Iodine and selenium deficiency associated with ...

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