Leonard Cheshire Disability and Inclusive Development Centre, University College London, UK; Malawi-Liverpool Wellcome Trust Clinical Research Programme, Malawi.
International Neurologic and Psychiatric Epidemiology Program, Michigan State University, MI.
Semin Pediatr Neurol. 2014 Mar;21(1):42-9. doi: 10.1016/j.spen.2014.01.003. Epub 2014 Jan 4.
Malnutrition and neurodisability are both major public health problems in Africa. This review highlights key areas where they interact. This happens throughout life and starts with maternal malnutrition affecting fetal neurodevelopment with both immediate (eg, folate deficiency causing neural tube defects) and lifelong implications (eg, impaired cognitive function). Maternal malnutrition can also increase the risk of perinatal problems, including birth asphyxia, a major cause of neurologic damage and cerebral palsy. Macronutrient malnutrition can both cause and be caused by neurodisability. Mechanisms include decreased food intake, increased nutrient losses, and increased nutrient requirement. Specific micronutrient deficiencies can also lead to neurodisability, for example, blindness (vitamin A), intractable epilepsy (vitamin B6), and cognitive impairment (iodine and iron). Toxin ingestion (eg, from poorly processed cassava) can cause neurodisability including a peripheral polyneuropathy and a spastic paraparesis. We conclude that there is an urgent need for nutrition and disability programs to work more closely together.
营养不良和神经残疾都是非洲的主要公共卫生问题。这篇综述强调了它们相互作用的关键领域。这种相互作用贯穿人的一生，始于母体营养不良影响胎儿的神经发育，既有即时影响（例如，叶酸缺乏导致神经管缺陷），也有终身影响（例如，认知功能受损）。母体营养不良还会增加围产期问题的风险，包括出生窒息，这是神经损伤和脑瘫的主要原因。宏量营养素营养不良既可以导致神经残疾，也可以由神经残疾引起。其机制包括食物摄入量减少、营养物质流失增加和营养物质需求增加。特定的微量营养素缺乏也会导致神经残疾，例如失明（维生素 A）、难治性癫痫（维生素 B6）和认知障碍（碘和铁）。毒素摄入（例如，来自加工不良的木薯）会导致神经残疾，包括周围性多发性神经病和痉挛性截瘫。我们的结论是，迫切需要营养和残疾计划更紧密地合作。
