Comparison of Human Milk Fatty Acid Composition of Women From Cambodia and Australia

Human milk is a rich source of omega-3 long-chain polyunsaturated fatty acids, which are postulated to be important for brain development. There is a lack of data on the human milk fatty acid composition of Cambodian women compared with data from Western women. The aim of this study was to determine the human milk fatty acid composition of women living in Cambodia and compare it with that of women living in Australia. Human milk samples from Cambodian (n = 67) and Australian (n = 200) mothers were collected at 3 to 4 months postpartum. Fatty acid composition was analyzed using capillary gas chromatography followed by Folch extraction with chloroform/methanol (2:1 v/v), and fat content was measured gravimetrically. Compared with Australian participants, human milk from Cambodian participants contained a significantly lower level of total fat (2.90 vs. 3.45 g/dL, p = .028), lower percentages of linoleic acid (9.30% vs. 10.66%, p < .0001) and α-linolenic acid (0.42% vs. 0.95%, p < .0001), but higher percentages of arachidonic acid (0.68% vs. 0.38%, p < .0001) and docosahexaenoic acid (0.40% vs. 0.23%, p < .0001). Differences in human milk fatty acid composition between Cambodian and Australian participants may be explained by differences in the dietary patterns between the two populations.Chang Gao, Ge Liu, Kyly C. Whitfield, Hou Kroeun, Timothy J. Green, Robert A. Gibson, Maria Makrides, and Shao J. Zho

Comparable performance characteristics of plasma thiamine and erythrocyte thiamine diphosphate in response to thiamine fortification in rural cambodian women

Background: Traditionally, vitamin B₁ status is assessed by a functional test measuring erythrocyte transketolase (ETK) activity or direct measurement of erythrocyte thiamine diphosphate (eThDP) concentration. However, such analyses are logistically challenging, and do not allow assessment of vitamin B₁ status in plasma/serum samples stored in biobanks. Using a multiplex assay, we evaluated plasma concentrations of thiamine and thiamine monophosphate (TMP), as alternative, convenient measures of vitamin B₁ status. Methods: We investigated the relationships between the established biomarker eThDP and plasma concentrations of thiamine and TMP, and compared the response of these thiamine forms to thiamine fortification using samples from 196 healthy Cambodian women (aged 18-45 years.). eThDP was measured by high performance liquid chromatography with fluorescence detection (HPLC-FLD) and plasma thiamine and TMP by high performance liquid chromatography-tandem mass spectrometry (LC-MS/MS). Results: Plasma thiamine and TMP correlated significantly with eThDP at baseline and study-end (p < 0.05). Among the fortification groups, the strongest response was observed for plasma thiamine (increased by 266%), while increases in plasma TMP (60%) and eThDP (53%) were comparable. Conclusions: Plasma thiamine and TMP correlated positively with eThDP, and all thiamine forms responded significantly to thiamine intervention. Measuring plasma concentrations of thiamine forms is advantageous due to convenient sample handling and capacity to develop low volume, high-throughput, multiplex assays.Adrian McCann, Øivind Midttun, Kyly C. Whitfield, Hou Kroeun, Mam Borath ... Timothy J. Gree

Homestead food production model contributes to improved household food security and nutrition status of young children and women in poor populations

Micronutrient malnutrition is a serious public health problem among women and children in Bangladesh, Cambodia, Nepal and the Philippines. Helen Keller International has been implementing homestead food production (HFP) programs (coupled with nutrition education) in these countries to increase and ensure year-round availability and intake of micronutrient-rich foods in poor households, particularly among women and children.  Between 2003 and 2007, the HFP program was implemented among ~30,000 households in these four countries. Data collected from representative samples taken for evaluations of HFP programs in these countries illustrated the benefit of the program for households. Data were collected through interviews with households in villages that had the HFP program and from control households in non-HFP program villages. Blood samples collected from ~1000 children aged 6-59 months and ~1200 non-pregnant women before and after program implementation were analyzed for hemoglobin. The review showed that the HFP program significantly improved dietary diversification. The combined data from all four countries showed improved animal food consumption among program households, with liver consumption increasing from 24% at baseline to 46% at endline and the median number of eggs consumed by families per week increasing from 2 to 5.  The sale of HFP products also improved household income. Anemia prevalence among children in program households decreased in all the countries; however, the decrease was only significant in Bangladesh and the Philippines.  Although anemia prevalence also decreased among control households in three countries, the magnitude of change was higher in program households compared with control households.Les carences en micronutriments représentent un grave problème de santé publique chez les femmes et les enfants au Bangladesh, au Cambodge, au Népal et aux Philippines. Helen Keller International met en œuvre dans ces pays un programme de production alimentaire en exploitations familiales (homestead food production - HFP) associé à une éducation à l'alimentation afin d’augmenter et de garantir la disponibilité et la consommation d'aliments riches en micronutriments tout au long de l'année dans les foyers pauvres, et plus particulièrement chez les femmes et les enfants. Entre 2003 et 2007, le programme HFP a été mis en œuvre dans environ 30 000 foyers de ces quatre pays. Les données fournies par les échantillons représentatifs utilisés pour l'évaluation de ce programme mettent en évidence les bénéfices qu'il représente pour les familles. Ces données sont le résultat des entretiens conduits avec des familles appartenant à des villages participant au programme HFP, ainsi qu’avec des familles de contrôle dans des villages non concernés par le programme. Des analyses de l’hémoglobine ont été réalisées sur des échantillons sanguins prélevés avant et après la mise en œuvre du programme sur environ 1 000 enfants âgés de 6 à 59 mois et environ 1 200 femmes (non enceintes). L’évaluation du programme HFP a montré qu’il avait amélioré significativement la diversification alimentaire. Les données combinées des quatre pays montrent une amélioration de la consommation de produits d’origine animale chez les familles du programme. La consommation de foie est passée de 24 % à 46 %, et le nombre médian d’œufs consommés par semaine et par famille est passé de 2 à 5. La vente des produits issus du programme HFP a également amélioré les revenus de ces foyers. La prévalence de l’anémie chez les enfants participant au programme a diminué dans tous les pays. Cette diminution n'était cependant significative qu'au Bangladesh et aux Philippines. Bien que, dans trois pays, la prévalence de l’anémie ait également diminué chez les familles de contrôle, la différence était plus grande chez les familles participant au programme en comparaison avec les familles de contrôle.La malnutrición en micronutrientes es un problema de salud pública serio entre las mujeres y los niños en Bangladesh, Camboya, Nepal y Filipinas. En estos países Helen Keller International ha implementado programas de producción de alimentos en casa (PAC), conjuntamente con una educación en nutrición, para aumentar y asegurar la disponibilidad y el consumo todo el año de alimentos ricos en micronutrientes en hogares desfavorecidos, en particular entre las mujeres y los niños. Entre 2003 y 2007, el programa PAC fue aplicado en unos 30.000 hogares en estos cuatro países. Los datos obtenidos de las muestras representativas tomadas para la evaluación de los programas PAC en dichos países mostraron los beneficios del programa para los hogares. Los datos fueron recogidos a través de entrevistas con hogares en los pueblos en los que se aplicó el programa PAC y con hogares de control en pueblos sin el programa PAC. Antes y después de la implementación del programa, se tomaron muestras de sangre de unos 1000 niños entre 6 y 59 meses de edad y de unas 1200 mujeres no embarazadas; dichas muestras fueron analizadas para ver la hemoglobina. El estudio revela que el programa PAC mejoró de manera significativa la diversificación en la dieta. Los datos combinados de los cuatro países mostraron una mejoría en el consumo de alimentos de origen animal entre los hogares afiliados al programa, con un aumento del consumo de hígado de 24 % al comienzo a 46 % al final, y un aumento de 2 a 5 del número medio de huevos consumidos por familia y por semana. La venta de productos PAC también mejoró los ingresos del hogar. La prevalencia de anemia en los niños de hogares afiliados al programa disminuyó en todos los países; sin embargo, la disminución sólo fue significativa en Bangladesh y Filipinas. Aunque la prevalencia de anemia también disminuyó entre los hogares de control en tres países, la magnitud del cambio fue mayor en hogares del programa que en hogares de control

Homestead food production model contributes to improved household food security and nutrition status of young children and women in poor populations

Micronutrient malnutrition is a serious public health problem among women and children in Bangladesh, Cambodia, Nepal and the Philippines. Helen Keller International has been implementing homestead food production (HFP) programs (coupled with nutrition education) in these countries to increase and ensure year-round availability and intake of micronutrient-rich foods in poor households, particularly among women and children.  Between 2003 and 2007, the HFP program was implemented among ~30,000 households in these four countries. Data collected from representative samples taken for evaluations of HFP programs in these countries illustrated the benefit of the program for households. Data were collected through interviews with households in villages that had the HFP program and from control households in non-HFP program villages. Blood samples collected from ~1000 children aged 6-59 months and ~1200 non-pregnant women before and after program implementation were analyzed for hemoglobin. The review showed that the HFP program significantly improved dietary diversification. The combined data from all four countries showed improved animal food consumption among program households, with liver consumption increasing from 24% at baseline to 46% at endline and the median number of eggs consumed by families per week increasing from 2 to 5.  The sale of HFP products also improved household income. Anemia prevalence among children in program households decreased in all the countries; however, the decrease was only significant in Bangladesh and the Philippines.  Although anemia prevalence also decreased among control households in three countries, the magnitude of change was higher in program households compared with control households.Les carences en micronutriments représentent un grave problème de santé publique chez les femmes et les enfants au Bangladesh, au Cambodge, au Népal et aux Philippines. Helen Keller International met en œuvre dans ces pays un programme de production alimentaire en exploitations familiales (homestead food production - HFP) associé à une éducation à l'alimentation afin d’augmenter et de garantir la disponibilité et la consommation d'aliments riches en micronutriments tout au long de l'année dans les foyers pauvres, et plus particulièrement chez les femmes et les enfants. Entre 2003 et 2007, le programme HFP a été mis en œuvre dans environ 30 000 foyers de ces quatre pays. Les données fournies par les échantillons représentatifs utilisés pour l'évaluation de ce programme mettent en évidence les bénéfices qu'il représente pour les familles. Ces données sont le résultat des entretiens conduits avec des familles appartenant à des villages participant au programme HFP, ainsi qu’avec des familles de contrôle dans des villages non concernés par le programme. Des analyses de l’hémoglobine ont été réalisées sur des échantillons sanguins prélevés avant et après la mise en œuvre du programme sur environ 1 000 enfants âgés de 6 à 59 mois et environ 1 200 femmes (non enceintes). L’évaluation du programme HFP a montré qu’il avait amélioré significativement la diversification alimentaire. Les données combinées des quatre pays montrent une amélioration de la consommation de produits d’origine animale chez les familles du programme. La consommation de foie est passée de 24 % à 46 %, et le nombre médian d’œufs consommés par semaine et par famille est passé de 2 à 5. La vente des produits issus du programme HFP a également amélioré les revenus de ces foyers. La prévalence de l’anémie chez les enfants participant au programme a diminué dans tous les pays. Cette diminution n'était cependant significative qu'au Bangladesh et aux Philippines. Bien que, dans trois pays, la prévalence de l’anémie ait également diminué chez les familles de contrôle, la différence était plus grande chez les familles participant au programme en comparaison avec les familles de contrôle.La malnutrición en micronutrientes es un problema de salud pública serio entre las mujeres y los niños en Bangladesh, Camboya, Nepal y Filipinas. En estos países Helen Keller International ha implementado programas de producción de alimentos en casa (PAC), conjuntamente con una educación en nutrición, para aumentar y asegurar la disponibilidad y el consumo todo el año de alimentos ricos en micronutrientes en hogares desfavorecidos, en particular entre las mujeres y los niños. Entre 2003 y 2007, el programa PAC fue aplicado en unos 30.000 hogares en estos cuatro países. Los datos obtenidos de las muestras representativas tomadas para la evaluación de los programas PAC en dichos países mostraron los beneficios del programa para los hogares. Los datos fueron recogidos a través de entrevistas con hogares en los pueblos en los que se aplicó el programa PAC y con hogares de control en pueblos sin el programa PAC. Antes y después de la implementación del programa, se tomaron muestras de sangre de unos 1000 niños entre 6 y 59 meses de edad y de unas 1200 mujeres no embarazadas; dichas muestras fueron analizadas para ver la hemoglobina. El estudio revela que el programa PAC mejoró de manera significativa la diversificación en la dieta. Los datos combinados de los cuatro países mostraron una mejoría en el consumo de alimentos de origen animal entre los hogares afiliados al programa, con un aumento del consumo de hígado de 24 % al comienzo a 46 % al final, y un aumento de 2 a 5 del número medio de huevos consumidos por familia y por semana. La venta de productos PAC también mejoró los ingresos del hogar. La prevalencia de anemia en los niños de hogares afiliados al programa disminuyó en todos los países; sin embargo, la disminución sólo fue significativa en Bangladesh y Filipinas. Aunque la prevalencia de anemia también disminuyó entre los hogares de control en tres países, la magnitud del cambio fue mayor en hogares del programa que en hogares de control

Thiamine dose response in human milk with supplementation among lactating women in Cambodia: study protocol for a double-blind, four-parallel arm randomised controlled trial

INTRODUCTION:Thiamine (vitamin B1) deficiency remains a concern in Cambodia where women with low thiamine intake produce thiamine-poor milk, putting their breastfed infants at risk of impaired cognitive development and potentially fatal infantile beriberi. Thiamine fortification of salt is a potentially low-cost, passive means of combating thiamine deficiency; however, both the dose of thiamine required to optimise milk thiamine concentrations as well as usual salt intake of lactating women are unknown. METHODS AND ANALYSIS:In this community-based randomised controlled trial, 320 lactating women from Kampong Thom, Cambodia will be randomised to one of four groups to consume one capsule daily containing 0, 1.2, 2.4 or 10 mg thiamine as thiamine hydrochloride, between 2 and 24 weeks postnatal. The primary objective is to estimate the dose where additional maternal intake of thiamine no longer meaningfully increases infant thiamine diphosphate concentrations 24 weeks postnatally. At 2, 12 and 24 weeks, we will collect sociodemographic, nutrition and health information, a battery of cognitive assessments, maternal (2 and 24 weeks) and infant (24 weeks only) venous blood samples (biomarkers: ThDP and transketolase activity) and human milk samples (also at 4 weeks; biomarker: milk thiamine concentrations). All participants and their families will consume study-provided salt ad libitum throughout the trial, and we will measure salt disappearance each fortnight. Repeat weighed salt intakes and urinary sodium concentrations will be measured among a subset of 100 participants. Parameters of Emax dose-response curves will be estimated using non-linear least squares models with both 'intention to treat' and a secondary 'per-protocol' (capsule compliance ≥80%) analyses. ETHICS AND DISSEMINATION:Ethical approval was obtained in Cambodia (National Ethics Committee for Health Research 112/250NECHR), Canada (Mount Saint Vincent University Research Ethics Board 2017-141) and the USA (University of Oregon Institutional Review Board 07052018.008). Results will be shared with participants' communities, as well as relevant government and scientific stakeholders via presentations, academic manuscripts and consultations. TRIAL REGISTRATION NUMBER:NCT03616288.Kyly C Whitfield, Hou Kroeun, Tim Green, Frank T Wieringa, Mam Borath, Prak Sophonneary, Jeffrey R Measelle, Dare Baldwin, Lisa N Yelland, Shalem Leemaqz, Kathleen Chan, Jelisa Gallan

Low-dose thiamine supplementation of lactating Cambodian mothers improves human milk thiamine concentrations: a randomized controlled trial.

BACKGROUND: Infantile 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. OBJECTIVES: We 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. METHODS: In 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. RESULTS: In 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. CONCLUSIONS: A supplemental thiamine dose of 2.35 mg/d was required to achieve a milk total thiamine concentration of 191 µg/L. However, 1.2 mg/d for 22 wk was sufficient to increase milk thiamine concentrations to similar levels achieved by higher supplementation doses (2.4 and 10 mg/d), and comparable to those of healthy mothers in regions without beriberi. This trial was registered at clinicaltrials.gov as NCT03616288

Low-dose thiamine supplementation of lactating Cambodian mothers improves human milk thiamine concentrations: a randomized controlled trial

Background Infantile 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. Objectives We 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. Methods In 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. Results In 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. Conclusions A supplemental thiamine dose of 2.35 mg/d was required to achieve a milk total thiamine concentration of 191 µg/L. However, 1.2 mg/d for 22 wk was sufficient to increase milk thiamine concentrations to similar levels achieved by higher supplementation doses (2.4 and 10 mg/d), and comparable to those of healthy mothers in regions without beriberi. This trial was registered at clinicaltrials.gov as NCT03616288.Jelisa Gallant, Kathleen Chan, Tim J Green, Frank T Wieringa, Shalem Leemaqz, Rem Ngik ... et al

Household food insecurity and dietary diversity as correlates of maternal and child undernutrition in rural Cambodia

OBJECTIVES: To assess household food insecurity and dietary diversity as correlates of maternal and child anthropometric status and anemia in rural Cambodia. METHODS: Trained interviewers administered a survey to 900 households in four rural districts of Prey Veng, Cambodia. The Household Food Insecurity Access Scale (HFIAS) and Household Dietary Diversity Score (HDDS) were used to assess household food insecurity and dietary diversity. The height, weight and hemoglobin concentration of the mother and youngest child under 5 years in each household were measured. Multivariate logistic regression models were constructed to assess the association between household food insecurity and dietary diversity, and child stunting and wasting, maternal thinness, maternal and child anemia. RESULTS: The mean (s.d.) HFIAS and HDDS scores were 5.3 (3.9) and 4.7 (1.6), respectively. The respective prevalences of mild, moderate and severe food insecurity were 33, 37 and 12%. Maternal thinness, child stunting and child wasting were present in 14.6, 25.4 and 8.1% of respondents, respectively. The risk of maternal thinness, but not child stunting or wasting, increased as the severity of household food insecurity increased. Household food insecurity was also positively associated with maternal, but not child, anemia. Household dietary diversity status was not significantly associated with any of the outcomes we assessed. CONCLUSIONS: Efforts to improve household food security are important as a means of promoting maternal nutritional status; however, additional research is needed to better understand the role of other factors that are driving the burden of child undernutrition in Cambodia

Homestead food production model contributes to improved household food security and nutrition status of young children and women in poor populations

Micronutrient malnutrition is a serious public health problem among women and children in Bangladesh, Cambodia, Nepal and the Philippines. Helen Keller International has been implementing homestead food production (HFP) programs (coupled with nutrition education) in these countries to increase and ensure year-round availability and intake of micronutrient-rich foods in poor households, particularly among women and children.  Between 2003 and 2007, the HFP program was implemented among ~30,000 households in these four countries. Data collected from representative samples taken for evaluations of HFP programs in these countries illustrated the benefit of the program for households. Data were collected through interviews with households in villages that had the HFP program and from control households in non-HFP program villages. Blood samples collected from ~1000 children aged 6-59 months and ~1200 non-pregnant women before and after program implementation were analyzed for hemoglobin. The review showed that the HFP program significantly improved dietary diversification. The combined data from all four countries showed improved animal food consumption among program households, with liver consumption increasing from 24% at baseline to 46% at endline and the median number of eggs consumed by families per week increasing from 2 to 5.  The sale of HFP products also improved household income. Anemia prevalence among children in program households decreased in all the countries; however, the decrease was only significant in Bangladesh and the Philippines.  Although anemia prevalence also decreased among control households in three countries, the magnitude of change was higher in program households compared with control households

Evaluation of two methods to measure hemoglobin concentration among women with genetic hemoglobin disorders in Cambodia: a method-comparison study

Abstract not availableCrystal D. Karakochuk, Amynah Janmohamed, Kyly C.Whitfield, SusanI. Barr, Suzanne M. Vercauteren, Hou Kroeun, Aminuzzaman Talukder, Judy McLean, Timothy J. Gree