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INTRODUCTION: It is accepted that even mild nutrient depletion may affect the evolution of the surgical patient. OBJECTIVE: To evaluate the influence of preoperative levels of plasma retinol and zinc on postoperative evolution of surgical patients; to evaluate the influence of inflammation on both level markers. METHODS: Plasma retinol and zinc were determined in 50 patients before programmed gastroenterological surgeries. To detect global malnutrition BMI and weight loss percentage (WL%) were included. C-reactive protein (CRP) was included as inflammation marker. During follow up postoperative complications were recorded. The present analysis was carried out in 43 patients with complete information. RESULTS: Low retinol values (< 20 µg/dl) were founded in 3 cases and low Zn values (< 85 µg/dl) in 20 cases, being 9 of them indicative of severe deficiency (< 70 µg/dl). Postoperative complications were recorded in 17 patients; patients with complications presented lower values of plasma Zn (78.4 ± 25.8 vs. 87.8 ± 25.7 µg/dl) and retinol (36.9 ± 14.5 vs. 49.7 ± 20.6; P = 0.0318) than those with no complications; the number of patients with complications decreased when retinol and Zn ranges increased. No relation between BMI or WL% and appearance of complications was founded; patients with higher WL% were those with higher usual weight. Inflammation affected both markers: retinol dropped from 50.1 ± 17.2 to 44.0 ±20.8 and to 23.7 ± 4.0 µg/dl for CRP ranges of < 0.5, 0.5-3.9 and ≥ 4 mg/dl, respectively (p = 0.0193); levels of zinc fell from 90.1 ± 17.8 to 85.2 ± 29.9 and to 55.0 ± 25.9 µg/dl for the same CRP ranges (P = 0.0195). Zn level influenced retinol level, dropping to 33.1 ± 11.7 µg/dl of retinol in the Zn severe deficiency group (P = 0.0386). CONCLUSIONS: The obtained results confirm the influence of vitamin A and zinc on postoperative evolution of the surgical patient, while alert about the interrelationships among vitamin A, zinc and inflammation, which lead to difficulty to establish the real source of deficiencies. Beyond these difficulties, retinol and zinc plasma levels determine the nutrient availability for the body and appear as promissory markers of surgical risk.

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BACKGROUND: The fact that deficient or even marginal nutritional levels may contribute to increase morbidity and mortality in the surgical patient is well accepted. The usefulness of vitamin and mineral markers has not been much explored. OBJECTIVE: To evaluate the usefulness of vitamin and mineral indicators as nutritional markers of surgical risk. METHODS: Biomarkers of vitamin A (plasma retinol), carotenes (plasma carotenes), vitamin C (plasma vitamin C), iron (hematocrit, hemoglobin, serum iron, transferrin saturation and erythrocyte protoporphyrin), calcium (calcium/creatinine in basal urine) and zinc (zinc/creatinine in basal urine), were performed 24 ours before surgery. Appearance of complications was evaluated in 100 adult patients from programmed surgical procedures of hernia (n = 41) or gallbladder lithiasis (n = 59), two of the most frequent interventions in general surgery services. RESULTS: Patients were grouped in those that presented postoperative complications (C; n = 26) and those who did not (NC; n=74). Two of the studied markers presented significant differences between both groups: plasma retinol and erythrocyte protoporphyrin. Plasma retinol of C was significantly lower than that obtained in NC: 33.2 +/- 13.5 microg/dl vs. 40.2 +/- 16.3 microg/dl; P = 0.0495 and an association between values below 30 microg/dl and postoperative complications was founded (53.8% in C vs. 30.1% in NC; P = 0.0360). Erythrocyte protoporphyrin of C was significantly higher to that obtained in NC: 52.0 +/- 34.0 microg/dl RBC vs. 36.8 +/- 17.5 microg/dl RBC; P = 0.0453 and the association between values higher than 70 microg/dl RBC and presence of complications were highly significant (25.0% vs. 4.2%; P = 0.0069). CONCLUSIONS: On the basis of the obtained results is concluded that plasma retinol and erythrocyte protoporphyrin would provide useful tools in evaluating surgical risk since they had been allowed to identify patients who were at risk of suffering postoperative complications.

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Malnutrition is one of the most important causes of normal growth disruption. Anthropometric methods are highly valuable in clinic pediatric diagnosis to determine the nutritional status of children and as recovery monitoring. In previous studies, we have demonstrated that the standards weight-age, height-age and weight-height of growing rats had similar distribution to those in normal children. However, to improve the diagnostic effectiveness of anthropometric information, statistical analysis to normally and non-normally distributed variables should be applied. One hundred Wistar rats (50 male and 50 female rats) from weaning (day = 25, weight = 35-40 g) to 70 days of age were fed with a commercial diet. Water and diet were offered "ad libitum". Body weight and height were recorded every two or four days, respectively. Percentiles of weight vs age, height vs age and weight vs height were plotted for male and female rats. The statistical criterion for classifying the anthropometric measurements into nutritional categories was based on percentiles cutoff and Z-score. The Z-score was calculated according to: Z = (standard mean value-subject value/standard deviation of standard). The statistical anthropometric categories of growing rats were similar to those obtained in children. This evidence suggest that the rat can be used as an experimental model to infer and predict the nutritional response in children.

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Nutritional status of 80 preoperative patients from programmed surgeries of hernias and lithiasis was studied by anthropometric and biochemical parameters. Nutritional deficiencies related to pathology were not expected in these patients. Results were as follows: 77% of the population showed overweight, being 15% obese. Prevalent protein intake, evaluated by the urea nitrogen/creatinine ratio, was adequate in 87.5% of the patients; however, patients presented 72% of albumin, 52% of prealbumin and 50% of RBP below reference values. Transferrin, ceruloplasmin, alpha 2-macroglobulin and haptoglobin were not decreased. Assessment of vitamin A, carotenes and vitamin C showed plasmatic levels below reference values in 16% of the patients for vitamin A, 5% for carotenes and 27% for vitamin C. Respect to calcium status, data of calcium/creatinine ratio show deficiency in 45% of the population. Respect to iron, the nutritional status was in general adequate, patients at risk being 5% by Htc, 11% by Hb, 5% by TS% and 12.5% by FEP, women showed over twice abnormal values than men. Although some isolated relations were observed, in this population sex, age and pathology were variable that did not affect in a relevant way the nutritional status. In spite of the individual analysis of each nutrient did not show important deficiencies, the analysis by patient showed that only a few of them (7%) presented an optimal biochemical profile with all the studied parameters within the reference values.

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Interrelationships between Erythrocyte Protoporphyrin (EP), dietary Iron/Protein ratio (Fe/Prot) and Fe liver content (Feh) were studied during nutritional recovery in an experimental model: weanling female Wistar rats (To) were depleted with a protein-free diet (LP), losing 20% of their initial body weight. Then they were recovered until 45 days of age (T45) with diets containing: casein: 20 g/100 g; Fe (ammonium Fe citrate) (ppm.): 0, 75 or 100 (groups A1, A2 and A3, respectively). Hematocrit, Hemoglobin (Hb) (g/dL). Erythrocyte Protoporphyrin (EP) (microgram/dL Red Blood Cells) and Feh (microgram) were determined at To, LP and T45. Results were compared with control rats (C) fed with 20% of casein and Fe, 50 ppm. EP: a) decreased in C from To to T45 (99 +/- 24; 36 +/- 9; p < 0.01); b) increased in A1 and A2 at T45 (123 +/- 21; 93 +/- 29, respectively, p < 0.01) while A3 did not show significant difference (45 +/- 7) regarding to C: c) correlated inversely with Feh. According to the inverse correlation between EP and Fe/Prot (r = -0.99), we found that 92 ppm was an adequate Fe amount to prevent EP increase. These results confirm that during recovery from undernutrition EP depends on iron liver content, being an adequate indicator of iron nutritional status; therefore, EP would be useful as a predictor of the optimum Fe/Prot ratio for nutritional recovery.

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The assessment of the iron (Fe) status is very important because its deficiency is one of the most common in both developing and industrialized countries, being particularly prevalent among infants and young children. Diagnosis is difficult in the presence of other conditions which interfere with the interpretation of laboratory tests, such as hemoglobin (Hb), hematocrit (Hct), serum iron, transferrin saturation percentage and serum ferritin. Free erythrocyte protoporphyrin (FEP) is a precursor of Heme and normally occurs in very low concentration in red blood cells (RBC); elevated values indicate early impaired iron nutritional status, providing information about gradual changes in the iron supply to the marrow. This laboratory test is a practical and convenient method because it needs a small blood sample easily preserved. Although the Second National Health and Nutritional Examination Survey (NHANES II) of USA has provided a good opportunity to define more precisely the cut-off points, it is doubtful whether the age-related differences in children represent normal development or the effects of iron deficiency. In order to provide information about these aspects the present experimental model was performed: weanling Wistar rats were fed until 95 days of age (t 95) with an isocaloric diet containing 20 or 30 g/100 g. of protein (casein) (N 20 and N 30, respectively), allowing the highest growth and erythropoiesis rates and covering the requirements of all the nutrients (Table 1). Body weight and food intake were recorded three times/week.(ABSTRACT TRUNCATED AT 250 WORDS)

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The assessment of the iron (Fe) status is very important because its deficiency is one of the most common in both developing and industrialized countries, being particularly prevalent among infants and young children. Diagnosis is difficult in the presence of other conditions which interfere with the interpretation of laboratory tests, such as hemoglobin (Hb), hematocrit (Hct), serum iron, transferrin saturation percentage and serum ferritin. Free erythrocyte protoporphyrin (FEP) is a precursor of Heme and normally occurs in very low concentration in red blood cells (RBC); elevated values indicate early impaired iron nutritional status, providing information about gradual changes in the iron supply to the marrow. This laboratory test is a practical and convenient method because it needs a small blood sample easily preserved. Although the Second National Health and Nutritional Examination Survey (NHANES II) of USA has provided a good opportunity to define more precisely the cut-off points, it is doubtful whether the age-related differences in children represent normal development or the effects of iron deficiency. In order to provide information about these aspects the present experimental model was performed: weanling Wistar rats were fed until 95 days of age (t 95) with an isocaloric diet containing 20 or 30 g/100 g. of protein (casein) (N 20 and N 30, respectively), allowing the highest growth and erythropoiesis rates and covering the requirements of all the nutrients (Table 1). Body weight and food intake were recorded three times/week.(ABSTRACT TRUNCATED AT 250 WORDS)

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The purpose of this study was to evaluate the fat and oil intake and their distribution according to the dietary origin in students of the University of Buenos Aires. A 7 day dietary record of students (49 males and 127 females) attendant to the 1989 Course of Nutrition, School of Pharmacy and Biochemistry, to obtain in Pharmacy and Biochemistry was collected. This information was processed in a PC Computer (VAN Program, Lujan University, Argentina) to obtain the energy and fat daily intake, according to the Dietary Composition Tables compiled by INCAP; missing data were completed t with the German, Italian or Argentine Tables. The results obtained were (average daily intake +/- SD) for females and males, respectively: Energy (Kcal): 1805 +/- 5431 and 2551 +/- 712; total fat (g): 65.6 +/- 21.8 and 87.8 +/- 28.7; percentage of energy provided by fat: 33.0 and 31.1. The distribution of fat intake according to its dietary source was (g/100 g): meat: 33.3; oils: 15.5; diary products: 19.3; cakes and pasta: 11.6; cereals (bread, crackers, etc.): 8.3; separate animal fat: 5.1; legumes and oil seeds: 1.4; eggs: 2.9; poultry: 1.5; margarines: 0.6; fish: 0.3; viscera: 0.3. These data show that the fat intake is not excessive, about 30% of the energy intake; but the high percentage of animal fat might be one of the risk factors responsible for the high incidence of cardiovascular diseases in the population of Buenos Aires.

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El aumento de la Protoporfirina Eritrocitaria Libre (FEP), detecta deficiencias marginales de hierro (Fe), constituyendo un indicador precoz que, a las características de simplicidad y rapidez, une las de su determinación en una muestra mínima de sangre de fácil conservación. Pese a esta ventajas, ha sido poco utilizada en estudios poblacionales, salvo en USA, donde su aplicación en la II Nutritional and National Health Examination Survey (NANHES II), ha permitido establecer valores normativos para las diferentes edades. En este trabajo, se aporta información sobre los valores hallados en una población escolar (n = 102), perteneciente al nivel socio-económico bajo y medio-bajo de la ciudad de Buenos Aires, en la que se determinó Hematocrito (Hto) y FEP (según Piomelli). Los resultados, expresados como FEP/dL de glóbulos rojos (FEP/dLg.r.), se agruparon de acuerdo con intervalos de edad y se compararon: a)entre sí, mediante análisis de varianza; b)con los valores normativos derivados de NHANES II, para los mismos rangos de edad. El 99%de la población mostró valores normales de Hto, y de FEP/dL g.r. Los promedios de FEP/dLg.r., para los datos agrupados por años de edad cumplida, no presentaron diferencias estadísticamente significativas: 40ñ22; 23ñ17; 25ñ14; 29ñ13; 31ñ15; 29ñ15; 28ñ20; 32ñ12; 30ñ30 (4 a 12 años, respectivamente). Estos valores fueron sensiblemente inferiores a los considerados normales en NHANES II y en el 90%de los casos inferiores a los de su mediana. Se observó correspondencia entre el valor de la mediana y el percentilo 5 de la población norteamericana. Los valores obtenidos para la mediana y percentilo 95 fueron, respectivamente: < 5 años: 25 & 55; 6-8 años: 25 & 57; 9-11 años: 29 & 55; 12-13 años; 29 & 51

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