Cassava (Manihot esculenta Crantz) leaves form the main source of protein in a diet consisting of processed cassava roots as sole staple food in konzo-affected areas of the Democratic Republic of Congo. Pounded cassava leaves were hydrolysed and analysed by HPLC before and after cooking to assess amino acid profiles and protein quality. An average of about 58% loss of total protein content was observed in five different cooked samples. The protein content in cassava leaves was high, an average of 285.9 g kg −1 dry weight in the raw and 119.2 g kg −1 dry weight in the cooked samples, but of poor quality, with sulphur amino acids as the most limiting amino acids. Lysine and leucine were also limiting amino acids in some of the raw samples. Lysine, histidine, leucine and isoleucine were limiting amino acids in the cooked samples besides the sulphur amino acids. The consumption of cassava leaves does not compensate the dietary deficiency of sulphur amino acids in the roots that are the staple food in konzo-affected areas. Sulphur amino acids are essential for detoxification of the residual cyanogens remaining in insufficiently processed cassava roots. Cereals and legumes, as sources of sulphur amino acids and lysine respectively, should be promoted as part of the diet in those areas to prevent the paralytic neuro-toxico-nutritional disease konzo among the poor population.
Konzo (caused by consumption of improperly processed cassava, Manihot esculenta) and neurolathyrism (caused by prolonged overconsumption of grass pea, Lathyrus sativus) are two distinct non-infectious upper motor neurone diseases with identical clinical symptoms of spastic paraparesis of the legs. They affect many thousands of people among the poor in the remote rural areas in the central and southern parts of Africa afflicting them with konzo in Ethiopia and in the Indian sub-continent with neurolathyrism. Both diseases are toxico-nutritional problems due to monotonous consumption of starchy cassava roots or protein-rich grass pea seeds as a staple, especially during drought and famine periods. Both foods contain toxic metabolites (cyanogenic glycosides in cassava and the neuro-excitatory amino acid β-ODAP in grass pea) that are blamed for theses diseases. The etiology is also linked to the deficiency in the essential sulfur amino acids that protect against oxidative stress. The two diseases are not considered reportable by the World Health Organization (WHO) and only estimated numbers can be found. This paper analyzes research performance and determines scientific interest in konzo and neurolathyrism. A literature search of over 21 years (from 1990 to 2010) shows that in terms of scientific publications there is little interest in these neglected motorneurone diseases konzo and neurolathyrism that paralyze the legs. Comparison is made with HTLV-1/TSP, an infectious disease occurring mainly in Latin America of which the clinical manifestation is similar to konzo and neurolathyrism and requires a differential diagnosis. Our findings emphasize the multidisciplinary nature of studies on these neglected diseases, which however have not really captured the attention of decision makers and project planners, especially when compared with the infectious HTLV-1/TSP. Konzo and neurolathyrism can be prevented by a balanced diet.
Processed cassava (Manihot esculenta Crantz) roots provide more than 60% of the daily energy intake for the population of the Democratic Republic of Congo. Insufficiently processed cassava roots in a diet deficient in sulfur amino acid have been reported to cause the irreversible paralytic disease konzo, afflicting thousands of women and children in the remote rural areas of Bandundu Province. "Cossettes" (processed cassava roots) purchased in several markets of Kinshasa were analyzed for their content of cyanogens, free amino acids, and total protein amino acids. Residual cyanogen levels were below the safe limit recommended by the codex FAO/WHO for cassava flour (10 mg kg(-1)). The amino acid score was evaluated. Lysine and leucine were the limiting amino acids. Methionine content was very low and contributed about 13% of the total sulfur amino acids. Dietary requirements for sulfur amino acids need to be adjusted for the loss caused by cyanogen detoxification.
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