Carga de Retardo Mental Leve atribuída à exposição pré-natal ao metilmercúrio na Amazônia: estimativas local e regional

Vasconcellos, Ana Claudia Santiago de; Barrocas, Paulo Rubens Guimarães; Ruiz, Claudia Maribel Vega; Mourão, Dennys de Souza; Hacon, Sandra de Souza

doi:10.1590/1413-812320182311.15812016

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ARTICLE • Ciênc. saúde colet. 23 (11) • Nov 2018 • https://doi.org/10.1590/1413-812320182311.15812016 copiar

Carga de Retardo Mental Leve atribuída à exposição pré-natal ao metilmercúrio na Amazônia: estimativas local e regional

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

A corrida pelo ouro na Amazônia elevou os níveis de mercúrio (Hg) no ambiente e, consequentemente, aumentou a exposição humana. Uma vez liberado em sistemas aquáticos, o Hg pode gerar metilmercúrio (MeHg), um composto tóxico que se acumula ao longo de cadeias tróficas. Vários estudos têm gerado evidências sobre a sensibilidade do cérebro ao MeHg, bem como sobre a vulnerabilidade do feto durante a gravidez. O principal objetivo deste trabalho foi estimar a carga de Retardo Mental Leve (RML) em populações amazônicas, causada pela exposição pré-natal ao MeHg, utilizando a metodologia proposta por Poulin (2008). As estimativas de RML, atribuída à exposição ao MeHg pré-natal, foram baseadas no cálculo dos Anos de Vida Ajustados por Incapacidade (DALY), que foi desenvolvido a partir de taxa de incidência RML nas populações estudadas. Em nível local, o cálculo da taxa de incidência RML baseou-se em dados primários sobre a exposição ao MeHg em mulheres ribeirinhas em idade fértil. A taxa de incidência RML foi igual a 5,96/1.000 nascidos, o que resulta na perda de 2,0 pontos de QI em 34,31% dos nascidos. A estimativa de DALY/1.000 nascidos foi igual a 71,2, enquanto o DALY foi de 576. Para as estimativas regionais, foram criados diferentes cenários de exposição. Os DALYs calculados variaram de 3.256 a 65.952 por ano.

Hg; DALY; Amazônia

Mercury Levels Distribution (µg/g)		MMR attributed to MeHg (Madeira River Basin)
Number of woman of childbearing age (15 – 49 years old)	462	Number live births (2010 year)	8.089*
Mean	6,49	% loss 2pts IQ (number)	34,31 (2.775)
Standard-desviation	8,69	Incidence Rate of MML / 1,000 infants	5,96
Range	0,02 – 71,73	DALY (YLD)	576
Median	4,03	DALY/1,000 inhabitants	71,2

Reference	Local	Mean (SD)	% 2 pts IQ	I.R MMR	DALYs/1000
Hacon et al.³¹31. Hacon S, Yokoo E, Valente J, Campos RC, Silva VA, Menezes AC, Moraes LP, Ignotti E. Exposure to mercury in pregnant women from Alta Floresta-Amazon basin, Brazil. Environ Res 2000; 84(3):204-210.	Teles Pires basin	1,12 (1,17)	0	0,89	10,6
Monrroy et al.³³33. Monrroy SX, Lopez RW, Roulet M, Benefice E. Lifestyle and mercury contamination of Amerindian populations along the Beni river (lowland Bolivia). J Environ Health 2008; 71(4):44-50.	Beni river	3,2 (2,1)	0,06	2,27	27,1
Dórea et al.³⁴34. Dórea JG, Souza JR, Rodrigues P, Ferrari I, Barbosa AC. Hair mercury (signature of fish consumption) and cardiovascular risk in Munduruku and Kayabi Indians of Amazonia. Environ Res 2005; 97(2):209-219.	Tapajós basin	3,4 (1,9)	0,03	2,38	28,5
Barbieri et al.³⁵35. Barbieri FL, Cournil A, Gardon J. Mercury exposure in a high fish eating Bolivian Amazonian population with intense small-scale gold-mining activities. Int J Environ Health Res 2009; 19(4):267-277.	Beni river	3,76 (2,52)	0,66	2,67	31,9
Santos et al.³⁶36. Santos EC, Câmara VM, Jesus IM, Brabo ES, Loureiro EC, Mascarenhas AF, Fayal KF, Sá Filho GC, Sagica FE, Lima MO, Higuchi H, Silveira IM. A contribution to the establishment of reference values for total mercury levels in hair and fish in amazonia. Environ Res 2002; 90(1):6-11	Amazonas river	3,98 (2,14)	0,25	2,76	32,9
Yokoo et al.³⁷37. Yokoo EM, Valente JG, Sichieri R, Silva EC. Validation and calibration of mercury intake through self-referred fish consumption in riverine populations in Pantanal Mato-grossense, Brazil. Environ Res 2001; 86(1):88-93.	Cuiabá river	4,2 (2,4)	0,78	2,93	35
Santos et al.³⁶36. Santos EC, Câmara VM, Jesus IM, Brabo ES, Loureiro EC, Mascarenhas AF, Fayal KF, Sá Filho GC, Sagica FE, Lima MO, Higuchi H, Silveira IM. A contribution to the establishment of reference values for total mercury levels in hair and fish in amazonia. Environ Res 2002; 90(1):6-11	Amazonas river	4,33 (2,18)	0,46	2,99	35,5
Santos ey al.³⁶36. Santos EC, Câmara VM, Jesus IM, Brabo ES, Loureiro EC, Mascarenhas AF, Fayal KF, Sá Filho GC, Sagica FE, Lima MO, Higuchi H, Silveira IM. A contribution to the establishment of reference values for total mercury levels in hair and fish in amazonia. Environ Res 2002; 90(1):6-11	Amazonas river	5,37 (3,09)	6,7	3,8	45,4
Monrroy et al.³³33. Monrroy SX, Lopez RW, Roulet M, Benefice E. Lifestyle and mercury contamination of Amerindian populations along the Beni river (lowland Bolivia). J Environ Health 2008; 71(4):44-50.	Beni river	5,5 (4,1)	13,62	4,06	48,5
Kehrig et al.³⁸38. Kehrig HA, Malm O, Akagi H, Guimarães JR, Torres JP. Methylmercury in fish and hair samples from the Balbina Feservoir, Brazilian Amazon. Environ Res 1998; 77(2):84-90.	Negro river	6,5 (5,4)	25,84	5,01	59,8
Barbosa et al.³⁹39. Barbosa AC, Silva SR, Dórea JG. Concentration of mercury in hair of indigenous mothers and infants from the Amazon basin. Arch Environ Contam Toxicol. 1998; 34(1):100-105.	Xingú basin	7,3 (3,5)	22,02	5,24	62,6
Barbosa et al.³⁹39. Barbosa AC, Silva SR, Dórea JG. Concentration of mercury in hair of indigenous mothers and infants from the Amazon basin. Arch Environ Contam Toxicol. 1998; 34(1):100-105.	Xingú basin	8,1 (3,2)	27,63	5,82	69,5
Present Study*	Madeira river	6,49 (8,69)	34,31	5,96	71,1
Santos et al.⁴⁰40. Santos EC, Câmara VM, Brabo ES, Loureiro EC, Jesus IM, Fayal K, Sagica F. Mercury exposure evaluation among Pakaanóva Indians, Amazon Region, Brazil. Cad Saude Publica 2003; 19(1):199-206.	Mamoré river	8,4 (6,4)	40,13	6,57	78,4
Santos et al.³⁶36. Santos EC, Câmara VM, Jesus IM, Brabo ES, Loureiro EC, Mascarenhas AF, Fayal KF, Sá Filho GC, Sagica FE, Lima MO, Higuchi H, Silveira IM. A contribution to the establishment of reference values for total mercury levels in hair and fish in amazonia. Environ Res 2002; 90(1):6-11	Amazonas river	8,6 (6,3)	41,21	6,69	79,9
Dolbec et al.⁴¹41. Dolbec J, Mergler D, Sousa Passos CJ, Sousa de Morais S, Lebel J. Methylmercury exposure affects motor performance of a riverine population of the Tapajós river, Brazilian Amazon. Int Arch Occup Environ Health 2000; 73(3):195-203.	Tapajós river	9,9 (5,6)	49,29	7,54	90
Fréry et al.⁴²42. Fréry N, Maury-Brachet R, Maillot E, Deheeger M, de Mérona B, Boudou A. Gold-mining activities and mercury contamination of native amerindian communities in French Guiana: key role of fish in dietary uptake. Environ Health Perspect 2001; 109(5):449-456.	Maroni river	11,4 (4,2)	63,06	8,59	102,5
Santos et al.⁴³43. Santos EC, Jesus IM, Brabo ES, Loureiro EC, Mascarenhas AF, Weirich J, Câmara VM, Cleary D. Mercury exposures in riverside Amazon communities in Pará, Brazil. Environ Res 2000; 84(2):100-107.	Brasília Legal	11,75 (7,95)	58,71	9,51	113,5
Boischio & Henshel⁴⁴44. Boischio AA, Henshel D. Fish consumption, fish lore, and mercury pollution--risk communication for the Madeira River people. Environ Res 2000; 84(2):108-126.	Madeira river	12,6 (6,5)	65,54	9,91	118,3
Lebel et al.⁴⁵45. Lebel J, Mergler D, Branches F, Lucotte M, Amorim M, Larribe F, Dolbec J. Neurotoxic effects of low-level methylmercury contamination in the Amazonian Basin. Environ Res 1998; 79(1):20-32.	Tapajós river	12,6 (7,0)	64,48	10	119,4
Dórea et al.³⁴34. Dórea JG, Souza JR, Rodrigues P, Ferrari I, Barbosa AC. Hair mercury (signature of fish consumption) and cardiovascular risk in Munduruku and Kayabi Indians of Amazonia. Environ Res 2005; 97(2):209-219.	Tapajós basin	12,8 (7,0)	65,54	10,17	121,4
Barbosa et al.³⁹39. Barbosa AC, Silva SR, Dórea JG. Concentration of mercury in hair of indigenous mothers and infants from the Amazon basin. Arch Environ Contam Toxicol. 1998; 34(1):100-105.	Madeira river	14,08 (10,67)	70	11,72	139,9
Fillion et al.⁴⁶46. Fillion M, Lemire M, Philibert A, Frenette B, Weiler HA, Deguire JR, Guimarães JR, Larribe F, Barbosa Júnior F, Mergler D. Visual acuity in fish consumers of the Brazilian Amazon: risks and benefits from local diet. Public Health Nutr 2011; 14(12):2236-2244.	Tapajós river	14,4 (10,5)	66,24	12,43	148,4
Bastos et al.³3. Bastos WR, Gomes JP, Oliveira RC, Almeida R, Nascimento EL, Bernardi JV, de Lacerda LD, da Silveira EG, Pfeiffer WC. Mercury in the environment and riverside population in the Madeira River Basin, Amazon, Brazil. Sci Total Environ 2006; 368(1):344-351.	Madeira river	15,2 (9,6)	70,6	12,87	153,6
Passos et al.⁴⁷47. Passos CJ, Mergler D, Fillion M, Lemire M, Mertens F, Guimarães JR, Philibert A. Epidemiologic confirmation that fruit consumption influences mercury exposure in riparian communities in the Brazilian Amazon. Environ Res 2007; 105(2):183-193.	Tapajós river	16,8 (10,3)	74,54	14,52	173,3
Barbosa et al.⁴⁸48. Barbosa AC, Jardim W, Dórea JG, Fosberg B, Souza J. Hair mercury speciation as a function of gender, age, and body mass index in inhabitants of the Negro River basin, Amazon, Brazil. Arch Environ Contam Toxicol 2001; 40(3):439-444.	Negro river	18,5 (10)	80,23	16	191,7
Barbosa et al.⁴⁸48. Barbosa AC, Jardim W, Dórea JG, Fosberg B, Souza J. Hair mercury speciation as a function of gender, age, and body mass index in inhabitants of the Negro River basin, Amazon, Brazil. Arch Environ Contam Toxicol 2001; 40(3):439-444.	Negro river	18,3 (11,1)	77,27	16,18	193,1
Santos et al.⁴³43. Santos EC, Jesus IM, Brabo ES, Loureiro EC, Mascarenhas AF, Weirich J, Câmara VM, Cleary D. Mercury exposures in riverside Amazon communities in Pará, Brazil. Environ Res 2000; 84(2):100-107.	São Luiz do Tapajós	19,91 (11,96)	76,63	18,03	215,2

	“Best Scenario” (Hacon et al.³¹31. Hacon S, Yokoo E, Valente J, Campos RC, Silva VA, Menezes AC, Moraes LP, Ignotti E. Exposure to mercury in pregnant women from Alta Floresta-Amazon basin, Brazil. Environ Res 2000; 84(3):204-210.) Mean ≤ 2,0 µg/g	“Intermediate Scenario” (Present work / Local estimate) 2 < Mean ≤ 10 µg/g	“Worst Scenario” (Santos et al.⁴³43. Santos EC, Jesus IM, Brabo ES, Loureiro EC, Mascarenhas AF, Weirich J, Câmara VM, Cleary D. Mercury exposures in riverside Amazon communities in Pará, Brazil. Environ Res 2000; 84(2):100-107.) Mean > 10 µg/g
Mean	1,12 µg/g	6,49 µg/g	19,91 µg/g
Standard-desviation	1,17 µg/g	8,69 µg/g	11,96 µg/g
Incidence Rate of MMR/1,000 births	0,89	5,96	18,03
DALY/1000 inhabitants	10,6	71,1	215,2
DALY Total	3.256	21.801	65.952
Number of Birth loss 2,0 pts de IQ (%)	0	105.133 (34,31)	244.004 (79,63)
IQ Loss Total Points	0	210.267	488.007

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[1] Collaborations

ACS Vasconcellos - PhD responsible for the development of the research project and the preparation of the manuscript; PRG Barrocas - Coorientador and supervisor of the research; DS Mourão - Project holder, responsible for collecting hair samples in the field; CMV Ruiz - Scholar of the research project, responsible for the analysis for the determination of mercury in the samples collected. SS Hacon - Advisor and coordinator of the research project.