Serum and Hair Zinc Levels in Patients with Endemic Osteochondropathy in China: A Meta-analysis

The Prevalence of Kashin-Beck Disease in China: a Systematic Review and Meta-analysis

Kashin-Beck disease (KBD) is a serious degenerative chronic joint disease. However, there are few quantitative syntheses of KBD prevalence studies. In this study, an initial systematic review and meta-analysis were performed to study the prevalence of KBD in China. Five databases (PubMed, Web of Science, Chinese National Knowledge Infrastructure (CNKI), WanFang Data, and the China Science-Technology Journal Database (VIP)) were searched by performing an overall search method to identify studies of KBD prevalence in China that were published from the inception of the database to May 30, 2022. The risk of bias was assessed with the standardized risk of bias tool. Heterogeneity was assessed with the I² statistic. A random-effect meta-analysis was performed to study the prevalence of KBD through an analysis of published studies. A total of 34 studies involving 24,820 patients with KBD were included in this meta-analysis. These studies were geographically divided into 3 endemic areas. The pooled overall prevalence rate for KBD was 0.06% (95% CI, 0.04-0.08%). The pooled prevalence estimates were 0.05% (95% CI, 0.01-0.12%) for northeast endemic areas, 0.06% (95% CI, 0.03-0.09%) for northwest endemic areas, and 0.04% (95% CI, 0-0.14%) for southwest endemic areas. There was a negative correlation between KBD prevalence and the publication year. No potential risk of publication bias was found by Begg's test and Egger's test. The publication year and quality score were significantly associated with the detected heterogeneity. Our study indicates that the occurrence and development of KBD have been effectively controlled in recent decades. More effective strategies are needed to prevent and treat KBD.

The Status of Selenium and Zinc in the Urine of Children From Endemic Areas of Kashin-Beck Disease Over Three Consecutive Years

Selenium deficiency is one of the main risk factors for Kashin-Beck disease (KBD). This study aimed to detect the status of selenium and zinc in the urine of children from endemic areas of KBD over three consecutive years and to evaluate whether selenium and zinc levels in children in Shaanxi Province remain normal after stopping selenium supplementation. The samples of urine were collected in consecutive years (2017–2019) to detect selenium content by hydride generation atomic fluorescence spectrometry (HGAFS) and to detect zinc content by atomic absorption spectrophotometry (AAS). Generalized estimation equation (GEE) analysis was integrated to assess the comprehensive nutritional status and dietary structure of children. Data were processed in duplicate and analyzed by SPSS 18.0. This study included 30 X-ray-positive KBD cases and 123 healthy children aged 7–12 years. A total of 424 urine and 137 hair samples were collected over three consecutive years for selenium determination. The mean value of urinary selenium in all subjects was 6.86 μg/l (2017), 8.26 μg/l (2018), and 4.04 μg/l (2019), and the mean value of urinary zinc in all subjects was 0.36 mg/l (2017), 0.39 mg/l (2018), and 0.31 mg/l (2019) for the three consecutive years of 2017–2019. The mean values of urinary selenium were 6.56 and 6.94 μg/l (2017), 8.69 and 8.14 μg/l (2018), and 4.57 and 3.90 μg/l (2019) in the KBD-X and normal groups, respectively; and the mean value of urinary zinc were 0.38 and 0.35 mg/l (2017), 0.41 and 0.39 mg/l (2018), and 0.43 and 0.28 mg/l (2019) in the KBD-X and normal groups, respectively. The mean value of hair selenium in 137 subjects was 275.08 μg/kg and the mean values of hair selenium were 267.48 and 276.61 μg/kg in the KBD-X group and normal group, respectively. The level of selenium/zinc showed a trend of increasing first and then decreasing during the three consecutive years. The level of selenium in all subjects from the endemic areas was lower than normal, which reminds us to monitor the state of KBD constantly and adjust selenium salt supplementation in accordance with the changes in the KBD state.

The Relationship Between Serum Copper and Overweight/Obesity: a Meta-analysis

The relationship between serum copper (Cu) level and overweight/obesity remains controversial. The purpose of this meta-analysis is to evaluate the relationship. A comprehensive literature search was performed in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang databases for relevant articles until March 20, 2019. The random-effect model (REM) was adopted to compute the combined standardized mean difference (SMD) with 95% confidence interval (CI). Publication bias was estimated using the visualization of funnel plots and Egger's test. In the end, twenty-one articles were included in the meta-analysis. Compared with controls, serum Cu level was higher in obese children (SMD (95% CI) 0.74 (0.16, 1.32)) and in obese adults (SMD (95% CI) 0.39 (0.02, 0.76)). There was no significant difference in serum Cu between overweight and control groups in children (SMD (95% CI) 1.52 (- 0.07, 3.12)) and in adults (SMD (95% CI) 0.16 (- 0.06, 0.38)). Moreover, subgroup analysis revealed a higher serum Cu level in obese children (SMD (95% CI) 0.90 (0.36, 1.45)) and obese adults (SMD (95% CI) 0.47 (0.05, 0.88)) compared with healthy weight controls. The SMD differs significantly between obese children diagnosed by weight-for-height and controls (SMD (95% CI) 1.56 (0.57, 2.55)), and there was a significant difference of serum Cu level between obese adults diagnosed by BMI (WHO) and controls (SMD (95% CI) 0.54 (0.08, 1.01)). This meta-analysis indicates that a higher serum Cu level might be associated with the risk of obesity in children and adults, and these findings need to be further confirmed.

Hair multi-bioelement profile of Kashin-Beck disease in the endemic regions of China

BACKGROUND

Kashin-Beck disease (KBD) is a serious chronic osteochondral disease that is endemic in humans. Selenium (Se) has been considered in hypotheses of the aetiology of KBD, but few studies have explored the relationship between other elements and KBD.

OBJECTIVE

This study explored the relationship between 39 elements and KBD.

METHODS

In this retrospective study, 150 boys aged 6 to 14 years were randomly selected from a total population of 1,214 children. Subjects from endemic areas were divided into five groups: (KBD -Bin, N = 30; KBD + Se-Yongshou, N = 30; Control -Bin, N = 30; Control + Se -Yongshou, N = 30; and Control External -Chang'an, N = 30). Samples of occipital hair were collected from each subject, and thirty-nine elements, including 15 toxic elements, 19 nutrient elements, and 5 other elements were assayed by inductively coupled plasma mass spectrometry (ICP-MS). Correlation analysis of the elements in each group was performed by ggcorrplot (visualization of a correlation matrix using 'ggplot2') and PerformanceAnalytics packages in the program R Project.

RESULTS

Among the 15 toxic elements, the levels of aluminum (Al) and bismuth (Bi) in the KBD -Bin were significantly higher than in the other groups, and the levels of silver (Ag), beryllium (Be), platinum (Pt), antimony (Sb), tin (Sn) and lead (Pb) in the KBD -Bin were significantly lower than in the other groups. Among the 19 nutrient elements, the levels of selenium (Se), iodine (I), sulfur (S), and boron (B) in the KBD -Bin were significantly lower than in the other groups. The levels of calcium (Ca), iron (Fe), manganese (Mn), chromium (Cr), strontium (Sr) and phosphorus (P) in the KBD -Bin were significantly higher than in the other groups. Correlations between various elements were remarkably different among the groups. There were positive correlations between As and Pb, Cd and Sb, Pb and Sb, Sb and U in the Control External -Chang'an, between Al and Ni, Cd and Pb, Tl and Ni, Ti and U in the Se-S KBD, and between B and I, B and Mo, Mn and V in the Control External -Chang'an.

CONCLUSIONS

These findings indicate that the interactions between elements do not represent a simple reciprocal relationship in the occurrence of KBD. In fact, KBD was associated with an imbalance in multiple elements that play a dynamic and interactive role in the development of the disease.

The systematic review and meta-analysis of X-ray detective rate of Kashin-Beck disease from 1992 to 2016

Background

Kashin-Beck disease (KBD) is a serious human endemic chronic osteochondral disease. However, quantitative syntheses of X-ray detective rate studies for KBD are rare. We performed an initial systematic review and meta-analysis to assess the X-ray detective rate of KBD in China.

Methods

For this systematic review and meta-analysis, we searched five databases (PubMed, Web of Science, Chinese National Knowledge Infrastructure (CNKI), WanFang Data and the China Science and Technology Journal Database (VIP))using a comprehensive search strategy to identify studies of KBD X-ray detective rate in China that were published from database inception to January 13, 2018. The X-ray detective rate of KBD was determined via an analysis of published studies using a random effect meta-analysis with the proportions approach. Subgroup analysis and meta-regression were used to explore heterogeneity, and study quality was assessed using the risk of bias tool.

Results

A total of 53 studies involving 14,039 samples with X-ray detective rate in 163,340 observations in total were included in this meta-analysis. These studies were geographically diverse (3 endemic areas). The pooled overall X-ray detective rate for KBD was 11% (95%CI,8–15%;Z = 13.14; p < 0.001). The pooled X-ray detective rate estimates were 11% (95%CI, 6–17%; Z = 7.06; p < 0.001) for northeast endemic areas, 13% (95%CI, 7–20%; Z = 7.45; p < 0.001) for northwest endemic areas, and 8% (95%CI, 5–12%; Z = 7.90; p < 0.001) for southwest endemic areas. There was a significant relationship between the survey year and the X-ray detective rate of KBD.

Conclusions

Our systematic review found that the summary estimate of the X-ray detective rate of KBD was 11% and, that KBD X-ray positive rate ranged from 8.00 to 15.00% depending on the study. Further research is required to identify effective strategies for preventing and treating KBD.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2461-z) contains supplementary material, which is available to authorized users.