Thiamine Diphosphate in Whole Blood, Thiamine and Thiamine Monophosphate in Breast-Milk in a Refugee Population

BACKGROUND: The provision of high doses of thiamine may prevent thiamine deficiency in the post-partum period of displaced persons. METHODOLOGY/PRINCIPAL FINDINGS: The 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 (R(2) = 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/SIGNIFICANCE: Thiamine 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

Micronutrient status in lactating mothers before and after introduction of fortified flour: cross-sectional surveys in Maela refugee camp

Background Deficiency of micronutrients is common in refugee populations. Objectives Identify deficiencies and whether provided supplements and wheat flour fortified with 10 micronutrients impacts upon status among breast-feeding women from Maela refugee camp. Methods Two sequential cross-sectional studies were conducted in different groups of lactating mothers at 12 weeks postpartum. The first survey was before and the second 4-5 months after micronutrient fortified flour (MFF) had been provided to the camp (in addition to the regular food basket). Iron status and micronutrients were measured in serum, whole blood, and in breast milk samples. Results Iron and zinc deficiency and anemia were highly prevalent while low serum retinol and thiamine deficiency were rarely detected. Iron and zinc deficiency were associated with anemia, and their proportions were significantly lower after the introduction of MFF (21 vs. 35% with soluble transferrin receptor (sTfR)>8.5 mg/L, P = 0.042, and 50 vs. 73% with serum zinc<0.66 mg/L, P = 0.001). Serum sTfR, whole-blood thiamine diphosphate (TDP) and serum β-carotene were significant predictors (P<0.001) of milk iron, thiamine and β-carotene, respectively. Lower prevalence of iron deficiency in the MFF group was associated with significantly higher iron and thiamine in breast milk. Conclusions High whole-blood TDP and breast milk thiamine reflected good compliance to provided thiamine; high prevalence of iron deficiency suggested insufficient dietary iron and low acceptance to ferrous sulfate supplements. MFF as an additional food ration in Maela refugee camp seemed to have an effect in reducing both iron and zinc deficiency postpartum. © Springer-Verlag 2012

Whole blood TDP and thiamine, TMP and total thiamine in breast-milk of women with a low (<63%) compared to those with a high (≥63%) TMP to total thiamine ratio ^1–3.

1<p>WB TDP, whole blood thiamine diphosphate.</p>2<p>TMP, thiamine monophosphate.</p>3<p>Total thiamine, sum of thiamine and TMP.</p

Risk factors for deficient breast-milk total thiamine (<300 nmol/L; n = 26/636) and low whole blood TDP (<65 nmol/L; n = 31/636)^1–3.

1<p>Total thiamine, sum of TMP and thiamine.</p>2<p>WB TDP, whole blood thiamine diphosphate.</p>3<p>TMP, thiamine monophosphate.</p

Multivariate linear regression analysis on TDP in whole blood and thiamine, TMP, and total thiamine in breast-milk, <i>N</i> = 636^1–6.

1<p>Independent predictors are listed in the order they were entered in the forward models.</p>2<p>Indicates the increase in outcome per unit increase in risk factor.</p>3<p>WB TDP, whole blood thiamine diphosphate.</p>4<p>SR, Square root.</p>5<p>TMP, thiamine monophosphate.</p>6<p>Total thiamine, sum of thiamine and TMP.</p

Thiamine and thiamine monophosphate (TMP) in breast-milk by quartiles of whole blood thiamine diphosphate (TDP).

<p>Thiamine and thiamine monophosphate (TMP) in breast-milk by quartiles of whole blood thiamine diphosphate (TDP).</p

Characteristics of the study population, whole blood TDP and breast-milk thiamine at 12 weeks post partum ^1–6.

1<p>Median (interquartile range), all such values.</p>2<p>Days of provided thiamine mononitrate (daily 100 mg).</p>3<p>Mean and standard deviation, all such values.</p>4<p>TDP/Hb, thiamine diphosphate per hemoglobin.</p>5<p>Geometric mean (95% confidence interval), all such values.</p>6<p>Total thiamine, sum of thiamine and thiamine monophosphate (TMP).</p