Henri Dirren

Cutaneous copper and zinc losses in burns

To measure the exudative cutaneous copper (Cu) and zinc (Zn) losses in burns, 10 patients, aged 36 +/- 9 years (mean +/- s.d.) with burns covering 33 +/- 10 per cent of the total body surface area, were studied from the first postburn day (D1) until D7. All intakes and losses were analysed for Cu, Zn and nitrogen (N) content. Cutaneous losses were extracted from textiles surrounding the patients. Urinary excretions were 0.12 +/- 0.06mg/24h for Cu, 0.9 +/- 0.6mg/24h for Zn, and 14.1 +/- 4.4g/24h for N. Mean daily exudative losses through wound seepage from D1 to D7 were 4.7 +/- 2.1mg/24h for Cu, 27.1 +/- 14.4mg/24h for Zn, and 8.7 +/- 3.8g/24h for N. The cumulated mean losses over 7 days were 37mg for Cu, and 212mg for Zn, representing respectively 20-40 per cent and 5-10 per cent of normal body content. Serum Cu and Zn levels were strongly depressed. The urinary Cu/N ratios correlated with clinical improvement. We conclude that the exudative Cu and Zn losses during the first week postburn contribute significantly to the increased nutrient requirements in burns.

Copper, selenium, and zinc status and balances after major trauma

To investigate the trace elements (TE) losses and status after trauma, 11 severely injured patients (Injury Severity Score: 29 +/- 6), admitted to the ICU were studied from the day of injury (D0) until D25. Balance studies were started within 24 hours after injury, until D7. Serum and urine samples were collected from D1 to D7, then on D10, 15, 20, and 25. Intravenous TE supplementation was initiated upon admission. SERUM: Selenium (Se) and zinc (Zn) levels were decreased until D7 and were normal thereafter. LOSSES: TE urinary excretions were higher than reference ranges until D20 in all patients. Fluid losses through drains contained large amounts of TE. BALANCES: Balances were slightly positive for copper (Cu) and Zn, and negative for Se from D5 to D7 despite supplements. Cu status exhibited minor changes compared to those observed with the Zn and Se status: Serum levels were decreased and losses increased. Considering the importance of Se and Zn in free radical scavenging, anabolism, and immunity, current recommendations for TE supplements in severely traumatized patients ought to be revised.

Effect of dietary phytic acid on zinc absorption in the healthy elderly, as assessed by serum concentration curve tests

Zn absorption was investigated in healthy elderly subjects aged 71-78 years and in young subjects aged 23-43 years using serum concentration curve (SCC) tests. Both groups had similar Zn and protein status. The increase in serum Zn was monitored for 180 min after ingestion of 200 ml of soya milk enriched with 50 mg of Zn. Three levels of phytic acid were used: 0 g/200 ml (totally dephytinized soya milk), 0.13 g/200 ml (half dephytinized), and 0.26 g/200 ml (natural phytic acid content). In a first study the effect of 0 v. 0.26 g/200 ml phytic acid was compared in 10 elderly and 10 young subjects, each subject receiving both treatments. In a second study soya milks with 0 and 0.13 g/200 ml were tested in nine elderly and ten young subjects, again receiving both treatments. Mean areas under the curve of the SCC tests conducted with the 0 g/200 ml soya milk were found to be the same in both studies. Phytic acid strongly depressed Zn absorption in both studies (P < or = 0.05), but to a greater extent at the 0.26 g/200 ml level. No difference was found between the groups of young and elderly subjects. Therefore, no significant effect of aging on Zn absorption, as evaluated by the SCC test, or on the inhibitory effect of phytic acid was detected.

Zinc Supplementation and Child Growth in Ecuador

The National Nutrition and Health Survey, implemented in 1986 in Ecuador, investigated nutritional status, food intake, morbidity and mortality of 0–5 year-old children in the country (Freire et al., 1988). High prevalences of malnutrition, as assessed by anthropometry, were found: prevalences of linear growth retardation ranged between 37% in the costal urban areas and 67% in the rural Andes. Single nutrient deficiencies were also widespread: anemia was a particularly serious problem with 69% of the children between 6 and 11 months of age being anemic; vitamin A status was marginal and riboflavin status was poor.

Micronutrient intake and status in rural Democratic Republic of Congo

Vitamin, mineral and trace element intakes were assessed in a rural African population using a novel dietary survey method, and compared with status measurements. In addition to the previously described protein deficiency, multiple micronutrient deficiencies were observed. Although vitamin A intakes were generally satisfactory, some low plasma retinol concentrations were observed in adults, due perhaps to the very low protein intakes or infectious diseases. Vitamin B1, B2 and niacin intakes were clearly inadequate, and for the two former were confirmed by status measurements. Whilst B6 intake was low, B6 status was adequate, probably resulting from lower requirements because of low protein intakes. B12 intake was low in some age groups, whereas that of folate was satisfactory. Fe, Cu and Mg intakes appeared to be adequate. Intakes of phosphorus and iodine were low for children and adolescents; those of Zn and Ca were clearly inadequate, except for Zn in women. Dietary interventions to prevent or treat malnutrition in this region should address several micronutrients in addition to protein.

A packaged rice-based oral rehydration solution for acute diarrhea.

Summary: In a 12-month community study in Ecuadorian preschool children, we compared a packaged rice-based oral rehydration solution (R-ORS) that contained 160 g of rice flour and 12 g of sucrose per liter as well as electrolytes and α-amylase, and required cooking before consumption, to the standard glucose-electrolyte oral rehydration solution (G-ORS) for the treatment of acute non-cholera diarrhea. The reconstituted R-ORS had energy and protein contents of 620 kcal/L and 12g/L, respectively, and an osmolarity of 230 mosm/L. In all, 156 cases were treated with the R-ORS and 144 with the standard G-ORS. Cases treated with R-ORS had a significantly shorter duration of diarrhea (p < 0.0001; median; 34 h versus 48 h), a lower number of stools (p < 0.001; median; four versus seven), and a greater weight gain after 4 days of treatment (p < 0.05; mean; 1.6% versus-0.2%) than those treated with G-ORS. ORS and total liquid intakes tended to be higher with the R-ORS. The two ORS were equivalent for the correction of mild dehydration and the maintenance of normal hydration status.

Infectious gastroenteritis does not act as a triggering mechanism for the synthesis of serum IgG antibody to β-lactoglobulin

β-Lactoglobulin (BLG)-specific serum IgG antibody was measured by enzyme-linked immunosorbent assay in 1,392 serum samples from newborn to 5-year-old Ecuadorian children enrolled into a representative nutrition and health survey. At a 1:100 serum dilution, 62% of the children showed specific antibody (blank-corrected optical density ≥ 0.1). This prevalence did not change with increasing age. More specifically, we did not observe a prevalence or titer increase of BLG-specific antibody in age groups where the majority of these Ecuadorian children experienced infection with rotavirus (8–24-month age groups) and enterotoxigenic Escherichiacoli (8–12-month age group). In addition, BLG-specific antibody did not differ between children who did or did not experience an episode of diarrhea 15 days before blood sampling. We observed a small but statistically significant difference in BLG-specific antibody between subsamples of Ecuadorian children regularly or only occasionally ingesting milk. Titers were higher in the group consuming more milk.

Dietary intake measurement in rural zaire: Macro-nutrients

Abstract A modified dietary survey method by weighing was employed to evaluate nutrient intakes in a poor rural community of Western Zaire. Energy intakes of children (4–11 years), equivalent to 1.1 times basal metabolic rate (BMR) were inadequate for normal growth and activity. Intakes of adolescents (11–18y) were marginal (1.5 BMR). Adult women and men had energy intakes corresponding to 2.0 and 1.5 BMR respectively. These amounts were compatible with the intensive physical activity of women and lighter activity of men on one hand, and with their small body size on the other. Mean daily protein intakes, after correction for digestibility and amino acid score according to FAO/WHO/UNU (1985) recommendations, were 0.63, 0.60 and 0.47 g/kg for children, adolescents and adults, respectively and corresponded to only 50 to 70% of recommended levels, and were thus in accordance with the commonly observed clinical and biochemical signs of protein depletion. Protein and fat accounted for only 4.5% and 9%, respectively, of energy intake. This situation is the result of the high consumption of cassava combined with the poor availability of foods rich in protein and fat. Dietary protein inadequacy, unlikely when energy requirements are met in populations with cereal food staples, can be a major problem in root tuber consuming populations.