Low Plasma Zinc Concentrations Research Articles

Zinc – a scoping review for Nordic Nutrition Recommendations 2023

Zinc is essential for several biological processes including those critical for the immune system, DNA synthesis, cell division, and growth. Zinc is involved in the pathophysiology of chronic diseases and protects proteins and lipids from oxidative damage. Inadequate zinc intake and low plasma zinc concentration are associated to an increased risk of chronic diseases such as cardiovascular diseases and type 2 diabetes; however, the evidence is limited. Zinc deficiency increases the risk of infections and poor growth and may contribute to the high burden of infectious diseases and stunting in children living in low- and middle-income countries. The risk of zinc deficiency in the populations of the Nordic and Baltic countries is low.

Deficiência de zinco na doença de Alzheimer: um estudo transversal com grupo comparação

Abstract Objective To identify whether there is a difference in plasma and erythrocyte zinc concentration in older adults with and without Alzheimer's disease. Methods Crosssectional study with a comparative group, conducted with older adults with and without Alzheimer's disease, matched by sex, education, and age. Zinc concentration was measured by atomic absorption spectrophotometry in a graphite furnace. Results There were 102 people, 68 in the healthy group (NDA-g) and 34 in the group with disease (AD-g). The AD-g group had lower plasma zinc concentrations and higher frequency in the first quartile for intraerythrocyte zinc concentrations. Plasma and erythrocyte concentrations did not correlate with the time of diagnosis and age in both groups. In the logistic regression analysis, plasma concentration was associated with AD-g (OR=0.964; p=0.028). Conclusion Older people with Alzheimer's disease have lower plasma and erythrocyte zinc concentrations.

Энтеропатический акродерматит у детей

Enteropathic acrodermatitis is a rare hereditary form of zinc deficiency, characterized by periorial and acral dermatitis, alopecia and diarrhea. Refers to congenital disorders of zinc metabolism, inherited as an autosomal recessive disease resulting from mutations in the gene for the zinc transporter SLC39A4. The prevalence ranges from 1 to 9:1,000,000, with an overall incidence of 1:500,000 newborns. The disease usually manifests itself in infancy, within a few weeks of stopping breastfeeding and switching the baby to a cow's milk-based formula, or in the first days of life if artificially fed from birth. The classical clinical manifestations of acrodermatitis enteropathic are characterized by the triad: acral and periofital dermatitis, alopecia and diarrhea, but all three signs together occur only in 20% of cases. Diarrhea may develop concurrently with skin symptoms, may precede or occur later. Characteristic signs of skin lesions include sharply demarcated, dry, scaly erythematous plaques or edematous foci with vesicles and pustules on the skin of the elbow and knee joints, distal extremities, genitals, in the inguinal folds, which are usually symmetrically distributed, have sharp boundaries and irregular outlines. The course of the skin syndrome is long, as it progresses, non-healing erosive and ulcerative areas appear. Plasma zinc deficiency is the gold standard for diagnosis. Most infants with AE have low plasma zinc concentrations (<500 mcg/L or <50 mcg/dl), but a level of less than 70 mcg/L on an empty stomach or less than 65 mcg/dl in older non-dieting children is considered diagnostically significant. Treatment for this disease usually includes enteral or parenteral zinc administration, at a dose of 1-3 mg/kg/day. for elemental zinc. A clinical response is observed within 5–10 days. Supportive zinc therapy is necessary throughout the patient's life, although periods of remission have been reported. Topical therapy is also used: Dexpanthenol in the form of a cream, applied 3 times a day in the area of dermatitis, can enhance re-epithelialization. There is no significant evidence of improvement with topical zinc application. No activity restrictions are required for patients with acrodermatitis enteropathic. Key words: zinc deficiency, enteropathic acrodermatitis, children

Severe undernutrition increases bleeding risk on vitamin-K antagonists

Hemorrhage occurs in 7-10% of patients treated with vitamin K antagonist (VKA), with major bleeding in 1-3%. Impact of nutritional status on the bleeding risk of patients on anticoagulants is still poorly documented. Our study aimed to analyze the link between the nutritional status of patients on VKA and the occurrence of hemorrhagic events. We also analyzed micronutrients status. A case-control, monocentric, and prospective study was conducted from August 2012 to October 2015. The case patients were those presenting with major bleeding and control patients those without any bleeding under VKA treatment. Overall, 294 patients under VKA treatment were paired according to age, gender, and index normalized ratio (INR). Out of these, 98 (33.3%) had major bleeding and 196 (66.7%) did not have any bleeding. Additionally, more than two-thirds of patients displayed undernutrition, which was more prevalent in bleeding than non-bleeding patients (OR=1.85, CI95%: 1.07-3.21). There was a higher bleeding risk for those with severe undernutrition (OR=2.66, CI95%: 1.58-4.46), with no difference found concerning moderate undernutrition. Bleeding patients had lower plasma-zinc concentrations than non-bleeding patients (9.4±3.6 vs. 10.5±3.7μmol/L, p=0.003); among them, there was a higher rate of patients with plasma zinc under 5μmol/L (9% vs. 2%, p<0.001). Patients with undernutrition on VKA exhibit a significantly higher bleeding risk, which increases three-fold in case of severe undernutrition. The evaluation of nutritional status provides additional, valuable prognosis information prior to initiating VKA therapy. CLINICALTRIALS. NCT01742871.

Considerations on the Influence of Zinc on Infectious Diseases in Children

Zinc modulates the human body defence against infections. Mild and medium deficiency in this mineral appears usually sub-clinically, being mistaken for other diseases, but the severe form can be fatal. The purpose of the study was to determine the plasma zinc concentration (PZC) for the most common infectious pathology in children. Zinc was measured in plasma using direct colorimetric assay based on the 5-Br-PAPS method (CV% 0.98-4.64%). In the paediatric patients, 0-3 years old, the PZC values were 15.20�1.37 μmol/L, with limits ranging between 13.05-20.6 μmol/L, the values falling within normal limits and proving the absence of zinc deficiency in the investigated population. During 3 years of follow up, 137 healthy children presented low values of plasma zinc concentration if they had acute lower respiratory infections, acute otitis media or giardiasis in past medical history. There were not found significant differences in case of children with viral or bacterial acute diarrheal diseases or viral exanthemas. In the present study, the children exposed to severe, complicated or chronic forms of infectious diseases were predisposed to low plasma zinc concentrations.

Plasma and Nail Zinc Concentrations, But Not Hair Zinc, Respond Positively to Two Different Forms of Preventive Zinc Supplementation in Young Laotian Children: a Randomized Controlled Trial

Plasma zinc concentrations (PZC) have been shown to significantly increase during zinc supplementation. This study investigated the effects of daily preventive zinc supplementation on hair and nail zinc concentrations compared with a control group. In a randomized controlled trial, 6- to 23-month-old children (n = 3407) in Lao PDR were randomly assigned to one of four groups and followed for ~ 36 weeks: daily preventive zinc dispersible tablet (7 mg/d; PZ), daily micronutrient powder (10 mg zinc/d; MNP), therapeutic zinc supplements for diarrhea treatment (20 mg/d for 10 days; TZ), or daily placebo powder (Control). Plasma, hair, and nail zinc concentrations were assessed in a sub-sample of participants (n = 457) at baseline and endline. At baseline, 75% of children had low PZC (< 65 μg/dL). At endline, geometric mean (95% CI) PZC were greater in the PZ and MNP groups compared with the TZ and control groups (P < 0.01), but hair zinc concentrations did not differ among groups (P = 0.99). Nail zinc concentrations were marginally higher in the PZ (115.8 (111.6, 119.9) μg/g) and the MNP (117.8 (113.3, 122.3) μg/g) groups than in the TZ group (110.4 (106.0, 114.8) μg/g; P = 0.055) at endline. This study does not support the use of hair zinc as a biomarker of zinc exposure in young children. However, it provides some evidence that zinc concentrations in nails may respond to supplemental zinc interventions and supports the need for collecting additional data on this emerging biomarker.

Effect of exogenous phytase added to small-quantity lipid-based nutrient supplements (SQ-LNS) on the fractional and total absorption of zinc from a millet-based porridge consumed with SQ-LNS in young Gambian children: a randomized controlled trial

Dietary phytate inhibits zinc absorption from composite meals in adults. The objective of this study was to investigate the effect of adding exogenous phytase to a small-quantity lipid-based nutrient supplement (SQ-LNS) on zinc absorption among young children. In a double-blind randomized controlled trial, intraindividual differences in fractional and total absorption of zinc (FAZ and TAZ, respectively) from a millet-based porridge containing SQ-LNS with and without phytase were measured in 30 asymptomatic children 18-23 mo of age in the Kiang West district of The Gambia. Using a crossover design, children received for 1 d each porridge test meals with 20 g SQ-LNS containing 8 mg zinc and either 1) exogenous phytase or 2) no exogenous phytase. The test meals were provided on consecutive days in randomized order. FAZ was measured using a triple stable isotope tracer ratio technique with Zn-67 and Zn-70 as oral tracers and Zn-68 as the intravenous tracer. Twenty-six participants completed the study. The prevalence of stunting and wasting were 20% and 13%, respectively; no children had low plasma zinc concentrations (<65 μg/dL). Total mean ± SD dietary zinc intake from the test meals was 7.3±2.2 mg (phytate:zinc molar ratio=3.1±0.3, not accounting for phytase activity). Mean FAZ increased from 8.6%±1.3% to 16.0%±1.3% when exogenous phytase was added to the SQ-LNS product (P<0.001). Mean TAZ from test meals containing SQ-LNS with phytase was more than double that from test meals containing SQ-LNS without phytase (1.1±0.1 mg and 0.5±0.1 mg, respectively; P<0.001). The addition of exogenous phytase to SQ-LNS increased both FAZ and TAZ. These results suggest that phytate reduction may be an important strategy to increase zinc absorption among young children. This trial was registered at clinicaltrials.gov as NCT02668133.

Exogenous Phytase Added to Lipid Based Nutrient Supplements Increases Fractional and Total Absorption of Zinc Among Young Gambian Children: A Randomized Controlled Trial (OR07-01-19)

ObjectivesDietary phytate inhibits zinc absorption from composite meals in adults. The objective of this study was to investigate the efficacy of adding exogenous phytase to a small-quantity lipid based nutrient supplement (SQ-LNS) on zinc absorption among young children. MethodsIn a double-blind randomized controlled trial, intra-individual differences in fractional and total absorption of zinc (FAZ and TAZ, respectively) from SQ-LNS with and without phytase were measured in 30 asymptomatic 18–23 month old children in the Kiang West district of The Gambia. Using a cross-over design, children received for one day each test meals of a millet-based porridge with 20 g SQ-LNS containing 8 mg zinc and either: 1) exogenous phytase (∼500 phytase units (FTU)) or 2) no exogenous phytase. The test meals were provided on consecutive days in randomized order. FAZ was measured using a dual-stable isotope tracer ratio technique with 67 Zn and 70 Zn as oral tracers, randomized independently of SQ-LNS product, and 68 Zn as the intravenous tracer. TAZ was calculated as the product of total dietary zinc (TDZ) intake from test meals (i.e., porridge, SQ-LNS and stable isotope) and FAZ. FAZ and TAZ were compared for meals with and without phytase using mixed-models ANOVA with product, study day, and oral isotope allocation as fixed effects and individual child as a random effect. ResultsTwenty-six participants completed the study. The prevalence of stunting, underweight and wasting were 20%, 30% and 13%, respectively; no children had low plasma zinc concentrations (< 65 μg/dL). TDZ and phytate intakes from the test meals were 7.2 ± 2.2 mg and 182.9 ± 64.7 mg, respectively (phytate: zinc molar ratio = 2.4 ± 0.2). Mean FAZ increased from 8.6 ± 1.3% to 16.0 ± 1.3% when exogenous phytase was added to the SQ-LNS product (P = 0.0002). Mean TAZ from porridge test meals containing SQ-LNS with phytase was more than double that from test meals containing SQ-LNS without phytase (1.12 ± 0.07 mg and 0.52 ± 0.07 mg, respectively; P < 0.0001). ConclusionsThe addition of exogenous phytase to a meal of millet-based porridge with SQ-LNS improved both FAZ and TAZ. These results suggest that phytate reduction may be an important strategy to improve zinc absorption among young children. Funding SourcesNutriset, SAS.

No Relation Between Zinc Status and Inflammatory Biomarkers in Adolescent Judokas.

This study aimed to assess the relation between zinc status and inflammation biomarkers in adolescent judokas. This cross-sectional study included 52 male adolescents, aged between 14 and 19 years, who were subdivided into two groups: judoka group (n = 25) and control group (n = 27). Zinc intake was monitored using 3-day food records and the NutWin software version 1.5. The plasma and erythrocyte zinc concentrations were determined by flame atomic absorption spectrophotometry. Analysis of cytokines (IL-1β, IL-6, and TNF-α) was performed. The mean values of zinc concentration in the diet were found to be higher than those recommended (11.0±3.9 mg/day and 20.3±11.9 mg/day for control group and judokas, respectively) although there was no significant difference between the groups. The mean plasma concentrations of zinc were below the reference range (71.4±16.0 μg/dL and 71.9±13.8 μg/dL for control group and judokas, respectively), without a significant difference between the groups. The mean concentrations of zinc erythrocyte were within the reference range (41.2±8.6 μg/gHb and 42.6±11.3 μg/gHb for control group and judokas, respectively), without a significant difference between the groups. There was no significant difference in the inflammatory biomarkers between the judokas and controls. There was not a significant correlation between biochemical parameters of zinc and inflammation biomarkers in adolescent judokas. Regarding the data found in the study, it can be concluded that the athletes evaluated have low plasma zinc concentrations, normal erythrocyte values, and high dietary intake of zinc. Moreover, the study don't show a relationship between zinc parameters and inflammatory markers evaluated.

Iron, Zinc, Folate, and Vitamin B-12 Status Increased among Women and Children in Yaoundé and Douala, Cameroon, 1 Year after Introducing Fortified Wheat Flour

Background: Few data are available on the effectiveness of large-scale food fortification programs.Objective: We assessed the impact of mandatory wheat flour fortification on micronutrient status in Yaoundé and Douala, Cameroon.Methods: We conducted representative surveys 2 y before and 1 y after the introduction of fortified wheat flour. In each survey, 10 households were selected within each of the same 30 clusters (n = ∼300 households). Indicators of inflammation, malaria, anemia, and micronutrient status [plasma ferritin, soluble transferrin receptor (sTfR), zinc, folate, and vitamin B-12] were assessed among women aged 15–49 y and children 12–59 mo of age.Results: Wheat flour was consumed in the past 7 d by ≥90% of participants. Postfortification, mean total iron and zinc concentrations of flour samples were 46.2 and 73.6 mg/kg (target added amounts were 60 and 95 mg/kg, respectively). Maternal anemia prevalence was significantly lower postfortification (46.7% compared with 39.1%; adjusted P = 0.01), but mean hemoglobin concentrations and child anemia prevalence did not differ. For both women and children postfortification, mean plasma concentrations were greater for ferritin and lower for sTfR after adjustments for potential confounders. Mean plasma zinc concentrations were greater postfortification and the prevalence of low plasma zinc concentration in women after fortification (21%) was lower than before fortification (39%, P < 0.001); likewise in children, the prevalence postfortification (28%) was lower than prefortification (47%, P < 0.001). Mean plasma total folate concentrations were ∼250% greater postfortification among women (47 compared with 15 nmol/L) and children (56 compared with 20 nmol/L), and the prevalence of low plasma folate values was <1% after fortification in both population subgroups. In a nonrepresentative subset of plasma samples, folic acid was detected in 77% of women (73% of those fasting) and 93% of children. Mean plasma and breast-milk vitamin B-12 concentrations were >50% greater postfortification.Conclusion: Although the pre-post survey design limits causal inference, iron, zinc, folate, and vitamin B-12 status increased among women and children in urban Cameroon after mandatory wheat flour fortification.

Zinc and copper status in childbearing age Tunisian women: Relation to age, residential area, socioeconomic situation and physiologic characteristics

Plasma zinc and copper status of 1689 non pregnant Tunisian women, aged 20–49 years old, was determined by flame atomic absorption spectrometry. A multiple regression was run to predict plasma trace element concentrations from age, BMI, marital status, menopause, education level, professional activity, economic level and area of living. The mean zinc and copper values were similar to those measured among comparable populations in earlier studies. However, a high prevalence of low plasma zinc and copper concentrations was observed assuming that women at childbearing age are at high risk of zinc and copper deficiencies and specific intervention may be considered. In univariate analysis, the mean values of plasma zinc and copper were associated with sitting areas and professional activity. For only plasma copper levels, there was an increase with BMI and parity, and a decrease with increasing schooling level and economic score. After adjustment for all variables, profession and parity showed a significant relationship between plasma levels copper.

Comparative sensitivity to zinc sulphate of Shigella isolates recovered from Nigerian children with low and marginal plasma zinc concentrations

This study aims to determine the ability of zinc sulphate to inhibit growth of <i>Shigella in vitro</i> and test the hypothesis that the isolates recovered from Nigerian children with low plasma zinc concentration are more sensitive than the marginal plasma zinc isolates. The effect of zinc sulphate on extracellular protease secretion was also investigated. A total of 15 <i>Shigella</i> isolates recovered from the stool samples of 117 diarrheic children at various health centers in Lagos, Nigeria were tested for sensitivity to zinc sulphate <i>in vitro</i> by agar dilution method. Plasma zinc concentration was determined spectrophotometrically to enable stratification of the patients into two zinc arms: low (plasma zinc <9.2 μmol/L) and marginal (plasma zinc: 9.2–4 μmol/L). The in vitro effect of zinc sulphate on extracellular protease secretion based on azocasein hydrolysis in these isolates was also determined. Isolates of <i>Shigella dysenteriae</i> and <i>Shigella flexneri</i> were found to be more sensitive to zinc sulphate (minimum inhibitory concentration = 0.89–0.98 ± 0.03–0.06 mg/mL) than the isolates of <i>Shigella sonnei</i> and <i>Shigella boydii</i> (minimum inhibitory concentration = 1.13–1.4 ± 0.06–0.1 mg/mL (<i>P</i> < 0.05). The late logarithmic growth kinetics of these isolates also produced similar response to zinc sulphate <i>in vitro</i>. The observed zinc sulphate-induced growth inhibition of the <i>Shigella isolates</i> tested was further found to be associated with a decline in their extracellular protease secretion in both zinc arms. Zinc sulphate elicits <i>in vitro</i> inhibition of growth and serogroups-dependent decline in extracellular protease activity among <i>Shigella</i> isolates from Nigerian children irrespective of their systemic zinc levels. We conclude that zinc sulphate may have potentials to be used as a shigellocidal and anti-virulent agent in the management of shigellosis in children.

The risk of copper deficiency in patients prescribed zinc supplements

AimsIn high doses zinc may cause copper deficiency, a diagnosis that is often missed resulting in anaemia, neutropenia and irreversible neurological symptoms. The aim of this study was to assess...

A meta-analysis of pica and micronutrient status.

Pica is the craving for and consumption of nonfood items, including the ingestion of earth (geophagy), raw starch (amylophagy), and ice (pagophagy). Pica has long been associated with micronutrient deficiencies, but the strength of this relationship is unclear. We aimed to evaluate the association between pica behavior and the risk of being anemic or having low hemoglobin (Hb), hematocrit (Hct), or plasma zinc (Zn) concentrations. We systematically reviewed studies in which micronutrient levels were reported by pica status. We calculated the pooled odds ratio for anemia or weighted mean difference in Hb, Hct, or Zn concentrations between groups practicing or not practicing pica behaviors. Forty-three studies including 6,407 individuals with pica behaviors and 10,277 controls were identified. Pica was associated with 2.35 times greater odds of anemia (95% CI: 1.94-2.85, P < 0.001), lower Hb concentration (-0.65 g/dl, 95% CI: -0.83 to -0.48 g/dl, P < 0.001), lower Hct concentration (-1.15%, 95% CI: -1.61 to -0.70%, P < 0.001), and lower Zn concentration (-34.3 μg/dl, 95% CI: -59.58 to -9.02 μg/dl, P = 0.008). Statistical significance persisted after excluding outliers and in subgroup analyses by pica type and life stage. Pica is significantly associated with increased risk for anemia and low Hb, Hct, and plasma Zn. Although the direction of the causal relationship between pica and micronutrient deficiency is unknown, the magnitude of these relationships is comparable to other well-recognized causes of micronutrient deficiencies. Pica warrants greater public health attention; specifically the potential physiological mechanisms underpinning the relationship between pica and micronutrient deficiencies merit further study.

Stunting Prevalence, Plasma Zinc Concentrations, and Dietary Zinc Intakes in a Nationally Representative Sample Suggest a High Risk of Zinc Deficiency among Women and Young Children in Cameroon1–3

Before initiating a mass zinc fortification program, this study assessed the prevalence of and risk factors for low zinc status among Cameroonian women and children. In a nationally representative survey, we randomly selected 30 clusters in each of 3 strata (North, South, and Yaoundé/Douala) and 10 households per cluster, each with a woman aged 15–49 y and a child aged 12–59 mo (n = 1002 households). Twenty-four-hour dietary recalls (with duplicates in a subset) and anthropometric measurements were conducted, and non-fasting blood was collected to measure plasma zinc concentration (PZC) and markers of inflammation. PZC was adjusted for methodologic factors (time of collection and processing, and presence of inflammation). The prevalence of stunting was 33% (32% South; 46% North; 13% Yaoundé/Douala). Among women, 82% had low adjusted PZC (<50 μg/dL for pregnant women; <66 μg/dL for others; 79% South, 89% North, 76% Yaoundé/Douala). Among children, 83% had low adjusted PZC (<65 μg/dL; 80% South, 92% North, 74% Yaoundé/Douala). Risk factors for low PZC among women and children and for low height-for-age Z-score among children were similar and included residence in the North region and rural areas and households with low socioeconomic status. Using estimated average requirement values from the International Zinc Nutrition Consultative Group (IZiNCG), 29 and 41% of women had inadequate zinc intakes, assuming moderate and low bioavailability, respectively, but only 8% of children had inadequate zinc intake. Depending on the estimated physiologic zinc requirement applied, 17% (IZiNCG) and 92% (Institute of Medicine) of women had inadequate absorbable zinc intakes. Total zinc intakes were greatest in the North region, possibly because of different dietary patterns in this area. Zinc deficiency is a public health problem among women and children in Cameroon, although PZC and dietary zinc yield different estimates of the prevalence of deficiency. Large-scale programs to improve zinc nutrition, including food fortification, are needed.

Plasma zinc in adults with cystic fibrosis: Correlations with clinical outcomes

BackgroundZinc status has been previously documented in cystic fibrosis (CF) infants, children and adolescents. However, despite the increasing life expectancy observed in CF populations, data regarding zinc status of CF adults are surprisingly lacking. The objectives of this study were to (1) characterize zinc status and (2) explore associations between zinc status and clinical outcomes of CF adult patients. MethodsA retrospective chart review was performed for patients who had their plasma zinc measured between 2009 and 2012. Data included demographics, clinical characteristics, biochemical parameters and co-morbid conditions. ResultsA total of 304 CF patients were included in the study. These patients displayed a good nutritional status (mean BMI±SD: 22.7±3.5) and moderate lung disease (mean FEV1±SD: 66.3±22.2). Low plasma zinc concentration (<9.2μmol/L) was found in 68 out of 304 CF patients (22.4%). Compared to patients with normal zinc, those with low zinc had significantly lower forced vital capacity and forced expiratory volume in one second. 72% of CF adults with low zinc suffered from bone disease (vs 49% with normal zinc, p=0.037) and 79% had impaired glycemic status (vs 58%, p=0.016). Accordingly, negative correlations were found between plasma zinc and glucose (r=−0.139, p=0.0001), HbA1c (r=−0.237, p=0.0001) and fructosamine (r=−0.134, p=0.034). In multiple linear regression, albumin and glycemic status were significant predictors of plasma zinc. ConclusionOur data indicated that nearly one quarter of CF adults with good nutritional status and moderate lung disease had low plasma zinc concentration and that low zinc status was associated with worse clinical outcomes.

Prevalence of low plasma zinc concentration and related risk factors among young children and women of reproductive age in a nationally representative sample survey in Cameroon

Information on the risk of zinc deficiency is required from nationally representative samples to assess the need for zinc intervention programs. We completed a multi‐stage, cluster survey of 812 children 12–59 mo of age and 853 women of reproductive age in Cameroon to assess plasma zinc concentration (PZC). 30 clusters were randomly chosen in each of 3 zones (North, South, and Large Cities); 10 households were randomly selected per cluster. IZiNCG recommendations for blood collection and processing and for measuring PZC were followed. PZC was measured by ICP‐OES; plasma C‐reactive protein (CRP) and α1‐acid‐glycoprotein (AGP) were measured by ELISA. Mean (95% CI) PZC, adjusted for CRP, AGP, time since last meal and time of day of blood collection and elapsed time to centrifugation, were 56.1 (54.9–57.2) μg/dL among children and 50.9 (49.6–52.2) μg/dL among women. Low adjusted PZC (&lt;65 μg/dL) was present in 81% (77–85%) of children and 89% (86–91%) of women (&lt; 66 μg/dL for non‐pregnant and &lt; 50 μg/dL for pregnant women). Risk factors for low PZC among both children and women were: living in the North region or in rural areas, low SES, and low maternal education. The high prevalence of low PZC among both children and women in Cameroon indicates an urgent need for zinc intervention programs.

Acrodermatitis enteropathica

The aim of the work was the presentation of one case with Acrodermatitis enteropathica. Acrodermatitis enteropathica is diagnosed based on the pedigree, typical clinical manifestations on the skin, laboratory results, small bowel biopsy, skin biopsy and kariotype. The patient was a two years old male toddler, hospitalized due to skin changes, chronic diarrhoea and total alopecia. Skin changes appeared on akral of the limbs, inguinal and perineal region, joints, perioral area and eyes. These changes appeared in different forms (erythematous, squamous, eczematiod, psoriasisforme and crusted). In the eyes were present these changes: blepharitis and conjunctivitis. Also total alopecia was prezent. Diarrhoea was chronic and specific. Laboratory findings showed the existence of sideropenic anemia, hypoproteinemia with hypoalbuminemia and low plasma zinc concentration (7.5 micromol/L). Hystopathological changes on the small bowel and skin biopsy were not typical for this disease. Following the beginning of treatment with zinc sulphate, all clinical skin manifestations disappeared within two months, but the disease itself was characterized with the periods of exarcerbation and remission. Acrodermatitis Enteropathica is a rare hereditary autosomal recessive disease. Mandatory clinical manifestations are: skin changes, chronic diarrhoea and alopecia. Treatment with zinc is obligatory for the life time.

Zinc supplementation in intensive care: Results of a UK survey

PurposeOur laboratory receives many routine requests for plasma zinc analysis from intensive care units (ICUs) throughout Scotland. However, such requests are inappropriate because plasma zinc concentrations fall independently of nutritional deficiency during the systemic inflammatory response and, therefore, in critically ill patients. This survey was performed to investigate how widespread this practice was and if low plasma zinc concentrations were interpreted as zinc deficiency so triggering inappropriate initiation of zinc supplementation. Materials and MethodsA questionnaire was sent to ICUs throughout the UK; nonresponders were contacted by telephone, and the questionnaire details were recorded. The questionnaire asked if plasma zinc was routinely requested, the frequency of requests, whether patients were supplemented with zinc, and if so, the grounds for supplementation and the dose given. ResultsPlasma measurement of zinc was routinely performed in 18% of UK ICUs. Zinc supplementation was given in 10%, usually as a result of finding low plasma zinc concentrations. Dosages of supplementation varied widely between ICUs: from 0.4 to 135 mg zinc per day. Approximately 6% of ICUs gave very high supplements of zinc of 90 and 135 mg/d. ConclusionsThe finding of a low plasma zinc concentration in Intensive Therapy Unit patients is often misinterpreted as indicating zinc deficiency and inappropriately prompts zinc supplementation. There is no evidence base to support high-dose zinc supplementation in ICU patients. This practice is justifiable only if future randomized trials demonstrate a benefit.

Zinc: an essential but elusive nutrient

Zinc is essential for multiple aspects of metabolism. Physiologic signs of zinc depletion are linked with diverse biochemical functions rather than with a specific function, which makes it difficult to identify biomarkers of zinc nutrition. Nutrients, such as zinc, that are required for general metabolism are called type 2 nutrients. Protein and magnesium are examples of other type 2 nutrients. Type 1 nutrients are required for one or more specific functions: examples include iron, vitamin A, iodine, folate, and copper. When dietary zinc is insufficient, a marked reduction in endogenous zinc loss occurs immediately to conserve the nutrient. If zinc balance is not reestablished, other metabolic adjustments occur to mobilize zinc from small body pools. The location of those pools is not known, but all cells probably have a small zinc reserve that includes zinc bound to metallothionein or zinc stored in the Golgi or in other organelles. Plasma zinc is also part of this small zinc pool that is vulnerable to insufficient intakes. Plasma zinc concentrations decline rapidly with severe deficiencies and more moderately with marginal depletion. Unfortunately, plasma zinc concentrations also decrease with a number of conditions (eg, infection, trauma, stress, steroid use, after a meal) due to a metabolic redistribution of zinc from the plasma to the tissues. This redistribution confounds the interpretation of low plasma zinc concentrations. Biomarkers of metabolic zinc redistribution are needed to determine whether this redistribution is the cause of a low plasma zinc rather than poor nutrition. Measures of metallothionein or cellular zinc transporters may fulfill that role.