Effect of zinc supplementation in the management of type 2 diabetes: A grading of recommendations assessment, development, and evaluation-assessed, dose-response meta-analysis of randomized controlled trials

Effect of Zinc Supplementation on Lipid Profile and Body Composition in Patients with Type 2 Diabetes Mellitus: A GRADE-Assessed Systematic Review and Dose-Response Meta-analysis

The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) is to investigate the overall effects of zinc supplementation on lipid profile and body composition such as body weight (BW), body mass index (BMI), triglycerides (TG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol (HDL-C) in patients with type 2 diabetes mellitus (T2DM). Scopus, Web of Science, PubMed, and Embase databases were searched from inception through October, 2023. The I2 and Cochran's Q tests were used to assess heterogeneity between studies. Nineteen RCTs (n = 1357 participants) were included in the meta-analysis. Zinc supplementation significantly reduced TG (WMD = - 17.41 mg/dL; 95% CI: - 22.60, - 12.22; P < 0.001), TC (WMD: - 19.60 mg/dL; 95% CI: - 28.46, - 10.73, P < 0.001), LDL-C (WMD = - 8.80 mg/dL; 95% CI: - 14.80, - 2.81; P = 0.004), and BMI (WMD = - 0.53 kg/m2; 95% CI: - 1.05, - 0.01; P = 0.046) but not BW (WMD: - 0.51 kg, 95 % CI: - 1.99, 0.97, P = 0.498). Moreover, zinc supplementation increased HDL-C (WMD = 4.82 mg/dL; 95% CI: 0.88, 8.76; P = 0.016) in patients with T2DM. Our results propose that zinc supplementation may be an effective strategy for improving lipid profile and body composition in patients with T2DM.

Marginal Zinc Deficiency Promotes Pancreatic Islet Enlargement While Zinc Supplementation Improves the Pancreatic Insulin Response in Zucker Diabetic Fatty Rats

Zinc deficiency has been associated with the worsening of diabetes while zinc supplementation has been proposed to ameliorate diabetes. This study examined the effects of marginal zinc deficiency (MZD) and zinc supplementation (ZS) on obesity, glycemic control, pancreatic islets, hepatic steatosis and renal function of Zucker diabetic fatty (ZDF) rats. Male ZDF rats were fed an MZD, zinc control (ZC) or ZS diet (4, 30 and 300 mg Zn/kg diet, respectively), and lean Zucker rats were fed a ZC diet for 8 weeks. MZD and ZS did not alter body weight or whole-body composition in ZDF rats. MZD ZDF rats had reduced zinc concentrations in the femur and pancreas, a greater number of enlarged pancreatic islets and a diminished response to an oral glucose load based on a 1.8-fold greater incremental area-under-the-curve (AUC) for glucose compared to ZC ZDF. ZS ZDF rats had elevated serum, femur and pancreatic zinc concentrations, unchanged pancreatic parameters and a 50% reduction in the AUC for insulin compared to ZC ZDF rats, suggesting greater insulin sensitivity. Dietary zinc intake did not alter hepatic steatosis, creatinine clearance, or levels of proteins that contribute to insulin signaling, inflammation or zinc transport in epididymal fat. Potential adverse effects of ZS were suggested by reduced hepatic copper concentrations and elevated serum urea compared to ZC ZDF rats. In summary, ZS improved the pancreatic insulin response but not the glucose handling. In contrast, reduced zinc status in ZDF rats led to impaired glucose tolerance and a compensatory increase in the number and size of pancreatic islets which could lead to β-cell exhaustion.

Effect of zinc supplementation on glycemic biomarkers: an umbrella of interventional meta-analyses

BACKGROUND

Several studies have evaluated the effects of zinc supplementation on glycemic biomarkers in humans and have demonstrated varying results. We systematically evaluated the literature and performed an umbrella meta-analysis of the effects of zinc supplementation on type 2 diabetes biomarkers.

METHODS

A comprehensive literature search was conducted in the following databases; PubMed, Embase, Embase, Cochrane Library, Scopus, and Web of Science for studies published up to March 10, 2024.

RESULTS

Zinc supplementation was effective in reducing serum FBS (WMD: - 13.58, 95% CI: - 17.38, - 9.77; p < 0.001; SMD: - 0.52, 95% CI - 0.79, - 0.25; p =  < 0.001), insulin (SMD: - 0.67, 95% CI - 0.96, - 0.38; p < 0.001), HOMA-IR levels (WMD - 0.52, 95% CI - 0.66, - 0.38; p < 0.001; SMD: - 0.78, 95% CI - 1.02, - 0.42; p < 0.001), and HbA1c (WMD: - 0.35, 95% CI - 0.43, - 0.27; p < 0.001).

CONCLUSION

Zinc supplementation significantly reduced FBS, HOMA-IR, insulin and HbA1c. These findings suggest that zinc is potentially an effective complementary intervention to improve type 2 diabetes biomarkers.

Novel strategy to the characterization and enhance the glycemic control properties of walnut-derived peptides via zinc chelation

This study aimed to utilize zinc coordination to promote the hypoglycemic and antioxidant properties of walnut-derived peptides, such as walnut protein hydrolysate (WPH) and Leu-Pro-Leu-Leu-Arg (LPLLR, LP5), of which LP5 was previously identified from WPH. The optimal conditions for the chelation were a peptide-to-zinc ratio of 6:1, pH of 9, duration of 50 min, and temperature of 50 °C. The WPH-Zn and LP5-Zn complexes increased the α-glucosidase inhibition, α-amylase inhibition, and antioxidant activity more than WPH and LP5 (p < 0.05). In particular, the antioxidant activity of WPH-Zn was superior to LP5-Zn. This is attributable to the WPH containing more aromatic amino acids, carboxylate groups and the imidazole groups, which implies its capacity to potentially coordinate with Zn2+ to form the WPH-Zn complex. Moreover, particle size, zeta potential, and scanning electron microscope indicated that the chelation of Zn2+ by peptides led to intramolecular and intermolecular folding and aggregation.

Relationship between Copper, Zinc, and Copper-to-Zinc Ratio in Hair and Severity of Coronary Artery Disease according to the SYNTAX Score

Coronary artery disease (CAD) continues to be a foremost contributor to global mortality, and the quest for modifiable risk factors could improve prophylactic strategies. Recent studies suggest a significant role of zinc (Zn) and copper (Cu) deficiency in atheromatous plaque formation. Furthermore, hair was previously described as a valuable source of information on elemental burden during the 6-8 week period before sampling. The aim of this study was to investigate the possibility of correlation between the extent of CAD evaluated with the SYNergy Between PCI With TAXUS and the Cardiac Surgery (SYNTAX) score with Cu and Zn content in hair samples, as well as with the Cu/Zn ratio in a cohort of 130 patients. Our findings describe a statistically significant inverse correlation between Cu content and the Cu/Zn ratio in hair samples and the extent of CAD. In contrast, no significant correlation was found between Zn content and the extent of CAD. Considering the scarcity of existing data on the subject, the analysis of hair samples could yield a novel insight into elemental deficiencies and their potential influence on CAD extent.

Diabetic cardiomyopathy - Zinc preventive and therapeutic potentials by its anti-oxidative stress and sensitizing insulin signaling pathways

Oxidative stress and insulin resistance are two key mechanisms for the development of diabetic cardiomyopathy (DCM, cardiac remodeling and dysfunction). In this review, we discussed how zinc and metallothionein (MT) protect the heart from type 1 or type 2 diabetes (T1D or T2D) through its anti-oxidative function and insulin-mediated PI3K/Akt signaling activation. Both T1D and T2D-induced DCM, shown by cardiac structural remodeling and dysfunction, in wild-type mice, but not in cardiomyocyte-specific overexpressing MT mice. In contrast, mice with global MT gene deletion were more susceptible to the development of DCM. When we used zinc to treat mice with either T1D or T2D, cardiac remodeling and dysfunction were significantly prevented along with increased cardiac MT expression. To support the role of zinc homeostasis in insulin signaling pathways, treatment of diabetic mice with zinc showed the preservation of phosphorylation levels of insulin-mediated glucose metabolism-related Akt2 and GSK-3β and even rescued cardiac pathogenesis induced by global deletion of Akt2 gene in a MT-dependent manner. These results suggest the protection by zinc from DCM is through both the induction of MT and sensitization of insulin signaling. Combined our own and other works, this review comprehensively summarized the roles of zinc homeostasis in the development and progression of DCM and its therapeutic implications. At the end, we provided pre-clinical and clinical evidence for the preventive and therapeutic potential of zinc supplementation through its anti-oxidative stress and sensitizing insulin signaling actions. Understanding the intricate connections between zinc and DCM provides insights for the future interventional approaches.