Trial of Thiamine Supplementation in Cambodia

Mount Saint Vincent University

Status: Completed

Conditions: Thiamine Deficiency

Treatments: Dietary Supplement: thiamine (as thiamine hydrochloride)

Study type: Interventional

Funder types: Other

Identifiers

NCT03616288

MSVUREB2017-141

112NECHR (Other Identifier)

Details and patient eligibility

About

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.

Full description

(see full protocol)

Enrollment: 335 patients

Sex: Female

Ages: 18 to 45 years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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335 participants in 4 patient groups, including a placebo group

Negative Control

Placebo Comparator group

Description:

placebo; 0 mg thiamine

Treatment:

Dietary Supplement: thiamine (as thiamine hydrochloride)

EAR Group

Experimental group

Description:

1.2 mg thiamine as thiamine hydrochloride

Treatment:

Dietary Supplement: thiamine (as thiamine hydrochloride)

Double EAR Group

Experimental group

Description:

2.4 mg thiamine as thiamine hydrochloride

Treatment:

Dietary Supplement: thiamine (as thiamine hydrochloride)

Positive Control

Experimental group

Description:

10 mg thiamine as thiamine hydrochloride

Treatment:

Dietary Supplement: thiamine (as thiamine hydrochloride)