All issues > Volume 10(1); 1967

Original Article

J Korean Pediatr Soc. 1967;10(1):18-32. Published online January 31, 1967.

Studies of Serum Alkaline Phosphatase Activity and Serum Calcium, Inorganic Phosphorus, Calcium-Inorganic Phosphorus Product and Serum Proteins in Healthy Individuals from Birth to Maturity, Nutritional Deficiency and Mother-Newborn Pair among Korean Peo

Johng Sup Lee¹, Kook Choo Rie², Han Woong Choi²

¹Department of Pediatrics,Hanil Hospital. Susomoon-Dong, Seoul
²Department of Pediatrics, Seoul National University, College of Medicine

Abstract

Following the discovery of enzyme as organic catalyst which was the active cause of the fermentation, came the first clue that the phosphate combining and splitting enzymes might be involved with processes of the fermentation in the animal body as well as in the yeast cells during the later ninteenth century. Then Robison proposed his well known “osteoblastic (alkaline) phosphatase" theory of bone formation based on the determination of a high concentration of a glucose-phosphate splitting enzyme in young growing bones. Kay found that the high levels of phosphatase activity in growing bones were reflected by a higher activity of the enzyme in the blood plasma of infants and children than in that of adults. Since those early developing days, many kind of phosphatases, both specific and non-specific ones, to the latter alkaline phosphatase belong, have been studied as tools of clinical assesment. Numerous investigations on the serum alkaline phosphatase had thus revealed： commensurate high levels of activity accompanied with the normal processes of growth and development in close correspondence; markedly increased levels of activity in disorders of the skeleton characterized by overactivity of substantial numbers of osteoblast and in disorders of the hepatobiliary system, notably those characterized by obstruction of the extrahepatic or intrahepatic biliary tract; and that of low levels in disorders of skeletal growth, of various etiology and possibly in some growth failure from malnutrition such as in kwashiorkor. On the account that there are still a considerable number of children afflicted with protein-calorie malnutrition since early infancy resulting in retardation from normal growth in Korea, author has undertaken studies of serum alkaline phosphatase (SAP) activity, and levels of serum calcium (Ca), inorganic phosphorus (Pi), calcium-inorganic phosphorus product (Ca X Pi), serum albumin, globulin and total protein in order A) to observe those of normative values by age and sex from birth to maturity in relation to growth and development, B)to observe those values in childhood malnutrition, namely, hypoproteinemia and malnutritional anemias of moderate and severe degrees and C)to compare those values in mother at term with those values in corresponding offspring in connection with the latter's growth in utero and possibly thereafter, or early infancy. Method: SAP was measured in Bessey, Lowry and Brock’s units (BLU) or sigma units which express micromoles of the para nitrophenol disodium phosphate；Ca, with the flame photometry； Pi, Fiske- Subbarow’s method and total protein, albumin and globulin were examined by the Kingsley’s biuret method. A.Study in Healthy Individuals from Birth to Maturity Material-Serum specimens were collected from apparantly healthy 56 newborns, 385 children and 110 adults during the period from October 1954 to September 1955. 1)The mean SAP activity was 2.95土 1.08 BLU at birth and highest in the 1-3 month group averaging 5.94土 1.20 units in male and 5.84±1. 29 units in femal (range was 3.15 to 7.85BLU), thereafter there was a steady fall to the yearly averages between 3.85 and 4.16 BLU for the 2 to 9 year age groups. At adolescence, values rose again averaging 4. 37土 1.41 BLU for the range between 1.72 and 12.0 units. This rise started at 9 years of age in girls and 12 years in boys. After pubertal rise there was a s teady fall until the adult range of 1.60 土 0.72 BLU reached at late-teens in girls and early twenties in boys. 2)The mean Ca concentration was highest at birth averaging 10.27+0.35 mg% and a decline to 9.51±0.37mg% followed during next first month of life. In the 1 to 2 year group, it rose again to 10.02土0.46mg%. Thereafter, it remained for the range between 9.60土0.26 to 10.04土0.45mg% during the life. 3)The mean Pi concetration was 5. 40±0.65mg% at birth and highest during the following first month of life averaging 6.14±0. 49mg%. Thereafter it declined steadily for the range between 5.55 ±0.50 to 4.71 ±0.58mg% during the rest childhood and it declined further to 3.64±0.56mg% in adults. 4)The mean CaXPi value was 55.45土7.19 at birth and highest as likewise that of Pi durig the first month of life averaging 57.69土7.17. It was for the range between 55.40土5.82 to 45.70土 5.03 during the rest childhood and declined to 36.01±5.51 in adults. For the values of Ca, Pi and CaXPi, there were bouts of peaks for the 4 to 7 year and the 9 to 12 year groups in female and for the 5 to 8 year and the 12 to 14 year groups in male. 5)Serum concentrations of the mean total protein, albumin and globulin were 5.65±0.90, 3.73+ 0.51 and 1.96±0.44gm% at birth and rose to 6.41±0.74, 3.97±0.36 and 2.37±0.51gm% during the first to third months of life. From the later infancy through the childhood they were in the ranges between 6.81 ±0.55 to 7.28±0.63gm%, 4.19±0.56 to 4.45±0.33gm% and 2.48±0.62 to 2.79±0.42 gm%. In adults, they were 7.14±0.59, 4.52土0.39 and 2.63±0.46gm%, repectively. 6)Albumin to globulin ratio were 1. 90 at birth, 1.82 during the first month of life and 1.68 up to 3 months showing a steady decline. It was in the range between 1.69 to 1.61 from the later infancy to the childhood and reached 1.72 in adults. 7)Protein levels approached in general to the adult level during the later infancy, and was highest in the 12~13 year group in boys and in the 14-15 year group in girls. B.Study in Nutritional Deficiency Material： Next are three groups of nutrional deficiency subdivided. Hypoproteinemia: 33 patients whose total serum protein levels showed below 5.5gm% and/or those of albumin, below 2. 5gm% were studied. Their age span was from 2 to 12 years. Anemia, moderate degree-A total of 45 patients ranging in age from 2 to 12 years who had hemoglobin values below 10~11gm% and/or those of packed cell volume below 30~32%, corresponding to age, were studied. As control for the above two groups, 40 healthy children with almost the same age and sex distribution were examined. Anemia, severe degree： A total of 13 female patients who had hemoglobin values below 7 gm% and/or those of packed cell volume below 23% were studied. As control 14 healthy girls around the same age were observed. In comparison with data obtained among the above three groups referring to respective controls, a summary is enumerated as following： 1)Levels of mean SAP, serum Ca, Pi and CaXPi were decreased in all three groups except that of SAP activity in the severe anemia where 12% increase of the activity was observed instead of 41 and 38% of respective decrease of the activity in the hypoproteinemia group and moderate anemia. 2)Alteration of mean Ca, Pi and CaXPi values were also utmost in the hypoproteinmia (9, 30and 35% decrease in each), then in the severe anemia (8, 23 and 26% decrease) and least in the moderate anemia (5, 15 and 17% decrease). 3)Decrease of mean albumin and globulin concentrations (43 and 5% decrease) were remarkable in the hypoproteinemia group and it was more pronounced in the albumin part than in that of globulin as reflected by the 2.46/2.46 or unity A/G ratio. 4)In the moderate and severe anemias, mean concentrations of respective albumin value showed 14 and 13% decrease and those of total protein, 3% of common decrease, whereas those o£ globulin showed 11 and 10% increase in each. Accordingly, some higher A/G ratios in the anemia groups than in the hypoproteinemia were figured resulting in 3.74/2.96 or 1.27 in the moderate anemia and 3.79/3.04 or 1.24 in the severa anemia. 5)In proportions, decrease of the mean total protein and albumin concentrations in both severe and moderate anemias were nearly in the same range, or slighly lighter for that of albumin in the severe anemia than in the moderate anemia whereas decrease of the mean serum Ca, Piand CaX Pi values were more pronounced in the severe anemia than in the moderate anemia indicating decrease of those values, even for calcium concentration, are not entirely related to that of serum protein levels. 6)It was thought that level of SAP activity has some proportional relationship to serum globulin concentration in every group but to Ca X Pi value, that relationship seemed :to exist only in the moderate anemia group where values of the Ca, Pi and Ca X Pi showed least decrease among three groups. C.Difference between Mother-Newborn Pairs Material： Serum specimens were obtained from 58 mother-newborn pairs who had normal delivery at this hospital. They were devided to two groups of pairs, namely, 34 non-anemic and 22 anemic mother-newborn pairs depending on mother’s hemoglobin level shown above or below 11. 5gm%. Control :for mother was set with 38 non-pregnant women of the same age decade. 1) Mean SAP activity in mothers were increased about 2.7 and 2.1 folds, from 1.31+0.43 BLU in the control, to 3.59±0.89 and 2.70土0.82 BLU in the non-anemic and anemic mothers indicating the SAP activity in the anemic mother was not so much raised as that of SAP in the non-anemic mother (t=3.701 p <0.005). The SAP activity in the mother of the non-anemic pair was also higher than that of SAP in the corresponding offsping： 3.59+0.89 vs. 2.86土 1.08units(t=7.56p <0.005), whereas a reveers was observed in the anemic pair： 2.70+0. 82 vs. 3. 09土 1. 08 units, in the mother and offspring although the difference was not statistically significant. In this connection it may be noted that mean serum globulin level in the anemic mother was lower than that level in the controls. 37±0.39 vs. 2.65±0.13gm%, however, there was no difference between the globulin level in the non-anemic mother and that level in the control： 2.65±0.48 -vs. 2.65±0.13gm%. 2)In the non-anemic mothers whose SAP activity, subgrouped by their offspring’s sex, revealed higher activity in 14 male-born mothers group than in 20 female-born mothers showing 4.18±1.18 vs. 3.13±0.53 BLU (t=3.389p <0.005). 3)In comparison the non-anemic mother with the non-pregnant control, mean Ca concentration was lower in the mother than in the control:9.62土0.44 vs. 9.87+0.12mg% (t=—8.6p <0.005), whereas mean Pi concentration was higher in the mother than in the controls. 81±0.46 vs. 3.61+ 0.57mg% (t—4.9 p <0.005). However, mean CaX Pi in both groups were within the same range with no statistical difference：36.63土6.05 vs. 35.64±5.49. On the other hand, levels of mean Ca, Pi and Ca X Pi were higher in both newborn groups than each corresponding mother group. It was assumed, therefore, decrease of Ca concentration in mother may, with raise of SAP activity, be related to mobilization of Ca from mother in order to provide material for the calcification of the growing fetus. 4)Decrease of mean total protein and albumin concentrations in both non-anemic and anemic mothers comparing with those concentrations in the control were noted and the decrease were more pronounced in the anemic mother. 5)Mean concentrations of total protein and globulin were decreased in both newborn groups of non-anemic and anemic mothers, comparing with respective mother groups, and the difference was slighter in the anemic pair than in the non-anemic pair. Meanalbumin concentration in the newborn group of the non-anemic mother was nearly equal with or slightly decreased than its mother group wheras that of increase was 5% in the newborn group of the anemic mother comparing with its mother group. 6)There was no difference between respective levels of SAP, Ca, Piand CaXPi in the newborn group of the anemic mother and levels of those in the newborn of the non-anemic mother or rather they were slighty higher in the former than the latter.

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