Search

one of the commonest nutritional deficiencies in man. According to the NHANES studies of 1999–2000, there was a 4% incidence of iron deficiency and a 2% incidence of iron deficiency anemia (IDA) in males over the age of 70 (1). In females of a comparable age, it was estimated that 7% were iron deficient and 2% actually had IDA. Iron deficiency is the most common nutritional deficiency in both developed and underdeveloped countries and, worldwide, nearly one-half billion individuals suffer from iron deficiency. [An excellent review of iron metabolism in man can be found in (2); and an in-depth overview of all aspects of iron metabolism can be found in (3).] It is important to recognize iron deficiency since iron deficiency interferes with learning in children and cognition in adults. In the pregnant woman, iron deficiency can lead to low birth weight infants. Importantly, in the elderly, iron deficiency is frequently a sign of underlying pathology.

Accelerator Mass Spectrometry is a mass spectrometric method of detecting long-lived radioisotopes without regard to their decay products or half-life. The technique is normally applied to geochronology, but is also available for bioanalytical tracing. AMS detects isotope concentrations to parts per quadrillion, quantifying labeled biochemicals to attomole levels in milligram-sized samples. Its advantages over non-isotopic and stable isotope labeling methods are reviewed and examples of analytical integrity, sensitivity, specificity, and applicability are provided.

Iron deficiency anaemia is the most prevalent nutritional deficiency. In developing countries the prevalence is especially high. However, even in industrial countries it remains high in children below two years of age, adolescent girls, menstruating women and pregnant women. One reason is that the major part of the world’s population consumes a diet with low quantities of meat. Their major sources of iron such as cereals and vegetables, contain a poor bioavailable iron (1,2). Meat, fish, poultry and offal are the only foods that contain the higher bioavailable heme iron besides the inorganic iron (nonheme iron) (1). Meat, especially red meat, is not only an important source of bioavailable iron but also zinc (3,4). Yokoi et al. (4) showed that frequent red meat intake by premenopausal women was associated with higher serum ferritin concentration and a “normal” plasma zinc disappearance. They suggested that avoidance of red meat increases the risk of iron and zinc deficiencies.

In a check-up of 298 tumor-patient histories with gastrointestinal tract cancer at the UKE in Hamburg, a statistical correlation between tumor stage and cholesterol level was found: T1 = 250 mg/dliter, T2 = 214 mg/dliter, T3 = 201 mg/dliter, and T4 = 170 mg/dliter. Metastasis was observed at smaller levels than 185 mg/dliter and no progression was observed at levels higher than 245 mg/dliter. Similar results have been obtained from other authors for different kinds of cancer.

Iodine deficiency disorders (IDD) are among the most important global public health problems with approximately one billion people at risk worldwide(1). Iodine deficiency is not restricted to developing countries and persists on the European Continent(1). The successful elimination of this nutritional deficiency, which may be associated with a wide range of neurologic, developmental, and intellectual impairments, requires an effective monitoring and surveillance program.

Malnutrition is a major health problem throughout the world. Although we usually associate malnutrition with conditions of poverty in underdeveloped countries, recent reports have clearly demonstrated that modern nations, including the United States, are not immune to this problem. Malnutrition may have an impact on as many as a half-million children in this country. Low birth weight, growth failure, weakened resistance to infection, increased vulnerability to environmental toxins such as lead, and other consequences of nutritional deficiency are not infrequent among low-income pediatric populations in this country (Physicians’ Task Force on Hunger in America 1985; Brown 1987).

Children with low birth-weight (LBW), defined as birthweight less than 2500 g, represent an important fraction of births in developing nations (Villar and Bellzan, 1982). Intrauterine growth retardation (IUGR), defined as having birthweight for gestational age below the 10th percentile, is a form of LBW ascribed to a nutritional deficiency or infectious illnesses during pregnancy (Battaglia and Lubschenko, 1967). IUGR can be chronic (symmetrical), i.e. persisting throughout pregnancy, or acute (asymmetrical), i.e. occurring in the latter phase of pregnancy. Both conditions are differentiated based on the ponderostatural index (PSI) (Lubschenko et al., 1966). The nature of the IUGR has implications for their post-natal prognosis for survival and development (Lubschenko et al., 1966).

The term thermogenesis can be applied to any component of heat production including basal metabolic rate, physical activity and the energy costs of growth, but is now considered to represent regulatory or adaptive forms of heat production. Of these, non-shivering thermogenesis (NST), which is activated in response to cold, is perhaps the most extensively studied, but it is now recognized that many other forms of thermogenesis share common effector mechanisms. For example, diet-induced thermogenesis (DIT) is stimulated by hyperphagia or nutritional deficiency such as protein deficient diets, and forms an important component of energy balance regulation particularly in small mammals (1,2). Fever is generated by increases in heat production as well as by suppression of heat loss, and the thermogenic responses to fever share many features with NST (3–5). In addition, other pathological stimuli such as injury, cancer and even psychological stress may result in increased rates of heat production that are not necessarily associated with fever but have an important impact on energy balance (2).

It is well known that lack of iron is the most common nutritional deficiency in the world, especially in developing countries. Its highest prevalence is observed in women during their reproductive life, and also in infants, children, and even in adolescents. The deficiency is produced when there is an imbalance between the iron absorbed from food and that eliminated in the shedding of epithelium, the formation of new tissue, the loss in menstrual blood, and the fetus’s need for iron during gestation. Additional iron loss is caused in developing countries by hookworm, trichuris, and Schistosoma haematobium infections. Consequently, the frequency and severity of iron deficiency are more evident in populations where those infections prevail.

The widespread notion that what we eat affects how we think has been difficult to prove. Even for the most flagrant example of poor nutrition, starvation in “Third World” countries, such a precept has not been indisputably demonstrated.

The role played by dietary factors in susceptibility to infectious disease has interested research workers for almost a century. Epidemiologic data and observations in vivo and in vitro, in man and in laboratory animals, have provided the much-needed base. Recent advances in immunologic methodology have led to renewed attempts at solving the maze of nutrition-immunity-infection interactions. The very many lacunae in our knowledge of this subject have been mentioned in earlier sections of this monograph, in the published proceedings of recent conferences (Chandra, 1974b; Katz et al., 1975; Hambraeus et al., 1977; Suskind, 1977), in the comprehensive review of Scrimshaw et al. (1968), and in the World Health Organization protocol for field studies and laboratory investigations (1972a).

Educational outcome measurements are a guide to the allocation of resources for formal and, nonformal learning. In the developing world they serve as well as input data in assessing the developmental impact of resource commitments to education. In the first instance the outcome measures serve the economist’s efficiency purpose; in the second they serve an economic growth purpose.

Mild zinc deficiency in childhood is one of the reasons why some children grow poorly. The provision of zinc supplements at nutritional doses to preschool children with low growth centiles resulted in improved height velocity and increased dietary intakes of energy, protein and zinc in the males1,2. During our studies of preschool children with mild zinc deficiency it became apparent that growth centiles first started to decline during infancy, generally between 6–15 months of age. Weight for age would initially decline typically over a period of 3–6 months and would drop from a mid-percentile level to a level close to the 5th percentile. During this period of decreased weight gain, length percentiles remained at first on their original curve, but subsequently a few months later declined to lower levels. Such decreases in weight velocity out of proportion to concomitant decreases in length velocity are generally indicative of an inadequate nutritional intake but could also be an early manifestation of mild nutritional zinc deficiency. The latter hypothesis was tested in a double-blind, controlled study of zinc supplementation in infants and toddlers with declining weight percentiles. The questions to be tested included that a nutritional deficiency of zinc was partially responsible for the declining growth centiles which sometimes occur in late infancy and that zinc supplementation under controlled conditions would be accompanied by increased growth velocity, particularly in weight for age. The pertinent methods and results of this study follow.

The definition of undernutrition has proved to be more difficult than might be expected for so prevalent a condition. The ease of clinical recognition of the two polar entities of kwashiorkor (from the Ga language of Ghana, meaning “displaced child”) (Fig. 3.1) and marasmus (Greek marasmos, withering) (Fig. 3.2) does not belittle the semantic and diagnostic problems surrounding less severe and intermediate forms of nutritional deficiencies.

Bone which contains about 27% of total body zinc1 has been considered as a storage organ for this element which may supply Zn to the soft tissues in periods of nutritional deficiency. We have shown previously that radioactive Zn which had been deposited in “deep” bone was not mobilized in Zn deficiency and furthermore that Zn deficiency does not lead to an enhanced resorption of bone mineral.2 On the other hand it was found that the level of Zn in bone decreases in Zn deficiency.2 This study was designed to examine the influence of Zn deficiency on the turnover of radioactive Zn in bone.

In many developing counties legumes contribute a significant part of dietary protein. Total protein consumed is small in instances of low food intake (e.g., in children), and any nutritional deficiency of that protein prevents its complete utilization. As recently reemphasized by Boulter (1975) and others, an improvement of protein quality is essential in such a situation, whether the diet be cereal-or legume-based.

An interactional causal model for failure to thrive (FTT), depicted in Figure 1, undergirds our clinical and research thinking with children who fail to thrive (Casey, 1983). Several aspects of these interactions have been addressed at this conference. The focus for this chapter is one corner of the model: undernutrition. Bithoney has stated that a common organic problem in all children who fail to thrive is one of malnutrition (Bithoney & Rathbun, 1983). We also believe that nutritional deficiencies play a major role in the pathophysiology of these children. Medical and nutritional scientists who evaluate children with malnutrition and FTT typically examine nutrition in terms of calories consumed, and the diet’s adequacy of the major food types of protein, carbohydrates and fat. The focus of this chapter will be on one specific nutritional deficiency: the trace mineral, zinc.