Biochemical Parameters and the Nutritional Status of Children

Novel Tools for Assessment

Anil Gupta

• Publisher: CRC Press
• Year: 2020
• ISBN:
  9781000073812
• Edition: 1
• Topic: Medicina
• Subtopic: Nutrizione, dietetica e bariatria

Biochemical parameters represent better, precise, and objective tools toward the assessment of the nutritional status of children in comparison to anthropometric, clinical, and dietary methods. They constitute laboratory tests to estimate the concentration of circulating nutrients in body fluids. Biochemical parameters are suggestive of acute or subclinical conditions when other methods of nutritional assessment fail to interpret the condition. These parameters exhibit substantial variability in their reproducibility. Moreover, these parameters are novel tools in the hands of clinicians for screening of the nutritional status of children.

Key Features

• Covers the latest biochemical parameters for nutritional assessment

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• Updated content is useful for clinicians, nutritionists, and general practitioners

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• A unique and concise treatise covering descriptive and research-based work on a crucial health issue of worldwide prevalence

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About the Author

Anil Gupta, PhD, is the Dean of Research at Desh Bhagat University and Professor and Head, Department of Physiology and Biochemistry at Desh Bhagat Dental College and Hospital, Mandi Gobindgarh, Punjab, India.

Chapter 1

Concept of Nutrition

The Meaning of Nutrition

Nutrition is the sum of physiological activities comprising intake of food, its digestion, absorption, assimilation, and egestion of undigested foodstuff from the alimentary canal. Nutrition is the science dealing with the intake of food and its effect on the growth and development of the human body (Cambridge Dictionary 2019). The word nutrition is taken from the Latin “nutritio” that signifies, “nurture” or “feeding.”

The science of nutrition deals with the interaction of nutrients with the body tissues and studies how the nutrients affect the living tissues of the body and what the body does to the nutrients (U.S. National Library of Medicine 2019; Whitney and Rolfes 2013).

According to the World Health Organization (WHO 2019), the living body needs energy to perform mental and physical activities. The energy need of the body is fulfilled through the intake of nutrients. A balanced diet is necessary for maintenance of health, whereas inadequate nutrition results in malnutrition, repeated infections, and delayed growth and development (WHO 2019).

According to the U.S. National Library of Medicine (USNLM 1998), the science of nutrition deals with every phase of interaction between food and body tissues. The USNLM (1998) explains the term clinical nutrition and defines it as the branch of the science of nutrition that studies the prevention, diagnosis, and treatment of various nutritional and metabolic diseases either in acute or chronic forms due to either deficiency or excess of calories and nutrients.

History of Human Nutrition

Ancient Concept of Nutrition

The first dietary suggestion that was recorded in human civilization probably dates from around 2500 bce; in the form of a carving in Babylonian stone, and recommended abstaining from onions for three days so as to heal internal pain. This age-old advice was reported by Payne-Palacio and Canter (2014), who also discuss the 1500 bce description of scurvy found in the Ebers Papyrus.

Ayurveda—a traditional medicinal system that originated around 3,000 to 4,000 years ago in the Indian subcontinent—provides exhaustive narrations about food, health, and diseases. Ahara (nutrition) in Ayurveda is the cornerstone of body health and disease. Ahara is mentioned as one of the three prime concepts of life, the other two being sleep and controlled sexual life. In around 600 bce in the Sanskrit text Taittiriya Upanishad, Ahara (nutrition) had been described as Brahma (the creator of universe) owing to its prime essentiality in sustaining life. The energy for growth and development for living organisms is derived from food/Ahara (Nathani 2014).

Another Sanskrit text from around 600 bce, the Sushruta Samhita, mentioned elaborately the value of Ahara and dependency of human life on the correct Ahara (food) and Vihara (lifestyle) (Shastri 2003).

According to Gratzer (2005), a British biophysical chemist, the science of nutrition emerged around 600 bce. It was around this time that foods were classified in India, China, Persia, and Malaysia. Foods such as meat, ginger, blood, and spices were kept in the category of hot foods, while food items like green vegetables were mentioned as cold food by the author (Gratzer 2005).

According to Gratzer (2005), Ho, a physician in China around 600 bce, mentioned that deficiency of elements like water, wood, fire, metal, and earth in the body of individuals was responsible for the onset of diseases.

Furthermore, Gratzer (2005) reports the written account of a Greek, Alcmaeon of Croton, around 600 bce, in Italy. Alcmaeon mentions the importance of equilibrium between the intake of food and excretion of undigested matter from the body, which was important in deciding the health of a person and onset of a disease like obesity or wasting.

According to authors Gratzer (2005) and Smith (2004), in around 400 bce Hippocrates mentioned that food should be selected judiciously so that it may become medicine for the person, and that medicine ought to become food so as to normalize the pathological state of the person. Hippocrates advocated the prudent use of food and performing sufficient physical exercise to help prevent the onset of disease and obesity.

Medieval Concept of Nutrition

Galen was a famous physician of the gladiators in the Roman Empire, and also treated Marcus Aurelius, the emperor in Rome in around 130–200 ce (Gratzer 2005). Regarding nutrition, Galen mentioned the concept of “humors of body” of Hippocrates—black bile, yellow bile, phlegm, and blood, pertaining to four temperaments of individuals. These “humors” described the constitution of the human body and provided the basis for the medicinal system in Ancient Rome and Greece.

Galen described the concept of pneuma, a Greek word meaning soul or breath, which was considered the essence of life that pervaded in the body organs (Gratzer 2005).

Around 1500, Paracelsus and Leonardo da Vinci severely criticized the work of Galen (Gratzer 2005). British Navy physician James Lind was the first person who performed scientific work on nutrition. It was found that sailors who were at sea for prolonged periods suffered from a fatal disorder involving swollen gums, known as scurvy. It was James Lind who discovered that lime juice could cure patients from scurvy (Willet and Skerrett 2005).

According to Gratzer (2005), it was Antoine Lavoisier in around 1770 who described metabolism. He discovered that oxidation of foodstuff could generate energy. Antoine Lavoisier, along with his assistant Armand Seguin, estimated the respiratory output of carbonic acid in humans at rest and while lifting weights (Kenneth 2003; Seguin and Lavoisier 1789).

In 1816, French physiologist and surgeon François Magendie conducted his famous experiments on dogs. He used a nutritious food (sugar) to feed dogs. Initially, the first dog ate well for a period of two weeks and was healthy. Thereafter, a corneal ulcer developed in the dog and it lost weight (Magendie 1816; Kenneth 2003). It died after a month. The feeding experiment was repeated with a second dog, by providing a diet rich in olive oil, butter, or gum. The corneal ulcer was not observed in the dog that was fed olive oil, otherwise the dogs fell ill and died (Magendie 1816; Kenneth 2003).

Magendie demonstrated that a protein-deficient diet containing carbohydrates, lipids, and water could not save the dogs from starvation, while a diet enriched with proteins could prevent starvation and provide all the nutritional needs of the dog. The experiment proved the health benefits of proteins in the food for living organisms (Magendie 1816; Kenneth 2003).

According to Ahrens (1977), in 1827, it was English chemist William Prout who was the first person to propose the elements as carbohydrates, fat, and protein that are constituents of food.

In 1860, the French physiologist Claude Bernard demonstrated the glycogenic role of the liver that proved vital for the discovery of diabetes mellitus (Young 1957).

In the 1880s, Takaki Kanehiro (who served in the Imperial Japanese Navy as a physician) reported that some Japanese sailors developed beriberi disease. It was observed by Takaki that the sailors consumed white rice only as food and he concluded the disease to be associated with the intake of white rice. He confirmed that beriberi was unheard of among British sailors and naval officers in Japan due to their diet containing meat and vegetables (Bay 2012; Low 2005). However, physicians from Tokyo Imperial University declared beriberi as an infectious disease (Bay 2012; Low 2005).

The Modern Concept of Nutrition

In the early years of the twentieth century, Carl von Voit was a German physiologist and pioneer in modern dietetics. He performed substantive work in estimation of the constituents of excreted urea under varying food intake conditions. He concluded that the quantity of nitrogenous substances in excreted urea was independent of the intake of nitrogenous dietary components, although it depends on the nutritional status of the person (Kafatos and Hatzis 2008). It is attributed to the varying needs of nitrogen to body tissues under different conditions as pregnancy, lactation, and diseases (Kafatos and Hatzis 2008).

Tryptophan is an essential amino acid. Its necessity for the normal growth and development of organisms was demonstrated by Willcock and Hopkins in 1906 (Peters 1991). Later in 1914, Osborne and Mendel described the essentiality of tryptophan for growth in mice and rats. Moreover, in 1957, Rose announced that tryptophan is the essential amino acid that is to be supplemented with diet for sustaining normal growth of individuals (Peters 1991).

In 1912, the English biochemist Sir Frederick Gowland Hopkins performed a series of feeding experiments on rats. He fed rats a diet containing an adequate quantity of essential nutrients such as proteins, fats, carbohydrates, and minerals, but the diet could not support the growth of rats. He concluded that some trace elements were missing from the diet that were vital for the growth and weight gain of animals and he named them as “essential food factors,” which were the vitamins (Hopkins 1912).

Phase of Vitamins

In 1912, Casimir Funk proposed that a complex chemical substance in unpolished rice could protect chickens from beriberi disease and he named it anti-beriberi factor and coined the term “vitamine” describing the complex as important and vital “amine” for the normal growth and development of the body. It was assumed by Funk that these vital substances were necessary for growth and for prevention of diseases. Later in 1926, the complex chemical substance that was isolated from unpolished rice was found to be thiamine (vitamin B1) (Eijkman 1929).

In 1913, Elmer McCollum discovered vitamin A and vitamin B. In 1919, Sir Edward Mellanby correlated the deficiency of vitamin A with rickets. He worked on cod liver oil and successfully treated rickets in dogs. Later in 1922, McCollum destroyed the vitamin A in the cod liver oil and fed the sick dogs this modified cod liver oil, and it still cured the dogs from rickets. McCollum concluded the presence of a substance in cod liver oil that could cure rickets that was different from vitamin A, and which was named vitamin D (Wolf 2004; Elena 2006; McClean and Budy 1964).

In 1925, Edwin B. Hart demonstrated that minute quantity of copper could stimulate iron absorption from the gastrointestinal tract (GIT). In 1928, Adolf Windaus was awarded the Nobel Prize in chemistry for his work on chemical structure of sterols and their link with vitamins (Windaus 1928). The sterols were vitamin D.

Albert Szent-Györgyi isolated ascorbic acid in 1928. Later in 1932, he commented on the role of ascorbic acid in the prophylaxis of scurvy. In 1937, he was awarded the Nobel Prize for synthesizing ascorbic acid.

In 1930, American nutritionist and biochemist William Cumming Rose’s work at Illinois was concentrated upon the metabolism of amino acids. His work documented the role of essential amino acids in growth. He discovered the amino acid threonine and published his work in 1949 as “Amino Acid Requirements of Man.”

Erhard Fernholz, a German chemist who worked on bile acids and sterols, described the chemical structure of vitamin E in 1938 (Evans et al. 1936).

In 1940, nutritional principles were forwarded by British nutritionist Elsie Widdowson. She supervised the government-mandated program of supplementation of vitamins to food and also undertook the project of rationing in the UK during World War II. Under this project, she led the program of the addition of calcium to bread. In 1942, Elsie Widdo...