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BackgroundInfantile beriberi-related mortality is still common in South and Southeast Asia. Interventions to increase maternal thiamine intakes, and thus human milk thiamine, are warranted; however, the required dose remains unknown.ObjectivesWe sought to estimate the dose at which additional maternal intake of oral thiamine no longer meaningfully increased milk thiamine concentrations in infants at 24 wk postpartum, and to investigate the impact of 4 thiamine supplementation doses on milk and blood thiamine status biomarkers.MethodsIn this double-blind, 4-parallel arm randomized controlled dose-response trial, healthy mothers were recruited in Kampong Thom, Cambodia. At 2 wk postpartum, women were randomly assigned to consume 1 capsule, containing 0, 1.2 (estimated average requirement), 2.4, or 10 mg of thiamine daily from 2 through 24 weeks postpartum. Human milk total thiamine concentrations were measured using HPLC. An Emax curve was plotted, which was estimated using a nonlinear least squares model in an intention-to-treat analysis. Linear mixed-effects models were used to test for differences between treatment groups. Maternal and infant blood thiamine biomarkers were also assessed.ResultsIn total, each of 335 women was randomly assigned to1 of the following thiamine-dose groups: placebo (n = 83), 1.2 mg (n = 86), 2.4 mg (n = 81), and 10 mg (n = 85). The estimated dose required to reach 90% of the maximum average total thiamine concentration in human milk (191 µg/L) is 2.35 (95% CI: 0.58, 7.01) mg/d. The mean ± SD milk thiamine concentrations were significantly higher in all intervention groups (183 ± 91, 190 ± 105, and 206 ± 89 µg/L for 1.2, 2.4, and 10 mg, respectively) compared with the placebo group (153 ± 85 µg/L; P < 0.0001) and did not significantly differ from each other.ConclusionsA supplemental thiamine dose of 2.35 mg/d was required to achieve a mi

Women reliant on mostly rice-based diets can have inadequate thiamine intake, placing breastfed infants at risk of thiamine deficiency and, in turn, physical and cognitive impairments. We investigated the impact of maternal thiamine supplementation doses on infants' cognitive, motor, and language development across the first year. In this double-blind, four-parallel-arm, randomized controlled trial, healthy mothers of exclusively breastfed newborn infants were recruited in Kampong Thom, Cambodia. At 2 weeks postnatal, women (n = 335) were randomized to one of four treatment groups to consume one capsule/day with varying amounts of thiamine for 22 weeks: 0, 1.2, 2.4, and 10 mg. At 2, 12, 24, and 52 weeks of age, infants were assessed with the Mullen Scales of Early Learning (MSEL) and the Caregiver Reported Early Development Instrument (CREDI). Multiple regression and mixed effects modeling suggest that by 6 months of age, the highest maternal thiamine dose (10 mg/day) held significant benefits for infants' language development, but generally not for motor or visual reception development. Despite having achieved standardized scores on the MSEL that approximated U.S. norms by 6 months, infants showed a significant drop relative to these norms in both language domains following trial completion, indicating that nutritional interventions beyond 6 months may be necessary.

IFPRI1; A4NH; HarvestPlus; Open Access, HarvestPlus, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Democratic Republic of the Congo (DRC) Micronutrient Cross-Sectional Household Survey is a comprehensive nutritional survey among women (18–45 years) and their children (6–59 months) in the South Kivu and Kongo Central Provinces of the Democratic Republic of Congo (DRC). The survey was conducted to assess the prevalence of anemia and micronutrient deficiencies among women of childbearing age and children under five years of age. In this cross-sectional survey, 744 mother-child pairs were recruited using a probability proportionate to size (PPS) sampling method in select health zones of South Kivu and the rural district of Lukaya in Kongo Central, DRC between June and October 2014. This dataset includes information on household's socio-economic characteristics; water, sanitation and hygiene practices; child health and health-seeking behavior; and consumption of bean. Anthropometric measurements were taken by trained personnel using the Food and Nutrition Technical Assistance (FANTA) Anthropometric Indicators Measurement Guide.

Children can be underweight because they have a low weight in relation to their height and/or because they are short in relation to their age. Waterlow introduced the term wasted for children with a low weight-for-height (WFH), and stunted for those who have a low height-for-age [1]. Children suffering from acute food shortage become wasted as they lose weight, but their height remains constant, and wasting is often considered as reflecting an episode of acute malnutrition (AM). In contrast, stunting is regarded as a more chronic form of malnutrition. Although wasting can also be chronic, and linear growth stops in the case of AM, AM is often defined by wasting, more specifically by a WFH <-2 z-score of the World Health Organization (WHO) growth standard [2]. Moderate acute malnutrition (MAM) is defined by a z-score between -2 and -3, and severe acute malnutrition (SAM) is defined by a WFH <-3 z-score or a mid-upper arm circumference (MUAC) <115 mm (in children aged 6 to 60 months) or the presence of nutritional edema [3]. The MUAC-based definition of SAM was introduced to include children with a low MUAC, because these children are at high risk of death [4]. In programs that aim to prevent malnutrition-associated mortality, MAM is also often defined by a MUAC between 115 and 125 mm [5]. The cutoffs for MAM and SAM are convenient for establishing programs, but there is no abrupt change of the pathophysiology or of the associated risk around these cutoffs, and there is a continuum between SAM and MAM.

Children can be underweight because they have a low weight in relation to their height and/or because they are short in relation to their age. Waterlow introduced the term wasted for children with a low weight-for-height (WFH), and stunted for those who have a low height-for-age [1]. Children suffering from acute food shortage become wasted as they lose weight, but their height remains constant, and wasting is often considered as reflecting an episode of acute malnutrition (AM). In contrast, stunting is regarded as a more chronic form of malnutrition. Although wasting can also be chronic, and linear growth stops in the case of AM, AM is often defined by wasting, more specifically by a WFH <-2 z-score of the World Health Organization (WHO) growth standard [2]. Moderate acute malnutrition (MAM) is defined by a z-score between -2 and -3, and severe acute malnutrition (SAM) is defined by a WFH <-3 z-score or a mid-upper arm circumference (MUAC) <115 mm (in children aged 6 to 60 months) or the presence of nutritional edema [3]. The MUAC-based definition of SAM was introduced to include children with a low MUAC, because these children are at high risk of death [4]. In programs that aim to prevent malnutrition-associated mortality, MAM is also often defined by a MUAC between 115 and 125 mm [5]. The cutoffs for MAM and SAM are convenient for establishing programs, but there is no abrupt change of the pathophysiology or of the associated risk around these cutoffs, and there is a continuum between SAM and MAM.

Vitamin B12 plays an essential role in fetal and infant development. In regions where animal source food consumption is low and perinatal supplementation is uncommon, infants are at risk of vitamin B12 deficiency. In this secondary analysis, we measured total vitamin B12 concentrations in maternal and infant serum/plasma and breast milk among two samples of mother-infant dyads in Canada (assessed at 8 weeks post-partum) and in Cambodia (assessed between 3-27 weeks post-partum). Canadian mothers (n = 124) consumed a daily vitamin B12-containing multiple micronutrient supplement throughout pregnancy and lactation; Cambodian mothers (n = 69) were unsupplemented. The maternal, milk, and infant total vitamin B12 concentrations (as geometric means (95% CI) in pmol/L) were as follows: in Canada, 698 (648,747), 452 (400, 504), and 506 (459, 552); in Cambodia, 620 (552, 687), 317 (256, 378), and 357 (312, 402). The majority of participants were vitamin B12 sufficient (serum/plasma total B12 > 221 pmol/L): 99% and 97% of mothers and 94% and 84% of infants in Canada and Cambodia, respectively. Among the Canadians, maternal, milk, and infant vitamin B12 were all correlated (p < 0.05); only maternal and infant vitamin B12 were correlated among the Cambodians (p < 0.001).

Vitamin B12 plays an essential role in fetal and infant development. In regions where animal source food consumption is low and perinatal supplementation is uncommon, infants are at risk of vitamin B12 deficiency. In this secondary analysis, we measured total vitamin B12 concentrations in maternal and infant serum/plasma and breast milk among two samples of mother-infant dyads in Canada (assessed at 8 weeks post-partum) and in Cambodia (assessed between 3-27 weeks post-partum). Canadian mothers (n = 124) consumed a daily vitamin B12-containing multiple micronutrient supplement throughout pregnancy and lactation; Cambodian mothers (n = 69) were unsupplemented. The maternal, milk, and infant total vitamin B12 concentrations (as geometric means (95% CI) in pmol/L) were as follows: in Canada, 698 (648,747), 452 (400, 504), and 506 (459, 552); in Cambodia, 620 (552, 687), 317 (256, 378), and 357 (312, 402). The majority of participants were vitamin B12 sufficient (serum/plasma total B12 > 221 pmol/L): 99% and 97% of mothers and 94% and 84% of infants in Canada and Cambodia, respectively. Among the Canadians, maternal, milk, and infant vitamin B12 were all correlated (p < 0.05); only maternal and infant vitamin B12 were correlated among the Cambodians (p < 0.001).

BACKGROUND: Thiamine deficiency is thought to be an issue in Cambodia and throughout Southeast Asia due to frequent clinical reports of infantile beriberi. However the extent of this public health issue is currently unknown due to a lack of population-representative data. Therefore we assessed the thiamine status (measured as erythrocyte thiamine diphosphate concentrations; eThDP) among a representative sample of Cambodian women of childbearing age (15-49 y) and their young children (6-69 mo).METHODOLOGY/PRINCIPLE FINDINGS: Samples for this cross-sectional analysis were collected as part of a national micronutrient survey linked to the Cambodian Demographic and Health Survey (CDHS) 2014. One-sixth of households taking part in the CDHS were randomly selected and re-visited for additional blood sampling for eThDP analysis (719 women and 761 children). Thiamine status was assessed using different cut-offs from literature. Women were mean (SD) 30 (6) y, and children (46% girls) were 41 (17) mo. Women had lower mean (95% CI) eThDP of 150 nmol/L (146-153) compared to children, 174 nmol/L (171-179; P < 0.001). Using the most conservative cut-off of eThDP < 120 nmol/L, 27% of mothers and 15% of children were thiamine deficient, however prevalence rates of deficiency were as high as 78% for mothers and 58% for children using a cut-off of < 180 nmol/L. Thiamine deficiency was especially prevalent among infants aged 6-12 mo: 38% were deficient using the most conservative cut-off (< 120 nmol/L).CONCLUSIONS/SIGNIFICANCE: There is a lack of consensus on thiamine status cut-offs; more research is required to set clinically meaningful cut-offs. Despite this, there is strong evidence of suboptimal thiamine status among Cambodian mothers and their children, with infants <12 mo at the highest risk. Based on eThDP from this nationally-representative sample, immediate action is required to address thiamine deficiency in Cambodia, and likely throughout Sou

BACKGROUND: Thiamine deficiency is thought to be an issue in Cambodia and throughout Southeast Asia due to frequent clinical reports of infantile beriberi. However the extent of this public health issue is currently unknown due to a lack of population-representative data. Therefore we assessed the thiamine status (measured as erythrocyte thiamine diphosphate concentrations; eThDP) among a representative sample of Cambodian women of childbearing age (15-49 y) and their young children (6-69 mo).METHODOLOGY/PRINCIPLE FINDINGS: Samples for this cross-sectional analysis were collected as part of a national micronutrient survey linked to the Cambodian Demographic and Health Survey (CDHS) 2014. One-sixth of households taking part in the CDHS were randomly selected and re-visited for additional blood sampling for eThDP analysis (719 women and 761 children). Thiamine status was assessed using different cut-offs from literature. Women were mean (SD) 30 (6) y, and children (46% girls) were 41 (17) mo. Women had lower mean (95% CI) eThDP of 150 nmol/L (146-153) compared to children, 174 nmol/L (171-179; P < 0.001). Using the most conservative cut-off of eThDP < 120 nmol/L, 27% of mothers and 15% of children were thiamine deficient, however prevalence rates of deficiency were as high as 78% for mothers and 58% for children using a cut-off of < 180 nmol/L. Thiamine deficiency was especially prevalent among infants aged 6-12 mo: 38% were deficient using the most conservative cut-off (< 120 nmol/L).CONCLUSIONS/SIGNIFICANCE: There is a lack of consensus on thiamine status cut-offs; more research is required to set clinically meaningful cut-offs. Despite this, there is strong evidence of suboptimal thiamine status among Cambodian mothers and their children, with infants <12 mo at the highest risk. Based on eThDP from this nationally-representative sample, immediate action is required to address thiamine deficiency in Cambodia, and likely throughout Sou

PR, IFPRI3; CRP4; ISI, HarvestPlus; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI3; ISI; CRP4, HarvestPlus; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)