Relative effect of parental birth weight on infant birth weight at term

The relations between some hereditary and environmental factors and the variation in infant birth weight were estimated by multiple linear regression analyses on a sample of 276 Scandinavian single term pregnancies. Gestational age explained 10.9%, fetal factors (maternal and paternal birth weights and fetal sex) 7.9%, maternal factors (parity, pre-pregnancy weight and height) 5.5% and external factors (adjusted weight gain and smoking) 5.8% of the variation in infant birth weight. It is concluded that maternal and paternal birth weights are rather poor predictors of infant birth weight. Together they explain only 5.6% of the variation in infant birth weight at term.

Trace elements and transport proteins in serum of children with Down syndrome and of healthy siblings living in the same environment

Twenty-two children with Down syndrome (DS), 8 boys and 14 girls, in the age range 5 to 15 years were investigated and compared with a control group of 22 healthy children, 9 boys and 13 girls of the same age group, 9 of them being siblings of patients with DS. Concentrations of iron, copper and zinc in serum were determined by atomic absorption spectrophotometry and serum proteins were quantitated by the radial immunodiffusion technique. The subjects with DS had significantly lower mean serum iron (P less than 0.01) and zinc (P less than 0.001) than the healthy controls. Four DS children had serum iron values that fell below the normal range. In more than 60 per cent of the DS patients the zinc concentration fell below the normal range. The children with DS had significantly higher mean serum copper (P less than 0.05) but lower serum iron (P less than 0.05) and zinc (P less than 0.05) levels than their healthy siblings living in the same family at the time of examination. The DS patients as a group had higher levels of caeruloplasmin (P less than 0.01), haptoglobin (P less than 0.001), orosomucoid (P less than 0.001) and alpha 2-macroglobulin (P less than 0.001) than the healthy controls and compared with their siblings. Except for prealbumin and retinol-binding protein (RBP), no age-related variation in the serum concentrations of the studied proteins was found in the DS patients. Albumin, prealbumin, RBP and transferrin levels were similar in the two study groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Selenium supplementation in X-linked muscular dystrophy. Effects on erythrocyte and serum selenium and on erythrocyte glutathione peroxidase activity

The selenium concentrations in serum and erythrocytes and the erythrocyte glutathione peroxidase activity were determined in 15 boys with the Duchenne type and in 5 boys with the Becker type of X-linked muscular dystrophy before and during long-term selenium and alpha-tocopherol supplementation and compared with values in unsupplemented controls. The purpose of the treatment was to improve the muscular strength. Twelve of the 20 patients had pretreatment levels of selenium in serum that were within the 95% confidence limit of the unsupplemented control children. The values in 2 patients, both with the Duchenne type of muscular dystrophy, fell below this level. Selenium supplementation in a daily dose of 6 micrograms/kg/day for 6 months caused a substantial rise in both serum and erythrocyte selenium, suggesting suboptimal pretreatment body contents of selenium. The greatest increases in both serum and erythrocyte selenium were observed in subjects with initially low selenium levels. Only in 4 of the 20 patients did the selenium supplementation result in a significant rise in erythrocyte glutathione peroxidase activity. As no sure improvement was noted in muscular strength during this treatment period, the Se dose was increased to 20 micrograms/kg/day. This resulted in a further rise in both serum and erythrocyte selenium, but not in erythrocyte glutathione peroxidase activity.

Reduced serum proteins in diabetic children on a twice-daily insulin schedule

The concentrations of selected proteins of transport and nutrition were investigated in 27 diabetic children and 13 healthy controls by an immunodiffusion technique. The diabetic children had significantly lower mean pre-albumin (p less than 0.001), albumin (p less than 0.01) and orosomucoid levels (p less than 0.05) than the healthy controls. No correlation was observed between age or sex and the blood concentrations of the specific proteins analyzed in this series. Haptoglobin and hemopexin showed positive correlations with serum triglycerides (both p less than 0.01) and slight positive correlations with some of the variables of carbohydrate control. The reduced levels of prealbumin and albumin were not correlated to diabetic control as measured by HbA1, fasting plasma glucose or urinary glucose excretion. The non-physiological distribution site and the abnormal temporal pattern of insulin offered to diabetic children might be the reason for the protein abnormalities found in this study. This is seemingly the first time reduced serum levels of proteins have been reported in diabetic children.

Magnesium and zinc in diabetic pregnancy

The concentrations of zinc and magnesium in serum were investigated in 23 non-pregnant and 14 pregnant women with insulin-dependent diabetes (IDDM) and 20 with gestational diabetes, and in cord blood from newborns of the latter two groups. These groups were compared with healthy women, non-pregnant as well as parturient, and newborns of the latter. In the non-pregnant state the mean serum concentrations of zinc and magnesium were lower in IDDM patients than in healthy control women. Although a decrease in S-Zn and S-Mg was observed during pregnancy in both IDDM and control subjects, the difference between carefully insulin-treated IDDM patients and controls was no longer apparent at term of pregnancy as regards S-Zn, whereas S-Mg was lower at term both in IDDM patients and in insulin-treated women with gestational diabetes. Besides the probable importance of a nearly normalized glucose metabolism in IDDM patients during pregnancy, it is postulated that the altered pattern of plasma proteins in diabetes and pregnancy, and possibly also exogenous insulin may influence the serum concentrations of zinc and magnesium seen at the end of pregnancy.

Dietary intake, trace elements and serum protein status in young diabetics

Dietary intake of energy and nutrients and its relation to trace element and protein status, as observed in 27 diabetic children and 13 healthy controls are discussed. The diabetic children had consistently higher intakes than the healthy controls in nearly all respects, except for carbohydrate and ascorbic acid. In spite of this, the diabetic children had a significantly lower mean serum magnesium than the healthy controls. It is suggested that hypomagnesemia in diabetic children may be the result of increased urinary loss or diversion of magnesium from normal metabolic pathways in this disease. This review also revealed a significantly higher mean serum selenium level in the diabetic children than in the healthy controls. However, no significant correlation was observed between serum selenium concentrations and protein intake, suggesting that a factor other than protein intake underlay the elevated levels of serum selenium. The diabetic children as a group had significantly lower levels of selected serum proteins than the controls, in spite of a significantly higher intake of protein by the diabetic group. It is suggested that both reduced serum proteins and elevated levels of serum selenium in the diabetic children are an expression of altered metabolism in combination with the effects of current modes of insulin treatment in this disease.

Subclinical trace element deficiency in children with undue susceptibility to infections

Serum concentrations of iron, copper, zinc and magnesium and also serum transferrin and ceruloplasmin were investigated in 28 children aged 10 months to 10 years with undue susceptibility to infections. None of the children had any classical immune defect. Seven of them had had frequent upper respiratory tract infections, 16 had suffered from frequent infections of the middle ear and five from mainly lower respiratory tract infections. Thirteen healthy children aged 9 to 18 years residing in the same area served as controls. The children with undue susceptibility to infections had significantly lower mean serum iron (p less than 0.05) and zinc (p less than 0.001) levels than the healthy controls. The mean serum concentrations of copper and magnesium and of transferrin and ceruloplasmin did not differ between the patients and controls. Children with frequent middle ear infections seemed to account for most of the differences in the serum levels of iron and zinc. An inverse correlation was observed between duration of breast feeding and serum concentration of zinc, and between weight as well as height and serum magnesium. The reasons for these changes and the possible role of trace element deficiency as a factor predisposing to or perpetuating undue susceptibility to infections in children are discussed.

Selenium in plasma and erythrocytes in patients with Down's syndrome and healthy controls. Variation in relation to age, sex and glutathione peroxidase activity in erythrocytes

The mean plasma selenium concentration (P-Se) in 65 patients with Down's syndrome (DS) did not differ from that in 90 healthy controls. The concentration of selenium in the erythrocytes (E-Se) was higher in DS patients than in controls (p less than 0.001). P-Se and E-Se increased progressively with age through childhood in both DS children and controls. The former children, however, started out with higher levels of E-Se and reached adult concentrations earlier (at 7-17 years) than controls (greater than or equal to 18 years). Adult DS patients and controls did not differ in their mean P-Se or E-Se concentration. There was a significant correlation between P-Se and E-Se both in DS patients and in controls. In DS patients each of these two variables was significantly correlated to glutathione peroxidase (GSH-Px) activity in erythrocytes. A sex difference in the DS children, but not in the controls, was observed with regard to P-Se and E-Se levels, these being higher in DS girls during childhood (0-17 years). This was in accordance with an earlier finding of higher GSH-Px activity in DS girls than in DS boys.

Dietary intake in Swedish diabetic children

The energy and nutrient intakes by 14 children with type I diabetes and 13 healthy peers were investigated by the 24-h recall method and the results were compared with current recommendations for the general population and with the guidelines for the dietary management of diabetes mellitus. The diabetic children showed not only good compliance with the recommendations but also a better intake in practically all respects than their healthy counterparts. The total energy intake by the diabetic children was in good agreement with the recommendations, while that of the controls was slightly lower. The protein energy per cent in the diet of the diabetic children was 18%, compared with 14% in the controls. Forty percent of the energy in the diet of the diabetic children was derived from fats, 36% in the controls. With the exception of carbohydrates, ascorbic acid and iron, the diet of the diabetic children had a higher nutrient density than that of the control children and the reverse was true for carbohydrates only. However, because of the generally higher energy intake displayed by the diabetic children, even the intake of these nutrients was at least as good in the diabetic children as in the controls. Eighty-six percent of the diabetic children but only 46% of the control children stated that the day for which intake data were given was a representative day.

The human milk contents of iron, copper, zinc, calcium and magnesium in a population with a habitually high intake of iron

The contents of iron, copper, zinc, calcium and magnesium were determined in human milk samples from 18 Ethiopian and 23 Swedish women. The Ethiopian women belonged to two groups with different socio-economic situations, a non-privileged and a privileged group. Both groups had an excessively high dietary iron intake--20 to 30 times that of the Swedish women--from the iron-rich traditional diet. In spite of this, the mean concentrations of iron in the milk, as well as of zinc and magnesium, were similar in all three groups. The mean copper concentration, however, was significantly lower in the Ethiopian than in the Swedish milk samples, the lowest mean value occurring in the privileged group. In contrast, a significantly higher mean calcium concentration was found in milk samples from the Ethiopian women than from the Swedish, the highest mean concentration being noted in the non-privileged group. The levels of minerals in breast milk showed no correlation to the birth weight of the infants or the length of gestation. Our data suggest that an excessively high dietary iron intake does not increase the breast milk content of iron in mothers with a good iron status. The reasons for the differences in the content of copper between the Ethiopian and Swedish milk samples are unclear. The higher calcium content in milk from the Ethiopian mothers, despite a low dietary calcium intake may be a result of an increased endogenous cholecalciferol synthesis due to greater exposure to sunshine.

Vitamin A nutrition in the human foetus. A comparison of Sweden and Ethiopia

The accumulation of vitamin A during foetal development was investigated post mortem in foetuses and newborn infants of well-defined socio-economic groups of Swedish and Ethiopian women. The median vitamin A concentration in the liver was 37.0 micrograms/g in the Swedish foetuses (n = 39) and 9.1 micrograms/g in the Ethiopian ones (n = 49) (p less than 0.001). The liver vitamin A concentration in the Swedish foetuses increased exponentially during the second and third trimesters of pregnancy. This trend was not evident in the Ethiopian material. The mean serum concentration of retinol-binding protein was only slightly lower in the healthy Ethiopian newborns (18.6 mg/l; n = 70.) than in the Swedish newborns. This finding suggests that vitamin A is retained i the foetal circulation in preference to storage, much like the situation in a vitamin A deficiency state in the adult.

Elevated serum selenium in diabetic children

Twenty-seven diabetic children, 16 girls and 11 boys, 5-18 years of age, with a duration of the disease ranging from 2-15 years, comprised the study group. Thirteen children with a similar age and sex distribution, living in the same area served as healthy controls. All 40 children had a normal growth pattern. The mean serum selenium concentration in the diabetic children, determined by neutron activation analysis, was 7.4 +/- 0.8 micrograms/100 ml (mean +/- SD) and in the healthy controls 6.5 +/- 0.8 micrograms/100 ml. The difference between the two groups was statistically highly significant (p less than 0.01). Boys and girls in both groups had nearly identical mean serum selenium levels and no correlation was observed between the selenium concentrations and either the age, weight or height of the children or the indicators of diabetic control. The selenium status in diabetic children has not been reported previously. The possibility of elevated serum selenium in diabetic children in response to altered lipid metabolism is discussed.

Hypomagnesemia in diabetic children

Serum concentrations of iron, copper, zinc and magnesium were determined in 27 Swedish children with well controlled diabetes without longterm diabetic complications. Thirteen of the diabetic children had age- and sex-matched healthy controls. Significantly lower serum magnesium concentrations were found in the diabetic children than in the matched healthy controls (p less than 0.01). The levels of iron, copper and zinc did not differ in the diabetic children from those in the controls. A negative correlation between serum magnesium level and duration of diabetes was found (p less than 0.05). This is seemingly the first report of hypomagnesemia in diabetic children.

Studies on human milk III. Secretory IgA quantity and antibody levels against Escherichia coli in colostrum and milk from underprivileged and privileged mothers

We studied the milk content of secretory IgA (SIgA) and of specific IgA antibodies to E. coli in relation to volume, in 24 h samples from mothers belonging to different socio-economic groups and living under different ecologic conditions in Ethiopia, Guatemala and Sweden. There were no statistically significant differences in the daily output of milk SIgA among the population groups investigated at different times after onset of lactation. There was, however, a certain trend towards lower SIgA levels among the Guatemalan poor women, compared to the corresponding privileged one (Tables 2 and 3). Three days after delivery the underprivileged Ethiopian mothers showed significantly lower antibody levels than the privileged Ethiopian. These differences were no longer seen when the values were corrected for differences in volume (Table 5). One month after delivery, the levels of SIgA antibodies in milk from Swedish women and Guatemalan privileged women, against a pool of eight E. coli somatic antigens were comparable; these two groups of mothers had significantly higher antibody levels than the Guatemalan rural and urban ones (Table 4). The same pattern was observed after correction for differences in 24 h volumes (Table 5). At 3 months after delivery, the Guatemalan urban privileged women, again showed higher levels and daily output of antibodies against the E. coli antigens than the urban poor and rural mothers (Tables 4 and 5). The milk samples taken from a population where malnutrition is evident, i.e., mothers from Santa María Cauqué, did not show any changes in the levels of SIgA and the anti-E. coli antibodies 3, 6, 9 months after initiation of lactation. The data presented here provide evidence that chronically malnourished mothers are able to produce SIgA and transfer it to their offspring via breast milk. Furthermore, they do so in quantities that are comparable to those observed in well-nourished populations. There was a wide range of concentrations and daily output of SIgA and of specific antibodies in all groups, suggesting that some of the infants get less than others. The observed differences in levels of antibodies against E. coli may be explained by differences in exposure to E. coli strains of the eight serogroups studied here. The possibility of a deficiency in the SIgA antibody response in the undernourished mothers still remains unanswered.

Serum ferritin in Ethiopian mothers and their newborn infants. Relation to iron intake and socio-economic conditions

Ferritin estimations were performed in serum from 38 Ethiopian and 10 Swedish pregnant women and in cord blood from their newborn infants. The mean ferritin level in the Ethiopian mothers was significantly higher than in the Swedish mothers as well as in a non-pregnant population of apparently healthy Swedish women. The Ethiopian mothers consisted of two groups with different economic situations, a privileged and a non-privileged group. The non-privileged group consumed the iron-rich traditional diet unique for Ethiopia, whereas some of the privileged mothers had abandoned this menu in favour of more refined food items with a lower iron content. Subnormal ferritin levels, indicating iron depletion, were found in 33% of the privileged and in 8% of the non-privileged group, in spite of the fact that the infants of the privileged group had a significantly higher mean birth weight, indicating a better nutritional standard in general. It is concluded that the previously reported rarity of gestational anaemia in Ethiopia is due mainly to the good iron state of Ethiopian women, especially those who still eat the traditional cereal bread. no correlation was found between maternal and cord blood ferritin. The relevance of cord blood ferritin in the diagnosis of the iron state is discussed.

Antibodies to heat-labile Escherichia coli enterotoxins in human milk and sera. A study of Ethiopian and Swedish mothers and their children

Maternal serum and cord blood from 50 Ethiopian, 10 Costa Rican and 20 Swedish newly delivered mothers and their babies was examined for the presence of antibodies against heat labile (LT) enterotoxin from a human strain of E. coli. 96% of the Ethiopian, 80% of the Costa Rican and 30% of the Swedish mothers and infants had detectable antibody levels. The titres were significantly higher in the Ethiopian material. Furthermore, antibody titres to E. coli enterotoxin were determined in breast milk collected from Ethiopian mothers at 48 h and at 1 month after delivery. One third of these mothers had detectable levels of antibodies in samples from early lactation. Experiments performed with LT enterotoxin from another human and with LT from a porcine E. coli strain confirmed the results. Neutralization tests with cholera enterotoxin as antigen were all negative in sera and milk samples from all these groups. The material has been collected in three different geographical areas which are nonendemic for cholera.

Ascariasis and malnutrition. A study in urban Ethiopian children

Treatment of 13 urban Ethiopian children with mild ascariasis did not produce any evidence of improved intestinal morphology and absorption or nutritional status. Ascariasis treatment had no impact on anthropometric measures in an additional study group of 84 children. A review of the literature reveals that the nutritional consequences of ascariasis are uncertain.

Plasma amino acid response to single test meals in humans. V. Ethiopian preschool children given lowcost protein supplements

The plasma amino acid response to single test meals was studied in preschool children, aged 9 months--5 years. The amount of protein given in each test meal was 1 g per kg body weight, which represented one-third of the daily intake of the children who were recovering from protein-energy malnutrition. The test meals given was gruels made from wheat mixed with a supplementary weaning food (Faffa or Superamin) or fish protein concentrate (FPC). The plasma amino acid responses were evaluated both as PAA ratios (a modification of the Longenecker and Hause method), and as deltaMR% (percentage change in the postprandial essential amino acid molar ratios according to Graham and Placko). Both evaluation models indicated that lysine, threonine and methionine were the limiting amino acids in the Faffa/wheat diet, and that lysine and threonine were limiting in the Superamin/wheat diet. All essential amino acids seemed to be supplied in adequate amounts in the FPC/wheat diet. These results were in close agreement with the amino acid score of the diets (based on chemical analysis).

Observations on intrauterine growth in urban Ethiopia

A total of 3144 deliveries comprising a wide range of socio-economic groups in Addis Abeba were investigated. A positive correlation was found between family income and birth weight, with a difference of nearly 500 g between the extremes of socio-economic classes. A seasonal variation in mean birth weight was also observed. The mean length of gestation was 7.4 days shorter, and the anthropometric measures at birth were significantly lower in the Ethiopian infants as compared with the Swedish norm. The median weight and length development in relation to gestational age in the Ethiopian newborns was similar to the Swedish standard up to approximately 34--35 weeks of gestation. After that time there was very little further intrauterine growth in Ethiopian infants. The possible reasons for the observed pattern of growth are discussed.

Nitrogen and protein components of human milk

The true protein content of human milk is 0.9%, in well-nourished as well as malnourished mothers. Casein constitutes only about 20% of the protein nitrogen in human milk. The remaining 80% is derived from the whey proteins, the three dominant components being alpha-lactalbumin, lactoferrin and secretory IgA. alpha-lactalbumin is a subunit of lactose synthetase. Lactoferrin is an iron-binding glycoprotein which plays a role in the defence against gastro-intestinal infections and is probably also involved in iron transport in the gut. Secretory IgA is comparatively stable at low pH; it is resistant to proteolytic enzymes and plays an essential role in the immunological defence against gastro-intestinal infections. Lysozyme is a minor component of the whey proteins and represents an active enzyme with a bactericidal effect. The nutritional and immunological significance of the marked differences with respect to the nitrogen and protein compositions of human milk and cow's milk should not be underestimated, but need further elucidation.

Westernization of diet and serum lipids in Ethiopians

The dietary pattern, physical work output, and blood lipids were studied in three groups of healthy, young, urban Ethiopian men differing in the degree of "Westernization." The results showed striking increases in serum lipids that were associated with the degree of Westernization of the diet. These changes could not be accounted for by differences in other group characteristics such as age, weight, smoking, or length of residence in Addis Ababa. The effects of the level of physical work output on serum lipids were equivocal because the methods used for the assessment of energy output yielded crude approximations only.

Subclinical protein-energy malnutrition in under-privileged Ethiopian mothers and their newborn infants

An increased glycine/valine ratio in the maternal and cord vein plasma was observed in under-privileged women and their newborn babies in Ethiopia. There was a delay in the decrease of branch-chained amino acids during the immediate neonatal period. These findings indicate malnutrition in utero and are identical with those of a previous study in an under-privileged group in Pakistan. A reduced cord/maternal ratio of tyrosine and methionine was found in the Ethiopian material, indicating placental dysfunction of unknown origin.