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Fortified fish sauce : a novel means of improving thiamin status in rural Cambodia Whitfield, Kyly C


Background: Infantile beriberi, a consequence of maternal thiamin deficiency, is not uncommon in Cambodia. The Cambodian diet consists largely of thiamin-poor, polished white rice and contains few thiamin-rich foods. Objectives: 1) Determine the thiamin status, assessed by erythrocyte thiamin diphosphate concentration (eTDP), among Cambodian women of childbearing age; 2) develop a stable and acceptable thiamin-fortified fish sauce; and 3) test the efficacy of thiamin-fortified fish sauce to increase eTDP among two groups in rural Cambodia: i) women and their youngest child aged 12-59 mo, and ii) pregnant and lactating women and their breastfed infants. Methods: eTDP was determined in samples of women 20-45 y from Prey Veng (n=121) and Phnom Penh (n=117), Cambodia, and for comparison, Canada (n=47). Thiamin stability in fish sauce was assessed under various conditions, and acceptability was determined through sensory evaluation. Women (18-45 y; n=354, 276 non-pregnant and non-lactating, and 78 pregnant and lactating) and their families in Prey Veng, Cambodia were randomized to: control, low (LC, 2 g/L) or high (HC, 8 g/L) concentration thiamin- fortified fish sauce. Results: Mean ± SD eTDP was significantly lower among women in Prey Veng (149 ± 36 nM) than Phnom Penh (156 ± 32 nM), which, in turn, was lower than in Vancouver, (179 ± 37 nM; P<0.05). Thiamin was stable in fish sauce, and accepted by Cambodian women. Among non-pregnant women, endline eTDP (mean; 95% CI) was higher among those in LC (232; 220, 244 nM) and HC (231; 219, 244 nM) groups versus control (175; 163, 188 nM; P<0.001). Similar results were found in children (P<0.05). Endline eTDP was higher among lactating mothers in LC (276; 246, 306 nM) and HC (238; 207, 268 nM) groups versus control (194; 163, 224 nM; P<0.05). Infants of mothers in HC group had higher eTDP (257; 215, 298 nM; P<0.05) versus LC (205; 175, 235 nM) and control (181; 153, 210 nM) groups. Conclusions: Thiamin-fortified fish sauce is an efficacious means of improving dietary thiamin intake and biochemical thiamin status in rural Cambodia, and as such highlights downstream potential to reduce mortality from a totally preventable disease, infantile beriberi.

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