Abstract
BackgroundThe provision of high doses of thiamine may prevent thiamine deficiency in the post-partum period of displaced persons.Methodology/Principal FindingsThe study aimed to evaluate a supplementation regimen of thiamine mononitrate (100 mg daily) at the antenatal clinics in Maela refugee camp. Women were enrolled during antenatal care and followed after delivery. Samples were collected at 12 weeks post partum. Thiamine diphosphate (TDP) in whole blood and thiamine in breast-milk of 636 lactating women were measured. Thiamine in breast-milk consisted of thiamine monophosphate (TMP) in addition to thiamine, with a mean TMP to total thiamine ratio of 63%. Mean whole blood TDP (130 nmol/L) and total thiamine in breast-milk (755 nmol/L) were within the upper range reported for well-nourished women. The prevalence of women with low whole blood TDP (<65 nmol/L) was 5% and with deficient breast-milk total thiamine (<300 nmol/L) was 4%. Whole blood TDP predicted both breast-milk thiamine and TMP (R2 = 0.36 and 0.10, p<0.001). A ratio of TMP to total thiamine ≥63% was associated with a 7.5 and 4-fold higher risk of low whole blood TDP and deficient total breast-milk thiamine, respectively. Routine provision of daily 100 mg of thiamine mononitrate post-partum compared to the previous weekly 10 mg of thiamine hydrochloride resulted in significantly higher total thiamine in breast-milk.Conclusions/SignificanceThiamine supplementation for lactating women in Maela refugee camp is effective and should be continued. TMP and its ratio to total thiamine in breast-milk, reported for the first time in this study, provided useful information on thiamine status and should be included in future studies of breast-milk thiamine.
Highlights
At the end of 1980s, thiamine deficiency was recognized as a major cause of infantile mortality in Maela refugee camp, northwestern Thailand [1]
thiamine monophosphate (TMP) contributed to a higher extent to total thiamine (63%) than did free thiamine
Previous studies failed to report breast-milk TMP because thiamine was analysed as total thiamine by a microbiological assay [14] or in hydrolysed samples following manual [15,16,17] or HPLC-coupled [2,18] fluorometric detection of thiochrome
Summary
At the end of 1980s, thiamine deficiency was recognized as a major cause of infantile mortality in Maela refugee camp, northwestern Thailand [1]. Following routine supplementary food rations (4 eggs and 500 g soybeans/wk) to all pregnant and post partum women, oral daily thiamine hydrochloride supplements (100 mg) were provided until delivery for those women with clinical signs of beriberi. Thiamine hydrochloride (10 mg) was provided weekly to all lactating women This supplementation program as well as intramuscular thiamine in suspected cases of deficiency, reduced the infantile mortality rate by 80%, but did not prevent biochemical thiamine deficiency (58% with erythrocyte transketolase activity ,1.20) and low breast-milk thiamine (median of 379 nmol/L, 17% with thiamine ,300 nmol/L) in women at 3 months postpartum [2]. Since 1998, additional weekly supplementary food rations (500 g split mung beans and 300 g dried fish) and daily thiamine mononitrate (100 mg) have been provided to all pregnant and post partum women attending the antenatal care consultations in the clinics of the Shoklo Malaria Research Unit (SMRU). The provision of high doses of thiamine may prevent thiamine deficiency in the post-partum period of displaced persons
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