Perinatal Consumption of Thiamine-Fortified Fish Sauce in Rural Cambodia

Whitfield, Kyly C.; Karakochuk, Crystal D; Kroeun, Hou; Hampel, Daniela; Ly, Sokhoing; Chan, Benny B.; Borath, Mam; Sophonneary, Prak; McLean, J.; Talukder, Aminuzzaman; Lynd, Larry D.; Li‐Chan, Eunice C.Y.; Kitts, David D.; Allen, Lindsay H.; Green, Timothy

doi:10.1001/jamapediatrics.2016.2065

Cited by 34 publications

(48 citation statements)

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“…These differences were not unexpected, because the Canadian mothers were consuming a daily vitamin B12-containing perinatal supplement providing >400% of the recommended dietary allowance for lactation [18]. Although all Cambodian mothers were consuming fish sauce as part of the original randomized control trial [14], this is not a significant source of dietary vitamin B12; American fish sauce provides only ~0.05 μg vitamin B12 per 10 mL fish sauce [19] as per international CODEX standards [20]. The lack of vitamin B12 deficiency in Cambodia is consistent with the most recent Cambodian Demographic and Health Survey (2014), which reported only 1% of mothers ( n = 731) were vitamin B12 deficient (<150 pmol/L) [21].…”

Section: Discussionmentioning

confidence: 99%

“…Participants in the Cambodian sample were recruited as part of a randomized control trial designed to test the efficacy of maternal ad libitum consumption of thiamin-fortified or control (non-thiamin fortified) fish sauce to improve maternal and infant erythrocyte thiamin diphosphate concentrations and breast milk thiamin concentrations [14]. Healthy women 18–45 years with a low-risk singleton pregnancy residing in Prey Veng province, Cambodia, were recruited between 3–8 months gestation (self-report), and consumed fish sauce for 6 months as part of this study.…”

Section: Methodsmentioning

confidence: 99%

“…With the relatively limited data currently available on perinatal vitamin B12 status, we used secondary data from two recent randomized control studies [13,14] to assess the vitamin B12 status of mothers, their breast milk, and their infants in two regions with differing perinatal supplementation and dietary patterns: Canada and Cambodia. We also explored associations between vitamin B12 concentrations in maternal blood, breast milk, and infant blood samples.…”

Section: Introductionmentioning

confidence: 99%

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Correlations between Maternal, Breast Milk, and Infant Vitamin B12 Concentrations among Mother–Infant Dyads in Vancouver, Canada and Prey Veng, Cambodia: An Exploratory Analysis

et al. 2017

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Vitamin B12 plays an essential role in fetal and infant development. In regions where animal source food consumption is low and perinatal supplementation is uncommon, infants are at risk of vitamin B12 deficiency. In this secondary analysis, we measured total vitamin B12 concentrations in maternal and infant serum/plasma and breast milk among two samples of mother–infant dyads in Canada (assessed at 8 weeks post-partum) and in Cambodia (assessed between 3–27 weeks post-partum). Canadian mothers (n = 124) consumed a daily vitamin B12-containing multiple micronutrient supplement throughout pregnancy and lactation; Cambodian mothers (n = 69) were unsupplemented. The maternal, milk, and infant total vitamin B12 concentrations (as geometric means (95% CI) in pmol/L) were as follows: in Canada, 698 (648,747), 452 (400, 504), and 506 (459, 552); in Cambodia, 620 (552, 687), 317 (256, 378), and 357 (312, 402). The majority of participants were vitamin B12 sufficient (serum/plasma total B12 > 221 pmol/L): 99% and 97% of mothers and 94% and 84% of infants in Canada and Cambodia, respectively. Among the Canadians, maternal, milk, and infant vitamin B12 were all correlated (p < 0.05); only maternal and infant vitamin B12 were correlated among the Cambodians (p < 0.001).

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Correlations between Maternal, Breast Milk, and Infant Vitamin B12 Concentrations among Mother–Infant Dyads in Vancouver, Canada and Prey Veng, Cambodia: An Exploratory Analysis

et al. 2017

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“…However, the methods used for micronutrient analyses in human milk were rarely described sufficiently and were sometimes unsuitable for the complex human-milk matrix (8); in some cases, the results obtained with different methods were not comparable (3, 9, 10). We reported several validated methods for accurately analyzing multiple vitamins in human milk (11–13), which have now been used in various studies (14–21). Given the undeniable importance of adequate micronutrient supply for an infant’s growth and development, we still have only very limited knowledge about the extent to which micronutrient concentrations in breast milk are sufficient to meet an infant’s requirements.…”

Section: Introductionmentioning

confidence: 99%

Vitamin Concentrations in Human Milk Vary with Time within Feed, Circadian Rhythm, and Single-Dose Supplementation

Hampel

Shahab‐Ferdows

Islam

et al. 2017

The Journal of Nutrition

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Background: Human milk is the subject of many studies, but procedures for representative sample collection have not been established. Our improved methods for milk micronutrient analysis now enable systematic study of factors that affect its concentrations.Objective: We evaluated the effects of sample collection protocols, variations in circadian rhythms, subject variability, and acute maternal micronutrient supplementation on milk vitamin concentrations.Methods: In the BMQ (Breast-Milk-Quality) study, we recruited 18 healthy women (aged 18–26 y) in Dhaka, Bangladesh, at 2–4 mo of lactation for a 3-d supplementation study. On day 1, no supplements were given; on days 2 and 3, participants consumed ∼1 time and 2 times, respectively, the US-Canadian Recommended Dietary Allowances for vitamins at breakfast (0800–0859). Milk was collected during every feeding from the same breast over 24 h. Milk expressed in the first 2 min (aliquot I) was collected separately from the remainder (aliquot II); a third aliquot (aliquot III) was saved by combining aliquots I and II. Thiamin, riboflavin, niacin, and vitamins B-6, B-12, A, and E and fat were measured in each sample.Results: Significant but small differences (14–18%) between aliquots were found for all vitamins except for vitamins B-6 and B-12. Circadian variance was significant except for fat-adjusted vitamins A and E, with a higher contribution to total variance with supplementation. Between-subject variability accounted for most of the total variance. Afternoon and evening samples best reflected daily vitamin concentrations for all study days. Acute supplementation effects were found for thiamin, riboflavin, and vitamins B-6 and A at 2–4 h postdosing, with 0.1–6.17% passing into milk. Supplementation was reflected in fasting, 24-h postdose samples for riboflavin and vitamin B-6. Maximum amounts of dose-responding vitamins in 1 feeding ranged from 4.7% to 21.8% (day 2) and 8.2% to 35.0% (day 3) of Adequate Intake.Conclusions: In the milk of Bangladeshi mothers, differences in vitamin concentrations between aliquots within feedings and by circadian variance were significant but small. Afternoon and evening collection provided the most-representative samples. Supplementation acutely affects some breast-milk micronutrient concentrations. This trial was registered at clinicaltrials.gov as NCT02756026.

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“…Due to lack of dietary diversity, Cambodian children have a high prevalence of thiamin deficiency (Whitfield et al., ), making fish sauce a practical target for thiamin fortification. In a field trial in rural Cambodia, thiamin‐fortified fish sauce was efficacious in improving thiamin status in pregnant women, breastfed children, and nonpregnant woman and their children (Whitfield et al., , ).…”

Section: Thiamin (Vitamin B1)mentioning

confidence: 99%

Global Concerns with B Vitamin Statuses: Biofortification, Fortification, Hidden Hunger, Interactions, and Toxicity

Titcomb

Tanumihardjo

2019

Comp Rev Food Sci Food Safe

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The prevalence of undernutrition due to insufficient energy intake has been reduced by nearly 50% since 1990. This reduction is largely attributed to improved yields of staple crops, such as wheat, rice, and maize; however, these improvements did little for micronutrient deficiencies that affect an estimated two billion people worldwide. Starchy staple crops are energy dense but are often lacking in one or more B vitamins, making resource‐constrained people who consume monotonous diets comprised predominantly of these staples at risk for developing deficiency. B vitamin deficiencies occur due to a poor overall nondiversified diet and rarely occur alone. Many B vitamins are essential cofactors involved in the metabolism of other nutrients, including other B vitamins, whereby the deficiency of one B vitamin affects the metabolism and status measurements of another. Food fortification efforts have nearly eradicated diseases of extreme B vitamin deficiency, such as beriberi from thiamin deficiency and pellagra from niacin deficiency. However, subclinical deficiency, sometimes referred to as hidden hunger, is still common especially in low‐income countries. Most dietary B vitamins, due to their water‐soluble nature, are not a concern for excessive intakes, but synthetic forms used for fortification and supplements sometimes can have adverse effects when consumed in high amounts. Biofortified crops offer a long‐term sustainable method to increase the amount of dietary B vitamins for people who rely on staple crops for most of their caloric intake. Efforts have been made to improve B vitamin content of crops, especially for thiamin, vitamin B6, and folate, but none have undergone human feeding trials; therefore, more research is needed to provide sustainable and scalable solutions in many parts of the world.

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Perinatal Consumption of Thiamine-Fortified Fish Sauce in Rural Cambodia

Cited by 34 publications

References 30 publications

Correlations between Maternal, Breast Milk, and Infant Vitamin B12 Concentrations among Mother–Infant Dyads in Vancouver, Canada and Prey Veng, Cambodia: An Exploratory Analysis

Correlations between Maternal, Breast Milk, and Infant Vitamin B12 Concentrations among Mother–Infant Dyads in Vancouver, Canada and Prey Veng, Cambodia: An Exploratory Analysis

Vitamin Concentrations in Human Milk Vary with Time within Feed, Circadian Rhythm, and Single-Dose Supplementation

Global Concerns with B Vitamin Statuses: Biofortification, Fortification, Hidden Hunger, Interactions, and Toxicity

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