Assessment of salt intake to consider salt as a fortification vehicle for thiamine in Cambodia

Ann N Y Acad Sci. 2021 Aug;1498(1):85-95. doi: 10.1111/nyas.14562. Epub 2021 Jan 7.


Thiamine deficiency is a public health issue in Cambodia. Thiamine fortification of salt has been proposed; however, the salt intake of lactating women, the target population, is currently unknown. We estimated salt intakes among lactating women (<6 months postpartum) using three methods: repeat observed-weighed intake records and 24-h urinary sodium excretions (n = 104), and household salt disappearance (n = 331). Usual salt intake was estimated by adjusting for intraindividual intakes using the National Cancer Institute method, and a thiamine salt fortification scenario was modeled using a modified estimated average requirement (EAR) cut-point method. Unadjusted salt intake from observed intakes was 9.3 (8.3-10.3) g/day, which was not different from estimated salt intake from urinary sodium excretions, 9.0 (8.4-9.7) g/day (P = 0.3). Estimated salt use from household salt disappearance was 11.3 (10.7-11.9) g/person/day. Usual (adjusted) salt intake from all sources was 7.7 (7.4-8.0) g/day. Assuming no stability losses, a modeled fortification dose of 275 mg thiamine/kg salt could increase thiamine intakes from fortified salt to 2.1 (2.0-2.2) mg/day, with even low salt consumers reaching the EAR of 1.2 mg/day from fortified salt alone. These findings, in conjunction with future sensory and stability research, can inform a potential salt fortification program in Cambodia.

Keywords: beriberi; fortification; human milk; salt; thiamine; urinary sodium.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cambodia / epidemiology
  • Dietary Supplements*
  • Disease Management
  • Disease Susceptibility
  • Family Characteristics
  • Female
  • Food, Fortified*
  • Humans
  • Male
  • Pregnancy
  • Public Health Surveillance
  • Sociodemographic Factors
  • Sodium Chloride, Dietary / administration & dosage*
  • Thiamine / administration & dosage*
  • Thiamine / blood
  • Thiamine / metabolism
  • Thiamine Deficiency / epidemiology*
  • Thiamine Deficiency / etiology
  • Thiamine Deficiency / prevention & control*


  • Sodium Chloride, Dietary
  • Thiamine