Project Lead(s): Tim Green
Infantile beriberi is a fatal disease caused by a lack of thiamin (vitamin B1) in the diet.
Beriberi has been largely eradicated in developed countries through food fortification and consumption of a varied diet.
However, it remains a problem in Cambodia and throughout Southeast Asia, where the main staple is thiamin-poor, white, polished rice and the consumption of thiamin-rich foods is low. Mothers consume little thiamin, so their breast milk is low in thiamin, putting their infants at risk of developing beriberi.
Fish sauce is a commonly consumed condiment in the Cambodian diet.
The researchers sought to test the benefit of a thiamin-fortified fish sauce as a simple, cost-effective and sustainable product to raise maternal blood and breast milk thiamin levels to reduce the rate of beriberi.
Three study fish sauces were produced and bottled at Leang Leng Enterprises in Phnom Penh, Cambodia: a higher concentration (8 g/L thiamin), a lower concentration (2 g/L thiamin) and a control (no thiamin).
Pregnant women and their families in Cambodia were randomized to consume one of these three fish sauces for six months.
To ensure that no babies suffered from beriberi, each family in the study participated in a nutrition education workshop to learn about the signs and symptoms of infantile beriberi, thiamin-rich foods, general nutrition information, and best practices for infant and young child feeding.
The project was successful in improving the blood thiamin levels of the pregnant/nursing women by introducing fortified fish sauce in their diets.
Mothers who consumed thiamin-fortified fish sauce at concentrations of 2g/L and 8g/L for six months had significantly higher blood and breast milk thiamin concentrations compared to those who consumed a control sauce containing no thiamin.
Consuming thiamin-fortified fish sauce at the 8g/L level had positive effects on infant’s blood thiamin status, raising it to a level consistent with a low risk of developing beriberi.
No cases of infantile beriberi were reported among any infants in the study. Nutritional education workshops also significantly improved awareness among the women in the rural region.
Through this project, the research team formed a new partnership with the National Sub-Committee for Food Fortification (NSCFF), Ministry of Planning, in Cambodia, who are considering scaling up thiamin fortification of fish sauce to the wider population.
The group is exploring the potential for this intervention to become part of the government-mandated fortification program. Advocacy from this research group led to biochemical thiamin measures being included in the first-ever national Cambodian micronutrient survey.
The project team intends to apply for Transition To Scale (TTS) funding, to focus on four research areas:
· Conduct a more pragmatic effectiveness study in a larger region.
· Conduct a larger, dose-dependent study of thiamin-fortified fish sauce among pregnant and breastfeeding women, to establish the minimal effective fortification level.
· Conduct in-depth, qualitative interviews and focus group discussions with rural Cambodian women, to determine whether fish sauce is truly the best fortification vehicle for thiamin in the region.
· Investigate the true prevalence of infantile beriberi by monitoring the population.