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Reliable methods are needed to diagnose undernourished patients, to identify metabolic complications from infections or other stresses and to assess if there is a more immediate response to nutritional therapy than that detected by a relatively slow change in body mass. Metallothionein levels in blood cells of rats decreased when their food intake was restricted. Although these metallothionein levels were initially measured by radioimmunoassay, more recently enzyme-linked immunosorbent assays (ELISAs) have been developed. Attempts were made to improve the precision of one of these ELISAs so that metallothionein levels could be measured in humans, particularly 18 undernourished hospital patients. Although metallothionein levels did not appear helpful in diagnosing undernourished patients, the surrogates for body composition, such as body mass index (BMI) or arm circumference, provided simple, reliable measurements for diagnosing patients at risk. In addition the metallothionein levels in these undernourished patients did not respond to nutritional stimuli, whereas serum insulin-like growth factor I (IGF-I) did increase after feeding. Indeed IGF-I levels increased within 3 days of feeding in all patients regardless of the degree of acute phase response. The presence of acute phase response was established by the increase in serum C-reactive protein (CRP) levels. Thus simple, reliable criteria are recommended to specify chronic energy deficiency (namely BMI and arm circumferences); to discriminate acute phase response (namely serum CRP levels) and to monitor the response to nutritional support (namely serum IGF-I levels).

The aim of my thesis was to assess the variability of EE and weight up the link between this variability and body composition in pre-school children (89 subjects). A further aim was to validate a wrist worn acelerometry (Actiwatch) against direct observation and compare two-points and multi-points calculation methods of total EE using DLW. Our results indicated that Actiwatch is valid and reliable for assessing physical activity (PA) pattern in children. In second study we observed that there was no significant difference between two sample points and multiple sample points to calculate total energy expenditure in pre-school children, while multi-samples gave more precise estimation of TEE than two samples. A considerable variation in resting metabolic rate (73.1%) and TEE (70.9%) was explained by body composition including fat mass and fat free mass. Sleep and PA pattern could make an additional contribution of 20.9% to variation of free-living TEE. Total and regional body composition obtained by dual energy X-ray absorptiometry (DXA) revealed that central FFM did not contribute more in variation of TEE and RMR than peripheral FFM. Although TEE was higher in boys, no significant gender difference was observed for RMR. Our results suggested that regional body composition is more associated to PA than total body composition. Cross-sectional data in this study did not allow us to determine the cause and effect manner of the association between PA and regional body composition. Increased watching TV was associated with greater body fat and it may happen by decreasing PA intensity and not by decreasing physical activity energy expenditure (PAEE) or Physical activity level (PAL). Even though, we die not observe any familial resemblance for PA and RMR between children and their parent, total body composition was more heritable than regional body composition at least in pre-school age children.

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