Thiamine Deficiency
Conditions
Brief summary
Beriberi is a potentially fatal disease caused by vitamin B1 (thiamine) deficiency that still occurs in Southeast Asia despite near eradication elsewhere. Mothers with a diet low in thiamine produce thiamine-poor milk, putting their infants at a high risk of developing thiamine deficiency and beriberi. There is also a growing body of evidence suggesting thiamine deficiency not severe enough to cause clinical symptoms may negatively effect cognitive development and functioning of the infant. Since human milk should be the sole source of nutrition for babies during the first six months, maternal thiamine intake must be improved to combat this disease. The investigators' recent study of thiamine-fortified fish sauce in Cambodia showed that fortification could increase maternal and infant thiamine status'. However, centrally produced fish sauce may not reach the poorest communities who make their own fish sauce, and fish sauce is not consumed in all regions where we find thiamine deficiency. Salt, by contrast, is a common condiment in most regions of the world and has proven to be a successful global fortification vehicle for iodine. Suboptimal maternal thiamine intake puts exclusively breastfed infants at risk of low thiamine status, impaired cognitive development, and infantile beriberi, which can be fatal. Thiamine fortification of salt is a potentially low-cost and sustainable means of combating suboptimal thiamine status; however knowledge gaps must be filled before thiamine fortification can proceed. In this study, mothers will consume thiamine supplements in order to model the thiamine dose required to optimize human milk thiamine concentrations for the prevention of beriberi. Other thiamine biomarkers will be assessed, and usual salt intake will be measured. Finally, the investigators will assess the effects of early-life thiamine exposure on infant neuro-cognitive development.
Detailed description
(see full protocol)
Interventions
DIETARY_SUPPLEMENTthiamine (as thiamine hydrochloride)
Opaque capsules containing varying amounts of thiamine hydrochloride and cellulose filler. All thiamine is delivered as thiamine hydrochloride, calculated using a 1.271 correction factor (ratio of molecular weights of thiamine hydrochloride and thiamine).
Sponsors
Sackler Institute for Nutrition Science
Bill and Melinda Gates Foundation
Helen Keller International
NCHADS - Ministry of Health of Cambodia
Ministry of Planning, Cambodia
South Australian Health and Medical Research Institute
Institut de Recherche pour le Developpement
University of Oregon
Mount Saint Vincent University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Investigator)
Masking description
double-blinded
Intervention model description
Randomized placebo controlled, double-blinded, four-parallel arm, multicentre trial
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 45 Years
Healthy volunteers
No
Inclusion criteria
Mothers of a newborn who: * are aged 18 - 45 years * had a recent normal pregnancy (i.e. no known chronic conditions, no preeclampsia, gestational diabetes etc), and the singleton infant was born without complications (e.g. low birth weight (\<2.5 kg), tongue tie, cleft palate) * are intending to exclusively breastfeed for six months * reside in Kampong Thom province, Cambodia, and are not planning to move in the next six months * are willing to consume one capsule daily from 2 weeks through to 24 weeks postpartum * are willing for her entire household consume only salt provided by the study team * are willing for the following biological samples to be collected: a maternal venous blood sample and human milk sample at 2 weeks postpartum, a human milk sample at 4 and 12 weeks postpartum, and maternal and infant blood samples and a human milk sample at 24 weeks postpartum.
Exclusion criteria
Mothers of a newborn who: * are currently taking or has taken thiamine-containing supplements over the past 4 months * are currently participating in nutrition programs beyond normal care
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Human milk total thiamine concentration | 24 weeks postpartum | To estimate the dose on the dose response curve where additional maternal intake of thiamine (oral dose) no longer meaningfully increases human milk total thiamine concentration at 24 weeks postpartum. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Human milk total thiamine concentrations | 4 and 12 weeks postpartum | To estimate the dose on the dose response curve where additional maternal intake of thiamine (oral dose) no longer meaningfully increases human milk total thiamine concentration at 4 and 12 weeks postpartum. |
| Infant transketolase activity | 24 weeks postnatal | To estimate the dose on the dose response curve where additional maternal intake of thiamine (oral dose) no longer meaningfully increases infant transketolase activity at 24 weeks postnatally, and assess whether this depends on the presence/absence of a genetic hemoglobin disorder. |
| Maternal ThDP (dose response) | 24 weeks postpartum | To estimate the dose on the dose response curve where additional maternal intake of thiamine (oral dose) no longer meaningfully increases maternal ThDP at 24 weeks postpartum, and assess whether this depends on the presence/absence of a genetic hemoglobin disorder. |
| Maternal transketolase activity (dose response) | 24 weeks postpartum | To estimate the dose on the dose response curve where additional maternal intake of thiamine (oral dose) no longer meaningfully increases maternal ETKac at 24 weeks postpartum, and assess whether this depends on the presence/absence of a genetic hemoglobin disorder. |
| Maternal ThDP (by arm) | 24 weeks postpartum | To test for differences between the 4 randomized groups on maternal ThDP at 24 weeks postpartum, and assess whether this depends on the presence/absence of genetic hemoglobin disorder. |
| Maternal transketolase activity (by arm) | 24 weeks postpartum | To test for differences between the 4 randomized groups on maternal ETKac at 24 weeks postpartum and assess whether this depends on the presence/absence of a genetic hemoglobin disorder. |
| Household salt intake | within 2 and 24 weeks postpartum | To estimate usual household salt intake from mean fortnightly salt disappearance (weight lost, in g). |
| Infant thiamine diphosphate concentrations (ThDP) | 24 weeks postnatal | To estimate the dose on the dose response curve where additional maternal intake of thiamine (oral dose) no longer meaningfully increases infant thiamine diphosphate concentrations (ThDP) 24 weeks postnatally, and assess whether this depends on the presence/absence of a genetic hemoglobin disorder. |
| Sodium intake of women | within 2 and 24 weeks postpartum | To estimate sodium intake using 24 hr urinary sodium concentrations among a subset of 100 lactating women. |
| Mullen scores | 24 and 52 weeks postnatal | To test for differences between the 0 & 10 mg randomized groups on Composite Mullen and the 5 subscales of the Mullen at 24 and 52 weeks postnatally. Score notes for Mullen Scales of Early Learning Gross Motor Scale: Raw score range: 0-36 (higher scores reflect better performance) Visual Reception Scale: Raw score range: 0-50 (higher scores reflect better performance) Fine Motor Scale: Raw score range: 0-49 (higher scores reflect better performance) Receptive Language Scale: Raw score range: 0-48 (higher scores reflect better performance) Expressive Language Scale: Raw score range: 0-50 (higher scores reflect better performance) All raw scores are converted to age-adjusted T-scores (provided by manual). An optional Early Learning Composite Score can be calculated by summing the T-scores of all but the Gross Motor Scale. |
| Visual paired comparison | 24 and 52 weeks postnatal | To test for differences between the 0 & 10 mg randomized groups on Visual Paired Comparison Novelty Score and the attention and processing speed subscales at 24 and 52 weeks postnatally. Score notes for Visual Paired Comparison task Scale ranges: An overall novelty score is calculated that averages across all face and pattern trials, and is a percentage reflecting the percent of time infants' looked at the novel item during the test phase, calculated as the duration looking to the novel item divided by the sum of the duration of looking to the novel item plus the duration looking to the familiar item. Sub-scales: Two sub-scales are calculated: the novelty score averaged across face trials, and the novelty score averaged across pattern trials. The total scale composite averages the novelty score across the two sub-scales. For all scales, he range is 0-100%, and higher novelty scores indicate better outcomes. |
| Language Preference Task | 24 weeks postnatal | To test for differences between the 0 & 10 mg randomized groups on the Language Preference Task Score at 24 weeks postnatally. |
| Oculomotor scores | 24 weeks postnatal | To test for differences between 0 & 10 mg randomized groups on oculomotor scores at 24 weeks postnatally. Score notes for the Oculomotor Test: The proposed oculomotor test is not a single, published instrument, but instead, combines several standard screening items. Strabismus: absent or present; score: 0-1 Nystagmus: absent or present; score: 0-1 Amblyopia: absent or present; score 0-1 Saccade: * guided saccade: absent or present; score 0-1 * scanning: absent or present; score 0-1 * predicted saccade: absent or present; score 0-1 Smooth pursuit: * overall pursuit: absent or present; score 0-1 * horizontal pursuit: score 0-1 * vertical pursuit: score 0-1 Total oculomotor score (optional): sum of all scored exam items: range 0-9 |
| Inflammation | 24 weeks postnatal | To determine the effect of inflammation, as measured by C-reactive protein (CRP) and α-1-acid-glycoprotein (AGP) on maternal ThDP at 2 and 24 weeks postpartum, and infant ThDP at 24 weeks postnatal. |
| Salt intake of household members | within 2 and 24 weeks postpartum | To estimate salt intake among a subset of 100 lactating women, their male partners (if applicable), and their children 24-59 months (if applicable) using observed weighed salt intake records. |
Countries
Cambodia
Outcome results
None listed