Low Plasma Zinc Levels Research Articles

Low plasma zinc levels (but not selenium) are associated with anti-SARS-COV-2 IGG and IGA seropositivity in the general population: A case-control study

Low plasma zinc levels (but not selenium) are associated with anti-SARS-COV-2 IGG and IGA seropositivity in the general population: A case-control study

Prevalence and determinants of low plasma zinc levels in adult peritoneal dialysis patients

ObjectiveZinc is an essential trace element, being a cofactor for almost 300 enzymes. As zinc is widely available in the diet, the European Best Practice Guidelines do not recommend routine supplementation in dialysis patients. However, some medicines prescribed to dialysis patients may potentially reduce absorption, and there may be increased losses with dialysis. As older and co-morbid patients are now treated by peritoneal dialysis (PD) we wished to determine the prevalence of patients with low plasma zinc levels. Design and methodsWe prospectively measured plasma zinc in 550 PD patients attending for their first peritoneal membrane assessment using atomic absorption spectroscopy. Body composition was determined by bioimpedance. ResultsPlasma zinc was measured in 550 patients, mean age 58.7 years, 60.6% male, mean value 10.8 ± 2.2 umol/L, with 66.5% having low zinc levels (<11.5 umol/L). Normal plasma zinc was associated with haemoglobin (odds ratio (OR) 1.41 (95% confidence limits (95%CL) 1.22–1.63), serum albumin (OR 1.04 (95%CL 1.002–1.087), higher glucose dialysates L/day (OR 1.06 (1.001–1.129), and negatively with 24-hour urinary protein losses (OR 0.786 (95%CL 0.673–0.918) and age (OR 0.985 (95%CL 0.972–1.0). There was no association with dialysis adequacy, original renal disease or dietary protein estimation. Prescription of phosphate binders had no effect on zinc levels (10.7 ± 2.2 vs 10.8 ± 2.3 umol/L). ConclusionsMost PD patients had low plasma zinc levels, associated with older age, probably reflecting reduced intake, urinary protein losses, and lower albumin and haemoglobin most likely linked to greater co-morbidity, low grade inflammation and volume expansion requiring higher glucose dialysates.

Association of zinc deficiency with infectious complications in pediatric hematopoietic stem cell transplantation patients.

Zinc plays essential roles in immune function and epithelial integrity. Patients undergoing hematopoietic stem cell transplantation (HSCT) often have low plasma zinc levels because of poor intake and diarrhea. We hypothesized that patients with zinc deficiency before HSCT had worse infectious complications after HSCT compared with patients with normal zinc levels. Citrulline, a marker of intestinal integrity, was also hypothesized to be lower in patients with zinc deficiency. Thirty patients undergoing HSCT at Ramathibodi Hospital during March 2020-September 2021 were enrolled. Blood samples for plasma zinc and citrulline were collected during the HSCT period. The 14- and 90-day outcomes after HSCT were prospectively recorded. Twelve of 30 (40%) patients had zinc deficiency before HSCT. Zinc-deficient patients were younger (median (interquartile range): 6 (8.8) vs 13 (5.8) years old; p = 0.017). Zinc levels tended to increase after admission in both groups. Patients with zinc deficiency had lower citrulline levels than those with normal zinc levels. Citrulline levels decreased in both groups after stem cell infusion, and the level was not significantly different between the two groups. Zinc-deficient patients had a higher rate of bacterial infection within 90 days after HSCT than those with normal zinc levels (6 in 12 patients (50.0%) vs 1 in 18 patients (5.6%); odds ratio [OR]: 17.0; 95% confidence interval [CI]: 1.68-171.70; p = 0.016). This remained significant after adjustments for age (adjusted OR: 12.31; 95% CI: 1.084-139.92; p = 0.043). The prevalence of zinc deficiency in pediatric patients undergoing HSCT was high. Zinc-deficient patients had lower citrulline levels and higher incidence of bacterial infection after HSCT. However, citrulline level was not different between patients with and without bacterial infections. It is worth to investigate whether zinc supplementation before HSCT can reduce bacterial infection after HSCT.

Zinc metabolism in healthy men and in patients with chronic bacterial prostatitis

Introduction: Zinc is a vital trace element, which regulates metabolism of a prostate gland. It has been established that a low plasma zinc level in men increases the risk of chronic prostatitis and vice versa, chronic prostatitis is often accompanied by zinc deficiency in the prostate gland. The purpose of this study is to research the features and possible correlations of zinc metabolism disorders at systemic (in blood) and local (in prostatic fluid) levels in healthy men and patients with chronic bacterial prostatitis (CBP).&#x0D; Materials and methods: Ninety patients with CBP (main group) and thirty healthy men (control group) were random­ized by age (mean age 38.5±2.9 years) and examined. In addition to standard examinations, the zinc levels in blood serum and prostatic fluid were determined, and the oxidative status of the prostate gland was assessed (the level of reac­tive oxygen species (ROS), conjugated dienes, malondialdehyde, superoxide dismutase (SOD) activity in the prostatic fluid) according to standard methods.&#x0D; Results and discussion: In patients with CBP, the absolute deficiency of plasma and prostatic zinc was detected 2.89 and 2.5 times more often, respectively, than in healthy men (p &lt; 0.05). At the same time, both the patients with CBP and healthy men had significant correlations between plasma zinc and zinc in prostatic fluid (r = 0.345; n = 37; p = 0.001 and r = 0.156; n = 30; p = 0.001; respectively). A significant positive correlation between the zinc level and the activity of SOD in prostatic fluid was revealed only in the patients with CBP (r = 0.389; n = 90; p = 0.001).&#x0D; Conclusion: Zinc concentration in blood plasma does not objectively reflect zinc metabolism disorders in the prostate gland, and therefore the determination of zinc in prostatic fluid is the most reliable and sensitive method for assessing zink disorders in patients with CBP.

Zinc Supplementation Effect in MDA and MMP8 During LPS-Induced Sepsis and Its Benefits to Reduce The Child Mortality in Hospital Practice

Background: Severe sepsis increases pro-inflammatory cytokines, causing systemic translocation to the commensal bacteria. A study in Southeast Asia involving 13 public hospitals in 3 countries, including Indonesia, found that sepsis mortality in children was 2% and a 28% incidence of severe sepsis. Low plasma zinc levels were found in severe and critically septic patients in children and adults. Objective: This study aims to explain the mechanism of sepsis improvement after zinc administration through MDA and MMP8 during LPS-induced sepsis in rodents. Material and Methods: We divided samples of 40 rats into four groups of Control, LPS, LPS-Zinc, and Zinc. Blood sampling in 2-hour after LPS or placebo administration to measure zinc level. Zinc was administered in LPS-Zinc and Zinc group and placebo in two other groups. Blood sampling in 8, 24, and 72 hours to measure MDA and MMP-8 by sandwich-ELISA method. Statistical analysis was carried out with one-way ANOVA, Kruskal Wallis, Mann-Whitney, Paired t-tests, Wilcoxon Signed Rank Test, and path analysis. Results: There were decreased in MDA, and MMP-8 serum levels in the LPS-Zinc group compared to the LPS group. Conclusion: Administration of zinc in sepsis improves the condition of sepsis by decreasing pro-inflammatory cytokine and increasing anti-inflammatory cytokine

STATUS ZINC DAN PERAN SUPLEMENTASI ZINC TERHADAP SISTEM IMUN PADA PASIEN HIV/AIDS: A SYSTEMATIC REVIEW [Zinc Status and The Role of Zinc Supplementation on Immune System in HIV/AIDS Patients: A Systematic Review]

Zinc has a potential role in defense system by taking control in immunity cells activity. Zinc is a micro-nutrient that attains in such prominence as a co-factor for hundred enzymes and inducing nutritional metabolism. In condition of HIV infection, low plasma zinc level can inhibit T cell establishment, then decreasing humoral and cellular immunity. Furthermore, zinc plasma defi ciency will impact the disease progression thus increasing mortality rate. Based on several studies, giving zinc supplementation to HIV/AIDS patient still shows controversial results. The aim of this systematic review was to analyze zinc status in HIV/AIDS patients and examine the effect of zinc supplementation related to immunity status. The method of the study was conducted comprehensive searches on adults HIV infected aged &gt;18 years who underwent outpatient care or hospitalized that received single zinc supplementation or in multivitamin and minerals form. The result from nine studies demonstrated that most of HIV/AIDS patients have a low plasma zinc level and after receiving zinc supplementation with a dose at least 12 mg for more than 1 month consecutively, the lymphocytes CD4+ and IFN-γ status in HIV/AIDS patients was increasing. Furthermore, the intervention of zinc supplementation also showed some positive improvement in other infections occurrence such as diarrhea, pneumonia, and tuberculosis. Zinc supplementation on HIV/AIDS patient has many benefi ts in increasing zinc status and improving the immune system.

Plasma zinc levels in normal and malnourished children with lower respiratory tract infection from 2 months to 5 years of age

Background: Acute Lower Respiratory Tract Infection (ALRI) is an important cause of morbidity and mortality in the developing world. Pneumonia is a severe form of ALRI that cause over 2 million deaths annually among children younger than 5 years of age. About 19% of all deaths, pneumonia is the leading cause of child mortality. Malnutrition is known to be associated with greater intensity of lower respiratory tract infections, higher the frequency of complications, longer episodes of infections. This study is to assess the plasma zinc levels in normal and malnourished children with LRI aged 2 months to 5 years.Methods: This is a case control study, which was carried out in the Department of Paediatrics, Sree Balaji Medical College and Hospital, the study period is one year from July 2016 to July 2017. 100 children between 2 months to 5 years of age with LRI was included in the study and children less than 2 months and more than 5 years. 50 Children with normal nutrition were taken as controls and 50 children with moderate and severe malnutrition were taken as cases. Age and sex were matched among cases and controls. Blood samples were collected for zinc estimation in both the cases and controls. All children were investigated and treated as per the department protocol for the particular condition. All statistical procedures were performed using SPSS v 21.0.Results: In present study, 66% of children had normal zinc levels, 34% of children had low zinc levels. The mean zinc level in our cases was 54.84±18.31 and in controls was 76.84±15.2, which was statistically significant (p = 0.000). Mean plasma zinc levels with respect to age and sex were not significant.Conclusions: Total 34% of children with LRI had low plasma zinc levels. Plasma zinc level were significantly low in malnourished children than normally nourished children with LRI, which is one of the most important cause of high childhood mortality in developing countries.

Comparison of Plasma Zinc Levels Among HIV+ and HIV- Subjects Infected with Condyloma Acuminata

Background:Condyloma acuminata is a type of human papilloma virus (HPV) infection in the anogenital area and often associated with immunosuppressive conditions, such as human immunodeficiency virus (HIV). Low plasma zinc levels could cause alteration of cellular immunity, leading to reduction of interleukin-2 (IL-2) and interferon-γ (IFN-γ), cytokines required for inhibition of HPV replication. Moreover, low plasma zinc levels could cause disruption of apoptotic regulation, results in the unimpeded proliferation of epithelial cells infected with HPV. This study aimed to compare the mean plasma zinc levels in condyloma acuminata patients with HIV and without HIV infection.Methods:This study used a cross-sectional method, involving 27 condyloma acuminata patients without HIV infection and 18 patients with HIV infection, who agreed to enroll and signed the informed consent. This study was conducted in the dermatology and venereology outpatient clinic in Sanglah Hospital and Kerti Praja Foundation, Denpasar. Bivariate analysis of the characteristics, age, sex orientation, location of lesion, clinical form of lesion, type of cases, duration of condyloma acuminata, age of the first sexual contact, comorbidity, treatment history, and mean plasma zinc level of condyloma acuminata patients with HIV and without HIV infection. The CD4+ cell count and history of ARV treatment were also obtained form patients with HIV infection.Results:A total of 45 subjects were diagnosed with condyloma acuminata, consisted of 27 subjects with condyloma acuminata without HIV infection and 18 subjects with HIV infection, showing average age of 32.04 ± 10.414. Mean plasma zinc levels in condyloma acuminata patients with HIV infection was significantly lower than subjects without HIV infection, and the difference in mean plasma zinc levels was 7.31 µg/dL (95% CI 2.25 - 12.37, p <0.05).Conclusions:The mean plasma zinc levels in condyloma acuminata patients with HIV was significantly lower than those of without HIV infection.

Zinc Status in Hair Samples and Common Neurodevelopmental Disorders

Zinc status is an important modifiable factor in Attention Deficit and Hyperactive Disorders (ADHD) and Autistic Spectrum Disorders (ASD), the two most common neurodevelopmental disorders. Many studies reported low serum or plasma zinc level in children with these conditions. While hair zinc level can be obtained non-invasively in young children, the reports of the hair zinc levels in ASD and ADHD children were varied. ASD children were reported to have lower than or indifferent level of hair zinc from that of healthy children. In ADHD children, hair zinc levels were reported as either lower or higher than their healthy control groups. Many factors interplayed and affected measurement of hair zinc level. Until more standardized method has been established, currently the zinc level in hair samples may be used as screening or supporting evidence. Other functional zinc markers such as serum zinc concentrations, dietary zinc intakes, and percentage of stunting rate, are still needed to assess the zinc status in susceptible children.

Prevalence of Zinc Deficiency in Cardiac Surgery Patients

The aim of this study was to define the status of preoperative zinc levels in patients with heart disease presenting for cardiac surgery and to identify any predictors for and any clinical consequences of low zinc levels. Adult patients presenting for elective surgery, either coronary artery bypass graft surgery and/or valve replacement, provided a fasting blood sample on the day of admission for surgery. Plasma and erythrocyte zinc levels were analysed and the levels correlated with the patient's characteristics and clinical outcomes. Of 56 patients 53% (n=30) had abnormally low plasma zinc levels (<12μmol/L) and 5.5% (n=3) had abnormally low erythrocyte zinc levels (<160μmol/L), indicative of deficiency. There were significant associations between lower plasma zinc levels and the presence of hypertension (p=0.02), hypercholesteraemia (p=0.02) and higher body mass index (BMI) (p=0.034) but no effect on major postoperative clinical outcomes. This small study shows that zinc deficiency is common in cardiac surgery patients, especially in the presence of hypertension, hypercholesterolaemia or obesity. The effects of zinc deficiency in cardiac surgery need to be further investigated.

Zinc Deficiency Is associated With Depressive Symptoms-Results From the Berlin Aging Study II.

Zinc plays an important role for behavioral and mental function, maintaining the correct functions of intracellular signal transduction, cellular and trans-membrane transport, protein synthesis, and antioxidant system. We investigated both dietary zinc intake and plasma zinc levels and the correlation with depressive symptoms in a large sample of community-dwelling old. One thousand five hundred fourteen older people (aged 60-84 years, 772 women) from the Berlin Aging Study II were included. Zinc intake was assessed by the EPIC Food Frequency Questionnaire. Plasma zinc levels were assessed with atomic-absorption spectrophotometry. Depressive symptoms were assessed with the "Center for Epidemiological Studies Depression Scale" and the "Geriatric Depression Scale." Zinc deficiency in blood plasma was found in 18.7% of participants, and depressive symptoms in 15.7%. Participants with depressive symptoms had lower energy-adjusted zinc intake (median 11.1 vs 11.6 µmol/L; p = .048) and lower plasma zinc levels (median 12.2 vs12.3 mg/dL; p = .037). Even after adjustment for known predictors of depression, plasma zinc deficiency remained significantly associated with depressive symptoms (odds ratio: 1.490, 95% confidence interval: 1.027-2.164; p = .036). In the multiple logistic regression model stratified by sex, we found that plasma zinc deficiency was strongly associated with a higher risk for depressive symptoms in women (odds ratio: 1.739, 95% confidence interval: 1.068-2.833; p = .026). Plasma zinc deficiency was common in our old study population. An increase in dietary zinc and higher plasma zinc levels may reduce the risk of depressive symptoms. A screening for reduced dietary zinc intake or plasma zinc deficiency might be beneficial in older people at risk of depressive symptoms.

Relationships between plasma zinc and ferritin with nutritional status in thalassemic children

Background Repeated blood transfusions in thalassemic chil-dren can lead to iron overload in the body. High ferritin level leadsto low plasma zinc status because of their competitive inhibition.Previous study found that there was a correlation between plasmazinc level and nutritional status.Objective To obtain plasma zinc level, to investigate the correla-tion between plasma zinc and ferritin, and the impact of plasmazinc on nutritional status in children with thallasemia.Methods A cross sectional study was conducted on 67 thalas-semic children. This study was performed at Thalassemia Center,Cipto Mangunkusumo Hospital, Jakarta, from 1 st until 31 st of March2005. The age of the patients ranged from 4 to 18 years, with fer-ritin levels more than 2000 ng/ml during the last 6 months or totaltransfusion more than 5 liters. The subjects were divided into 2groups, i.e. group 1 (4-10 years) and group 2 (&gt;10-18 years). Di-etary intake was assessed by 3 day-dietary recall. The nutritionalstatus were judged by mid upper arm circumference (MUAC) forage and height for age (H/A). Venous blood was obtained to mea-sure plasma zinc and ferritin levels. Statistical analysis was doneby Student’s t-test (2-tailed) and linear regression analysis.Results We found that 42% subjects were well-nourished, 51%were undernourished, and 7% were severely malnourished. All sub-jects had low plasma zinc status 31.9 (SD 16.9) μg/dl. There was aweak negative correlation between plasma zinc and ferritin level (r= -0.282, P=0.021). Lower zinc intake was detected in 65 out of 67subjects.Conclusion All thalassemic children in our hospital had low plasmazinc level. There was a weak negative correlation between plasmazinc level and ferritin level. There was no significant correlationbetween plasma zinc status and nutritional status

The use of topical zinc in tuberculin test

with under-diagnosis or over-diagnosis commonly occurring. The tuberculin test as a supporting examination for tuberculosis infection has a false negative value rate of 10-25%. Also, a majority of children with tuberculosis have lower plasma zinc levels than healthy children. Zinc deficiency may impair the immune response, leading to more false negative skin-test results.Objective To evaluate the effectiveness of topical zinc for augmenting the diameter of tuberculin induration in children with tuberculosis.Methods This unblinded, clinical trial was performed from October to December 2012 in subjects matched with themselves. Subjects were children with tuberculosis aged 2-18 years at the Department of Child Health at Cipto Mangunkusumo Hospital and Persahabatan Hospital. Every subject was injected tuberculin in volar region of left and right arm. Test sites then were covered with topical zinc cream on the right arm and placebo cream on the left arm. Indurations were measured after 72 hours. The difference of tuberculin diameter of 3 mm was considered as clinically significant. Data analysis was performed with Wilcoxon signed rank test.Results There were 47 subjects in this study. The majority of subjects were well-nourished (53%). Subjects’ median treatment duration was &lt; 6 months, median age was 72 months and 47% of subjects were under the age of five years. Sixteen subjects had a median 1 mm difference in tuberculin induration diameter between the zinc arm and placebo arm (P&lt;0.001), but this was clinically insignificant. Twenty-two subjects (43%) had Koch reaction after zinc cream application, but the placebo cream did not cause Koch reaction.Conclusion Application of topical zinc does not increase tuberculin induration compared to placebo.

Ocular symptoms as the initial signs of zinc deficiency

A 2-year-old boy with a history of food allergy presented with severe edema and erythema, excoriations and honey-colored crusting on both lower eyelids, and erythematous rash on his perioral region. An evaluation for micronutrient deficiencies revealed low plasma zinc level. The patient was started on a regimen of zinc supplementation, and at 4weeks' follow-up there was nearly complete resolution of the lesions.

Lower Plasma Zinc Levels in Hyperglycemic People Living with HIV in the MASH cohort.

Zinc deficiency is prevalent in HIV and hyperglycemic patients. Antiretroviral therapy (ART) is a treatment to control HIV progression; however it increases the risk for hyperglycemia. The objective of this study was to assess the plasma zinc levels in hyperglycemic people living with HIV (PLWH). Secondary analysis was conducted on the data from the Miami Adult Studies in HIV (MASH) cohort in Florida. Patients were categorized into hyperglycemic group (fasting blood glucose ≥100 mg/dL) and normal group (<100 mg/dL). Plasma zinc status and CD4 levels were lower in the hyperglycemic group, however the difference was not significant. There was a greater percentage of plasma zinc deficiency in the hyperglycemic group (69%) compared to the normoglycemic group (64%). Although not statistically significant, related biomarkers such as plasma zinc levels and CD4 levels were lower in the hyperglycemic group. This may be due to the role zincplays in the immune system. Due to the fact that there was a higher percentage of plasma zinc deficiency in the hyperglycemic group (69%) compared to the normoglycemic group (64%), it is important to monitor and manage blood glucose levels to minimize complications. Our findings along with previous findings suggest that zinc supplementation may benefit hyperglycemic PLWH.

Acquired acrodermatitis enteropathica after gastric bypass surgery responsive to IV supplementation

Nutritional deficiency is rare in developed countries, but can be acquired from decreased nutrient intake, reduced absorption, and increased gastrointestinal excretion. We report a patient with acquired acrodermatitis enteropathica (AE) who exhibited low plasma zinc levels and concurrent nutritional deficiencies (pyridoxine, selenium and fatty acids). Our patient had undergone Roux-en-Y gastric bypass 13 years prior to presentation. The rash, consistent with AE clinically and histologically, nearly resolved one week after starting IV zinc supplementation, total parenteral nutrition, and micronutrient supplements. This case highlights the importance of long-term post-operative follow-up for gastric bypass patients who are at high risk for micronutrient and macronutrient deficiencies and illustrates the potential for rapid improvement with IV supplementation.

Hyperammonemic syndrome after Roux-en-Y gastric bypass.

Hyperammonemic encephalopathy is an uncommon but severe complication of the Roux-en-Y gastric bypass surgery for obesity. Mechanisms underlying this complication are incompletely understood, resulting in delayed recognition and management. This study evaluated common laboratory findings and possible etiology of hyperammonemic encephalopathy after successful Roux-en-Y gastric bypass surgery. A retrospective review of 20 patients identified through our own clinical practice was conducted, with the addition of similar cases from other institutions identified through the review of literature. Patients presenting with hyperammonemic encephalopathy after Roux-en-Y gastric bypass surgery presented with overlapping clinical and laboratory findings. Common features included: (1) weight loss following successful Roux-en-Y gastric bypass for obesity; (2) hyperammonemic encephalopathy accompanied by elevated plasma glutamine levels; (3) absence of cirrhosis; (4) hypoalbuminemia; and (5) low plasma zinc levels. The mortality rate was 50%. Ninety-five percent of patients were women. Three patients were diagnosed with proximal urea cycle disorders. One patient experienced improvement in the hyperammonemia after surgical correction of spontaneous splenorenal shunt. Hyperammonemic encephalopathy after Roux-en-Y gastric bypass surgery is a newly recognized, potentially fatal syndrome with diverse pathophysiologic mechanisms encompassing genetic and nongenetic causes.

Renal dysfunction in fetal alcohol syndrome: a potential contributor on developmental disabilities of offspring.

Renal dysfunction in fetal alcohol syndrome: a potential contributor on developmental disabilities of offspring.

Mineral Requirements in Children with Chronic Liver Disease

Introduction: Decreased oral intake or impaired function / structure in the gut, such as hypertension port associated with atrophic changes in the protein nutrition - calories can lead to micronutrient deficiencies.This paper examines the status of micronutrients in chronic liver disease in children. Materials and Methods: In this review study databases including proquest, pubmedcentral, scincedirect, ovid, medlineplus were been searched with keyword words such as” chronic liver disease” minerals””children” between 1999 to 2014. Finally, 3 related articles have been found. Results: In chronic liver disease changes in micronutrient metabolism lead to changes in the daily requirements, such that in certain circumstances intake increasing or decreasing is needed. Low serum calcium and phosphate concentrations are often the reflection of malabsorption-induced bone disease that is unresponsive to vitamin D store normalization. Iron is usually deficient in children with CLD and supplementation frequently needed. The origin of iron deficiency is multifactorial and includes ongoing losses, inadequate intakes, serial blood draws and malabsorption secondary to hypertensive enteropathy. Zinc plays an important role in cognitive function, appetite and taste, immune function, wound healing, and protein metabolism. Low plasma zinc levels are frequent in children with chronic cholestasis, but unfortunately plasma concentrations are not reflective of total body zinc status. Copper and manganese, unlike other minerals, are increased in CLD, because they are normally excreted through bile. Parenteral nutrition in cholestatic patients can induce manganese intoxication and accumulation in basal ganglia. Conclusion: In fants with CLD are prone to multiple nutritional deficiencies. Mineral state should be evaluated, treated and reevaluated, until sufficient daily requirement achieved. Poster Presentation, N 33

Comparison of plasma vitamin A and E, copper and zinc levels in free‐ranging and captive greater flamingos (Phoenicopterus roseus) and their relation to pododermatitis

Pododermatitis is a worldwide problem in captive flamingos. Studies in domestic poultry showed that nutrition is a possible influencing factor for pododermatitis. Vitamin A and E, copper and zinc levels were analysed in two different diets (diet 1 = in-house mix and diet 2 = commercial diet) and in plasma of captive greater flamingos fed these diets and compared to those of free-ranging greater flamingos. Results were analysed with respect to type and severity of foot lesions of the individuals from the different groups. Juvenile and subadult/adult captive flamingos on diet 1 showed various types and severities of foot lesions, whereas no foot lesions were found at the time of blood sampling in juvenile captive flamingos on diet 2. Juvenile captive flamingos on diet 1 had significantly lower plasma zinc levels than juvenile captive flamingos on diet 2 and juvenile free-ranging flamingos; data were also lower than reference ranges for flamingos, poultry and cranes. There were no significant differences in plasma vitamin A, vitamin E, copper or zinc levels between animals with different types of foot lesions or with different severity scores. Shortly after the change to diet 2 (fed to juvenile captive flamingos that did not show any foot lesion), the flooring of the outdoor water pools was covered with fine granular sand. Because both factors (nutrition and flooring) were changed during the same evaluation period, it cannot be concluded which factor contributed in what extent to the reduction of foot lesions. While it is assumed that low plasma zinc levels identified in the group of juvenile captive flamingos on diet 1 were not directly responsible for foot lesions observed in these animals, they may have played a role in altering the skin integrity of the feet and predisposing them to pododermatitis.