinical presentation. The dietary staple of Cambodia is B-vitamin poor, white, polished rice. Low maternal thiamin intake directly impacts breast milk thiamin content, putting exclusively breastfed infants at risk of thiamin deficiency and infantile beriberi. Using a common Cambodian condiment as a vehicle for fortification, we developed a novel thiamin-fortified fish sauce as a way to increase the dietary intake of thiamin. Our aim was to evaluate the efficacy of the thiamin-fortified fish sauce to increase maternal and infant blood thiamin concentrations, as well as breast milk thiamin concentrations, compared to a control fish sauce. In this double-blind, randomized controlled trial 77 pregnant women (18–45 y; 26 – 7 weeks gestation at baseline) were recruited from Prey Veng province, Cambodia. Women were individually randomized to one of three treatment groups: high concentration thiamin (HC, 8g/L; n = 23), low concentration thiamin (LC, 2g/L; n = 27), or control (C, no thiamin; n = 27) fish sauce. Women and their families consumed the fish sauce ad libitum for six months (average consumption of 15 – 5 bottles/6 months; consumption did not differ between treatment groups, p = 0.198). Maternal blood was collected at baseline (t = 0), and maternal blood, breast milk, and infant blood were collected at endline (t = 6 months). HPLC-FLD was used to measure erythrocyte thiamin diphosphate (eTDP) concentration, as well as breast milk thiamin (T) and thiamin monophosphate (TMP) concentrations. Women across the three groups were not statistically different (age, BMI, antenatal care, weeks gestation) at baseline. Generalized estimating equation models were used to compare treatment groups at endline. At endline, women’s (baseline adjusted) eTDP was significantly higher in HC (266– 108 nM; p = 0.002) and LC (288 – 104 nM; p < 0.001) than C (182 – 55 nM). HC infant’s eTDP, 257 – 81 nM, was significantly higher than C (178 – 69 nM; p = 0.002); neither differed significantly from LC (204 – 71 nM). Breast milk TMP was 329 – 143 nM (140 – 61 lg/ L), 388 – 113 nM (165– 48 lg/L), and 313 – 113 nM (133 – 48 lg/ L) for HC, LC, and C, respectively; LC was significantly higher than C (p = 0.017). Breast milk T was significantly lower among C (60 – 73 nM or 18 – 22lg/L) than HC (180– 150 nM or 54 – 45 lg/ L; p < 0.001) and LC (180 – 130 nM or 64 – 39lg/L; p < 0.001). Total breast milk thiamin was significantly higher among HC (180– 77 lg/L;p = 0.021) and LC (212 – 66 lg/L; p < 0.001) compared to C (136 – 43 lg/L). Maternal consumption of thiaminfortified fish sauce over 6 months improves maternal and infant eTDP and breast milk TMP and T compared to consumption of a control sauce. A larger dose-dependent study of thiamin-fortified fish sauce is required to establish the minimal effective fortification level. The study was supported by Grand Challenges Canada Stars in Global Health Grant (Round VI), Canadian Institutes of Health Research (CIHR) Doctoral Award, and International Development Research Centre (IDRC) Doctoral Research Award.