Dietary Zinc Intake Research Articles

Δ5 and Δ6 desaturase indices are not associated with zinc intake as determined by dietary assessment or modified by a zinc-FADS1 rs174547 SNP interaction in young Canadian adults

BackgroundZinc is an essential trace mineral that serves as a cofactor for the delta-5 and delta-6 desaturases (D5D, D6D) that are critical for long-chain polyunsaturated fatty acid (LC-PUFA) synthesis. While plasma zinc levels are generally reported to be associated with D5D and D6D indices in humans, it remains unclear if dietary zinc intake can be similarly associated with desaturase indices. Therefore, the present investigation examined if zinc intake determined by food frequency questionnaire (FFQ) is associated with desaturase indices in young Canadian adults. Additionally, we explored whether desaturase indices were modified by an interaction between dietary zinc intake and a common variant in the FADS1 gene. MethodsDietary zinc intake (FFQ), plasma fatty acids (gas chromatography) and the FADS1 rs174547 polymorphism were analyzed in young men and women (n = 803) from the cross-sectional Toronto Nutrigenomics and Health Study. Product-to-precursor fatty acid ratios were used to determine desaturase enzyme indices (D5D = 20:4n-6/20:3n-6; D6D = 18:3n-6/18:2n-6). Individuals were grouped according to dietary zinc intake, as well as by their rs174547 genotype (TT vs. TC+CC). Data were analyzed by 1-way and 2-way ANCOVA. ResultsPlasma fatty acids and D5D/D6D indices did not differ between individuals grouped according to dietary zinc intake. Further, the recently proposed biomarker of zinc intake, 20:3n-6/18:2n-6, was not associated with dietary zinc intake. Although the FADS1 rs174547 SNP was significantly associated with D5D and D6D indices in both men and women (p < 0.0001), we did not find evidence of a dietary zinc intake – FADS1 SNP interaction on D5D or D6D indices. ConclusionDietary zinc intake, as determined using FFQs, does not predict differences in desaturase indices, irrespective of FADS1 genotype.

Maternal Zinc, Copper, and Selenium Intakes during Pregnancy and Congenital Heart Defects.

The effects of zinc, copper, and selenium on human congenital heart defects (CHDs) remain unclear. This study aimed to investigate the associations of the maternal total, dietary, and supplemental intakes of zinc, copper, and selenium during pregnancy with CHDs. A hospital-based case-control study was performed, including 474 cases and 948 controls in Northwest China. Eligible participants waiting for delivery were interviewed to report their diets and characteristics in pregnancy. Mixed logistic regression was adopted to examine associations and interactions between maternal intakes and CHDs. Higher total intakes of zinc, selenium, zinc to copper ratio, and selenium to copper ratio during pregnancy were associated with lower risks of total CHDs and the subtypes, and the tests for trend were significant (all p < 0.05). The significantly inverse associations with CHDs were also observed for dietary intakes of zinc, selenium, zinc to copper ratio, selenium to copper ratio, and zinc and selenium supplements use during pregnancy and in the first trimester. Moreover, high zinc and high selenium, even with low or high copper, showed a significantly reduced risk of total CHDs. Efforts to promote zinc and selenium intakes during pregnancy need to be strengthened to reduce the incidence of CHDs in the Chinese population.

Zinc Intakes and Health Outcomes: An Umbrella Review.

It is widely accepted that the zinc element is crucial in human beings. Zinc has gained more attention during the COVID-19 pandemic due to its utilization for the treatment and prevention of respiratory tract infections. However, some studies also pointed out that zinc intake might cause unwanted side effects and even be dangerous when overdosed. To reveal the relationship between zinc intake and health outcomes, we performed an umbrella review from human studies. In total, the umbrella review included 43 articles and identified 11 outcomes for dietary zinc intake and 86 outcomes for supplementary zinc intake. Dietary zinc intake in the highest dose would decrease the risk of overall and specific digestive tract cancers, depression, and type 2 diabetes mellitus (T2DM) in adults. Supplementary zinc consumption in adults was linked to an improvement of depression, antioxidant capacity and sperm quality, higher serum zinc concentration, and lower concentration of inflammatory markers. Zinc supplementation in children would reduce the incidence of diarrhea and pneumonia, improve zinc deficiency and boost growth. However, zinc might not decrease all-cause mortality in adults or the in-hospital mortality of COVID-19. And better maternal and neonatal outcomes may not derive from pregnant women who consumed higher or lower doses of zinc supplementation (>20 mg/day and <20 mg/day, respectively). Dose-response analyses revealed that a daily 5 mg increment of zinc would lower the risk of colorectal and esophageal cancer, whereas a large dose of zinc supplementation (daily 100 mg) showed no benefit in reducing prostate cancer risk.

Biofortified Wheat Increases Dietary Zinc Intake: A Randomised Controlled Efficacy Study of Zincol-2016 in Rural Pakistan.

A new variety of zinc biofortified wheat (Zincol-2016) was released in Pakistan in 2016. The primary aim of this study was to examine the effects of consuming Zincol-2016 wheat flour on biochemical and functional markers of zinc status in a population with widespread zinc deficiency. An individually-randomised, double-blind, placebo-controlled cross over design was used. Fifty households were recruited to participate in the study, with each household included at least one woman of reproductive age (16–49 years) who was neither pregnant nor breast feeding or currently taking nutritional supplements. All households were provided with control flour for an initial 2-week baseline period, followed by the intervention period where households were randomly allocated in a 1:1 ratio to receive biofortified flour (group A; n = 25) and control flour (group B; n = 25) for 8-weeks, then switched to the alternate flour for 8-weeks. The trial has been registered with the ISRCTN (https://www.isrctn.com), ID ISRCTN83678069. The primary outcome measure was plasma zinc concentration, and the secondary outcome measures were plasma selenium and copper concentrations, plasma copper:zinc ratio and fatty acid desaturase and elongase activity indices. Nutrient intake was assessed using 24-h dietary recall interviews. Mineral concentrations in plasma were measured using inductively coupled plasma mass spectrometry and free fatty acids and sphingolipids by mass spectrometry. Linear Mixed Model regression and General Linear Model with repeated measures were used to analyse the outcomes. Based on an average flour consumption of 224 g/day, Zincol-2016 flour provided an additional daily zinc intake of between 3.0 and 6.0 mg for white and whole grain flour, respectively. No serious adverse events were reported. This resulted in significant, increase in plasma zinc concentration after 4 weeks [mean difference 41.5 μg/L, 95% CI (6.9–76.1), p = 0.02]. This was not present after 8 weeks (p = 0.6). There were no consistent significant effects of the intervention on fatty acid desaturase and elongase activity indices. Regular consumption of Zincol-2016 flour increased the daily zinc intake of women of reproductive age by 30–60%, however this was not associated with a sustained improvement in indices of zinc status.

Dietary Trace Element Intake and Risk of Breast Cancer: A Mini Review.

Trace elements are essentially required for various physiological and metabolic functions, and any disturbance in the trace elements homeostasis may result in the development of chronic diseases including breast cancer. Breast cancer is the most prevalent cancer type reported in women equally affecting both the high-income and low-income countries. This review therefore aimed to evaluate the impact of dietary trace element intake in relation to the incidence of breast cancer. We focused on five trace elements, thus emphasizing dietary selenium, zinc, iron, copper, and cadmium intake and risk of breast cancer. A systematic approach was applied to perform this review through entering a search term in PubMed and Scopus databases. A total of 24 articles were included after meeting the inclusion and exclusion criteria. Most of the studies regarding dietary iron intake showed a detrimental effect of increased dietary heme iron on breast cancer incidence risk. In addition, there is a limited evidence of high dietary intake of selenium and zinc to reduce the risk of breast cancer. Also, a few studies showed a relationship between high cadmium consumption and risk of breast cancer. More studies related to cadmium and copper exposure are needed to confirm this relationship. As a result, the findings of this review suggested that high dietary heme iron is a potential risk factor for breast cancer.

Correlation Between Zinc Nutritional Status with Serum Zonulin and GastrointestinalSymptoms in Diarrhea-Predominant Irritable Bowel Syndrome: A Case-Control Study.

Zinc is known to have a critical role in the maintenance of intestinal homeostasis, immune cells, and anti-diarrheal and anti-inflammatory actions. The aim of this study was to evaluate the correlation between zinc status with serum zonulin and gastrointestinal symptoms in diarrhea-predominant patients with irritable bowel syndrome (IBS-D). This case-control study included 61 newly diagnosed IBS-D patients and 61 healthy matched controls. Dietary zinc intake, serum zinc, and zonulin levels were measured. IBS severity was evaluated using the IBS severity score system (IBS-SSS) questionnaire. Serum zinc levels were lower in the IBS-D group compared with the controls (p = 0.001). Serum zinc was negatively correlated with serum zonulin in IBS-D patients (r = - 0.271; p = 0.035). Also, a reverse association between the serum zinc and odds of IBS-D was found [OR = 0.979; 95% CI (0.966-0.992)]. Our results suggest that zinc may have a role in the pathogenesis of IBS. However, clinical trial studies are warranted to evaluate this finding.

Perceived immune fitness, depression, and dietary zinc intake

Perceived immune fitness, depression, and dietary zinc intake

The impact of past year’s immune fitness and dietary zinc intake on subjective intoxication and alcohol hangover severity

The impact of past year’s immune fitness and dietary zinc intake on subjective intoxication and alcohol hangover severity

Dietary iron and zinc intakes and nonalcoholic fatty liver disease: A meta-analysis.

The differences of dietary iron and zinc intakes between patients with nonalcoholic fatty liver disease (NAFLD) and controls remain controversial. The meta-analysis aimed to explore the differences of dietary iron and zinc intakes between NAFLD patients and healthy subjects. A systematic literature search was performed up to July 2021 in databases of PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), and Wanfang. Using a randomeffects model, the differences of dietary iron and zinc intakes between cases and controls were calculated as standardized mean differences (SMDs) with 95% confidence intervals (CIs). A total of 21 studies from 19 articles with 6639 cases were included. The pooled estimate showed no difference in dietary iron consumption in the NAFLD groups compared with control groups. The difference became significant in Asia (SMD=0.16; 95% CI: 0.04, 0.28; I2=89.1%; pheterogeneity<0.001) as well as in cross-sectional studies (SMD=0.12; 95% CI: 0.07, 0.17; I2=4.7%; pheterogeneity=0.350). The difference in dietary zinc intake between cases and controls was not significant. We noticed a statistically significant increase of dietary zinc intake in NAFLD compared to controls in studies using food-frequency questionnaire (FFQ) to evaluate dietary intake (SMD=0.15; 95% CI: 0.10, 0.20; I2=12.2%; pheterogeneity=0.332). Our findings indicated that dietary iron intake in patients with NAFLD was higher than healthy subjects in Asia.

Iron, Zinc and Copper from Cereal Food Sources and Cognitive Performance in Older Adults in China.

Background:We aimed to determine the risk factors associated with cognitive performance in older adults in China.Methods:A longitudinal study was conducted in a group of 1,898 adults aged 60 yr and over in China, Cognitive score was determined by a modified Telephone Interview for Cognitive Status (TICSM). The dietary intake of iron (Fe), zinc (Zn) and copper (Cu) from cereal source foods (CSF) were calculated by using Food Frequency Questionnaire (FFQ) and Chinese Food Composition Tables. Descriptive statistics and multivariate mixed regression models were utilized to explore the association between the intake of these elements and cognitive function.Results:The mean dietary intakes of Fe, Zn and Cu from CSF were 12.01, 6.90 and 1.30 mg/d respectively. Compared with participants in the high-cognitive group, those in the low-cognitive group had lower total dietary intakes of Fe, Zn and Cu. However, with respect to ratios of CSF-Zn, CSF-Fe and CSF-Cu to their respective total values, participants in the low-cognitive group had significantly higher ratios than those in the high-cognitive group. The results of multivariate mixed regression model revealed that although total dietary Zn intake was positively linked with cognitive function, the CSF-Zn/Zn ratio was negatively associated with cognitive performance.Conclusion:Excessive intake of Zn from a specific food source, such as CSF, was found to be negatively associated with cognitive status. Avoiding over-intake of Zn from CSF foods and diversifying intake of Zn from different food sources seemed to protect individuals from cognitive decline.

Influence of Dairy Products on Bioavailability of Zinc from Other Food Products: A Review of Complementarity at a Meal Level.

In this paper, we reviewed the role of dairy products in dietary zinc absorption. Dairy products can have a reasonable contribution for dietary zinc intake in Western diets, where dairy consumption is high. However, the co-ingestion of dairy products can also improve zinc absorption from other food products. Such improvements have been observed when dairy products (e.g., milk or yoghurt) were ingested together with food such as rice, tortillas or bread products, all of which are considered to be high-phytate foods with low inherent zinc absorption. For foods low in phytate, the co-ingestion of dairy products did not improve zinc absorption. Improved zinc absorption of zinc from high-phytate foods following co-ingestion with dairy products may be related to the beneficial effects of the citrate and phosphopeptides present in dairy products. Considering that the main dietary zinc sources in areas in the world where zinc deficiency is most prevalent are typically high in phytate, the inclusion of dairy products in meals may be a viable dietary strategy to improve zinc absorption.

A Retrospective Cross-Sectional Cohort Trial Assessing the Prevalence of MTHFR Polymorphisms and the Influence of Diet on Platinum Resistance in Ovarian Cancer Patients.

Simple SummaryOvarian cancer (EOC) has a very poor prognosis, with a 5-year survival rate of just 43%. One of the biggest challenges is the resistance to standard chemotherapeutics. Nutrition modification is a potential adjunct that may be suitable to support cancer therapies through epigenetic modifications of DNA and biochemical pathways associated with drug response. It was retrospectively hypothesised that carrying a methylenetetrahydrofolate reductase (MTHFR) gene polymorphism may affect chemo response in EOC, and that nutrient status may further influence response to standard platinum therapy. This small pilot study of twenty-five participants provided a novel foundation for identifying that dietary intake of vitamins B12, B6 and zinc may impact platinum-drug response in EOC dependent on MTHFR genotype. Further large-scale investigations are required to verify the findings of this study.Ovarian cancer has the lowest survival rate in gynaecologic malignancies with a 5-year survival rate of 43%. Platinum resistance is one of the main drivers of ovarian cancer mortality, of which aberrant methylation has been cited as a significant contributor. Understanding the essential role of the methylenetetrahydrofolate reductase enzyme (MTHFR) on DNA synthesis and repair, and how nutrient status can vastly affect its performance, led to the investigation of MTHFR status and dietary influence on platinum response in epithelial ovarian cancer (EOC) patients. Twenty-five adult female patients who completed first-line platinum-based chemotherapy for primary ovarian cancer were selected from Icon Cancer Centres in Australia. Participants were grouped based on platinum response. A full medical and family history, food frequency questionnaire and single blood test were completed, testing for MTHFR polymorphisms, serum folate, serum and active B12 and homocysteine levels. Nineteen of twenty-five participants had an MTHFR polymorphism. Of those, 20% were compound heterozygous, 12% were heterozygous C677T (CT), 4% homozygous C677T, 12% homozygous A1298C and 28% were heterozygous A1298C (AC). Statistically significant associations were found between dietary zinc (p = 0.0086; 0.0030; 0.0189) and B12 intakes in CT genotypes (p = 0.0157; 0.0030; 0.0068) indicating that zinc or vitamin B12 intakes below RDI were associated with this genotype. There were strong associations of vitamin B6 intakes in AC genotypes (p = 0.0597; 0.0547; 0.0610), and dietary folate in compound heterozygotes with sensitive and partially sensitive disease (p = 0.0627; 0.0510). There were also significant associations between serum folate (p = 0.0478) and dietary B12 (p = 0.0350) intakes above RDI and platinum sensitivity in wild-types as well as strong associations with homocysteine levels (p = 0.0886) and zinc intake (p = 0.0514). Associations with dietary B12 (p = 0.0514) and zinc intakes (p = 0.0731) were also strong in resistant wild types. Results indicate that dietary zinc, B12 and B6 intakes may be associated with platinum sensitivity dependent on MTHFR genotype. These results require further research to clarify the dosages necessary to elicit a response; however, they provide a novel foundation for acknowledging the role of diet on treatment response in EOC.

Effect of Zinc Deficiency on Blood Glucose, Lipid Profile, and Antioxidant Status in Streptozotocin Diabetic Rats and the Potential Role of Sesame Oil.

Zinc is recognized to have a crucial function in insulin production. As a result, its absence may have a deleterious impact on the progression of diabetes and associated consequences. So, this study was undertaken to evaluate the effect of sesame oil on biochemical parameters, zinc status, and oxidative stress biomarkers in streptozotocin (STZ)-induced diabetic rats fed zinc-deficient diet. Rats were divided into four groups. The first group consisted of non-diabetic rats that were fed in a sufficient zinc diet, whereas the second was a diabetic group which received also sufficient zinc diet, while the third and fourth groups were diabetic rats fed in a deficient zinc diet, one was non-treated and the other was treated with sesame oil 6% diet for 27days. Zinc deficiency has affected the weight of the diabetic animals. It was also noticed that inadequate dietary zinc intake increased concentrations of glucose, cholesterol, triglycerides, malondialdehyde, and transaminases activities. Furthermore, zinc deficiency feed provoked a decrease in zinc level in tissues (femur, liver, and pancreas); glutathione concentration; and lactic dehydrogenase, amylase, catalase, superoxide dismutase, and glutathione-S-transferase activities. However, sesame oil treatment ameliorated all the previous parameters approximately to their normal values. It was found out that sesame oil supplementation is a potent factor in mitigating the oxidative severity of zinc deficiency in diabetes through its effective antioxidant potential.

Dietary Zinc, Copper, and Selenium Intake and High-Risk Human Papillomavirus Infection among American Women: Data from NHANES 2011–2016

Studies have shown that the micronutrients, zinc (Zn), copper (Cu), and selenium (Se) are associated with the HPV-associated cervical cancer, yet between dietary Zn/Cu/Se intake and high-risk HPV (hrHPV) infection remain unclear. We obtained publicly available data in the present cross-sectional study from the National Health and Nutrition Examination Survey (NHANES) performed between 2011 and 2016. Dietary Zn, Cu, and Se intakes were assessed from two 24-h diet recalls. A total of 4628 female with the age of 18–59 years were included in this secondary analysis. Comparing the highest with the lowest quartiles of Zn intake, the adjusted odds ratio (aOR) for hrHPV infection was 0.72 (95% CI, 0.54–0.98). The aOR upon comparison of the quartile three with the lowest quartile of Cu intake was 0.67 (95% CI, 0.50–0.90). Whereas no significant association was found between intakes of Se and hrHPV infection in multivariate analysis. Moreover, compared with those below the Recommended Dietary Allowance (RDA), hrHPV infection risk was significantly decreased among women who met the RDA for Cu (aOR: 0.74; 95% CI = 0.60–0.92), but not for Zn and Se. In conclusion, high dietary Zn and moderate copper intakes were independently and negatively associated with hrHPV infection in addition to Se.

U-shaped Association Between Dietary Zinc Intake and New-onset Diabetes: A Nationwide Cohort Study in China.

We aimed to investigate the relationship of dietary zinc intake with new-onset diabetes among Chinese adults. A total of 16 257 participants who were free of diabetes at baseline from the China Health and Nutrition Survey were included. Dietary intake was measured by 3 consecutive 24-hour dietary recalls combined with a household food inventory. Participants with self-reported physician-diagnosed diabetes, or fasting glucose ≥ 7.0 mmol/L, or glycated hemoglobin ≥ 6.5% during the follow-up were defined as having new-onset diabetes. A total of 1097 participants developed new-onset diabetes during a median follow-up duration of 9.0 years. Overall, the association between dietary zinc intake and new-onset diabetes followed a U-shape (P for nonlinearity < 0.001). The risk of new-onset diabetes was significantly lower in participants with zinc intake < 9.1 mg/day (per mg/day: hazard ratio [HR], 0.73; 95% CI, 0.60-0.88), and higher in those with zinc intake ≥ 9.1 mg/day (per mg/day: HR, 1.10; 95% CI, 1.07-1.13). Consistently, when dietary zinc intake was assessed as deciles, compared with those in deciles 2-8 (8.9 -<12.2 mg/day), the risk of new-onset diabetes was higher for decile 1 (<8.9 mg/day: HR, 1.29; 95% CI, 1.04-1.62), and deciles 9 to 10 (≥12.2 mg/day: HR, 1.62; 95% CI, 1.38-1.90). Similar U-shaped relations were found for plant-derived or animal-derived zinc intake with new-onset diabetes (all P for nonlinearity < 0.001). There was a U-shaped association between dietary zinc intake and new-onset diabetes in general Chinese adults, with an inflection point at about 9.1 mg/day.

The Relationship of Dietary Intake of Zinc, Selenium, and Magnesium and Anthropometric Profiles with Depression in Female Medical Students at Zahedan University of Medical Sciences

Background: Depression, as the second leading cause of dysfunction, is one of the most common mental health disorders. Given that micronutrients have always played a significant role in all physical and psychological aspects of individuals. This study was conducted to investigate the relationship of dietary intake of Selenium, Magnesium, Zinc, and anthropometric profiles with depression in female students at Zahedan University of Medical Science, Zahedan, Iran. Methods: In this cross-sectional study, 200 female medical students of Zahedan University of Medical Sciences participated. The amount of dietary intake of Selenium, Magnesium, and Zinc were measured by Food Frequency Questionnaire (FFQ). For determining the depression score, Beck anxiety questionnaire was administered. To analyze the data, SPSS 22 software was used. Results: The mean of age, body mass index, waist-to hip ratio and waist-to-height ratio were 23.41 ± 2.26 years, 23.54 ± 4.49 kg/m2, 0.85 ± 0.08, and 0.59±0.10, respectively. The mean daily intake of Magnesium, Zinc, and Selenium were 196.37 ± 42.08 mg, 7.38 ± 3.41 mg, and 106.52 ± 31.69 mg, respectively. The mean of depression score was 31.21±10.58. Zinc and Magnesium intake had a significantly strong inverse relationship with depression score and anthropometric indices. Conclusions: The findings showed that Zinc and Magnesium intake as well as anthropometric indices had a significant inverse relationship with depression score. However, the association between Selenium intake and depression score was not significant.

Serum zinc and dietary intake of zinc in relation to risk of different breast cancer subgroups and serum levels as a marker of intake: a prospective nested case-control study

PurposeZinc has been suggested to be protective against breast cancer, but the evidence remains inconclusive. One reason for inconsistent findings in previous studies may be that zinc only influences the risk of developing certain subtypes of breast cancer. Our study is the first study assessing zinc levels in relation to the risk of different breast cancer subgroups, defined by their tumor characteristics. In addition, we analyze serum zinc as a marker of dietary intake.MethodsThe Malmö Diet and Cancer Study is a population-based cohort study that took place 1991–1996 in Malmö, Sweden. Until end of follow-up, 31 December 2013, 1186 incident cases were identified and matched to an equal number of controls. Odds ratios (ORs) for breast cancer, and having a certain tumor characteristic, were estimated in quartiles of baseline serum zinc and zinc intake and adjusted for potential confounders.ResultsNo associations were found between zinc, measured in serum or diet pre-diagnostically, and breast cancer risk. The adjusted OR for breast cancer in serum zinc Q4 compared to Q1 was 1.09 (0.85–1.41) and in zinc intake Q4 versus Q1 was 0.97 (0.77–1.23). Moreover, there were no clear associations between zinc and any breast cancer characteristics. The kappa value, 0.025 (P = 0.022), showed poor agreement between serum zinc and zinc intake.ConclusionOur findings indicate that there is no clear association between zinc and overall breast cancer risk or risk of different breast cancer subgroups. Finally, our results suggest that serum zinc is a poor marker of zinc intake.

The role of zinc in the prevention and treatment of nonalcoholic fatty liver disease

The zinc element is an essential nutrient for human health. Zinc is involved in the glucose, lipid, and protein metabolism and antioxidant processes in biological pathways. Zinc deficiency can lead to several chronic liver diseases. Nonalcoholic fatty liver disease (NAFLD) is one of the most common liver diseases where zinc deficiency plays a critical role in pathogenesis. Human and animal studies showed that both NAFLD risk factors (i.e., insulin resistance, diabetes mellitus, dyslipidemia, obesity, hypertension) and NAFLD itself are associated with decreased blood levels of zinc. Additionally, endoplasmic reticulum stress and inflammation due to unfolded protein response, inadequate dietary zinc intake, and decreased zinc absorption from the gastrointestinal tract can result in zinc deficiency leading to NAFLD. Herein, we reviewed the mechanistic links between zinc deficiency and NAFLD development and the role of zinc in the prevention and treatment of NAFLD.

Dietary Antioxidant Micronutrient Intake and Toxicity during Remission Induction in Children with Acute Lymphoblastic Leukemia (ALL): Results from Dana-Farber Cancer Institute (DFCI) ALL Consortium Trial 05-001

Introduction: Treatment related toxicities are a major contributor to morbidity during induction therapy in childhood ALL. Our prior study in 103 children with ALL suggested that low intakes of antioxidant micronutrients were associated with toxicity and delays in chemotherapy administration (Am J Clin Nutr 79:1029, 2004). The objective of this study was to examine whether inadequate antioxidant micronutrient dietary intake in children with ALL is associated with episodes of infection or ≥grade 3 mucositis during Remission Induction.Methods: Assessment of dietary intake was collected in patients (pts) ages 1-17.9 years enrolled on the DFCI ALL Consortium Protocol 05-001 from 2005-2011. Institutional review board approval was obtained by each of the 9 participating centers. Grade 3 or higher (NCI CTCAEvs) mucositis, culture positive bacteremia and fungemia, and radiographic invasive fungal disease were prospectively collected. Dietary intake was assessed with the Harvard Service Food Frequency Questionnaire (FFQ) for children ages 1-5 years and the Youth and Adolescent Harvard FFQ for children ages 5-18 years and queried about intake in the past 30 days at the end of induction. Dietary antioxidant intake from food sources ± supplementation was examined by comparing consumption above and below recommended intake for age and sex as per the Dietary Reference Intake (DRI). Micronutrient intake was summarized with descriptive statistics and plotted by the presence/absence of a given toxicity in induction. Categorical and continuous variables were compared between group with the Fisher's exact test and the Wilcoxon rank sum test respectively. Logistic regression was used to model the probability of a given toxicity univariately and with a multivariable adjustment for sex and age.Results: Among 794 eligible pts, 561 (71%) had analyzable FFQs. The sample with dietary surveys responses was marginally younger (p=0.06) and more often classified as initial standard risk (p=0.01) than those with no end of induction survey. DRI recommendations were not met for vitamin C (18%), vitamin E (67%) and zinc (12%); 39% of pts reported zinc overconsumption. 141 (25%) of pts with dietary data had ≥1 bacterial and/or fungal infection, 131 (23%) had ≥1 bacterial infection, and 19 (3%) had ≥1 fungal infection. 24 (4%) pts experienced at least 1 event of ≥grade 3 mucositis. Female sex was associated with overall and bacterial infection (p=0.02) and marginally with mucositis (p=0.06). The proportion of patients with ≥Grade 3 mucositis was marginally higher (p=0.06) for those not meeting the vitamin C recommendation (OR=2.3; 95% CI 1.0-5.5), but was not significant (p=0.10) in a multivariable model. Supplementation was reported by 88 (16%) for zinc, vitamins C, E, and A in combination, 16 (3%) for β-carotene and total carotene, and 87 (15%) for vitamin E alone. Intake levels of vitamins C, E, and A, zinc and total carotenoids from food sources and total (food + supplementation) were compared for pts with and without infection and mucositis (unadjusted for age/sex) (Figure 1). Bacterial infection was associated with low intake from food only of zinc (p=0.02), vitamin A (p=0.01), and vitamin E (p=0.049). Mucositis was associated with the following: low intakes of vitamin C from food (p=0.04), vitamin E from food (p=0.03), total lycopene (p=0.03), total α-carotene (p=0.01), total β-carotene (p=0.007) and from food (p=0.008), total carotene (p=0.005) and carotene from food (p=0.006), and total vitamin A (p=0.01) and vitamin A from food (p=0.004). Females age <10 had higher rates of bacterial infection with low β-carotene (p=0.05) and vitamin A from food (p=0.004). In males age ≥10, low vitamin E from food was observed in those with bacterial infections (p=0.05). Supplementation did not confer an added benefit for most nutrients.Conclusions: Confirming our pilot study, data from a large prospective cohort show that low dietary intakes of antioxidant vitamins, carotenoids and zinc primarily from food sources predict risk for bacterial infection or mucositis during induction therapy for childhood ALL. Dietary supplementation for most vitamins and minerals did not confer an added benefit for prevention of infection or mucositis over levels obtained from food. Our results suggest a possible modifiable dietary intervention to reduce toxicity during induction therapy for ALL. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Iron status predicts cognitive test performance of primary school children from Kumasi, Ghana.

BackgroundGood nutritional status of school-aged children is crucial in achieving improved cognition. The objective of this study was to assess the relationship between nutritional status and cognition of school-aged children in the Kumasi metropolis, Ghana.Methods389 children were selected from ten government-owned schools. Socio-demographic and anthropometric data were collected. Blood samples were collected and analyzed for nutrients levels. Dietary intakes were assessed using food frequency questionnaire and previous day’s nutrients intake. Cognition test was performed using the Ravens Colored Progressive Matrix (RCPM).ResultsMean age of participants was 8.9±1.4 years, mean RCPM score was 17.9±5.4. More girls scored RCPM below the 40th percentile (45.5%) than boys (33.7%), while mother’s level of education significantly associated with RCPM percentiles of the children (p = 0.037). Four dietary patterns were generated from food frequency data, and scores of the second pattern, depicting vegetables, non-fruits, bread and cereals, showed a weak negative correlation (r = -0.132, p = 0.026) with previous day’s dietary zinc intake. Cognitive status did not vary by anthropometric and dietary patterns. More anemic (54.4%) than non-anemic (33.3%) children were below the 40th RCPM percentile. Mean previous day’s intake for folate (p<0.001), vitamin B6 (p = 0.018), iron (p<0.001), and zinc (p = 0.001) differed significantly between the cognitive test score percentiles of the children. Spearman rank correlation showed weak positive associations between RCPM score and hemoglobin (r = 0.246, p = 0.003) and serum ferritin (r = 0.176, p = 0.036). Binary regression analysis showed anemic children (aOR = 0.4; 95%CI = 0.2–0.8, p = 0.014), compared with non-anemic had decreased odds, while boys, compared with girls had increased odds (aOR = 2.0 95%CI = 1.0–4.0, p = 0.035) for scoring above the 50th RCPM percentile.ConclusionsIron status, especially hemoglobin levels, correlated with the cognitive performance of school-aged children in the metropolis. Thus nutritional strategies aimed at reducing iron deficiency anemia are needed.