Low Serum Zinc Concentrations Research Articles

Serum Zinc Concentrations by Inflammation Status, Time of Day, and Fasting Status for Estimating Zinc Deficiency in 6–59-Mo-Old Children: Results from the Brazilian National Survey on Child Nutrition (ENANI-2019)

BackgroundSerum zinc concentration (SZC) is considered the best biomarker of zinc status in population-level evaluations. However, zinc deficiency (ZD) estimations can be biased if they do not consider blood collection timing, inflammation, and fasting status. ObjectivesThe objectives of this study were to determine SZC without and with adjustment for inflammation, according to blood collection timing and fasting status, estimate ZD prevalence, and evaluate the associated factors with ZD in a representative sample of Brazilian children aged <5 y. MethodsPopulation-based study with 7597 children aged 6–59 mo surveyed by the Brazilian National Survey on Child Nutrition. SZC was adjusted for inflammation using the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia regression correction approach, with high-sensitive C-reactive protein, assessed according to blood collection timing (morning/afternoon) and fasting status (<8 and ≥8 h). SZC <65 μg/dL (morning collection) or SZC <57 μg/dL (afternoon collection) were classified as ZD. The analysis between associated factors and ZD used the adjusted prevalence ratio (PR). ResultsAfter adjusting for inflammation, SZC was higher in all percentiles and varied according to collection timing and fasting status. Children who had blood collected in the morning without fasting or in the afternoon had lower SZC than those assessed in the morning with fasting. The differences in adjusted SZC according to the timing of collection and fasting status were greater in the higher percentiles of the distribution, with the greatest absolute difference observed when comparing the 95th percentile of morning fasting compared with nonfasting (20.3 μg/dL). The prevalence of ZD estimated without and with adjusting SZC for inflammation was 17.8% and 13.8%, respectively. The occurrence of diarrhea, fever, or respiratory symptoms in the 15 d before blood collection was associated with a higher prevalence of ZD (PR: 1.42; 95% confidence interval: 1.04, 1.94). ConclusionsAdjusting SZC for inflammation and considering fasting status is important to avoid overestimating the prevalence of ZD.

Association between serum copper, zinc, and selenium concentrations and depressive symptoms in the US adult population, NHANES (2011–2016)

BackgroundEvidence suggests that alterations in serum trace element concentrations are closely associated with mental illness. However, ​studies on the relationship between serum copper, zinc, and selenium concentrations and depressive symptoms are limited and with controversial results. We aimed to investigate the association between serum concentrations of these trace elements and depressive symptoms in US adults.MethodsData from the National Health and Nutrition Examination Survey (NHANES) (2011–2016) were used in this cross-sectional study. The Patient Health Questionnaire-9 Items (PHQ-9) was employed to assess depressive symptoms. Multiple logistic regression was performed to determine the relationship between the serum concentrations of copper, zinc, and selenium and depressive symptoms.ResultsA total of 4552 adults were included. Subjects with depressive symptoms had higher serum copper concentrations (123.88 ± 1.87) than those without depressive symptoms (116.99 ± 0.86) (p < 0.001). In Model 2, weighted logistic regression analysis showed that the second (Q2) quartile of zinc concentrations (odds ratio [OR] = 1.534, 95% confident interval [CI]: 1.018 to 2.313) were significantly associated with an increased risk of depressive symptoms. Subgroup analysis revealed that the third (Q3) and fourth (Q4) quartiles of copper concentrations (Q3: OR = 2.699, 95% CI: 1.285 to 5.667; Q4: OR = 2.490, 95% CI: 1.026 to 6.046) were also positively associated with depressive symptoms in obese individuals after controlling for all confounders. However, no significant relationship between serum selenium concentrations and depressive symptoms was observed.ConclusionsObese US adults with high serum copper concentrations, as well as US adults in general with low serum zinc concentrations, were susceptible to depressive symptoms. Nevertheless, the causal mechanisms underlying these relationships need to be further explored.

Association between Dietary Zinc Intake, Serum Zinc Level and Multiple Comorbidities in Older Adults.

Zinc is one of the essential micronutrients in the geriatric population, but the importance of zinc status and dietary zinc intake has been poorly characterized. We aimed to explore the relationships among dietary zinc intake, serum zinc concentrations and multimorbidity in a cross-sectional study of 300 employees of Electric Generating Authority of Thailand aged ≥ 60 years. Comprehensive questionnaires were completed, and clinical and laboratory assessments were performed. Factors associated with low serum zinc concentrations were identified using multivariate multinomial logistic regression analyses. The mean serum zinc level was 80.5 (12.8) µg/dL. After adjustment for baseline characteristics, being female and having been in education for ≤12 years were independent risk factors for the lowest tertile (T1) of serum zinc. After additional adjustment for clinical and biochemical parameters, there was a significant association between depression (Thai Geriatric Depression Scale-15 score > 5) and low serum zinc levels (T1 vs. T3, odds ratio (OR): 2.24; 95% confidence interval (CI): 1.06−4.77). Furthermore, as serum albumin increased, serum zinc concentration substantially increased (T1 vs. T3, OR: 0.01; 95% CI: 0.002−0.070). Therefore, the early detection of risk factors and the further management of depression and low serum albumin may assist physicians in preventing low serum concentrations.

Low serum zinc concentration is associated with low serum testosterone but not erectile function.

To investigate the relation between serum zinc concentration and several factors, including serum testosterone concentration and the score of questionnaires on sexual function in patients with sexual problems. This study comprised 720 men (age, 46.3 [21-83] years) with some kind of sexual problem. Age, scores of the Sexual Health Inventory for Men and the Erection Hardness Score, and endocrinologic data including serum concentrations of testosterone, prostate-specific antigen, and zinc were included in this study. After serum zinc concentration of the men was classified into 5 groups (<70, 70≤ <80, 80≤ <90, 90≤ <100, ≤100 μg/dl), the relation of each parameter with serum zinc concentration was assessed for a trend analysis. Finally, the relation between serum concentrations of zinc and testosterone as well sexual function evaluated by the scores of the questionnaires was investigated. Only serum testosterone concentration (ptrend=0.028) and serum cortisol concentration (ptrend=0.003) showed a statistically significant relation to serum zinc concentration by trend analysis. Interestingly, trend analysis between serum concentrations of testosterone and zinc still showed a significant association after adjustment for serum cortisol concentration (ptrend=0.032). However, no significant association was found in the relation between serum zinc concentration and the scores of the questionnaires after adjustment for serum concentrations of testosterone and cortisol. We clearly showed that after adjustment for serum cortisol concentration by trend analysis, serum testosterone concentration decreased as serum zinc concentration decreased, although sexual symptoms were not associated with this decrease.

Zinc deficiency is associated with gynecologic cancer recurrence.

Zinc deficiency can cause various symptoms, including hair loss, anemia, and taste disorders. Recently, the association between cancer and zinc deficiency has received much attention with respect to its antioxidant properties. However, only a few studies have investigated the association between gynecologic cancers and zinc; to date, no studies have evaluated serum zinc status at the onset of gynecologic cancer or the relationship between zinc and cancer recurrence. The objectives of the present study were to determine whether serum zinc concentrations are associated with the development of gynecologic cancer, to clarify serum zinc dynamics between the onset and recurrence of gynecologic cancer, and to identify the associated factors. Accordingly, we retrospectively determined serum zinc concentrations before treatment in gynecologic patients with benign disease or cancer at the Nippon Medical School Chiba Hokusoh Hospital. We investigated anemia and hypoalbuminemia-the most common causes of zinc deficiency-as indicators of hyponutrition to determine the causal relationship of this deficiency with chemotherapy, radiation therapy, and recurrence, which may affect zinc concentration during cancer recurrence. The results indicated that there was no difference in zinc concentration between preoperative cancer patients and noncancer patients and that serum zinc concentrations were not associated with developing gynecologic cancers. However, patients with gynecologic cancer exhibited significantly lower serum zinc concentrations following treatment, and patients with recurrent cancer were 4.8 times more likely to develop zinc deficiency than those with nonrecurrent cancer. A serum zinc concentration of <61 μg/dL was an independent predictor of recurrence. Once zinc deficiency occurred, the recurrence rate of zinc deficiency reached as high as 69%. Overall, our study indicates that zinc deficiency is associated with recurrence in gynecological cancers and physicians should monitor zinc levels during disease management.

Reference cut-offs to define low serum zinc concentrations in healthy 1-19 year old Indian children and adolescents.

Population zinc (Zn) status assessment is based on serum zinc concentration (SZC) cut-offs defined by the International Zinc Nutrition Consultative Group (IZiNCG). The objective of this study is to derive reference SZC cut-offs in apparently healthy 1-19 year Indian children and adolescents using comprehensive national nutrition survey (CNNS) data, and to measure the prevalence of Zn deficiency. Apparently healthy children (n = 12,473) were selected from the CNNS, by including the highest 2 wealth quintiles, and excluding stunted, thin and obese children, and those with CRP > 5 mg/L, anaemia, hypo-albuminemia, diabetes, recent diarrhoea and history of smoking. The 2.5th centile of age-based distributions defined the SZC cut-offs, used to measure the prevalence of Zn deficiency in India, as against the IZiNCG cut-offs. The present study SZC cut-offs were significantly lower, by 10-18 µg/dL, than the IZiNCG cut-offs; more in adolescents. Prevalence of Zn deficiency in the entire CNNS, with these cut-offs, was 2.7 (<10 years) to 5.5 (10-19 years) times lower than with the IZiNCG cut-offs. No geographical state, nor any age group, had Zn deficiency as a serious public health problem (≥20%). In contrast, with IZiNCG cut-offs, 9-27 states (depending on age group) had a public health problem. The present study reference SZC cut-offs for Zn deficiency are lower than the IZiNCG cut-offs, and their rigorous selection from a national sample makes them more appropriate for use in India. A re-examination of the global applicability of IZiNCG recommended cut-offs in other LMICs appears appropriate.

J-shaped relationship between serum zinc levels and the severity of hepatic necro-inflammation in patients with MAFLD

Background and aimsZinc is an essential trace element that plays an important role in maintaining health, and affecting gene expression, signal transduction and regulation of apoptosis. It is uncertain whether serum zinc levels are altered in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). We aimed to investigate the association between serum zinc levels and the severity of hepatic necro-inflammation (HN) in patients with MAFLD. Methods and resultsLiver disease severity was graded histologically using the NAFLD activity score. HN was defined as the sum of ballooning and lobular inflammation. We used a smooth function regression model to analyze the relationship between serum zinc levels and HN. A total of 561 (76.5% men) patients with biopsy-confirmed MAFLD were enrolled. They had a mean age of 41.3 years, and a mean serum zinc level of 17.0 ± 4.1 μmol/L. Compared to those with mild hepatic necro-inflammation (MHN, grades 0–2; n = 286), patients with severe hepatic necro-inflammation (SHN, grades 3–5; n = 275) had lower serum zinc concentrations (16.3 ± 4.2 vs. 17.6 ± 4.0 μmol/L; p < 0.001). However, a threshold saturation effect analysis showed that there was an inflection in serum zinc levels at 24 μmol/L. After adjustment for potential confounders, serum zinc levels <24 μmol/L were inversely associated with SHN (adjusted-odds ratio 0.88, 95%CI 0.83–0.93; p < 0.001), whereas serum zinc levels >24 μmol/L were positively associated with SHN (adjusted-odds ratio 1.42, 95%CI: 1.03–1.97; p = 0.035). ConclusionsThere is a J-shaped relationship between serum zinc levels and the severity of hepatic necro-inflammation in patients with biopsy-proven MAFLD.

Assessment of zinc inadequacy among tribal adolescent population of central India - A cross-sectional study.

Zinc is a crucial micronutrient in adolescence, required for promoting growth and sexual maturation. Adolescents of some tribes may be at high risk of zinc deficiency due to dietary inadequacy and poor bioavailability of zinc from plant-based diets. This study aimed to evaluate the risk of zinc deficiency by estimating prevalence of inadequate zinc intake, prevalence of low serum zinc and stunting among tribal adolescents. A cross-sectional community-based survey was conducted among adolescents (10-19 yr) in three purposively selected districts where Bhil, Korku and Gond tribes were in majority. Structured data collection instrument comprising information about sociodemographic characteristics and dietary recall data was used. Anthropometric assessment was conducted by standardized weighing scales and anthropometry tapes, and blood sample was collected from antecubital vein into trace element-free vacutainers. Serum zinc was estimated using an atomic absorption spectrophotometer. A total of 2310 households were approached for participation in the study, of which 2224 households having 5151 adolescents participated. Out of these enlisted adolescents, 4673 responded to dietary recall (90.7% response rate). Anthropometry of 2437 participants was carried out, and serum zinc was analyzed in 844 adolescents. The overall prevalence of dietary zinc inadequacy was 42.6 per cent [95% confidence interval (CI) 41.2 to 44.1] with reference to the estimated average requirement suggested by International Zinc Nutrition Consultative Group (IZiNCG) and 64.8 per cent (95% CI 63.4 to 66.2) with Indian Council of Medical Research-recommended requirements. Stunting was observed in 29 per cent (95% CI 27.2 to 30.8) participants. According to IZiNCG cut-offs, low serum zinc was detected in 57.5 per cent (95% CI 54.1 to 60.8) of adolescents, whereas it was 34.4 per cent (95% CI: 31.2-37.5) according to the national level cut-off. Risk of dietary zinc inadequacy and low serum zinc concentration amongst adolescents of the Gond, Bhil and Korku tribes is a public health concern.

Zinc in fibromyalgia patients: relationship with body mass index and sleep quality

Introduction and aim. Given the potential relationship between oxidative stress and fibromyalgia and well-documented antioxidant efficacy of zinc, the present study aimed to determine serum zinc concentration in FM patients as compared to healthy controls, as well as to identify the correlation of serum zinc concentration with the body mass index (BMI) and sleep quality, Material and methods. In this case-control study, 54 fibromyalgia patients were consecutively recruited between October 01, 2021 and December 01, 2021. The control group consisted of 54 age- and sex-matched healthy controls. Results. Fibromyalgia group had significantly lower zinc concentration, higher body mass index, and lower sleep quality scores as compared to the healthy control group. The correlation analysis revealed a significantly negative correlation between serum zinc concentration and body mass index and a significantly positive correlation between serum zinc concentration and sleep quality both in fibromyalgia and healthy control groups. Conclusion. Our results both support the hypothesis that low serum zinc concentration plays a role in the pathophysiology of fibromyalgia and indicate that fibromyalgia may lead to weight gain and poor sleep quality, which needs to be confirmed in large-cohort studies.

Prevalence of Micronutrient Deficiencies among Preschool and School-Going Children in Flood-Hit Areas of Pakistan.

There is minimal literature regarding micronutrient deficiencies in flood-affected regions. In our study, we aimed to find the prevalence of micronutrient deficiencies (vitamin A, calcium, zinc, iron, and iodine) among preschool and school-age children in flood-hit areas of Khyber Pakhtunkhwa, Pakistan. In this cross-sectional study, a multi-stage sampling technique was used for the selection of 656 households. Serum micronutrient status was detected in the targeted population in the affected districts. The least significant difference test was used with analysis of variance to determine significant differences in nutrient contents in different areas. Of the total respondents, 90.8% of the children were calcium deficient, 88.3% were zinc deficient, 26.7% were iron deficient, 53.5% were vitamin A deficient, and 39.5% were had an iodine deficiency in flood-affected areas. A significant difference (P < 0.05) was found in different age groups of children for zinc (5.7-42.63 μg/dL) and urinary iodine (69.6-85.4 μg/L). The 10- to 12-year-old age group had a lower serum zinc concentration (5.7 μg/dL), whereas the 1- to 3-year-old age group had a lower urinary iodine concentration (69.6 μg/L) than other groups. There was no significant difference (P > 0.05) between male and female children and various age groups for calcium and iron status. Vitamin A levels were significantly (P < 0.05) different among different age groups (high in age group 4-6 years) and districts. Vitamin A concentration was lower in the Nowshera District, whereas serum iron and zinc were lower in the Dera Ismail Khan District. All the important micronutrients in the population of children were deficient in the flood-affected areas of Pakistan. Therefore, policymakers should implement potential prevention strategies, such as food security, school health nutrition, food fortification, nutrition in the first 1,000 golden days, nutrition knowledge, and awareness of the local population, to reduce the burden of micronutrients deficiencies in flood-affected areas.

Testing metal, proving mettle—findings from the 2016–2018 India Comprehensive National Nutrition Survey regarding the prevalence of low serum zinc concentrations among children and adolescents, and their implications for public health

Testing metal, proving mettle—findings from the 2016–2018 India Comprehensive National Nutrition Survey regarding the prevalence of low serum zinc concentrations among children and adolescents, and their implications for public health

Prevalence of low serum zinc concentrations in Indian children and adolescents: findings from the Comprehensive National Nutrition Survey 2016–18

It is thought that there is a high risk of zinc deficiency in India, but there are no representative national estimates. We aimed to evaluate the national and state-level prevalence of low serum zinc concentrations (SZCs) in Indian children from the nationally representative Comprehensive National Nutrition Survey. Prevalence of low SZC, adjusted for C-reactive protein, was estimated among preschool (1-4 y; n=7874) and school-age children (5-9 y; n=10,430) and adolescents (10-19 y; n=10,140), using SZC cutoffs defined by the International Zinc Nutrition Consultative Group. Prevalence of low SZC was high among adolescents (31.1%; 95% CI: 29.8%, 32.4%), compared with school-age (15.8%; 95% CI: 15.3%, 16.3%) or preschool children (17.4%; 95% CI: 16.7%, 18.0%). However, stratification of prevalence by fasting status or using an alternative lower SZC cutoff independent of fasting status led to a reduction in prevalence by 3.7% or 7.8% in children <10 y, respectively. The prevalence of low SZC was higher among rural preschool children, those belonging to households with poor socioeconomic status, and those with severe stunting or underweight. Preschool children with diarrhea (22.6%; 95% CI: 20.8%, 24.4%), productive cough (22.7%; 95% CI: 18.5%, 27.5%), or malaria/dengue (38.5%; 95% CI: 29.4%, 48.2%) in the 2 wk preceding the survey had a higher prevalence of low SZC than those without morbidity (16.5%; 95% CI: 15.9%, 17.2%; 17.6%; 95% CI: 16.9%, 18.2%; and 17.5%; 95% CI: 16.8%, 18.1%, respectively). The national prevalence of low SZC among preschool (17%) or school-age children (16%) was <20%, which is considered the cutoff indicating a problem of public health significance; but there were variations by state and socioeconomic status. In adolescents, however, the prevalence of low SZC was 31%, which warrants further investigation. The association of low SZC with diarrhea in preschool children necessitates better coverage of Zn administration in the management of diarrhea.

Low Serum Zinc Concentration Is Associated With Infection Particularly in Patients With Stage 5 Chronic Kidney Disease Medicated with Proton Pump Inhibitors

Zinc (Zn) plays an important role in immune function. Several studies have identified an association between a Zn deficiency and infection. Infectious diseases are major complications of chronic kidney disease (CKD). We investigated whether serum Zn concentrations are associated with risk of infection in patients with advanced CKD. We retrospectively analyzed data from 299 patients with CKD whose serum Zn values were measured to evaluate anemia between January 2013 and December 2016. Among them, 9 who were supplemented with Zn and 67 who had started urgent dialysis at the time of measurement were excluded. We analyzed infection events, length of infection-related hospitalization and infection-related and all-cause mortality in the remaining 223 patients during a median follow-up of 36months. We assigned the patients to groups with low or high Zn values (≤50 and>50μg/dL, respectively) based on a median value of 50μg/dL. Data were analyzed using Kaplan-Meier curves and Cox hazards models. During a median follow-up of 36months, 40 patients were hospitalized with infections. The rate of infection-related and long-term hospitalization (>10days) due to infection was higher for patients with low, than high, Zn values (23.3% vs. 12.6%; P=.042 and 26.2% vs. 12.4%; P=.007, respectively). After adjustment in Cox hazards models, low serum Zn values remained an independent risk factor for infection-related hospitalization (Hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.01-3.71; P=.048), especially for patients on proton pump inhibitor (PPI) medications (HR, 2.66, 95%; CI, 1.22-5.81; P=.014). Patients with advanced CKD accompanied by low serum Zn concentration, and particularly those medicated with PPI, are at high risk of infection-related hospitalization, which results in long-term hospitalization.

Reference Cut-Offs to Define Low Serum Zinc Concentrations in 1-19 Year Old Indian Children and Adolescents

Background: The quantification of population zinc (Zn) deficiency is based on serum zinc concentration (SZC) cut-offs, defined by International Zinc Nutrition Consultative Group (IZiNCG), derived from the 2·5th centile of age- and sex-specific SZC distributions from a high-income country. However, the SZC distributions, and its 2·5tthcentile cut-offs, can left-shift for a variety of reasons in lower middle-income countries (LMICs). The recent quality-controlled Indian Comprehensive National Nutrition Survey (CNNS) offered an opportunity to re-examine the SZC cut-offs in healthy 1–19-year-old children and adolescents and evaluate whether Zn deficiency was truly a public health problem in India. Methods: A healthy population (n=12473) of children was selected by including the highest 2 wealth quintiles, and excluding stunted, thin and obese children, and those with CRP >5mg/L, anemia, hypo-albuminemia, diabetes, recent diarrhea and a history of smoking. The 2·5th centile of the SZC distribution from this sample yielded the present cut-off to re-evaluate the prevalence of Zn deficiency against the IZiNCG cut-offs. Findings: The present study SZC cut-offs were significantly lower, by 10–18 µg/dL, than the IZiNCG cut-offs; more in adolescents. Thus, the prevalence of Zn deficiency in the entire CNNS sample, with the present cut-offs, was 2·7 to 5·5 times lower than with the IZiNCG cut-offs. No geographical state, nor any age group, showed Zn deficiency as a serious public health problem (≥20%). In contrast, with the IZiNCG cut-offs, between 9 to 27 states (depending on age group) had a serious public health problem with Zn deficiency. Interpretation: The present study reference SZC cut-offs for Zn deficiency are lower than the IZiNCG cut-offs, and since they were selected rigorously from a national sample, are more appropriate for use in India. A re-examination of the global applicability of IZiNCG recommended cut-offs to quantify Zn deficiency in other LMICs is required. Funding Source: CNNS is funded by The Mittal Foundation. However, there is no specific funding for this secondary analysis. Declaration of Interests: HSS designed the draft protocol of the CNNS with consultancy support from UNICEF, India. HSS, UK, and AVK were members of the Technical Advisory Committee of the CNNS, constituted by the Ministry of Health and Family Welfare of the Government of India, to oversee its conduct and analysis. HSS is a member of the WHO Nutrition Guidance Expert Advisory Subgroup on Diet and Health and Guideline Development Group on the use and interpretation of haemoglobin concentrations for assessing anaemia status in individuals and populations, member of the World Health Organization Nutrition Guidance Expert Advisory Subgroup on Diet and Health and Expert group on nutrient requirements: setting calcium, vitamin D and Zn nutrient intake values for children aged 0-4 years. He is also member of Expert Groups of the Ministry of Health and Family Welfare on Nutrition and Child Health. SD was involved in the CNNS study implementation. There were no other conflicts to declare. Ethics Approval Statement: The Population Council’s International Review Board (New York, USA) and the Ethics Committee of the Post Graduate Institute of Medical Education and Research (Chandigarh, India) gave ethical approval. Written consent from parent/caregiver for children under 10 years, consent of parent/caregiver as well as assent from adolescents (11-17 years) and written consent of adolescents above 17 years were obtained after due description of study details in local languages.

Relationship between serum zinc concentration and semen quality in newly-wed men.

To clarify factors associated with semen quality and confirm whether there is an association between semen quality and serum zinc concentration. A semen test was performed on 217 men just after or just before marriage. Variables assessed in the study were: age; symptomatic scores, including sexual function evaluated using several specific questionnaires; endocrinological profiles, especially follicle-stimulating hormone; and serum zinc concentrations. Based on World Health Organization criteria for assessing sperm quality, semen volume ≥1.5mL, sperm concentration ≥15million/mL, or sperm motility rate ≥40%, the men were grouped according to whether they had values below or above these criteria. The two groups were compared with regard to the study variables, and correlation between serum zinc concentration and semen quality was evaluated. Independent predictors for inclusion in the group with values below the criteria were investigated further. Of the 217 men included in the study, 45 (20.7%) were categorized as having values below the World Health Organization criteria. The men in this group were significantly older and had significantly worse sexual function, significantly higher follicle-stimulating hormone levels, and significantly lower serum zinc concentrations, than those in the group with values above the criteria. There was no significant correlation between serum zinc concentration and semen quality. However, the independent predictors for having values below the criteria in binomial logistic regression analysis were follicle-stimulating hormone and serum zinc concentration. We suggest that semen analysis may be considered in men with a low level of serum zinc and high level of follicle-stimulating hormone when developing a life plan for fertilization.

Serum Zinc Concentrations of Adults in an Outpatient Clinic and Risk Factors Associated With Zinc Deficiency

Subclinical features of zinc deficiency can be challenging to recognize. The prevalence of zinc deficiency based on blood zinc concentration in an adult outpatient clinic setting has not been well-studied. To estimate the prevalence of low serum zinc concentrations among community-dwelling adults, and to characterize clinical features and risk factors associated with zinc deficiency. This retrospective pilot prevalence study took place from 2014 to 2017 at an outpatient clinic in southeast Ohio. Patients aged 50 years or older with a stable health status were categorized into a case group with zinc deficiency (serum zinc concentration, <0.66 µg/mL) and a control group (serum zinc concentration, ≥0.66 µg/mL). Measurements included serum zinc concentration, nutritional biomarkers (ie, magnesium, calcium, albumin, and total 25-hydroxy vitamin D levels), patient history of fractures and events such as hospitalization, antibiotic use, and self-reported falls that occurred within 1 year prior to the date serum zinc concentration was measured (index date). Patients were excluded if they had a serum zinc measurement within 2 months after a hospitalization, severe renal insufficiency (3 patients with serum creatinine concentration above 2.5 mg/dL), or serum zinc concentration above 1.20 µg/mL. This study included 157 patients, consisting of a case group of 41 (26%) patients with zinc deficiency and a control group of 116 (74%) without zinc deficiency. Mean (SD) zinc concentrations of the case and control groups were 0.58 (0.05) µg/mL and 0.803 (0.13) µg/mL, respectively (P<.01). Patients in the case group were more likely to have had a history of hospitalization, antibiotic use, a fall within 1 year before the index date, and a history of fractures and hip fracture (P<.01 in each case). Patients taking gastric acid suppressants had increased odds of lower zinc concentrations (odds ratio, 2.24; 95% CI, 1.08-4.63). Both logistic and multivariate linear regression models revealed that past fractures, hip fractures, and hypoalbuminemia (albumin <3.5 g/dL) were associated with zinc deficiency or lower zinc concentrations. This study revealed that 26% of patients in an outpatient adult clinic had zinc deficiency based on serum concentrations. Patients with fracture history and low serum albumin were at higher risk for zinc deficiency.

Serum zinc concentrations and characteristics of zinc deficiency/marginal deficiency among Japanese subjects.

BackgroundStudies that have examined serum zinc deficiency/marginal deficiency in developed countries, including Japan, are still limited. The aim of this study was to assess serum zinc concentrations and associated characteristics among Japanese subjects.MethodsThis cross‐sectional study, conducted from September 2016 to December 2018, included 2056 eligible subjects who participated in a voluntary health checkup. Serum zinc concentration categories were defined as deficiency (<60 μg/dL), marginal deficiency (≥60 to <80 μg/dL), and normal (≥80 μg/dL). Serum zinc concentrations were compared between the first age category (<40 years) and other age categories with Dunnett's method. Trends in P‐values were estimated using the Jonckheere‐Terpstra test for continuous variables.ResultsThe proportions of subjects with deficiency and marginal deficiency were 0.4% and 46.0% in men, and 0.6% and 38.4% in women, respectively. The deficiency/marginal deficiency group had significantly lower lipid profiles and nutritional status, and a significantly lower proportion were non–daily drinkers in both genders. Older age was significantly associated with lower serum zinc concentration only in men.ConclusionsOur findings clarified a high proportion of serum zinc deficiency/marginal deficiency, especially in men, and suggest a possible association between serum zinc levels and nutritional status and alcohol consumption. It may be necessary to manage nutritional status, including zinc intake.

Magnesium, zinc and iron serum levels as potential parameters significant for effective glycemic control in children with type 1 diabetes

Background. Various trace elements contribute to the development of diabetes and its complications through their roles in glucose metabolism and the oxidative stress response. The aim of this study was to ascertain the difference in serum magnesium, zinc and iron concentrations between healthy children and children with type 1 diabetes mellitus (T1DM). This study also aimed to determine whether serum concentrations of magnesium, zinc, and iron in children with T1DM correlated with the duration of the disease and the quality of glycemic control in this group. Material and methods. A total of 99 children with T1DM and 40 healthy children were included in this study. Magnesium, zinc and iron serum levels were assessed using the photometric method. Results. Significantly lower levels of magnesium and zinc (P < 0.001) were observed, between the T1DM group and the healthy control group but no statistically significant differences were found in iron levels (P = 0.13) between the two groups. While there were no statistically significant differences in serum concentrations with respect to the duration of disease, it was, however, discovered that children with poorer glycemic control had significantly lower serum zinc concentrations (P < 0.001) while magnesium and iron levels remained similar (P = 0.07 and 0.21 respectively). Conclusion. This study found that while there was no significant difference in iron serum levels in children with T1DM compared to healthy controls, children with T1DM did have more significantly decreased magnesium and zinc serum levels than the control group. Serum zinc levels in this study also directly correlated to poorer glycemic control. Further studies are required to explore whether magnesium and zinc supplementa­tion, or nutritional intake, could potentially be used to achieve better glycemic control in children with T1DM.

P0940CLINICAL ASSOCIATION BETWEEN SEVERE INFECTION AND HYPOZINCEMIA IN INCIDENT PATIENTS ON HEMODIALYSIS

Abstract Background and Aims Hypozincemia can arise in patients with advanced chronic kidney disease (CKD) due to low protein intake and urinary or dialytic loss. Several studies have confirmed an association between hypozincemia and infection. Because infections comprise a major complication in patients with advanced CKD, we investigated whether hypozincemia is associated with infection risk in incident patients on dialysis. Method We prospectively analyzed 380 consecutive patients aged 20 years old or more who started hemodialysis between January 2013 and December 2018. Six patients who were receiving zinc supplementation at the time of the study were excluded. Serum zinc values were obtained at the time of dialysis initiation. We followed up the remaining patients after enrollment. The endpoint was severe infection defined as infection-related death or bacteremia confirmed by the detection of microorganisms in two sets of culture bottles. The patients were equally divided into groups with low, middle or high serum zinc concentrations. Data were analyzed using Kaplan-Meier curves and Cox hazards models. The local ethics committee approved this research. Informed consent was obtained from each individual participant included in the study. Results The rate of severe infection events over a follow-up of one year was the highest in the group with low zinc (p = 0.030). Cox hazards models adjusted for age, sex, diabetes mellitus, serum albumin and serum zinc, selected hypozincemia as an independent risk factor for severe infection events (HR, 10.76; 95% CI, 1.28–90.41; p = 0.029). Conclusion Hypozincemia is associated with risk of subsequent severe infection in incident patients on dialysis.

Low serum zinc concentrations in Sudanese patients with visceral leishmaniosis does not impair the anti-Leishmania antibody response.

Visceral leishmaniosis (VL) is a poverty-related disease, affecting poor peoples in the developing countries. For unknown reasons, the rK39 rapid test has poor diagnostic sensitivity in some endemic areas such as East Africa. Here, the hypothesis was tested whether micronutrient deficiency is associated with low Leishmania-specific antibody responses and consequently decreased diagnostic sensitivity. Serum zinc concentrations in 107 human sera of VL and controls that were HIV-negative were measured using atomic absorption spectroscopy. Anti-Leishmania donovani antibodies were detected quantitatively by rKLO8 ELISA. The influence of low serum zinc concentrations on the amount of anti-Leishmania antibody and outcome of the rK39 rapid test was tested. Serum zinc concentrations were significantly (p ˂ 0.0001) reduced in VL sera (mean 0.41 ± 0.15) as compared to healthy control groups (mean ˃ 0.75 ± 0.13). Interestingly, the majority (92.2%) of the VL patients had low serum zinc concentrations (˂ 0.6 mg/l) whereas all healthy controls showed normal levels. Unexpectedly, VL sera with normal (0.94-0.6 mg/l) or low (˂ 0.6 mg/l) zinc concentrations demonstrated no significant difference in amounts of Leishmania antibodies. In addition, VL sera with positive or negative rK39 rapid test results demonstrated similar serum zinc concentrations; mean values of 0.39 ± 0.14 mg/l and 0.38 ± 0.1 mg/l for VL sera of positive or negative rK39 results, respectively. Low serum zinc concentration seems not to play an important role in lowering anti-L. donovani antibody titers observed among Sudanese VL patients and doesn't affect rK39 rapid test results.