Zinc Deficiency Research Articles

Adherence to Oral Zinc Supplementation in the Management of Acute Diarrhoeal Disease among Under Five Children: A Systematic Review and Meta-analysis.

Zinc in eye health, retinal biology and disease.

Novel phosphate zinc controlled release nano-composite (P Zn CRnC) escalates early growth and development in rice under P and Zn deficiency

Lost in the scales: Alcohol-induced zinc deficiency

Zinc (Zn2+), an essential trace element, has been increasingly recognized for its crucial role in neural development and regeneration. Although its function in central nervous system neurogenesis is well documented, its involvement in parasympathetic innervation remains insufficiently characterized. In this study, we examined the neurochemical interplay between Zn2+ and the neurotrophic factor neurturin (NRTN) during submandibular salivary gland (SMG) development, with particular emphasis on the PI3K/AKT signaling axis involved in parasympathetic innervation. Employing an exvivo embryonic mouse SMG organ culture system combined with a bioengineered agarose-based hydrogel for sustained Zn2+ delivery, we demonstrate that zinc supplementation markedly enhances both epithelial branching morphogenesis and neurite outgrowth. Mechanistic investigations revealed that Zn2+ activates the PI3K/AKT pathway and promotes epithelial and neuronal development, even in the presence of pharmacological inhibitors targeting PI3K or AKT. NRTN, a critical neurotrophic factor implicated in parasympathetic innervation, was identified as an upstream activator of AKT, and its signaling activity was substantially enhanced by Zn2+. Notably, co-administration of Zn2+ and NRTN restored SMG morphogenesis and neuronal extension despite PI3K/AKT pathway inhibition, indicating a robust compensatory mechanism. This synergistic interaction reveals a previously unrecognized crosstalk between metal ion-mediated and neurotrophin-dependent signaling pathways during peripheral organ development. Collectively, this work broadens the current understanding of zinc's biological functions beyond the central nervous system and highlights its therapeutic potential in regenerative approaches targeting salivary gland dysfunction and related disorders involving compromised autonomic innervation.

25. Weighing benefits and burdens: zinc supplementation strategies for sows and their environmental footprint

Background: Oxidative stress represents a key pathogenic factor in spondyloarthritis (SpA), yet its comprehensive assessment remains underutilized in routine clinical practice. Objectives: We evaluated oxidative stress biomarker profiles in SpA patients to determine associations with disease activity, systemic inflammation, structural damage, lifestyle factors, and therapeutic responses for practical clinical implementation. Methods: This cross-sectional study included 101 patients meeting the Assessment of SpondyloArthritis International Society (ASAS) 2009 criteria. Oxidative stress assessment utilized a validated biomarker panel: copper, zinc, glutathione peroxidase (GPx), ceruloplasmin (Cp), transferrin (TF), haptoglobin (Hp), bilirubin (BR), and uric acid (UA). Clinical, radiological, lifestyle, and therapeutic data underwent systematic analysis. Results: Glutathione peroxidase activity was elevated in 82.1% of patients, establishing it as the most sensitive oxidative stress marker. Copper levels increased in 30.7% and zinc deficiency occurred in 36.4% of cases. Oxidative stress markers correlated significantly with inflammatory parameters (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], neutrophil-to-monocyte ratio [NMR], systemic immune-inflammation index [SII]) and disease activity scores (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Ankylosing Spondylitis Disease Activity Score based on CRP [ASDAS-CRP], Disease Activity Score 44 [DAS44-CRP]). Higher oxidative stress was associated with a poorer quality of life, as indicated by elevated Ankylosing Spondylitis Quality of Life (ASQoL) scores. Physical activity and adherence to a Mediterranean diet were independently associated with better antioxidant capacity. Smoking and nonsteroidal anti-inflammatory drug (NSAID) use correlated with increased oxidative burden. Anti-tumor necrosis factor alpha (anti-TNFα) therapy was associated with reduced levels of oxidative stress. Structural damage, particularly cervical spine involvement, correlated with heightened oxidative stress. Conclusions: This comprehensive evaluation reveals significant clinical correlations between oxidative stress and multiple disease domains in SpA. Modifiable lifestyle factors and therapeutic interventions have a significant impact on the redox balance. These findings establish practical targets for personalized management. The integration of oxidative stress assessment into routine practice could enhance disease monitoring and inform the development of antioxidant-based therapeutic strategies.

Zinc deficiency among preschool-age children is a significant global public health concern, particularly in low- and middle-income countries, with severe consequences for growth and development. However, research on zinc deficiency among preschoolers in Ethiopia, including the Sidama region, remains limited. To address this gap, we assessed the prevalence and factors associated with zinc deficiency among preschool-age children in rural Sidama. A community-based cross-sectional study was conducted from September 17 to October 3, 2024, involving 364 children aged 24–59 months. Study participants were selected via systematic random sampling. Serum zinc concentration was analyzed at the Ethiopian Public Health Institute’s nutrition laboratory, and anthropometric indices were computed using WHO Anthro 2007 Software. We collected the data using KoboCollect. Modified Poisson regression was employed to identify factors associated with zinc deficiency using Stata 17. Among the preschool-age children surveyed, 203 (55.77%) were male, with a mean age of 43.99 months (standard deviation [SD] = 12.14). The overall prevalence of zinc deficiency was 53.57% (95% confidence intervals [CI]: 48.41%–58.66%). Preschool-age children in households with five or more members had a 53% higher prevalence of zinc deficiency compared to those in smaller households (Adjusted Prevalence Ratio (APR) = 1.53, 95% CI: 1.24–1.90). The prevalence was 22% higher in children with unmet dietary diversity (APR = 1.22, 95% CI: 1.01–1.46) and 26% higher in anemic children (APR = 1.26, 95% CI: 1.04–1.51). The high prevalence of zinc deficiency among preschool-age children in rural Sidama highlights a critical public health concern. Contributing factors include larger family size, unmet dietary diversity, and anemia. Addressing this issue requires a multifaceted approach. Interventions should focus on promoting zinc-rich foods through education and diet diversification, raising awareness about birth spacing to mitigate the impact of large family size, and implementing measures to prevent and manage anemia.

Background. Since its introduction, botulinum toxin type A has become an indispensable tool in aesthetic medicine, allowing not only the elimination of expression lines, but also the restoration of symmetry and correction of facial contours through the harmonious redistribution of muscle tone. Given the pace of modern life and patients' desire to maintain daily social activity, there is a growing need to optimize results and increase the duration of botulinum therapy. Among the possible solutions that could affect the effectiveness of neuromodulators, the elimination of local zinc deficiency is of particular interest. Zinc, acting as an indispensable cofactor of the light chain of botulinum toxin type A, not only stabilizes the structure of the toxin, but also dynamically supports its protease activity in presynaptic neurons. A local deficiency of this element can become a "hidden barrier" to achieving optimal aesthetic results. Recent studies reveal the dual role of zinc: in addition to its direct effect on the catalytic domain of BTA, it regulates many other processes that indirectly determine the rate of toxin elimination and the duration of the effect. However, traditional methods of correcting deficiency, such as oral supplementation, show conflicting results, highlighting the need for innovative solutions. Results. This article systematizes data on the molecular mechanisms of zinc dependence of botulinum toxin type A, factors contributing to tissue deficiency of this trace element, and modern strategies for its correction. Particular attention is paid to clinical markers of hidden zinc deficiency relevant to everyday practice and the prospects for combined approaches combining highly purified botulinum toxin type A preparations with adjuvant zinc delivery methods. The results of the analysis are intended to revise the paradigm of preparing patients for botulinum therapy, making the correction of local zinc deficiency an important step in increasing the effectiveness and prolonging the aesthetic result. For cosmetic doctors, understanding these relationships is key to overcoming resistance, reducing the frequency of repeat procedures, and achieving lasting patient satisfaction-the most important criteria for success in modern aesthetic medicine.

Metallothionein-dependent recovery of alcohol-related liver injury by zinc-glutathione.

Background: Inflammatory bowel disease (IBD) can lead to zinc deficiency, which plays a critical role in immune function and tissue repair. This study aims to determine the prevalence, clinical characteristics, and impact of zinc deficiency in IBD patients. Methods: This is a retrospective study of patients aged ≥14 years with confirmed IBD and available zinc level measurement. Zinc deficiency was defined as a level <10.6 µmol/L. Primary outcomes included the prevalence of zinc deficiency and the characterization of the clinical profile of patients with zinc deficiency. Secondary outcomes included IBD-related hospitalizations, emergency room visits, surgeries, and complications (anemia, small bowel obstruction, new perianal disease, intra-abdominal abscess). Results: Among 447 patients (54.4% male; 79.2% Crohn’s disease) with a median age of 29 years (IQR: 22–38), 45.6% had zinc deficiency (83.8% Crohn’s disease). Zinc-deficient patients had higher C-reactive protein and fecal calprotectin (both p < 0.001) levels, and were more likely to be on corticosteroids (p = 0.04). Zinc deficiency was associated with higher rates of IBD-related hospitalizations (48.0% vs. 17.7%), surgeries (19.6% vs. 5.8%), complications (30.4% vs. 12.4%), and emergency room visits (40.2% vs. 17.3%) (all p < 0.001). Upon multivariate analysis, predictors of IBD-related hospitalization were zinc deficiency (OR 2.42, 95% CI 1.07–5.48, p = 0.03) and low albumin (OR 9.03, 95% CI 3.38–24.15, p < 0.001). Zinc deficiency was associated with IBD-related surgeries (OR 5.23, 95% CI 1.27–21.45, p = 0.02) and complications (OR 3.98, 95% CI 1.52–10.41, p = 0.005). Conclusions: Zinc deficiency is prevalent in patients with IBD, associated with a high inflammatory burden, and was linked to worse clinical outcomes after controlling for markers of inflammation.

Background: Obesity is a multifactorial metabolic disorder influenced not only by excessive caloric intake but also by micronutrient imbalances such as zinc deficiency. Emerging evidence suggests that zinc regulates microRNA (miRNA) biogenesis and expression, linking nutritional status to metabolic regulation. Objective: This review delineates the molecular interplay between zinc and miRNAs in obesity, emphasizing the mechanistic, clinical, and translational relevance of zinc-sensitive miRNAs in adipogenesis, insulin resistance, inflammation, and oxidative stress. Results: Zinc deficiency alters miRNA expression profiles associated with metabolic dysregulation. Key miRNAs—miR-21, miR-34a, miR-122, and miR-144-3p—are consistently modulated by zinc status, influencing inflammation, lipid metabolism, and insulin signaling. Zinc repletion restores several miRNAs (e.g., miR-10b, miR-155, miR-145), suggesting reversibility, while excessive zinc may upregulate miR-144-3p and exacerbate oxidative stress. Circulating and exosomal miRNAs show promise as dynamic biomarkers for zinc intervention efficacy. Methods: A literature search was performed in 4 databases up to August 2025 using keywords related to zinc, miRNAs, and obesity. Eligible studies included both preclinical and human research evaluating zinc status or supplementation and miRNA expression in metabolic contexts. Conclusion: Maintaining optimal zinc levels may normalize miRNA expression and improve insulin sensitivity. The “zinc–miRNA axis” represents a novel frontier for precision nutrition in obesity management.

Background Childhood pneumonia remains a leading cause of morbidity and mortality in low- and middle-income countries, driven by a complex interplay of socioeconomic, environmental, and modifiable risk factors. Objective To investigate determinants of pneumonia among children aged 2–59 months in resource-limited settings, with a focus on healthcare, nutritional, and environmental factors. Methods A retrospective hospital-based case–control study was conducted using medical records of children aged 2–59 months. Cases were physician-diagnosed pneumonia based on WHO IMCI criteria, while controls were children without respiratory illness presenting for unrelated conditions. Data on demographics, household exposures, immunization, nutrition, and feeding practices were extracted using a standardized form. Results Multivariable analysis identified significant risk factors: use of unclean cooking fuel (AOR = 2.01; 95% CI: 1.25–3.23), incomplete immunization (AOR = 2.78; 95% CI: 1.24–6.20), and lack of exclusive breastfeeding for 6 months (AOR = 2.10; 95% CI: 1.32–3.34). Maternal age ≥25 years was also associated with increased risk (AOR = 2.04; 95% CI: 1.26–3.31). Malnutrition showed an unexpected protective effect (AOR = 0.13; 95% CI: 0.08–0.23), while zinc supplementation showed a moderate effect (AOR = 1.63; 95% CI: 1.01–2.64). No significant associations were observed for HIV status, vitamin A supplementation, smoking exposure, child age, sex, or household crowding. Conclusion Childhood pneumonia in under-five children is strongly influenced by modifiable factors, particularly breastfeeding practices, immunization coverage, nutritional status, and household energy sources. Targeted interventions addressing these determinants may substantially reduce the burden of pneumonia in resource-limited settings.

The neuroinflammation plays a crucial role in the pathogenesis and progression of depression. Microglia serve as the principal source of neuroinflammatory factors and regulate neuroinflammation via M1 and M2 polarization phenotypes. Moreover, NOD like receptor protein 3 (NLRP3) inflammasome pathway is considered to be important in regulating pro-inflammatory cytokine release in the hippocampus. Zinc supplementation has been shown to effectively alleviate depressive symptoms in patients. In this study, we utilized a lipopolysaccharide (LPS)-induced mouse model of depression and LPS-activated BV-2 cells to examine the impact of zinc supplementation. The findings indicated that zinc supplementation could: (1) ameliorate the depressive-like behaviors of the mouse model with inhibition of inflammatory cytokines and zinc homeostasis recovery. (2) induce the polarization of microglia towards the M2 phenotype in vivo and in vitro. (3) suppress the activation of the NLRP3 inflammasome pathway by impeding the expression of P2X purinergic receptor 7 (P2 × 7) induced by LPS, thereby regulating microglial polarization. This may represent a crucial pathway via which zinc inhibits the M1 polarization of microglia, promotes polarization towards the M2 phenotype, thus improving neuroinflammation and exerting an antidepressant effect.

Constructing a zinc delivery system is crucial for scientific zinc supplementation. In this study, gelatin-based zinc-loaded hydrogels were constructed with the assistance of sodium alginate and a ZnSO4 solution soaking method. The zinc loading capacity, texture properties, rheological properties, microstructure, and pH sensitivity of hydrogels under different ratios of gelatin to sodium alginate were investigated. Results showed that the loading of zinc by hydrogel was successfully achieved through a ZnSO4 solution soaking method, and increasing the ZnSO4 concentration was conducive to zinc loading and hydrogel structure strengthening. Adding sodium alginate further enhanced the zinc loading capacity of hydrogel. When the concentration of ZnSO4 was 25 wt%, the zinc loading of hydrogel containing only gelatin and hydrogel with a 7:3 ratio of gelatin to sodium alginate was 29 mg/g and 52 mg/g, respectively. In addition, sodium alginate also endowed the hydrogel with a certain pH sensitivity. When the ratio of gelatin to sodium alginate was 7:3, the hydrogel showed obvious pH response behavior. Spectroscopy results revealed that zinc sulfate strengthened the hydrogel structure by inducing hydrophobic interactions and the formation of hydrogen bonds, while Zn2+ was bound to oxygen atoms through coordination bonds in hydrogel. These results could provide new ideas for the construction of zinc-loaded hydrogels.

Disclosure: M. Kometani: asken.inc. Y. Oiwa: None. K. Aiga: None. Y. Noda: None. S. Konishi: None. D. Aono: None. M. Kadono: None. T. Yoneda: None.Background: Nutritional management for the elderly is essential for extending healthy life expectancy and improving quality of life (QOL). An appropriate nutrition intake particularly plays an important role in the prevention and management of chronic diseases. In recent years, the development of digital technology has made it possible to monitor nutrition intake using tools such as meal recording applications, and accumulate variety of evidence. However, detailed data on seasonal fluctuations in the nutritional intake of the elderly and deviations from nutritional intake standards are limited, and the impact of insufficient or excessive intake of salt or minerals on health risks has not been fully investigated. The aim of this study is to evaluate the nutrition intake status of people aged 65 years or older based on information obtained from diet and health management applications. Methods: This study analyzed users of a diet and health management application who were 65 years or older. Data were collected from November 2021 to November 2023. The evaluation criteria was set by nutrition intake and the rate of achievement of nutritional intake standards. The distribution of intake was also analyzed using box-and-whisker plots, and comparisons were made with the National Health and Nutritional Survey in Japan. The National Health and Nutrition Survey in Japan is an annual nationwide survey by the Ministry of Health, Labour and Welfare, assessing the health and nutritional intake of approximately 5,000 households. Results: A total of 9,385 participants met the criteria and were included in the final analysis. The analysis revealed seasonal fluctuations in the intake of major nutrients. Salt intake peaked in February, with a difference of 0.6g from August. In the analysis of the rate of achievement of nutritional intake standards in Japan, deficiencies in zinc and magnesium were particularly noticeable, at 15% for men and 21% for women, and 22% for men and 29% for women, respectively. Excessive salt intake was particularly noticeable, with 88% of men and 80% of women exceeding the standard. Conclusion: This study revealed seasonal fluctuations in nutrient intake and nutrient deficiencies through data analysis using an application. Of note, the increase in salt intake in winter and the deficiencies of magnesium and zinc are likely to be important issues for the elderly. These results could provide a basis for designing new approaches to the nutritional intake of the elderly using digital technology.Presentation: Monday, July 14, 2025

Background and objective: End-stage renal disease (ESRD), particularly in patients undergoing haemodialysis (HD), often results in altered serum mineral and electrolyte levels, which can lead to additional health complications. This study aims to assess serum zinc levels, electrolyte concentrations, and renal function markers in HD, providing a comprehensive analysis of these parameters for the first time in this population. Methods: This cross-sectional study, which included a comparison group, enrolled 65 ESRD patients undergoing regular HD at the Erbil Dialysis Centre and 65 healthy control subjects individuals from Erbil City. Information on dietary intake, medication use, and demographic factors was gathered through structured interviews, medical record reviews, and serum analysis, which measured kidney function biomarkers, serum zinc levels, and electrolyte levels. Results: Serum zinc levels were significantly lower, and potassium concentrations were notably higher in HD patients compared to the control group. Zinc depletion was more pronounced in HD patients with hypertension than in those without. These alterations showed a negative correlation with estimated glomerular filtration rate (eGFR) levels among HD patients, with hyperkalaemia being significantly associated with lower eGFR values. Conclusion: Monitoring serum zinc levels and electrolyte balance is crucial in HD patients, as zinc deficiency appears independently linked to hypertension. Addressing this deficiency may improve patient outcomes, through larger sample-size studies.

The objective was to determine the optimal dietary organic zinc (Zn) concentration to maximize growth performance and skeletal Zn deposition in broilers. A total of 240 one-d-old broiler chicks were assigned to 5 dietary treatments for a 20-d feeding trial, with 8 cages per treatment. All diets met or exceeded recommended nutrient requirement estimates for broilers, except for Zn. The 5 treatments were as follows: (1) a corn-soybean meal-based diet with 40 mg/kg inorganic Zn from ZnSO4·7H2O; (2) a corn-soybean meal-based diet without supplemental Zn; (3-5) treatment 2 supplemented with 5, 10, or 20 mg/kg of organic Zn from Zn proteinate (Bioplex Zn®). Body weight gain, feed intake, and feed conversion ratio were measured from d 0 to 20. On d 20, tibia samples were collected, and Zn concentration in tibia ash was determined. Orthogonal polynomial contrasts were used to evaluate linear and quadratic responses to increasing supplemental organic Zn. Pairwise contrasts were performed between diets containing 40 mg/kg of inorganic Zn and those containing either 10 or 20 mg/kg of organic Zn. The optimal supplemental level of organic Zn for tibia Zn concentration was estimated using a one-slope broken-line model. Average daily gain, feed intake, and tibia Zn concentration increased linearly (p<0.05) with increasing organic Zn. Broilers fed 10 mg/kg organic Zn exhibited similar growth to those receiving 40 mg/kg inorganic Zn, but lower tibia Zn concentration (p<0.001). In contrast, 20 mg/kg organic Zn supported both growth and bone Zn deposition equivalent to the inorganic Zn group. A one-slope broken-line analysis indicated that 16.5 mg/kg organic Zn was the minimum level required to maximize tibia Zn concentration. Bioplex Zn® was more bioavailable than inorganic Zn from Zn sulfate, and 16.5 mg/kg was sufficient to optimize both growth and skeletal Zn deposition in broilers.

Abstract Disclosure: S. Silva-Echeandia: None. J. Fathelbab: None. A. Raj: None. K. Jong: None. Celiac disease (CD) is an emerging global issue, affecting about 1% of the population worldwide. While known to cause abdominal pain, bloating, and diarrhea, its extra-intestinal manifestations of low bone mineral density (BMD) and osteoporosis (OP) are often overlooked. We present a case of CD diagnosed due to elevated parathyroid hormone (PTH) level and OP-range BMD in order to discuss treatment considerations in this population. A 73-year-old man with rheumatoid arthritis is referred for elevated PTH level. He has no history of fractures or kidney stones. He weighs 72kg with a BMI of 21.60 kg/m2. He takes vitamin D and magnesium. Prior calcium levels were low-normal (8.0-8.7 mg/dL) and he reports very little dietary calcium intake. Labs show PTH 210.9 pg/mL, vitamin D 29.6ng/mL, calcium 9.0, albumin 4.3, creatinine 0.96, eGFR 83, phosphorus 4.0, magnesium 2.1. After 2 weeks of calcium carbonate supplementation, his 24-hour urine calcium is undetectable. DXA shows osteoporosis with T-score -2.8 at left femoral neck. On further questioning, patient does report frequent loose stools for several years, but has no abdominal pain. Despite switching to calcium citrate supplementation, 24-hour urine calcium remains undetectable. Celiac panel is positive, and he has other vitamin and mineral deficiencies consistent with malabsorption. He is referred to GI and subsequent small bowel biopsy shows celiac disease. He is started on a gluten-free diet with calcium citrate, cholecalciferol, magnesium, zinc, iron, and B12 supplementation with plans to repeat DXA scan in 1 year prior to starting any targeted osteoporosis treatment. The etiology of low BMD in CD is well-known, including both malabsorption of calcium and vitamin D from gluten-induced villous atrophy and increased osteoclast activity from pro-inflammatory cytokines. OP-range BMD is present at the time of CD diagnosis in about 18-35% of patients; however, there is little guidance on screening or management of OP in these patients. While some groups recommend bisphosphonates according to general OP guidelines for post-menopausal women, this approach may not benefit CD patients as it fails to account for impact of osteomalacia and secondary hyperparathyroidism affecting BMD. Indeed, premature treatment with bisphosphonates may actually hinder BMD recovery by reducing bone turnover. We chose to treat first with gluten-free diet and vitamin/mineral supplementation and anticipate that he will have significant improvement in BMD with these modifications alone, potentially obviating a need for targeted OP therapy. Presentation: Monday, July 14, 2025

Abstract Background and Aims Zinc (Zn) deficiency is associated with the development and progression of cardiovascular disease. Recently, it has also been observed that Zn supplementation can reduce albuminuria in patients with diabetic kidney disease. The aim of this study was to analyze the prevalence of Zn deficiency in patients with chronic kidney disease (CKD) and evaluate its implications for their renal and overall prognosis. Method A retrospective observational study was conducted, including patients with CKD who were evaluated at our hospital between January 2019 and May 2022, and who had a baseline serum Zn measurement and follow-up of &amp;gt;1 year. The cohort was stratified according to baseline Zn levels into three groups: severe deficiency (&amp;lt;60 µg/dl), mild deficiency (60–80 µg/dl), and normal (≥80 µg/dl). Demographic, analytical, and comorbidity variables were collected. The composite outcome was defined as doubling of serum creatinine, progression to end-stage CKD, and/or death. Results A total of 78 patients were included, with a mean age of 61.4 ± 17.3 years; 67.9% were men, with a mean glomerular filtration rate (GFR) of 43.9 ± 27.9 ml/min and median proteinuria of 3 g/24 h (IQR 1.17–5.29 g/24 h) at baseline. Baseline serum Zn levels were 74.9 ± 15.2 µg/dl. Of the patients included, 28 (35.9%) had mild deficiency, and 15 (19.2%) had severe deficiency. A direct correlation was found between baseline Zn levels and serum albumin (r = 0.68, P &amp;lt; 0.001) and calcium (r = 0.23, P = 0.047), while an inverse correlation was found with proteinuria (r = −0.33, P = 0.02) and serum phosphate levels (r = −0.33, P = 0.003). No correlation with age or GFR was found. After a median follow-up of 25 months, 13 patients (16.7%) progressed to end-stage CKD, and 14 patients (17.9%) died. A total of 30 patients (38.5%) reached the composite outcome. Severe Zn deficiency was associated with higher mortality (40% vs. 12.7%, P = 0.013). In survival analysis for the composite outcome, the group of patients with severe Zn deficiency exhibited the worst survival (Log-rank χ² 6.5, P = 0.039). The Cox proportional hazards model, adjusted for age, GFR, proteinuria, and baseline calcium, showed a higher risk of reaching the composite outcome in the severe Zn deficiency group (HR 5.31, 95% CI 1.14–24.77). Conclusion Zn deficiency in CKD is common and may represent a risk factor for CKD progression and mortality. Monitoring Zn levels and supplementation in patients with Zn deficiency should be considered. Prospective studies are needed to assess the effect of Zn supplementation.