Beriberi, which causes vomiting, convulsions and signs of heart failure, generally presents among breastfed infants at three months. It can be fatal for an infant unless thiamine is rapidly administered.
It was thought to have become an historic illness, but has recently been branded “Asia’s forgotten disease”, with cases reported in Burma, Laos, and Cambodia.
Beriberi can result because of maternal dietary factors, including significant consumption of polished white rice, which lacks in thiamine, and little consumption of thiamine-rich foods.
A new study published online by JAMA Pediatrics and led by Timothy J. Green of the South Australian Health and Medical Research Institute in Adelaide, presents the findings of a clinical trial of rural Cambodian women.
It sought to discover whether consuming fish sauce fortified with low or high concentrations of thiamine for six months during pregnancy would yield higher erythrocyte thiamine diphosphate concentrations (eTDP), a marker of thiamine status. Fish sauce is a popular condiment in Cambodia.
Passive intervention
The study noted previous reports have shown that thiamine supplements for breastfeeding women improves breast milk thiamine concentrations.
“However, supplementation is a targeted, resource-intensive intervention that requires heavily on individual compliance.” the study states. “Alternatively, food fortification is a passive intervention that requires little or no behaviour change.”
Therefore, the trial recruited 90 pregnant women and 30 of them were assigned to each of three groups: low-concentration thiamine-fortified fish sauce (2g/L); high-concentration thiamine-fortified fish sauce (8 g/L) or a control group that received fish sauce with no detectable thiamine.
Levels of eTDP were higher among lactating women consuming thiamine-fortified fish sauce and their breastfed infants than in the control group, according to the results.
“In this double-blind randomises clinical efficacy trial, eTDP concentrations were significantly higher among women consuming thiamine-fortified fish sauce and their infants than in the control group,’’ states the report.
High infant mortality
“[This means] thiamine-fortified fish sauce has the potential to prevent Beriberi-related infant mortality in Cambodia and across Southeast Asia where diets are thiamine poor and infant mortality remains high.”
The study also points out that fish sauce has already been successfully fortified with iron in both Cambodia and Vietnam.
"This intervention is facilitated by existing fortification infrastructure within existing factories because fish sauce has already been successfully fortified with iron in Cambodia and Vietnam. Therefore, fish sauce could be a simple and sustainable vehicle for thiamine fortification throughout Southeast Asia, and there is potential for the addition of other micronutrients as well.”
“However, 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, optimising the level of fortification and acquiring clinical diagnoses of infantile beriberi," the study concludes.
Source: JAMA Pediatrics
Published online ahead of print: doi:10. 1001/jamapediatrics.2016.2065
Authors: Timothy Green, et al