Methods of assessment of iodine status in humans: a systematic review

Assessing potential biomarkers of micronutrient status by using a systematic review methodology: methods

BACKGROUND

To explore the relation between micronutrient status and health, it is important to understand which markers of micronutrient status can be relied on and under what circumstances.

OBJECTIVE

The objective of this article was to develop a common systematic review methodology for use in the assessment of micronutrient status for selenium, iodine, copper, zinc, riboflavin, vitamin B-12, vitamin D, and omega-3 (n-3) long-chain polyunsaturated fatty acids.

DESIGN

We developed a methodology on the basis of defining studies that clearly altered micronutrient status and then pooled data on the effects of this intervention on each specific biomarker to assess objectively the response of various status markers to changes in intake.

RESULTS

The generic methodology included defining, and systematically searching for, studies that resulted in a change in micronutrient status. Study inclusion, data extraction, and assessment of validity were conducted with a minimum of 10% independent duplication. For each study and each potential biomarker, the highest dose and longest duration intervention data were selected to assess the statistical significance of any change in intake on the status biomarker. The consistency of biomarker response was explored by subgrouping the studies according to baseline micronutrient status, sex, population group, supplementation type, dose, duration, and analytic method.

CONCLUSION

This methodology allows systematic assessment of the usefulness of a number of biomarkers for a selection of micronutrients.

Methods of assessment of zinc status in humans: a systematic review

BACKGROUND

Zinc is an essential micronutrient for human health and has numerous structural and biochemical roles. The search for a reliable, sensitive, and specific index of zinc status has been the subject of considerable research, which has resulted in the identification of a number of potentially useful biomarkers.

OBJECTIVE

The objective was to assess the usefulness of biomarkers of zinc status in humans.

DESIGN

The methods included a structured search strategy using Ovid MEDLINE, EMBASE (Ovid), and the Cochrane Library CENTRAL databases; formal inclusion and exclusion criteria; data extraction into an Access database; quality and validity assessment; and meta-analysis.

RESULTS

Data on 32 potential biomarkers from 46 publications were analyzed. Plasma zinc concentration responded in a dose-dependent manner to dietary manipulation in adults, women, men, pregnant and lactating women, the elderly, and those at low and moderate baseline zinc status. Urinary zinc excretion responded to zinc status overall and in all subgroups for which there were sufficient data. Hair zinc concentration also responded, but there were insufficient studies for subgroup analysis. Platelet, polymorphonuclear cell, mononuclear cell, and erythrocyte zinc concentration and alkaline phosphatase activity did not appear to be effective biomarkers of zinc status.

CONCLUSIONS

This systematic review confirms that in healthy individuals, plasma, urinary, and hair zinc are reliable biomarkers of zinc status. Further high-quality studies using these biomarkers are required, particularly in infants, adolescents, and immigrant population groups for whom there are limited data. Studies are also required to fully assess a range of additional potential zinc biomarkers.

Methods of assessment of copper status in humans: a systematic review

BACKGROUND

The assessment of dietary adequacy of copper is constrained by the absence of recognized copper status biomarkers.

OBJECTIVES

The objectives were to systematically review the usefulness of copper status biomarkers and identify those that reflected changes in status over > or =4 wk.

DESIGN

The methods included a structured search on Ovid MEDLINE, EMBASE (Ovid), and Cochrane databases to October 2007, followed by the use of formal inclusion/exclusion criteria, data extraction, validity assessment, and meta-analysis.

RESULTS

A total of 16 studies (288 participants) were included in the review, with data on 16 possible copper biomarkers. All of the included studies were small and at high risk of bias. Data for serum copper suggested its value as a biomarker, reflecting changes in status in both depleted and replete individuals, although these changes were smaller in the latter. Total ceruloplasmin protein is related to copper status but reflects changes in highly depleted individuals only. Erythrocyte superoxide dismutase and urinary deoxypyridinoline are not useful biomarkers, but there were insufficient data to draw firm conclusions about plasma, erythrocyte, and platelet copper; leukocyte superoxide dismutase; erythrocyte, platelet, and plasma glutathione peroxidase; platelet and leukocyte cytochrome-c oxidase; total glutathione; diamine oxidase; and urinary pyridinoline. The paucity of data prevented detailed subgroup analysis.

CONCLUSIONS

Despite limited data, serum copper appears to be a useful biomarker of copper status at the population level. Further large studies with low risk of bias are needed to explore the effectiveness of other biomarkers of copper status and the relation between biomarker responsiveness, dose, and period of supplementation.