The relationship between micronutrients and anthropometric measurements in malnourished children / Relaţia între micronutrienţi şi măsurătorile antropometrice la copiii malnutriţi

Lidia Man 1 , Adrian Man 2 , Cristina Oana Mărginean 1 , Ana Maria Pitea 1 , and Maria Despina Baghiu 1
  • 1 University of Medicine and Pharmacy Tirgu-Mures, Romania; Pediatrics Clinic I, Emergency Clinical County Hospital Tirgu-Mures, Romania
  • 2 Department of Microbiology, University of Medicine and Pharmacy Tirgu-Mures, Romania; Central laboratory, Clinical County Hospital of Tirgu-Mures, Romania


Purpose: to evaluate the serum levels of micronutrients in children with nutritional disorders, and to find if there is a direct correlation between them and the anthropometric measurements. Materials and methods: the study was conducted on 125 children (0-18 years); the working group consisted in children with Z-score < -2 standard deviations for at least one anthropometric measurement, while the children without growth disorders were considered as controls. Thus, for each anthropometric measurement, we had different working/control groups that were used for the assessment of correlation with laboratory findings. We followed eight anthropometric parameters and their relation with five of the micronutrients (Ca, Mg, Fe, Zn and Cu). Results: no statistical differences were found in micronutrients serum levels between genders or provenance. Most mean serum levels of micronutrients were lower in the children with Z-scores < -2 standard deviations (except Cu). Mg and Ca were positively correlated with most of the anthropometric measurements. For Fe, Zn and Cu, we found no correlation with any of the anthropometric measures. Differences in mean serum levels were found for Mg, with lower values in children with low weight-forage and triceps-skinfold-thickness, and for Cu, with higher levels in children with low triceps-skinfold-thickness. The red blood cell indices were positively associated with Fe and Zn levels. Conclusions: correlations between the serum level of micronutrients and anthropometric evaluation scores were found for Mg and Ca, but not for Fe and Zn, which were instead directly correlated with red blood cells indices. Mg, Fe and Zn tend to present small serum values in children with growth deficits. Considering the costs, the routine evaluation of Zn and Cu serum levels in growth disorder suspicion is not justified in our geographic area.

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  • 1. Mărginean CO, Man L, Pitea AM, Man A, Mărginean CL, Cotoi OS. The assessment between IL-6 and IL-8 and anthropometric status in malnourished children. Romanian J Morphol Embryol Rev Roum Morphol Embryol. 2013;54(4):935-8.

  • 2. Brown JL, Pollitt E. Malnutrition, poverty and intellectual development. Sci Am. 1996 Feb;274(2):38-43. DOI: 10.1038/scientificamerican0296-38

  • 3. Stechmiller JK. Understanding the role of nutrition and wound healing. Nutr Clin Pract Off Publ Am Soc Parenter Enter Nutr. 2010 Feb;25(1):61-8. DOI: 10.1177/0884533609358997

  • 4. Belluscio LM, Berardino BG, Ferroni NM, Ceruti JM, Cánepa ET. Early protein malnutrition negatively impacts physical growth and neurological reflexes and evokes anxiety and depressive-like behaviors. Physiol Behav. 2014 Apr 22;129:237-54. DOI: 10.1016/j.physbeh. 2014.02.051

  • 5. Micro-nutrient | Define Micro-nutrient at Dictionary. com [Internet]. [cited 2014 Aug 15]. Available from:

  • 6. Sadava DE, Hillis DM, Heller HC, Berenbaum M. Life: The Science of Biology. Ninth Edition. Sunderland, MA: MPS / W. H. Freeman & Co; 2012. 1266 p.

  • 7. Goldstein DA. Serum Calcium. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations [Internet]. 3rd ed. Boston: Butterworths; 1990 [cited 2014 Aug 15]. Available from: NBK250/

  • 8. Swaminathan R. Magnesium metabolism and its disorders. Clin Biochem Rev Aust Assoc Clin Biochem. 2003 May;24(2):47-66.

  • 9. Jahnen-Dechent W, Ketteler M. Magnesium basics. Clin Kidney J. 2012 Feb 1;5(Suppl 1):i3-i14. DOI: 10.1093/ndtplus/sfr163

  • 10. Munoz M, Villar I, Garcia-Erce JA. An update on iron physiology. World J Gastroenterol WJG. 2009 Oct 7;15(37):4617-26. DOI: 10.3748/wjg.15.4617

  • 11. Pantopoulos K, Porwal SK, Tartakoff A, Devireddy L. Mechanisms of mammalian iron homeostasis. Biochemistry (Mosc). 2012 Jul 24;51(29):5705-24. DOI: 10.1021/bi300752r

  • 12. King LE, Fraker PJ. Zinc deficiency in mice alters myelopoiesis and hematopoiesis. J Nutr. 2002 Nov;132(11):3301-7.

  • 13. Powell SR. The antioxidant properties of zinc. J Nutr. 2000 May;130(5S Suppl):1447S-54S.

  • 14. King JC, Shames DM, Woodhouse LR. Zinc Homeostasis in Humans. J Nutr. 2000 May 1;130(5):1360S-1366S.

  • 15. Osredkar J, Sustar N. Copper and Zinc, Biological Role and Significance of Copper/Zinc Imbalance. J Clin Toxicol S. 2011;3:2161-0494. DOI: 10.4172/2161-0495.S3-001

  • 16. Yamamoto M, Yamaguchi T, Yamauchi M, Yano S, Sugimoto T. Acute-onset hypomagnesemia-induced hypocalcemia caused by the refractoriness of bones and renal tubules to parathyroid hormone. J Bone Miner Metab. 2011 Nov;29(6):752-5. DOI: 10.1007/s00774-011-0275-7

  • 17. Hoffman HN, Phyliky RL, Fleming CR. Zinc-induced copper deficiency. Gastroenterology. 1988 Feb;94(2):508-12.

  • 18. Sharp P. The molecular basis of copper and iron interactions. Proc Nutr Soc. 2004 Nov;63(4):563-9. DOI: 10.1079/PNS2004386

  • 19. Jothimuthu P, Wilson RA, Herren J, Pei X, Kang W, Daniels R, et al. Zinc Detection in Serum by Anodic Stripping Voltammetry on Microfabricated Bismuth Electrodes. Electroanalysis. 2013 Feb;25(2). DOI:10.1002/elan.201200530

  • 20. Pei X, Kang W, Yue W, Bange A, Heineman WR, Papautsky I. Improving Reproducibility of Lab-on-a-Chip Sensor with Bismuth Working Electrode for Determining Zn in Serum by Anodic Stripping Voltammetry. J Electrochem Soc. 2014 Feb 1;161(2):B3160-B3166. DOI: 10.1149/2.022402jes

  • 21. Board ADAME. Malnutrition. PubMed Health [Internet]. 2013 Apr 13 [cited 2014 Aug 23]; Available from:

  • 22. Centers for Disease Control and Prevention, World Food Programme. A Manual: Measuring and Interpreting Malnutrition and Mortality. World Food Programme; 2005. 231 p.

  • 23. Ferraz IS, Daneluzzi JC, Vannucchi H, Jordão Jr AA, Ricco RG, Del Ciampo LA, et al. Zinc serum levels and their association with vitamin A deficiency in preschool children. J Pediatr (Rio J). 2007 Dec;83(6):512-7. DOI:10.2223/JPED.1725 DOI: 10.1590/S0021-75572007000800006

  • 24. Arvanitidou V, Voskaki I, Tripsianis G, Athanasopoulou H, Tsalkidis A, Filippidis S, et al. Serum copper and zinc concentrations in healthy children aged 3-14 years in Greece. Biol Trace Elem Res. 2007 Jan;115(1):1-12.

  • DOI: 10.1385/BTER:115:1:1

  • 25. Nepal AK, Gelal B, Mehta K, Lamsal M, Pokharel PK, Baral N. Plasma zinc levels, anthropometric and socio-demographic characteristics of school children in eastern Nepal. BMC Res Notes. 2014;7:18. DOI: 10.1186/1756-0500-718

  • 26. Temiye EO, Duke ES, Owolabi MA, Renner JK. Relationship between Painful Crisis and Serum Zinc Level in Children with Sickle Cell Anaemia. Anemia [Internet]. 2011 [cited 2014 Aug 15];2011. Available from:

  • 27. Cole CR, Grant FK, Swaby-Ellis ED, Smith JL, Jacques A, Northrop-Clewes CA, et al. Zinc and iron deficiency and their interrelations in low-income African American and Hispanic children in Atlanta. Am J Clin Nutr. 2010 Apr 1;91(4):1027-34. DOI: 10.3945/ ajcn.2009.28089

  • 28. Wians FH, Urban JE, Keffer JH, Kroft SH. Discriminating Between Iron Deficiency Anemia and Anemia of Chronic Disease Using Traditional Indices of Iron Status vs Transferrin Receptor Concentration. Am J Clin Pathol. 2001 Jan 1;115(1):112-8. DOI: 10.1309/6L34- V3AR-DW39-DH30

  • 29. Sedlak E, Zoldak G, Wittung-Stafshede P. Role of Copper in Thermal Stability of Human Ceruloplasmin. Biophys J. 2008 Feb 15;94(4):1384-91. DOI: 10.1529/ biophysj.107.113696

  • 30. Hegazy AA, Zaher MM, El-Hafez MAA, Morsy AA, Saleh RA. Relation between anemia and blood levels of lead, copper, zinc and iron among children. BMC Res Notes. 2010 May 12;3(1):133. DOI: 10.1186/1756-0500-3-133

  • 31. Gautam B, Deb K, Banerjee M, Ali MS, Akhter S, Shahidullah SM, et al. Serum zinc and copper level in children with protein energy malnutrition. Mymensingh Med J MMJ. 2008 Jul;17(2 Suppl):S12-15.

  • 32. Singla PN, Chand P, Kumar A, Kachhawaha JS. Serum, zinc and copper levels in children with protein energy malnutrition. Indian J Pediatr. 1996 Apr;63(2):199-203. DOI: 10.1007/BF02845244

  • 33. Amare B, Moges B, Fantahun B, Tafess K, Woldeyohannes D, Yismaw G, et al. Micronutrient levels and nutritional status of school children living in Northwest Ethiopia. Nutr J. 2012;11:108. DOI: 10.1186/1475-2891-11-108

  • 34. Zhan Y, Chen R, Zheng W, Guo C, Lu L, Ji X, et al. Association between serum magnesium and anemia: china health and nutrition survey. Biol Trace Elem Res. 2014 Jun;159(1-3):39-45. DOI: 10.1007/s12011-014-9967-x

  • 35. Shi Z, Hu X, He K, Yuan B, Garg M. Joint association of magnesium and iron intake with anemia among Chinese adults. Nutr Burbank Los Angel Cty Calif. 2008 Oct;24(10):977-84. DOI: 10.1016/j.nut.2008.05.002

  • 36. Guo C-H, Chen P-C, Yeh M-S, Hsiung D-Y, Wang C-L. Cu/Zn ratios are associated with nutritional status, oxidative stress, inflammation, and immune abnormalities in patients on peritoneal dialysis. Clin Biochem. 2011 Mar;4(4):275-80. DOI: 10.1016/j.clinbiochem. 2010.12.017

  • 37. WHO | Romania [Internet]. WHO. [cited 2014 Aug 15]. Available from: countries/rou/en/

  • 38. Purice M, Maximilian C, Dumitriu I, Ioan D. Zinc and copper in plasma and erythrocytes of Down’s syndrome children. Endocrinologie. 1988 Jun;26(2):113-7.

  • 39. Schneider JM, Fujii ML, Lamp CL, Lönnerdal B, Zidenberg-Cherr S. The prevalence of low serum zinc and copper levels and dietary habits associated with serum zinc and copper in 12- to 36-month-old children from low-income families at risk for iron deficiency. J Am Diet Assoc. 2007 Nov;107(11):1924-9. DOI: 10.1016/j.jada.2007.08.011

  • 40. Roman Vi-as B, Ribas Barba L, Ngo J, Gurinovic M, Novakovic R, Cavelaars A, et al. Projected prevalence of inadequate nutrient intakes in Europe. Ann Nutr Metab. 2011;59(2-4):84-95. DOI: 10.1159/000332762

  • 41. Mensink GBM, Fletcher R, Gurinovic M, Huybrechts I, Lafay L, Serra-Majem L, et al. Mapping low intake of micronutrients across Europe. Br J Nutr. 2013 Aug 28;110(4):755-73. DOI: 10.1017/S000711451200565X


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