iodine and selenium deficiency could be associated with the elevated frequency ... China. (6), Algeria. (7), and. Sicily. (8), whereas neurological cretinism.
Iodine and selenium deficiency associated with cretinism in northern Zaire13 Jean B Vanderpas, Kibambe Niambue,
ABSTRACT
Selenium
demic-goiter the
area
reference
nium
Bernard Jacques
and
values
in subjects
Contempr#{233}, Ngidai L Duale, Willy Goossens, Ngo Dumont, Claude H Thilly, and Anthony T Diplock
status
was
in a control
determined
area
in the core
area,
ofthe
northern
(RBC-GPX)
still two
times
iodine-deficient status
was
lower city
was
five
of the
moderately
At Karawa
normalized
both
the
endemia
‘
moderate
In a less severely
(Businga),
selenium
linearly
WORDS
Iodine
and
Subjects
the
deficiency,
RBC-GPX.
selenium
The goiter
This
deficiency,
cre-
Introduction
Since
the description
layan
valleys,
guished. overt
with
of McCarrison
two
forms
Endemic
disease
retardation
frequently and
normal
growth,
of cretinism
are
neurological
deficiency.
Nepalese
Hima-
classically
distin-
is characterized
and
variable
with
function.
deaf-mutism, More
in Papua
New
than
Africa. Northern
4 million
Zaire people
6% cretinism
prevalence
Guinea
and
by an endemic-goiter rate
goiter (9),
prevalence mostly
of the
of the cretins ( 10, 1 1 )]. for a variable distribution ofboth unclear. It was recently proposed
form [78-85% The reason ism remains iodine
is covered at a 65-85%
selenium
Am J C/in Nuir
l990;52:
deficiency
1087-93.
could
Printed
involve
(2),
in USA.
Latin
(7), and in Cenaffecting
and
at a 2-
myxedematous forms of cretinthat a combined the
(Kikwit).
the
of the
deficiency
The same
in Karawa
and
and
in a Zairian
selenium villages
selenium
endemic-goiter
status was
area
in normal
also
compared.
Karawa
along
same
endemia.
9-18
y) and
in two
rural
2 (Botolo)]
Zaire the
and
in a small
Ubangi
River
In the first two 28 cretins
villages
close
to Karawa
ofthe
endemic-
in the core
(aged
town
(Businga)
villages, 3-25
was obtained according teachers, both parents,
were
language
in local
sex-paired
subjects
samples
were
obtained
during
blood
collections
verbal
consent.
In these
of the from for
Height median
same
area.
30 hospitalized medical places
iodized
Medical
Team,
Public
In-
custom. children
community
health
was recorded and exheight of normal ageAt Businga adults
checkups
three
examined.
to local and the
by the local
of the nature of the study.) as the percentage of the
at 90
at the border
52 schoolchildren
y) were
formed verbal consent (The village chief, the informed
located
biological (21-42
after
oil has been
years)
informed available
thyroid
© 1990 American
From
the Cemubac
Health
School.
Free Uni-
versity of Brussels; Communaut#{233} Evang#{233}lique de l’Ubangi-Mongala, Karawa, ZaIre; Laboratorium van Hematologie, Gasthuisbergziekenhuis, Leuven, Belgium; Ecole de Sante Publique, Kinshasa, ZaIre; Bureau des Troubles dus a la Carence Iod#{233}e, Kinshasa, ZaIre; Institut de Recherche Interdisciplinaire en Biologie Humaine et Nucl#{233}aire,Campus Erasme, Free University ofBrussels; and Division ofBiochemistry, United Medical and Dental Schools, University of London. Guy’s Hospital, London. 2 Supported in part by the Centre d’Etudes M#{233}dicaleset Scientifiques de l’Universit#{233}de Bruxelles pour les Actions de Cooperation (Cemubac); the Academic Programs and Medicine Overseas (APMO), Brussels University; the Fonds de Ia Recherche Scientifique M#{233}dicale (contract FRSMULB 3.4507.87), Belgium; and the Wellcome Trust, London. 3 Address reprint requests to I Vanderpas. Clinique Louis Caty, 7420 Baudour, Belgium. Received October 6. 1989. Accepted for publication January 24. 1990.
of cases
belt rate
iodine
of the
and
of northern
(aged
I
normal 50%
America (3, 4), Vietnam (5), eastern China (6), Algeria Sicily (8), whereas neurological cretinism is uncommon tral
in myx-
by
intellectual
cretins show a severe neuand ataxic gait) and mental
associated thyroid
are
cretinism
stunted
development. Endemic neurological rological impairment (spastic diplegia growth,
iodine
(1) in the
of this
myxedematous
hypothyroidism,
severe
oflife
to determine core
in Businga)
was conducted
ofthe
and is associated
years
methods
1 (Boyalulia) area
leader pressed
cretinism
study
km from
tinism
Endemic
(severe
goiter
was in the
deficiency
in cretins
and
[villages
combined iodine and selenium deficiency could be associated with the elevated frequency ofendemic myxedematous cretinism in Central Africa. Am J Clin Nutr 1990;52:l087-93.
KEY
endemic
subjects
first
selenium was
supplementation
and
work living
Zaire
the
(14).
present
iodine
without
concentration up to a value of 15 U/g Hb at greater selenium
selenium
of the
Thorpe,
during
of Zaire
in a population
belt of northern
in 52 schoolglutathione
activity
aim
status
13) observed
cretins
The
sele-
endemic-
in schoolchildren
0.004).
RBC-GPX
villages,
serum
lower
=
(P
same
altered.
associated with serum selenium 1 140 nmol/L and leveled offat concentration.
times
in cretins
(12,
edematous
Roger
in-
Society
for Clinical
Nutrition
1087
Downloaded from www.ajcn.org by guest on July 10, 2011
and
volution
enwith
serum
Zaire
goiter belt (Karawa villages) was seven times lower children and similarly low in 23 cretins; erythrocyte peroxidase
an
Compared
of a noniodine-deficient
living
in
ofZaire.
Bebe,
1088
VANDERPAS
to pregnant Nine
women
attending
and
paramedical
medical
the
prenatal
workers
iodine-deficient
area
(Kikwit,
Bandundu
control
The
protocol
was approved
subjects.
ofthe hospitals ofKarawa and of the Ecole de Sante Publique committee
of the
Erasme
region)
A).
and
The
University
RBC-GPX
B) or with
schoolchildren
1984.
volunteered
the
as staff
placebo
in village
cretins
the next 4 mo into as selenomethionine)
a supplemented and a placebo
was
of
considered
sumed/2
wk).
before
Selenium
the end
that
the
results
children
study
because
function,
12 tablets
oflogistical tablets.
iodized
oil [0.5
mL
Lipiodol
France)] was adto all school-
were
in tubes
for erythrocyte
treated
determination
with
enzyme
ethylenediamine
of hematological
surement of erythrocyte tubes for measurement lenium concentration.
with
adenine
citrate
activity
indices
and
for
mea-
thyroid
status
the
was
serum
and
at Baudour,
free
VILLAGE
thyroxine
Belgium,
I
Day6O113N+1Or1
I
I I
I
1100 ug Se]
i-I
Month
6
subjects
high
at Kikwit
I
of
was per-
the independent in the
variables three
analysis. The multifactorial of the endemic area who the All
Statistical
variance
groups) analysis were rela-
of the
statistical
biological
procedures
Package
for
Social
+
of Businga (4.53
P
ofsubjects,
I
1 SD, or geometric
±
RBC, red blood cell; G6PD,
mean
glucose-6-phosphate
with range
proportion
schoolchildren roidism and severe
ofgoiter
presented the cretins
hypothyroidism.
enzyme drogenase,
dehydrogenase
hemoglobin
(hemoglobin
moglobin
A2 consistent four
selenium and
and
normal
markedly
lower
± 355
ofKikwit
in both
groups
(n
= 29),
± 347
nmol/L
nmol/L [2555
RBC-GPX
(Fig
dehyof glu-
of abnormal
trait)
concentration
[343
(n
than
P
2) was
of he-
were