Infantile beriberi exists in Cambodia. Low maternal thiamin intake reduces breast milk thiamin concentrations, placing breastfed infants at risk of this potentially fatal disease. We aimed to determine if ad libitum consumption of thiamin-fortified fish sauce yielded higher erythrocyte thiamin diphosphate concentrations (eTDP) among women (18-45y) and their newborn infants, and breast milk thiamin concentrations, compared to a control sauce.
In this double-blind, randomized controlled efficacy trial 90 women Prey Veng, Cambodia were randomized to receive low (LC, 2g/L) or high concentration (HC, 8g/L) thiamin-fortified, or control (no thiamin) fish sauce. Maternal eTDP concentration was assessed at baseline and endline; breast milk thiamin and infant eTDP were measured at endline. Differences between treatment groups were assessed using general linear models.
Women were 23 ± 7wk pregnant at enrollment. Household fish sauce consumption was similar across treatment groups (p=0.07). Baseline-adjusted endline eTDP (estimated marginal mean; 95% CI) was higher among women in LC (276; 246, 306nM) and HC (238; 207, 268nM) groups versus control (194; 163, 224nM; p<0.05). Breast milk total thiamin was higher among women in LC (211; 187, 236µg/L) and HC groups (180; 152, 209µg/L) versus control (136; 110, 162µg/L; p<0.05). Infants of HC group mothers had higher eTDP (257; 215, 298nM; p<0.05) compared to LC (205; 175, 235nM) and control (181; 153, 210nM).
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. (Funding: Grand Challenges Canada)