Adjusting plasma or serum zinc concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project

ABSTRACT Background The accurate estimation of zinc deficiency at the population level is important, as it guides the design, targeting, and evaluation of nutrition interventions. Plasma or serum zinc concentration (PZC) is recommended to estimate zinc nutritional status; however, concentrations may decrease in the presence of inflammation. Objectives We aimed to assess the relation between PZC and inflammation in preschool children (PSC; 6–59 mo) and nonpregnant women of reproductive age (WRA; 15–49 y), and to compare different inflammation adjustment approaches, if adjustment is warranted. Methods Cross-sectional data from 13 nationally representative surveys (18,859 PSC, 22,695 WRA) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project were analyzed. Correlation and decile analyses were conducted, and the following 3 adjustment methods were compared if a consistent negative association between PZC and C-reactive protein (CRP) or α-1-acid glycoprotein (AGP) was observed: 1) exclude individuals with CRP > 5 mg/L or AGP > 1 g/L; 2) apply arithmetic correction factors; and 3) use the BRINDA regression correction (RC) approach. Results In 6 of 12 PSC surveys, the estimated prevalence of zinc deficiency increased with increasing CRP deciles, and to a lesser extent, with increasing AGP deciles. In WRA, the association of PZC with CRP and AGP was weak and inconsistent. In the 6 PSC surveys in which adjustment methods were compared, application of RC reduced the estimated prevalence of zinc deficiency by a median of 11 (range: 4–18) percentage points, compared with the unadjusted prevalence. Conclusions Relations between PZC and inflammatory markers were inconsistent, suggesting that correlation and decile analyses should be conducted before applying any inflammation adjustments. In populations of PSC that exhibit a significant negative association between PZC and CRP or AGP, application of the RC approach is supported. At this time, there is insufficient evidence to warrant inflammation adjustment in WRA.

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High Prevalence of Zinc Deficiency in Rural Nigerian Preschool Children: A Community-Based Cross-Sectional Study

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.1515/rjdnmd-2017-0004 ◽

2017 ◽

Vol 24 (1) ◽

pp. 31-39

Author(s):

Amarabia N.E. Ibeawuchi ◽

Alphonsus N. Onyiriuka ◽

Philip O. Abiodun

Keyword(s):

Zinc Deficiency ◽

Rural Community ◽

Zinc Concentration ◽

Serum Zinc ◽

Cross Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Serum Zinc Concentration ◽

High Prevalence ◽

Zinc Concentrations

AbstractBackground and Aims: In Nigeria, community-based epidemiological data related to the prevalence of zinc deficiency in preschool children are scarce. We assessed the prevalence of zinc deficiency and the associated socio-demographic variables in children aged between 6 and 60 months, living in a Nigerian rural community.Materials and Methods: In this cross-sectional study, the serum zinc concentrations of 252 children aged between 6 and 60 months in a rural community in Nigeria were assessed, using atomic absorption spectrophotometry. The study population was selected by multistage random sampling and at least two children were selected from every household which had children in the study age group. The socio-demographic characteristics of the subjects were obtained, using an interviewer-administered questionnaire.Results: A total of 252 children were studied, 134 (53.2%) males and 118 (46.8%) females. The mean age was 32.7±17.0 months, similar for both sexes. Overall, 220 (87.3%) had low serum zinc concentrations (less than 7.65µmol/L). According to age, the highest mean serum zinc concentration was 5.43±3.52µmol/L in children aged between 6 and 12 months. Correlation between serum zinc concentration and family size or socio-economic status (SES) showed that the smaller the family size and the higher the SES, the higher the serum zinc concentration.Conclusions: The high prevalence of low serum zinc concentration indicates that zinc deficiency is a public health problem in our rural communities, requiring public health intervention.

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National Risk of Zinc Deficiency as Estimated by National Surveys

Food and Nutrition Bulletin ◽

10.1177/0379572116689000 ◽

2017 ◽

Vol 38 (1) ◽

pp. 3-17 ◽

Cited By ~ 17

Author(s):

Sonja Y. Hess

Keyword(s):

Zinc Deficiency ◽

Serum Zinc ◽

Reproductive Age ◽

Health Concern ◽

Middle Income ◽

Representative Sampling ◽

Balance Sheets ◽

National Surveys ◽

Nationally Representative ◽

The Republic

Background: Information is needed on the national prevalence of zinc deficiency to guide program development and evaluation. Objective: To summarize results of national surveys that assessed plasma or serum zinc concentrations (PZC) and compare the prevalence of low PZC with other methods used to estimate countries’ risk of zinc deficiency. Methods: National surveys that included PZC were identified through Internet searches and personal contacts. A survey was eligible if a nationally representative sampling scheme was used, PZC was analyzed, and the survey was implemented in a low- or middle-income country. Twenty surveys were eligible; 19 countries assessed PZC in young children and 14 in women of reproductive age. Results: In 13 of the 19 surveys, the prevalence of low PZC in children was >20%. Only Afghanistan, Azerbaijan, Nigeria, the Republic of Maldives, Sri Lanka, and China found a low prevalence of inadequate PZC among children. Some of these conclusions may be due to the lower than recommended cutoff that was used. Similarly, in 13 of 14 surveys, the prevalence of low PZC in women was >20%. Estimates of percentage population with inadequate dietary zinc intake based on food balance sheets underestimate the risk of zinc deficiency. The national stunting prevalence seems to be a useful proxy, as both indicators categorized countries similarly into high versus low risk of zinc deficiency, with some exceptions. Conclusions: Results from 20 countries suggest that zinc deficiency is a public health concern in the majority of these countries and zinc intervention strategies should be considered.

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Serum Zinc Levels in Cirrhotic Patients Attending General and Specialty Hospitals, Yangon

Myanmar Health Sciences Research Journal ◽

10.34299/mhsrj.00956 ◽

2019 ◽

Vol 31 (3) ◽

pp. 251-256

Keyword(s):

Clinical Practice ◽

Hepatic Encephalopathy ◽

Zinc Deficiency ◽

Serum Zinc ◽

Zinc Level ◽

The Body ◽

Serum Zinc Level ◽

Cross Sectional ◽

Cirrhotic Patients ◽

Cirrhosis Of Liver

Cirrhosis of liver is one of the common medical problem in daily clinical practice and one of the leading causes of morbidity and mortality. Zinc is an essential trace elements for human and plays in many biological roles in the body. Among them, zinc deficiency is thought to be involved in metabolism of ammonia and causes hyperammonia that worsen hepatic encephalopathy. This study aimed to find out the severity of cirrhosis of liver was by Child Turcotte Pugh score and to investigate the associations between serum zinc level and severity of cirrhosis. A hospital-based cross-sectional descriptive study was performed on 78 patients with different underlying causes of cirrhosis of liver at the Medical Units of Yangon General Hospital and Yangon Specialty Hospital. Among the study population, Child grade A was found to be 28.21%, Child grade B was 30.77% and Child grade C was 41.03%. Regarding result of serum zinc level, 62.8% were low level, 28.2% were within normal level and 8.9% were high level. Mean value of serum zinc level in grade A was 0.68 mg/l, grade B was 0.54 mg/l and grade C was 0.48 mg/l (p=0.00). It was found out that there was a high prevalence of zinc deficiency in severe cirrhotic patients. The zinc level was significantly lowest among patients with Child-Pugh C as compare to those with Child-Pugh B and C. Severity of zinc deficiency should be requested for supplementation therapy in cirrhotic patients as to prevent complications such as hepatic encephalopathy, hepatocellular carcinoma and liver failure. Screening for zinc deficiency may need in these patients with more advanced cirrhosis because it seems to be a marker of advanced liver disease and it can be deducted that awareness of serum zinc level among cirrhotic patients is very important in clinical practice.

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A cross-sectional study of the correlation between diabetic therapy and serum zinc concentrations

Diabetology International ◽

10.1007/s13340-021-00521-6 ◽

2021 ◽

Author(s):

Mamoru Sakurai ◽

Junko Sasaki ◽

Hirotsugu Suwanai ◽

Jumpei Shikuma ◽

Rokuro Ito ◽

...

Keyword(s):

Serum Zinc ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Zinc Concentrations

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Association between serum zinc concentrations and metabolic risk factors among Chinese children and adolescents

British Journal Of Nutrition ◽

10.1017/s0007114521000258 ◽

2021 ◽

pp. 1-31

Author(s):

Qianrang Zhu ◽

Yue Dai ◽

Jingxian Zhang ◽

Wei Xie ◽

Hui Zuo ◽

...

Keyword(s):

Risk Factors ◽

Children And Adolescents ◽

Density Lipoprotein ◽

Serum Zinc ◽

Negative Association ◽

Metabolic Risk Factors ◽

Chinese Children ◽

Metabolic Risk ◽

Zinc Concentrations ◽

Chinese Children And Adolescents

Abstract Purpose Zinc plays an important role in metabolic processes in human organisms and is indispensable in many enzymatic processes. To date, few studies have assessed the association between serum zinc and metabolic risk factors in children and adolescents. The aim of the present study was to examine whether serum zinc concentrations was associated with metabolic risk factors in Chinese children and adolescents. Methods This study was a cross-sectional analysis of data from the 2016-2017 China National Nutrition and Health Surveillance for Children and Nursing in Jiangsu Province. A total of 3241 participants aged 6 -17years were included. Metabolic risk factors included fasting glucose (FG), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), systolic blood pressure and diastolic blood pressure. Data were analyzed using multivariable linear regression and generalized additive models, which were adjusted for age, gender, high sensitive C-reactive protein, estimated glomerular filtration rate, body mass index and region of residence, to assess the associations of serum zinc concentrations with metabolic risk factors. Results We observed a negative association between serum zinc concentrations and FG (coefficient = -0.532; 95% CI: -0.569, -0.495; p< 0.001). Moreover, TC (coefficient = 0.175 ; 95% CI 0.127, 0.222; p< 0.001), HDL-C (coefficient = 0.137 ; 95% CI 0.082, 0.193; p< 0.001) and LDL-C (coefficient = 0.195 ; 95% CI 0.128, 0.263; p< 0.001) were found to be positively associated with zinc levels. A generalized additive model showed that the negative association between serum zinc and FG was weak at lower serum zinc concentrations, and was stronger with the increase in serum zinc concentrations. Additionally, a U-shaped association between serum zinc and TG was observed. Conclusions Serum zinc concentrations were associated with FG, TC, TG, HDL-C and LDL-C levels in Chinese children and adolescents. Lower levels of serum zinc were more likely related to a poor metabolic status.

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Metabolic syndrome may be associated with a lower prevalence of iron deficiency in Ecuadorian women of reproductive age

Journal of Nutritional Science ◽

10.1017/jns.2020.55 ◽

2021 ◽

Vol 10 ◽

Author(s):

Melisa A. Muñoz-Ruiz ◽

Laura I. González-Zapata ◽

Victoria Abril-Ulloa ◽

Diego A. Gaitán-Charry

Keyword(s):

Metabolic Syndrome ◽

Prevalence Ratio ◽

Population Level ◽

Reproductive Age ◽

Fe Deficiency ◽

Lower Prevalence ◽

Women Of Reproductive Age ◽

Nutrition Survey ◽

Cross Sectional ◽

Total Prevalence

Abstract The present study aimed to assess the associations of the stages of Fe deficiency (Fe deficiency without anaemia (ID) and Fe-deficiency anaemia (IDA)) and anaemia with metabolic syndrome (MetS) in Ecuadorian women. A cross-sectional study was conducted in 5894 women aged 20–59 years, based on data from the 2012 Ecuadorian National Health and Nutrition Survey. The sample was stratified by age. A χ2 test was used to assess the possible associations of ID, IDA and anaemia with MetS. The prevalence ratio (PR) for each stage of Fe deficiency and anaemia was estimated considering women without MetS as a reference. The total prevalence of MetS, ID, IDA and anaemia was 32⋅3 % (se 0⋅6), 6⋅2 % (se 0⋅3), 7⋅1 % (se 0⋅3) and 5⋅0 % (se 0⋅3), respectively. In women aged 20–29, 30–39 and 40–49 years, MetS was associated with a lower prevalence of ID (PR (95 % CI; P-value)): 0⋅17 (0⋅06, 0⋅46; P < 0⋅001), 0⋅69 (0⋅48, 0⋅99; P = 0⋅044) and 0⋅44 (0⋅29, 0⋅67; P < 0⋅001), respectively. In women aged 50–59 years, MetS was associated with IDA and anaemia (PR (95 % CI; P-value)): 0⋅12 (0⋅02, 0⋅96; P = 0⋅026) and 0⋅22 (0⋅07, 0⋅64; P = 0⋅002), respectively. In conclusion, Ecuadorian women of reproductive age with MetS have a lower prevalence of ID compared with those without MetS. Furthermore, the MetS and IDA coexist at the population level. These findings require an analysis from a dietary pattern approach, which could provide key elements for developing public policies that simultaneously address all forms of malnutrition.

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Getting Under the Skin: The Association Between Social Isolation and Inflammatory Markers

Innovation in Aging ◽

10.1093/geroni/igaa057.1975 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 589-590

Author(s):

Thomas K M Cudjoe ◽

Carl Latkin ◽

David Roth ◽

Roland Thorpe ◽

Cynthia Boyd

Keyword(s):

Social Isolation ◽

Community Dwelling ◽

Morbidity And Mortality ◽

Multiple Chronic Conditions ◽

Cross Sectional ◽

Reactive Protein ◽

Health Aging ◽

Important Health ◽

Nationally Representative ◽

Community Dwelling Older Adults

Abstract Social isolation is a risk factor for morbidity and mortality comparable to well-established risk factors including smoking, hypertension, and a sedentary lifestyle. Specific mechanisms that connect social isolation to important health outcomes remain unclear. We examine the cross-sectional relationship between social isolation and two biological markers: Interleukin-6 (IL-6) and C-Reactive Protein (CRP) in a nationally representative population of community dwelling older adults (IL-6: n=4336, CRP: n=4178) from the National Health Aging Trends Study in 2017. Adjusting for age, gender, race, income, tobacco use, body mass index, and multiple chronic conditions, we found that social isolation compared to no social isolation was associated with higher levels of IL-6 (p = 0.043) and CRP (p = 0.038). These results suggest that investigating inflammatory pathways between social isolation and morbidity and mortality is important.

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Prevalence of zinc deficiency among primary school children in a poor peri-urban informal settlement in South Africa

Health SA Gesondheid ◽

10.4102/hsag.v15i1.433 ◽

2010 ◽

Vol 15 (1) ◽

Cited By ~ 4

Author(s):

Folake O. Samuel ◽

Abdulkadir A. Egal ◽

Wilna H. Oldewage-Theron ◽

Carin E. Napier ◽

Christine S. Venter

Keyword(s):

Social Sciences ◽

South Africa ◽

Zinc Deficiency ◽

Informal Settlement ◽

Serum Zinc ◽

Primary School Children ◽

World Health ◽

Food Sources ◽

Cross Sectional ◽

The Mean

This cross-sectional study assessed the risk of zinc deficiency in randomly selected children, aged between 7 and 11 years, living in a poor, peri-urban informal settlement in South Africa. Dietary intake of 149 respondents was evaluated by 24-hour recall and quantitative food frequency questionnaires. Anthropometric and biochemical indices of a subset of 113 were determined. Descriptive statistics, analysis of variance and Pearson correlations were computed using the Statistical Package for Social Sciences, version 14.0. Anthropometric data were analysed using the World Health Organization Anthro plus version 1.0.2 statistical software. Dietary data were analysed with FoodFinder® version 3. The mean age of the children was 9.0±1.1 years. Few zinc-rich sources appeared in the diet that was predominantly plant-based. Mean dietary zinc intake was 4.6±2.2 mg/day. The mean value of serum zinc was 66.4±21.5 µg/dL, with 46% of the children having values less than the 70 µg/dL cut-off. The findings indicate a high risk of zinc deficiency and suboptimal zinc status for the majority of this study population of children, possibly as a result of low consumption of food sources with high bioavailability of zinc, which invariably is a direct consequence of poverty and food insecurity.OpsommingDie doel van hierdie dwarsdeursnitstudie was die bepaling van die risiko van ’n sinktekort in ’n ewekansige steekproef van 7 tot 11 jaar-oue kinders, woonagtig in ’n arm, voorstedelike informele woonbuurt in Suid Afrika. Dieetinnames van 149 respondente is geëvalueer deur 24-uur herroep en kwantitatiewe voedselfrekwensie vraelyste. Antropometriese en biochemiese indikatore van ’n kleiner steekproef van 113 is ook bepaal. Beskrywende statistiek, analise van variansie en Pearsonkorrelasies is bepaal deur die Statistical Package for Social Sciences, uitgawe 14.0. Antropometriese data is geanaliseer deur die statistiese program, Anthro plus, uitgawe 1.0.2, van die Wêreld Gesondheid Organisasie. Dieetdata is met behulp van FoodFinder® uitgawe 3 geanaliseer. Die gemiddelde ouderdom van die kinders was 9.0±1.1 jaar. Min sinkryke voedselbronne is in die hoofsaaklik plantryke dieet waargeneem. Die gemiddelde sinkinname was 4.6±2.2 mg/dag en die gemiddelde serumsinkwaarde was 66.4±21.5 µg/dL, met 46% van die kinders se waardes onder die 70 µg/dL afsnypunt. Die bevindings dui op ’n hoë risiko vir sinktekort en suboptimale sinkstatus vir die meerderheid van hierdie kinders, moontlik as gevolg van die swak inname van voedselbronne met hoë biobeskikbare sink, wat gewoonlik ’n direkte gevolg van armoede en huishoudelike voedsel insekuriteit is.

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101 National Trends in Emergency Department Ondansetron Use and Clinical Outcomes Among Children with Acute Gastroenteritis

Paediatrics & Child Health ◽

10.1093/pch/pxab061.082 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e72-e73

Author(s):

Sarah Rogers ◽

Stephen Freedman ◽

Terry Klassen ◽

Brett Burstein

Keyword(s):

Emergency Department ◽

Acute Gastroenteritis ◽

Multivariable Analysis ◽

Population Level ◽

Subject Area ◽

Fluid Administration ◽

Cross Sectional ◽

Ed Visits ◽

Nationally Representative ◽

Over Time

Abstract Primary Subject area Emergency Medicine - Paediatric Background Acute gastroenteritis (AGE) is among the most common illnesses for which children are evaluated in the Emergency Department (ED). Among children with AGE, ondansetron has been shown to reduce vomiting, intravenous (IV) fluid administration and hospitalizations when administered in the ED. Objectives To determine whether increasing ondansetron administration is associated with a concomitant decline in IV rehydration and hospitalization among children presenting with AGE in a broad, nationally representative ED sample. Design/Methods This was a cross-sectional analysis of the US Centers for Disease Control and Prevention (CDC) National Hospital Ambulatory Medical Care Survey (NHAMCS) database from 2006 to 2015. Children < 18 years old with a discharge diagnosis of AGE were included for analysis. Survey weighting procedures were applied to generate population-level estimates and to perform multivariable logistic regression to identify factors associated with ondansetron administration. Results There were an estimated 15.1 million (95% CI 13.5-16.7) visits for AGE during the 10-year study period. AGE visits increased as a proportion of all pediatric ED visits over time (4.6% in 2006, 5.7% in 2015; p-trend=0.013). The mean patient age was 4.7 (95% CI 4.5-5.0) years, and most visits were to non-teaching (86.6%, 95% CI 83.3-89.3%) and non-pediatric (83.4%, 95% CI 78.2-87.5%) hospitals. The proportion of patients receiving ondansetron increased over time (11.8% in 2006, 62.5% in 2015; p-trend < 0 .001), both in the ED (10.6% in 2006, 55.5% in 2015; p-trend < 0 .001) and as outpatient prescriptions (3.3% in 2006, 45.3% in 2015; p-trend < 0 .001). Over the same period, there was no change in hospitalizations (2.9% overall, 95% CI 2.2-3.7%; p-trend=0.144). IV hydration for AGE decreased (31.8% in 2006, 24.9% in 2015; p-trend < 0 .048), as did IV fluid administration across all other pediatric ED visits (10.3% in 2006, 7.8% in 2015; p-trend < 0 .023). After adjustment for patient- and hospital-level factors, the odds ratio for IV rehydration among children with AGE was 0.97 (95% CI 0.92-1.01). Multivariable analysis found younger age (aOR 0.94, 95% CI 1.04-1.09), Medicaid/Medicare insurance (aOR 0.74; 95% CI 0.57-0.97), and presentation to a teaching hospital (aOR 0.74; 95% CI 0.54-0.99) were inversely associated with ondansetron administration. Other antiemetics most commonly used were promethazine (7.4%, 95% CI 5.9-9.2%), metoclopramide (1.8%, 95% CI 1.3-2.5%) and trimethobenzamide (1.5%, 95% CI 1.1-2.1%). Antimotility agents, H2-receptor blockers, and probiotics were infrequently used. Conclusion Both ED and outpatient prescribing of ondansetron for children with AGE increased; however, no concomitant decline was observed in hospitalizations or IV rehydration. Guidelines and quality improvement efforts are needed to target ondansetron administration to children most likely to benefit to minimize adverse events and costs associated with overuse.

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Copper and Copper/Zinc Ratio in a Series of Cystic Fibrosis Patients

Nutrients ◽

10.3390/nu12113344 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3344

Author(s):

Marlene Fabiola Escobedo-Monge ◽

Enrique Barrado ◽

Carmen Alonso Vicente ◽

María Antonieta Escobedo-Monge ◽

María Carmen Torres-Hinojal ◽

...

Keyword(s):

Cystic Fibrosis ◽

Zinc Deficiency ◽

Linear Regression Analysis ◽

Bone Conduction ◽

Serum Zinc ◽

Abdominal Ultrasound ◽

Serum Copper ◽

Cross Sectional ◽

Inflammatory Status ◽

Copper Zinc

Cystic fibrosis (CF) patients require a stable and sufficient supply of micronutrients. Since copper is an essential micronutrient for human development, a cross-sectional study was carried out to investigate the serum copper levels, serum copper/zinc (Cu/Zn) ratios, and their relationship with nutritional indicators in a group of CF patients. Anthropometric, biochemical, and dietary measurements, an abdominal ultrasound, and respiratory and pancreatic tests were conducted. Seventeen CF patients were studied (10 females, 59%), 76.5% of whom were ∆F580. Their mean serum copper (113 ± 23 μg/dL) was normal, and there was only one teenager with hypocupremia (6%) and two children with hypercupremia (18%). A significant association between serum copper and zinc levels was discovered. The Cu/Zn ratio was higher than 1.00 for 94% of patients, which is an indicator of an inflammation status. There was no significant correlation between the serum copper concentrations and respiratory and pancreatic function, respiratory colonization, and the results of the abdominal ultrasound. Linear regression analysis showed that serum copper had a positive association with both the Z-score body mass index (BMI) and mean bone conduction speed (BCS). Therefore, since 94% of CF patients had a Cu/Zn ratio > 1.00, this factor must alert us to consider the risk of zinc deficiency and high inflammatory response. The measurement of serum zinc alone does not show one’s zinc status. However, the Cu/Zn ratio may be an indicator of zinc deficiency and the inflammatory status of CF patients.

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