Suboptimal thiamin status is common in
Cambodian women of childbearing age
Whitfield, KC, Liu, Y, Karakochuk, CD, Talukder,...
The Fish on Farms project is being jointly conducted by the University of
British Columbia (UBC) and Helen Keller Internat...
University of British Columbia Ministry of Health, Cambodia
Dr. Tim Green, Associate Professor, Human Nutrition Ministry o...
Karen People of Mae La Refugee Camp
•  Thai-Burmese border; settled in
1986
•  High infant mortality rate
unrelated to maj...
Background: Thiamin
•  Vitamin B1
•  Thiamin diphosphate (TDP)
plays major role in carbohydrate
metabolism
•  Pentose-Phos...
Infantile beriberi
•  Stems from thiamin (vitamin B1)
deficiency
•  Symptoms
•  signs of right-sided heart failure
•  rapid...
Thiamin deficiency
© Kyly Whitfield 2012
Rationale
Research question
What is the current
level of thiamin
deficiency among
women of childbearing
age (20-45y) in rural
and urb...
Regional (urban/rural)
n=160 per region
16 villages per
region
10 women per
village
Protocol
Purposeful
Selection
Random S...
Protocol
© Kyly Whitfield 2013
© Kyly Whitfield 2013
© Kyly Whitfield 2013
Protocol
© Kyly Whitfield 2014
Results
Phnom Penh
(n=146)
Prey Veng
(n=156)
Vancouver
(n=50)
Age
(years; mean±SD)
32.6 ± 7.2 35.1 ± 6.3 26.4 ± 4.6
Body M...
Thiamin deficiency cut-offs
Thiamin Deficiency Status
Thiamin Diphosphate
(TDP; nmol/L)
Sufficient > 90
Marginally Deficient 70 ...
61%
41%
84%
27%
35%
12%
12%
24%
4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Phnom Penh (urban
Cambodia)
Prey Veng (rura...
Results
Population
Mean TDP ± SD
(nmol/L)
Range
(nmol/L)
Phnom Penh
(urban Cambodia)
100 ± 28 40 - 195
Prey Veng
(rural Ca...
What next?
© Kyly Whitfield 2013
Randomized Control Trial
Rationale
Need to improve maternal thiamin status to decrease the
incidence of infantile beriberi
Infantile Beriberi
•  ch...
Overall Objective
Develop a thiamin-fortified
product that, when
consumed by women of
childbearing age, increases
thiamin i...
Fortified fish sauce
Protocol
Best option? There are many condiments that
could be fortified
Results
Fish Paste Number of Participants %
Purchase fish paste at market 144 of 320 45%
No brand 144 of 144 100%
Salt Numb...
Intervention
© Kyly Whitfield 2013
Fish Sauce Fortification
© Kyly Whitfield 2013
© Kyly Whitfield 2013
Fish Sauce Fortification
© Kyly Whitfield 2013
© Kyly Whitfield 2013
Randomized Control Trial
6 month, 3 armed, double blind randomized
control trial
Intervention A:
8 mg/mL thiamin
fortified ...
Intervention Arms: RCT
Placebo
Intervention
© Kyly Whitfield 2013
Potential Significance
•  Potential to significantly decrease thiamin deficiency in
Cambodia, which in turn will lower the ri...
Thank you!
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Nutrition and health: Suboptimal thiamin status is common in Cambodian women of childbearing age

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Nutrition and health: Suboptimal thiamin status is common in Cambodian women of childbearing age

  1. 1. Suboptimal thiamin status is common in Cambodian women of childbearing age Whitfield, KC, Liu, Y, Karakochuk, CD, Talukder, A, Kroeun, H, Kevanna, O, Kitts, DD, Li-Chan, ECY, McLean, J, Green TJ   Sponsored by Hosted by Presented at the International Food Security Dialogue 2014 Enhancing Food Production, Gender Equity and Nutritional Security in a Changing World Under-nutrition measures for women and children in Africa and Asia
  2. 2. The Fish on Farms project is being jointly conducted by the University of British Columbia (UBC) and Helen Keller International (HKI), with technical assistance from World Fish, in Prey Veng Province, Cambodia. This randomized control trial investigates an integrated Homestead Food Production models in relation to poverty, gender empowerment, and food and nutrition security, particularly among women and children.  This is the first project known to rigorously measure the effectiveness of different models of Homestead Food Production at reducing undernutrition using biochemical and anthropometric measurements.
  3. 3. University of British Columbia Ministry of Health, Cambodia Dr. Tim Green, Associate Professor, Human Nutrition Ministry of Planning, Cambodia Dr. Judy McLean, Assistant Professor, Human Nutrition Dr. Susan Barr, Professor, Human Nutrition Dr. Larry Lynd, Professor & Director, Collaboration for Outcomes Research & Evaluation Dr. Tony Farrell, Professor, Centre for Aquaculture and Environmental Research Dr. David Kitts, Professor, Food Science & Associate Dean of Research Dr. Ian Forster, Centre for Aquaculture and Environmental Research Jen Foley, Fish on Farms Program Coordinator Helen Keller International - Cambodia Graduate Students Dr. Zaman Talukder Kyly Whitfield (PhD, Nutrition) Mr. Hou Kroeun Crystal Karakochuk (PhD, Nutrition) Ms. Ly Sokhoing Vashti Verbowski (MSc, Nutrition) Field Research Team Pardis Lakzadeh (MSc, Public Health) Jeff Tang (BSc, Science)
  4. 4. Karen People of Mae La Refugee Camp •  Thai-Burmese border; settled in 1986 •  High infant mortality rate unrelated to major killers •  diarrhea and respiratory illness •  Between 1987 – 1990, infantile beriberi caused 40% of all infant deaths McGready et al 2001; Luxemburger et al 2003; Stuetz et al 2012
  5. 5. Background: Thiamin •  Vitamin B1 •  Thiamin diphosphate (TDP) plays major role in carbohydrate metabolism •  Pentose-Phosphate Pathway •  Kreb’s Cycle •  Modulates neuronal and neuro- muscular transmissions Images from: Beltramo, E (2011)
  6. 6. Infantile beriberi •  Stems from thiamin (vitamin B1) deficiency •  Symptoms •  signs of right-sided heart failure •  rapid breathing •  generalized edema •  distinctive, hoarse cry •  Presents around 3 months of age •  Infant AI: 0.2 mg/day •  AI based on [breast milk thiamin] from apparently replete women •  Root cause: maternal thiamin deficiency
  7. 7. Thiamin deficiency © Kyly Whitfield 2012
  8. 8. Rationale
  9. 9. Research question What is the current level of thiamin deficiency among women of childbearing age (20-45y) in rural and urban Cambodia? © Kyly Whitfield 2013
  10. 10. Regional (urban/rural) n=160 per region 16 villages per region 10 women per village Protocol Purposeful Selection Random Selection: Lists Random Selection: Draw
  11. 11. Protocol © Kyly Whitfield 2013 © Kyly Whitfield 2013 © Kyly Whitfield 2013
  12. 12. Protocol © Kyly Whitfield 2014
  13. 13. Results Phnom Penh (n=146) Prey Veng (n=156) Vancouver (n=50) Age (years; mean±SD) 32.6 ± 7.2 35.1 ± 6.3 26.4 ± 4.6 Body Mass Index (kg/m2 ; mean±SD) 23.4 ± 4.1 21.6 ± 2.9 22.4 ± 3.8 Ethnicity Khmer Caucasian Non-Caucasian 146 (100%) - - 156 (100%) - - - 34 (68%) 16 (32%)
  14. 14. Thiamin deficiency cut-offs Thiamin Deficiency Status Thiamin Diphosphate (TDP; nmol/L) Sufficient > 90 Marginally Deficient 70 - 90 Deficient < 70 •  Measured using high performance liquid chromatography (HPLC)
  15. 15. 61% 41% 84% 27% 35% 12% 12% 24% 4% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Phnom Penh (urban Cambodia) Prey Veng (rural Cambodia) Vancouver (urban Canada) Results 59% 39% n=146 n=156 n=50
  16. 16. Results Population Mean TDP ± SD (nmol/L) Range (nmol/L) Phnom Penh (urban Cambodia) 100 ± 28 40 - 195 Prey Veng (rural Cambodia) 87 ± 26 38 - 191 Vancouver (urban Canada) 128 ± 38 42 - 213
  17. 17. What next? © Kyly Whitfield 2013
  18. 18. Randomized Control Trial
  19. 19. Rationale Need to improve maternal thiamin status to decrease the incidence of infantile beriberi Infantile Beriberi •  change dietary behaviours •  supplementation •  food fortification
  20. 20. Overall Objective Develop a thiamin-fortified product that, when consumed by women of childbearing age, increases thiamin in women’s blood to a level consistent with a low risk of infantile beriberi. © Kyly Whitfield 2013
  21. 21. Fortified fish sauce
  22. 22. Protocol Best option? There are many condiments that could be fortified
  23. 23. Results Fish Paste Number of Participants % Purchase fish paste at market 144 of 320 45% No brand 144 of 144 100% Salt Number of Participants % Purchase salt at market 319 of 320 99% No brand 173 of 319 54% Fish Sauce Number of Participants % Purchase fish sauce market 202 of 320 63% No brand 26 of 202 13%
  24. 24. Intervention © Kyly Whitfield 2013
  25. 25. Fish Sauce Fortification © Kyly Whitfield 2013 © Kyly Whitfield 2013
  26. 26. Fish Sauce Fortification © Kyly Whitfield 2013 © Kyly Whitfield 2013
  27. 27. Randomized Control Trial 6 month, 3 armed, double blind randomized control trial Intervention A: 8 mg/mL thiamin fortified fish sauce Intervention B: 2 mg/mL thiamin fortified fish sauce Control: Placebo fish sauce
  28. 28. Intervention Arms: RCT Placebo Intervention © Kyly Whitfield 2013
  29. 29. Potential Significance •  Potential to significantly decrease thiamin deficiency in Cambodia, which in turn will lower the risk of infantile beriberi •  Possibility of scaling up the production and distribution of fortified product throughout Cambodia •  Potential for multiple micronutrient fortification; for example: riboflavin
  30. 30. Thank you!

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