The Journal of Nutrition

Symposium: Food-Based Approaches to Combating Micronutrient Deficiencies in Children of Developing Countries

The Role of Fish in Food-Based Strategies

to Combat Vitamin A and Mineral Deficiencies
in Developing Countries1,2
Nanna Roos,3 Md. Abdul Wahab,4 Chhoun Chamnan,5 and Shakuntala H. Thilsted3*
3
Department of Human Nutrition, The Royal Veterinary and Agricultural University, 1958 Frederiksberg, Denmark; 4Faculty of
Fisheries, Bangladesh Agricultural University, 2202 Mymensingh, Bangladesh; and 5Inland Fisheries Research and Development Institute,
PO Box 582 Phnom Penh, Cambodia

Abstract
Fish is important in the diets and livelihoods of many poor people suffering from vitamin and mineral deficiencies. In this
article, fish intake in rural Bangladesh and Cambodia and the vitamin A, calcium, iron, and zinc contents and nutrient
bioavailability of commonly consumed species are presented. The contribution of these species to nutrient intakes as well
as their potential to meet dietary recommendations are presented and discussed. Data from consumption surveys were

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analyzed to obtain fish intake by species. Commonly consumed species were analyzed for nutrient contents, and studies
on nutrient bioavailability were conducted. In poor, rural, Bangladeshi households, mean fish intake was 13–83 g raw,
whole fish per person/d. Frequency of intake of small fish was high, and small fish made up 50–80% of all fish eaten during
the fish production season in rural Bangladesh and Cambodia. Many small fish are eaten whole and therefore are a rich
calcium source; some are also rich in vitamin A, iron, and zinc. Even small production of the vitamin A–rich fish mola in
ponds in Bangladesh can meet the annual vitamin A recommendation of 2 million children, and a traditional daily meal with
the iron-rich fish trey changwa plieng can meet 45% of the daily median iron requirement of Cambodian women. Fish
consumption data on the species level, nutrient analyses, awareness of the nutritional value of fish, as well as promotion
of the production and accessibility of nutrient-dense species can lead to the use of fish in food-based strategies to combat
nutrient deficiencies in poor people in Asia and Africa. J. Nutr. 137: 1106–1109, 2007.

Introduction
In riparian and coastal areas with rich fish resources in
developing countries, fish and fisheries play an important role
in the diets, livelihoods, and income of many poor population
groups who suffer from vitamin and mineral deficiencies. As
official data on fish catch, production, and consumption often
exclude fish caught, consumed, and traded within these groups,
the benefits derived from fish are not well documented and can
be grossly underestimated (1). It is well accepted that fish are a
1
Presented as part of the symposium ‘‘Food-Based Approaches to Combating
Micronutrient Deficiencies in Children of Developing Countries’’ given at the
2006 Experimental Biology meeting on April 3, 2006, San Francisco, CA.
Previously presented in part at the 18th International Congress of Nutrition,
September 2005, Durban, South Africa, abstract page 11. The symposium was
sponsored by the American Society for Nutrition and supported in part by an
educational grant from Merck & Company. The supplement is the responsibility
of the Guest Editors to whom the Editor of The Journal of Nutrition has delegated
supervision of both technical conformity to the published regulations of The
Journal of Nutrition and general oversight of the scientific merit of each article.
The opinions expressed in this publication are those of the authors and are not
attributable to the sponsors or the publisher, Editor, or Editorial Board of The
Journal of Nutrition. Guest Editors for the symposium publication are Charlotte
G. Neumann and Suzanne P. Murphy.
2
Supported by the Danish International Development Assistance, Ministry of
Foreign Affairs of Denmark.
* To whom correspondence should be addressed. E-mail: sht@kvl.dk.
good source of animal protein; however, their role as a source of
vitamins and minerals in developing countries is often over-
looked. Thus, quantification of the nutritional contribution
from fish in poor, rural households is necessary to assess the role
fish can play in food-based strategies to combat vitamin A and
mineral deficiencies in developing countries. This article de-
scribes results from research and capacity-building projects
focusing on fish intake in rural Bangladesh and Cambodia. The
vitamin A, calcium, iron, and zinc contents of commonly
consumed fish species, nutrient bioavailability, and the
contribution of these fish to the intakes of these essential,
limiting nutrients are described. In addition, the potential of
these fish to meet dietary recommendations of these nutrients is
discussed.
Materials and Methods
Data on fish consumption in rural Bangladesh and Cambodia.
Data on intake of fish species in selected rural areas of Bangladesh in
different seasons were obtained from food consumption surveys
conducted in 1991–1992, 1995, 1996–1997, and 1997–1998 (2–7).
The methods used were 24-h food weighing and 24-h recall at the
individual level of all foods consumed and 5 d recall at the household
level of fish species consumed. Data on the intake of small indigenous fish
species (SIS), with a length ,25 cm at maximum size (8), were also

1106 0022-3166/07 $8.00 ª 2007 American Society for Nutrition.

collected. In rural Cambodia, a small study on the catch and consump-
tion of fish and other aquatic animals based on biweekly household
interviews was conducted in Svag Rieng province in 1997–1998 (9). In
addition, a small survey conducted in 30 poor rural households in
Kandal province in October–December 2004 used observations and
interviews to estimate the amount of the common, small fish, trey
changwa plieng (Esomus longimanus), consumed by women in a
traditional sour soup dish (10).
Vitamin A and mineral content in fish species. Samples of selected,
commonly consumed fish species were collected fresh from landing sites,
local markets, fishermen, and farmers for nutrient analyses. Subsamples
of raw, cleaned parts were obtained by having village women clean the
fish according to their traditional practices. Vitamin A compounds (all-
trans retinol, 13-cis retinol, all-trans 3,4-dehydroretinol, 13-cis 3,4-
dehydroretinol, and b-carotene) in fish samples were analyzed using
high-performance liquid chromatography (11,12). Calcium, iron, and
zinc were determined by atomic absorption spectrometry (13,14). The
content of nonheme iron was determined by the widely used ferrozine
colorometric method (15). This fraction does not, however, include a
high-molecular-weight subpool of complex-bound nonheme iron, such
as ferritin or ferritin-like compounds and is termed inorganic iron (14).
The iron fractions not quantified by the above method; heme iron and
complex-bound nonheme iron, were calculated as the difference between
total iron and inorganic iron. In some samples of trey changwa plieng,
heme iron was measured (14).
Bioavailability of nutrients from fish and nutritional contribution
of fish. The bioavailability of calcium in the Bangladeshi SIS mola
(Amblypharyngodon mola) was determined in both humans and rats
(16,17). An efficacy study of the effect of mola on vitamin A status in
Bangladeshi children has been completed (Shakuntala H. Thilsted,
Department of Human Nutrition, The Royal Veterinary and Agricultural
University, Frederiksberg, Denmark, personal communication), and in
vitro studies on the bioavailability of iron from mola and trey changwa
plieng are being conducted (Nanna Roos, Department of Human
Nutrition, The Royal Veterinary and Agricultural University, Frederiks-
berg, Denmark, personal communication). Estimations of the contribu-
tion of mola to vitamin A recommendation of Bangladeshi children and
trey changwa plieng to iron requirements of Cambodian women and
children were made.
Results and Discussion
Fish intake in Bangladesh and Cambodia. Consumption
surveys conducted in selected areas of rural Bangladesh showed
that the amount of fish consumed varies with location and
household socioeconomic status and is highly seasonal. In poor
households with small landholdings, the mean fish intake ranged
from 13 to 83 g/d raw, whole fish per person (7). The fish
consumption survey conducted in 84 rural households in
Kishoreganj, Bangladesh in 3 rounds, July 1997, October
1997, and February 1998 showed that the total fish intake was
highest (median 6 SD: 82 6 65 g/d raw, edible parts per capita)
in October, with SIS making up a much greater proportion, 84%
of the total fish intake, than large fish. The frequency of fish
intake, in particular SIS, was high. All households consumed SIS
on at least 1 of the 5 d, except 1 household in July and 2 in
October, whereas one-third of the households did not consume
large fish (5,18).
There are very few data on fish intake in Cambodia. In the
small study conducted in 66 poor, rural households in the Svag
Rieng province in 1997–1998, an average intake of 70 g/d raw,
edible parts of fish per person as well as 9 g/d of other aquatic
animals (for example frog, snail, and snake) per person were
recorded (9). Based on a survey of fish consumption in fishing
communities around the Tonle Sap lake in 1998, using structured
interviews, it was estimated that the average fish consumption
was 67 kg/y raw, whole fish per person (19), corresponding to a
average intake of 128 g/d raw, cleaned parts per person,
adjusting for cleaning loss (30% weight of raw, whole fish) (9).
These studies showed that small fish made up 50–80% of all
fish eaten during the fish production season in rural Bangladesh
and Cambodia. In Bangladesh, with decreased freshwater
capture fisheries and reduced access to open-water fisheries for
poor, rural households, the total fish intake of the poor, as well as
the proportion of SIS of the total fish intake, have declined. At
the same time, aquaculture has become highly successful, and
the production of carp, especially silver carp (Hypophthalmich-
thys molitrix), in ponds has increased. The intake of silver carp
by the poor has increased because of its accessibility and low
price, one-half that of other large fish species, even though it is
less preferred than other cultured carp species (5,7). This
changing pattern of fish consumption has resulted in a decreased
contribution of vitamin A and minerals from fish. The edible
parts of many SIS, whole fish with bones, have high contents of
these essential, limiting nutrients; however, the edible parts of
large fish, including silver carp, mainly the muscles, contain low
contents of these nutrients.
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Nutrient contents of commonly consumed fish. The vita-
min A, calcium, iron, and zinc contents of selected, commonly
consumed fish in Bangladesh and Cambodia are shown in Table
1. Some common SIS have high contents of preformed vitamin
A, mainly as retinoids (vitamin A-1) and dehydroretinoids
(vitamin A-2), found predominantly in the eyes and viscera. The
proportions of vitamin A-1 and vitamin A-2 vary considerably
between species. For example, in chanda (Parambassis baculis),
vitamin A-1 accounts for 90% of the total vitamin A content,
expressed as retinol activity equivalent (RAE), and 20% in
darkina (Esomus danricus). Many SIS are eaten whole, including
the bones, and are, therefore, a rich calcium source. Large fish do
not contribute to calcium intake because their bones are
discarded as plate waste and not eaten (4). The 2 species from
the genus Esomus, darkina from Bangladesh and trey changwa
plieng from Cambodia, have significantly higher iron content
than the other analyzed species. Iron in fish is present in the
forms of heme iron, a high-molecular subpool of complex-
bound nonheme iron, and inorganic iron, the proportions
varying with fish species (14). Trey changwa plieng also has
higher zinc content than the other analyzed Cambodian species.
The interspecies variations in the contents of iron and zinc seem
to be less than that for Vitamin A.
The nutritional value of fish. In the above-mentioned fish
consumption survey in Kishoreganj, Bangladesh, it was esti-
mated that SIS contributed 40% and 31% of the total
recommended intakes of vitamin A and calcium, respectively,
at household level in the peak fish production season. In
Bangladesh, we have conducted studies that show that the
nutrient-dense SIS mola can be successfully integrated into carp
polyculture in small, seasonal ponds belonging to poor, rural
households without negatively affecting carp production. At the
same time total fish production increased, and the nutritional
value of the total production significantly increased (4). A
production of only 10 kg/y of mola in each of the estimated 1.3
million ponds in Bangladesh meets the annual recommended
intake of vitamin A of .2 million children (5).
To quantify the nutritional value of a fish species, it is
important that cleaning practices be recorded, that analysis of
Fish to combat micronutrient deficiencies 1107
TABLE 1 Vitamin A, calcium, iron, and zinc contents in selected, commonly consumed fish species in Bangladesh and Cambodia

Contents per 100 g raw, cleaned parts

Common name1 Scientific name Vitamin A RAE2 Calcium, g Calcium,3 g Iron, mg Zinc, mg

Bangladesh mean 6 SD (n)4

SIS5
Baim/Chikra Macrognathus aculeatus 90 6 15 (3) 0.4 6 0.1 (5) 0.2 6 0.0 (5) 2.4 6 0.4 (5) 1.2 6 0.2 (5)
Macrognathus pancahu 90 (1)
Mastacembelus armatus 30 (1)
Chanda Parambassis ranga 1679 6 1000 (3) 1.0 6 0.3 (5) 0.9 6 0.3 (5) 1.8 6 0.7 (5) 2.3 6 0.6 (5)
Parambassis baculis 340 6 105 (3)
Chanda nama 170 (1)
Darkina Esomus danricus 890 6 380 (3) 0.9 6 0.4 (3) 0.8 6 0.3 (3) 12.0 6 9.1 (3) 4.0 6 1.0 (3)
Kachki Corica soborna 90 6 20 (7) 0.5 6 0.0 (2) 0.4 6 0.0 (2) 2.8 6 1.2 (2) 3.1 6 0.5 (2)
Mola Amblypharyngodon mola 2680 6 390 (7) 0.9 6 0.1 (3) 0.8 6 0.0 (3) 5.7 6 3.7 (3) 3.2 6 0.5 (3)
Puti Puntius sophore 60 6 20 (3) 1.2 6 0.2 (4) 0.8 6 0.1 (4) 3.0 6 0.9 (4) 3.1 6 0.5 (4)
Puntius chola 70 (1)
Puntius ticto 20 (1)
Taki Channa punctatus 140 6 45 (3) 0.8 6 0.2 (3) 0.3 6 0.1 (3) 1.8 6 0.4 (3) 1.5 6 0.2 (3)
Commonly cultured large fish species: carp
Mrigal Cirrhinus cirrhosus , 30 (1) 1.0 6 0.1 (3) 0.0 6 0.0 (3) 2.5 6 1.3 (3) —6
Silver carp Hypophthamichyths molitrix , 30 (3) 0.9 6 0.4 (3) 0.0 6 0.0 (3) 4.4 6 1.8 (3) —
Cambodia

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SIS
Changwe mool Rasbora torniere 374 6 111 (3) 0.7 6 0.0 (3) — 0.7 6 0.1 (3) 2.7 6 0.2 (3)
Chunteas phluk Parachela siamensis 480 6 35 (3) 0.6 6 0.1 (3) — 1.2 6 0.3 (3) 2.2 6 0.1 (3)
Kangtrang preng Parambassis wolffi 260 (1)7 1.1 6 0.1 (3) — 1.4 6 0.5 (3) 1.6 6 0.3 (3)
Trey changwa plieng Esomus longimanus 415 (1) 0.8 6 0.2 (3) — 11.3 6 3.4 (5) 4.9 6 0.5 (3)
Commonly cultured large fish species: snakehead
Giant snakehead Channa micropeltes — 1.1 6 0.1 (3) — 1.2 6 0.1 (3) 1.4 6 0.1 (3)
Great snakehead Channa marulius 200 (1)7 1.4 6 0.2 (3) — 1.5 6 0.9 (3) 1.5 6 0.1 (3)
1
Fish species are listed in alphabetical order for each subgroup.
2
RAE, retinol activity equivalent.
3
In raw, edible parts, after correcting for calcium in the plate waste (mainly bones).
4
n, number of samples. For SIS, a sample contained 10–300 fish and for large fish, 1–2 fish.
5
SIS, small indigenous fish species.
6
—, not measured.
7
Measured in raw, whole fish.
Sources: 5,7,12,14,20.

nutrient composition be carried out on samples of raw, cleaned
fish parts, ready for cooking, and that plate waste be measured.
In the above-mentioned study in Kandal province, Cambodia, it
was recorded that the majority (80%) of the households cooked
the commonly consumed fish, trey changwa plieng, with the
head intact. The contents of calcium, iron, and zinc were
considerably higher (58, 25, and 53%, respectively) in raw,
cleaned samples, with the head than in samples in which the
head was discarded during cleaning (10).
The biological activity of preformed vitamin A and bioavail-
ability of minerals in fish are determining factors for its
nutritional value. A biological activity of 40% in relation to
all-trans retinol was used to calculate RAE from vitamin A-2 in
fish samples, based on the growth response of vitamin A-2 in rats
(21). The results from the efficacy study with mola fed to
Bangladeshi children will shed light on the effect of vitamin A-2
on vitamin A status. The calcium in SIS has been shown to have
the same high bioavailability as that from milk in both humans
and rats (16,17).
Analysis of 16 common Cambodian fish species showed that,
on average, 30% of the iron in these fish was present as
inorganic iron, the remainder being heme iron and complex-
bound nonheme iron. The bioavailability of heme iron is
1108 Symposium
estimated as 25%, 25% for complex-bound nonheme iron,
and 10% for inorganic iron (14). Our study in poor, rural
households in Cambodia on the preparation and the consump-
tion by women of a traditional meal, consisting of a sour soup
dish, prepared with trey changwa plieng and boiled rice,
indicated that the sour soup dish contributed a significant
amount of absorbable iron. The average meal consisted of 257 g
sour soup dish (containing 49 g fish) per woman per meal and
367 g boiled rice per woman per meal. Based on the measured
iron contents of the meal components, it was estimated that the
fractions of heme iron and complex nonheme iron supplied 1.94
mg iron per woman per meal, equivalent to 0.49 mg absorbable
iron per woman per meal. With the daily median iron require-
ment for women weighing 50 kg (1.35 mg/d iron per woman)
(22), the above 2 iron fractions supplied 36% of the daily
median iron requirement for women. In addition, the fraction of
inorganic iron in the meal supplied 0.12 mg absorbable iron per
woman per meal, 9% of the daily median iron requirement.
Thus, a traditional meal of a sour soup dish prepared with trey
changwa plieng and boiled rice has the potential to meet 45% of
the daily median iron requirement of Cambodian women of
childbearing age (14). Assuming an intake of 100 g sour soup
dish (containing 25 g trey changwa plieng) in a meal in children,
the contribution to the daily median iron requirement (0.45 mg/
d iron per child) (22) is 42%.
In quantifying the contribution of fish species to recom-
mended amounts of vitamin A and minerals, factors other than
the cleaning practices and plate waste, such as processing and
cooking methods, are important. It has been shown that sun
drying of mola destroyed nearly all of the vitamin A (12). In
addition, a dish prepared by boiling trey changwa plieng,
compared with one fried at a higher temperature had a higher
content of heme iron (14).
Our studies show that in Bangladesh and Cambodia, SIS with
low market value are commonly consumed and make up a large
part of the everyday diet of the poor. SIS are an important source
of calcium. Some are rich in vitamin A and/or iron and zinc.
Data on fish consumption at the species level and analyses of
nutrients in commonly consumed fish species and fish dishes are
needed to quantify the present and potential contribution of fish
to vitamin A and mineral requirements. Awareness of the impor-
tance of nutrient-dense fish species to combat vitamin A and
mineral deficiencies should be raised at the household level as
well as all levels in the agriculture, health, and nutrition sectors.
The inclusion of suitable nutrient-dense fish species in aquacul-
ture in Bangladesh should be promoted (23). Access to these fish,
through management of fisheries resources, including open-
water fisheries should be protected and enhanced. These steps
can lead to nutrient-dense fish being used in food-based strat-
egies to combat vitamin A and mineral deficiencies. The work
we have done in Bangladesh and Cambodia also has relevance
for addressing nutrient deficiencies in poor population groups in
Africa, for example those living in the Lake Victoria region.
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Fish to combat micronutrient deficiencies 1109