Plasma Zinc Levels, Lipid Profile Parameters and CVD Risk Markers in Relation to Glycemic Status in T2 DM Patients

Background: Diabetes is global endemic rapidly increasing in both developed and developing countries and is a common secondary cause of hyperlipidaemia in T2DM patients. Diabetic- dyslipidemic patients exhibit atherogenic lipid profile, which greatly increases their CVD risk. Zinc, essential trace element, has significant function in energy metabolism and has been shown to serve a regulatory role in insulin signalling pathway and in supporting structural integrity of endothelial cells. A study designed to assess the plasma zinc status in t2 dm patients and to correlate zinc levels with lipid parameters, CVD markers as well as with glycemic status. Methods: The t2dm patients in the age group 30-60 years were randomly selected and were sub-grouped age wise, glycemic status-wise and diabetic duration-wise. Fasting Glucose, lipid parameters and zinc were estimated and atherogenic Index of Plasma (AIP), Atherogenic Coefficient (AC), and Cardiac Risk Ratio (CRR) were calculated. Results: The results shows levels of glucose, lipid parameters, AIP, AC and CRR are significantly elevated whereas the levels of HDLC and zinc are significantly lowered in t2dm patients and the rises as well as the fall in HDLC and zinc are proportional to glycemic status. Conclusion: It can be concluded from the present study that zinc levels are lower in t2dm patients and is reciprocally related to glycemic status as well as to the diabetic duration. Further the rise in CVD markers is directly proportional to the glycemic status but inversely related to CVD markers. Keywords: t2dm, CVD markers, glycemic status, zinc.

The Interplay between Non-Esterified Fatty Acids and Plasma Zinc and Its Influence on Thrombotic Risk in Obesity and Type 2 Diabetes

Thrombosis is a major comorbidity of obesity and type-2 diabetes mellitus (T2DM). Despite the development of numerous effective treatments and preventative strategies to address thrombotic disease in such individuals, the incidence of thrombotic complications remains high. This suggests that not all the pathophysiological mechanisms underlying these events have been identified or targeted. Non-esterified fatty acids (NEFAs) are increasingly regarded as a nexus between obesity, insulin resistance, and vascular disease. Notably, plasma NEFA levels are consistently elevated in obesity and T2DM and may impact hemostasis in several ways. A potentially unrecognized route of NEFA-mediated thrombotic activity is their ability to disturb Zn2+ speciation in the plasma. Zn2+ is a potent regulator of coagulation and its availability in the plasma is monitored carefully through buffering by human serum albumin (HSA). The binding of long-chain NEFAs such as palmitate and stearate, however, trigger a conformational change in HSA that reduces its ability to bind Zn2+, thus increasing the ion’s availability to bind and activate coagulation proteins. NEFA-mediated perturbation of HSA-Zn2+ binding is thus predicted to contribute to the prothrombotic milieu in obesity and T2DM, representing a novel targetable disease mechanism in these disorders.

Comparison of Serum, Plasma, and Liver Zinc Measurements by AAS, ICP-OES, and ICP-MS in Diverse Laboratory Settings

Progress improving zinc nutrition globally is slowed by limited understanding of population zinc status. This challenge is compounded when small differences in measurement can bias the determination of zinc deficiency rates. Our objective was to evaluate zinc analytical accuracy and precision among different instrument types and sample matrices using a standardized method. Participating laboratories analyzed zinc content of plasma, serum, liver samples, and controls, using a standardized method based on current practice. Instrument calibration and drift were evaluated using a zinc standard. Accuracy was evaluated by percent error vs. reference, and precision by coefficient of variation (CV). Seven laboratories in 4 countries running 9 instruments completed the exercise: 4 atomic absorbance spectrometers (AAS), 1 inductively coupled plasma optical emission spectrometer (ICP-OES), and 4 ICP mass spectrometers (ICP-MS). Calibration differed between individual instruments up to 18.9% (p < 0.001). Geometric mean (95% CI) percent error was 3.5% (2.3%, 5.2%) and CV was 2.1% (1.7%, 2.5%) overall. There were no significant differences in percent error or CV among instrument types (p = 0.91, p = 0.15, respectively). Among sample matrices, serum and plasma zinc measures had the highest CV: 4.8% (3.0%, 7.7%) and 3.9% (2.9%, 5.4%), respectively (p < 0.05). When using standardized materials and methods, similar zinc concentration values, accuracy, and precision were achieved using AAS, ICP-OES, or ICP-MS. However, method development is needed for improvement in serum and plasma zinc measurement precision. Differences in calibration among instruments demonstrate a need for harmonization among laboratories.

Zinc status in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis of observational studies

Previous studies regarding the zinc status in attention-deficit/hyperactivity disorder (ADHD) yielded inconsistent results. Thus, the present meta-analysis was aimed to estimate the association between hair and serum/plasma zinc levels and ADHD. Online databases of Medline, EMBASE, and Scopus were searched up to October 2020 with no limitation in time and language. Weighted mean differences (WMDs) of hair and serum/plasma zinc levels were calculated using a random-effects model. Overall, 22 articles with 1280 subjects with ADHD and 1200 controls were included. The pooled effect size indicated that serum/plasma zinc levels in subjects with ADHD were not statistically different than their controls (WMD = − 1.26 µmol/L; 95% CI − 3.72, 1.20). Interestingly, the exclusion of one study from the analysis showed that people with ADHD significantly have lower circulating levels of zinc compared to their controls (WMD: − 2.49 µmol/L; 95% CI − 4.29, − 0.69). Also, the pooled effect size indicated that hair zinc levels in cases with ADHD were not statistically different than their controls (WMD = − 24.19 μg/g; 95% CI − 61.80, 13.42). Present meta-analysis raises the possibility that subjects with ADHD are prone to have declined levels of zinc levels. Based on current findings, screening the zinc levels in subjects with ADHD could be reasonable. Further well-designed studies are needed to clarify the role of zinc in the etiology of ADHD.

Plasma zinc status and hyperinflammatory syndrome in hospitalized COVID-19 patients

Background SARS-CoV-2 is associated with significant mortality and morbidity in a subgroup of patients who develop cytokine releasing syndrome (CRS) and the related acute respiratory distress syndrome. Precedent evidence suggests that deficiency of the element zinc can be associated with similar complications as well as impaired antiviral response. Herein, beyond determining the zinc status, we explore the association between the plasma zinc concentration, the development of CRS, and the clinical outcomes in hospitalized COVID-19 patients. Methods We conducted a prospective, single-center, observational study in a tertiary university hospital (CUB-Hopital Erasme, Brussels). Hospitalized adult patients with PCR-confirmed SARS-CoV-2 infection were enrolled within 72 hours of hospital admission. We assessed the presence and severity of COVID-19-associated hyperinflammatory syndrome (cHIS), an additive six-point clinical scale that we independently validated in the current study. We defined the clinical outcomes as the length of hospitalization, the incidence of mechanical ventilation, and mortality. We recorded the outcomes with a follow-up of 90 days from hospital admission. Results One hundred and thirty-nine eligible patients were included between May 2020 and November 2020 (median age of 65 years [IQR, 54 to 77]). Our cohort's mean plasma zinc concentration was 56.2 mcg/dL (standard deviation [SD], 14.8). The absolute majority of patients (96%) were zinc deficient (<80mcg/dL). The mean plasma zinc concentration was lower in patients with CRS (cHIS ≧ 2)compared to those without CRS (-5 mcg/dL; 95% CI, -10.5 to 0.051; p = 0.048). We observed that the plasma zinc concentration is weakly but significantly correlated with the length of hospital stay (rho = -0.19; p = 0.022). However, the plasma zinc concentration was not significantly associated with the risk of mortality or morbidity. Conclusions Markedly, an absolute majority of hospitalized COVID-19 patients are zinc deficient. We found no significant association between zinc plasma concentration and cHIS. We find a weak (reverse) correlation between plasma zinc concentration and the length of hospital stay, but not with mortality or morbidity. As such, our findings do not support the role of zinc as a robust prognostic factor among hospitalized COVID-19 patients. We encourage further studies to explore the role of zinc as a biomarker for assessing the risk of developing a tissue-damaging CRS and predicting outcomes in patients diagnosed with COVID-19.

Zinc absorption and zinc status are reduced after either sleeve gastrectomy or Roux-en-Y gastric bypass in premenopausal women with severe obesity studied prospectively over 24 postoperative months

ABSTRACT Background Roux-en-Y gastric bypass (RYGBP) is known to reduce zinc absorption; the effects of vertical sleeve gastrectomy (SG) and its long-term implications on zinc absorption have not yet been studied. Objective The aim was to evaluate the effects of SG and RYGBP on zinc absorption and zinc status in premenopausal women with severe obesity up to 24 mo after surgery. Methods Twenty-six premenopausal women undergoing SG [BMI (in kg/m2): 37.3 ± 3.2] and 32 undergoing RYGBP (BMI: 42.0 ± 4.2) were studied. A series of anthropometric, dietary, and zinc status parameters (plasma and hair zinc), and the size of the exchangeable zinc pool (EZP), as well as percentage zinc absorption from a standardized dose using a stable isotope methodology were evaluated in the patients before the surgical procedure and at 12 and 24 mo after SG or RYGBP. SG patients received 15 mg and RYGBP received 25 mg of supplemental Zn/d. Results In premenopausal women, zinc absorption was decreased by 71.9% and 52.0% in SG and RYGBP, respectively, 24 mo postsurgery, compared with initial values. According to 2-factor repeated-measures ANOVA, time effect was significant (P = &lt;0.0001), but not time × group interaction (P = 0.470). Plasma zinc below the cutoff point of 70 µg/dL increased from 0 to 15.4% and 38.1% in SG and RYGBP, respectively. Mean EZP was significantly reduced 24 mo after surgery, although no time × group interactions were observed. Hair zinc did not change across time or between groups. Conclusions Both SG and RYGBP have profound effects on zinc absorption capacity, which are not compensated for after 24 mo. Although zinc absorption reduction was similar in both types of surgeries, plasma zinc was more affected in RYGBP than SG, despite greater zinc supplementation in RYGBP. This trial was registered at http://www.isrctn.com as ISRCTN31937503.

Multiple Micronutrients, Including Zinc, Selenium and Iron, Are Positively Associated with Anemia in New Zealand Aged Care Residents

Anemia is a significant comorbidity for older adults not fully attributable to iron deficiency. Low-grade inflammation and other micronutrient deficiencies also contribute. This cross-sectional study examined the relationships between nutrient and non-nutrient factors with hemoglobin and anemia in 285 residents (>65 years) of 16 New Zealand aged-care facilities. Blood samples were analyzed for hemoglobin, ferritin, sTfR, hepcidin, zinc, selenium, and interleukin-6 (IL-6), (with ferritin, sTfR, zinc and selenium adjusted for inflammation). Linear regression models examined the relationships between micronutrient biomarkers (iron, zinc, selenium, vitamin B-12 and D), age, sex, and health factors with hemoglobin. Thirty-two percent of participants exhibited anemia, although <2% had either depleted iron stores or iron deficiency. Plasma zinc and selenium deficiencies were present in 72% and 38% of participants, respectively. Plasma zinc and total body iron (TBI) were positively associated (p < 0.05) with hemoglobin, while gastric acid suppressing medications, hepcidin, and interleukin-6 were inversely associated. These relationships were maintained after the application of anemia cut-offs. These findings emphasize the importance of considering multiple micronutrient deficiencies as risk factors for anemia.