Centre for International Health, Department of Global Health and Primary Care, University of Bergen, Bergen, Norway.
Department of Neurology, University of Kinshasa, Congo-Kinshasa, Democratic Republic of the Congo.
PLoS One. 2018 Apr 17;13(4):e0193261. doi: 10.1371/journal.pone.0193261. eCollection 2018.
Dietary cyanogen exposure from ingesting bitter (toxic) cassava as a main source of food in sub-Saharan Africa is related to neurological impairments in sub-Saharan Africa. We explored possible association with early child neurodevelopmental outcomes.
We undertook a cross-sectional neurodevelopmental assessment of 12-48 month-old children using the Mullen Scale of Early Learning (MSEL) and the Gensini Gavito Scale (GGS). We used the Hopkins Symptoms Checklist-10 (HSCL-10) and Goldberg Depression Anxiety Scale (GDAS) to screen for symptoms of maternal depression-anxiety. We used the cyanogen content in household cassava flour and urinary thiocyanate (SCN) as biomarkers of dietary cyanogen exposure. We employed multivariable generalized linear models (GLM) with Gamma link function to determine predictors of early child neurodevelopmental outcomes.
The mean (SD) and median (IQR) of cyanogen content of cassava household flour were above the WHO cut-off points of 10 ppm (52.18 [32·79]) and 50 (30-50) ppm, respectively. Mean (SD) urinary levels of thiocyanate and median (IQR) were respectively 817·81 (474·59) and 688 (344-1032) μmole/l in mothers, and 617·49 (449·48) and 688 (344-688) μmole/l in children reflecting individual high levels as well as a community-wide cyanogenic exposure. The concentration of cyanide in cassava flour was significantly associated with early child neurodevelopment, motor development and cognitive ability as indicated by univariable linear regression (p < 0.05). After adjusting for biological and socioeconomic predictors at multivariable analyses, fine motor proficiency and child neurodevelopment remained the main predictors associated with the concentration of cyanide in cassava flour: coefficients of -0·08 to -.15 (p < 0·01). We also found a significant association between child linear growth, early child neurodevelopment, cognitive ability and motor development at both univariable and multivariable linear regression analyses coefficients of 1.44 to 7.31 (p < 0·01).
Dietary cyanogen exposure is associated with early child neurodevelopment, cognitive abilities and motor development, even in the absence of clinically evident paralysis. There is a need for community-wide interventions for better cassava processing practices for detoxification, improved nutrition, and neuro-rehabilitation, all of which are essential for optimal development in exposed children.
在撒哈拉以南非洲，食用作为主要食物来源的苦味（有毒）木薯导致的膳食氰化物暴露与撒哈拉以南非洲的神经损伤有关。我们探讨了其与儿童早期神经发育结局之间可能存在的关联。
我们对 12-48 月龄的儿童进行了一项横断面神经发育评估，使用了 Mullen 早期学习量表（MSEL）和 Gensini Gavito 量表（GGS）。我们使用 Hopkins 症状清单-10（HSCL-10）和 Goldberg 抑郁焦虑量表（GDAS）筛查了母亲的抑郁-焦虑症状。我们使用家庭木薯粉中的氰化物含量和尿硫氰酸盐（SCN）作为膳食氰化物暴露的生物标志物。我们采用具有伽马链接函数的多变量广义线性模型（GLM）来确定儿童早期神经发育结局的预测因素。
家庭木薯粉中氰化物的平均（SD）和中位数（IQR）分别高于世界卫生组织 10 ppm（52.18[32·79]）和 50 ppm（30-50）的切点。母亲尿硫氰酸盐的平均（SD）和中位数（IQR）分别为 817.81（474.59）和 688（344-1032）μmol/L，儿童尿硫氰酸盐的平均（SD）和中位数（IQR）分别为 617.49（449.48）和 688（344-688）μmol/L，反映了个体的高浓度以及社区范围内的氰化物暴露。单变量线性回归分析表明，木薯粉中氰化物的浓度与儿童早期神经发育、运动发育和认知能力显著相关（p<0.05）。在多变量分析中调整了生物和社会经济预测因素后，精细运动能力和儿童神经发育仍然是与木薯粉中氰化物浓度相关的主要预测因素：系数为-0.08 至-0.15（p<0.01）。我们还发现，在单变量和多变量线性回归分析中，儿童线性生长、儿童早期神经发育、认知能力和运动发育之间存在显著关联，系数为 1.44 至 7.31（p<0.01）。
膳食氰化物暴露与儿童早期神经发育、认知能力和运动发育有关，即使没有明显的瘫痪。需要进行社区范围的干预措施，以改善木薯加工实践以解毒、改善营养和神经康复，这些都是暴露儿童最佳发育所必需的。
