and serum specimens and either may be analysed. Thus, most investigations of zinc-associated clinical problems require analysis of specimens of plasma or serum. In certain situations it is appropriate to determine urinary excretion while whole blood, erythrocyte, leucocyte or hair concentrations are relevant to some studies.i-' Typical concentrations of zinc in these specimens are shown in Table 2. A few workers have monitored the zinc concentrations of plasma fractions (e.g. zinc bound to albumin, transferrin, and amino acids), in attempts to develop more sensitive parameters of zinc status than the total serum zinc concentration.' 7 However, this line of investigation has not proven helpful. Methods for plasma fractionation of zinc are complex, involving techniques such as electrophoresis and ultrafiltration, which require large volumes of sample and risk contamination errors. Results can be of academic interest but clinically useful markers of zinc status have not been identified. Analyses of tissues, foodstuffs Zinc is an essential trace element for animals and man.' It is a cofactor for a large number of enzymes in virtually all metabolic pathways, is a component of transcription activation factorsthe zinc fingers, is involved in neurotransmitter function, immune activity and the action of hormones such as insulin. Thus, zinc is of major importance in physiology and biochemistry and, by implication, to the health of the individual. Deficiency of zinc is manifest by a variety of symptoms (Table 1) and though uncommon, excessive exposure will also cause morbidity.? No more than 1% of the total body zinc is present in the circulation with around four-fifths of this fraction contained in the red cells. Plasma, therefore, contains about 0·2% of the total body load of zinc most of which is bound to albumin with the remainder found in 1)(-2 macroglobulin and amino acid complexes. High concentrations of zinc are found in tissues where cell turnover is rapid, such as the liver, testes and intestinal mucosa. The major zinc reservoirs include muscle, bone, skin and hair, but zinc is not readily mobilized from these sites in times of deficiency. Zinc deficiency will develop if there is inadequate dietary intake or absorption, excessive loss or failure to meet an increased demand. Investigation of zinc nutritional status is appropriate when there are symptoms suggestive of perturbation of zinc metabolism (Table 1), in patients receiving total parenteral nutrition, artificial diets or other nutritional setbacks, and where there is occupational exposure.? Despite the very low proportion of total body zinc in the plasma and the influence of the acute phase response, total plasma zinc concentration is the most useful indicator of deficiency.I: Concentrations of zinc are similar in plasma
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