Adequate zinc nutrition is essential for human health because of zinc’s critical structural and functional roles in multiple enzyme systems that are involved in gene expression, cell division and growth, and immunologic and reproductive functions. Zinc deficiency is an important driver of undernutrition in children under 5 years of age and is associated with growth stunting, lower respiratory infections and diarrhea. It is known that even a mild deficiency of zinc in humans affects clinical, biochemical, and immunological functions adversely. During the past 50 years, it has become apparent that deficiency of zinc in humans is prevalent. The major factor contributing to zinc deficiency is high phytate-containing cereal protein intake. Phytates—which are present in whole-grain breads, cereals, legumes, and other foods—bind zinc and inhibit its absorption. Symptoms of zinc deficiency can include growth retardation, loss of appetite, and impaired immune function. In more severe cases, zinc deficiency causes hair loss, diarrhea, delayed sexual maturation, impotence, hypogonadism in males, and eye and skin lesions. Oysters, red meat, and poultry are excellent sources of zinc. Baked beans, chickpeas, and nuts (such as cashews and almonds) also contain zinc. Supplementation may also be considered in cases of deficiency.
‘Lifestyle interventions such as maintaining an ideal body weight to prevent obesity, regular exercises, avoidance of smoking and alcohol abuse, intake of a balanced diet and nutrients to include adequate calcium and vitamin D, modification of the work environment and avoidance of certain repetitive activities will prevent or ameliorate disorders such as osteoarthritis, osteoporosis, rheumatoid arthritis, gout and musculoskeletal pain syndromes including low back pain and work-related pain syndromes. These prevention strategies also contribute to reducing the prevalence and outcome of diseases such as hypertension, cardiovascular diseases, diabetes and respiratory diseases. Thus, prevention strategies require urgent attention globally.’
A rapidly developing evidence base demonstrates a link between academic performance and physical fitness (closely linked to physical activity) for children of all ages and socioeconomic groups. There is also an inverse association between physical fitness and reported violent and antisocial incidents in school. Physical education, games and sport for children have demonstrated positive impact on physical health, and affective, social and cognitive function. Furthermore, physical activity habits in childhood seem to determine, in part, adult physical activity behavior which is a key determinant of adult health. Yet school children spend an average of 7–8 h a day being sedentary (ie, sitting). Much of this waking time is spent sitting at school.
A recent editorial in the British Journal of Sports Medicine emphasizes the need for the promotion of physical activity for expectant mothers and young children, a message frequently forgotten by the public, doctors and obstetricians. Physical activity should be encouraged from birth. All children and young people should minimize the amount of time spent being sedentary.
How much physical activity should children get? Children of preschool age who are capable of walking unaided should be physically active daily for at least 180 min (3 h), spread across the day. Children and young people (aged 5–18 years) should engage in moderate-to-vigorous intensity physical activity for at least 60 min and up to several hours every day, with vigorous intensity weight-bearing activities that strengthen muscle and bone being incorporated at least 3 days a week.
A new study using data from 26 896 women and men investigated the relationship between sleep problems and risk of chronic pain in the low back and neck/shoulders, and whether physical exercise and body mass index (BMI) alter this association. Results showed that persons with sleep problems ‘sometimes’ and who exercised ≥1 hour per week had lower risk of chronic pain in the low back and neck/shoulders than inactive persons with a similar level of sleep problems. Likewise, persons with BMI <25 kg/cm2 and sleep problems ‘sometimes’ had lower risk of chronic pain in the low back and neck/shoulders than persons with BMI ≥25 kg/cm2 and a similar level of sleep problems. Study authors concluded therefore that sleep problems are associated with an increased risk of chronic pain in the low back and neck/shoulders. Regular exercise and maintenance of normal body weight may reduce the adverse effect of mild sleep problems on risk of chronic pain.
Low back pain (LBP) needs to be viewed not as a regional pain disorder but as part of a more general and widespread pain problem and this needs to be reflected in the diagnosis and management of patients. However, LBP and indeed musculoskeletal pain in general are associated with problems in other body systems as well. Patients with musculoskeletal disorders such as LBP and osteoarthritis report co-morbidities in other body systems more frequently than persons without these issues. LBP is the leading cause of years lived with disability in the world (an estimated 632 million people are affected). Chronic musculoskeletal pain has become the most common cause of severe long-term physical disability and a substantial burden on both individuals and societies. A recent review on the subject found that having pain in several sites compared to just one site is associated with poorer physical and mental function, poorer response to treatment and greater risk of chronicity and disability.