Thiamine-Fortified Fish Sauce Could Help Fight Infant Beriberi in Southeast Asia

Highlights

Thiamine deficiency causes infantile beriberi, leading to higher rates of infant mortality.
Infantile beriberi is more common in Southeast Asia
Thiamine-fortified fish sauce can improve thiamine levels in maternal blood and breast milk

Infantile beriberi is more common in Southeast Asia due to poor sources of thiamine in the mother’s diet. Supplementation of thiamine-fortified fish sauce to pregnant and lactating women can improve their blood thiamine concentrations, thus preventing infantile beriberi.

Thiamine Deficiency

Thiamine (vitamin B1) is a water-soluble micronutrient which plays a crucial role in the energy metabolism for growth, development and function of cells. Thiamine is found in whole grains, beans, bread, meat, and fish. Thiamine deficiency occurs when the diet mainly consists of polished rice and wheat flour, which are poor sources of thiamine.

Beriberi Disease - Causes, Risk Factors, Symptoms, Diagnosis, Treatment, Prognosis
Beriberi is caused due to thiamine deficiency (vitamin B1). There are 2 types - wet beri beri that affects the heart & dry beriberi that affects the musculoskeletal & nervous system

‘Consumption of fish sauce fortified with high concentrations of thiamine can help increase thiamine levels in pregnant and lactating women to prevent infantile beriberi.’

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Thiamine can also be lost when the rice is washed or when the cooked rice water is discarded. Thiamine deficiency in Southeast Asia is due to the large scale production and distribution of milled rice. The requirement of thiamine increases when the diet is rich in carbohydrate. Eating a thiamine-deficient diet for two to three months can lead to disability and death. Thiamine deficiency is more common among pregnant women who have increased demands for thiamine.

Infantile Beriberi

Thiamine deficiency remains a public health concern in countries that rely on polished rice which is a poor source of thiamine. Lack of thiamine in the mother’s diet causes beriberi in infants (infantile beriberi), leading to heart failure and death. Infantile beriberi is characterized by vomiting, convulsions and signs of heart failure. The disorder could be fatal if not treated within 24 hours.

Medical Management of Vitamin Deficiencies
Vitamins are essential for our body to grow and develop normally. Vitamin deficiencies are widespread. Understand the role of dietary sources in vitamin deficiency prevention.

Infantile beriberi is widespread across Southeast Asia and kills 700 children a year in Cambodia. Maternal dietary factors and lack of consumption of thiamine-rich foods are the causes of infantile beriberi in Cambodia. Infantile beriberi can be eradicated by food fortification - an inexpensive process which improves the foods’ nutritive value by adding the essential micronutrient.

Recommended Dietary Allowance (RDA) for Thiamine

Age	Thiamine Requirement
Birth to 6 months	0.2mg
7 to 12 months	0.2mg
1 to 3 years	0.5mg
14 to 18 years	1.2 mg
19 to 50 years (Male)	1.2mg
19 to 50 years (Female)	1.1mg
Pregnancy	1.4mg
Lactation	1.4mg

Thiamine-Fortified Fish Sauce

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Fish sauce is widely used as a condiment in Cambodia. Thus, fish sauce was fortified with higher concentrations of thiamine. A clinical trial was conducted among rural Cambodian women to study whether consumption of thiamine-fortified fish sauce for six months could help combat infantile beriberi.

Researcher Timothy J. Green, Ph.D., of the South Australian Health and Medical Research Institute, Adelaide, Australia, along with coauthors conducted the clinical trial. The researchers studied whether the fish sauce fortified with higher and lower concentrations of thiamine would improve the levels of erythrocyte thiamine diphosphate concentrations (eTDP), a marker of thiamine status.

The researchers recruited 90 pregnant women for the clinical trial. The participants were divided into three groups. Group one received lower concentrations of fish sauce (2g/L). Participants in group two received higher concentrations of thiamine-fortified fish sauce(8g/L). Participants in the control group received fish sauce with no traces of thiamine.

The results of the clinical trial showed that the levels of eTDP were higher among lactating women who consumed thiamine-fortified fish sauce and their breastfed infants than those in the control group.

The limitations of the study included lack of normal levels of eTDP for women due to variability in the cutoff value. Fish sauce has already been fortified with iron in Cambodia and Vietnam. So, the authors considered fortifying fish sauce with thiamine throughout Southeast Asia.

The authors concluded that “more research designed to enable a large, pragmatic randomized clinical trial is required to address some of the limitations of this efficacy trial, in particular, optimizing the level of fortification and acquiring clinical diagnoses of infantile beriberi."

The findings are published in the JAMA Pediatrics.

References:

http://media.jamanetwork.com
http://apps.who.int/iris/bitstream/10665/66139/1/WHO_NHD_99.13.pdf
https://ods.od.nih.gov/factsheets/Thiamin-HealthProfessional/

Source-Medindia