The UK Department For International Development (DEID) Technical Development and Research (TDR) programme funded a three-year project between 1995 and 1998 entitled 'Cerium & Endomyocardial Fibrosis in Tropical Terrains\" (Project R6228). The presence of elevated levels of dietary cerium (Ce), and deficient levels of dietary magnesium (Mg) in southern India have been assigned as potential environmental cofactors in the aetiology of Endomyocardial Fibrosis (EMF), which is also endemic in certain areas of Uganda. The principal objectives of the project were to:
To reproduce the findings of the Kerala, India group in a Ugandan context;
To investigate whether the hypothesis put forward by workers in Kerala State could explain the occurrence of EMF in Uganda
To assess the relative importance of various exposure scenarios for the Ugandan population to Ce and to define protective measures if required.
The results of the studies have indicated that whilst Ugandans are exposed to elevated Ce and are likely to be magnesium deficient there is no direct evidence to indicate that exposure to Ce is a significant factor in the development of EMF in Uganda. The hypothesis put forward by workers in Kerala State cannot therefore be used to explain the occurrence of EMF in Uganda. In the course of the study a comparative inventory of cerium and the rare earth elements in the teeth of children from the United Kingdom and Uganda was compiled. This represents a significant breakthrough in the study of the potential relationship between EMF and cerium in that it enables the relative exposure of living EMF patients and members of exposed populations to be determined.
In terms of limiting exposure to Ce and increasing exposure to Mg, the results place particular emphasis on:
The practice of geophagy (habitual eating of soil), the accurate assessment of its magnitude (especially within the cultural contexts of the developing world) and its potential human health impact in terms of nutrition and toxicity.
The contamination of cassava by soil during processing at a local level.
Additionally the project has clearly demonstrated the benefits to be gained from multidisciplinary studies in the fields of environmental geochemistry and health, nutrition and medical studies, and the power of combining modern analytical techniques to the study of trace elements and human health in the developing world.
This report is available to download in full colour (5371 kb) and in black and white (1735 kb).
Cerium and endomyocardial fibrosis in tropical terrain: project summary report. (WC/98/026)