A joint study by the South Australian Health and Medical Research Institute and the University of Adelaide found that introducing fish sauce fortified with the thiamine to the Cambodian diet provided enough nutrition to prevent beriberi disease, which is a leading cause of infant death in the country.
The study involved a trial in Cambodia led by the South Australian researchers where varying levels of thiamine (vitamin B1) was added to fish sauce products during the manufacturing process.
Breastfeeding mothers and children who ate the fish sauce were then tested to confirm adequate levels of thiamine was present in their blood to prevent the disease.
Beriberi is caused by thiamine deficiency and in infant cases can quickly progress from mild symptoms such as vomiting and diarrhoea to heart failure.
With the findings published in the Journal of Paediatrics, Principal Nutritionist and Affiliate Professor at SAHMRI Tim Green says the next step is to lobby for funds to expand the trial in a bid to convince the Cambodian government of the merits of thiamine fortification.
“We’ve done this relatively large randomised controlled trial, but we provided the fish sauce in this case,” he says.
“Our next step is to scale up – to get Cambodian government or Cambodian industry involved and show that it works with 100,000 or 200,000 people.
“And if we can show that works, we can provide evidence to the government and they can also mandate the addition of thiamine to fish sauce.”
While fish sauce has no nutritional advantage over other foods trialled in the study, it was selected because of its near ubiquitous use in Cambodian culture.
Fish sauce is produced in centralised locations, making it easier for government and industry to control, and is already fortified with iron
Fortification is used in many countries around the world, but to be effective it is important to select a foodstuff already consumed by the majority of the population.
“Fortification is used in a lot of different settings – we do it in Australia, for example fortifying wheat flour with folic acid, or salt with iodine,” Green says.
“However, the important thing to consider is what you fortify may differ from country to country depending on what the staple is.
“We found that fish sauce in South East Asia is a good vehicle because it’s so popular and so widely consumed.”
While the trial was focused on Cambodia, Green says a similar strategy could be adopted in other South East Asian countries affected by beriberi disease.
“Because beriberi isn’t always recognised and the onset from the initial symptoms – which can be quite mild – to death is so rapid, the best thing to do would be to prevent it in the first place,” Green says.
While the study focused on thiamine fortification, the identification of fish sauce as the food of choice for delivery could also be expanded to cover other nutritional deficiencies.
Green says his team has also considered the possibility of using fish sauce to deliver vitamin B2.
– Thomas Luke