Kashin–Beck Osteoarthropathy in Rural Tibet in Relation to Selenium and Iodine Status

Moreno‐Reyes, Rodrigo; Suetens, Carl; Mathieu, Françoise; Begaux, Françoise; Zhu, Dan; Rivera, Maria; Boelaert, Marleen; Nève, Jean; Perlmutter, Noémi; Vanderpas, Jean

doi:10.1056/nejm199810153391604

Cited by 287 publications

(208 citation statements)

References 25 publications

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“…The severity of Se de®ciency in the children in this study is comparable to that described in the most Se de®cient areas of Zaire and China (Thilly et al, 1993;Moreno-Reyes et al, 1998). Despite very low serum Se levels, the children in this study showed a rapid and sustained response to the oral iodized oil.…”

Section: Discussionsupporting

confidence: 78%

“…In these regions, interactions between Se and iodine de®ciency may be important determinants of patterns of disease. In Tibet, where severe Se de®ciency is endemic, iodine de®ciency is a risk factor for Kashin ± Beck disease (Moreno-Reyes et al, 1998). In rural Zaire, combined iodine and Se de®ciency is associated with increased risk for endemic myxoedematous cretinism (Vanderpas et al, 1990).…”

Section: Introductionmentioning

confidence: 99%

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Effect of oral iodized oil on thyroid size and thyroid hormone metabolism in children with concurrent selenium and iodine deficiency

Zimmermann

Adou²,

Torresani³

et al. 2000

Eur J Clin Nutr

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Objectives: To determine the ef®cacy of oral iodized oil in goitrous children who are both selenium (Se) and iodine de®cient; to investigate if Se status modi®es the response of iodine de®cient, goitrous children to oral supplementation with iodized oil. Design: A longitudinal intervention trial. Setting: Two rural villages in the western Co Ãte d'Ivoire. Subjects: 51 goitrous non-anemic schoolchildren with both iodine and Se de®ciency. Intervention: Each child received an oral dose of 0.4 ml iodized poppyseed oil containing 200 mg of iodine. They were followed for 1 y with measurements of urinary iodine (UI), thyrotropin (TSH), thyroxine (T4), and thyroid volume by ultrasound. Results: At baseline all children were goitrous and Se de®cient; median UI was 29 mgal and mean serum Se (s.d.) was 14.8 (10.7) mgal. After receiving iodized oil, thyroid volume decreased signi®cantly vs baseline at 10, 15, 30 and 50 weeks (P`0.001). At 50 weeks mean percentage change in thyroid volume from baseline was746.6% and only ®ve children remained goitrous. Median TSH values at 5, 10, 15, 30 and 50 weeks were reduced signi®cantly (P`0.001) compared to baseline. Among individual children the severity of Se de®ciency predicted the degree of response to iodized oil. Baseline serum Se and percentage change in thyroid volume from baseline at 50 weeks were strongly correlated (r 2 0.554). Baseline Se and percentage decrease in TSH from baseline at 30 weeks were also well-correlated (r 2 0.467). Conclusion: Although more severe Se de®ciency partially blunts the thyroid response to iodine supplementation, oral iodized oil is an effective method for iodine repletion in goitrous children who are Se de®cient.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Effect of oral iodized oil on thyroid size and thyroid hormone metabolism in children with concurrent selenium and iodine deficiency

Zimmermann

Adou²,

Torresani³

et al. 2000

Eur J Clin Nutr

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“…This sum gives a scale from 0 to 36. This scale is divided into four stages: stage 0, I (1-10), II (11)(12)(13)(14)(15)(16)(17)(18)(19)(20) and III (21-36). The bilateral presence of radiological signs was tested for each variable with the κ-test.…”

Section: Methodsmentioning

confidence: 99%

The anatomical distribution of radiological abnormalities in Kashin-Beck disease in Tibet

Hinsenkamp

Ryppens

Begaux

et al. 2001

International Orthopaedics (SICOT)

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A radiological study of osteoarticular changes in Kashin-Beck Disease (KBD) was undertaken on the appendicular skeleton in 105 patients with KBD, in 31 healthy subjects living in an endemic area and in 30 healthy subjects living in a non-endemic area. The bone age was delayed in all three populations with no significant difference between the three studied Tibetan populations. Radiological changes occur in 56% of patients with KBD, and are usually bilateral. An analysis of the distribution of lesions shows a proximo-distal gradient. The changes are more common in the distal aspect of the limb and the lower limb is involved more commonly than the upper limb. The foot and ankle are involved in 89.5% of cases. The radiological changes and their distribution might be explained by the hypothesis of inhibition of angiogenesis by mycotoxins, exacerbated by chemical and physical environmental factors.Résumé Une étude radiographique des lésions ostéoarti-culaires produites par la maladie de Kashin-Beck (KBD) a été réalisée au Tibet sur le squelette appendiculaire de 105 patients atteints de KBD, de 31 sujets cliniquement sains vivant en région endémique et de 30 sujets en ré-gion non endémique. La détermination de l'âge osseux révèle un retard de la maturité osseuse dans les trois groupes. Les lésions radiologiques sont présentes dans 56% des cas cliniques de KBD et sont bilatérales dans presque tous les cas. Le nombre de lésions augmente vers la périphérie. Le membre inférieur est plus souvent atteint que le membre supérieur. Le pied et la cheville sont atteints dans 89.5% des cas présentant une lésion radiologique. Les lésions radiologiques observées et leur distribution pourraient être expliquées par une inhibition de l'angiogénèse aggravée par les facteurs environnementaux chimiques et physiques.

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“…Whether the Kashin Beck osteoarthropathy is also caused by selenium deficiency or combined selenium and iodine deficiency is still the topic of scientific controversy. In any event, further pathogenic factors, e. g. mycotoxins, appear to contribute to this peculiar syndrome (Ge and Young, 1993;Moreno-Reyes et al, 1998).…”

Section: Manifest Selenium Deficiencymentioning

confidence: 99%

Selenium in Biology: Facts and Medical Perspectives

Köhrl¹,

Brigelius‐Flohé²,

Böck³

et al. 2000

Biological Chemistry

245

143

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Several decades after the discovery of selenium as an essential trace element in vertebrates approximately 20 eukaryotic and more than 15 prokaryotic selenoproteins containing the 21 st proteinogenic amino acid, selenocysteine, have been identified, partially characterized or cloned from several species. Many of these proteins are involved in redox reactions with selenocysteine acting as an essential component of the catalytic cycle. Enzyme activities have been assigned to the glutathione peroxidase family, to the thioredoxin reductases, which were recently identified as selenoproteins, to the iodothyronine deiodinases, which metabolize thyroid hormones, and to the selenophosphate synthetase 2, which is involved in selenoprotein biosynthesis. Prokaryotic selenoproteins catalyze redox reactions and formation of selenoethers in (stress-induced) metabolism and energy production of E. coli, of the clostridial cluster XI and of other prokaryotes. Apart from the specific and complex biosynthesis of selenocysteine, selenium also reversibly binds to proteins, is incorporated into selenomethionine in bacteria, yeast and higher plants, or posttranslationally modifies a catalytically essential cysteine residue of CO dehydrogenase. Expression of individual eukaryotic selenoproteins exhibits high tissue specificity, depends on selenium availability, in some cases is regulated by hormones, and if impaired contributes to several pathological conditions. Disturbance of selenoprotein expression or function is associated with deficiency syndromes (Keshan and Kashin-Beck disease), might contribute to tumorigenesis and atherosclerosis, is altered in several bacterial and viral infections, and leads to infertility in male rodents.

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Kashin–Beck Osteoarthropathy in Rural Tibet in Relation to Selenium and Iodine Status

Abstract: In areas where severe selenium deficiency is endemic, iodine deficiency is a risk factor for Kashin-Beck disease.

Cited by 287 publications

References 25 publications

Effect of oral iodized oil on thyroid size and thyroid hormone metabolism in children with concurrent selenium and iodine deficiency

Effect of oral iodized oil on thyroid size and thyroid hormone metabolism in children with concurrent selenium and iodine deficiency

The anatomical distribution of radiological abnormalities in Kashin-Beck disease in Tibet

Selenium in Biology: Facts and Medical Perspectives

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