Cut-off Serum Zinc Concentration Affecting the Appetite, Growth, and Nutrition Status of Undernourished Children Supplemented With Zinc

Immunity-enhancing Micronutrients and Community Pharmacists: An Opportunity to Expand Self-Care Practices among the Public

Background: The urban lifestyle and environment pose a constant immune challenge to city dwellers. A major such challenge is influenza, which creates substantial public health and socio-economic burdens. The global healthcare paradigm has begun emphasizing the importance and cost-effectiveness of self-care in partnership with healthcare professionals such as community pharmacists for the management of mild ailments. For the general public, micronutrient supplementation is an affordable and potentially feasible self-care strategy for immunity enhancement and disease management. At the same time, micronutrient deficiencies are a serious public health concern in both developing and developed areas. Objective: This review focuses on the clinical evidence for the efficacy and safety of three key micronutrients — vitamins C, D and zinc — on respiratory infections. Key findings: These micronutrients are important for optimal immune function through their complementary roles in supporting both innate and adaptive immunity, as well as epithelial barriers. The need to improve public awareness of self-care in prevention and health management is highlighted by recent public health issues and the global fight against antimicrobial resistance. Community pharmacists could play a crucial role in empowering patient autonomy. Conclusion: With this review we aim to offer insights into the supplementation of these micronutrients as a self-care approach to the management of immune health.

Feeding difficulties in Asian children with autism spectrum disorder

BACKGROUND

To characterize the nature and severity of feeding difficulties in Asian young children with Autism Spectrum Disorders (ASD) and identify potential predictors of poorer feeding outcomes.

METHODS

Cross sectional study of children aged 1-7 years with ASD. Parents completed the following: demographic information, brief autism mealtime behavior inventory, aberrant behavior checklist (ABC), behavioral pediatrics feeding assessment scale (BPFAS) and caregiver feeding style questionnaire. Additional information (medical data, cognitive and developmental assessment results, e.g., Autism Diagnostic Observation Schedule Second Edition, Autism Diagnostic Interview, Revised, Vineland Adaptive Behaviour Scales, etc.) were subsequently obtained from electronic medical records retrospectively by one of the study team members.

RESULTS

Of the 67 children, 28.4% had feeding difficulties (high BPFAS total frequency score). Caregiver feeding styles were authoritarian (34.8%) or indulgent (39.4%). Child characteristics did not significantly predict for the severity of feeding difficulties. Univariate analysis revealed that authoritarian feeding style (p = 0.001) and ABC hyperactivity score (p = 0.006) were significantly associated with BPFAS severity score. Multivariate analysis revealed that ABC hyperactivity score remained significantly associated with BPFAS severity score after controlling for all other ABC subscale scores. A final regression model including all child characteristics and ABC scores did not reveal any significant predictors of BPFAS total frequency score (R2 = 0.557).

CONCLUSION

Our findings suggest an association between hyperactivity, authoritarian feeding style and feeding difficulties. Children with ASD who have significant hyperactivity behaviors in the context of parents with an authoritarian feeding style should be actively screened for problematic feeding behaviors.

Serum micronutrient status, sleep quality and neurobehavioural function among early adolescents

OBJECTIVE

To examine associations between serum micronutrients and neurobehavioural function and the mediating role of sleep quality in early adolescents.

DESIGN

In this cross-sectional study, peripheral blood samples were analysed for Fe and Zn levels. The Pittsburgh Sleep Quality Index and Penn Computerized Neurocognitive Battery were used to assess sleep quality and neurobehavioural function, respectively. The logistic/linear regressions and generalised structural equation modelling were performed to estimate the associations.

SETTING

Jintan, China.

PARTICIPANTS

In total, 226 adolescents (106 females) from the Jintan Child Cohort study.

RESULTS

Adolescents with low Fe (<75 μg/dl) (OR = 1·29, P = 0·04) and low Zn (<70 μg/dl) (OR = 1·58, P < 0·001) were associated with increased odds for poor sleep quality. Adolescents with low Fe and Zn were associated with fast (Fe: β = -1353·71, P = 0·002, Zn: β = -2262·01, P = 0·02) but less-accurate (Fe: β = -0·97, P = 0·04; Zn: β = -1·76, P = 0·04) performance on non-verbal reasoning task and poor sleep quality partially mediated the associations between low Fe/Zn and non-verbal reasoning (P < 0·05). Additionally, low Fe was associated with a slower reaction on spatial processing task (β = 276·94, P = 0·04), and low Zn was associated with fast (β = -1781·83, P = 0·03), but error-prone performance (β = -1·79, P = 0·04) on spatial processing ability and slower reaction speed (β = 12·82, P = 0·03) on the attention task. We observed similar trends using a cut-off point of 75 μg/dl for low serum Zn, except for the association with attention task speed (P > 0·05).

CONCLUSION

Fe and Zn deficiencies may possibly be associated with poor sleep and neurobehavioural function among early adolescents. Poor sleep may partially mediate the relationship between micronutrients and neurobehavioural function.

Essential trace elements in Norwegian obese patients before and 12 months after Roux-en-Y gastric bypass surgery: Copper, manganese, selenium and zinc

OBJECTIVES

The objective of the present study was to assess trace element status in morbidly obese subjects before and one year after Roux-en-Y gastric bypass (RYGB) in order to identify possible deficiencies.

METHODS

The study population included 46 patients in the age range 27-59 years, the majority (85 %) were women. The enrolled patients attended an eight week course on lifestyle changes before bariatric surgery. After RYGB they were recommended daily micronutrient supplements with a commonly used multivitamin-mineral tablet in addition to intramuscular vitamin B₁₂ injections (1 mg) every third month for 12 months. Whole blood concentrations of Cu, Mn, Se and Zn were determined using high resolution inductively coupled plasma mass spectrometry.

RESULTS

During the 12 months follow up after bariatric surgery, the patients had lost mean 32.3 kg and median whole blood concentrations of Cu (-16 %) were reduced, Mn (+14 %) and Zn (+6%) were increased, while the Se values were essentially unchanged. Compared with reference ranges, median postoperative concentrations of all essential trace elements were either below (Zn) or in the lower reference range (Cu, Mn, Se).

CONCLUSION

Essential trace elements were below or in the lower reference range twelve months after RYGB. Our results indicate a need for updated guidelines in Nordic countries for trace metal monitoring and supplements in patients after bariatric surgery, especially when gastric bypass surgery is used. Further studies are required to explore and prevent trace element deficiency related to obesity and bariatric surgery.

Prevalence of Zinc Deficiency and the Effect of Zinc Supplementation on the Prevention of Acute Respiratory Infections

OBJECTIVE

Acute lower respiratory infections are an important cause of morbidity and mortality in developing countries. Recent randomized trials of zinc supplementation for the prevention of acute lower respiratory tract infections have revealed discrepant findings. The main aim of this study was to evaluate the prevalence of zinc deficiency and the effect of zinc supplementation on respiratory infections.

MATERIAL AND METHODS

A single center, prospective open-label interventional single-arm pre-post study of the effect of oral zinc supplementation in zinc deficient children aged 6 months to 5 years was done. A total of 465 healthy children of age 6 months to 5 years were enrolled in the study for estimation of the prevalence of zinc deficiency. Children having zinc deficiency were recruited to study the efficacy and safety of oral administration of 20 mg zinc for two weeks during a 6-month follow-up period.

RESULTS

There were statistically significant differences between the zinc deficient and non-deficient groups according to modified Kuppuswamy categorization of family status and exclusive breast feeding. There was significant difference in the mid arm circumference between the zinc deficient and non-deficient groups (p<0.001). There was significant difference (p<0.001) in the number of episodes of acute upper respiratory infections (AURI), mean duration of AURI, and acute lower respiratory infections (ALRI) between the two groups. There was no significant difference in the ALRI episodes between the two groups. After zinc supplementation in zinc deficient children, there was significant decrease in the number of episodes and mean duration of AURI (p<0.001) and ALRI (p<0.001) within six months after supplementation as compared with the preceding six months before supplementation.

CONCLUSION

This study reveals that a short course of zinc supplementation may reduce the burden of AURI/ALRI among the zinc deficient children, but larger studies are needed.

Pretreatment with zinc protects Kupffer cells following administration of microbial products

BACKGROUND

Systemic inflammation and severe fibrosis can reduce serum zinc levels, while zinc supplementation is reported to improve the prognosis of patients with chronic liver disease (CLD).

OBJECTIVES

We aimed to investigate the clinical application of serum zinc in patients with CLD and the anti-infective mechanism of zinc supplementation.

METHODS

Based on the serum zinc level, 149 CLD patients were divided into 3 groups and their clinical parameters were compared. In in-vitro experiments, microbial isolates derived from patients were used to stimulate human liver non-parenchymal cells, and the zinc sulfate solution was added in certain experiments. The effect of zinc was compared by LDH and thromboxane A₂ levels in the cell supernatant.

RESULT

Compared with other groups, patients with low serum zinc levels had significantly higher C-reactive protein (CRP), total bilirubin, INR, creatinine, and MELD scores, while albumin and GOT levels were reduced. Only CRP and albumin were significantly correlated with serum zinc in both low and normal-zinc groups. Bacterial isolates significantly increased LDH levels in Kupffer cells (KCs) and stellate cells but had no effect on sinusoidal endothelial cells, whereas zinc pretreatment protected KCs but not stellate cells. Thromboxane A₂ secreted by KCs can also be induced by bacterial stimulation, accompanied by increased gene expression of Myd88, MAPK and NF-kB, while zinc pretreatment can attenuate that.

CONCLUSION

Serum zinc levels can be used to estimate infection and liver fibrosis in CLD patients. As a new antibacterial weapon, zinc supplementation acts on KCs through Myd88-MAPK related pathways.

Bioelectrical Impedance Vector Analysis and Phase Angle on Different Oral Zinc Supplementation in Eutrophic Children: Randomized Triple-Blind Study

The parameters derived from bioelectrical impedance, phase angle (PA) and bioelectrical impedance vector analysis (BIVA) have been associated with cell membrane integrity and body cell mass. Zinc is a micronutrient that exerts important structural functions and acts in maintaining cellular functionality. To evaluate cell integrity and body cell mass, PA and BIVA were evaluated in children orally supplemented with zinc at different concentrations. Anthropometric, bioelectrical (resistance and reactance) and serum zinc variables were collected from two randomized, triple-blind, controlled clinical trials. Sampling was composed of 71 children consisting of three groups: a control group who received a placebo and two experimental groups who received oral supplementation of 5 or 10 mg-Zn/day for three months. The three groups presented increases (p < 0.001) in the linear height and weight. In the group supplemented with 10 mg-Zn/day, there was an increase in reactance values (p = 0.036) and PA (p = 0.002), in addition to vector displacement (p < 0.001) in relation to the confidence ellipses. An increase in serum zinc concentration was found (p < 0.001) in all three groups. Whit this, the supplementation with 10 mg-Zn/day promotes changes in the integrity of the cell membrane associated with the increase in the cellular mass of healthy children.