Dietary cyanogen exposure and early child neurodevelopment: An observational study from the Democratic Republic of Congo

BackgroundDietary 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.MethodsWe 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.ResultsThe 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 p p ConclusionDietary 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.背景 在撒哈拉以南非洲地区，以苦（有毒）木薯为主要食物来源所导致的膳食氰暴露，与该地区的神经功能损伤存在关联。本研究旨在探讨其与儿童早期神经发育结局的潜在关联。 方法 本研究采用穆伦早期学习量表（Mullen Scale of Early Learning, MSEL）与詹西尼·加维托量表（Gensini Gavito Scale, GGS），对12~48月龄儿童开展横断面神经发育评估。采用霍普金斯症状清单-10（Hopkins Symptoms Checklist-10, HSCL-10）与戈德堡抑郁焦虑量表（Goldberg Depression Anxiety Scale, GDAS）筛查孕产妇抑郁焦虑症状。以家庭食用木薯粉中的氰含量与尿液硫氰酸盐（thiocyanate, SCN）作为膳食氰暴露的生物标志物。采用带有Gamma连接函数的多变量广义线性模型（multivariable generalized linear models, GLM），分析儿童早期神经发育结局的预测因素。 结果 家庭木薯粉的氰含量均值（标准差）与中位数（四分位间距）分别为52.18（32.79）与50（30~50）ppm，均高于世界卫生组织（WHO）设定的10 ppm截断值。孕产妇尿液硫氰酸盐水平均值（标准差）与中位数（四分位间距）分别为817.81（474.59）与688（344~1032）μmol/L，儿童对应值分别为617.49（449.48）与688（344~688）μmol/L，这反映出个体及社区范围内普遍存在较高的氰暴露水平。经单变量线性回归分析显示，木薯粉中的氰化物浓度与儿童早期神经发育、运动发育及认知能力存在显著关联（原文此处p值相关内容表述不完整）。 结论 即便未出现临床可见的麻痹症状，膳食氰暴露仍与儿童早期神经发育、认知能力及运动发育存在关联。需开展社区层面的干预措施，优化木薯脱毒加工工艺、改善营养状况并实施神经康复，这些均对暴露儿童的最优发育至关重要。