Nutritional significance of alterations in serum amino acid patterns in goitrous patients.

Twenty-nine amino acids were analyzed in the sera of 105 adult Senegambian goitrous patients classified as stages I, II, and III according to World Health Organization recommendations. Mean serum concentration of all essential amino acids revealed highly significant drops (p less than 0.001) as goiter stage increased, except for methionine (Met). Most nonessential amino acids (NEAA) and intermediary metabolites were similarly characterized by a general decrease to the subnormal range, although some resisted depression in stages II and III. Homocystine (Hcy) demonstrated a unique pattern in that it was the only NEAA distinguished by regularly rising serum levels. These data are consistent with the view that endemic goiter is associated with overall stepwise downregulation in protein metabolism. In addition to iodine restriction, generalized malnutrition may aggravate the goitrogenic processes. Serum levels of Met and Hcy strongly suggest that the first step of the transsulfuration pathway is impaired in protein-depleted states due to cystathionine beta-synthase (EC 4.2.1.22) deficiency.

Zinc status of healthy elderly adults: response to supplementation.

The zinc status of 53 healthy elderly subjects was evaluated. The dietary Zn intake estimated by 24-h recall was 9.2 mg/d and 65% of subjects had intakes less than two-thirds of the RDA. Mean serum Zn concentration (13.0 mumol/L) and urinary Zn excretion (7.0 mumol/d) were normal. The Zn content of platelets, mononuclear cells, and polymorphonuclear cells was 5.8, 147, and 135 nmol/10(9) cells, respectively. Seventeen subjects were supplemented for 28 d with 30 mg Zn/d. The mean concentration of Zn in serum and urine increased 24% and 2.5-fold, respectively. Zn content of platelets and leukocytes did not change with Zn supplementation. The concentration of visceral proteins (ie, albumin, prealbumin, transferrin, and retinol-binding protein) and immunoglobulins (ie, IgG, IgA, and IgM) did not change with Zn supplementation. The data indicate that aging per se does not necessarily imply poor Zn status.

Zinc absorption in healthy elderly humans and the effect of diet.

Absorption of a zinc stable isotope was measured on two consecutive occasions in nine young and eight elderly healthy men aged 24-40 and 70-83 y, respectively. A zinc stable-isotope label (0.8 mg 70Zn) was added to a test meal of either high or low zinc bioavailability, depending mainly on phytic acid content. Zinc absorption from the high-bioavailability test meal was not significantly different (P > 0.05) in the young (38.9 +/- 9.8%, mean +/- SD) and elderly (35.0 +/- 10.9%) subjects. Zinc absorption from the low-bioavailability test meal was 40% and 43% lower, at 23.4 +/- 10.2% and 19.8 +/- 6.1% in these young and elderly men, respectively. Again, no significant effect of age was found. These results show that aging does not lead to nutritionally relevant changes in zinc absorption and in the effect of dietary inhibitors on zinc absorption. Thus, zinc absorption ability seems to be preserved in healthy elderly people, at least until the age of 80 y.

Selenium losses in 10 burned patients.

To determine the selenium (Se) losses and balances, 10 patients with burns of 32 +/- 9% (mean +/- SD) of total body surface and aged 36 +/- 9 years were studied from D1 (first post-injury) unitl D7. Cutaneous losses were extracted from the textiles surrounding the patients. Serum and urine were collected until D20. Exudative losses of nitrogen decreased progressively (mean 8.7 +/- 3.8 g/24H). Se was detectable in wound seepage only during excision-grafting: mean operative loss was 342 +/- 191 mug. Mean urinary Se excretion was 41 +/- 13 mug/24H. Operative cutaneous losses led to some negative balances. Serum Se and glutathione peroxydase (GSHPx) were depressed until D20. Serum Se was related to N intake (p < 0.001). The decreased Se and GSHPx levels reflect a deficiency state, which measured losses did not explain, but limitations of the measurement methods prevented detection of Se cutaneous losses 100 mug/24H.

Longitudinal changes in iron and protein status of elderly Europeans. SENECA Investigators.

OBJECTIVE: Describe the iron and protein status of European elderly people studied in 1993, together with changes observed in the previous four years. DESIGN: Two optional designs: (1) A transversal study from a randomly selected group of female and male elderly subjects born between 1913 and 1914. (2) A longitudinal study including base-line measurements in 1988/1989 in subjects born in 1913-1918, which were repeated and extended in 1993. SETTING: Nineteen towns in 12 European countries participated in the baseline study in 1988/ 1989. Eleven centres in nine countries completed the follow-up study in 1993, and two new towns joined in 1993. The study included blood sampling for analysis of markers of nutritional status. RESULTS: The mean haemoglobin (Hb) values during the follow-up study for the different town populations ranged from 142 to 159 g/l for men and from 129 to 146 g/l for women. Prevalences of anaemia, based on WHO criteria (Hb < 130 g/l for men, and Hb < 120 g/l for women), amounted to 6.0% and 5.0% for men and women, respectively, and were very close to the baseline prevalences of 5.6% and 5.5%. A small decrease in Hb was observed after 4y in men. The mean haematocrit (Hct) values for the different towns ranged from 42% to 48% in men and from 39% to 44% in women. For both sexes, a decrease in Hct was observed. White blood cell (WBC) counts and differentials were measured in the follow-up study only. Mean WBC counts ranged from 5.8 x 10(3)/microliter to 7.1 x 10(3)/microliter in men and from 5.6 x 10(3)/microliter to 6.7 x 10(3)/microliter in women. Mean lymphocyte counts ranged from 1.6 x 10(3)/microliter to 2.4 x 10(3)/microliter in men and from 1.7 x 10(3)/microliter to 2.3 x 10(3)/microliter in women and mean neutrophile counts ranged from 3.4 x 10(3)/microliter to 4.4 x 10(3)/microliter and from 3.1 x 10(3)/microliter to 4.0 x 10(3)/microliter, respectively. The mean serum albumin values for the different towns varied from 39.9 g/l to 43.2 g/l for men, and from 39.3 g/l to 42.4 g/l for women, quite similar to the baseline study. In 25 subjects (2.2%) only serum albumin level was below 35 g/l and five subjects (0.4%) had a serum albumin level below 30 g/l. No albumin changes were detected for either sex over the four year period. The group of survivors in the follow-up study had higher mean albumin concentrations at baseline than the group of subjects who had died between the baseline and the follow-up study. CONCLUSION: In this population of elderly subjects in their seventies, Hb, Hct and albumin showed little change over the 4 year follow-up period. The prevalence of anaemia and low serum albumin values was relatively low, which is indicative of a relatively good health.

Altitude correction for hemoglobin.

OBJECTIVE: To propose a correction for the hemoglobin (Hb) increase induced by altitude-associated hypoxia. DESIGN: Part of a national study of nutrition and health of preschool children (0-59 months), based on a stratified, probabilistic, cluster sample. SETTING: Coastal and Andean regions of Ecuador, comprising about 97% of the population, living at altitudes ranging from sea level to 3400 m. SUBJECTS: Subsample of 469 girls and boys, 6-59 months old, with normal iron (Fe) status parameters, i.e serum ferritin > or = 10 micrograms/l, transferrin saturation > or = 12%, zinc protoporphyrin < or = 2.8 micrograms/g Hb. RESULTS: Exponential regression curves are adapted through the Hb values of the children, grouped by altitude ranges, and through the data reported by Hurtado in 1945 for male adults. From these exponential curves, correction factors for Hb are derived for altitudes ranging from sea level to 3400 m. CONCLUSION: The striking parallelism between the hypoxia-induced hemoglobin increase with altitude in young children (girls and boys) and that in male adults strongly suggests that the proposed correction factors for Hb are applicable for all ages and possibly both genders, at least in the Andes.

Nutritional status: haematology and albumin. Euronut SENECA investigators.

In the context of the Euronut SENECA study of nutrition and the elderly, performed in 19 towns situated in 12 European countries, blood haemoglobin and haematocrit, and serum albumin were measured in a large sample of 70-75-year-old subjects. The mean haemoglobin (Hb) values for the different towns ranged from 144 g l-1 to 157 g l-1 for men and from 131 g l-1 to 150 g l-1 for women. The town haematocrit (Hct) means ranged from 43.0% to 48.9% for men and from 39.7% to 46.4% for women. No clear geographical pattern emerged for either Hb or Hct. The 95% ranges (2.5-97.5 percentile intervals) for Hb and Hct for all towns combined (without any claim of being representative of Europe) were very similar to those reported in the NHANES II study of the USA. Prevalences of anaemia, using the WHO definition (Hb less than 130 g l-1 for men and Hb less than 120 g l-1 for women) were 5.2% for men and 5.7% for women. The town mean serum albumins ranged from 40.3 g l-1 to 44.3 g l-1 for men and from 40.3 g l-1 to 43.2 g l-1 for women. No clear geographical pattern emerged. Mean values were somewhat lower than for younger adults and comparable to other published data. Most albumin values were in the normal range, with only 2.0% of both men and women having levels below 35 g l-1 and only 0.4% of men and no women having levels below 30 g l-1. These results show that these 70-75-year-old subjects who chose to participate in the study were in relatively good health as judged from their haemoglobin, haematocrit and serum albumin levels.

Summary and conclusions of the report on the second data collection period and longitudinal analyses of the SENECA Study.

In 1988 SENECA (Survey in Europe on Nutrition and the Elderly, a Concerted Action) was initiated to study cross cultural differences in nutritional issues and life style factors affecting health and performance of elderly Europeans. Nine of the original 19 participating towns in 12 European countries decided to conduct a longitudinal study. This supplement presents the findings of the second data collection period and the first longitudinal analyses of these nine towns. In addition, cross-sectional results are discussed for two towns from which few baseline data were collected, and for two towns which were only involved in the 1993 survey: one from the United Kingdom and one from the United States. Ethical permission for the studies was obtained from local ethical committees.

Influence of large intakes of trace elements on recovery after major burns.

Because Cu, Se, and Zn are involved in immune and antioxidative defense mechanisms and tissue repair, deficiencies might aggravate complications classically observed with burns. After measuring massive cutaneous trace element losses in 10 burn patients, our aim in this study was to determine whether large intravenous intakes of Cu, Zn, and Se can modify serum trace element levels and recovery after major burns. Ten patients, aged 34 +/- 6 yr (mean +/- SD), admitted to the burns center of a Swiss university hospital with thermal burns on 41 +/- 9% of their body surface were studied prospectively, with trace element balance studies from day 1 (D1) to D7 postinjury. Urine and blood samples were also collected on D10, D15, D20, and D25. The patients were divided into two groups of five and received either standard (group 1, control) or greatly increased (group 2, treatment: 4.5 mg Cu, 190 micrograms Se, and 40 mg Zn/day) trace element intakes. Energy and protein intake and wound treatment were similar in both groups. The treatment group was characterized by improved Cu, Se, and Zn status (increase in serum levels and various protein indicators), a much larger leukocyte increase between D4 and D14 (mainly neutrophils), and shorter hospital stay (45 days) compared with the untreated group (57 days). Grafting requirements were more extensive in group 1. Although severity of injury and wound treatment were similar in the groups, the duration of hospitalization was lower in the treated group. Further studies are required to determine whether this is related to trace element supplementation.

Five year changes in mental health and associations with vitamin B12/folate status of elderly Europeans.

OBJECTIVE: To describe 5-year changes of mental health in SENECA participants, and to examine whether mental health is associated with the status of vitamin B12 and folate. DESIGN: A longitudinal, multicentre study including a Baseline study, a Follow-up study, and a Finale study. SUBJECTS: Inhabitants of 11 European towns, born between 1913 and 1918, were randomly selected at baseline to participate in the SENECA study. Of the 1099 enrolled subjects in the Follow-up study, 586 participated in the Finale study. INTERVENTION: Mental health status was assessed by the Mini-Mental State Examination (MMSE, cognitive impairment defined as MMSE<23) and the 15-item Geriatric Depression Scale (GDS, depression defined as GDS>5). RESULTS: In the Finale study, mean overall MMSE score was 26.1 for men and 25.6 for women, while mean overall GDS score was 3.1 for men and 4.1 for women. Among subjects that participated in both the Follow-up and the Finale study, MMSE scores decreased with 0.9 points (P<0.0001) and 1.0 points (P<0.0001) among men and women respectively. The GDS scores decreased with 0.7 points (P<0.0001) for men and 0.8 points (P<0.0001) for women. Among subjects that participated in the Finale study, no significant correlations have been observed between mental health and vitamin B12/folate status. CONCLUSION: In the Finale study, mental health of the majority of the SENECA participants remained intact. In contrast to the Follow-up study, no associations between mental health and vitamin B12/folate status were emerged.

Nutritional status of institutionalised elderly in Ecuador.

The nutritional status of 111 elderly men and women aged 60 to 99 years in two institutions in the Ecuadorian Andes was evaluated using dietary, anthropometric and biochemical measurements. Mean daily energy intakes of men and women were 1720 and 1650 kcal, respectively (7.2 and 6.9 MJ), corresponding to 1.5 times the calculated basal metabolic rate (BMR). 6% of subjects had intakes less than 1.2 x BMR and 40% less than 1.5 x BMR. Body mass index (BMI) was below 20 kg/m2 in 21% of subjects; 45% were between 20 and 24. Only one subject had a BMI over 29. Intakes of protein, calcium, iron, riboflavin and vitamin C were satisfactory, in contrast to those of zinc, vitamin A, niacin and thiamin. Using sex- and altitude-specific cutoffs for hemoglobin, anemia was observed in 11% of subjects. Nutritional status, evaluated using biochemical indicators, was satisfactory with respect to riboflavin, vitamin A, vitamin E and copper. 14% of subjects had low serum zinc levels and 17% had serum albumin values below 35 g/L. Low physical activity was associated with low energy intake and low serum albumin levels.

Effect of malnutrition in Ecuadorian children on titers of serum antibodies to various microbial antigens.

The titers of serum antibodies to natural infection with enteric and respiratory pathogens, to a food antigen and to tetanus and diphtheria toxoid were evaluated by enzyme-linked immunosorbent assay in 1,554 Ecuadorian children younger than 5 years of age. The nutritional status of the children was assessed by anthropometry and measurement of biochemical status indicators. The children were enrolled in a representative national nutrition and health survey. Antibody titers were analyzed as a function of the nutritional status of the children. For 12 of 14 antibody concentrations tested, underweight children showed lower antibody titers than did control children. The difference was statistically significant for antibody to both T-cell-dependent antigens (tetanus toxoid, rotavirus, respiratory syncytial virus) and T-cell-independent antigens (lipopolysaccharide, polyribosyl-ribitol phosphate, capsular polysaccharide). When children with a recent episode of diarrhea were excluded, many of the differences remained significant. When these children were further classified by age, only difference in titers of antibodies to respiratory syncytial virus and tetanus toxoid remained significant. No statistically significant difference was detected between underweight and control children with respect to protective antibody levels to four bacterial antigens. Anemic children showed significantly lower antibody levels to both T-cell-dependent and T-cell-independent antigens than did control children, and a higher proportion of anemic children had diphtheria antitoxin below a conservatively defined protective antibody level. No major differences in antibody titers were seen between children with different retinol and zinc concentrations in serum.

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.

Sex-related patterns in the profiles of human urinary amino acids.

The urinary amino acid profiles of 79 young women and 72 young men were studied with an automated highpressure amino acid analyzer. A nonparametric statistical analysis was applied for detecting profile differences related to sex and other variables. A strong sex-related pattern was confirmed and its power for sex determination was evaluated. For the women, profile differences related to the use of oral contraceptives were also discovered and evaluated. No correlation with the menstrual cycle was detected.

[Swiss Survey in Europe on Nutrition and the Elderly: nutritional status of a Yverdon population aged 74 to 79 years old over a period of four years]. / SENECA Suisse: état nutritionnel d'une population yverdonnoise âgée de 74 à 79 ans, et son évolution sur une période de quatre ans.

In Switzerland the longitudinal SENECA study (Survey in Europe on Nutrition and the Elderly, a Concerted Action of the 3rd European Framework Programme) was implemented in the city of Yverdon-les-Bains. The study investigated the nutritional and health status of 70 to 75-year old elderly living at home, in relation with their food habits, life style, social network and physical activity with a follow-up study 4 years later. Results of the follow-up study, with the subjects aged 74 to 79 years, and changes observed over the 4 years are presented here. The participants reported a rather good self-assessed health and were quite independent in their daily activities. Food and nutrient intakes decreased over the 4-year follow-up, as did physical activity, independence in daily activities and height. However, biological markers (haemoglobin, haematocrit, albumin, lipids and vitamins) of nutritional status showed little change and remained mostly in the normal range. Low energy intake was measured in 21% of the men (< 1500 kcal/d) and in 24% of the women (< 1200 kcal). This is a source of concern since such low energy intakes make it difficult to cover micronutrient requirements. It is therefore important to find ways to maintain or increase the quality of the diet and adequate nutrient intakes.

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

beta-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 greater than or equal to 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 Escherichia coli (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.

Prevalence and serotype specificity of rotavirus antibodies in different age groups of Ecuadorian infants.

The age-specific prevalence of antibody to rotavirus was studied in 1404 Ecuadorian children enrolled in a national nutrition and health survey. ELISA and neutralizing antibody analysis showed evidence for primary rotavirus infection in 6- to 12-month-old children, who showed also a more-than-threefold increase in significant diarrheal episodes in comparison with infants less than 6 months old. At this age, 56% of the sera with neutralizing antibody were monospecific. With increasing age a gradual decrease in prevalence of monospecific sera, to 10% in 5-year-old children, was observed. Monospecific sera were directed in decreasing frequency against serotypes 4 (56%), 3 (20%), 2 (14%), and 1 (10%). Serotype 4-specific antibody was acquired at an earlier age than were antibodies to the other serotypes, and 91% of sera with dual specificity neutralized serotype 4, whereas only 2% of sera that neutralized three serotypes failed to neutralize serotype 4.