Thiamine fortification strategies in low‐ and middle‐income settings: a review

Abstract

Thiamine (vitamin B 1 ) is an essential micronutrient in energy metabolism and cognitive and neurological health. Thiamine deficiency disorders (TDDs) have a range of clinical presentations that result in various morbidities and can be fatal if not promptly recognized and treated, especially in infants. To intervene, thiamine intakes by breastfeeding mothers and others at risk of thiamine deficiency should be increased to ensure adequate thiamine intake. Although thiamine fortification programs have a long history in high-income countries, there are few mandatory fortification programs to address TDDs in low-and middle-income countries (LMICs), particularly in the regions of greatest concern, South and Southeast Asia. This review highlights essential aspects for consideration in the development of a mandatory fortification program in LMICs, including an overview of the data required to model fortification dosing schemes, available thiamine fortificants, and potential fortification vehicles, as well as identifies current knowledge gaps.

Thiamine deficiency disorders: a clinical perspective

“…Large‐scale mandatory food fortification may be a preferred and more sustainable method to improve the thiamine status of a population at high risk of deficiency, with limited behavior change needed. Thiamine fortification strategies in low‐ and middle‐income settings are reviewed in detail elsewhere in this special issue 95 …”

“…Thiamine fortification strategies in low‐ and middle‐income settings are reviewed in detail elsewhere in this special issue. 95 …”

Modeling thiamine fortification: a case study from Kuria atoll, Republic of Kiribati

“…Details of thiamine fortification modeling are described in another article in this special issue 11 . Briefly, the Intake Modeling, Assessment and Planning Program (IMAPP) (Iowa State University, Ames, IA) was used to determine usual thiamine intake distributions and thiamine inadequacy among each group.…”

“…As described in a review in this special issue, 11 to design a fortification strategy, the usual thiamine intake distribution of the target population is needed, as well as the deficit between the current intake of thiamine and the desired intake. The next step is to identify potential fortification vehicles and quantify their usual intake consumption.…”

A fresh look at thiamine deficiency—new analyses by the global thiamine alliance

“…highlight the essential aspects to consider in developing a mandatory fortification program in LMICs, including an overview of the information required to design fortification programs, including dosing schemes, available thiamine fortificants, and potential fortification vehicles. 20 The complex choices involved are aptly illustrated by Green et al . based on their experience in Kiribati.…”