Balanced diet theory challenged: Micronutrients more important

Former Professor and Head of the Department of Paediatrics of All India Institute of Medical Sciences Prof. Meharban Singh in an interview with HealthWatch last week said:

"The prevailing dogma in nutritional science that a 'balance diet' is sufficient to meet all the requirements of a growing child into a healthy citizen has been challenged by the UN Sub-Committee on nutrition. They say it is not possible to meet the requirements of 100 per cent recommended dietary allowances (RDAS) of micronutrients from dietary sources alone.

Thus nutritional supplements are mandatory to improve physical growth and mental development and prevent occurrence of common day-to-day infections of children, who are the future nation builders."

Prof. Singh who was in Colombo to address a meeting of paediatricians on 'Nutrition for optimal health and well-being of children', said:

Health and well-being of children

The health and well-being of children depends upon the interaction between their genetic potential and exogenous factors like adequacy of nutrition, safety of environment, social interactions, physical activity and stimulation. Nutrition has a global role to promote physical growth, enhance neuromotor development, boost host defences to ward off common day-to-day infections, retard the process of aging, and prevent occurrence of age-related degenerative diseases and thus improve the quality of life.

Over the years there have been significant changes in the clinical profile of nutrition-related disorders in developing countries. The florid cases of kwashiorkor, severe protein-energy malnutrition and various syndromes (like scurvy, rickets, pellagra, beri-beri etc.) due to gross deficiencies of single nutrients have become rare. Nevertheless, there are still wide spread diseases of public health relevance due to deficiency of micronutrients like iron deficiency anaemia, iodine deficiency disorders and milder forms of Vitamin A deficiency.

Nutritional status and infections

Research studies during the past two decades have demonstrated the importance of optimal nutrition for the functional integrity of the immune system.

Both under nutrition and over-nutrition as well as deficiencies and excess of single nutrients have been shown to have adverse effects on the immune system. Recently studies have shown that immunological dysfunction is the earliest marker of deficiency of micronutrients.

A large number of vitamins (vitamins A, E, C, pyridoxine, folic acid) and trace minerals (iron, zinc, selenium, copper) are credited to enhance cell-mediated and humoral immunse responses. There is increasing clinic and laboratory evidence to suggest that children with subclinical deficiencies of various macronutrients are more vulnerable to develop a variety of common day-to-day infections. They are likely to have more severe infections with prolonged convalescence.

Infective illnesses are recognised to adversely affect the nutritional status by causing anorexia, tissue catabolism and enhanced utilisation of micronutrients, thus setting up a vicious cycle of undernutrition, recurrent infections and unsatisfactory physical growth.

Brain development

It is not generally realised that neurons are more sensitive to nutrients and dietary chemicals compared to other body cells. Optimal nutrition during pregnancy and first 3 years of life is most crucial because 70 per cent of the human brain develops during fetal life and remaining 30 per cent during pre-school years.

Macronutrients are required for production of several enzymes and co-factors for a number of metabolic pathways. It has been well known that pellagra (niacin deficiency) leads to reduced cognition and dementia.

A number of other B-complex vitamins especially B1, B2, B6, B12 and folic acid are needed for synthesis of several neurotransmitters. Deficiency of folate B6, B12 and choline is associated with elevation of plasma homocysteine level which may lead to thromboembolic complications and stroke. Iodine is required for synthesis of tri-iodothyronin and thyroxin. Iron is required for functioning of neurotransmission system by production of dopamine, serotonin and GABA.

Zinc is a component of a large number of metalloenzymes and there is high concentration of zinc in the brain. Copper is an important component of cytochrome-C oxidase and superoxide dismutase in the brain. Fish and fish oils are important sources of omega-3 fatty acids and decosahexaenoic acid (DHA).

Omega-3 fatty acids are credited to reduce cellular and vascular inflammation in the brain, promote vasodilatation and ensure integrity of brain cell membranes to keep them soft and pliable. DHA is the building material for fabrication of synaptic communications and constitute almost one-half of the total fat in the brain cell membranes. It increases the level of 'feel good' neurotransmitter serotonins and the 'memory boosting' chemical acetylcholine. The brain-friendly nutrients are listed below.

Smart nutrients for the brain

* Omega-3 fatty acids, decosahexaenoic acid (DHA) and arachidonic acid.
* Vitamin B complex, folic acid, vitamin C, vitamin E
* Iodine, iron, zinc, copper and selenium
* Essential amino acids including taurine
* Glucose
* Choline
* Antioxidants

Life-cycle approach for the care of girl children

Health and well-being of mothers and their children are intimately linked. Healthy mothers produce healthy babies while sick and malnourished mothers produce high-risk and low birth weight babies. The health and growth of the fetus in the womb is dependent upon the health, well being and nutritional status of the mother (rather than the father) because she is both the seed as well as the soil where baby is nurtured for 9 months.

Moreover, healthy and well-informed mothers are in a better position to look after the health need of their children. Therefore, a life-cycle approach should be followed to provide optimal nutrition and health care to girl children from infancy through childhood, adolescence, pregnancy and lactation.

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An international conference on psychiatry in Colombo

Last week, the executive committee of the South Asian Forum on Mental Health and Psychiatry (UK chapter) was in Colombo making initial arrangements to hold their third international conference on psychiatry in Colombo in July this year.

Dr. S. Somasunderam (FRCPsychi a member of the ex-co) a Sri Lankan expatriate in UK speaking to the Health Watch on the forthcoming event said the South Asian Forum (UK Chapter) was his brainchild to help develop mental health and psychiatry in this part of the world, in association with other international bodies of this speciality.

The UK Forum had so many Sri Lankan expatriate members and they were all keen and doing their very best to help Sri Lanka as much as possible.

In fact, he said it was owing to this deep feeling they had for their motherland that they had their first international conference here in Colombo in association with the Sri Lanka College of Psychiatrists two years ago.

Since then they had constantly been in touch with the Sri Lankan professional bodies, friends and had done a considerable amount of work to help uplift to some extent the mental health services in this country.

Dr. Somasunderam added among other things following the first conference they were able to make arrangements to get a lecturer on psychiatry from UK to lecture on psychiatry periodically at the PGIM, Colombo.

Dr. Somasunderam said that they are working on several other projects to help Sri Lanka in this field, which will be taken up at the forthcoming conference which will be held in Trans Asia Hotel in Colombo from July 24 to 27 this year.

The Colombo conference which is being sponsored by the Asian Forum (UK chapter) is co-sponsored by the World Psychiatric Association in collaboration with the Sri Lanka College of Psychiatrists, Royal College of Psychiatrists and the World Association for Psycho-social Rehabilitation.

Dr. V. Sagar, Prof. C. Mohan and Dr. A. Javed all Executive Committee Members of the UK chapter of (SAFMHP) were associated with Dr. Somasunderam in the interview.

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The need to empower vulnerable groups to access health services

"As should be already well-known access to suitable healthcare facilities is a fundamental right of and is recognised as such by most of the Democratic constitutions.

However, it is our belief that all vulnerable groups in a national society need to be first sufficiently empowered - particularly economically - to enable them to access healthcare services, said Associate Editor, Daily News Lynn Ockersz.

Continuing , he said: "Some of these vulnerable groups are women and children. At a time of national crisis, for instance, it is such groups and the poor in general who are worst affected and thereby deprived of the ability to access the services of the State.

Therefore states in particularly the developing world need to continually prop-up the essential pillars of the welfare state and work towards egalitarian ideals.

Further he said:

Salient issues

"These salient issues are of particular importance today, World Health Day, and are relevant to its theme, 'Make Every Mother and Child Count'. In the case of Sri Lanka, these issues are of crucial significance because the devastation of December 26, 2004 have left in our midst a vast number of widows and orphans and they need to be cared for. We at the Daily News, hope to do our best for them through our 'HealthWatch' page.

"The HealthWatch is particularly privileged to have as its Medical Advisory Panel, a body currently headed by Professor Colvin Gooneratne. It was earlier headed by Dr. Tara de Mel.

Centenarian study project

"The page since it began in the year 2000 has several interesting features like the Centenarian Study Project, headed by Prof. Colvin Gooneratne, the Medical Crossword and a students' health study on the school bag headed by Dr. Dennis J. Aloysius.

From the first Medical Crossword

"From the first Medical Crossword in August last year, we have had over 200 entries and 99 per cent of them are correct.

"This proves that the general English Language readership of this country possesses a sound knowledge of health issues.

"The Medical Crossword is sponsored by Novartis Medical Nutrition and all prizes are awarded by them. We at the Daily News are happy that the WHO office in Colombo made the HealthWatch Medical Crossword Draw No. 10, a part of its World Health Day programme. Dr. Sarveshwar Puri, Technical Officer (Programme and Management) of the WHO Colombo office has in consultation with the Health and Nutrition Ministry and Health Education Bureau, finalised these arrangements today.

"Our weekly HealthWatch page in the Daily News is proof of the commitment of the Daily News to raise popular awareness on health issues and of our dedication to the cause of creating a healthy nation.

"HealthWatch page has continued to be a vibrant feature of the Daily News and the public response to it has been highly positive.

'"We hope to continue the good work and call on the medical community to cooperate with us in this cause as they have done to date.

"A special word of thanks to WHO Librarian, Shamali Thebuwana, for the interest taken by her to have this item included in today's programme".