Selection and Formulation of Research Topic

Effect of Zinc on Protein-Energy Malnutrition

Introduction

Remarkable advances have been made in trace mineral research, especially in the last decade.
Several elements, including zinc, have been found to be essential to man.
Knowledge of interrelationships between the actions of several nutrients in the body is growing.
Zinc and copper, for example, compete for uptake in the intestinal lumen. This is due to similarity
of their atomic orbitals. For totally different reasons, some nutrients exert very similar biological
effects. The antioxidant effects of selenium and vitamin E are examples. Skin pathology produced
by deficiency of essential fatty acids or zinc is another. There is also a whole range of very similar
clinical symptoms which both protein-energy malnutrition (PEM) and zinc
deficiencies share.
The need to identify the exact roles of dietary zinc and protein in PEM has become increasingly
necessary. Clinical findings are showing the presence of zinc deficiency in many cases of PEM.
Thus, there is the possibility that the PEM syndrome may be an overlapping of the deficiency
symptoms of both protein and zinc.

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Selection and Formulation of Research Topic

Literature Review

Zinc was first recognized by Raulin in 1869 to be essential for Aspergillus niger. Somer and
Lipman, in 1926, determined that it is essential for higher plants. Later, it was found to be essential
for many experimental animals, including the rat. Its deficiency in man was first suspected in 1961
and established in 1963. Prasad and Oberleas emphasizes the great importance of zinc by pointing
out that its metabolic roles are so numerous "that biochemistry may have to be rewritten around
this one element."
The term "protein-calorie malnutrition" (PCM) was first introduced by Jelliffe in 1959 to cover
not only marasmus and kwashiorkor but also their mild subclinical stages. Some prefer the
synonym "protein-energy malnutrition" (PEM) to "protein-calorie malnutrition." The preference
is meant to emphasize that insufficient dietary energy leads to the metabolic energy deficiency of
the syndrome and that the calorie is only the most customary measure of this energy.
The newer term - "energy-protein malnutrition" (EPM) is coming into greater use. This is to
emphasize the unconfirmed suspicion that marasmus is the more predominant form of protein-
energy malnutrition rather than kwashiorkor. While an overall lack of food energy causes
marasmus, kwashiorkor appears to be caused by a deficiency of dietary protein. A definition of
the three basic forms of PEM - marasmus, kwashiorkor, marasmic-kwashiorkor - has been
discussed by Waterlow. Edema and severe dermatosis are the distinguishing features of
kwashiorkor. Extreme weight loss or growth failure typifies marasmus.
Malnutrition has been known for centuries in many parts of the world. Commonly, it was in the
form of marasmus in North America and Europe. Marasmus occurred elsewhere, too. Detailed
study of PEM began in the 1920s. It, however, took the appointment of the first female medical
officer (Cecily Williams) to Gold Coast (now Ghana) to give a detailed description of the disease
in 1932. The disease she described was the kwashiorkor form of PEM. "Kwashiorkor" was the
name of the edemic form of PEM in Gold Coast. For a time, some suspected it was "infantile
pellagra" resulting from niacin deficiency. Later, Trowell (cited by Darby, 15) noticed unusually
low plasma albumin levels associated with it. Helen McKay suggested an association with dietary
amino acid or protein deficiency.
Studies show that not all dietary zinc may be available for absorption. It is less available in plant
products than animal products. In plant products, it may be bound by fiber, phytate, calcium, starch
or wheat proteins. Calcium does not inhibit zinc absorption in man but does in other animals.

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Selection and Formulation of Research Topic

Contrary to popular thought, it is fiber and not phytate that binds more zinc. Fiber may be
beneficial to health, but excesses, by causing mineral losses, can be detrimental to health. The
optimum dietary level and type for health needs to be determined.
Zinc availability is improved by dietary cysteine, histidine, ethylenediaminetetraacetate and high
dietary proteins. This might imply the likely involvement of dietary amino acids in the mechanism
of zinc absorption. Protein deprivation can, on the other hand, cause negative zinc balance. This
might explain the incidence of zinc deficiency in cases of PEM in Egypt, South Africa, and India.
Oberleas and Prasad have suggested zinc-supplementation of high protein vegetable mixtures
formulated to treat kwashiorkor.

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Selection and Formulation of Research Topic

Methodology of Research

In this research, exploratory method will be used to determine the effect of zinc on protein
energy malnutrition. Basically, I will go through the diet history to determine zinc intake and its
effect on protein energy malnutrition.

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Selection and Formulation of Research Topic

References
 Prasad, A. S., and Oberleas, D., Eds. 1976. Trace elements in human health and disease.
Vol. I. Academic Press, New York.
 Agglelt, P. J. 1980. Animal models for study of trace metal requirements. Proc. Nutr.
Soc. 39: 241.
 Hill, C. H., and G. Matrone. 1969. Chemical parameters in the study of in vivo and in
vitro interactions of transition elements. Fed. Proc. 29: 1474-1481.
 Burk, R. F. 1976. Selenium. Pages 100 and 313 Present Knowledge in Nutrition. 4th
edition. Nutrition Foundation, Inc., New York.
 Davidson, S., Passmore, R., Brock, J. S., and Truswell, A. S. 1975. Protein-energy
malnutrition. Pages 302-317 Human Nutrition and Dietetics. 6th edition. Churchill
Livingstone, London.
 Sandstead, H. H., Shukry, A. S., Prasad, A. S., Gabr, M., Hefney, A. E., Mokhtar, N., and
Darby, W. J. 1965. Kwashiorkor in Egypt. Clinical and biochemical studies with special
reference to plasma zinc and serum lactic dehydrogenase. Am. J. Clin. Nutr. 17: 15-26.