Dietary intake of sulfur amino acids and risk of kwashiorkor malnutrition in eastern Democratic Republic of the Congo

BACKGROUND

Kwashiorkor is an often-fatal type of severe acute malnutrition affecting hundreds of thousands of children annually, but whose etiology is still unknown. Evidence suggests inadequate sulfur amino acid (SAA) status may explain many signs of the condition but studies evaluating dietary protein intake in relation to the genesis of kwashiorkor have been conflicting. We know of no studies of kwashiorkor that have measured dietary SAAs.

OBJECTIVES

We aimed to determine whether children in a population previously determined to have high prevalence of kwashiorkor [high-prevalence population (HPP)] have lower dietary intakes of SAAs than children in a low-prevalence population (LPP).

METHODS

A cross-sectional census survey design of 358 children compared 2 previously identified adjacent populations of children 36-59 mo old in North Kivu Province of the Democratic Republic of the Congo. Data collected included urinary thiocyanate (SCN), cyanogens in cassava-based food products, recent history of illness, and a 24-h quantitative diet recall for the child.

RESULTS

The HPP and LPP had kwashiorkor prevalence of 4.5% and 1.7%, respectively. A total of 170 children from 141 households in the LPP and 169 children from 138 households in the HPP completed the study. A higher proportion of HPP children had measurable urinary SCN (44.8% compared with 29.4%, P < 0.01). LPP children were less likely to have been ill recently (26.8% compared with 13.6%, P < 0.01). Median [IQR] intake of SAAs was 32.4 [22.9-49.3] mg/kg for the LPP and 29.6 [18.1-44.3] mg/kg for the HPP (P < 0.05). Methionine was the first limiting amino acid in both populations, with the highest risk of inadequate intake found among HPP children (35.1% compared with 23.6%, P < 0.05).

CONCLUSIONS

Children in a population with a higher prevalence of kwashiorkor have lower dietary intake of SAAs than children in a population with a lower prevalence. Trial interventions to reduce incidence of kwashiorkor should consider increasing SAA intake, paying particular attention to methionine.

Aflatoxin contamination in food and body fluids in relation to malnutrition and cancer status in Cameroon

Aflatoxins are food contaminants usually associated with hepatitis, immunodepression, impairment of fertility and cancer. The present work was to determine the presence of aflatoxins in eggs, milk, urine, and blood samples that were collected from various sources and periods; and hepatitis B virus antigen in blood samples. Aflatoxin was found in eggs (45.2%), cow raw milk (15.9%), breast milk (4.8%), urine from kwashiorkor and marasmic kwashiorkor children (45.5%), and sera from primary liver cancer patients (63.9%); HbsAg was also detected in 69.4% of the serum samples, but there was no association between both factors. Both AF and hepatitis B virus seem to be risk factors that could increase the incidence and prevalence rates of malnutrition and cancer in Cameroon.

[Prevalence of iodine deficiency and related factors in 4 year-old schoolchildren]

BACKGROUND AND OBJECTIVE

Iodine deficiency in early years of life can cause important disorders in body growth and development. The aim of this study was to determine the prevalence of iodine deficiency in 4 year-old schoolchildren from the town of Mataró (Barcelona, Spain) and to know the factors associated with this nutritional deficiency.

PATIENTS AND METHOD

A population-based cross-sectional study was designed, which included all 4 year-old schoolchildren of this town. A physicians team performed a basic physical examination and collected urine samples for iodine determination. Parents were asked to answer a nutritional habits questionnaire.

RESULTS

Eight hundred and sixty urine samples were obtained from 987 participants. Mean urinary iodine levels were 214.1 g/l (SD = 103.3 g/l) and the median was 189.0 g/l. Prevalence of iodine deficiency was 7.8% at a 100 g/l cut-off point and 1.2% at a 50 g/l cut-off point. Statistical differences in the prevalence of iodine deficiency were observed between ethnic groups: while natives had a prevalence of 7.0%, in Magrebins it was 18.4%, Subsaharians 20.0% and other ethnical groups 14.3% (p = 0.016).

CONCLUSIONS

Schoolchildren in Mataró have adequate urinary iodine levels according to WHO recommendations with a relatively low prevalence of iodine deficiency. However, even after adjustments for the knowledge of the existence of iodized salt, iodine deficiency correlates with the child's ethnic origin (native or immigrant).

Prediction of nutritional status by chemical analysis of urine and anthropometric methods

A combination of anthropometric and chemical indices was used to investigate the nutritional status of 26 healthy (H) and kwashiorkor (K) children aged 2-5 years and possibly predict the onset of malnutrition. The healthy children had significantly (p>0.05) higher values for weight, height, middle upper arm circumference and weight/height ratio than kwashiorkor children. The healthy children had significantly higher urinary concentrations of urea, inorganic sulphate and sulphate relative to creatinine, but significantly lower thiocyanate and thiocyanate relative to creatinine than the kwashiorkor children. The results of the present study would tend to indicate that a chemical analysis especially of urea, inorganic sulphate or thiocyanate alone or the urea/creatinine, inorganic sulphate/creatinine or thiocynate/creatinine ratio could be used to predict malnutrition after the initial anthropometric measurements. This study should however be repeated with a large population of volunteers to determine the specific cut-off points for each anthropometric and chemical analysis.

National study on the prevalence of iodine deficiency disorders among schoolchildren 8-12 years of age in Bahrain

A cross-sectional survey of primary-school children in Bahrain was conducted to estimate the prevalence of goitre and iodine deficiency according to age, sex and area of residence. During January-May 1999, 1600 children were randomly chosen from all government schools. Children were examined for goitre and of those, 50% were randomly selected for urinary iodine level assessment. Only 26 children (1.7%) had goitre. Although median urinary iodine was above 100 microg/L, 121 of 749 children (16.2%) had low urinary iodine levels. Although iodine deficiency does not pose a significant public health problem in Bahrain, education about the nutritional value of iodized salts in the prevention of this disorder could increase public awareness.

[Assessment of the level of urinary iodine deficiency in children of Senegalese central regions]

Iodine deficiency disorders (IDD) are a major public health problem in Senegal, where strategies of salt iodization were adopted in the southern and eastern regions. The aim of this study led in four districts (Koungheul, Bambey, Mekhe and Kebemer), was to estimate by a questionnaire, the women knowleges, attitudes and practices (KAP) concerning IDD, and to measure children urinary iodine excretion by the Sandell-Kolthoff method to assess a potential deficiency. Six hundred ninety eight households were selected covering 1336 women (age 15 to 49 years) and 400 children (age 6 to 12 years). Sixty three per cent of the women knew the goiter, 89% of them considered that it was a disease and only 0.6% knew the role of iodized salt in the treatment. On the other hand, 20% of the children presented a normal range of urinary iodine excretion superior to 100 microg/l, the deficiency was light (50 to 100 microg/l) in 38% of the children, moderate (25 to 50 microg/l) in 27% and severe (< 25 microg/l) in 15% of them. These results show that other Senegalese regions are concerned by iodine deficiency disorders and need information, education and iodine supplementation programmes, notably for children and young women.

The influence of iodine deficiency on the cognitive performance of school children in Saki, south-west Nigeria

The influence of inadequate iodine intake on the thyroid status and cognitive performance of school children in Saki, a town within the goitre belt of South-western Nigeria with known environmental iodine deficiency, was assessed. One hundred and ninety-seven (197) study subjects from Saki and seventy (70) appropriately matched control subjects from Moniya, near Ibadan, the Oyo State capital were recruited into the study. The subjects were apparently healthy primary school pupils between the ages of 10 and 14 years and had been resident in the respective locality for at least two (2) years. After establishing the presence of goitre, blood was collected for thyroid function tests by venepuncture from each pupil. The cognitive function tests, Draw-A-Person (DAP) test and the Standard Progressive Matrices (SPM) were administered simultaneously to all the pupils in the class. Urine samples were collected for urinary iodine estimation. The mean urinary iodine concentration was significantly lower in Saki than in Moniya (134.81 +/- 69.86 vs 220.00 +/- 69.00 ug/L, P < 0.01). The total goitre rates (TGR) and the visible goitre rates (VGR) were 15.2% and 1.5% for Saki, and 8.6% and 4.3% for Moniya, respectively. The mean plasma total T4 was significantly lower in Saki pupils (97.55 +/- 26.64 nmol/L vs 122.52 +/- 26.51 nmol/L P < 0.05). The TSH level was higher in Saki pupils than in Moniya pupils (4.72 +/- 1.38 mU/L vs 4.26 +/- 1.28 mU/L), but the difference was not statistically significant. Scores on intelligence function tests (DAP and SPM) were lower for Saki pupils when compared with Moniya pupils, though the differences were not statistically significant. These results show that there is a mild but significant iodine deficiency disorder problem in Saki. However, the children in Saki still maintained euthyroidism and the mild degree of iodine deficiency did not seem to have adversely affected their cognitive performance.